@include('common.modalHead')
            <div class="row">
                <div class="col-sm-12 col-md-6">
                    <div class="form-group">
                        <label>Nombre</label>
                        <input type="text" class="form-control" wire:model.lazy="name" placeholder="ej. Cita médica">
                        @error('name')
                            <span class="text-danger er">{{ $message }}</span>
                        @enderror
                    </div>
                </div>
                <div class="col-sm-12 col-md-6">
                    <div class="form-group">
                        <label>Requiere documento de soporte?</label>
                        <select class="form-select form-control" wire:model.lazy="support_document_required">
                            <option value="0">No</option>
                            <option value="1">Si</option>
                        </select>
                        @error('support_document_required')
                            <span class="text-danger er">{{ $message }}</span>
                        @enderror
                    </div>
                </div>
                <div class="col-sm-12 col-md-12">
                    <div class="form-group">
                        <label>Descripción</label>
                        <textarea class="form-control" wire:model.lazy="description" rows="3" placeholder="ej. Cita médica para el día de hoy"></textarea>
                        @error('description')
                            <span class="text-danger er">{{ $message }}</span>
                        @enderror
                    </div>
                </div>


            </div>
@include('common.modalFooter')
