<commit_before>    <?php
        $p = "partials/forms/new_medical_visit_form.";
    ?>
    {{-- 1. BASIC BENEFITER INFO --}}
    <div class="form-section no-bottom-border">
        <div class="underline-header">
            <h1 class="record-section-header padding-left-right-15">1. @lang($p."personal_info")</h1>
        </div>
        <div class="row padding-top-20">
            <div class="col-md-12">
                <div class="row">
                    <div class="padding-left-right-15">
                        <div class="form-group padding-left-right-15 float-left">
                            {!! Form::label('folder_number', Lang::get($p.'folder_number')) !!}
                            {!! Form::text('folder_number', $benefiter_folder_number, array('class' => 'custom-input-text text-align-right' , 'disabled')) !!}
                        </div>
                    </div>
                </div>
            </div>
        </div>
        <div class="row">
            <div class="col-md-12">
                <div class="row">
                    <div class="padding-left-right-15">
                        {{-- LASTNAME --}}
                        <div class="form-group make-inline padding-left-right-15 margin-right-30 float-left col-md-2">
                            {!! Form::label('lastname', Lang::get($p.'lastname')) !!}
                            {!! Form::text('lastname', $benefiter->lastname, array('class' => 'custom-input-text', 'disabled')) !!}
                        </div>
                        {{--NAME --}}
                        <div class="form-group make-inline padding-left-right-15 margin-right-30 float-left col-md-2">
                            {!! Form::label('name', Lang::get($p.'name')) !!}
                            {!! Form::text('name', $benefiter->name, array('class' => 'custom-input-text' , 'disabled')) !!}
                        </div>
                        {{-- GENDER --}}
                        <div class="form-group make-inline padding-left-right-15 margin-right-30 float-left col-md-2">
                            {!! Form::label('gender_id', Lang::get($p.'gender')) !!}
                            <div class="make-inline">
                                <?php
                                $male = false;
                                $female = false;
                                if($benefiter->gender_id == 2){
                                    $female = true;
                                } else {
                                    $male = true;
                                }
                                ?>
                                <div class="make-inline">
                                    {!! Form::radio('gender_idm', 1, $male, array('class' => 'make-inline', 'disabled' => 'disabled')) !!}
                                    {!! Form::label('gender_idm', Lang::get('basic_info_form.male'), array('class' => 'radio-value')) !!}
                                    {!! Form::radio('gender_idf', 2, $female, array('class' => 'make-inline', 'disabled' => 'disabled')) !!}
                                    {!! Form::label('gender_idf', Lang::get('basic_info_form.female'), array('class' => 'radio-value')) !!}
                                </div>
                            </div>
                        </div>
                        {{-- DATE OF BIRTH --}}
                        <div class="form-group make-inline padding-left-right-15 margin-right-30 float-left col-md-2">
                            {!! Form::label('birth_date', Lang::get($p.'birth_date')) !!}
                            <div class="make-inline">
                                {!! Form::text('birth_date', $benefiter->birth_date, array('class' => 'custom-input-text width-80-percent date-input', 'disabled' => 'disabled')) !!}
                            </div>
                        </div>
                    </div>
                </div><commit_msg>[BEN-293] - Import 'other' as gender value in modal medical form.<commit_after>    <?php
        $p = "partials/forms/new_medical_visit_form.";
    ?>
    {{-- 1. BASIC BENEFITER INFO --}}
    <div class="form-section no-bottom-border">
        <div class="underline-header">
            <h1 class="record-section-header padding-left-right-15">1. @lang($p."personal_info")</h1>
        </div>
        <div class="row padding-top-20">
            <div class="col-md-12">
                <div class="row">
                    <div class="padding-left-right-15">
                        <div class="form-group padding-left-right-15 float-left">
                            {!! Form::label('folder_number', Lang::get($p.'folder_number')) !!}
                            {!! Form::text('folder_number', $benefiter_folder_number, array('class' => 'custom-input-text text-align-right' , 'disabled')) !!}
                        </div>
                    </div>
                </div>
            </div>
        </div>
        <div class="row">
            <div class="col-md-12">
                <div class="row">
                    <div class="padding-left-right-15">
                        {{-- LASTNAME --}}
                        <div class="form-group make-inline padding-left-right-15 margin-right-30 float-left col-md-2">
                            {!! Form::label('lastname', Lang::get($p.'lastname')) !!}
                            {!! Form::text('lastname', $benefiter->lastname, array('class' => 'custom-input-text', 'disabled')) !!}
                        </div>
                        {{--NAME --}}
                        <div class="form-group make-inline padding-left-right-15 margin-right-30 float-left col-md-2">
                            {!! Form::label('name', Lang::get($p.'name')) !!}
                            {!! Form::text('name', $benefiter->name, array('class' => 'custom-input-text' , 'disabled')) !!}
                        </div>
                        {{-- GENDER --}}
                        <div class="form-group make-inline padding-left-right-15 margin-right-30 float-left col-md-2">
                            {!! Form::label('gender_id', Lang::get($p.'gender')) !!}
                            <div class="make-inline">
                                <?php
                                $male = false;
                                $female = false;
                                $other = false;
                                if($benefiter->gender_id == 1){
                                    $male = true;
                                } elseif ($benefiter->gender_id == 2) {
                                    $female = true;
                                } else {
                                    $other = true;
                                }
                                ?>
                                <div class="make-inline">
                                    {!! Form::radio('gender_idm', 1, $male, array('class' => 'make-inline', 'disabled' => 'disabled')) !!}
                                    {!! Form::label('gender_idm', Lang::get('basic_info_form.male'), array('class' => 'radio-value')) !!}
                                    {!! Form::radio('gender_idf', 2, $female, array('class' => 'make-inline', 'disabled' => 'disabled')) !!}
                                    {!! Form::label('gender_idf', Lang::get('basic_info_form.female'), array('class' => 'radio-value')) !!}
                                    {!! Form::radio('gender_ido', 3, $other, array('class' => 'make-inline', 'disabled' => 'disabled')) !!}
                                    {!! Form::label('gender_ido', Lang::get('basic_info_form.other'), array('class' => 'radio-value')) !!}
                                </div>
                            </div>
                        </div>
                        {{-- DATE OF BIRTH --}}
                        <div class="form-group make-inline padding-left-right-15 margin-right-30 float-left col-md-2">
                            {!! Form::label('birth_date', Lang::get($p.'birth_date')) !!}
                            <div class="make-inline">
                                {!! Form::text('birth_date', $benefiter->birth_date, array('class' => 'custom-input-text width-80-percent date-input', 'disabled' => 'disabled')) !!}
                            </div>
                        </div>
                    </div>
                </div>
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