<div class="modal fade" tabindex="-1" role="dialog" aria-hidden="false" data-backdrop="static" data-keyboard="false"   id="addPatientPH" style="min-width:1000px;">
    <div class="modal-dialog  modal-lg wds95">
        <div class="modal-content">
            <div class="modal-header">
                <button type="button" class="close" data-dismiss="modal" aria-hidden="true"></button>
                <h4 class="modal-title">  </h4>
            </div>
            <div class="modal-body">
                <div class="portlet-body form">
                    <form class="form-horizontal" role="form" action="" method="post" id="phform" enctype="multipart/form-data">
                        <div class="row">
                            <div class="col-md-12">
                                <div class="portlet blue-hoki box">
                                    <div class="portlet-title">
                                        <div class="caption" style=" font-size: 16px; font-weight: 700; width: 280px; "> Today <input type="text" class="form-control datepicker " id="invDate" name="invDate" value="{$today}"  readonly="" placeholder="Date" style="display: inline; width: 62%"> </div>
                                        <div class="actions">
                                            <button type="button" class="btn default printph" data-print ="0" data-controller="gyna"> Save </button>
                                            <button type="button" class="btn default printph" data-print ="1" data-controller="gyna"> Save and Print  </button>
                                            <button type="button" class="btn default" id="closemodel" data-dismiss="modal"> Close</button>
                                        </div>

                                        <div class="caption" style=" font-size: 16px; font-weight: 700; width: 280px; "> Print Date <input type="text" class="form-control datepicker " data-controller="antenalvisit"  id="printInvDate" name="printInvDate" value="{$today}"  readonly="" placeholder="Date" style="display: inline;width: 110px;margin: 0px 10px;"> </div>

                                    </div>
                                    <div class="portlet-body">
                                        <input type="hidden" id="pIdph" value="" name="patientId"/>
                                        <div class="row" style="padding-left: 9px;padding-top:5px;overflow-y: scroll;">
                                            <div class="wds20 fleft">
                                                {assign var=i value=1}
                                                {foreach $group1 as $cat}

                                                <label style="font-weight:bold; text-decoration:underline" for="catId{$cat->id}"> {$cat->name}
                                                    <span>
                                                        <input type="checkbox" data-gClass="{$cat->id}Check" id="catId{$cat->id}" class="iiin checkGroup" name="catId[]"   value="{$cat->id}" >
                                                    </span>
                                                </label>
                                                <div class="checkbox-list">
                                                    {assign var=j value=1}
                                                    {foreach $cat->answers as $inv}
                                                    <label>
                                                        <span>
                                                            <input type="checkbox" class="iiin {$cat->id}Check checkParent"  value="{$inv->id}" name="invCheck{$cat->id}[]" data-parent="{$cat->id}" >
                                                        </span> {$inv->name}
                                                    </label>

                                                    {capture assign=j}{$j+1}{/capture}
                                                    {/foreach}
                                                </div>
                                                {capture assign=i}{$i+1}{/capture}
                                                {/foreach}
                                            </div>
                                            <div class="wds20 fleft">
                                                {assign var=i value=1}
                                                {foreach $group2 as $cat}

                                                <label style="font-weight:bold; text-decoration:underline" for="catId{$cat->id}"> {$cat->name}
                                                    <span>
                                                        <input type="checkbox" data-gClass="{$cat->id}Check" id="catId{$cat->id}"  class="iiin checkGroup" name="catId[]"   value="{$cat->id}">
                                                    </span>
                                                </label>
                                                <div class="checkbox-list">
                                                    {assign var=j value=1}
                                                    {foreach $cat->answers as $inv}
                                                    <label>
                                                        <span>
                                                            <input type="checkbox" class="iiin {$cat->id}Check checkParent"  value="{$inv->id}" name="invCheck{$cat->id}[]" data-parent="{$cat->id}">
                                                        </span> {$inv->name}
                                                    </label>

                                                    {capture assign=j}{$j+1}{/capture}
                                                    {/foreach}
                                                </div>
                                                {capture assign=i}{$i+1}{/capture}
                                                {/foreach}
                                            </div>
                                            <div class="wds20 fleft">
                                                {assign var=i value=1}
                                                {foreach $group3 as $cat}

                                                <label style="font-weight:bold; text-decoration:underline" for="catId{$cat->id}"> {$cat->name}
                                                    <span>
                                                        <input type="checkbox" data-gClass="{$cat->id}Check" id="catId{$cat->id}"  class="iiin checkGroup" name="catId[]"   value="{$cat->id}">
                                                    </span>
                                                </label>
                                                <div class="checkbox-list">
                                                    {assign var=j value=1}
                                                    {foreach $cat->answers as $inv}
                                                    <label>
                                                        <span>
                                                            <input type="checkbox"  class="iiin {$cat->id}Check checkParent"  value="{$inv->id}" name="invCheck{$cat->id}[]" data-parent="{$cat->id}">
                                                        </span> {$inv->name}
                                                    </label>

                                                    {capture assign=j}{$j+1}{/capture}
                                                    {/foreach}
                                                </div>
                                                {capture assign=i}{$i+1}{/capture}
                                                {/foreach}
                                            </div>
                                            <div class="wds20 fleft">
                                                {assign var=i value=1}
                                                {foreach $group4 as $cat}

                                                <label style="font-weight:bold; text-decoration:underline" for="catId{$cat->id}"> {$cat->name}
                                                    <span>
                                                        <input type="checkbox" data-gClass="{$cat->id}Check" id="catId{$cat->id}"  class="iiin checkGroup" name="catId[]"   value="{$cat->id}">
                                                    </span>
                                                </label>
                                                <div class="checkbox-list">
                                                    {assign var=j value=1}
                                                    {foreach $cat->answers as $inv}
                                                    <label>
                                                        <span>
                                                            <input type="checkbox"  class="iiin {if $cat->name == 'Male(Husband)'}husbandCheck{/if} {$cat->id}Check checkParent" value="{$inv->id}" name="invCheck{$cat->id}[]" data-parent="{$cat->id}">
                                                        </span> {$inv->name}
                                                    </label>

                                                    {capture assign=j}{$j+1}{/capture}
                                                    {/foreach}
                                                </div>
                                                {capture assign=i}{$i+1}{/capture}
                                                {/foreach}
                                            </div>

                                            <div class="wds20 fleft">
                                                {foreach $others  as $cat}

                                                <label style="font-weight:bold; text-decoration:underline" for="catId{$cat->id}"> {$cat->name}
                                                    <span>
                                                        <input type="checkbox" data-gClass="{$cat->id}Check" id="catId{$cat->id}"  class="iiin checkGroup" name="catId[]"   value="{$cat->id}">
                                                    </span>
                                                </label>
                                                <div class="checkbox-list">
                                                    {assign var=j value=1}
                                                    {foreach $cat->answers as $inv}
                                                    <label>
                                                        <span>
                                                            <input type="checkbox" class="{$cat->id}Check iiin checkParent"  value="{$inv->id}" name="invCheck{$cat->id}[]" data-parent="{$cat->id}" >
                                                        </span> {$inv->name}
                                                    </label>

                                                    {capture assign=j}{$j+1}{/capture}
                                                    {/foreach}
                                                </div>
                                                {capture assign=i}{$i+1}{/capture}
                                                {/foreach}

                                                {assign var=i value=1}
                                                {foreach $group5 as $cat}

                                                <label style="font-weight:bold; text-decoration:underline" for="catId{$cat->id}"> {$cat->name}
                                                    <span>
                                                        <input type="checkbox" data-gClass="{$cat->id}Check" id="catId{$cat->id}"  class="iiin checkGroup" name="catId[]"   value="{$cat->id}">
                                                    </span>
                                                </label>
                                                <div class="checkbox-list">
                                                    {assign var=j value=1}
                                                    {foreach $cat->answers as $inv}
                                                    <label>
                                                        <span>
                                                            <input type="checkbox" class="iiin {$cat->id}Check checkParent"  value="{$inv->id}" name="invCheck{$cat->id}[]" data-parent="{$cat->id}" >
                                                        </span> {$inv->name}
                                                    </label>

                                                    {capture assign=j}{$j+1}{/capture}
                                                    {/foreach}
                                                </div>
                                                {capture assign=i}{$i+1}{/capture}
                                                {/foreach}
                                            </div>
                                        </div>


                                        <div  id="inv_div">

                                        </div>



                                    </div>
                                </div>
                            </div>
                        </div>
                        <div>

                        </div>
                </div>
                </form>
            </div>
        </div>


    </div>
</div>