@extends('Admin.layout')

@section('content')
    <div class="row align-items-center justify-content-between mb-3 mt-3">
        <!-- Heading -->
        <div class="col-auto">
            <h5>
                <button type="button" class="btn btn-icon bg-white waves-effect me-2"
                    style="box-shadow: 0px 9px 12px -2px #66328E1F;">
                    <a href="{{route('customer_table')}}"><svg xmlns="http://www.w3.org/2000/svg" width="24" height="24"
                            viewBox="0 0 24 24" fill="none" stroke="#000" stroke-width="2" stroke-linecap="round"
                            stroke-linejoin="round" class="icon icon-tabler icons-tabler-outline icon-tabler-chevron-left">
                            <path stroke="none" d="M0 0h24v24H0z" fill="none" />
                            <path d="M15 6l-6 6l6 6" />
                        </svg>
                    </a></button>{{$data->name}} Details
            </h5>
        </div>

    </div>

    <h6 class="ms-2">Patient Name : {{$data->name}}</h6>
    <div class="card p-2">

        <div class="container">
            <form id="login_form" action="{{ route('update_customer') }}" method="POST">
                @csrf
                <input type="hidden" name="id" value="{{ $data->id }}">
                <h6>Personal Details</h6>
                <hr>
                <div class="row">
                    <div class="col-lg-4 mb-2">
                        <label class="form-label">Name <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('name') is-invalid @enderror" name="name"
                            placeholder="Enter Name" value="{{ old('name', $data->name) }}">
                        @error('name')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label"> Phone Number <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('phone') is-invalid @enderror" name="phone"
                            placeholder="Enter Number" value="{{ old('phone', $data->phone) }}">
                        @error('phone')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label"> Enter Email<span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('email') is-invalid @enderror" name="email"
                            placeholder="Email" value="{{ old('email', $data->email) }}">
                        @error('email')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label">Date Of Birth <span class="text-danger">*</span></label>
                        <input type="date" class="form-control @error('dob') is-invalid @enderror" id="dob" name="dob"
                            placeholder="Enter DOB" value="{{ old('dob', $data->dob) }}">
                        @error('dob')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label">Age<span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('age') is-invalid @enderror" id="age"
                            name="age" value="{{ old('age', $data->age) }}" readonly>
                        @error('age')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label"> Address <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('address') is-invalid @enderror" name="address"
                            placeholder="Enter Address" value="{{ old('address', $data->address) }}">
                        @error('address')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>

                </div>
                <h6 class="mt-2">Referral Details</h6>
                <hr>
                <div class="row">
                    <div class="col-lg-6 mb-2">
                        <label class="form-label">Referral Name <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('ref_name') is-invalid @enderror" name="ref_name"
                            placeholder="Enter Referral Name" value="{{ old('ref_name', $data->ref_name) }}">
                        @error('ref_name')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-6 mb-2">
                        <label class="form-label"> Referral Number <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('ref_num') is-invalid @enderror" name="ref_num"
                            placeholder="Enter Referral Number" value="{{ old('ref_num', $data->ref_num) }}">
                        @error('ref_num')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>

                </div>
                <h6>Health Details</h6>
                <hr>
                <div class="row">
                    <div class="col-lg-4 mb-2">
                        <label class="form-label">Height <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('height') is-invalid @enderror" name="height"
                            placeholder="Enter Height" value="{{ old('height', $data->height) }}">
                        @error('height')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label"> Weight <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('weight') is-invalid @enderror" name="weight"
                            placeholder="Enter Weight" value="{{ old('weight', $data->weight) }}">
                        @error('weight')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label"> BMI <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('bmi') is-invalid @enderror" name="bmi" id="bmi"
                            placeholder="Enter BMI" value="{{ old('bmi', $data->bmi) }}">
                        @error('bmi')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label">VF<span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('vf') is-invalid @enderror" name="vf"
                            placeholder="Enter VF" value="{{ old('vf', $data->vf) }}">
                        @error('vf')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label"> BMR <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('bmr') is-invalid @enderror" name="bmr"
                            placeholder="Enter BMR" value="{{ old('bmr', $data->bmr) }}">
                        @error('bmr')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label"> Body Age <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('body_age') is-invalid @enderror" name="body_age"
                            placeholder="Enter Body Age" value="{{ old('body_age', $data->body_age) }}">
                        @error('body_age')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                </div>
                <h6>Eating Habits</h6>
                <hr>
                <div class="row">
                    <div class="col-lg-4 mb-2">
                        <label class="form-label">Wake Up <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('wake_up') is-invalid @enderror" name="wake_up"
                            placeholder="Enter Wake Up Time" value="{{ old('wake_up', $data->wake_up) }}">
                        @error('wake_up')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label">Tea/Coffee <span class="text-danger">*</span></label>
                        <select class="form-select @error('tea') is-invalid @enderror" name="tea">
                            <option value="">Select</option>
                            <option value="Tea" {{ old('tea', $data->tea) == 'Tea' ? 'selected' : '' }}>Tea</option>
                            <option value="coffee" {{ old('tea', $data->tea) == 'coffee' ? 'selected' : '' }}>Coffee</option>

                        </select>
                        @error('tea')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label"> Break Fast <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('break_fast') is-invalid @enderror" name="break_fast"
                            placeholder="Enter Break Fast" value="{{ old('break_fast', $data->break_fast) }}">
                        @error('break_fast')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label">Lunch <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('lunch') is-invalid @enderror" name="lunch"
                            placeholder="Enter Lunch" value="{{ old('lunch', $data->lunch) }}">
                        @error('lunch')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label">Evening Snacks <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('snacks') is-invalid @enderror" name="snacks"
                            placeholder="Enter Evening Snacks" value="{{ old('snacks', $data->snacks) }}">
                        @error('snacks')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label"> Dinner<span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('dinner') is-invalid @enderror" name="dinner"
                            placeholder="Enter Dinner" value="{{ old('dinner', $data->dinner) }}">
                        @error('dinner')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-6 mb-2">
                        <label class="form-label">Veg/Non-Veg <span class="text-danger">*</span></label>
                        <select class="form-select @error('veg') is-invalid @enderror" name="veg">
                            <option value="">Select</option>
                            <option value="veg" {{ old('veg', $data->veg) == 'veg' ? 'selected' : '' }}>Veg</option>
                            <option value="non-veg" {{ old('veg', $data->veg) == 'non-veg' ? 'selected' : '' }}>Non-Veg
                            </option>

                        </select>
                        @error('veg')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-6 mb-2">
                        <label class="form-label"> Water Intake <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('water') is-invalid @enderror"
                            placeholder="Enter Water Intake" name="water" value="{{ old('water', $data->water) }}">
                        @error('water')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                </div>
                <h6>Health Conditions</h6>
                <hr>
                <div class="row">
                    <div class="col-lg-4 mb-2">
                        <label class="form-label">Blood Pressure <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('bp') is-invalid @enderror"
                            placeholder="Enter Blood Pressure" name="bp" value="{{ old('bp', $data->bp) }}">
                        @error('bp')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label">Head Ache <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('head_ache') is-invalid @enderror"
                            placeholder="Enter Head Ache" name="head_ache" value="{{ old('head_ache', $data->head_ache) }}">
                        @error('head_ache')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label"> Sugar <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('sugar') is-invalid @enderror"
                            placeholder="Enter Sugar" name="sugar" value="{{ old('sugar', $data->sugar) }}">
                        @error('sugar')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label">Giddiness <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('giddiness') is-invalid @enderror"
                            placeholder="Enter Giddiness" name="giddiness" value="{{ old('giddiness', $data->giddiness) }}">
                        @error('giddiness')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label"> Cardiac<span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('cardiac') is-invalid @enderror"
                            placeholder="Enter Cardiac" name="cardiac" value="{{ old('cardiac', $data->cardiac) }}">
                        @error('cardiac')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label"> Gastritis <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('gastritis') is-invalid @enderror"
                            placeholder="Enter Gastritis" name="gastritis" value="{{ old('gastritis', $data->gastritis) }}">
                        @error('gastritis')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label"> Tiredness<span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('tiredness') is-invalid @enderror"
                            placeholder="Enter Tiredness" name="tiredness" value="{{ old('tiredness', $data->tiredness) }}">
                        @error('tiredness')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>

                    <div class="col-lg-4 mb-2">
                        <label class="form-label"> Acidity <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('acidity') is-invalid @enderror"
                            placeholder="Enter Acidity" name="acidity" value="{{ old('acidity', $data->acidity) }}">
                        @error('acidity')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label"> Indigestion <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('indigestion') is-invalid @enderror"
                            placeholder="Enter Indigestion" name="indigestion"
                            value="{{ old('indigestion', $data->indigestion) }}">
                        @error('indigestion')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label"> Constipation <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('constipation') is-invalid @enderror"
                            placeholder="Enter Constipation" name="constipation"
                            value="{{ old('constipation', $data->constipation) }}">
                        @error('constipation')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label">Pain <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('pain') is-invalid @enderror" placeholder="Enter Pain"
                            name="pain" value="{{ old('pain', $data->pain) }}">
                        @error('pain')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-4 mb-2">
                        <label class="form-label"> Breathing Problem <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('breath') is-invalid @enderror"
                            placeholder="Enter Breathing Problem" name="breath" value="{{ old('breath', $data->breath) }}">
                        @error('breath')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                    <div class="col-lg-12 mb-2">
                        <label class="form-label"> Sleeping Disorder <span class="text-danger">*</span></label>
                        <input type="text" class="form-control @error('sd') is-invalid @enderror"
                            placeholder="Enter Sleeping Disorder" name="sd" value="{{ old('sd', $data->sd) }}">
                        @error('sd')
                            <span class="text-danger small">{{ $message }}</span>
                        @enderror
                    </div>
                </div>


                <div class="form-actions mt-4 d-flex gap-3 justify-content-center">
                    <button type="button" class="btn btn-primary text-nowrap" data-bs-toggle="modal"
                        data-bs-target="#update" id="submit_btn">
                        Update
                    </button>

                    <button type="reset" class="btn btn-secondary">
                        Discard
                    </button>
                </div>

            </form>
        </div>

    </div>
    <div class="modal fade" id="update" tabindex="-1">
        <div class="modal-dialog modal-sm modal-dialog-centered">
            <div class="modal-content rounded-4 px-4 py-5 text-center">

                <h5 class="fw-bold mb-2">Are you sure?</h5>
                <p class="text-muted mb-4">Do you confirm to update?</p>

                <div class="d-flex justify-content-center gap-3 mt-3">

                    <!-- Cancel -->
                    <button type="button" class="btn btn-outline-secondary px-4" data-bs-dismiss="modal">
                        Cancel
                    </button>

                    <!-- Final submit -->
                    <button type="submit" class="btn btn-primary px-4 fw-semibold" id="finalSubmit">
                        Yes, Sure
                    </button>

                </div>
            </div>
        </div>
    </div>

    <script>
        document.getElementById("dob").addEventListener("change", function () {
            let dob = new Date(this.value);
            let today = new Date();

            let age = today.getFullYear() - dob.getFullYear();
            let month = today.getMonth() - dob.getMonth();
            let day = today.getDate() - dob.getDate();

            // Adjust if birthday hasn't come yet this year
            if (month < 0 || (month === 0 && day < 0)) {
                age--;
            }

            document.getElementById("age").value = age;
        });



        document.getElementById('finalSubmit').addEventListener('click', function (e) {
            e.preventDefault();
            let btn = this;
            btn.disabled = true;
            btn.innerText = 'Processing...';
            document.getElementById('login_form').submit();
        });
    </script>

@endsection