<?php $__env->startSection('title'); ?>
	@parent  | Provider Search Audit Settings
<?php $__env->stopSection(); ?>

<?php $__env->startSection('content'); ?>

	<div class="center clearfix">
		<h2>Provider Search Audit Settings</h2>
		<div id="audit">
			<?php echo Form::open(array('url' => 'audit/update')); ?>


				<div class="form-pair">
					<?php echo Form::label('audit_date', 'Search Date'); ?><br>
					<?php echo Form::text('audit_date_formatted', date('n/j/Y', strtotime($audit_date)), ['id' => 'audit_date_formatted', 'autocomplete' => 'off']); ?>

					<?php echo Form::hidden('audit_date', $audit_date, ['autocomplete' => 'off']); ?>

				</div>

				<div class="form-pair">
					<?php echo Form::label('tpa_id', 'TPA ID'); ?><br>
					<?php echo Form::select('tpa_id', $tpa_ids, $tpa_id, ['autocomplete' => 'off']); ?>

				</div>

				<div class="form-pair">
					<?php echo Form::label('client_id', 'Client ID'); ?><br>
					<?php echo Form::select('client_id', $client_ids, $client_id, ['autocomplete' => 'off']); ?>

				</div>

				<div class="form-pair">
					<?php echo Form::label('region_id', 'Region(s)'); ?><br>
					<?php echo Form::select('region_id[]', $regions_options, $regions, ['multiple' => 'multiple', 'id' => 'region_id', 'autocomplete' => 'off' ]); ?>

				</div>

				<?php echo Form::submit('Submit', ['id' => 'audit_submit']); ?>

			<?php echo Form::close(); ?>

		</div>
	</div>

	<script type="text/javascript">
		var tpa_id = '<?php echo $tpa_id; ?>',
			client_id = '<?php echo $client_id; ?>',
			regions = <?php echo json_encode(array_keys($regions)); ?>;
	</script>
<?php $__env->stopSection(); ?>

<?php echo $__env->make('layouts.master', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>