
<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-2">
            <div class="form-group">
                <!--<label class="control-label col-md-2 ls2">Type</label>-->
                <select  class="form-control contype contype updateElement allupdateselect" data-val=""  id="contype{$itr}" data-itr="{$itr}" name="contype" data-colName="contype"  select-tableName="phcontracttype"  data-id="{$phconstract_obj->id}" data-tableName="phcontraception" >
                    <option value="">choose</option>
                    {foreach  $allphcontracttype as $myallphcontracttype}
                    <option value="{$myallphcontracttype->id}">{$myallphcontracttype->name} </option>
                    {/foreach}
                    <option value="-2" class="deleteoptincompo" >Delete</option>
                </select>
            </div>
        </div>


        <div class="col-md-2">
            <div class="form-group form-md-line-input form-md-floating-label has-info">
                <input type="text" class="form-control  updateElement" placeholder="Duration" name="contduration" data-colName="contduration"   data-id="{$phconstract_obj->id}" data-tableName="phcontraception" />
                <!--<label for="form_control_1">Duration</label>-->
                <span class="input-group-addon">Y</span>
            </div>
        </div>



        <div class="col-md-2">
            <div class="form-group form-md-line-input form-md-floating-label has-info">
                <input type="text" class="form-control  updateElement" placeholder="Stopped" name="contstopped" data-colName="contstopped"  data-id="{$phconstract_obj->id}" data-tableName="phcontraception" />
                <!--<label for="contstopped">Stopped</label>-->
                <span class="input-group-addon">Y</span>
            </div>
        </div>

        <div class="col-md-6">
            <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" placeholder="Note" name="contranote" data-colName="contranote"   data-id="{$phconstract_obj->id}" data-tableName="phcontraception"/>
                </div>
                <button type="button" class="btn btn-xs red fright deleteElement delbtnsml" data-id="{$phconstract_obj->id}" data-tableName="phcontraception"><i class="fa fa-close"></i></button>
            </div>
        </div>


        <!-- END SAMPLE FORM PORTLET-->

    </div>
</div>