<button type="button" class="btn btn-primary add_agreement_patient" ><i class="fa fa-plus"></i> {$_L['Scheduling_Agreement_Add']}
</button>
{*{$_L['Scheduling_Agreement_Module']}*}
<form class="form-horizontal" id="form_agreement_contact" name="form_patient" method="post"
      action="" enctype="multipart/form-data">

    <input type="hidden" id="id" name="id" value="{$id}">
    <span id="deleted_module_med_agreement_patient">
    </span>

    <div class="alert alert-danger hide" id="emsgModalAddPatient">
        <span id="emsgbodyModalAddPatient"></span>
    </div>

    <div class='row'>
        <div class="table-responsive m-t">
            <table class="table " id="patient_agreemnets">
                <thead>
                    <tr>
                        <th class="col-md-7">{$_L['Scheduling_Agreement']}</th>
                        <th class="col-md-3 ">{$_L['Scheduling Agreement number identification']}
                        </th> 
                        <th class="col-md-2 ">{$_L['Scheduling Agrement expirarion']}
                        </th> 
                    </tr>
                </thead>
                <tbody>
                    {assign var=rowNum value="0"}
                    {foreach $agreementPatient as $item}
                        <tr class="itm_nm_ftura ">
                            <td class="middle"> 
                                <input type='hidden' name='module_med_agreement_patient[]' value="{$item->id}">
                                <select data-row="{$rowNum}" style="width:100%"  id="select_agreement_{$rowNum}" name="agreement_id[]"  class="form-control select_agreement">
                                    <option value="{$item->module_med_agreement_id}" >{$item->agreement_company_name}</option>
                                </select>
                            </td> 
                            <td class="middle"><input type="text" data-row="{$rowNum}"  class="form-control " value="{$item->identification}" name="agreement_identification[]" maxlength="60" id="agreement_identification_{$rowNum}"></td>
                            <td class="middle">
                                <input type="text" data-row="{$rowNum}"  class="form-control agreemnt_date " value="{date( $_c['df'],strtotime($item->expiration))}" name="agreement_date_expiration[]" id="agreement_date_expiration_{$rowNum}"></td>
                         
                            <td class="middle col-xs-1"> <span class="btn btn-danger btn-xs delete_agrement_patient" data-id="{$item->id}" data-row="{$rowNum++}" ><i class="fa fa-trash"></i> </span></td>
                        </tr>


                    {/foreach}

                </tbody>

            </table>
                <div class='col-xs-12'>

                        <div class="row" style="margin-top:20px">  
                            <div class=" col-md-12 form-group">
                                <div class="col-md-offset-2 col-lg-10">
                                    <button class="md-btn md-btn-primary waves-effect waves-light" id="submit_agrrement_contact"><i class="fa fa-check"></i> {$_L['Save']}</button> | <a href="#" onclick="location.reload()">{$_L['Or Cancel']}</a>
                                </div>
                            </div>
                        </div>
                                
                </div>
                             
            <input id="rowNumAgreementPatient" type="hidden" value="{$rowNum}">
        </div>
    </div>
</form>