@model Hims.Domain.Configurations.ISalucroConfiguration
@{
    Layout = null;

}
<!DOCTYPE html>
<html>
<body>
    <div class="patient-payment">

        <form action="@Model.PatientPaymentURL" method="post">

            <input type="hidden" name="token" id="token" value='{"auth":{"user":"@Model.User","key":"@Model.Key"},"username":"@Model.PatientAppUserName","accounts":[{"patient_name":"@ViewBag.PatientName","account_number":"@ViewBag.PatientUmrNo","amount":"@ViewBag.Amount","email":"@ViewBag.PatientEmail","phone":"@ViewBag.PatientMobile"}],"processing_id":"@ViewBag.ProcessingId","paymode":"","payment_source":"@Model.PaymentSource","custom":"@ViewBag.Custom","custom1":"@ViewBag.Custom1","response_url":"@Model.ResponseURL","return_url":"@Model.PatientAppReturnURL"}' />

            <input type="hidden" name="mid" id="mid" value="@Model.MId" />

            <input type="hidden" name="check_sum_hash" id="check_sum_hash" value="@ViewBag.CheckSumHash" />
        </form>
    </div>
</body>
</html>