@extends('admin.layouts.app')

@section('content')
    <section id="number-tabs">
        <div class="row">
            <div class="col-12">
                <div class="card">
                    <div class="card-header">
                        <h4 class="card-title">{!! $form['heading'] !!}</h4>
                    </div>
                    <div class="card-content">
                        <div class="card-body">
                            <form method="POST" action="{!! $form['action'] !!}" class="number-tab-steps wizard-circle"
                                enctype="multipart/form-data">
                                <input type="hidden" name="id" value="{{ $data->id }}">
                                @csrf
                                <input type="hidden" name="_method" value="{!! $form['method'] !!}">
                                <div class="row">

                                    <div class="col-md-4">
                                        <div class="form-group">
                                            <label for="name">Name <span class="text-danger">*</span> </label>
                                            <input type="text" id="name" name="name"
                                                value="{{ old('name', $data->name) }}" class="form-control" required>
                                        </div>
                                    </div>

                                    <div class="col-md-4">
                                        <div class="form-group">
                                            <label for="size">Size <span class="text-danger">*</span> </label>
                                            <input type="text" id="size" name="size"
                                                value="{{ old('size', $data->size) }}" class="form-control" required>
                                        </div>
                                    </div>

                                    <div class="col-md-4">
                                        <div class="form-group">
                                            <label for="type">Type <span class="text-danger">*</span> </label>
                                            <select name="type" id="type" class="form-control" required>
                                                <option value="" disabled selected>Select Type</option>
                                                @forelse ($data->types() as $key => $type)
                                                    <option value="{{ $key }}" {!! matchSelected($key, old('type', $data->type_id) ?? '') !!}>
                                                        {{ $type }}</option>
                                                @empty
                                                    <option value="" disabled>No Record Found</option>
                                                @endforelse
                                            </select>
                                        </div>
                                    </div>

                                    <div class="col-md-4">
                                        <div class="form-group">
                                            <label for="emr">EMR <span class="text-danger">*</span> </label>
                                            <select name="emr" id="emr" class="form-control" required>
                                                <option value="" disabled selected>Select EMR</option>
                                                @forelse ($data->emr() as $key => $emr)
                                                    <option value="{{ $key }}" {!! matchSelected($key, old('emr', $data->emr_id) ?? '') !!}>
                                                        {{ $emr }}</option>
                                                @empty
                                                    <option value="" disabled>No Record Found</option>
                                                @endforelse
                                            </select>
                                        </div>
                                    </div>

                                    <div class="col-md-4">
                                        <div class="form-group">
                                            <label for="longitude">Longitude <span class="text-danger">*</span> </label>
                                            <input type="text" id="longitude" name="longitude"
                                                value="{{ old('longitude', $data->longitude) }}" class="form-control"
                                                required>
                                        </div>
                                    </div>

                                    <div class="col-md-4">
                                        <div class="form-group">
                                            <label for="latitude">Latitude <span class="text-danger">*</span> </label>
                                            <input type="text" id="latitude" name="latitude"
                                                value="{{ old('latitude', $data->latitude) }}" class="form-control"
                                                required>
                                        </div>
                                    </div>

                                    <div class="col-md-4">
                                        <div class="form-group">
                                            <label for="image">Image <span class="text-danger">*</span> </label>
                                            <input type="file" id="image" name="image"
                                                value="{{ old('document', $data->document) }}" class="form-control">
                                        </div>
                                    </div>

                                    @if (filled($data->userdocument->first()))
                                    <div class="col-md-4">
                                        <img src="{{$data->userdocument->first()->document_url}}" alt="" class="img-fluid">
                                    </div>
                                    @endif

                                    <div class="col-sm-12">
                                        <div class="form-group">
                                            <label for="address">Address <span class="text-danger">*</span> </label>
                                            <input type="text" id="address" name="address"
                                                value="{{ old('address', $data->address) }}" class="form-control" required>
                                        </div>
                                    </div>

                                    <div class="col-sm-12">
                                        <div class="form-group">
                                            <label for="description">Description <span class="text-danger">*</span> </label>
                                            <textarea type="text" name="description" maxlength="190" class="form-control" required>{{ old('description', $data->description) }}</textarea>
                                        </div>
                                    </div>

                                    <div class="col-md-12 text-right">
                                        <button type="submit"
                                            class="btn btn-primary mr-1 mb-1 waves-effect waves-light">Save Changes</button>
                                        <a href="{!! $form['cancel_url'] !!}"
                                            class="btn btn-danger mr-1 mb-1 waves-effect waves-light"
                                            style="color: white">Cancel</a>
                                    </div>

                                </div>
                            </form>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </section>
@endsection
@section('footer-js')
    <script>
        $(document).ready(function() {});
    </script>
@endsection