@extends('Admin/layout/master')
@section('title', 'Patient Add')
@section('content')
    <div class="content-wrapper">
        <div class="container-xxl flex-grow-1 container-p-y">
            <div class="row">
                <div class="col-md-12">
                    <div class="card mb-4">
                        <h5 class="card-header">Patient Add</h5>
                        {!! Form::open(['route' => 'patient.store', 'method' => 'post', 'enctype' => 'multipart/form-data']) !!}
                        <div class="card-body">
                            <div class="row">
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('first_name', 'First Name', ['class' => 'form-label']) !!}
                                        {!! Form::text('first_name', null, ['class' => 'form-control', 'placeholder' => 'Enter First Name']) !!}
                                        {!! $errors->first('first_name', '<span class="text-danger">:message</span>') !!}
                                    </div>
                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('last_name', 'Last Name', ['class' => 'form-label']) !!}
                                        {!! Form::text('last_name', null, ['class' => 'form-control', 'placeholder' => 'Enter Last Name']) !!}
                                        {!! $errors->first('last_name', '<span class="text-danger">:message</span>') !!}
                                    </div>
                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('email', 'Email', ['class' => 'form-label']) !!}
                                        {!! Form::email('email', null, ['class' => 'form-control', 'placeholder' => 'Enter Email']) !!}
                                        {!! $errors->first('email', '<span class="text-danger">:message</span>') !!}
                                    </div>
                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('date', 'Date Of Birth', ['class' => 'form-label']) !!}
                                        {!! Form::date('date_of_birth', null, ['class' => 'form-control', 'placeholder' => 'Enter Date of Birth']) !!}
                                        {!! $errors->first('date_of_birth', '<span class="text-danger">:message</span>') !!}
                                    </div>
                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('address', 'Address', ['class' => 'form-label']) !!}
                                        {!! Form::text('address', null, ['class' => 'form-control', 'placeholder' => 'Enter Address']) !!}
                                        {!! $errors->first('address', '<span class="text-danger">:message</span>') !!}
                                    </div>
                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('mobile', 'Phone', ['class' => 'form-label']) !!}
                                        {!! Form::text('phone', null, ['class' => 'form-control', 'placeholder' => 'Enter Phone No']) !!}
                                        {!! $errors->first('phone', '<span class="text-danger">:message</span>') !!}
                                    </div>
                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('gender', 'Gender', ['class' => 'form-label']) !!}
                                        {!! Form::select('gender', ['male' => 'Male', 'female' => 'Female'], null, ['class' => 'form-control ']) !!}

                                    </div>
                                </div>

                                <div class="col-6">
                                    {!! Form::label('walk', 'Patient Type', ['class' => 'form-label']) !!}
                                    <div class="d-flex align-items-center justify-content-around mt-2">
                                        <div>
                                            {!! Form::radio('patient_type', 'walk', true, ['id' => 'walk', 'class' => 'form-check-input']) !!}
                                            {!! Form::label('walk', 'Walk In', ['class' => 'form-check-label']) !!}
                                        </div>
                                        <div>
                                            {!! Form::radio('patient_type', 'physian', false, ['id' => 'physian', 'class' => 'form-check-input']) !!}
                                            {!! Form::label('physian', 'Physician Refrence', ['class' => 'form-check-label']) !!}
                                        </div>
                                    </div>
                                </div>
                                <div id="walkDiv" class="row">
                                    <hr class="mt-4">
                                    <div class="col-12" id="id_card">
                                        <div>
                                            {!! Form::label('id_card', 'ID Card Upload', ['class' => 'form-label']) !!}
                                            {!! Form::file('id_card', ['class' => 'form-control', 'placeholder' => 'Enter Last Name']) !!}
                                            {!! $errors->first('id_card', '<span class="text-danger">:message</span>') !!}
                                        </div>
                                    </div>
                                    <div class="col-6" id="authrization" style="display: none;">
                                        <div>
                                            {!! Form::label('authrization', 'Authrization', ['class' => 'form-label']) !!}
                                            {!! Form::text('authrization', null, ['class' => 'form-control', 'placeholder' => 'Authrization']) !!}
                                            {!! $errors->first('authrization', '<span class="text-danger">:message</span>') !!}
                                        </div>
                                    </div>
                                    <div class="col-6 mt-2" id="insurence_company">
                                        <div>
                                            {!! Form::label('insurence_company', 'Insurence Company', ['class' => 'form-label']) !!}
                                            {!! Form::select('insurence_company', $insurence_companies, null, [
                                                'class' => 'form-control',
                                                'placeholder' => 'Select Diagnonsis',
                                            ]) !!}
                                        </div>
                                    </div>
                                    <div class="col-6">
                                        <div>

                                            <div class="d-flex align-items-center justify-content-between mt-2 me-2">
                                                {!! Form::label('physician', 'Referening Physician', ['class' => 'form-label ']) !!}
                                                <div>
                                                    {!! Form::radio('physician_type', 'MD', false, ['id' => 'physician-type', 'class' => 'form-check-input']) !!}
                                                    {!! Form::label('physician-type', 'MD', ['class' => 'form-check-label']) !!}
                                                </div>
                                                <div>
                                                    {!! Form::radio('physician_type', 'DPM', false, ['id' => 'physician-type', 'class' => 'form-check-input']) !!}

                                                    {!! Form::label('physician-type', 'DPM', ['class' => 'form-check-label']) !!}
                                                </div>
                                            </div>
                                            {!! Form::select('physician_id', [''=>'Select Physician'], null, [
                                                'class' => 'form-control',
                                                'id' => 'physicians',
                                            ]) !!}
                                            {!! $errors->first('physician_id', '<span class="text-danger">:message</span>') !!}

                                        </div>
                                    </div>
                                    <div class="col-6">
                                        <div>
                                            {!! Form::label('qtv', 'QTY', ['class' => 'form-label']) !!}
                                            {!! Form::text('qty_id', null, ['class' => 'form-control quantity', 'placeholder' => 'Quantity', 'readonly']) !!}
                                        </div>
                                    </div>

                                    <div class="col-6">
                                        <div>
                                            {!! Form::label('diagnonsis', 'Diagnonsis', ['class' => 'form-label']) !!}
                                            {!! Form::select('diagnonsis_id[]', $diagnonsises, null, [
                                                'class' => 'form-control js-example-basic-multiple',
                                                'multiple',
                                                'data-placeholder' => 'Select Diagnonsis',
                                            ]) !!}
                                            {!! $errors->first('diagnonsis_id', '<span class="text-danger">:message</span>') !!}

                                        </div>
                                    </div>
                                    <div class="col-6">
                                        <div>
                                            {!! Form::label('hcpcs', 'HCPCS', ['class' => 'form-label']) !!}
                                            {!! Form::select('hcpcs_id[]', $hcpcses, null, [
                                                'class' => 'form-control js-example-basic-multiple selectedOption',
                                                'data-placeholder' => 'Select HCPCS',
                                                'multiple',
                                            ]) !!}
                                            {!! $errors->first('hcpcs_id', '<span class="text-danger">:message</span>') !!}

                                        </div>
                                    </div>
                                    <div class="col-6" id="signature">
                                        <div>
                                            {!! Form::label('signature', 'Signature', ['class' => 'form-label']) !!}
                                            {!! Form::text('signature', null, ['class' => 'form-control signature', 'placeholder' => 'Enter Signature']) !!}
                                            <span id="signatureText"></span>
                                        </div>
                                    </div>
                                </div>
                            </div>
                            {!! Form::submit('Add', ['class' => 'btn btn-primary btn-sm my-2 add']) !!}
                            <a href="{{ route('insurence.index') }}" class="btn btn-info btn-sm">Back</a>
                        </div>
                        {!! Form::close() !!}
                    </div>
                </div>
            </div>
        </div>
        <div class="content-backdrop fade"></div>
    </div>
@endsection
@section('scripts')
    <script>
        $(document).ready(function() {
            $('.js-example-basic-multiple').select2();
            $('.add').attr("disabled", true);

            $(".selectedOption").on("change", function() {
                var selectedCount = $(this).select2("data").length;
                $('.quantity').val(selectedCount);

            });
        });
        $('.signature').keyup(function() {
            var enterValue = $(this).val();
            if (enterValue != '') {
                $.ajax({
                    url: "{{route('checkSignature')}}",
                    type: "GET",
                    data: {
                        'value': enterValue
                    },
                    success: function(response) {
                        $('#signatureText').text('');
                        if (response.success === true) {
                            $('#signatureText').attr("class", "text-success").text(response.message);
                            $('.add').removeAttr("disabled");
                        } else {
                            $('.add').attr("disabled", true);
                            $('#signatureText').attr("class", "text-danger").text(response.message);
                        }
                    }
                });
            } else {
                $('#signatureText').text("");
                $('.add').attr("disabled", true);
            }
        });
        $('input[name="physician_type"]').change(function() {
            var selectedValue = $('input[name="physician_type"]:checked').val();
            $.ajax({
                url: "{{route('checkPhycisain')}}",
                type: "GET",
                data: {
                    'value': selectedValue
                },
                success: function(response) {

                    appendOptions(response.data);
                }

            });
        });

        function appendOptions(options) {
            $('#physicians').empty();
            $.each(options, function(index, option) {
                $('#physicians').append('<option value="' + option.id + '">' + option.fisrt_name + '</option>');
            });
        }
    </script>
@endsection