@extends('cancer_center_admin.layouts.app')

@section('title', 'Create Patient')

@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 Patient</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('center/patients') }}">Home</a></li>
                        <li class="breadcrumb-item active newRedCommonColor">Create Patient</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="{{url('center/patients/store')}}" enctype="multipart/form-data">
                        @csrf <!-- Include CSRF token for security in Laravel -->

                        <!-- Patient Name Field -->
                        <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 patient name" required>
                        </div>

                        <!-- Email Field -->
                        <div class="mb-3">
                            <label for="email" class="form-label">Email</label>
                            <input type="email" class="form-control" id="email" name="email"value="{{old('email')}}" placeholder="Enter patient email" required>
                        </div>

                        <!-- Phone Number Field -->
                        <div class="mb-3">
                            <label for="phone_number" class="form-label">Phone Number</label>
                            <input type="tel" class="form-control" id="phone_number" name="phone_number"value="{{old('phone_number')}}" placeholder="Enter patient phone number" required>
                        </div>

                        <!-- Notes Field -->
                        <div class="mb-3">
                            <label for="notes" class="form-label">Notes</label>
                            <textarea name="notes" class="form-control" rows="5" required>{{old('notes')}}</textarea>
                        </div>
                        <div class="text-start">
                            <button type="submit" class="btn btn-primary">Create Patient</button>
                            <a href="{{url('center/patients')}}" class="btn btn-danger">Cancel</a>
                        </div>
                    </form>
                </div>
            </div>
        </div>
        <!-- ============================================================== -->
        <!-- End Info box -->
        <!-- ============================================================== -->
    </div>
    <!-- ============================================================== -->
    <!-- End Container fluid  -->
    <!-- ============================================================== -->
</div>
<!-- ============================================================== -->
<!-- End Page wrapper  -->
<!-- ============================================================== -->

@endsection

@section('scripts')
    <script>
     $(document).ready(function() {
        $("#phone_number").inputmask("(999) 999-9999");
    });
    </script>
@endsection