

<!-- end app-header -->
<!-- begin app-container -->
<div class="app-container">
    <!-- begin app-nabar -->
    <aside class="app-navbar">
        <? include "application/views/template/menu/sidemain.php"; ?>
    </aside>
    <!-- end app-navbar -->
    <!-- begin app-main -->
    <div class="app-main" id="main">
        <!-- begin container-fluid -->
        <div class="container-fluid">

            <? include "application/views/template/topstrip.php"; ?>
            <!-- begin row -->

            <div class="row">
                <div class="col-lg-6 col-xxl-4 m-b-30">
                    <div class="card card-statistics h-100 mb-0">
                        <div class="card-header d-flex justify-content-between">
                            <div class="card-heading">
                                <h4 class="card-title">New Patient</h4>
                            </div>
                            <div class="dropdown">
                                <!-- a class="btn btn-round btn-inverse-primary btn-xs" href="#">View all </a -->
                            </div>
                        </div>
                        <div class="card-body">
                            
                            
                            <div class="card-body">
                                <form>
                                     <div class="form-row">
                                        <div class="form-group col-md-6">
                                            <label for="inputEmail4">Firstname</label>
                                            <input type="text" class="form-control" id="firstname" placeholder="Firstname">
                                        </div>
                                        <div class="form-group col-md-6">
                                            <label for="inputPassword4">Lastname</label>
                                            <input type="text" class="form-control" id="lastname" placeholder="Lastname">
                                        </div>
                                    </div>
                                    
                                    <div class="form-row">
                                        <div class="form-group col-md-6">
                                            <label for="inputEmail4">Email</label>
                                            <input type="email" class="form-control" id="inputEmail4" placeholder="Email">
                                        </div>
                                        <div class="form-group col-md-6">
                                            <label for="inputPassword4">Password</label>
                                            <input type="password" class="form-control" id="inputPassword4" placeholder="Password">
                                        </div>
                                    </div>
                                    <div class="form-group">
                                        <label for="inputAddress">Address</label>
                                        <input type="text" class="form-control" id="inputAddress" placeholder="1234 Main St">
                                    </div>
                                    <div class="form-group">
                                        <label for="inputAddress2">Address 2</label>
                                        <input type="text" class="form-control" id="inputAddress2" placeholder="Apartment, studio, or floor">
                                    </div>
                                    <div class="form-row">
                                        <div class="form-group col-md-6">
                                            <label for="inputCity">City</label>
                                            <input type="text" class="form-control" id="inputCity">
                                        </div>
                                        <div class="form-group col-md-4">
                                            <label for="inputState">State</label>
                                            <select id="inputState" class="form-control">
                                                <option selected>Select State</option>
                                                <option>Ontario</option>
                                                <option>Toronto</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>
                                    
                                    <div class="form-row">
                                        <div class="form-group col-md-9">
                                         
                                        </div>
                                        <div class="form-group col-md-3">
                                           <button type="submit" class="btn btn-primary">Add Patient</button>
                                        </div>
                                    </div>
                                    
                                   
                                </form>
                            </div>

                            
                            
                            
               
                        </div>
                    </div>
                </div>



                <div class="col-xxl-8 m-b-20">
                    <? include 'application/views/provider/components/patient_listing.php'; ?>
                </div>

            </div>





   
        </div>
        <!-- end container-fluid -->
    </div>
    <!-- end app-main -->
</div>
<!-- end app-container -->
<!-- begin footer -->

