?>
<?php
echo $form->textAreaGroup($model, 'icd', array('widgetOptions' => array('htmlOptions' => array('rows' => 6, 'cols' => 50, 'class' => 'span8'))));
?>
<?php
echo $form->dropDownListGroup($model, 'plastic_surgeon_id', array('wrapperHtmlOptions' => array('class' => 'col-sm-5'), 'widgetOptions' => array('data' => CHtml::listData($doctors, 'id', 'name'), 'htmlOptions' => array('prompt' => '未選擇'))));
?>
<?php
echo $form->dropDownListGroup($model, 'dentist_id', array('wrapperHtmlOptions' => array('class' => 'col-sm-5'), 'widgetOptions' => array('data' => CHtml::listData($doctors, 'id', 'name'), 'htmlOptions' => array('prompt' => '未選擇'))));
?>
<?php
echo $form->dropDownListGroup($model, 'pay_type', array('wrapperHtmlOptions' => array('class' => 'col-sm-5'), 'widgetOptions' => array('data' => ViewHelper::payTypeSelectOptions(), 'htmlOptions' => array('prompt' => '未選擇'))));
?>
<?php
echo $form->textAreaGroup($model, 'complications', array('widgetOptions' => array('htmlOptions' => array('rows' => 6, 'cols' => 50, 'class' => 'span8'))));
?>
<?php
echo $form->dropDownListGroup($model, 'is_sleep_test', array('wrapperHtmlOptions' => array('class' => 'col-sm-5'), 'widgetOptions' => array('data' => ViewHelper::yesOrNotSelectOptions(), 'htmlOptions' => array('prompt' => '未選擇'))));
?>
<?php
echo $form->textFieldGroup($model, 'preoperative_sleep_ahi', array('widgetOptions' => array('htmlOptions' => array('class' => 'span5', 'maxlength' => 255))));
?>
<?php