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<!DOCTYPE html>
<html>
<head>
<title>Doc Main</title>
<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
<link rel="stylesheet" type="text/css" href="css/bootstrap.min.css">
<script src="https://code.jquery.com/jquery-3.3.1.slim.min.js" integrity="sha384-q8i/X+965DzO0rT7abK41JStQIAqVgRVzpbzo5smXKp4YfRvH+8abtTE1Pi6jizo" crossorigin="anonymous"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/popper.js/1.14.3/umd/popper.min.js" integrity="sha384-ZMP7rVo3mIykV+2+9J3UJ46jBk0WLaUAdn689aCwoqbBJiSnjAK/l8WvCWPIPm49" crossorigin="anonymous"></script>
<script src="https://stackpath.bootstrapcdn.com/bootstrap/4.1.3/js/bootstrap.min.js" integrity="sha384-ChfqqxuZUCnJSK3+MXmPNIyE6ZbWh2IMqE241rYiqJxyMiZ6OW/JmZQ5stwEULTy" crossorigin="anonymous"></script>
<link href="css/style.css" rel="stylesheet">
<script src="jquery/effect.js" crossorigin="anonymous"></script>
</head>
<body>
<nav class="navbar navbar-expand-lg navbar-dark bg-dark navbar-inverse navbar-fixed-top">
<a class="navbar-brand" href="#">Hospital</a>
<button class="navbar-toggler" type="button" data-toggle="collapse" data-target="#navbarSupportedContent" aria-controls="navbarSupportedContent" aria-expanded="false" aria-label="Toggle navigation">
<span class="navbar-toggler-icon"></span>
</button>
<div class="collapse navbar-collapse" id="navbarSupportedContent">
<ul class="navbar-nav mr-auto">
<li class="nav-item active">
<a class="nav-link" href="#"><span class="sr-only">(current)</span></a>
</li>
<li class="nav-item dropdown">
<a class="nav-link dropdown-toggle" href="#" id="navbarDropdown" role="button" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">
More
</a>
<div class="dropdown-menu" aria-labelledby="navbarDropdown">
<a class="dropdown-item" href="#">Patients</a>
<a class="dropdown-item" href="#">Records</a>
<div class="dropdown-divider"></div>
<a class="dropdown-item" href="#">Something else here</a>
</div>
</li>
<li class="form-inline my-2 my-lg-0 nav-item dropdown">
<a class="nav-link dropdown-toggle" href="#" id="navbarDropReq" role="button" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">Requests
<span class="badge badge-danger">9</span></a>
<div class="dropdown-menu drop-width" aria-labelledby="navbarDropReq">
<p class="dropdown-item" href="#">
<h4 class="title-pad">Patients</h4>
<hr style="width=5px;">
<div class="row align-items-start">
<div class="col">
<div class="col-md-6 img-thumb">
<img src="images/pat_01.png" class="rounded float-left" alt="patients_1">
</div>
</div>
<div class="col-md-6 details">
<div class="user-info">
<blockquote>
<h5>Kwame Ampomah</h5>
<small><cite title="Source Title">Age : 26 <i class="icon-map-marker"></i></cite></small>
</blockquote>
<button type="button" class="btn btn-dark">Accept</button>
<button type="button" class="btn btn-danger">Reject</button>
</div>
</div>
<div class="col-md-6 details">
</div>
</div>
</p>
</li >
<li class="nav-item">
<a class="nav-link disabled" href="#">Logout</a>
</li>
</ul>
<form class="form-inline my-2 my-lg-0">
<input class="form-control mr-sm-2" type="search" placeholder="Search" aria-label="Search">
<button class="btn btn-outline-success my-2 my-sm-0" type="submit">Search</button>
</form>
</div>
</nav>
<!--Main Page-->
<div class="container-fluid">
<div class="row">
<nav class="col-md-2 d-none d-md-block bg-dark sidebar">
<div class="sidebar-sticky">
<ul class="nav flex-column">
<br>
<li class="nav-item">
<a class="nav-link active" href="#">
<img src="images/dr_julia.jpg" alt="dr_julia" class="img-thumbnail">
<span class="sr-only">(current)</span>
</a>
</li>
<br>
<li class="nav-item">
<a class="nav-link active" href="doc_main.html" class="switch-page">
<svg xmlns="http://www.w3.org/2000/svg" width="24" height="24"
viewBox="0 0 24 24" fill="none" stroke="currentColor"
stroke-width="2" stroke-linecap="round" stroke-linejoin="round"
class="feather feather-home"><path d="M3 9l9-7 9 7v11a2 2 0 0 1-2 2H5a2 2 0 0 1-2-2z"></path>
<polyline points="9 22 9 12 15 12 15 22"></polyline></svg>
Dashboard
<span class="sr-only">(current)</span>
</a>
</li>
<br>
<li class="nav-item">
<a class="nav-link " href="doc_documents.html">
<svg xmlns="http://www.w3.org/2000/svg" width="24" height="24"
viewBox="0 0 24 24" fill="none" stroke="currentColor"
stroke-width="2" stroke-linecap="round" stroke-linejoin="round"
class="feather feather-files">
<path d="M13 2H6a2 2 0 0 0-2 2v16a2 2 0 0 0 2 2h12a2 2 0 0 0 2-2V9z"></path>
<polyline points="13 2 13 9 20 9"></polyline></svg>
Documents
<span class="sr-only">(current)</span>
</a>
</li>
<br>
<li class="nav-item">
<a class="nav-link" href="doc_patients.html">
<svg xmlns="http://www.w3.org/2000/svg" width="24" height="24" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2" stroke-linecap="round" stroke-linejoin="round" class="feather feather-users"><path d="M17 21v-2a4 4 0 0 0-4-4H5a4 4 0 0 0-4 4v2"></path>
<circle cx="9" cy="7" r="4"></circle>
<path d="M23 21v-2a4 4 0 0 0-3-3.87">
</path><path d="M16 3.13a4 4 0 0 1 0 7.75"></path></svg>
Patients
<span class="sr-only">(current)</span>
</a>
</li>
<br>
<li class="nav-item">
<a class="nav-link" href="doc_reports.html">
<svg xmlns="http://www.w3.org/2000/svg" width="24" height="24" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2" stroke-linecap="round" stroke-linejoin="round" class="feather feather-bar-chart-2">
<line x1="18" y1="20" x2="18" y2="10">
</line><line x1="12" y1="20" x2="12" y2="4">
</line><line x1="6" y1="20" x2="6" y2="14"></line></svg>
Reports
</a>
</li>
<br>
<li class="nav-item">
<a class="nav-link" href="#">
<svg xmlns="http://www.w3.org/2000/svg" width="24" height="24" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2" stroke-linecap="round" stroke-linejoin="round" class="feather feather-bar-chart-2">
<line x1="18" y1="20" x2="18" y2="10">
</line><line x1="12" y1="20" x2="12" y2="4">
</line><line x1="6" y1="20" x2="6" y2="14"></line></svg>
Pending Requests
<span class="badge badge-danger">9</span></a>
</a>
</li>
<br>
<li class="nav-item">
<a class="nav-link" href="#">
<svg xmlns="http://www.w3.org/2000/svg" width="24" height="24" viewBox="0 0 24 24" fill="none" stroke="currentColor"
stroke-width="2" stroke-linecap="round" stroke-linejoin="round" class="feather feather-layers"><polygon points="12 2 2 7 12 12 22 7 12 2">
</polygon><polyline points="2 17 12 22 22 17"></polyline><polyline points="2 12 12 17 22 12"></polyline></svg>
Dispensary
</a>
</li>
</ul>
</div>
</nav>
<nav role="main" class="col-md-9 ml-sm-auto col-lg-10 px-4">
<div class="chartjs-size-monitor" style="position: absolute; left: 0px; top: 0px;
right: 0px; bottom: 0px; overflow: hidden;
pointer-events: none; visibility: hidden; z-index: -1;">
</div>
<div class="d-flex justify-content-between
flex-wrap flex-md-nowrap
align-items-center pt-3 pb-2 mb-3 border-bottom" id="main-transition">
<h1 class="h2 hos-heade">Dr. Julia Owusu</h1>
<div class="btn-toolbar mb-2 mb-md-0">
<div class="btn-group mr-2">
<button class="btn btn-sm btn-outline-secondary dropdown-toggle">
<svg xmlns="http://www.w3.org/2000/svg" width="24" height="24"
viewBox="0 0 24 24" fill="none" stroke="currentColor"
stroke-width="2" stroke-linecap="round" stroke-linejoin="round"
class="feather feather-calendar"><rect x="3" y="4" width="18"
height="18" rx="2" ry="2"></rect><line x1="16" y1="2" x2="16"
y2="6"></line><line x1="8" y1="2" x2="8" y2="6">
</line><line x1="3" y1="10" x2="21" y2="10"></line></svg>
This Week
</button>
</div>
</div>
</div>
<!--Dispensary Form-->
<main role="main" class="col-md-9 ml-sm-auto col-lg-10 px-4">
<h1 class="h2 hos-header">
Dispensary Form
<hr>
<br>
</h1>
<form>
<div class="form-row">
<div class="form-group col-md-6">
<label for="inputEmail4">Date</label>
<input type="date" class="form-control" id="inputEmail4" placeholder="Email">
</div>
<div class="form-group col-md-6">
<label for="inputPassword4">Hospital</label>
<input type="text" class="form-control" id="inputPassword4" placeholder="Hospital Name">
</div>
<div class="form-group col-md-6">
<label for="inputEmail4">Patient Name</label>
<input type="text" class="form-control" id="inputEmail4" placeholder="Patient Name">
</div>
<div class="form-group col-md-6">
<label for="inputPassword4">Patient Number</label>
<input type="text" class="form-control" id="inputPassword4" placeholder="Patient Number">
</div>
<div class="form-group col-md-6">
<label for="inputAddress">Pharmacy</label>
<select class="form-control" placeholder="Pharmacy">
<option selected style="font-weight:bold;">Select Pharmacy..</option>
<option>Telad Pharmacy</option>
<option>Isaac Drug Store</option>
</select>
</div>
<div class="form-group col-md-6">
<label for="inputAddress2">Select Drug</label>
<input type="text" class="form-control" id="inputAddress2" placeholder="Enter Drug Name ">
</div>
</div>
<br>
<div class="form-group">
<label for="inputAddress2">Select Drug</label>
<textarea type="text" class="form-control" id="inputAddress2" style="height:120px; width: 450px;" placeholder="Enter Dosage"></textarea>
</div>
<div class="form-row">
<div class="form-group col-md-4">
<label for="inputState">Quantity</label>
<select id="inputState" class="form-control">
<option selected style="font-weight:bold;">Choose...</option>
<option>1</option>
<option>2</option>
<option>3</option>
<option>4</option>
</select>
</div>
<div class="form-group col-md-2">
<label for="inputZip">Zip</label>
<input type="text" class="form-control" id="inputZip">
</div>
</div>
<div class="form-group">
<div class="form-check">
<input class="form-check-input" type="checkbox" id="gridCheck">
<label class="form-check-label" for="gridCheck">
Check me out
</label>
</div>
</div>
<button type="submit" class="btn btn-primary">Submit</button>
</form>
</main>
</nav>
</div>
</div>
</body>
</html>