

<div class="row">
    <div class="col-xs-3 form-group form-group-sm">
        <label for="">Número de Expediente</label>
        <input maxlength="15" id="NExp" name="NExp" type="text" class="form-control"
               placeholder="">
    </div>
    <div class="col-xs-3 form-group form-group-sm">
        <label for="">CURP</label>
        <div class="input-group">
            <input maxlength="18" id="Curp" name="Curp" type="text" class="form-control"
                   placeholder="">
            <span class="input-group-btn">
                                    <button id="openModal" class="btn btn-default btn-sm"
                                            type="button"><i
                                                class="fa fa-search"></i></button>
                                </span>
        </div><!-- /input-group -->
    </div>
</div>

<div class="row">

    <div class="col-xs-3 form-group form-group-sm">
        <label for=""><span
                    class="text-red">*</span> Nombre(s)</label>
        <input maxlength="50" required id="Nombre" name="Nombre" type="text"
               class="form-control"
               placeholder="">
    </div>
    <div class="col-xs-3 form-group form-group-sm">
        <label for=""><span
                    class="text-red">*</span> Primer Apellido</label>
        <input maxlength="50" required id="PrimerAp" name="PrimerAp" type="text"
               class="form-control"
               placeholder="">
    </div>
    <div class="col-xs-3 form-group form-group-sm">
        <label for="">Segundo Apellido</label>
        <input maxlength="50" id="SegundoAp" name="SegundoAp" type="text"
               class="form-control"
               placeholder="">
    </div>

</div>

<div class="row">

    <div class="col-xs-2 form-group form-group-sm">
        <label for=""><span class="text-red">*</span> Nacionalidad</label>
        {!! $nacionalidades !!}
    </div>

    <div class="col-xs-2 form-group form-group-sm">
        <label for=""><span class="text-red">*</span> Entidad de Nacimiento</label>
        {!! $entidades !!}
    </div>

    <div class="col-xs-2 form-group form-group-sm">
        <label for=""><span class="text-red">*</span> Fecha de Nacimiento</label>
        <input required id="FechaNac" name="FechaNac" type="text" class="form-control"
               placeholder="">
    </div>
    <div class="col-xs-2 form-group form-group-sm">
        <label for="">Hora de Nacimiento</label>
        <input id="HoraNac" name="HoraNac" type="text"
               class="form-control timepicker" placeholder="hh:mm hrs">
    </div>
    <div class="col-xs-3 form-group form-group-sm">
        <label for="">Certificado Único</label>
        <input name="CUN" id="CUN" type="text" class="form-control"
               placeholder="">
    </div>

</div>


<div class="row">

    <div class="col-xs-2 form-group form-group-sm">
        <label for=""><span class="text-red">*</span> Género</label>
        {!! $sexos !!}
    </div>
    <div class="col-xs-2 form-group form-group-sm">
        <label for="">Grupo Sanguíneo</label>
        {!! $gSanguineos !!}
    </div>
    <div class="col-xs-2 form-group form-group-sm">
        <label for="">Religión</label>
        {!! $religiones !!}
    </div>
    <div class="col-xs-2 form-group form-group-sm">
        <label for=""><span class="text-red">*</span> Tipo beneficiario</label>
        {!!$tbeneficiarios!!}
    </div>
    <div class="col-xs-2 form-group form-group-sm">
        <label for="">Ocupación Habitual</label>
        {!!$ocupacion!!}
    </div>
</div>


<div class="row">
    <div class="col-xs-4 form-group form-group-sm">
        <label for="">Habla o entiende alguna lengua indígena?</label>
        <div class="input-group">
            <label class="radio-inline">
                <input type="radio" name="lengua_indigena" id="lengua_indigena" value="1">
                Si
            </label>
            <label class="radio-inline">
                <input type="radio" checked name="lengua_indigena" id="lengua_indigena1"
                       value="2">
                No
            </label>
            <label class="radio-inline">
                <input type="radio" name="lengua_indigena" id="lengua_indigena2" value="3">
                No
                Responde
            </label>
            <label class="radio-inline">
                <input type="radio" name="lengua_indigena" id="lengua_indigena3" value="4">
                No
                Sabe
            </label>
        </div>
        <div class="input-group col-xs-12">
            {!! $lenguas !!}
        </div>
    </div>
    <div class="col-xs-6 form-group form-group-sm">
        <label for="">Pertenece A:</label>
        <div class="input-group">
            <label class="checkbox-inline">
                <input type="checkbox" id="indigena" name="indigena" value="1"> Indígena
            </label>
            <label class="checkbox-inline">
                <input type="checkbox" id="migrante" name="migrante" value="1"> Migrante
            </label>
            <label class="checkbox-inline">
                <input type="checkbox" id="prospera" name="prospera" value="1"> Prospera
            </label>
            <label class="checkbox-inline hidden" id="prosperaDiv">
                <input id="folio_prospera" name="folio_prospera" type="text"
                       style="margin-left: -15px; width: 95px;"
                       class="form-control" placeholder="Folio Prospera">
                <input id="ConsecutivoProspera" name="ConsecutivoProspera" type="text"
                       style="width: 45px;" class="form-control"
                       placeholder="">
            </label>
        </div>


    </div>
    <!--<div class="col-xs-2 form-group form-group-sm hidden" id="prosperaDiv">
        <label for="">&nbsp;</label>
        <div class="input-group">
            <input id="folio_prospera" name="folio_prospera" type="text" style="width: 65%;"
                   class="form-control" placeholder="">
            <input id="ConsecutivoProspera" name="ConsecutivoProspera" type="text"
                   style="width: 25%; float: right;" class="form-control"
                   placeholder="">
        </div>
        <span id="helpBlock" class="help-block">Folio Prospera (Personal)</span>
    </div>-->

</div>
