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Rev 27681 Rev 27693
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				</div>
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				</div>
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				<div class="col-lg-3 form-group">
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				<div class="col-lg-3 form-group">
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				   	<input placeholder="Last Name" name="lastName" type="text" value="" class="form-control input-sm lastName">
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				   	<input placeholder="Last Name" name="lastName" type="text" value="" class="form-control input-sm lastName">
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				</div>
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				</div>
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				<div class="col-lg-2 form-group">
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				<div class="col-lg-2 form-group">
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				   	<input id="emailIds" name="emailId" type="email" value="" class="form-control input-sm email" placeholder="Email(xyz@gmail.com)">
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				   	<input id="emailId" name="emailId" type="email" value="" class="form-control input-sm email" placeholder="Email(xyz@gmail.com)">
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				</div>
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				</div>
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				<div class="col-lg-2 form-group">
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				<div class="col-lg-2 form-group">
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				   	<button type="button" class="btn btn-block btn-primary mk_add_customer" style="display:none">Add customer</button>
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				   	<button type="button" class="btn btn-block btn-primary mk_add_customer" style="display:none">Add customer</button>
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				   	<button type="button" class="btn btn-block btn-primary mk_add_email" style="display:none">Update Customer</button>
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				</div>
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				</div>
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  			</div>
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  			</div>
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  		</div>
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  		</div>
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  		<div class="row billinginfo" style="display:none">
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  		<div class="row billinginfo" style="display:none">
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  			<div class="row">
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  			<div class="row">
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				</table>
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				</table>
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			</div>
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			</div>
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		</div>
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		</div>
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  		<div>
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  		<div>
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  			<div class="row">
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  			<div class="row">
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				<h4 class="modelHeaderCustom" style="font-size:22px;">Insurance Informartion</h4>
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				<h4 class="modelHeaderCustom" style="font-size:22px;">Insurance Information</h4>
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			</div>
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			</div>
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		</div>
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		</div>
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	     	<div class="row mk_insurance_row" style="display:none">
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	     	<div class="row mk_insurance_row" style="display:none">
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				<div class="col-lg-3 form-group">
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				<div class="col-lg-3 form-group">
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				 <label for="gender">Gender</label>
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				 <label for="gender">Gender</label>