{!! Form::text('first_name')
-> label(trans('care_provider::care_provider.label.first_name'))
-> placeholder(trans('care_provider::care_provider.placeholder.first_name'))!!}
{!! Form::text('last_name')
-> label(trans('care_provider::care_provider.label.last_name'))
-> placeholder(trans('care_provider::care_provider.placeholder.last_name'))!!}
{!! Form::text('email')
-> label(trans('care_provider::care_provider.label.email'))
-> placeholder(trans('care_provider::care_provider.placeholder.email'))!!}
{!! Form::numeric('phone')
-> label(trans('care_provider::care_provider.label.phone'))
-> placeholder(trans('care_provider::care_provider.placeholder.phone'))!!}
{!! Form::text('address_line1')
-> label(trans('care_provider::care_provider.label.address_line1'))
-> placeholder(trans('care_provider::care_provider.placeholder.address_line1'))!!}
{!! Form::text('address_line2')
-> label(trans('care_provider::care_provider.label.address_line2'))
-> placeholder(trans('care_provider::care_provider.placeholder.address_line2'))!!}
{!! Form::text('city')
-> label(trans('care_provider::care_provider.label.city'))
-> placeholder(trans('care_provider::care_provider.placeholder.city'))!!}
{!! Form::text('post_code')
-> label(trans('care_provider::care_provider.label.post_code'))
-> placeholder(trans('care_provider::care_provider.placeholder.post_code'))!!}
{!! Form::numeric('state_id')
-> label(trans('care_provider::care_provider.label.state_id'))
-> placeholder(trans('care_provider::care_provider.placeholder.state_id'))!!}
{!! Form::inline_radios('package_type')
-> radios(trans('care_provider::care_provider.options.package_type'))
-> label(trans('care_provider::care_provider.label.package_type'))!!}
{!! Form::text('type')
-> label(trans('care_provider::care_provider.label.type'))
-> placeholder(trans('care_provider::care_provider.placeholder.type'))!!}
{!! Form::inline_radios('self_managed')
-> radios(trans('care_provider::care_provider.options.self_managed'))
-> label(trans('care_provider::care_provider.label.self_managed'))!!}
{!! Form::text('care_provider')
-> label(trans('care_provider::care_provider.label.care_provider'))
-> placeholder(trans('care_provider::care_provider.placeholder.care_provider'))!!}
{!! Form::text('care_first_name')
-> label(trans('care_provider::care_provider.label.care_first_name'))
-> placeholder(trans('care_provider::care_provider.placeholder.care_first_name'))!!}
{!! Form::text('care_last_name')
-> label(trans('care_provider::care_provider.label.care_last_name'))
-> placeholder(trans('care_provider::care_provider.placeholder.care_last_name'))!!}
{!! Form::text('care_email')
-> label(trans('care_provider::care_provider.label.care_email'))
-> placeholder(trans('care_provider::care_provider.placeholder.care_email'))!!}
{!! Form::numeric('care_phone')
-> label(trans('care_provider::care_provider.label.care_phone'))
-> placeholder(trans('care_provider::care_provider.placeholder.care_phone'))!!}
{!! Form::text('submitted_by')
-> label(trans('care_provider::care_provider.label.submitted_by'))
-> placeholder(trans('care_provider::care_provider.placeholder.submitted_by'))!!}
{!! Form::text('referel_source')
-> label(trans('care_provider::care_provider.label.referel_source'))
-> placeholder(trans('care_provider::care_provider.placeholder.referel_source'))!!}
{!! Form::numeric('terms')
-> label(trans('care_provider::care_provider.label.terms'))
-> placeholder(trans('care_provider::care_provider.placeholder.terms'))!!}
{!! Form::numeric('company_id')
-> label(trans('care_provider::care_provider.label.company_id'))
-> placeholder(trans('care_provider::care_provider.placeholder.company_id'))!!}
{!! Form::numeric('case_manager_id')
-> label(trans('care_provider::care_provider.label.case_manager_id'))
-> placeholder(trans('care_provider::care_provider.placeholder.case_manager_id'))!!}