{# {{ form_start(form) }}
    {{ form_widget(form) }}
    <button class="btn">{{ button_label|default('Save') }}</button>
{{ form_end(form) }} #}

<div class="form-group row">
	{{ form_label(form.patient, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.patient, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.patient) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.mode_of_booking, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.mode_of_booking, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.mode_of_booking) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.opd_ipd_, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.opd_ipd_, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.opd_ipd_) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.department, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.department, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.department) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.date_of_addmission, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.date_of_addmission, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.date_of_addmission) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.date_of_discharge, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.date_of_discharge, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.date_of_discharge) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.ambulance_reg_no, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.ambulance_reg_no, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.ambulance_reg_no) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.ambulance_type, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.ambulance_type, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.ambulance_type) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.by_owner, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.by_owner, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.by_owner) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.driver_name	, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.driver_name	, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.driver_name	) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.mobile_no	, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.mobile_no	, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.mobile_no	) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.licence_no	, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.licence_no	, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.licence_no	) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.age, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.age, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.age) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.location_of_parking, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.location_of_parking, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.location_of_parking) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.gps_location, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.gps_location, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.gps_location) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.booking_address, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.booking_address, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.booking_address) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.total_km, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.total_km, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.total_km) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.estimated_time, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.estimated_time, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.estimated_time) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.ambulance_charges, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.ambulance_charges, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.ambulance_charges) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.per_km_charges	, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.per_km_charges	, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.per_km_charges	) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.total, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.total, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.total) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.gst, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.gst, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.gst) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.total_payble, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.total_payble, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.total_payble) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.payment_type, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.payment_type, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.payment_type) }}
	</div>
</div>
<div class="form-group row">
	{{ form_label(form.payment, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

	<div class="col-8 col-xl-4">
		{{ form_widget(form.payment, {'attr': { 'class': 'form-control' }}) }}
		{{ form_errors(form.payment) }}
	</div>
</div>