@extends('layouts.app')

@section('title')
    Add Patient
@endsection

@section('vendor_css')
    <link rel="stylesheet" type="text/css" href="{{ URL('/temp_dashboard/app-assets/vendors/css/forms/selects/select2.min.css') }}">

    <link rel="stylesheet" type="text/css" href="{{ URL('/temp_dashboard/app-assets/vendors/css/pickers/daterange/daterangepicker.css') }}">
    <link rel="stylesheet" type="text/css" href="{{ URL('/temp_dashboard/app-assets/vendors/css/pickers/datetime/bootstrap-datetimepicker.css') }}">
    <link rel="stylesheet" type="text/css" href="{{ URL('/temp_dashboard/app-assets/vendors/css/pickers/pickadate/pickadate.css') }}">
@endsection

@section('page_level_css')
    <link rel="stylesheet" type="text/css" href="{{ URL('/temp_dashboard/app-assets/css-rtl/core/menu/menu-types/vertical-menu.css') }}">
    <link rel="stylesheet" type="text/css" href="{{ URL('/temp_dashboard/app-assets/css-rtl/core/menu/menu-types/vertical-overlay-menu.css') }}"> 
    <link rel="stylesheet" type="text/css" href="{{ URL('/temp_dashboard/app-assets/css-rtl/plugins/pickers/daterange/daterange.css') }}">
@endsection

@section('custom_css')
    <link rel="stylesheet" type="text/css" href="{{ URL('/temp_dashboard/app-assets/vendors/css/forms/selects/select2.rtl.css') }}">
@endsection

@section('content') 
<section>
    <div class="row">
        <div class="col-md-12">
            <div class="card"> 
                <div class="card-body">
                    <div class="card-header">
                        <a class="heading-elements-toggle"><i class="fa fa-ellipsis-v font-medium-3"></i></a>
                        <div class="heading-elements">
                            <ul class="list-inline mb-0">
                                <li><a data-action="collapse"><i class="ft-minus"></i></a></li>
                                <li><a data-action="reload"><i class="ft-rotate-cw"></i></a></li>
                                <li><a data-action="expand"><i class="ft-maximize"></i></a></li>
                                <li><a data-action="close"><i class="ft-x"></i></a></li>
                            </ul> 
                        </div>
                    </div>
                    <form class="form-horizontal" method="POST" action="{{ route('store-patient') }}">
                        <div class="card-block">
                            <div class="row">
                                <div class="col-xl-4 col-lg-6 col-md-12 mb-1">
                                    <fieldset class="form-group form-group{{ $errors->has('name') ? ' has-error' : '' }}">
                                        <label for="name">Full Name</label>
                                        <input type="text" class="form-control" id="name" name="name" required autofocus>
                                    </fieldset>
                                </div>

                                <div class="col-xl-4 col-lg-6 col-md-12 mb-1">
                                    <fieldset class="form-group form-group{{ $errors->has('phone') ? ' has-error' : '' }}">
                                        <label for="phone">Phone</label>
                                        <input type="text" class="form-control" id="phone" name="phone" >
                                    </fieldset>
                                </div>
                            </div>

                            <div class="row">
                                <div class="col-xl-4 col-lg-6 col-md-12 mb-1">
                                    <fieldset class="form-group form-group{{ $errors->has('gender') ? ' has-error' : '' }}">
                                        <label for="gender">Gander</label>
                                        <select name="gender" id='gender' class="select2 form-control" required >
                                                <option value="1">Male</option>
                                                <option value="2">Female</option>
                                        </select>
                                    </fieldset>
                                </div>

                                <div class="col-xl-4 col-lg-6 col-md-12 mb-1">
                                    <fieldset class="form-group form-group{{ $errors->has('email') ? ' has-error' : '' }}">
                                        <label for="email">Email</label>
                                        <input type="email" class="form-control" id="email" name="email"  >
                                    </fieldset>
                                </div>
                            </div>

                            <div class="row">
                                <div class="col-xl-4 col-lg-6 col-md-12 mb-1">
                                    <fieldset class="form-group form-group{{ $errors->has('city_id') ? ' has-error' : '' }}">
                                        <label for="gander">City</label>
                                        <select name="city_id" id='city_id' class="select2 form-control" required >
                                            @foreach($cities as $city)
                                                <option value="{{$city->id}}">{{$city->name}}</option>
                                            @endforeach
                                        </select>
                                    </fieldset>
                                </div>
                                <div class="col-xl-4 col-lg-6 col-md-12 mb-1">
                                    <fieldset class="form-group form-group{{ $errors->has('national_id') ? ' has-error' : '' }}">
                                        <label for="national_id">National ID</label>
                                        <input type="text" class="form-control" id="national_id" name="national_id" required >
                                    </fieldset>
                                </div>
                            </div>  

                            <div class="row">
                                <div class="col-xl-4 col-lg-6 col-md-12 mb-1">
                                    <fieldset class="form-group form-group{{ $errors->has('brith') ? ' has-error' : '' }}">
                                        <label for="brith">Brith Date</label> 
                                        <input type='text' id='brith' name='brith' class="form-control pickadate-dropdown" />
                                    </fieldset>
                                </div> 
                            </div>
                            <div class="row">
                                <div class="col-xl-4 col-lg-6 col-md-12 mb-1">
                                    <fieldset class="form-group form-group{{ $errors->has('address') ? ' has-error' : '' }}">
                                        <label for="address">Address</label>
                                        <textarea  class="form-control" id="address" name="address"></textarea>
                                         
                                    </fieldset>
                                </div>
                            </div> 

                            <div class="row">
                                <div class="col-xl-4 col-lg-6 col-md-12 mb-1"> <button type="submit" class="btn btn-primary">Add <i class="ft-thumbs-up position-right"></i></button>
                                        <button type="reset" class="btn btn-warning">Reset <i class="ft-refresh-cw position-right"></i></button>
                                    </fieldset>
                                </div>
                            </div> 

                        </div>   
                        {{ csrf_field() }}
                    </form> 
                </div>
            </div>
        </div>
    </div>
</section>
@endsection

@section('page_vendor_js')
    <script src="{{ URL('/temp_dashboard/app-assets/vendors/js/forms/select/select2.full.min.js') }} " type="text/javascript"></script>
    <script src="{{ URL('/temp_dashboard/app-assets/vendors/js/pickers/dateTime/moment-with-locales.min.js') }}" type="text/javascript"></script>
    <script src="{{ URL('/temp_dashboard/app-assets/vendors/js/pickers/dateTime/bootstrap-datetimepicker.min.js') }}" type="text/javascript"></script>
    <script src="{{ URL('/temp_dashboard/app-assets/vendors/js/pickers/pickadate/picker.js') }}" type="text/javascript"></script>
    <script src="{{ URL('/temp_dashboard/app-assets/vendors/js/pickers/pickadate/picker.date.js') }}" type="text/javascript"></script>
    <script src="{{ URL('/temp_dashboard/app-assets/vendors/js/pickers/pickadate/picker.time.js') }}" type="text/javascript"></script>
    <script src="{{ URL('/temp_dashboard/app-assets/vendors/js/pickers/pickadate/legacy.js') }}" type="text/javascript"></script>
    <script src="{{ URL('/temp_dashboard/app-assets/vendors/js/pickers/daterange/daterangepicker.js') }}" type="text/javascript"></script>
@endsection

@section('page_level_js')
    <script src="{{ URL('/temp_dashboard/app-assets/js/scripts/forms/select/form-select2.js') }}" type="text/javascript"></script>
    <script src="{{ URL('/temp_dashboard/app-assets/js/scripts/pickers/dateTime/picker-date-time.js') }}" type="text/javascript"></script>
@endsection