<div class="modal displayBlock" id="clinicExceptionForm">
    <div class="modal-dialog">
        <div class="modal-content">
            <div class="modal-header">
                {{#ifEquals mode "add"}}
                <h4 class="modal-title">{{i18n 'adminsetting.addClinicExceptionHeader'}}</h4>
                {{else}}
                <h4 class="modal-title">{{i18n 'adminsetting.editClinicExceptionHeader'}}</h4>
                {{/ifEquals}}
            </div>
            <div class="container modal-body">
                <div class="col-xs-7 col-lg-6">
                    <div class="required margin-right-10">{{i18n 'FirstAccess.required'}}</div>
                </div>
                <br/>
                <form id="clexception-form" class="form-horizontal group-settings paddingtop-10" action="">
                    <div class="form-group paddingtop-10">
                        <label for="blockedClinic" class="col-xs-2 control-label">
                            {{i18n 'adminsetting.clinicExceptionTbHdBlockedClinic'}}
                        </label>
                        <div class="col-xs-5 col-lg-4">
                            <select id="clinicExcp" name="clinicExcp" class="form-control">
                                <option value="" {{#unless ../Id}}selected="selected"{{/unless}}>{{i18n 'adminsetting.selectClinic'}}</option>
                                {{#each clinics}}
                                <option value="{{Id}}" {{#ifEquals Id ../Id}}selected="selected"{{/ifEquals}}>
                                    {{Description}}
                                </option>
                                {{/each}}
                            </select>
                        </div>
                        <div class="clear-both"></div>
                        <div class="col-xs-7 col-lg-6">
                            <span class="help-block float-right hidden control-label"></span>
                        </div>
                    </div>
                   <div class="clear-both"></div>
                   <div class="form-group paddingtop-10">
                      <label for="languageSelect" class="col-xs-2 control-label">
                         {{i18n 'FirstAccess.LanguageLabel'}}
                      </label>
                       <div class="col-xs-5 col-lg-4">
                         <select id="languageSelect" name="languageSelect" class="form-control">
                            {{#each languages}}
                            <option value="{{LangCd}}" {{Selected}}>{{languageDesc}}
                            </option>
                            {{/each}}
                         </select>
                      </div>
                      <div class="clear-both"></div>
                      <div class="col-xs-7 col-lg-6">
                         <span class="help-block float-right hidden control-label"></span>
                      </div>
                   </div>
                   <div class="clear-both"></div>
                    <div class="form-group paddingtop-10">
                        <label for="clinicexception-bclabel" class="col-xs-2 control-label">
                            <span class="asterix">*</span> {{i18n 'adminsetting.clinicExceptionTbHdMessage'}}
                        </label>
                        <div class="col-xs-5 col-lg-4">
                           <textarea id="messageText" name="messageText" class="form-control" placeholder="Enter Message" rows="5" maxlength="4000">{{ExcpMessage}}</textarea>
                        </div>
                        <div class="clear-both"></div>
                        <div class="col-xs-7 col-lg-6">
                            <span class="help-block float-right hidden control-label"></span>
                        </div>
                    </div>
                </form>
            </div>
            <div class="modal-footer">
                <button type="button" class="btn btn-default excpCancel-btn" data-dismiss="modal">{{i18n 'FirstAccess.cancel'}}</button>
                <button type="button" class="btn btn-primary excpSave-btn" data-dismiss="modal">{{i18n 'FirstAccess.done'}}</button>
            </div>
        </div>
    </div>
</div>

