{{ Form::label('high_blood_pressure', __('messages.prescription.high_blood_pressure') . ':', ['class' => 'form-label']) }} {{ Form::text('high_blood_pressure', null, ['class' => 'form-control', 'placeholder' => __('messages.prescription.high_blood_pressure'), 'id' => 'highBloodPressure']) }}

{{ Form::label('food_allergies', __('messages.prescription.food_allergies') . ':', ['class' => 'form-label']) }} {{ Form::text('food_allergies', null, ['class' => 'form-control', 'placeholder' => __('messages.prescription.food_allergies'), 'id' => 'foodAllergies']) }}

{{ Form::label('tendency_bleed', __('messages.prescription.tendency_bleed') . ':', ['class' => 'form-label']) }} {{ Form::text('tendency_bleed', null, ['class' => 'form-control', 'placeholder' => __('messages.prescription.tendency_bleed'), 'id' => 'tendencyBleed']) }}

{{ Form::label('heart_disease', __('messages.prescription.heart_disease') . ':', ['class' => 'form-label']) }} {{ Form::text('heart_disease', null, ['class' => 'form-control', 'placeholder' => __('messages.prescription.heart_disease'), 'id' => 'heartDisease']) }}

{{ Form::label('diabetic', __('messages.prescription.diabetic') . ':', ['class' => 'form-label']) }} {{ Form::text('diabetic', null, ['class' => 'form-control', 'placeholder' => __('messages.prescription.diabetic'), 'id' => 'diabetic']) }}

{{ Form::label('medical_history', __('messages.prescription.medical_history') . ':', ['class' => 'form-label']) }} {{ Form::text('medical_history', null, ['class' => 'form-control' . (getLoggedInUser()->thememode ? ' bg-light' : ' bg-white'), 'placeholder' => __('messages.prescription.medical_history'), 'id' => 'prescriptionAddedAt', 'autocomplete' => 'off']) }}

{{ Form::label('female_pregnancy', __('messages.prescription.female_pregnancy') . ':', ['class' => 'form-label']) }} {{ Form::text('female_pregnancy', null, ['class' => 'form-control', 'placeholder' => __('messages.prescription.female_pregnancy'), 'id' => 'femalePregnancy']) }}

{{ Form::label('breast_feeding', __('messages.prescription.breast_feeding') . ':', ['class' => 'form-label']) }} {{ Form::text('breast_feeding', null, ['class' => 'form-control', 'placeholder' => __('messages.prescription.breast_feeding'), 'id' => 'breastFeeding']) }}

{{ Form::label('current_medication', __('messages.prescription.current_medication') . ':', ['class' => 'form-label']) }} {{ Form::text('current_medication', null, ['class' => 'form-control', 'placeholder' => __('messages.prescription.current_medication'), 'id' => 'currentMedication']) }}

{{ Form::label('surgery', __('messages.prescription.surgery') . ':', ['class' => 'form-label']) }} {{ Form::text('surgery', null, ['class' => 'form-control', 'placeholder' => __('messages.prescription.surgery'), 'id' => 'surgery']) }}

{{ Form::label('accident', __('messages.prescription.accident') . ':', ['class' => 'form-label']) }} {{ Form::text('accident', null, ['class' => 'form-control', 'placeholder' => __('messages.prescription.accident'), 'id' => 'accident']) }}

{{ Form::label('others', __('messages.prescription.others') . ':', ['class' => 'form-label']) }} {{ Form::text('others', null, ['class' => 'form-control', 'placeholder' => __('messages.prescription.others'), 'id' => 'others']) }}

{{ Form::label('plus_rate', __('messages.prescription.plus_rate') . ':', ['class' => 'form-label']) }} {{ Form::text('plus_rate', null, ['class' => 'form-control', 'placeholder' => __('messages.prescription.plus_rate'), 'id' => 'plusRate']) }}

{{ Form::label('temperature', __('messages.prescription.temperature') . ':', ['class' => 'form-label']) }} {{ Form::text('temperature', null, ['class' => 'form-control', 'placeholder' => __('messages.prescription.temperature'), 'id' => 'temperature']) }}

{{ Form::label('problem_description', __('messages.prescription.problem_description') . ':', ['class' => 'form-label']) }} {{ Form::textarea('problem_description', null, ['class' => 'form-control', 'rows' => 5, 'placeholder' => __('messages.prescription.problem_description'), 'id' => 'problemDescription']) }}