@extends('Admin/layout/master')
@section('title', 'Search Phycisian')
@section('content')
    <div class="content-wrapper">
        <!-- Content -->

        <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">Search Phycisian</h5>
                        {!! Form::open(['route'=>'physician.show','method'=>"post"]) !!}
                        <div class="card-body">
                            <div class="row">
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('verion', 'Version', ['class' => 'form-label']) !!}
                                        {!! Form::text('version', 2.1, ['class' => 'form-control', 'placeholder' => 'Enter Name', 'readonly']) !!}

                                    </div>
                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('number', 'Number', ['class' => 'form-label']) !!}
                                        {!! Form::text('number', null, ['class' => 'form-control', 'placeholder' => 'Exactly 10 digits']) !!}
                                    </div>
                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('enumeration_type', 'Enumeration Type', ['class' => 'form-label']) !!}
                                        {!! Form::text('enumeration_type', null, [
                                            'class' => 'form-control',
                                            'placeholder' => 'NPI-1 or NPI-2 (Other criteria required)',
                                        ]) !!}

                                    </div>
                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('taxonomy_description', 'Taxonomy Description', ['class' => 'form-label']) !!}
                                        {!! Form::text('mobile', null, [
                                            'class' => 'form-control',
                                            'placeholder' => 'Exact Description or Exact Specialty or wildcard * after 2 characters',
                                        ]) !!}
                                        <small></small>
                                    </div>
                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('name_purpose', 'Name Purpose', ['class' => 'form-label']) !!}
                                        {!! Form::text('name_purpose', null, [
                                            'class' => 'form-control',
                                            'placeholder' => 'AO or PROVIDER (Other criteria required)',
                                        ]) !!}

                                    </div>

                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('first_name', 'First Name', ['class' => 'form-label']) !!}
                                        {!! Form::text('first_name', null, [
                                            'class' => 'form-control',
                                            'placeholder' => 'Exact name, or wildcard * after 2 characters',
                                        ]) !!}
                                    </div>
                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('use_first_name_alias', 'Use First Name Alias', ['class' => 'form-label']) !!}
                                        {!! Form::text('use_first_name_alias', null, [
                                            'class' => 'form-control',
                                            'placeholder' => 'True or False (Other criteria required)',
                                        ]) !!}

                                    </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' => 'Exact name, or wildcard * after 2 characters',
                                        ]) !!}
                                    </div>
                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('organization_name', 'Organization Name', ['class' => 'form-label']) !!}
                                        {!! Form::text('organization_name', null, [
                                            'class' => 'form-control',
                                            'placeholder' => 'Exact name, or wildcard * after 2 characters',
                                        ]) !!}

                                    </div>

                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('address_purpose', 'Address Purpose', ['class' => 'form-label']) !!}
                                        {!! Form::text('address_purpose', null, [
                                            'class' => 'form-control',
                                            'placeholder' => 'LOCATION, MAILING, PRIMARY or SECONDARY. (Other criteria required)',
                                        ]) !!}
                                    </div>
                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('city', 'City', ['class' => 'form-label']) !!}
                                        {!! Form::text('city', null, [
                                            'class' => 'form-control',
                                            'placeholder' => 'Exact city, or wildcard * after 2 characters',
                                        ]) !!}

                                    </div>
                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('state', 'State', ['class' => 'form-label']) !!}
                                        {!! Form::text('state', null, [
                                            'class' => 'form-control',
                                            'placeholder' => '2 Characters (Other criteria required)',
                                        ]) !!}
                                    </div>
                                </div>

                                <div class="col-6">
                                    <div>
                                        {!! Form::label('postal_code', 'Postal Code', ['class' => 'form-label']) !!}
                                        {!! Form::text('postal_code', null, [
                                            'class' => 'form-control',
                                            'placeholder' => 'Exact Postal Code (5 digits will also return 9 digit zip + 4), or wildcard * after 2 characters',
                                        ]) !!}
                                    </div>
                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('country_code', 'Organization Name', ['class' => 'form-label']) !!}
                                        {!! Form::text('country_code', null, [
                                            'class' => 'form-control',
                                            'placeholder' => 'Exactly 2 characters (if "US", other criteria required)',
                                        ]) !!}

                                    </div>

                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('limit', 'Limit', ['class' => 'form-label']) !!}
                                        {!! Form::text('limit', null, [
                                            'class' => 'form-control',
                                            'placeholder' => 'Limit results, default = 10, max = 200',
                                        ]) !!}
                                    </div>
                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('skip', 'Skip', ['class' => 'form-label']) !!}
                                        {!! Form::text('skip', null, ['class' => 'form-control', 'placeholder' => 'Skip first N results, max = 1000']) !!}

                                    </div>
                                </div>
                                <div class="col-6">
                                    <div>
                                        {!! Form::label('pretty', 'Response will be formatted with indented lines', ['class' => 'form-label']) !!}
                                        {!! Form::checkbox('pretty', 'pretty', false) !!}
                                    </div>
                                </div>
                            </div>
                            {!! Form::submit('Show', ['class' => 'btn btn-primary btn-sm my-2 ']) !!}
                            {{-- <a href="{{ route('user.index') }}" class="btn btn-info btn-sm ">Back</a> --}}
                        </div>
                        {!! Form::close() !!}
                    </div>
                </div>
            </div>
        </div>
        <div class="content-backdrop fade"></div>
    </div>
@endsection