@php
    $s = $suffix ?? '';
    $variant = $variant ?? 'main';
@endphp
<tr>
    <td align="left" valign="top">Package Amount</td>
    <td align="left" valign="top">
        <input name="PkgAmt" type="text" class="form-control" id="PkgAmt{{ $s }}" value="" placeholder="">
    </td>
    <td align="left" valign="top">TPA Company</td>
    <td align="left" valign="top" style="min-width:220px;">
        <select name="TpaCompany" class="form-control ot-cashless-wide-select" id="TpaCompany{{ $s }}" style="min-width:220px;width:100%;">
            <option value="">Select</option>
            @foreach($tpaCompanyList ?? [] as $tpaOption)
            <option value="{{ is_object($tpaOption) ? $tpaOption->Name : $tpaOption }}">{{ is_object($tpaOption) ? $tpaOption->Name : $tpaOption }}</option>
            @endforeach
        </select>
    </td>
    <td align="left" valign="top">Insurane Company</td>
    <td align="left" valign="top" style="min-width:220px;" colspan="3">
        <select name="InsComp" class="form-control ot-cashless-wide-select" id="InsComp{{ $s }}" style="min-width:220px;width:100%;">
            <option value="">Select</option>
            @foreach($insCompList ?? [] as $insCompOption)
            <option value="{{ is_object($insCompOption) ? $insCompOption->Name : $insCompOption }}">{{ is_object($insCompOption) ? $insCompOption->Name : $insCompOption }}</option>
            @endforeach
        </select>
    </td>
</tr>
<tr>
<td align="left" valign="top">Policy No</td>
    <td align="left" valign="top">
        <input name="PolicyNo" type="text" class="form-control" id="PolicyNo{{ $s }}" value="" placeholder="">
    </td>
    <td align="left" valign="top">Claim ID No</td>
    <td align="left" valign="top">
        <input name="ClainNo" type="text" class="form-control" id="ClainNo{{ $s }}" value="" placeholder="">
    </td>
    <td align="left" valign="top">Request Amount</td>
    <td align="left" valign="top" colspan="3">
        <input name="ReqAmt" type="text" class="form-control" id="ReqAmt{{ $s }}" value="" placeholder="">
    </td>
   
</tr>
<tr>
<td align="left" valign="top">Sanctioned Amount</td>
    <td align="left" valign="top">
        <input name="SanctAmt" type="text" class="form-control" id="SanctAmt{{ $s }}" value="" placeholder="">
    </td>
    <td align="left" valign="top">Additional Amt Paid from Patient</td>
    <td align="left" valign="top">
        <input name="AddAmt" type="text" class="form-control" id="AddAmt{{ $s }}" value="" placeholder="">
    </td>
    <td align="left" valign="top">Settle Amount</td>
    <td align="left" valign="top" colspan="3">
        <input name="SettleAmt" type="text" class="form-control" id="SettleAmt{{ $s }}" value="" placeholder="">
    </td>
    
</tr>
<tr>
@if($variant === 'main')
    <td align="left" valign="top" class="ot-cashless-inline-opt">
        <input type="checkbox" name="PostPone" id="PostPone" value="1"
            style="transform: scale(1);margin-left: 4px;margin-right: 6px;">
        <label for="PostPone">PostPone</label>
    </td>
    <td align="left" valign="top">
        <select class="form-control form-control-sm" name="Language" id="Language">
            <option value="1">Marathi</option>
            <option value="2">Hindi</option>
            <option value="3">English</option>
        </select>
    </td>
   
  
    @elseif($variant === 'other')
    <td align="left" valign="top" class="ot-cashless-inline-opt">
        <input type="checkbox" name="PostPone" id="PostPone2" value="1"
            style="transform: scale(1);margin-left: 4px;margin-right: 6px;">
        <label for="PostPone2">PostPone</label>
    </td>
    <td align="left" valign="top">
        <select class="form-control form-control-sm" name="Language" id="Language2">
            <option value="1">Marathi</option>
            <option value="2">Hindi</option>
            <option value="3">English</option>
        </select>
    </td>
    @endif

    @if($variant === 'other')
    <td align="left" valign="top">Settle Date</td>
    <td align="left" valign="top">
        <input type="date" class="form-control" name="SettleDate" id="SettleDate2" value="">
    </td>
    <td align="left" valign="top">UTR No</td>
    <td align="left" valign="top">
        <input name="UtrNo" type="text" class="form-control" id="UtrNo2" value="" placeholder="">
    </td>
    @endif

    <td align="left" valign="top" class="ot-cashless-inline-opt" colspan="2">
        @if($variant === 'main')
        <input type="checkbox" name="Tab1" id="Tab1" value="1" checked
            style="transform: scale(1);margin-left: 4px;margin-right: 6px;">
        <label for="Tab1">Tab 1</label> &nbsp;&nbsp;
        <input type="checkbox" name="Tab2" id="Tab2" value="1" checked
            style="transform: scale(1);margin-left: 4px;margin-right: 6px;">
        <label for="Tab2">Tab 2</label> &nbsp;&nbsp;
        <input type="checkbox" name="Cataract" id="Cataract" value="1" checked
            style="transform: scale(1);margin-left: 4px;margin-right: 6px;">
        <label for="Cataract">Cataract</label>
        @else
        <input type="checkbox" name="Tab1" id="Tab12" value="1"
            style="transform: scale(1);margin-left: 4px;margin-right: 6px;">
        <label for="Tab12">Tab 1</label> &nbsp;&nbsp;
        <input type="checkbox" name="Tab2" id="Tab22" value="1"
            style="transform: scale(1);margin-left: 4px;margin-right: 6px;">
        <label for="Tab22">Tab 2</label>
        @endif
    </td>
</tr>