invoice.php

<div class="panel panel-default">
			  <div class="panel-body">
			  		<div class="row">
                            <div class="col-md-6">
                                <div class="bill-to">
                                    <p class="h5 mb-xs text-dark text-semibold"><strong>Invoiced To:</strong></p>
                                    <address>
                                        Full Name: <br>
                                        Address: <br>
                                        City: <br>
                                        ZipCode:<br>
                                        Mobile<br>
                                        <strong>Email:</strong> youemail@domain.com
                                    </address>
                                </div>
                            </div>

                            <div class="col-md-6">
                                <div class="bill-data text-right">
                                    <p class="mb-none">
                                        <span class="text-dark">Invoice Date:</span>
                                        <span class="value"><?php echo date("M d Y"); ?></span>
                                    </p>
                                    <p class="mb-none">
                                        <span class="text-dark">Due Date:</span>
                                        <span class="value"><?php echo date("M d Y"); ?></span>
                                    </p>

                                 </div>
                            </div>
                        </div>

                    <div class="table-responsive">
                        <table class="table invoice-items">
                            <thead>
                            <tr class="h4 text-dark">
                                <th id="cell-id" class="text-semibold">Item_no</th>
                                <th id="cell-item" class="text-semibold">Medicine</th>

                                <th id="cell-price" class="text-center text-semibold">Price</th>
                            </tr>
                            </thead>
                            <tbody>
                            <tr id="prodinv"></tr>
								<tr id="prodinv">
                                    <td>001</td>
                                    <td class="text-semibold text-dark">#</td>
                                    <td class="text-center amount">#</td>
                                </tr>


                            </tbody>
                        </table>
                    </div>

                    <div class="row">
                    	<div class="col-sm-4">

                    	</div>
                    	<div class="col-md-4">
                    		 <h2> Invoice Total: <span class="amount">#</span> </h2>
                    	</div>
                    	<div class="col-md-4">
                    		Amount Paid By :
					  		<select name="paymentmode" class="form-control">
							  <option value="cash">Cash</option>
							  <option value="card">Card</option>
							</select>
                    	</div>
                    </div>

			  </div>
	</div>

<form method="post">
	Amount Paid By :
		<select name="paymentmode" class="form-control">
	  <option value="cash">Cash</option>
	  <option value="card">Card</option>
	</select>
	<input type="hidden" name="uid" value="<?php echo $_GET['id']; ?>">
	<?php if(isset($_GET['medicine']) & !empty($_GET['medicine'])){ ?>
	<input type="hidden" name="productids" value="<?php echo implode(",", $_GET['medicine']) ?>">
	<?php } ?>
	<br>
	<input type="submit" value="Invoice Paid" class="btn btn-primary btn-lg">
</form>