From d66e72172eec420e9c79d034ad1feb6c863ca349 Mon Sep 17 00:00:00 2001
From: Tanuja Pansare <tanuja@stratawiz.com>
Date: Mon, 20 Jul 2026 13:44:48 +0530
Subject: [PATCH] Add COPD POB units form

---
 ...0572-2331-4f7a-98a2-12915e09735e.blade.php | 375 ++++++++++++++++++
 1 file changed, 375 insertions(+)
 create mode 100644 resources/views/form/rapport-copd/1784530104-4d4b0572-2331-4f7a-98a2-12915e09735e.blade.php

diff --git a/resources/views/form/rapport-copd/1784530104-4d4b0572-2331-4f7a-98a2-12915e09735e.blade.php b/resources/views/form/rapport-copd/1784530104-4d4b0572-2331-4f7a-98a2-12915e09735e.blade.php
new file mode 100644
index 00000000..c13dcb3a
--- /dev/null
+++ b/resources/views/form/rapport-copd/1784530104-4d4b0572-2331-4f7a-98a2-12915e09735e.blade.php
@@ -0,0 +1,375 @@
+<!DOCTYPE html>
+<html lang="en">
+<head>
+    @include('layouts.shared/title-meta', ['title' => "Form"])
+    @include('layouts.shared/head-css', ["mode" => $mode ?? '', "demo" => $demo ?? ''])
+    <link href="{{asset('assets/libs/sweetalert2/sweetalert2.min.css')}}" rel="stylesheet" type="text/css" />
+</head>
+<div id="pageloader">
+   <img src="http://cdnjs.cloudflare.com/ajax/libs/semantic-ui/0.16.1/images/loader-large.gif" alt="processing..." />
+</div>
+@php
+$brandData = [
+    [
+        'brand' => 'Voltido Trio',
+        'slug' => 'voltido_trio_units'
+    ],
+    [
+        'brand' => 'Duolin Synchrobreathe',
+        'slug' => 'duolin_synchrobreathe_units'
+    ],
+    [
+        'brand' => 'Voltido 200 Rotacaps',
+        'slug' => 'voltido_200_rotacaps_units'
+    ],
+    [
+        'brand' => 'Voltido 100 Ciphaler',
+        'slug' => 'voltido_100_ciphaler_units'
+    ]
+];
+@endphp
+<body class="loading">
+    <div class="account-pages">
+        <div class="container">
+            <div class="row justify-content-center">
+                <div class="col-md-8 col-lg-6 col-xl-5 p-0">
+                    <div class="card bg-pattern">
+                        <div class="card-body p-3 row">
+
+                            @if(Session::has('error'))<div class="alert alert-danger">{{Session::get('error')}}</div>
+                            <br>@endif
+                            @if(session('success'))<div class=" alert alert-success">{{ session('success') }}
+                            </div>
+                            <br>@endif
+                            <div class="col-8">
+                                <h4 class="page-title">{{$form->title}}</h4>
+                            </div>
+                            @if(!isset($form->is_approval) || (isset($form->is_approval) && $form->is_approval != 'yes' ) )
+                            <div class="col-4">
+                                @if($form->link_type == 'form')
+                                <a href="/form/history" class="float-end pt-1">View History</a>
+                                @else
+                                <a href="{{url()->previous()}}" class="float-end pt-1">Back</a>
+                                @endif
+                            </div>
+                            @endif
+                            @if(isset($form->user_info))
+                            <div class="col-12">
+                                <h6>Submitted By: {{$form->user_info->name}}</h6>
+                            </div>
+                            @endif
+                            <form method="POST" action="/form/submit" id="report-form" enctype="multipart/form-data">
+                                <input type="hidden" name="form_id" value="{{$form_id}}">
+                                @csrf
+                                @if($id)
+                                <input type="hidden" name="id" value="{{$id}}">
+                                @endif
+                                @if(isset($form->manager_can_submit) && $form->manager_can_submit == true)
+                                <div class="col-md-12 mb-2">
+                                    <label for="field-user_id" class="form-label"> Select User / Territory <span class="text-danger">*</span> </label>
+                                    <select class="form-control" id="field-user_id" name="user_id" required>
+                                        <option value=""> -- Select -- </option>
+                                        @foreach($form->users as $option)
+                                        <option value="{{$option->value}}" hierarchy="{{$option->hierarchy_id}}" {{isset($question->value) && $question->value == $option->value ? 'selected':''}}>{{$option->display}}</option>
+                                        @endforeach
+                                    </select>
+                                    <input type="hidden" id="field-hierarchy_id" name="hierarchy_id" value="">
+                                </div>
+                                @endif
+
+                                @foreach($questions as $question)
+                                    <div class="col-md-12 mb-2">
+                                    <label for="field-{{$question->code}}" class="form-label">{{$question->question}} {!!$question->required == 'yes' ? '<span class="text-danger">*</span>':''!!} </label>
+                                    @switch($question->type)
+                                        @case('hidden')
+                                            <input type="{{$question->type}}" id="field-{{$question->code}}" name="{{$question->code}}" value="{{isset($question->value)?$question->value:''}}">
+                                            @break
+                                        @case('text')
+                                        @case('email')
+                                        @case('tel')
+                                        @case('date')
+                                            <input type="{{$question->type}}" id="field-{{$question->code}}" name="{{$question->code}}" class="form-control" {{$question->required == 'yes'?'required':'' }} value="{{isset($question->value)?$question->value:''}}">
+                                            @break
+                                        @case('number')
+                                            <input type="{{$question->type}}" min="0" max="9999999999" step="1" id="field-{{$question->code}}" name="{{$question->code}}" class="form-control" {{$question->required == 'yes'?'required':'' }}  value="{{isset($question->value)?$question->value:0}}">
+                                            @break
+                                        @case('textarea')
+                                            <textarea id="field-{{$question->code}}" name="{{$question->code}}" class="form-control" {{$question->required == 'yes'?'required':'' }}>{{isset($question->value)?$question->value:''}}</textarea>
+                                            @break
+                                        @case('dropdown')
+                                            <select class="form-control" id="field-{{$question->code}}" name="{{$question->code}}" {{$question->required == 'yes'?'required':'' }}>
+                                                <option value=""> -- Select -- </option>
+                                                @foreach($question->options as $option)
+                                                <option value="{{$option->value}}" {{isset($question->value) && $question->value == $option->value ? 'selected':''}}>{{$option->display}}</option>
+                                                @endforeach
+                                            </select>
+                                            @break
+                                        @case('radio')
+                                            @foreach($question->options as $option)
+                                            <div class="form-check mb-2 form-check-success">
+                                                <input class="form-check-input" type="radio" name="{{$question->code}}" id="field-{{$question->code}}_{{$option->value}}" value="{{$option->value}}">
+                                                <label class="form-check-label" for="field-{{$question->code}}_{{$option->value}}">{{$option->display}}</label>
+                                            </div>
+                                            @endforeach
+                                            @break
+                                        @case('radiometrix')
+                                            @php
+                                                // Decode the first option's value to use as heading labels
+                                                $headings =
+                                                    count($question->options) > 0
+                                                        ? json_decode($question->options[0]->value)
+                                                        : [];
+                                            @endphp
+
+                                            {{-- Matrix Wrapper with Horizontal Scroll on Small Screens --}}
+                                            <div class="table-responsive">
+                                                <div class="d-table w-100">
+                                                    {{-- Table Headers --}}
+                                                    <div class="d-table-row font-weight-bold">
+                                                        <div class="d-table-cell p-2" style="width: 150px;"></div>
+                                                        {{-- Placeholder for row labels --}}
+                                                        @foreach ($headings as $head)
+                                                            <div class="d-table-cell text-center p-2">{{ $head }}
+                                                            </div>
+                                                        @endforeach
+                                                    </div>
+
+                                                    {{-- Table Rows --}}
+                                                    @foreach ($question->options as $option)
+                                                        @php $nn = json_decode($option->value); @endphp
+                                                        <div class="d-table-row align-middle">
+                                                            <div class="d-table-cell font-weight-bold p-2"
+                                                                style="width: 150px;">
+                                                                {{ $option->display }}
+                                                            </div>
+
+                                                            @foreach ($nn as $value)
+                                                                <div class="d-table-cell text-center p-2">
+                                                                    <input type="radio"
+                                                                id="field-{{ $option->display }}-{{ $value }}"
+                                                                name="{{ $question->code }}[{{$option->display}}]" value="{{$value}}" class="form-check-input"
+                                                                {{ isset($question->display) && $option->display != $option->display ? 'checked' : '' }}>
+
+                                                                </div>
+                                                            @endforeach
+                                                        </div>
+                                                    @endforeach
+                                                </div>
+                                            </div>
+                                        @break    
+                                        @case('checkbox')
+                                            @foreach($question->options as $option)
+                                            <div class="form-check mb-2 form-check-primary ms-2">
+                                                <input class="form-check-input" type="checkbox" id="field-{{$question->code}}-{{$option->value}}" name="{{$question->code}}[]" value="{{$option->value}}" {{isset($question->value) && $question->value != '' && in_array($option->value, $question->value) ? 'checked':''}}>
+                                                <label class="form-check-label" for="field-{{$question->code}}-{{$option->value}}">{{$option->display}}</label>
+                                            </div>
+                                            @endforeach
+                                            @break
+                                        @case('file')
+                                        @if(!isset($form->is_approval) || (isset($form->is_approval) && $form->is_approval != 'yes' ) )
+                                             <input type="file" id="field-{{$question->code}}" name="{{$question->code}}" class="form-control" value="" {{$question->required == 'yes'?'required':'' }}>
+                                        @elseif(isset($question->value))
+                                             <img src="{{$question->value}}" class="img-fluid">
+                                        @endif
+                                           
+                                            @break
+                                        @case('multitextbox')
+
+<div class="table-responsive">
+
+<table class="table table-bordered">
+
+    <thead class="table-light">
+        <tr>
+            <th width="70%">Brand</th>
+            <th width="30%">POB Units</th>
+        </tr>
+    </thead>
+
+    <tbody>
+
+    @foreach($brandData as $brand)
+
+        <tr>
+
+            <td>{{ $brand['brand'] }}</td>
+
+            <td>
+
+                <input
+                    type="number"
+                    min="0"
+                    step="1"
+                    class="form-control pob-unit"
+                    id="field-{{ $brand['slug'] }}"
+                    name="{{ $brand['slug'] }}"
+                    value="{{ $id && isset($formdata->{$brand['slug']}) ? $formdata->{$brand['slug']} : 0 }}"
+                >
+
+            </td>
+
+        </tr>
+
+    @endforeach
+
+    <tr class="table-secondary">
+
+        <th>Total POB Units</th>
+
+        <th>
+
+            <input
+                type="number"
+                id="field-total_pob_units"
+                name="total_pob_units"
+                class="form-control"
+                readonly
+                value="{{ $id && isset($formdata->total_pob_units) ? $formdata->total_pob_units : 0 }}"
+            >
+
+        </th>
+
+    </tr>
+
+    </tbody>
+
+</table>
+
+</div>
+
+@break
+                                    @endswitch
+                                    </div>
+                                @endforeach
+                                @if(!isset($form->is_approval) || (isset($form->is_approval) && $form->is_approval != 'yes' ) )
+                                <div class="text-center d-grid mt-3">
+                                    <button class="btn btn-primary" type="submit" id="submit-btn"> Submit </button>
+                                </div>
+                                @endif
+                            </form>
+
+                        </div> <!-- end card-body -->
+                    </div>
+                    <!-- end card -->
+
+                    <!-- end row -->
+
+                </div> <!-- end col -->
+            </div>
+            <!-- end row -->
+        </div>
+        <!-- end container -->
+    </div>
+    <!-- end page -->
+<style type="text/css">
+#pageloader {
+  background: rgba( 255, 255, 255, 0.8 );
+  display: none;
+  height: 100%;
+  position: fixed;
+  width: 100%;
+  z-index: 9999;
+}
+
+#pageloader img {
+  left: 50%;
+  margin-left: -32px;
+  margin-top: -32px;
+  position: absolute;
+  top: 50%;
+}
+.form-label {
+    font-weight:bold;
+    font-size:16px;
+}
+</style>
+@include('layouts.shared/footer-script')
+<script src="{{asset('assets/libs/sweetalert2/sweetalert2.min.js')}}"></script>
+<script type="text/javascript">
+    jQuery(document).ready(function($){
+        $('#field-user_id').change(function(){
+            let hierarchy = $('option:selected', this).attr('hierarchy');
+            $('#field-hierarchy_id').val(hierarchy)
+            event.preventDefault();
+            $.ajax({
+                type: "GET",
+                url: '/form/getdoctorlist?partition={{$form->partition}}&hierarchy='+hierarchy,
+                processData: false,
+                contentType: false,
+                success: function( data ) {
+                    $("#pageloader").fadeOut();
+                    $('#field-contact_id').html('')
+                    $('#field-contact_id').append($("<option></option>").attr("value",'').text('-- Select --'));
+                    for(let itm of data) {
+                        $('#field-contact_id').append($("<option></option>").attr("value",itm.value).text(itm.display));
+                    }                    
+                },
+            });
+
+            console.log(hierarchy)
+        })
+
+        $('#report-form').on('submit', function(event){
+            event.preventDefault();
+            $("#pageloader").fadeIn();
+            $.ajax({
+                type: "POST",
+                url: '/form/ajaxsubmit',
+                data: new FormData($('#report-form')[0]),
+                processData: false,
+                contentType: false,
+                success: function( data ) {
+                    $("#pageloader").fadeOut();
+                    if(data.status == 'success') {
+                        Swal.fire({
+                          title: 'Great!',
+                          text: 'Your data is successfully submitted!',
+                          icon: 'success'
+                        })
+                        $('#report-form').trigger("reset");
+                    } else {
+                        Swal.fire({
+                            icon: 'error',
+                            title: data.hasOwnProperty('message') ? 'You are not mapped to any position code' : 'Data not submitted',
+                            text: data.hasOwnProperty('message') ? 'for resolution please email Position code, L1 Manager and L2 Manager details to support1@stratawiz.com':'Something went wrong, please try again after some time!'
+                        })
+                    }
+                },
+            });
+        });
+        
+        $(document).on('input', '.pob-unit', function () {
+
+    let total = 0;
+
+    $('.pob-unit').each(function () {
+
+        total += parseInt($(this).val()) || 0;
+
+    });
+
+    $('#field-total_pob_units').val(total);
+
+});
+
+$(document).on('input', '.pob-unit', function () {
+
+    this.value = this.value.replace(/[^0-9]/g,'');
+
+});
+$('#field-total_pob_units').attr('readonly', true);
+
+            var today = new Date();
+            var dd = String(today.getDate()).padStart(2, '0');
+            var mm = String(today.getMonth() + 1).padStart(2, '0');
+            var yyyy = today.getFullYear();
+            today = yyyy + '-' + mm + '-' + dd;
+
+            var plandateField = document.getElementById('field-record_date');
+
+            plandateField.setAttribute('min', today);
+    });
+</script>
+</body>
+
+</html>
\ No newline at end of file