<?php echo csrf_field(); ?>
<div class='row'>
  <div class="col-md-12 col-sm-12  ">
    <div class="x_panel">

      <div class="x_content">
        
        <form id='form-nuevo'>

          <div class="row form-group">
            <div class="col-lg-2 col-md-2 col-sm-12"></div>
            <div class="col-lg-8 col-md-8 col-sm-12">

              <div class="text-center"><h2>Datos Personales</h2></div>
              <div class="row form-group">
                <div class="col-lg-3 col-md-3 col-sm-12 text-md-right text-sm-left font-weight-bolder"><label class="pt-1" for='nombre'>Nombre:</label></div>
                <div class="col-lg-8 col-md-8 col-sm-12">
                  <input type="text" class="form-control form-control-sm" id="nombre" name="nombre" required autocomplete="off" />
                </div>
              </div>
              <div class="row form-group">
                <div class="col-lg-3 col-md-3 col-sm-12 text-md-right text-sm-left font-weight-bolder"><label class="pt-1" for='paterno'>Apellido Paterno:</label></div>
                <div class="col-lg-8 col-md-8 col-sm-12">
                  <input type="text" class="form-control form-control-sm" id="paterno" name="paterno" required autocomplete="off" />
                </div>
              </div>

              <div class="row form-group">
                <div class="col-lg-3 col-md-3 col-sm-12 text-md-right text-sm-left font-weight-bolder"><label class="pt-1" for='materno'>Apellido Materno :</label></div>
                <div class="col-lg-8 col-md-8 col-sm-12">
                  <input type="text" class="form-control form-control-sm" id='materno' name="materno" required autocomplete="off" />
                </div>
              </div>

              <div class="row form-group">
                <div class="col-lg-3 col-md-3 col-sm-12 text-md-right text-sm-left font-weight-bolder"><label class="pt-1" for='sexo'>Sexo:</label></div>
                <div class="col-lg-8 col-md-8 col-sm-12">
                	<input type="radio" id='femenino' value="femenino" name="sexo" checked />
                  <label for="femenino" class="pt-1">Femenino</label>
                  <span class="ml-2"></span>
                  <input type="radio" id='masculino' value="masculino" name="sexo" />
                  <label for="masculino" class="pt-1">Masculino</label>
                </div>
              </div>

              <div class="row form-group">
                <div class="col-lg-3 col-md-3 col-sm-12 text-md-right text-sm-left font-weight-bolder"><label class="pt-1" for='telefono'>Teléfono:</label></div>
                <div class="col-lg-8 col-md-8 col-sm-12">
                    <input type="text" class="form-control form-control-sm" placeholder="" id="telefono" name="telefono" required autocomplete="off">
                </div>
              </div>

              <div class="row form-group">
                <div class="col-lg-3 col-md-3 col-sm-12 text-md-right text-sm-left font-weight-bolder"><label class="pt-1" for='correo'>Correo:</label></div>
                <div class="col-lg-8 col-md-8 col-sm-12">
                  <input type="email" class="form-control form-control-sm" id="correo" name="correo" required autocomplete="off" />
                </div>
              </div>

              <div class="row form-group">
                <div class="col-lg-3 col-md-3 col-sm-12 text-md-right text-sm-left font-weight-bolder"><label class="pt-1" for='examen'>Examen:</label></div>
                <div class="col-lg-8 col-md-8 col-sm-12">
                	<input type="radio" id='ubicacion' value="ubicacion" name="examen" checked />
                  <label for="ubicacion" class="pt-1">Ubicación</label>
                  <span class="ml-2"></span>
                  <input type="radio" id='liberacion' value="liberacion" name="examen" />
                  <label for="liberacion" class="pt-1">Liberación</label>
                </div>
              </div>

            </div>
            <div class="col-lg-2 col-md-2 col-sm-12"></div>
            
          </div>


          <div class="row mt-5">
            <div class="col-md-3 col-sm-12"></div>
            <div class="col-md-6 col-sm-12">
              <div class="row">
                <div class="col">
                  <button type="button" onclick="javascript:ngl_ext_add();" class="btn btn-success btn-block"><i class="fa fa-save"></i> Guardar</button>
                </div>
                <div class="col">
                  <button type="button" class="btn btn-warning btn-block" onclick="javascript:ngl_ext_listado();" style="color: #fff;"><i class="fa fa-times"></i> Cancelar</button>
                </div>
              </div>
            </div>
            <div class="col-md-3 col-sm-12"></div>
          </div>

        </form>
        
      </div>
    </div>
  </div>
</div>


