<div class="row mt-5">
<div class="col col-6 mx-auto">
<form class="row" wire:submit.prevent="save">
<div class="col col-12 text-center">
<h3>{{ $titulo }} Paciente</h3>
</div>
<div class="col col-12 mt-3">
<label for="name" class="form-label">Nombre</label>
<input class="form-control" id="name" wire:model="form.name">
@error('form.name') <span class="text-danger">{{ $message }}</span> @enderror
</div>
<div class="col col-12 mt-3">
<label for="middle-name" class="form-label">Apellido Paterno</label>
<input class="form-control" id="middle-name" wire:model="form.middle_name">
@error('form.middle_name') <span class="text-danger">{{ $message }}</span> @enderror
</div>
<div class="col col-12 mt-3">
<label for="last-name" class="form-label">Apellido Materno</label>
<input class="form-control" id="last-name" wire:model="form.last_name">
@error('form.last_name') <span class="text-danger">{{ $message }}</span> @enderror
</div>
<div class="col col-12 d-grid mt-5">
<button type="submit" class="btn btn-primary">{{ $tituloBtn }}</button>
</div>
<div class="col col-12 d-grid mt-2">
<a href="/pacientes" class="btn btn-secondary">Volver</a>
</div>
</form>
</div>
</div>
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