
<div>
    {if $ProgramesettingData->displaydoctorname eq 1}
    <div class="row ltr" >
        <div class="col-md-1">
            <div class="form-group form-md-line-input form-md-floating-label has-info">
                <label class="control-label col-md-2 ">{$username}</label>
            </div>
        </div>
    </div>
    {/if}
    <div class="row ltr" >
        <div class="col-md-3">
            <div class="form-group">
                <!--<label class="control-label col-md-2 ls2">Disease</label>-->
                <select  class="form-control  medicaldisease updateElement allupdateselect" id="medicaldisease{$itr}" data-itr="{$itr}"  name="medicaldisease" data-colName="medicaldisease" select-tableName="phpastmedicaldisease" data-id="{$phpastmedical_obj->id}" data-tableName="phpastmedical" >
                    <option value="">choose</option>
                    {foreach  $allphpastmedicaldisease as $myallphpastmedicaldisease}
                    <option value="{$myallphpastmedicaldisease->id}" >{$myallphpastmedicaldisease->name} </option>
                    {/foreach}
                    <option value="-2" class="deleteoptincompo">Delete</option>
                </select>
            </div>
        </div>



        <div class="col-md-8">
            <div class="form-group form-md-line-input form-md-floating-label has-info">
                <div class="form-group form-md-line-input form-md-floating-label has-info">
                    <input type="text" class="amrpop form-control updateElement"  name="medicalnote" data-colName="medicalnote" placeholder="Note" data-id="{$phpastmedical_obj->id}"  data-tableName="phpastmedical"/>
                </div>
            </div>
        </div>

        <div class="col-md-1" style="padding-left: 3%;" >
            <div class="form-group form-md-line-input form-md-floating-label has-info">
                <input type="checkbox"   id="for_husband" value="1" class="updateElementCheck" 
                       data-id="{$phpastmedical_obj->id}" data-tableName="phpastmedical" 
                       data-colName="for_husband"  
                       {if $phpastmedical_obj->for_husband  == 1 } checked {/if}>
                <button type="button" class="btn btn-xs red fright deleteElement delbtnsml" 
                        data-id="{$phpastmedical_obj->id}" data-tableName="phpastmedical">
                    <i class="fa fa-close"></i></button>

            </div>
        </div>

    </div>
</div>