@extends('layouts.app')

@section('content')
    <div class="container-fluid mt-3">
        <div class="row">
            <div class="col-md-12">
                <div class="card shadow">
                    <div class="card-header border-0 bg-secondary">
                        <div class="row align-items-center">
                            <div class="col"><h3
                                    class="mb-0">{{__('Document pentru pacientul: '). $patient->first_name.' '.$patient->last_name}}</h3>
                            </div>
                        </div>
                    </div>
                    <div class="card-body">
                        @if ($errors->any())
                            <div class="alert alert-danger">
                                <ul>
                                    @foreach ($errors->all() as $error)
                                        <li>{{ $error }}</li>
                                    @endforeach
                                </ul>
                            </div>
                        @endif
                        <form action="{{ route('patientsDocuments.update', [$document->id, 'duplicate'=>$duplicate]) }}" method="POST">
                            @csrf
                            @method('PUT')
                            <input type="hidden" readonly="" name="patientId" value="{{$document->patient_id}}">
                            <div class="row">
                                <div class="col-md-6">
                                    <div class="mb-5">
                                        <b>{{__('Tipul documentului').': '.$templateName}}</b>
                                    </div>
                                </div>
                                <div class="col-md-6 text-right">
                                    <a href="{{ route('patientsDocuments.printDocument', ['documentId'=>$document->id]) }}"
                                       class="btn btn-info" target="_blank"><span>{{__('Printează')}}</span></a>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="form-group{{ $errors->has('av') ? ' has-danger' : '' }}">
                                    <div class="input-group input-group-alternative mb-3">
                                        <div class="input-group-prepend">
                                            <span class="input-group-text"><i class="ni ni-align-left-2"></i></span>
                                        </div>
                                        <input
                                            class="form-control{{ $errors->has('registry_no') ? ' is-invalid' : '' }}"
                                            placeholder="{{ __('Numar') }}" type="text" name="registry_no"
                                            value="{{$document->registry_no}}" autofocus>
                                    </div>
                                    @if ($errors->has('registry_no'))
                                        <span class="invalid-feedback" style="display: block;" role="alert">
                                        <strong>{{ $errors->first('registry_no') }}</strong>
                                    </span>
                                    @endif
                                </div>
                            </div>
                            <div class="row">
                                <div class="custom-control custom-checkbox ml-3">
                                    <input class="custom-control-input" name="mf" id="mf"
                                           type="checkbox" >
                                    <label class="custom-control-label" for="mf">{{__('MF')}}</label>
                                </div>
                                <div class="custom-control custom-checkbox ml-3">
                                    <input class="custom-control-input" name="ambulatory" id="ambulatory"
                                           type="checkbox" >
                                    <label class="custom-control-label" for="ambulatory">{{__('Ambulatoriu')}}</label>
                                </div>
                                <div class="custom-control custom-checkbox ml-3">
                                    <input class="custom-control-input" name="hospital" id="hospital"
                                           type="checkbox" >
                                    <label class="custom-control-label" for="hospital">{{__('Spital')}}</label>
                                </div>
                            </div>

                            <div class="form-group mt-3 mb-3">
                                <label><strong>{{__('Diagnostic')}}</strong></label>
                                <textarea id="pd_diagnostic" class="form-control"
                                          name="diagnostic" style="height: 100px">{{$document->diagnostic}}</textarea>
                            </div>

                            <h4>{{__('Deficiență organică sau functională')}}</h4>
                            <div class="col-md-6">
                                <div class="custom-control custom-checkbox ml-3">
                                    <input class="custom-control-input" name="occupational_disease"
                                           id="occupational_disease"
                                           type="checkbox" >
                                    <label class="custom-control-label"
                                           for="occupational_disease">{{__('nu este ca urmare a unei boli profesionale')}}</label>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="custom-control custom-checkbox ml-3">
                                    <input class="custom-control-input" name="not_occupational_disease"
                                           id="not_occupational_disease"
                                           type="checkbox" >
                                    <label class="custom-control-label"
                                           for="not_occupational_disease">{{__('nu este ca urmare a unui accident de munca ori sportiv')}}</label>
                                </div>
                            </div>

                            <h4 class="mt-3">{{__('Pentru stomii și reținere sau/și incontinență urinară se bifează una dintre căsuțele:')}}</h4>
                            <div class="col-md-6">
                                <div class="custom-control custom-checkbox ml-3">
                                    <input class="custom-control-input" name="permanent" id="permanent"
                                           type="checkbox" >
                                    <label class="custom-control-label" for="permanent">{{__('permanentă')}}</label>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="custom-control custom-checkbox ml-3">
                                    <input class="custom-control-input" name="temporary" id="temporary"
                                           type="checkbox" >
                                    <label class="custom-control-label" for="temporary">{{__('temporară')}}</label>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="custom-control custom-checkbox ml-3">
                                    <input class="custom-control-input" name="modified" id="modified"
                                           type="checkbox" >
                                    <label class="custom-control-label" for="modified">{{__('set modificat')}}</label>
                                </div>
                            </div>

                            <h4 class="mt-3">{{__('Pentru echipamentele pentru oxigenoterapie si ventilație noninvazivă se bifează una dintre căsuțele:')}}</h4>
                            <div class="col-md-6">
                                <div class="custom-control custom-checkbox ml-3">
                                    <input class="custom-control-input" name="with_certificate" id="with_certificate"
                                           type="checkbox" >
                                    <label class="custom-control-label"
                                           for="with_certificate">{{__('cu certificat de încadrare un grad de handicap grav sau accentuat')}}</label>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="custom-control custom-checkbox ml-3">
                                    <input class="custom-control-input" name="without_certificate"
                                           id="without_certificate"
                                           type="checkbox" >
                                    <label class="custom-control-label"
                                           for="without_certificate">{{__('fără certificat de încadrare in grad de handicap grav sau accentuat')}}</label>
                                </div>
                            </div>
                            <div class="col-md-6 mt-1">
                                <div class="form-group{{ $errors->has('equipment_time') ? ' has-danger' : '' }}">
                                    <div class="input-group input-group-alternative mb-3">
                                        <div class="input-group-prepend">
                                            <span class="input-group-text"><i class="ni ni-align-left-2"></i></span>
                                        </div>
                                        <input
                                            class="form-control{{ $errors->has('equipment_time') ? ' is-invalid' : '' }}"
                                            placeholder="{{ __('Nr. de zile reccomandat(maximum 90/91/92 zile sau 12 luni)') }}"
                                            type="text" name="equipment_time"
                                            autofocus value="{{$checkboxes['equipment_time']??null}}">
                                    </div>
                                    @if ($errors->has('equipment_time'))
                                        <span class="invalid-feedback" style="display: block;" role="alert">
                                        <strong>{{ $errors->first('equipment_time') }}</strong>
                                    </span>
                                    @endif
                                </div>
                            </div>

                            <h4 class="mt-3">{{__('Pentru fotolii rulante se bifează una dintre căsuțele:')}}</h4>
                            <div class="col-md-6">
                                <div class="custom-control custom-checkbox ml-3">
                                    <input class="custom-control-input" name="undefined_period" id="undefined_period"
                                           type="checkbox" >
                                    <label class="custom-control-label"
                                           for="undefined_period">{{__('perioadă nedeterminată')}}</label>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="custom-control custom-checkbox ml-3">
                                    <input class="custom-control-input" name="defined_period" id="defined_period"
                                           type="checkbox" >
                                    <label class="custom-control-label"
                                           for="defined_period">{{__('perioadă determinată')}}</label>
                                </div>
                            </div>
                            <div class="col-md-3 mt-1">
                                <div class="form-group{{ $errors->has('period_time') ? ' has-danger' : '' }}">
                                    <div class="input-group input-group-alternative mb-3">
                                        <div class="input-group-prepend">
                                            <span class="input-group-text"><i class="ni ni-align-left-2"></i></span>
                                        </div>
                                        <input
                                            class="form-control{{ $errors->has('period_time') ? ' is-invalid' : '' }}"
                                            placeholder="{{ __('Nr. de zile reccomandat(maximum 90/91/92 zile)') }}"
                                            type="text" name="period_time"
                                            value="{{$checkboxes['period_time']??null}}" autofocus >
                                    </div>
                                    @if ($errors->has('period_time'))
                                        <span class="invalid-feedback" style="display: block;" role="alert">
                                        <strong>{{ $errors->first('period_time') }}</strong>
                                    </span>
                                    @endif
                                </div>
                            </div>
                            <h4 class="mt-3">{{__('Pentru protezele de membru inferior se bifează una dintre casuțele:')}}</h4>
                            <div class="col-md-6">
                                <div class="custom-control custom-checkbox ml-3">
                                    <input class="custom-control-input" name="temporary_prosthesis"
                                           id="temporary_prosthesis"
                                           type="checkbox" >
                                    <label class="custom-control-label"
                                           for="temporary_prosthesis">{{__('proteză provizorie')}}</label>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="custom-control custom-checkbox ml-3">
                                    <input class="custom-control-input" name="definitive_prosthesis"
                                           id="definitive_prosthesis"
                                           type="checkbox" >
                                    <label class="custom-control-label"
                                           for="definitive_prosthesis">{{__('proteză definitivă')}}</label>
                                </div>
                            </div>
                            <h4 class="mt-3">{{__('Dispozitive medicale, tehnologii, dispozitive asistive ce se pot acorda pereche:')}}</h4>
                            <div class="col-md-6">
                                <div class="custom-control custom-checkbox ml-3">
                                    <input class="custom-control-input" name="left_side" id="left_side"
                                           type="checkbox" >
                                    <label class="custom-control-label" for="left_side">{{__('stanga')}}</label>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="custom-control custom-checkbox ml-3">
                                    <input class="custom-control-input" name="right_side" id="right_side"
                                           type="checkbox" >
                                    <label class="custom-control-label" for="right_side">{{__('dreapta')}}</label>
                                </div>
                            </div>
                            <div class="col-md-12 mt-3">
                                <div class="form-group">
                                    <label><strong>{{__('Denumirea și tipul dispozitivului medical, tehnologiei sau dispozitivului asistiv recomandat:')}}</strong></label>
                                    <textarea id="medical_equipment" class="form-control"
                                              name="medical_equipment"
                                              style="height: 100px">{{$document->medical_equipment}}</textarea>
                                </div>
                            </div>

                            <div class="col-md-12 text-right">
                                <button type="submit" class="btn btn-primary">{{__('Salvează')}}</button>
                            </div>
                        </form>
                    </div>
                </div>
            </div>
        </div>
    </div>
    <script type='text/javascript'>

        const config = {
            toolbarGroups: [
                {name: 'basicstyles', groups: ['basicstyles', 'cleanup']},
                {name: 'paragraph', groups: ['list', 'indent', 'blocks', 'align', 'bidi', 'paragraph']},
                {name: 'styles', groups: ['styles']},
                {name: 'colors', groups: ['colors']},
                {name: 'about', groups: ['about']}
            ],
            removePlugins: 'scayt,radio,horizontalrule,specialchar,exportpdf,radioicon,elementspath,save,image,flash,iframe,link,smiley,tabletools,find,pagebreak,templates,about,maximize,showblocks,newpage,language',
            removeButtons: 'Preview,Checkbox,Copy,Cut,Paste,Undo,Redo,Print,Form,TextField,Textarea,Button,SelectAll,NumberedList,BulletedList,CreateDiv,Table,PasteText,PasteFromWord,Select,HiddenField',
        };

        $(document).ready(function () {
            CKEDITOR.replace('medical_equipment', config);
            CKEDITOR.replace('pd_diagnostic', config);
        });


        // Initialize select2
        $("#s_template").select2({
            ajax: {
                url: "{{ route('documentsTemplates.search') }}",
                type: "post",
                dataType: 'json',
                data: function (params) {
                    return {
                        query: params.term,
                        "_token": "{{ csrf_token() }}",
                    };
                },
                processResults: function (data) {
                    return {
                        results: $.map(data, function (obj) {
                            return {
                                id: obj.id,
                                text: obj.name
                            };
                        })
                    };
                }
            }
        });
    </script>
@endsection