@extends('admin.layout.index')

@section('content')



<div class="row">
    <div class="col-md-12">
        <div class="card">
            <div class="card-header">
                <h4 class="card-title">Add Patient</h4>
            </div>
            @if ($errors->any())
            <div class="alert alert-danger">
                <ul>
                    @foreach ($errors->all() as $error)
                        <li>{{ $error }}</li>
                    @endforeach
                </ul>
            </div>
        @endif
            <div class="card-body">
                <h4 class="card-title">Personal Information</h4>
                <form method="POST" action="{{route('patient.store')}}" class="form">
                @csrf                    
                <div class="row">
                        <div class="col-xl-6">
                            <div class="form-group row">
                                <label class="col-lg-3 col-form-label">Full Name</label>
                                <div class="col-lg-9">
                                    <input type="text" class="form-control" name = 'name'>
                                </div>
                            </div>
                          <div class="form-group row">
                                <label class="col-lg-3 col-form-label">Role</label>
                                <div class="col-lg-9">
                                <select name="type" id="">
                                    <option value="">Select Role</option>
                                    @foreach ($roles ?? '' as $role)   
                                    <option value="{{$role->id}}">{{$role->name}}</option>
                                    @endforeach
                                </select>

                            </div>
                            </div> 
                            <div class="form-group row">
                                <label class="col-lg-3 col-form-label">Gender</label>
                                <div class="col-lg-9">
                                    <div class="form-check form-check-inline">
                                        <input class="form-check-input" type="radio" name="gender" id="gender_male" value="Male" checked>
                                        <label class="form-check-label" for="gender_male">
                                        Male
                                        </label>
                                    </div>
                                    <div class="form-check form-check-inline">
                                        <input class="form-check-input" type="radio" name="gender" id="gender_female" value="Female">
                                        <label class="form-check-label" for="gender_female">
                                        Female
                                        </label>
                                    </div>
                                </div>
                            </div>
                            <div class="form-group row">
                                <label class="col-lg-3 col-form-label">Date of Birth</label>
                                <div class="col-lg-9">
                                    <input type="date" class="form-control" name='dob'>
                                </div>
                            </div>
                            <!-- <div class="form-group row">
                                <label class="col-lg-3 col-form-label">Gender</label>
                                <div class="col-lg-9">
                                    <div class="form-check form-check-inline">
                                        <input class="form-check-input" type="radio" name="gender" id="gender_male" value="option1" checked>
                                        <label class="form-check-label" for="gender_male">
                                        Male
                                        </label>
                                    </div>
                                    <div class="form-check form-check-inline">
                                        <input class="form-check-input" type="radio" name="gender" id="gender_female" value="option2">
                                        <label class="form-check-label" for="gender_female">
                                        Female
                                        </label>
                                    </div>
                                </div>
                            </div> -->
                            
                        </div>
                        <div class="col-xl-6">
                            <!-- <div class="form-group row">
                                <label class="col-lg-3 col-form-label">Username</label>
                                <div class="col-lg-9">
                                    <input type="text" class="form-control" name = 'username'>
                                </div>
                            </div> -->
                            <div class="form-group row">
                                <label class="col-lg-3 col-form-label">Email</label>
                                <div class="col-lg-9">
                                    <input type="text" class="form-control" name = 'email'>
                                </div>
                            </div>
                            <div class="form-group row">
                                <label class="col-lg-3 col-form-label">Password</label>
                                <div class="col-lg-9">
                                    <input type="password" class="form-control" name = 'password'>
                                </div>
                            </div>
                            <div class="form-group row">
                                <label class="col-lg-3 col-form-label">Repeat Password</label>
                                <div class="col-lg-9">
                                    <input type="password" class="form-control" name='repeat_password'>
                                </div>
                            </div>
                        </div>
                    </div>
                    <!-- <div class="col-xl-6">
                            <div class="form-group row">
                                <label class="col-lg-3 col-form-label">Region / Location</label>
                                <select class="col-lg-3 custom-select" name="digital_address" id="status-select">
                                    {{-- @foreach ($postRegion ?? '' as $region)
                                    @if ($town->region_id == $region->id)

                                    <option value="{{$region->id}}">{{$region->name}}</option>
                                    @endif
                                    @endforeach --}}

                                    <option value="">Select Region</option>
                                    @if ($postRegion->isNotEmpty())
                        @foreach ($postRegion as $region)
                            <option value="{{$region->id}}">{{$region->name}}</option>
                        @endforeach
                    @endif
                                </select>
                                <div class="col-lg-6">
                                    <select class="form-control" name="town_id" id="town" required>
                                        <option value="">Select Town</option>
                                    </select>
                                </div>
                            </div> -->
                            <div class="form-group row">
                                <label class="col-lg-3 col-form-label">Phone Number</label>
                                <div class="col-lg-9">
                                    <input type="text" class="form-control" name='contact_person'>
                                </div>
                            </div>
                     <div class="form-group row">
                                <label class="col-lg-3 col-form-label">Location</label>
                                <div class="col-lg-9">
                                    <input type="text" class="form-control" name='location'>
                                </div>
                            </div> 
                        </div>
                    </div>
                    <!-- <h4 class="card-title">Address</h4>
                    <div class="row">
                        <div class="col-xl-6">
                            <div class="form-group row">
                                <label class="col-lg-3 col-form-label">Address Line 1</label>
                                <div class="col-lg-9">
                                    <input type="text" class="form-control">
                                </div>
                            </div>
                            <div class="form-group row">
                                <label class="col-lg-3 col-form-label">Address Line 2</label>
                                <div class="col-lg-9">
                                    <input type="text" class="form-control">
                                </div>
                            </div>
                            <div class="form-group row">
                                <label class="col-lg-3 col-form-label">State</label>
                                <div class="col-lg-9">
                                    <input type="text" class="form-control">
                                </div>
                            </div>
                        </div>
                        <div class="col-xl-6">
                            <div class="form-group row">
                                <label class="col-lg-3 col-form-label">City</label>
                                <div class="col-lg-9">
                                    <input type="text" class="form-control">
                                </div>
                            </div>
                            <div class="form-group row">
                                <label class="col-lg-3 col-form-label">Country</label>
                                <div class="col-lg-9">
                                    <input type="text" class="form-control">
                                </div>
                            </div>
                            <div class="form-group row">
                                <label class="col-lg-3 col-form-label">Postal Code</label>
                                <div class="col-lg-9">
                                    <input type="text" class="form-control">
                                </div>
                            </div>
                        </div> -->
                    </div>
                    <div class="text-right">
                        <button type="submit" class="btn btn-primary">Submit</button>
                    </div>
                </form>
            </div>
        </div>
    </div>
</div>

						</div>
					</div>
                    <script>
     $(document).ready(function(){
        $('select[name="region"]').on('change',function(){
            let regID=$(this).val();

            if(regID){
                $.ajax({
                    url:'/location/'+regID,
                    type:'GET',
                    dataType:'JSON',
                    success:function(data){
                        $('select[name="town"]').empty();
                        let items = '<option value="">Select Town </option>';
                        for (var i = 0; i < data.length; i++) {
                        items += "<option value='" + data[i].name + "'>" + data[i].name + "</option>";
                        }
                        $('#town').empty().append(items);
                        }
                });

                  $.ajax({
                    url:'/region/getRegionDetails/'+regID,
                    type:'GET',
                    dataType:'JSON',
                    success:function(data){
                         $('#RegionCode').val(data[0].code);
                    }
                });
            }
        });
    });
</script>
@endsection

					</div>
				
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