@extends('admin.layouts.app')

@section('title', 'Create Cancer Center')

@section('content')
<!-- ============================================================== -->
<!-- Page wrapper  -->
<!-- ============================================================== -->
<div class="page-wrapper">
    <!-- ============================================================== -->
    <!-- Container fluid  -->
    <!-- ============================================================== -->
    <div class="container-fluid">
        <!-- ============================================================== -->
        <!-- Bread crumb and right sidebar toggle -->
        <!-- ============================================================== -->
        <div class="row page-titles">
            <div class="col-md-5 align-self-center">
                <h4 class="text-themecolor">Create Cancer Center</h4>
            </div>
            <div class="col-md-7 align-self-center text-end">
                <div class="d-flex justify-content-end align-items-center">
                    <ol class="breadcrumb">
                        <li class="breadcrumb-item"><a href="{{ url('admin/dashboard') }}">Home</a></li>
                        <li class="breadcrumb-item active newRedCommonColor">Create Cancer Center</li>
                    </ol>
                    <!-- <button type="button" class="btn btn-info d-none d-lg-block m-l-15 text-white"><i class="fa fa-plus-circle"></i> Create New</button> -->
                </div>
            </div>
        </div>
        <!-- ============================================================== -->
        <!-- End Bread crumb and right sidebar toggle -->
        <!-- ============================================================== -->
        <!-- ============================================================== -->
        <!-- Info box -->
        <!-- ============================================================== -->
        <div class="row g-0">
            <div class="card border">
                <div class="card-body">
                    <form id="create-patient-form" method="POST" action="{{ route('cancer.center.store') }}" enctype="multipart/form-data">
                        @csrf
                        <div class="mb-3">
                            <label for="name" class="form-label">Name</label>
                            <input type="text" class="form-control" id="name" name="name" value="{{old('name')}}" placeholder="Enter Cancer Center name" required>
                        </div>

                        <!-- <div class="mb-3">
                            <label for="domain_name" class="form-label">Domain Name</label>
                            <input type="text" class="form-control" id="domain_name" name="domain_name" value="{{old('domain_name')}}" placeholder="Enter domain name" required>
                        </div> -->
                        
                        <!-- <div class="mb-3">
                            <label for="domain_url" class="form-label">Domain Url</label>
                            <input type="url" class="form-control" id="domain_url" name="domain_url" value="{{old('domain_url')}}" placeholder="Enter domain url" required>
                        </div> -->

                        <!-- <div class="mb-3">
                            <label for="country" class="form-label">Domain Location</label>
                            <select class="form-select" required name="country">
                                <option value="">Select country</option>
                                @php $countryList = App\Models\Country::all(); @endphp
                                @foreach($countryList as $country)
                                    <option value="{{$country->id}}">{{$country->name}}</option>                                
                                @endforeach
                            </select>
                        </div>

                        <div class="mb-3">
                            <select class="form-select" name="state">
                                <option value="">Select state</option>
                            </select>
                        </div>
                        
                        <div class="mb-3">
                            <select class="form-select" name="city">
                                <option value="">Select city</option>
                            </select>
                        </div> -->

                        <!-- <div class="mb-3">
                            <label for="is_active">Domain Is Active ?</label>
                            <div class="form-check form-check-inline">
                            <input class="form-check-input" type="radio" id="is_active_yes" name="is_active" value="1" required>
                            <label class="form-check-label" for="is_active_yes">Yes</label>
                            </div>
                            <div class="form-check form-check-inline">
                            <input class="form-check-input" type="radio"
                            id="is_active_no" name="is_active" value="0" required>
                            <label class="form-check-label" for="is_active_no">No</label>
                            </div>
                        </div> -->

                        <div class="mb-3">
                            <label for="domain_url" class="form-label">Login email</label>
                            <input type="email" name="login_email" required class="form-control">
                        </div>

                        <div class="text-start">
                            <button type="submit" class="btn btn-primary">Save</button>
                            <a href="{{ route('cancer.center.list') }}" class="btn btn-danger">Cancel</a>
                        </div>
                    </form>
                </div>
            </div>
        </div>
        <!-- ============================================================== -->
        <!-- End Info box -->
        <!-- ============================================================== -->
    </div>
    <!-- ============================================================== -->
    <!-- End Container fluid  -->
    <!-- ============================================================== -->
</div>
<!-- ============================================================== -->
<!-- End Page wrapper  -->
<!-- ============================================================== -->

@endsection