@extends('admin.layouts.contentLayoutMaster')

@section('title','Patient Edit')
@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.update', ['id' => \App\Helpers\Helper::encrypt($editdata->order_id)])}}" method="post" id="form">
                      {{ csrf_field() }}
                      <div class="row">
                        <div class="input-field col s12">
                            <input id="fname" type="text" name="fname" value="{{$editdata->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="{{$editdata->mname}}" maxlength="10">
                            <label for="mname">Middle Name<span class="red-text">*</span></label>
                        </div>
                      </div>
                      <div class="row">
                        <div class="input-field col s12">
                          <input id="lname" type="text" name="lname" value="{{$editdata->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" {{$editdata->gender == 1 ? 'checked' : ''}}/>
                            <span>Male</span>
                          </label>
                        </p>
                      </div>
                      <div class="input-field col s12">
                        <p>
                          <label>
                            <input name="gender" type="radio" value="2" {{$editdata->gender == 2 ? 'checked' : ''}} {{$editdata->gender != 1 ? 'checked' : ''}}/>
                            <span>Female</span>
                          </label>
                        </p>
                      </div>
                      </div>
                      <div class="row">
                        <div class="input-field col s12 m4">
                          <select name="dobm" class="dobm">
                            <option value="" disabled selected>Choose Month</option>
                            @for($m=1;$m<=12;$m++)
                                @if($m < 10)
                                @php
                                $m = '0'.$m;
                                @endphp
                                @endif
                                <option value="{{$m}}" {{$editdata->dobm == $m ? 'selected' : ''}}>{{date('F', mktime(0, 0, 0, $m, 1))}}</option>
                            @endfor
                          </select>
                          <label>Date Of Birth<span class="red-text">*</span></label>
                        </div>
                        <div class="input-field col s12 m4">
                          <select name="dobd" class="dobd">
                            <option value="" disabled selected>Choose Date</option>
                            @for($d=1;$d<=31;$d++)
                                @if($d < 10)
                                @php
                                $d = '0'.$d;
                                @endphp
                                @endif
                                <option value="{{$d}}" {{$editdata->dobd == $d ? 'selected' : ''}}>{{$d}}</option>
                            @endfor 
                          </select>
                        </div>
                        <div class="input-field col s12 m4">
                          <select name="doby" class="doby">
                            <option value="" disabled selected>Choose Year</option>
                            @for($y=1950;$y<=2022;$y++)
                                <option value="{{$y}}" {{$editdata->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="{{$editdata->phno}}" maxlength="12">
                          <label for="phno">Phone No.<span class="red-text">*</span></label>
                        </div>
                      </div>
                      <div class="row">
                        <div class="input-field col s12">
                          <input id="email" type="text" name="email" value="{{$editdata->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" {{$editdata->idtype == 1 ? 'checked' : ''}}/>
                              <span>Driving Licence</span>
                            </label>
                          </p>
                        </div>
                        <div class="input-field col s12">
                          <p>
                            <label>
                              <input name="idtype" type="radio" value="2" {{$editdata->idtype == 2 ? 'checked' : ''}} {{$editdata->idtype != 1 ? 'checked' : ''}}/>
                              <span>Passport Number<span class="red-text">*</span></span>
                            </label>
                          </p>
                        </div>
                      </div>                      
                      <div class="row">
                        <div class="input-field col s12">
                          <input id="id_number" type="text" name="id_number" value="{{$editdata->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="{{$editdata->travel_agent}}">
                          <label for="travel_agent">Referring Travel agent or Airline<span class="red-text">*</span></label>
                        </div>
                      </div>
                      <div class="row">
                        <div class="input-field col s12">
                          <textarea class="materialize-textarea" name="address">{{$editdata->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="{{$editdata->state}}">
                          <label for="state">State<span class="red-text">*</span></label>
                        </div>
                      </div>
                      <div class="row">
                        <div class="input-field col s12">
                          <input id="city" type="text" name="city" value="{{$editdata->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="{{$editdata->zipcode}}">
                          <label for="zipcode">Zipcode<span class="red-text">*</span></label>
                        </div>
                      </div>
                      <div class="row" style="display:none;">                     
                      <div class="input-field col s12">
                        <p>
                          <label>
                            <input name="travelling" class="travelling" type="radio" value="1" {{$editdata->travelling == 1 ? 'checked' : ''}} {{$editdata->travelling != 2 ? 'checked' : ''}}/>
                            <span>No</span>
                          </label>
                        </p>
                      </div>
                      <div class="input-field col s12">
                        <p>
                          <label>
                            <input name="travelling" class="exposed"  type="radio" value="2" {{$editdata->travelling == 2 ? 'checked' : ''}} />
                            <span>Yes</span>
                          </label>
                        </p>
                      </div>
                      </div>
                      @if($editdata->expsymp == 1)
                      @php
                      $show = "display:block;";
                      @endphp
                      @else
                      @php
                      $show = "display:none;";
                      @endphp
                      @endif
                      <div>
                      <label>Are you currently experiencing any of the following? fever, cough, shortness of breath, the new loss of taste or smell or any other COVID-19 symptoms?</label>
                      <div class="row">                      
                      <div class="input-field col s12">
                        <p>
                          <label>
                            <input class="expsymp-yes" name="expsymp" type="radio" value="1" {{$editdata->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" {{$editdata->expsymp == 2 ? 'checked' : ''}} {{$editdata->expsymp != 1 ? 'checked' : ''}}/>
                            <span>No</span>
                          </label>
                        </p>
                      </div>
                      </div>
                      <div class="div_is_travelling" style="{{$show}}">
                      <label>Which of the following COVID symptoms are you experiencing?</label>
                      <div class="row">                        
                        <div class="input-field col s12">
                        <p>
                          <label>
                            <input name="fever" type="checkbox" value="1" {{$editdata->fever == 1 ? 'checked' : ''}}/>
                            <span>Fever</span>
                          </label>
                        </p> 
                        </div>
                        <div class="input-field col s12">                       
                          <p>
                            <label>
                              <input name="headache" type="checkbox" value="1" {{$editdata->headache == 1 ? 'checked' : ''}}/>
                              <span>Headache</span>
                            </label>
                          </p> 
                          </div>
                          <div class="input-field col s12">                       
                            <p>
                            <label>
                              <input name="vomit" type="checkbox" value="1" {{$editdata->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" {{$editdata->diarrhoea == 1 ? 'checked' : ''}}/>
                              <span>Diarrhoea</span>
                            </label>
                          </p>
                          </div>
                          <div class="input-field col s12">                        
                            <p>
                            <label>
                              <input name="chills" type="checkbox" value="1" {{$editdata->chills == 1 ? 'checked' : ''}}/>
                              <span>Chills</span>
                            </label>
                          </p>
                        </div>
                        <div class="input-field col s12">
                          <p>
                          <label>
                            <input name="fatigue" type="checkbox" value="1" {{$editdata->fatigue == 1 ? 'checked' : ''}}/>
                            <span>Fatigue</span>
                          </label>
                        </p>  
                        </div>
                        <div class="input-field col s12">                      
                          <p>
                            <label>
                              <input name="bodyache" type="checkbox" value="1" {{$editdata->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" {{$editdata->losmell == 1 ? 'checked' : ''}}/>
                              <span>Loss of smell or taste</span>
                            </label>
                          </p> 
                          </div>
                          <div class="input-field col s12">                       
                            <p>
                            <label>
                              <input name="sbreath" type="checkbox" value="1" {{$editdata->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" {{$editdata->cough == 1 ? 'checked' : ''}}/>
                              <span>Cough</span>
                            </label>
                          </p>
                        </div>
                        <div class="input-field col s12">
                          <p>
                          <label>
                            <input name="cpain" type="checkbox" value="1" {{$editdata->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" {{$editdata->nscovid == 1 ? 'checked' : ''}}/>
                              <span>near someone with COVID</span>
                            </label>
                          </p> 
                          </div>                    
                      </div>
                      </div>
                      <label>Have you been exposed to a known COVID-19 positive individual in the last 14 days?</label>
                      <div class="row">                      
                      <div class="input-field col s12">
                        <p>
                          <label>
                            <input name="covexposed" type="radio" value="1" {{$editdata->covexposed == 1 ? 'checked' : ''}}/>
                            <span>Yes</span>
                          </label>
                        </p>
                      </div>
                      <div class="input-field col s12">
                        <p>
                          <label>
                            <input name="covexposed" type="radio" value="2" {{$editdata->covexposed == 2 ? 'checked' : ''}} {{$editdata->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="{{isset($editdata->covtestdate) ? date("m-d-Y", strtotime($editdata->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="{{isset($editdata->sympdate) ? date("m-d-Y", strtotime($editdata->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",
          app_time: "required",
          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",
          todayHighlight: true
        });
        $(".expsymp-yes").click(function () {
        $(".div_is_travelling").toggle();
        $('html, body').animate({
            scrollTop: $("#zipcode").offset().top
        });
        });
        $(".expsymp-no").click(function () {
        $(".div_is_travelling").hide();
        });
        jQuery.validator.addMethod("lettersonly", function(value, element) {
            return this.optional(element) || /^[a-z]+$/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"); 
        
    });
  $(".dobm, .dobd, .doby").change(function() {
    var dobm = $('.dobm').val();
    var dobd = $('.dobd').val();
    var doby = $('.doby').val();
    //alert(dobm);
    var today = new Date();
    var dd = String(today.getDate());
    var mm = String(today.getMonth() + 1); //January is 0!
    var yyyy = today.getFullYear();
    if(dd < 10)
    {
      dd = "0"+dd;
    }
    if(mm < 10)
    {
      mm = "0"+mm;
    }
    today = mm + '/' + dd + '/' + yyyy;
    var selected = dobm + '/' + dobd + '/' + doby;
    if (selected == today) {
        $('.dobm').val('');
        $('.dobd').val('');
        $('.doby').val('');
        $('.dob-error').text('Date of birth must be past date');
    }
});
</script>
@stop