ces %}
											<div class="col-12 col-md-10 col-lg-11">

                        
												<div class="row form-row">

													<div class="col-12 col-md-6 col-lg-3">
														<div class="form-group">
															<label>Hospital Name</label>
															<input type="text" class="form-control" value="{{e.work_place_name}}">
														</div>
													</div>

													<div class="col-12 col-md-6 col-lg-3">
														<div class="form-group">
															<label>From</label