<div class="card p-4">
    <div class="row">
        <div class="col-xl-6">
            <h4>Staff</h4>
            <div class="row">
                <div class="col-6">
                    Endoscopist
                </div>
                <div class="col-6">
                    Consultant
                </div>
                <div class="col-6 mt-1">
                    <select class="js-example-disabled" name="state">
                        <option value="AL">Select Users</option>
                        <option value="MA">Madrid</option>
                        <option value="TO">Toronto</option>
                        <option value="LO">Londan</option>
                        <option value="WY">Wyoming</option>
                    </select>
                </div>
                <div class="col-6 mt-1">
                    <select class="js-example-disabled" name="state">
                        <option value="AL">Select Users</option>
                        <option value="MA">Madrid</option>
                        <option value="TO">Toronto</option>
                        <option value="LO">Londan</option>
                        <option value="WY">Wyoming</option>
                    </select>
                </div>
            </div>
            <div class="col-6">
                Attendant
            </div>
            <div class="col-12">
                <select class="js-example-disabled" name="state">
                    <option value="AL">Select Users</option>
                    <option value="MA">Madrid</option>
                    <option value="TO">Toronto</option>
                    <option value="LO">Londan</option>
                    <option value="WY">Wyoming</option>
                </select>
            </div>
        </div>

        <div class="col-xl-6">
            <div class="row">
                <div class="col-12 mt-28">
                    Other
                </div>

                <div class="col-9">
                    <textarea name="" id="" cols="30" rows="5" class="form-control" placeholder="Free text"></textarea>
                </div>
                <div class="col-3">
                    <button class="btn btn-success h-100 w-100 me-3" type="button">
                        <i class=" ri-dossier-fill ri-2x"></i>
                        <span style="display: block;">Create Report</span>
                    </button>
                </div>
            </div>
        </div>
    </div>
</div>
