File: /var/www/vhost/disk-apps/dev-telemedicina.teky.com.co/resources/views/agenda/modal_cancel.blade.php
<div class="modal fade" id="modal-cancel" style="display: none;">
<div class="modal-dialog" style="width: 40%; ">
<div class="modal-content" style="height: 100%;">
<div class="modal-header">
<button type="button" class="close" data-dismiss="modal" aria-label="Close">
<span aria-hidden="true">×</span>
</button>
<h4 class="modal-title">Administrar Consulta</h4>
</div>
<div class="modal-body">
<div class="row">
<div class="col-xs-12">
<label for="exampleFormControlInput1">{{ __('messages.agenda_modal.tag_2') }}</label>
<select class="form-control" name="template_response_id" id="template_response_id">
<option value="">{{ __('messages.select') }}</option>
@foreach($responses_cancel as $c)
<option value="{{$c->name}}">{{$c->name}}</option>
@endforeach
</select>
</div>
</div>
<div class="row" style="margin-top:10px;">
<div class="col-xs-12">
<textarea class="form-control" name="text_cancel" id="text_cancel" cols="30" rows="4" width="100%"
maxlength="191"></textarea>
</div>
</div>
<div class="row">
<div class="col-xs-3">
<label for="exampleFormControlInput1">{{ __('messages.agenda.consent_received') }}</label>
<div class="checkbox checbox-switch switch-success">
<label>
{{ __('messages.no') }}
<input type="checkbox" class="chkInsurances" id="consent_received" name="consent_received" disabled>
<span></span>
{{ __('messages.yes') }}
</label>
</div>
</div>
<div class="col-xs-3">
<label for="exampleFormControlInput1">{{ __('messages.agenda.payment_received') }}</label>
<div class="checkbox checbox-switch switch-success">
<label>
{{ __('messages.no') }}
<input type="checkbox" class="chkInsurances" id="payment_received" name="payment_received" disabled>
<span></span>
{{ __('messages.yes') }}
</label>
</div>
</div>
<div class="col-xs-3">
<a href="#" id="consent_file_download" target="_blank"></a>
</div>
</div>
</div>
<div class="modal-footer">
<button id="btn-create-invoice" type="button" class="btn btn-default pull-left" onclick="invoiceConfirmed()" data-dismiss="modal" data-event_id="">
Facturado
</button>
<button type="button" class="btn btn-default pull-right" data-dismiss="modal">
{{ __('messages.agenda_modal.tag_3') }}
</button>
<button type="button" class="btn btn-success pull-right" style="margin-right:15px;" onclick="commitCancelDate()"
id="btn-modal-cancel" data-id="">
{{ __('messages.agenda_modal.tag_1') }}
</button>
</div>
</div>
<!-- /.modal-content -->
</div>
<!-- /.modal-dialog -->
</div>
<script type="text/javascript">
</script>