@extends('admin.main')
@section('content')
            <div class="row">
                <div class="col-md-12">
                    <div class="card">
                        <div class="card-header">
                          <h4 class="">Patient / Edit<a href="{{ route('patient.index') }}" class="btn btn-primary float-right">Back</a></h4>
                        </div>
                        <div class="card-body">                           
                           <form method="POST" action="{{ route('patient.update', $patient->id) }}" enctype="multipart/form-data">
                               @csrf
                               @method('PUT')
                               <div class="border p-3 mb-3 mt-3">
                                  <div class="row">
                                         <div class="col-md-10">
                                            <div class="row">
                                                <div class="form-group col-md-6">
                                                    <label for="name">Patient Name <span class="text-danger">*</span></label>
                                                    <div class="input-group mb-2">
                                                        <div class="input-group-prepend">
                                                            <button class="btn btn-outline-secondary dropdown-toggle title_btn" type="button" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false"><strong>{{ $patient->title ?? "Mr"}}</strong></button>
                                                            <div class="title_dropdown dropdown-menu name_prefix_dropdown">
                                                                @foreach(config('constants.user_prefix') as $u_prefix)
                                                                  <a class="dropdown-item" href="javascript:void(0);" data-value="{{$u_prefix}}">{{ucfirst( $u_prefix)}}</a>
                                                                @endforeach
                                                            </div>
                                                            <input type="hidden" class="form-control" id="title" name="title" value="{{ old('title', $patient->title ?$patient->title: 'Mr') }}" required>
                                                            <!-- <div class="input-group-text text-dark"><strong>Mr</strong></div> -->
                                                        </div>
                                                        <input type="text" class="form-control" id="name" name="name" value="{{ old('name', $patient->name) }}" required>
                                                    </div>
                                                    @error('name')
                                                    <p class="errors-msg text-danger">{{ $message }}</p>
                                                    @enderror
                                                </div>
                                                <div class="form-group col-md-6">
                                                    <label for="phone">Phone <span class="text-danger">*</span></label>
                                                    <input type="text" class="form-control integer_only" id="phone" name="phone" 
                                                        value="{{ old('phone', $patient->phone) }}" required>
                                                    @error('phone')
                                                    <p class="errors-msg text-danger">{{ $message }}</p>
                                                    @enderror
                                                </div>
                                                <div class="form-group col-md-2">
                                                    <label for="gender">Gender <span class="text-danger">*</span></label>
                                                    <div class="btn-group btn-group-toggle d-block" data-toggle="buttons">
                                                        <label class="btn btn-outline-primary mb-1 {{$patient->gender == 'M' ? 'active' : ''}}">
                                                            <input type="radio" id="edit_gender_M" name="gender" value="M" autocomplete="off"
                                                                {{ old('gender', $patient->gender) == 'M' ? 'checked' : '' }}> M
                                                        </label>
                                                        <label class="btn btn-outline-primary ml-2 mb-1 {{$patient->gender == 'F' ? 'active' : ''}}">
                                                            <input type="radio" id="edit_gender_F" name="gender" value="F" autocomplete="off"
                                                                {{ old('gender', $patient->gender) == 'F' ? 'checked' : '' }}> F
                                                        </label>
                                                        <label class="btn btn-outline-primary ml-2 mb-1 {{$patient->gender == 'Other' ? 'active' : ''}}">
                                                            <input type="radio" id="edit_gender_Other" name="gender" value="Other" autocomplete="off"
                                                                {{ old('gender', $patient->gender) == 'Other' ? 'checked' : '' }}> Other
                                                        </label>
                                                    </div>
                                                    @error('gender')
                                                    <p class="errors-msg text-danger">{{ $message }}</p>
                                                    @enderror
                                                </div>
                                                <div class="form-group col-md-5">
                                                    <label for="dob_or_age">DOB</label>
                                                    <input type="date" class="form-control" id="dob_or_age" name="dob_or_age" value="{{ old('dob_or_age', $patient->dob_or_age) }}">
                                                    @error('dob_or_age')
                                                    <p class="errors-msg text-danger">{{ $message }}</p>
                                                    @enderror
                                                </div>
                                                <div class="form-group col-md-1">
                                                     <label for="age">Age</label>
                                                      <input type="number" class="form-control" id="age" name="age" value="{{ old('age', $patient->age) }}" min="1" placeholder="Enter Age">
                                                        @error('age')
                                                             <p class="errors-msg text-danger">{{ $message }}</p>
                                                        @enderror
                                                </div>
                                                <div class="form-group col-md-4">
                                                    <label for="preferred_language">Preferred Language</label>
                                                    <select class="form-control" id="preferred_language" name="preferred_language">
                                                        <option value="">Select Language</option>
                                                        <option value="English" {{ old('preferred_language', $patient->preferred_language) == 'English' ? 'selected' : '' }}>English</option>
                                                        <option value="Spanish" {{ old('preferred_language', $patient->preferred_language) == 'Spanish' ? 'selected' : '' }}>Spanish</option>
                                                        <option value="French" {{ old('preferred_language', $patient->preferred_language) == 'French' ? 'selected' : '' }}>French</option>
                                                        <option value="Hindi" {{ old('preferred_language', $patient->preferred_language) == 'Hindi' ? 'selected' : '' }}>Hindi</option>
                                                    </select>
                                                    @error('preferred_language')
                                                    <p class="errors-msg text-danger">{{ $message }}</p>
                                                    @enderror
                                                </div>
                                            </div>
                                        </div>
                                      <div class="col-md-2">
                                            <label for="profile_image">Profile Image</label>
                                            <div class="mb-2">
                                                <img src="{{ $patient->profile_image ? asset('profile_images/'.$patient->profile_image) : asset('/img/upload.png') }}" 
                                                    id="imagePreview" class="img-fluid border w-25 p-1" alt="Profile Image">
                                            </div>
                                            <input type="file" class="form-control-file" id="profile_image" name="profile_image" accept="image/*" onchange="previewImage(event)">
                                            @error('profile_image')
                                            <p class="errors-msg text-danger">{{ $message }}</p>
                                            @enderror
                                        </div>
                                     <div class="col-md-12">
                                        <div class="row">
                                           <div class="col-md-6">
                                              <div class="form-group mt-2">
                                                 <label for="pin">Pin</label>
                                                 <input type="text" class="form-control integer_only" id="pin" name="pin" placeholder="Enter Pin" maxlength="6" value="{{ old('pin', $patient->pin)}}">
                                                 @error('pin')
                                                   <p class="errors-msg text-danger">{{ $message }}</p>
                                                 @enderror
                                              </div>
                                              <div class="form-group">
                                                 <label for="city">City <span class="text-danger">*</span></label>
                                                 <input type="text" class="form-control" id="city" name="city" placeholder="Enter City" value="{{ old('city', $patient->city)}}" required>
                                                 @error('city')
                                                   <p class="errors-msg text-danger">{{ $message }}</p>
                                                 @enderror
                                              </div>
                                           </div>
                                           <div class="col-md-6">
                                              <div class="form-group">
                                                 <label for="address">Address <span class="text-danger">*</span></label>
                                                 <textarea required class="form-control" id="address" name="address" rows="5" placeholder="Enter Address">{{ old('address', $patient->address)}}</textarea>
                                                 @error('address')
                                                   <p class="errors-msg text-danger">{{ $message }}</p>
                                                 @enderror
                                              </div>
                                           </div>
                                        </div>
                                     </div>
                                  </div>
                               </div>
                               <div class="row">
                                  <div class="col-md-12">
                                     <div class="border p-3 mb-3 mt-3">
                                        <h4 class="mt-3 mb-3 text-secondary">Marital Status</h4>
                                        <div class="row">
                                           <div class="form-group col-md-6">
                                              <label for="marital_status" class="d-block">Marital Status</label>
                                              <select class="form-control d-inline" id="marital_status" name="marital_status" style="width: 74%;">
                                                 <option value="" selected disabled hidden>Select Marital Status</option>
                                                  <option value="single" {{ old('marital_status', $patient->marital_status) == 'single' ? 'selected' : '' }}>Single</option>
                                                 <option value="married" {{ old('marital_status', $patient->marital_status) == 'married' ? 'selected' : '' }}>Married</option>
                                                 <option value="divorced" {{ old('marital_status', $patient->marital_status) == 'divorced' ? 'selected' : '' }}>Divorced</option>
                                                 <option value="widowed" {{ old('marital_status', $patient->marital_status) == 'widowed' ? 'selected' : '' }}>Widowed</option>
                                              </select>
                                              <input type="date" class="form-control w-25 d-inline" id="marital_status_since" name="marital_status_since" placeholder="Enter date" value="{{ old('marital_status_since', $patient->marital_status)}}">
                                               @error('marital_status')
                                                   <p class="errors-msg text-danger">{{ $message }}</p>
                                                 @enderror
                                             @error('marital_status_since')
                                               <p class="errors-msg text-danger">{{ $message }}</p>
                                             @enderror
                                           </div>
                                           <div class="form-group col-md-6">
                                              <label for="blood_group" class="d-block">Blood Group</label>
                                              <select class="form-control" id="blood_group" name="blood_group">
                                                 <option value="" selected disabled hidden>Select Blood Group</option>
                                                 <option value="A+" {{ old('blood_group', $patient->blood_group) == 'A+' ? 'selected' : '' }}>A+</option>
                                                 <option value="A-" {{ old('blood_group', $patient->blood_group) == 'A-' ? 'selected' : '' }}>A-</option>
                                                 <option value="B+" {{ old('blood_group', $patient->blood_group) == 'B+' ? 'selected' : '' }}>B+</option>
                                                 <option value="B-" {{ old('blood_group', $patient->blood_group) == 'B-' ? 'selected' : '' }}>B-</option>
                                                 <option value="O+" {{ old('blood_group', $patient->blood_group) == 'O+' ? 'selected' : '' }}>O+</option>
                                                 <option value="O-" {{ old('blood_group', $patient->blood_group) == 'O-' ? 'selected' : '' }}>O-</option>
                                                 <option value="AB+" {{ old('blood_group') == 'AB+' ? 'selected' : '' }}>AB+</option>
                                                 <option value="AB-" {{ old('blood_group') == 'AB-' ? 'selected' : '' }}>AB-</option>
                                          </select>
                                               @error('blood_group')
                                               <p class="errors-msg text-danger">{{ $message }}</p>
                                             @enderror
                                           </div>
                                           <div class="form-group col-md-6">
                                              <label for="spouse_name">Spouse Name</label>
                                              <input type="text" class="form-control" id="spouse_name" name="spouse_name" placeholder="Enter Spouse Name" value="{{old('spouse_name', $patient->spouse_name)}}">
                                               @error('spouse_name')
                                               <p class="errors-msg text-danger">{{ $message }}</p>
                                             @enderror
                                           </div>
                                           <div class="form-group col-md-6">
                                              <label for="spouse_blood_group" class="d-block">Spouse Blood Group</label>
                                              <select class="form-control" id="spouse_blood_group" name="spouse_blood_group">
                                                  <option value="" selected disabled hidden>Select Blood Group</option>
                                                  <option value="A+" {{ old('spouse_blood_group', $patient->spouse_blood_group) == 'A+' ? 'selected' : '' }}>A+</option>
                                                  <option value="A-" {{ old('spouse_blood_group', $patient->spouse_blood_group) == 'A-' ? 'selected' : '' }}>A-</option>
                                                  <option value="B+" {{ old('spouse_blood_group', $patient->spouse_blood_group) == 'B+' ? 'selected' : '' }}>B+</option>
                                                  <option value="B-" {{ old('spouse_blood_group', $patient->spouse_blood_group) == 'B-' ? 'selected' : '' }}>B-</option>
                                                  <option value="O+" {{ old('spouse_blood_group', $patient->spouse_blood_group) == 'O+' ? 'selected' : '' }}>O+</option>
                                                  <option value="O-" {{ old('spouse_blood_group', $patient->spouse_blood_group) == 'O-' ? 'selected' : '' }}>O-</option>
                                                  <option value="AB+" {{ old('spouse_blood_group', $patient->spouse_blood_group) == 'AB+' ? 'selected' : '' }}>AB+</option>
                                                  <option value="AB-" {{ old('spouse_blood_group', $patient->spouse_blood_group) == 'AB-' ? 'selected' : '' }}>AB-</option>
                                            </select>
                                                @error('spouse_blood_group')
                                                   <p class="errors-msg text-danger">{{ $message }}</p>
                                                 @enderror
                                           </div>
                                        </div>
                                     </div>
                                     <div class="border p-3 mt-2">
                                        <h4 class="mt-3 mb-3 text-secondary">Other Details</h4>
                                        <div class="row">
                                           <div class="form-group col-md-4">
                                              <label for="existing_id">Existing ID (if any)</label>
                                              <input type="text" class="form-control" id="existing_id" name="existing_id" placeholder="Enter Existing ID"  value="{{old('existing_id', ($patient->existing_id || $patient->existing_id != '') ?$patient->existing_id: $patient->id)}}">
                                               @error('id')
                                                   <p class="errors-msg text-danger">{{ $message }}</p>
                                               @enderror
                                           </div>
                                            <div class="col-md-4">
                                              <div class="form-group">
                                                    <label for="p_category_id">Patient Category</label>
                                                    <select class="form-control" id="p_category_id"  name="p_category_id">
                                                       <option value="" selected disabled hidden>Select Category</option>
                                                       @foreach($p_category as $category)
                                                           <option style="color: {{$category->color_code}}" value="{{$category->id}}" {{ old('p_category_id', $patient->p_category_id) == $category->id ? 'selected' : '' }}>{{$category->name}}</option>
                                                       @endforeach
                                                    </select>
                                                    @error('p_category_id')
                                                      <p class="errors-msg text-danger">{{ $message }}</p>
                                                    @enderror
                                              </div>
                                           </div>
                                           <div class="form-group col-md-4">
                                              <label for="spouse_name">Status</label>
                                                <select class="form-control" id="status"  name="status">
                                                   <option value="active" {{ old('status', $patient->status) == 'active' ? 'selected' : '' }}>Active</option>
                                                   <option value="inactive" {{ old('status', $patient->status) == 'inactive' ? 'selected' : '' }}>Inactive</option>
                                               </select>
                                               @error('status')
                                                   <p class="errors-msg text-danger">{{ $message }}</p>
                                               @enderror
                                           </div>
                                           <div class="form-group col-md-6">
                                              <label for="referred_by">Referred By</label>
                                              <div class="input-group mb-2">
                                                 <div class="input-group-prepend">
                                                    <div class="input-group-text">Dr.</div>
                                                 </div>
                                                 <input type="text" class="form-control" id="referred_by" name="referred_by" placeholder="Enter Referred" value="{{old('referred_by')}}">
                                                 <select class="form-control" id="specialty"  name="specialty_id">
                                                    <option value="" selected disabled hidden>Speciality</option>
                                                    @foreach($specialty as $s)
                                                        <option value="{{ $s->id }}" 
                                                            {{ old('specialty', $patient->specialty_id) == $s->id ? 'selected' : '' }}>
                                                            {{ $s->name }}
                                                        </option>
                                                    @endforeach

                                                 </select>
                                                 @error('referred_by')
                                                   <p class="errors-msg text-danger">{{ $message }}</p>
                                               @enderror
                                               @error('specialty')
                                                   <p class="errors-msg text-danger">{{ $message }}</p>
                                               @enderror
                                              </div>
                                           </div>
                                           <div class="form-group col-md-6">
                                              <label for="email">Email</label>
                                              <div class="input-group mb-2">
                                                 <div class="input-group-prepend">
                                                    <div class="input-group-text">
                                                       <i class="i-Email"></i>
                                                    </div>
                                                 </div>
                                                 <input type="text" class="form-control" id="email" name="email" placeholder="Enter Email" value="{{old('email', $patient->email)}}">
                                                  @error('email')
                                                   <p class="errors-msg text-danger">{{ $message }}</p>
                                                  @enderror
                                              </div>
                                           </div>
                                           <div class="form-group col-md-6">
                                              <label for="channel">Channel (How did the patient hear about you?)</label>
                                              <input type="text" class="form-control" id="channel" name="channel" placeholder="Enter how the patient heard about you" value="{{old('channel', $patient->channel)}}">
                                               @error('channel')
                                                   <p class="errors-msg text-danger">{{ $message }}</p>
                                               @enderror
                                           </div>
                                           <div class="form-group col-md-6">
                                              <label for="co">C/O</label>
                                              <input type="text" class="form-control" id="co" name="co" placeholder="Enter C/O" value="{{old('co', $patient->co)}}">
                                               @error('co')
                                                   <p class="errors-msg text-danger">{{ $message }}</p>
                                               @enderror
                                           </div>
                                           <div class="form-group col-md-6">
                                              <label for="occupation">Occupation</label>
                                              <input type="text" class="form-control" id="occupation" name="occupation" placeholder="Enter Occupation" value="{{old('occupation', $patient->occupation)}}">
                                              @error('occupation')
                                                   <p class="errors-msg text-danger">{{ $message }}</p>
                                               @enderror
                                           </div>
                                           <div class="form-group col-md-6">
                                              <label for="tag">Tag</label>
                                              <input type="text" class="form-control" id="tag" name="tag" placeholder="Enter Tag" value="{{old('tag', $patient->tag)}}">
                                              @error('tag')
                                                   <p class="errors-msg text-danger">{{ $message }}</p>
                                               @enderror
                                           </div>
                                           <div class="form-group col-md-6">
                                              <label for="mobile_2">Mobile 2</label>
                                              <input type="text" class="form-control integer_only" id="mobile_2" name="mobile_2" placeholder="Enter Secondary Number" value="{{old('mobile_2', $patient->mobile_2)}}">
                                               @error('mobile_2')
                                                   <p class="errors-msg text-danger">{{ $message }}</p>
                                               @enderror
                                           </div>
                                           <div class="form-group col-md-6">
                                              <label for="aadhar_number">Aadhar Number</label>
                                              <input type="text" class="form-control integer_only_aadhar_num" id="aadhar_number" name="aadhar_number" placeholder="Enter Aadhar Number" value="{{old('aadhar_number',$patient->aadhar_number)}}">
                                               @error('aadhar_number')
                                                   <p class="errors-msg text-danger">{{ $message }}</p>
                                               @enderror
                                           </div>
                                        </div>
                                     </div>
                                  </div>
                               </div>
                               <button type="submit" class="btn btn-primary mt-3">Update</button>
                            </form>
                        </div>
                    </div>
                </div>
            </div>
        </div>
<script>
    $(document).ready(function () {
        $('.name_prefix_dropdown a').on("click",function(){ 
         var user_title = $(this).attr("data-value"); 
         var namePrefix = "edit_";
         $("."+namePrefix+"prefix_btn strong").html($(this).html());
         $("#"+namePrefix+"name_prefix").val(user_title);
         $('.btn-group-toggle label').removeClass('active');
         $('.btn-group-toggle label input').prop('checked', false);
         if(user_title == 'mr'){
            $("#" + namePrefix + "gender_M").prop('checked', true);
            $("#" + namePrefix + "gender_M").parent().addClass('active');
         }else if(user_title == 'mrs' || user_title == 'miss'){
            $("#" + namePrefix + "gender_F").prop('checked', true);
            $("#"+namePrefix+"gender_F").parent().addClass('active');
         }else{
            $('.btn-group-toggle label input').prop('checked', false);
            $('.btn-group-toggle label').removeClass('active');
         }

     });



        $('.title_dropdown a').on("click",function(){
            var user_title = $(this).attr("data-value");
            $(".title_btn strong").html(user_title);
            $("#title").val(user_title);
        });

         $('#dob_or_age').on('change', function() {
            var dob = $(this).val();
            if(dob) {
                var birthDate = new Date(dob);
                var currentDate = new Date();
                var age = currentDate.getFullYear() - birthDate.getFullYear();
                var monthDifference = currentDate.getMonth() - birthDate.getMonth();
                
                if (monthDifference < 0 || (monthDifference === 0 && currentDate.getDate() < birthDate.getDate())) {
                    age--;
                }
                
                $('#age').val(age);
            } else {
                $('#age').val('');
            }
        });
    });
</script>
@endsection