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		             	</select>
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		             	</select>
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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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					<label for="remark"> Remark</label>
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					<label for="remark"> Remark</label>
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						<select class="form-control input-sm" id = "remark" name = "remark" placeholder="Remark">
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						<select class="form-control input-sm" id = "remark" name = "remark" onchange="changeRemark()" placeholder="Remark">
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							<option value="" disabled selected>Remark</option>
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							<option value="" disabled selected>Remark</option>
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		             		<option value="done">Done</option>
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		             		<option value="done">Done</option>
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		             		<option value="Not Reachable">Not Reachable</option>
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		             		<option value="Not Reachable">Not Reachable</option>
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		             		<option value="Out of Service">Out of Service</option>
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		             		<option value="Out of Service">Out of Service</option>
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		             		<option value="Ringing">Ringing</option>
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		             		<option value="Ringing">Ringing</option>
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		             		<option value="disconnected">Disconnected</option>
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		             		<option value="disconnected">Disconnected</option>
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		             		<option value="Duplicate number">Duplicate number</option>
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		             		<option value="Duplicate number">Duplicate number</option>
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		             		<option value="Wrong number">Wrong number</option>
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		             		<option value="Wrong number">Wrong number</option>
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		             		<option value="Partner number">Partner number</option>
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		             		<option value="Partner number">Partner number</option>
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		             		<option value="Misbehaved">Misbehaved</option>
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		             		<option value="Misbehaved">Misbehaved</option>
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		             		<option value="No Incoming Call"> No Incoming Call</option>
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		             		<option value="other">Other</option>
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		             	</select>
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		             	</select>
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		             	<br>
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		             	 	<input placeholder="Remark" id="textRemark" name="textRemark" type="text" value="" class="form-control input-sm">
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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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					<label for="hygieneRating"> Hygiene Rating</label>
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					<label for="hygieneRating"> Hygiene Rating</label>