<div class="modal-dialog" role="document">
    <div class="modal-content">
        {!! Form::open(['route' => 'meddoc.documents.store', 'class' => 'meddoc-form', 'files' => true]) !!}
        <div class="modal-header">
            <button type="button" class="close" data-dismiss="modal">&times;</button>
            <h4 class="modal-title">@lang('meddocuments::lang.upload_document')</h4>
        </div>
        <div class="modal-body">
            <div class="row">
                <div class="col-md-6"><div class="form-group">
                    {!! Form::label('doc_type_key', __('meddocuments::lang.doc_type') . ':*') !!}
                    {!! Form::select('doc_type_key', $types, null, ['class' => 'form-control', 'required']) !!}
                </div></div>
                <div class="col-md-6"><div class="form-group">
                    {!! Form::label('title', __('meddocuments::lang.title') . ':') !!}
                    {!! Form::text('title', null, ['class' => 'form-control', 'placeholder' => __('meddocuments::lang.title_placeholder')]) !!}
                </div></div>
            </div>
            <div class="form-group">
                {!! Form::label('file', __('meddocuments::lang.file') . ':*') !!}
                {!! Form::file('file', ['class' => 'form-control', 'required']) !!}
                <p class="help-block">@lang('meddocuments::lang.file_help')</p>
            </div>
            <div class="row">
                <div class="col-md-6"><div class="form-group">
                    {!! Form::label('contact_id', __('meddocuments::lang.patient_contact_id') . ':') !!}
                    {!! Form::number('contact_id', null, ['class' => 'form-control', 'min' => 1]) !!}
                </div></div>
                <div class="col-md-6"><div class="form-group">
                    {!! Form::label('tags', __('meddocuments::lang.tags') . ':') !!}
                    {!! Form::text('tags', null, ['class' => 'form-control', 'placeholder' => __('meddocuments::lang.tags_placeholder')]) !!}
                </div></div>
            </div>
            <div class="row">
                <div class="col-md-6"><div class="form-group">
                    {!! Form::label('entity_type', __('meddocuments::lang.entity_type') . ':') !!}
                    {!! Form::text('entity_type', null, ['class' => 'form-control', 'placeholder' => 'Modules\\...\\Entities\\Foo']) !!}
                </div></div>
                <div class="col-md-6"><div class="form-group">
                    {!! Form::label('entity_id', __('meddocuments::lang.entity_id') . ':') !!}
                    {!! Form::number('entity_id', null, ['class' => 'form-control', 'min' => 1]) !!}
                </div></div>
            </div>
            <div class="form-group">
                {!! Form::label('notes', __('meddocuments::lang.notes') . ':') !!}
                {!! Form::textarea('notes', null, ['class' => 'form-control', 'rows' => 2]) !!}
            </div>
        </div>
        <div class="modal-footer">
            <button type="submit" class="btn btn-primary">@lang('meddocuments::lang.upload')</button>
            <button type="button" class="btn btn-default" data-dismiss="modal">@lang('messages.close')</button>
        </div>
        {!! Form::close() !!}
    </div>
</div>
