<div class="modal fade" tabindex="-1" role="dialog" id="modal-wizard-derma-dialog">
  <div class="modal-dialog modal-lg modal-95" role="document">
    <div class="modal-content">
      <div class="modal-header">
        <h5 class="modal-title"><?php echo _('Wizard Derma'); ?></h5>
        <button type="button" class="close" data-dismiss="modal" aria-label="Close">
          <span aria-hidden="true">&times;</span>
        </button>
      </div>
      <div class="modal-body">
	      <div class="row">
		      <div class="col-lg-6">
			      <div class="row">
				      <div class="col-lg-6 text-center">
					      <div class="derma-image-wrapper text-center <?php echo isset($this->view->dermaPositions['single']) ? 'derma-image-selected' : ''; ?>" data-type="single">
						      <div class="derma-title"><?php echo $this->view->dermaPositionLabels['single']; ?></div>
						      <img src="/images/wizards/derma/1_Singola.jpg" alt="">
						      <input type="checkbox" name="data[derma_position][value][]" class="derma-position-check" id="derma-position-check-single" class="derma-position-check" data-label="<?php echo _('Position'), ': ', $this->view->dermaPositionLabels['single']; ?>" value="single" <?php echo isset($this->view->dermaPositions['single']) ? 'checked' : ''; ?>>
						  </div>
				      </div>
				      <div class="col-lg-6 text-center">
					      <div class="derma-image-wrapper text-center <?php echo isset($this->view->dermaPositions['multiple-localized']) ? 'derma-image-selected' : ''; ?>" data-type="multiple-localized">
						      <div class="derma-title"><?php echo $this->view->dermaPositionLabels['multiple-localized']; ?></div>
						      <img src="/images/wizards/derma/2_Multiple_localizzate.jpg" alt="">
						      <input type="checkbox" name="data[derma_position][value][]" class="derma-position-check" id="derma-position-check-multiple-localized" class="derma-position-check" data-label="<?php echo _('Position'), ': ', $this->view->dermaPositionLabels['multiple-localized']; ?>" value="multiple-localized" <?php echo isset($this->view->dermaPositions['multiple-localized']) ? 'checked' : ''; ?>>
						  </div>
				      </div>
			      </div>
			      <div class="row">
				      <div class="col-lg-6 text-center">
					      <div class="derma-image-wrapper text-center <?php echo isset($this->view->dermaPositions['multiple-spread']) ? 'derma-image-selected' : ''; ?>" data-type="multiple-spread">
						      <div class="derma-title"><?php echo $this->view->dermaPositionLabels['multiple-spread']; ?></div>
						      <img src="/images/wizards/derma/3_Multiple_diffuse.jpg" alt="">
						      <input type="checkbox" name="data[derma_position][value][]" class="derma-position-check" id="derma-position-check-multiple-spread" class="derma-position-check" data-label="<?php echo _('Position'), ': ', $this->view->dermaPositionLabels['multiple-spread']; ?>" value="multiple-spread" <?php echo isset($this->view->dermaPositions['multiple-spread']) ? 'checked' : ''; ?>>
						  </div>
				      </div>
				      <div class="col-lg-6 text-center">
					      <div class="derma-image-wrapper text-center <?php echo isset($this->view->dermaPositions['clusted']) ? 'derma-image-selected' : ''; ?>" data-type="clusted">
						      <div class="derma-title"><?php echo $this->view->dermaPositionLabels['clusted']; ?></div>
						      <img src="/images/wizards/derma/4_A_grappolo.jpg" alt="">
						      <input type="checkbox" name="data[derma_position][value][]" class="derma-position-check" id="derma-position-check-clusted" class="derma-position-check" data-label="<?php echo _('Position'), ': ', $this->view->dermaPositionLabels['clusted']; ?>" value="clusted" <?php echo isset($this->view->dermaPositions['clusted']) ? 'checked' : ''; ?>>
						  </div>
				      </div>
			      </div>
			      <div class="row">
				      <div class="col-lg-6 text-center">
					      <div class="derma-image-wrapper text-center <?php echo isset($this->view->dermaPositions['metameric']) ? 'derma-image-selected' : ''; ?>" data-type="metameric">
						      <div class="derma-title"><?php echo $this->view->dermaPositionLabels['metameric']; ?></div>
						      <img src="/images/wizards/derma/5_Metamerica.jpg" alt="">
						      <input type="checkbox" name="data[derma_position][value][]" class="derma-position-check" id="derma-position-check-metameric" class="derma-position-check" data-label="<?php echo _('Position'), ': ', $this->view->dermaPositionLabels['metameric']; ?>" value="metameric" <?php echo isset($this->view->dermaPositions['metameric']) ? 'checked' : ''; ?>>
						  </div>
				      </div>
				      <div class="col-lg-6 text-center">
					      <div class="derma-image-wrapper text-center <?php echo isset($this->view->dermaPositions['linear']) ? 'derma-image-selected' : ''; ?>" data-type="linear">
						      <div class="derma-title"><?php echo $this->view->dermaPositionLabels['linear']; ?></div>
						      <img src="/images/wizards/derma/6_Lineare.jpg" alt="">
						      <input type="checkbox" name="data[derma_position][value][]" class="derma-position-check" id="derma-position-check-linear" class="derma-position-check" data-label="<?php echo _('Position'), ': ', $this->view->dermaPositionLabels['linear']; ?>" value="linear" <?php echo isset($this->view->dermaPositions['linear']) ? 'checked' : ''; ?>>
						  </div>
				      </div>
			      </div>
			      <div class="row">
				      <div class="col-lg-6 text-center">
					      <div class="derma-image-wrapper text-center <?php echo isset($this->view->dermaPositions['acral']) ? 'derma-image-selected' : ''; ?>" data-type="acral">
						      <div class="derma-title"><?php echo $this->view->dermaPositionLabels['acral']; ?></div>
						      <img src="/images/wizards/derma/7_Acrale.jpg" alt="">
						      <input type="checkbox" name="data[derma_position][value][]" class="derma-position-check" id="derma-position-check-acral" class="derma-position-check" data-label="<?php echo _('Position'), ': ', $this->view->dermaPositionLabels['acral']; ?>" value="acral" <?php echo isset($this->view->dermaPositions['acral']) ? 'checked' : ''; ?>>
						  </div>
				      </div>
				      <div class="col-lg-6 text-center">
					      <div class="derma-image-wrapper text-center <?php echo isset($this->view->dermaPositions['symmetrical']) ? 'derma-image-selected' : ''; ?>" data-type="symmetrical">
						     <div class="derma-title"><?php echo $this->view->dermaPositionLabels['symmetrical']; ?></div>
						     <img src="/images/wizards/derma/8_Simmetrica.jpg" alt="">
						      <input type="checkbox" name="data[derma_position][value][]" class="derma-position-check" id="derma-position-check-symmetrical" class="derma-position-check" data-label="<?php echo _('Position'), ': ', $this->view->dermaPositionLabels['symmetrical']; ?>" value="symmetrical" <?php echo isset($this->view->dermaPositions['symmetrical']) ? 'checked' : ''; ?>>
						  </div>
				      </div>
			      </div>
		      </div>
		      <div class="col-lg-6">
			      <div class="row">
				      <div class="col"><?php echo $this->helper->getRequestExam($this->view->exams, 'Margins', 'derma'); ?></div>
			      </div>
			      <hr>
			      <div class="row">
				      <div class="col"><?php echo $this->helper->getRequestExam($this->view->exams, 'Symptoms', 'derma'); ?></div>
			      </div>
			      <hr>
			      <div class="row">
				      <div class="col"><?php echo $this->helper->getRequestExam($this->view->exams, 'Sexual intercourse', 'derma'); ?></div>
			      </div>
			      <hr>
				  <div class="row">
				      <div class="col"><?php echo $this->helper->getRequestExam($this->view->exams, 'Other information 1', 'derma'); ?></div>
			      </div>
			      <hr>
			      <div class="row">
				    <div class="col"><?php echo $this->helper->getRequestExam($this->view->exams, 'Other information 2', 'derma'); ?></div>
			      </div>
		      </div>
	      </div>
      </div>
      <div class="modal-footer">
      	<button type="button" class="btn btn-primary" data-dismiss="modal"><?php echo _('Done'); ?></button>
      </div>
    </div>
  </div>
</div>
