@extends('layouts.vertical', ['page_title' => 'Edit'])

@section('css')
    <link href="{{ URL::asset('assets/libs/flatpickr/flatpickr.min.css')}}" rel="stylesheet" type="text/css" />
    <link href="{{ URL::asset('assets/libs/dropify/dropify.min.css')}}" rel="stylesheet" type="text/css" />
@endsection
@section('content')
<!-- Start Content-->
<div class="container-fluid">
    <form method="post" id="form-availiblity" enctype="multipart/form-data">
    <!-- start page title -->
    <div class="row">
        <div class="col-12">
            <div class="page-title-box">
                <div class="page-title-right">
                    <button type="submit" class="btn btn-secondary float-right">Submit</button>         
                </div>
                <h4 class="page-title">{{$item['request_type']}}</h4>
            </div>
        </div>
    </div>     
    <!-- end page title -->
@if(session()->has('message'))
    <div class="alert alert-success">
        {{ session()->get('message')}}
    </div>
@endif
    <div class="row">
        <div class="col-xl-12">
            <div class="card">
                <div class="card-body">
                    @csrf
                    <div class="row">
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="emp_id">Emp ID of TM</label>
                                <input type="text" id="emp_id" name="emp_id" class="form-control" value="{{$item['emp_id']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="emp_name">Name of TM</label>
                                <input type="text" id="emp_name" name="emp_name" class="form-control" value="{{$item['emp_name']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="emp_phone">TM Mobile Number</label>
                                <input type="text" id="emp_phone" name="emp_phone" class="form-control" value="{{$item['emp_phone']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="emp_email">TM Email ID</label>
                                <input type="text" id="emp_email" name="emp_email" class="form-control" value="{{$item['emp_email']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="abm_name">ABM Name</label>
                                <input type="text" id="abm_name" name="abm_name" class="form-control" value="{{$item['abm_name']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="rbm_name">RBM Name</label>
                                <input type="text" id="rbm_name" name="rbm_name" class="form-control" value="{{$item['rbm_name']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="msl_code">MSL CODE of Dr</label>
                                <input type="text" id="msl_code" name="msl_code" class="form-control" value="{{$item['msl_code']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="request_letter">Upload Request Letter</label>
                                <input type="file" id="request_letter" name="request_letter" class="form-control" value="{{$item['request_letter']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="patient_name">Patient Name</label>
                                <input type="text" id="patient_name" name="patient_name" class="form-control" value="{{$item['emp_id']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="patient_phone">Patient Mobile Number</label>
                                <input type="text" id="patient_phone" name="patient_phone" class="form-control" value="{{$item['patient_phone']}}">
                            </div>
                        </div>

                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="doctor_name">Dr Name</label>
                                <input type="text" id="doctor_name" name="doctor_name" class="form-control" value="{{$item['doctor_name']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="doctor_phone">Doctor Mobile Number</label>
                                <input type="text" id="doctor_phone" name="doctor_phone" class="form-control" value="{{$item['doctor_phone']}}">
                            </div>
                        </div>
                        
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="doctor_speciality">Speciality</label>
                                <input type="text" id="doctor_speciality" name="doctor_speciality" class="form-control" value="{{$item['doctor_speciality']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="no_of_nebulizer">No of Nebulizer</label>
                                <input type="text" id="no_of_nebulizer" name="no_of_nebulizer" class="form-control" value="{{$item['no_of_nebulizer']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="value_of_parcel">Value of the Parcel</label>
                                <input type="text" id="value_of_parcel" name="value_of_parcel" class="form-control" value="{{$item['value_of_parcel']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="team">Team</label>
                                <input type="text" id="team" name="team" class="form-control" value="{{isset($item['team']) ? $item['team'] : ''}}">
                            </div>
                        </div>

                        @if($item['request_type'] != 'Cipla to Doctor')
                        <div class="col-md-12">
                            <h5>Pickup Address</h5>
                        </div>
                        
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="pickup_type">Clinic / Hospital / Home Name</label>
                                <input type="text" id="pickup_type" name="pickup_type" class="form-control" value="{{$item['pickup_type']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="pickup_building">Building Name </label>
                                <input type="text" id="pickup_building" name="pickup_building" class="form-control" value="{{$item['pickup_building']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="pickup_line_1">Address line 1</label>
                                <input type="text" id="pickup_line_1" name="pickup_line_1" class="form-control" value="{{$item['pickup_line_1']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="pickup_line_2">Address line 2</label>
                                <input type="text" id="pickup_line_2" name="pickup_line_2" class="form-control" value="{{$item['pickup_line_2']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="pickup_landmark">Landmark</label>
                                <input type="text" id="pickup_landmark" name="pickup_landmark" class="form-control" value="{{$item['pickup_landmark']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="pickup_state">State</label>
                                <input type="text" id="pickup_state" name="pickup_state" class="form-control" value="{{$item['pickup_state']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="pickup_city">City</label>
                                <input type="text" id="pickup_city" name="pickup_city" class="form-control" value="{{$item['pickup_city']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="pickup_pin_code">Pin Code</label>
                                <input type="text" id="pickup_pin_code" name="pickup_pin_code" class="form-control" value="{{$item['pickup_pin_code']}}">
                            </div>
                        </div>
                        @endif
                        <div class="col-md-12">
                            <h5>Drop Address</h5>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="address_type">Clinic / Hospital / Home Name</label>
                                <input type="text" id="address_type" name="address_type" class="form-control" value="{{$item['address_type']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="address_building">Building Name </label>
                                <input type="text" id="address_building" name="address_building" class="form-control" value="{{$item['address_building']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="address_line_1">Address line 1</label>
                                <input type="text" id="address_line_1" name="address_line_1" class="form-control" value="{{$item['address_line_1']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="address_line_2">Address line 2</label>
                                <input type="text" id="address_line_2" name="address_line_2" class="form-control" value="{{$item['address_line_2']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="address_landmark">Landmark</label>
                                <input type="text" id="address_landmark" name="address_landmark" class="form-control" value="{{$item['address_landmark']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="address_state">State</label>
                                <input type="text" id="address_state" name="address_state" class="form-control" value="{{$item['address_state']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="address_city">City</label>
                                <input type="text" id="address_city" name="address_city" class="form-control" value="{{$item['address_city']}}">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="address_pin_code">Pin Code</label>
                                <input type="text" id="address_pin_code" name="address_pin_code" class="form-control" value="{{$item['address_pin_code']}}">
                            </div>
                        </div>
                </div> <!-- end card-body -->
            </div> <!-- end card-->
        </div> <!-- end col -->

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

@endsection

@section('script')
    <script src="{{ URL::asset('assets/libs/flatpickr/flatpickr.min.js')}}"></script>
    <script src="{{ URL::asset('assets/libs/dropify/dropify.min.js')}}"></script>
    <script type="text/javascript">
        $(document).ready(function(){
            $('.date-picker').flatpickr();
            $('.datetime-picker').flatpickr({
                enableTime: true,
                dateFormat: "Y-m-d H:i"
            });
            $('.dropify').dropify({
                messages: {
                    'default': 'Drag and drop a file here or click',
                    'replace': 'Drag and drop or click to replace',
                    'remove': 'Remove',
                    'error': 'Ooops, something wrong appended.'
                },
                error: {
                    'fileSize': 'The file size is too big (1MB max).'
                }
            });
        });
    </script>
@endsection