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<?php
$i=$_POST['i'];
echo '<tr>
<td>Refer to</td>
<td><input type="text" name="refer_by[]"></td>
<td>Assessed By</td>
<td><input type="text" name="assessed_by[]"></td>
</tr>
<tr>
<td>Assessed date</td>
<td>
<div class="input-append date-picker">
<input type="text" name="assessed_date[]" class="dateISO" required="true">
<span class="add-on">
<i class="icon-calendar" data-date-icon="icon-calendar" data-time-icon="icon-time"></i>
</span>
</div>
</td>
<td>Assessed document</td>
<td colspan="3">
<div class="fileupload fileupload-new" style="margin:0px" data-provides="fileupload">
<div class="input-append">
<div class="uneditable-input ">
<i class="icon-file fileupload-exists"></i>
<span class="fileupload-preview"><a href="diagnose_report/<? //= $attachment[$attribute] ?>" target="_blank"><? //= $attachment[$attribute] ?></a></span>
</div>
<span class="btn btn-file">
<span class="fileupload-new">Select file</span>
<span class="fileupload-exists">Change</span>
<input type="file" name="assessed_doc'.$i. '">
</span>
<a href="#" class="btn fileupload-exists" data-dismiss="fileupload">Remove</a>
</div>
</div>
</td>
</tr>';
?>
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