<?php

use yii\helpers\Html;
use yii\widgets\ActiveForm;

/* @var $this yii\web\View */
/* @var $model common\models\RiaFrmHVLAB */
/* @var $form yii\widgets\ActiveForm */
?>

<div class="ria-frm-hvlab-form">

    <?php $form = ActiveForm::begin(); ?>

    <?= $form->field($model, 'RiaHDocDate')->textInput() ?>

    <?= $form->field($model, 'RiaHDocID')->textInput(['maxlength' => true]) ?>

    <?= $form->field($model, 'PatName')->textInput(['maxlength' => true]) ?>

    <?= $form->field($model, 'PatAge')->textInput() ?>

    <?= $form->field($model, 'PatHN')->textInput(['maxlength' => true]) ?>

    <?= $form->field($model, 'PatWard')->textInput(['maxlength' => true]) ?>

    <?= $form->field($model, 'CustID')->textInput(['maxlength' => true]) ?>

    <?= $form->field($model, 'CustTitle')->textInput(['maxlength' => true]) ?>

    <?= $form->field($model, 'CustName')->textInput(['maxlength' => true]) ?>

    <?= $form->field($model, 'CustFax')->textInput(['maxlength' => true]) ?>

    <?= $form->field($model, 'RiaHPaySts')->textInput() ?>

    <?= $form->field($model, 'RiaHCrDay')->textInput() ?>

    <?= $form->field($model, 'RiaHReqBy')->textInput(['maxlength' => true]) ?>

    <?= $form->field($model, 'RiaHRemark')->textInput(['maxlength' => true]) ?>

    <?= $form->field($model, 'CsHDocID')->textInput(['maxlength' => true]) ?>

    <?= $form->field($model, 'RiaHSUPrice')->textInput() ?>

    <?= $form->field($model, 'RiaHDataFlag')->textInput() ?>

    <?= $form->field($model, 'RiaHReEntryFlag')->textInput() ?>

    <?= $form->field($model, 'UserIDEntry')->textInput(['maxlength' => true]) ?>

    <?= $form->field($model, 'UserDateEntry')->textInput() ?>

    <?= $form->field($model, 'UserIDReEntry')->textInput(['maxlength' => true]) ?>

    <?= $form->field($model, 'UserDateReEntry')->textInput() ?>

    <?= $form->field($model, 'RiaLHGRFlag')->textInput() ?>

    <?= $form->field($model, 'CustLabQty')->textInput() ?>

    <?= $form->field($model, 'RiaLHPreExpFlag')->textInput() ?>

    <?= $form->field($model, 'RiaLHExpFlag')->textInput() ?>

    <?= $form->field($model, 'PatAgeType')->textInput(['maxlength' => true]) ?>

    <?= $form->field($model, 'PatAgeDesc')->textInput(['maxlength' => true]) ?>

    <?= $form->field($model, 'RiaHRepType')->textInput() ?>

    <?= $form->field($model, 'Sex')->textInput(['maxlength' => true]) ?>

    <?= $form->field($model, 'RiaHMsightFlag')->textInput() ?>

    <div class="form-group">
        <?= Html::submitButton('Save', ['class' => 'btn btn-success']) ?>
    </div>

    <?php ActiveForm::end(); ?>

</div>
