@extends('admin.layouts.contentLayoutMaster')

@section('title','Patient Create')
@section('pagelevelcss')
@stop
@section('content')
<div class="section">
    <div class="card">
        <div class="card-content">
            <div class="row">
              <!-- Form Advance -->
              <div class="col s12 m12 l12">
                  <div class="card-content">
                    <form action="{{route('patient.save')}}" method="post" id="form">
                      {{ csrf_field() }}
                      <input type="hidden" name="kittype" value="{{ app('request')->input('kittype') }}">
                      <div class="row">
                        <div class="input-field col s12">
                            <input id="fname" type="text" name="fname" value="{{old('fname')}}" maxlength="10">
                            <label for="fname">First Name<span class="red-text">*</span></label>
                        </div>
                      </div>
                      <div class="row">
                        <div class="input-field col s12">
                            <input id="mname" type="text" name="mname" value="{{old('mname')}}" maxlength="10">
                            <label for="mname">Middle Name<span class="red-text">*</span></label>
                        </div>
                      </div>
                      <div class="row">
                        <div class="input-field col s12">
                          <input id="lname" type="text" name="lname" value="{{old('lname')}}" maxlength="10">
                          <label for="lname">Last Name<span class="red-text">*</span></label>
                        </div>
                      </div>
                      <label>Gender</label>
                      <div class="row">                      
                      <div class="input-field col s12">
                        <p>
                          <label>
                            <input name="gender" type="radio" value="1" {{old('gender') == 1 ? 'checked' : ''}}/>
                            <span>Male</span>
                          </label>
                        </p>
                      </div>
                      <div class="input-field col s12">
                        <p>
                          <label>
                            <input name="gender" type="radio" value="2" {{old('gender') == 2 ? 'checked' : ''}} {{old('gender') != 1 ? 'checked' : ''}}/>
                            <span>Female</span>
                          </label>
                        </p>
                      </div>
                      </div>
                      <div class="row">
                        <div class="input-field col s12 m4">
                          <select name="dobm" class="dobm">
                            <option value="">Choose Month</option>
                            @for($m=1;$m<=12;$m++)
                                @if($m < 10)
                                @php
                                $m = '0'.$m;
                                @endphp
                                @endif
                                <option value="{{$m}}" {{old('dobm') == $m ? 'selected' : ''}}>{{date('F', mktime(0, 0, 0, $m, 1))}}</option>
                            @endfor
                          </select>
                          <label>Date Of Birth<span class="red-text">*</span></label>
                        </div>
                        <div class="input-field col s12 m4">
                          <select name="dobd" class="dobd">
                            <option value="">Choose Date</option>
                            @for($d=1;$d<=31;$d++)
                                @if($d < 10)
                                @php
                                $d = '0'.$d;
                                @endphp
                                @endif
                                <option value="{{$d}}" {{old('dobd') == $d ? 'selected' : ''}}>{{$d}}</option>
                            @endfor 
                          </select>
                        </div>
                        <div class="input-field col s12 m4">
                          <select name="doby" class="doby">
                            <option value="">Choose Year</option>
                            @for($y=1950;$y<=2022;$y++)
                                <option value="{{$y}}" {{old('doby') == $y ? 'selected' : ''}}>{{$y}}</option>
                            @endfor
                          </select>
                        </div>
                        <span class="dob-error error ml-1"></span>
                      </div>
                      <div class="row">
                        <div class="input-field col s12">
                          <input name="phno" id="phno" type="text" value="{{old('phno')}}" maxlength="12">
                          <label for="phno">Phone No.<span class="red-text">*</span></label>
                        </div>
                      </div>
                      <div class="row">
                        <div class="input-field col s12">
                          <input id="email" type="text" name="email" value="{{old('email')}}">
                          <label for="email">Email<span class="red-text">*</span></label>
                        </div>
                      </div>
                      <label>Identification Type</label>
                      <div class="row">
                        <div class="input-field col s12">
                          <p>
                            <label>
                              <input name="idtype" type="radio" value="1" {{old('idtype') == 1 ? 'checked' : ''}}/>
                              <span>Driving Licence</span>
                            </label>
                          </p>
                        </div>
                        <div class="input-field col s12">
                          <p>
                            <label>
                              <input name="idtype" type="radio" value="2" {{old('idtype') == 2 ? 'checked' : ''}} {{old('idtype') != 1 ? 'checked' : ''}}/>
                              <span>Passport Number</span>
                            </label>
                          </p>
                        </div>
                      </div>                      
                      <div class="row">
                        <div class="input-field col s12">
                          <input id="id_number" type="text" name="id_number" value="{{old('id_number')}}">
                          <label for="id_number">ID Number<span class="red-text">*</span></label>
                        </div>
                      </div>
                      <div class="row">
                        <div class="input-field col s12" style="display:none;">
                          <input id="travel_agent" type="text" name="travel_agent" value="{{old('travel_agent')}}">
                          <label for="travel_agent">Referring Travel agent or Airline<span class="red-text">*</span></label>
                        </div>
                      </div>
                      <div class="row">
                        <div class="input-field col s12">
                          <textarea class="materialize-textarea" name="address">{{old('address')}}</textarea>
                          <label for="address">Address<span class="red-text">*</span></label>
                        </div>
                      </div>
                      <div class="row">
                        <div class="input-field col s12">
                          <input id="state" type="text" name="state" value="{{old('state')}}">
                          <label for="state">State<span class="red-text">*</span></label>
                        </div>
                      </div>
                      <div class="row">
                        <div class="input-field col s12">
                          <input id="city" type="text" name="city" value="{{old('city')}}">
                          <label for="city">City<span class="red-text">*</span></label>
                        </div>
                      </div>
                      <div class="row">
                        <div class="input-field col s12">
                          <input id="zipcode" type="text" name="zipcode" value="{{old('zipcode')}}">
                          <label for="zipcode">Zipcode<span class="red-text">*</span></label>
                        </div>
                      </div>
                      <div class="row">
                        <div class="input-field col s12">
                            <input type="text" class="appointment-datepicker" name="app_date" id="app_date" value="{{old('app_date') ? date("d-m-Y", strtotime(old('app_date'))) : ''}}" readonly/>
                            <label for="app_date">Appointment Date<span class="red-text">*</span></label>
                        </div>
                      </div>
                      <div class="row">
                        <div class="input-field col s12">
                            <select class="form-control browser-default" name="app_time" id="app_time">
                              <option value="">Select time</option>
                            </select>
                            <!-- <input type="text" class="datetimepicker" name="app_time" id="app_time" value="{{old('app_time') ? date("d-m-Y", strtotime(old('app_time'))) : ''}}" /> 
                            <label for="app_time">Appointment Time<span class="red-text">*</span></label> -->
                        </div>
                      </div>
                      <div class="row" style="display:none;">
                      <div class="input-field col s12">
                        <p>
                          <label>
                            <input name="travelling" class="travelling" type="radio" value="1" {{old('travelling') == 1 ? 'checked' : ''}} {{old('travelling') != 2 ? 'checked' : ''}}/>
                            <span>No</span>
                          </label>
                        </p>
                      </div>
                      <div class="input-field col s12">
                        <p>
                          <label>
                            <input name="travelling" class="exposed" type="radio" value="2" {{old('travelling') == 2 ? 'checked' : ''}} />
                            <span>Yes</span>
                          </label>
                        </p>
                      </div>
                      </div>
                      @if(old('expsymp') == 1)
                      @php
                      $show = "display:block;";
                      @endphp
                      @else
                      @php
                      $show = "display:none;";
                      @endphp
                      @endif
                      <div>
                      <label>Are you currently experiencing any of the following? fever, cough, shortness of breath, the new loss of taste or smell or any other COVID-19 symptoms?</label>
                      <div class="row">                      
                      <div class="input-field col s12">
                        <p>
                          <label>
                            <input class="expsymp-yes" name="expsymp" type="radio" value="1" {{old('expsymp') == 1 ? 'checked' : ''}}/>
                            <span>Yes</span>
                          </label>
                        </p>
                      </div>
                      <div class="input-field col s12">
                        <p>
                          <label>
                            <input class="expsymp-no" name="expsymp" type="radio" value="2" {{old('expsymp') == 2 ? 'checked' : ''}} {{old('expsymp') != 1 ? 'checked' : ''}}/>
                            <span>No</span>
                          </label>
                        </p>
                      </div>
                      </div>
                      <div class="div_is_travelling" style="{{$show}}">
                      <label>Which of the following COVID symptoms are you experiencing?</label>
                      <div class="row">                        
                        <div class="input-field col s12">
                        <p>
                          <label>
                            <input name="fever" type="checkbox" value="1" {{old('fever') == 1 ? 'checked' : ''}}/>
                            <span>Fever</span>
                          </label>
                        </p> 
                        </div>
                        <div class="input-field col s12">                       
                          <p>
                            <label>
                              <input name="headache" type="checkbox" value="1" {{old('headache') == 1 ? 'checked' : ''}}/>
                              <span>Headache</span>
                            </label>
                          </p> 
                          </div>
                          <div class="input-field col s12">                       
                            <p>
                            <label>
                              <input name="vomit" type="checkbox" value="1" {{old('vomit') == 1 ? 'checked' : ''}}/>
                              <span>Nausea or Vomiting</span>
                            </label>
                          </p> 
                          </div>
                          <div class="input-field col s12">                       
                            <p>
                            <label>
                              <input name="diarrhoea" type="checkbox" value="1" {{old('diarrhoea') == 1 ? 'checked' : ''}}/>
                              <span>Diarrhoea</span>
                            </label>
                          </p>
                          </div>
                          <div class="input-field col s12">                        
                            <p>
                            <label>
                              <input name="chills" type="checkbox" value="1" {{old('chills') == 1 ? 'checked' : ''}}/>
                              <span>Chills</span>
                            </label>
                          </p>
                        </div>
                        <div class="input-field col s12">
                          <p>
                          <label>
                            <input name="fatigue" type="checkbox" value="1" {{old('fatigue') == 1 ? 'checked' : ''}}/>
                            <span>Fatigue</span>
                          </label>
                        </p>  
                        </div>
                        <div class="input-field col s12">                      
                          <p>
                            <label>
                              <input name="bodyache" type="checkbox" value="1" {{old('bodyache') == 1 ? 'checked' : ''}}/>
                              <span>Body Ache</span>
                            </label>
                          </p> 
                          </div>
                          <div class="input-field col s12">                       
                            <p>
                            <label>
                              <input name="losmell" type="checkbox" value="1" {{old('losmell') == 1 ? 'checked' : ''}}/>
                              <span>Loss of smell or taste</span>
                            </label>
                          </p> 
                          </div>
                          <div class="input-field col s12">                       
                            <p>
                            <label>
                              <input name="sbreath" type="checkbox" value="1" {{old('sbreath') == 1 ? 'checked' : ''}}/>
                              <span>Shortness of breath</span>
                            </label>
                          </p>  
                          </div>
                          <div class="input-field col s12">                      
                            <p>
                            <label>
                              <input name="cough" type="checkbox" value="1" {{old('cough') == 1 ? 'checked' : ''}}/>
                              <span>Cough</span>
                            </label>
                          </p>
                        </div>
                        <div class="input-field col s12">
                          <p>
                          <label>
                            <input name="cpain" type="checkbox" value="1" {{old('cpain') == 1 ? 'checked' : ''}}/>
                            <span>Chest pain</span>
                          </label>
                        </p> 
                        </div>
                        <div class="input-field col s12">                       
                          <p>
                            <label>
                              <input name="nscovid" type="checkbox" value="1" {{old('nscovid') == 1 ? 'checked' : ''}}/>
                              <span>near someone with COVID</span>
                            </label>
                          </p> 
                          </div>                    
                      </div>
                      </div>
                      <label>Have you been exposed to a known COVID-19 positive individual in the last 14 days?</label>
                      <div class="row">                      
                      <div class="input-field col s12">
                        <p>
                          <label>
                            <input name="covexposed" type="radio" value="1" {{old('covexposed') == 1 ? 'checked' : ''}}/>
                            <span>Yes</span>
                          </label>
                        </p>
                      </div>
                      <div class="input-field col s12">
                        <p>
                          <label>
                            <input name="covexposed" type="radio" value="2" {{old('covexposed') == 2 ? 'checked' : ''}} {{old('covexposed') != 1 ? 'checked' : ''}}/>
                            <span>No</span>
                          </label>
                        </p>
                      </div>
                      </div>
                      <div class="row">
                        <div class="input-field col s12">
                            <input class="datepicker1" id="covtestdate" type="text" name="covtestdate" value="{{old('covtestdate') ? date("d-m-Y", strtotime(old('covtestdate'))) : ''}}" readonly>
                            <label for="covtestdate">What date was your most recent COVID test? </label>
                        </div>
                      </div>
                      <div class="row">
                        <div class="input-field col s12">
                            <input class="datepicker1" id="sympdate" type="text" name="sympdate" value="{{old('sympdate') ? date("d-m-Y", strtotime(old('sympdate'))) : ''}}" readonly>
                            <label for="sympdate">What date did you start having symptoms?</label>
                        </div>
                      </div>
                    </div>
                      <div class="row">
                        <div class="row">
                          <div class="input-field col s12">
                            <button class="btn waves-effect waves-light left" type="submit">Submit
                            </button>
                          </div>
                        </div>
                      </div>
                    </form>
                  </div>
              </div>
            </div>
        </div>
    </div>
</div>
@endsection
@section('pageleveljs')
<script type="text/javascript">
  $(function(){
      $("#form").validate({
        ignore: '',
        rules: {
          fname: {
             required: true,
             lettersonly: true
          },
          mname: {
             required: true,
             lettersonly: true
          },
          lname: {
             required: true,
             lettersonly: true
          },
          dobm: {
             required: true,
             dob: true
          },
          dobd: {
             required: true,
             dob: true
          },
          doby: {
             required: true,
             dob: true
          },
          phno: {
             required: true,
             phoneonly: true
          },
          id_number: "required",
          //travel_agent: "required",
          address: "required",
          state: {
             required: true,
             lettersonly: true
          },
          city: {
             required: true,
             lettersonly: true
          },
          zipcode: {
             required: true,
             number: true
          },
          app_date: {
            required: true,
            checkappointmentdate: true
          },
          app_time: {
            required: true,
            checkappointmenttime: true
          },
          email: {
            required: true,
            email: true
          }
        },
        messages : {
          email: {
            required: "Please enter email",
            email: "Please enter valid email"
          },
          fname: {
            required: "Please enter first name",
          },
          mname: {
            required: "Please enter middle name",
          },
          lname: {
            required: "Please enter last name",
          },
          dobm: {
            required: "Please select month",
            dob: "Date of birth must be past date",
          },
          dobd: {
            required: "Please select date",
            dob: "Date of birth must be past date",
          },
          doby: {
            required: "Please select year",
            dob: "Date of birth must be past date",
          },
          phno: {
            required: "Please enter phone number",
          },
          id_number: {
            required: "Please enter Id number",
          },
          // travel_agent: {
          //   required: "Please enter Referring Travel agent or Airline",
          // },
          address: {
            required: "Please enter address",
          },
          state: {
            required: "Please enter state",
          },
          city: {
            required: "Please enter city",
          },
          zipcode: {
            required: "Please enter zipcode",
          },
          app_date: {
            required: "Please enter appointment date",
          },
          app_time: {
            required: "Please enter appointment time",
          }
        },
        errorElement : 'span',
        invalidHandler: function(form, validator) {
            var errors = validator.numberOfInvalids();
            if (errors) {
                $('html, body').animate({
                    scrollTop: ($(validator.errorList[0].element).offset().top - 100)
                }, 1000);

            }
        }
      });
        $('.datepicker1').datepicker({
          format: 'mm-dd-yyyy',
          endDate: "today",
          autoclose: true,
          todayHighlight: true
        });
        $(".expsymp-yes").click(function () {
        $(".div_is_travelling").toggle();
        $('html, body').animate({
            scrollTop: $(".datetimepicker").offset().top
        });
        });
        $(".expsymp-no").click(function () {
        $(".div_is_travelling").hide();
        });
        $('.datepicker-from-today').datepicker({
          format: 'mm-dd-yyyy',
          autoclose: true,
          todayHighlight: true,
          startDate: new Date()
        });
        $('.appointment-datepicker').datepicker({
          format: 'mm-dd-yyyy',
          autoclose: true,
          todayHighlight: true,
          startDate: new Date(),
          daysOfWeekDisabled: [0, 6]
        }).on('changeDate', function(ev){
            //var id = $(this).attr('id');
            //const myArray = id.split("-");
            $.ajax({
              type: "get",
              url: "{{ route('covid.appointment.time') }}",
              dataType: "json",
              data: {app_date:$(this).val()},
              async: false,
              success: function (response){
                if (response.success == true) {
                  $('#app_time').html(response.html);
                }
              }
            });
        });
        $('.datetimepicker').datetimepicker({
            format: 'hh:mm A',
            stepping: 15,
            disabledTimeIntervals: [
                [moment().hour(0).minutes(0), moment().hour(8).minutes(59)],
                [moment().hour(16).minutes(30), moment().hour(24).minutes(0)]
            ]
        });
        jQuery.validator.addMethod("lettersonly", function(value, element) {
            return this.optional(element) || /^[a-z]+$/i.test(value);
        }, "Only alphabetical characters"); 
        jQuery.validator.addMethod("phoneonly", function(value, element) {
              return this.optional(element) || /^([0-9\-\+\(\)]*)$/.test(value);
          }, "Invalid phone number");
        jQuery.validator.addMethod("emailonly", function(value, element) {
             return this.optional(element) || /^[a-zA-Z0-9._-]+@[a-zA-Z0-9.-]+\.[a-zA-Z]{2,4}$/i.test(value);
            }, "Please enter valid email address!"); 
        });
        jQuery.validator.addMethod("dob", function(value, element) {
              var today = new Date();
              var dd = String(today.getDate());
              var mm = String(today.getMonth() + 1); //January is 0!
              var yyyy = today.getFullYear();
              var dobm = $('.dobm').val();
              var dobd = $('.dobd').val();
              var doby = $('.doby').val();
              var today = new Date(yyyy, mm, dd).getTime();
              var selected = new Date(doby, dobm, dobd).getTime();
              today = yyyy + '-' + mm + '-' + dd;
              var date = new Date(today);
              newtest = doby + '-' + dobm + '-' + dobd;
              var newtest = new Date(newtest).getTime();
              today = yyyy + '-' + mm + '-' + dd;
              var today = new Date(today).getTime();
              if (newtest >= today) {
                return false;
              }else{
                return true;
              }              
          }, "Date of birth must be past date");  
      $.validator.addMethod("checkappointmentdate", function (value, element) {
        var isFound = false;
        var app_time = $('#app_time').val();
        $.ajax({
            type: "POST",
            url: "{{ route('appointmentAlreadyRegistered') }}",
            dataType: "json",
            data: { _token: "{{ csrf_token() }}",app_time:app_time,app_date:value,type:2 },
            async: false,
            success: function (response)
            {
                // if the email address does not exists, it returns a string "true"
                if (response.msg == true) {
                    isFound = false;
                } else {
                    isFound = true;
                }
            }
        })
        return isFound;
    }, "Appointment is Already Taken");
    $.validator.addMethod("checkappointmenttime", function (value, element) {
        var isFound = false;
        var app_date = $('#app_date').val();
        $.ajax({
            type: "POST",
            url: "{{ route('appointmentAlreadyRegistered') }}",
            dataType: "json",
            data: { _token: "{{ csrf_token() }}",app_time:value,app_date:app_date,type:2 },
            async: false,
            success: function (response)
            {
                // if the email address does not exists, it returns a string "true"
                if (response.msg == true) {
                    isFound = false;
                } else {
                    isFound = true;
                }
            }
        })
        return isFound;
    }, "Appointment is Already Taken");      
</script>
@stop