@extends('layouts.app')

@section('bread-crumb')
    <div class="row mb-2">
        <div class="col-sm-6">
        <h1>REF # {{$referral->referral_no}} </h1>
        </div>
        <div class="col-sm-6">
        <ol class="breadcrumb float-sm-right">
            <li class="breadcrumb-item"><a href="/dashboard">Dashboard</a></li>
            <li class="breadcrumb-item"><a href="/referrals">Referrals</a></li>
            <li class="breadcrumb-item active">REF # {{$referral->referral_no}}</li>
        </ol>
        </div>
    </div>
@endsection

@section('content')
<div class="card card-info">
    <div class="card-header">
        <h3 class="card-title">Created by: {{ucfirst(Auth::user()->fname)}} {{ucfirst(Auth::user()->lname)}}</h3>
    </div>
    <form class="form-horizontal" method="POST" action="/referral/{{$referral->id}}">
        @method('PUT')
        @csrf
        <div class="card-body p-5">
            <h3 class="text-center mb-5">REF # {{$referral->referral_no}}</h3>

            @if ($errors->any())
                <div class="alert alert-danger">
                    <ul>
                        @foreach ($errors->all() as $error)
                            <li>{{ $error }}</li>
                        @endforeach
                    </ul>
                </div>
            @endif

            @if (session()->has('referral.update'))
                @if (session()->get('referral.update'))
                    <div class="alert alert-success alert-dismissible col-12" id="alert">
                        <button type="button" class="close" data-dismiss="alert" aria-hidden="true">&times;</button>
                        <h5><i class="icon fas fa-check"></i> Success!</h5>
                        REF # {{$referral->referral_no}} successfully sent to selected hospital!
                    </div>
                @endif
            @endif

            @if ($referral->ref_to_hospital == null)
                <div class="form-group row">
                    <label for="ref_from_hospital" class="col-sm-2 col-form-label">REFER TO *</label>
                    <div class="col-sm-10">
                        <select class="form-control select2" name="ref_to_hospital" style="width: 100%;" required>
                            <option selected="selected" value="">Please select a hospital</option>
                            @foreach ($hospitals as $item)
                                @if ($item->id != $referral->ref_from_hospital)
                                    <option value="{{$item->id}}" @if($item->id == old('ref_to_hospital')) selected @endif class="text-capitalize"> {{$item->hospital}} </option>
                                @endif

                            @endforeach
                        </select>

                        @error('ref_from_hospital')
                            <span>
                                {{ $message }}
                            </span>
                        @enderror
                    </div>
                </div>
            @else
                <div class="form-group row">
                    <label for="ref_from_hospital" class="col-sm-2 col-form-label">REFERRED TO </label>
                    <div class="col-sm-10">
                        @foreach ($hospitals as $item)
                            @if ($item->id == $referral->ref_to_hospital)
                                <input type="text" class="form-control" value=" {{$item->hospital}} " readonly  >
                            @endif
                        @endforeach
                    </div>
                </div>
            @endif

            <div class="form-group row">
                <label for="ref_from_hospital" class="col-sm-2 col-form-label">REFERRED FROM </label>
                <div class="col-sm-10">
                    @foreach ($hospitals as $item)
                        @if ($item->id == $referral->ref_from_hospital)
                            <input type="text" class="form-control text-capitalize" value=" {{$item->hospital}} " readonly  >
                        @endif
                    @endforeach
                </div>
            </div>



            <div class="form-group row">
                <label for="patient_name" class="col-sm-2 col-form-label">PATIENT NAME</label>
                <div class="col-sm-10">
                    <input type="text" class="form-control text-capitalize" value=" {{$referral->patient}} " readonly  >
                </div>
            </div>

            <div class="form-group row">
                <label for="age" class="col-sm-2 col-form-label">AGE</label>
                <div class="col-sm-10">
                    <input type="text" class="form-control" value=" {{$referral->age}} " readonly  >
                </div>
            </div>

            <div class="form-group row">
                <label for="sex" class="col-sm-2 col-form-label">SEX</label>
                <div class="col-sm-10">
                    <input type="text" class="form-control text-capitalize" value=" {{$referral->sex}} " readonly  >
                </div>
            </div>

            <div class="form-group row">
                <label for="birthdata" class="col-sm-2 col-form-label">BIRTHDATE</label>
                <div class="col-sm-10">
                                        <input type="text" class="form-control" value=" {{date_format($date,"Y/m/d")}} " readonly  >
                </div>
            </div>

            <div class="form-group row">
                <label for="civil_status" class="col-sm-2 col-form-label">CIVIL STATUS</label>
                <div class="col-sm-10">
                    <input type="text" class="form-control  text-capitalize" value=" {{$referral->civil_status}} " readonly  >
                </div>
            </div>

            <div class="form-group row">
                <label for="address" class="col-sm-2 col-form-label">ADDRESS</label>
                <div class="col-sm-10">
                    <input type="text" class="form-control text-capitalize" value=" {{$referral->address}} " readonly  >
                </div>
            </div>

            <div class="form-group row">
                <label for="occupation" class="col-sm-2 col-form-label">OCCUPATION</label>
                <div class="col-sm-10">
                    <input type="text" class="form-control text-capitalize" value=" {{$referral->occupation}} " readonly  >
                </div>
            </div>

            <div class="form-group row">
                <label for="religion" class="col-sm-2 col-form-label">RELIGION</label>
                <div class="col-sm-10">
                    <input type="text" class="form-control" value=" {{$referral->religion}} " readonly  >
                </div>
            </div>

            <div class="form-group row">
                <label for="guardian" class="col-sm-2 col-form-label">GUARDIAN</label>
                <div class="col-sm-10">
                    <input type="text" class="form-control text-capitalize" value=" {{$referral->guardian}} " readonly  >
                </div>
            </div>

            <div class="form-group row">
                <label for="" class="col-sm-2 col-form-label"></label>
                <div class="col-sm-10">
                    <div class="form-group clearfix">
                        <div class="icheck-success d-inline mr-3">
                            <input type="radio" readonly @if($referral->state == 'pwd') checked @endif>
                            <label for="state1">
                                PWD
                            </label>
                        </div>
                        <div class="icheck-success d-inline mr-3">
                            <input type="radio" readonly @if($referral->state == 'sc') checked @endif>
                            <label for="state2">
                                SC
                            </label>
                        </div>
                        <div class="icheck-success d-inline">
                            <input type="radio" readonly @if($referral->state == 'ic') checked @endif>
                            <label for="state3">
                                IC
                            </label>
                        </div>
                      </div>
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">CHIEF COMPLAINT</label>
                <div class="col-sm-10">
                    <textarea class="form-control" rows="5" readonly  >{{$referral->complaint}}</textarea>
                </div>
            </div>

            <div class="form-group row">
                <label for="inputPassword3" class="col-sm-2 col-form-label">VITAL SIGNS</label>
                <div class="col-sm-10 row">
                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">BP</label>
                            <input type="text" class="form-control form-control-sm" readonly value="{{$referral->vs_bp}}"  >
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">HR</label>
                            <input type="text" class="form-control form-control-sm" readonly value="{{$referral->vs_hr}}"  >
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">RR</label>
                            <input type="text" class="form-control form-control-sm" readonly value="{{$referral->vs_rr}}"  >
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">TEMP</label>
                            <input type="text" class="form-control form-control-sm" readonly value="{{$referral->vs_temp}}"  >
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">WEIGHT</label>
                            <input type="text" class="form-control form-control-sm" readonly value="{{$referral->vs_weight}}"  >
                        </div>
                    </div>
                </div>
            </div>

            <div class="form-group row bg-warning">
                <label for="inputPassword3" class="col-sm-2 col-form-label">NEW VITAL SIGNS</label>
                <div class="col-sm-10 row">
                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">BP</label>
                            <input type="text" class="form-control form-control-sm" name="vs_bp" value="{{ old('vs_bp') }}" placeholder="-">
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">HR</label>
                            <input type="text" class="form-control form-control-sm" name="vs_hr" value="{{ old('vs_hr') }}" placeholder="-">
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">RR</label>
                            <input type="text" class="form-control form-control-sm" name="vs_rr" value="{{ old('vs_rr') }}" placeholder="-">
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">TEMP</label>
                            <input type="text" class="form-control form-control-sm" name="vs_temp" value="{{ old('vs_temp') }}" placeholder="-">
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">WEIGHT</label>
                            <input type="text" class="form-control form-control-sm" name="vs_weight" value="{{ old('vs_weight') }}" placeholder="-">
                        </div>
                    </div>
                </div>
            </div>

            <div class="form-group row">
                <label for="inputPassword3" class="col-sm-2 col-form-label">OB HISTORY</label>
                <div class="col-sm-10 row">
                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">G</label>
                            <input type="text" class="form-control form-control-sm" readonly value="{{$referral->obh_g}}"  >
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">P</label>
                            <input type="text" class="form-control form-control-sm" readonly value="{{$referral->obh_p}}"  >
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">LMP</label>
                            <input type="text" class="form-control form-control-sm" readonly value="{{$referral->obh_lmp}}"  >
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">EDC</label>
                            <input type="text" class="form-control form-control-sm" readonly value="{{$referral->obh_edc }}"  >
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">AOG</label>
                            <input type="text" class="form-control form-control-sm" readonly value="{{$referral->obh_aog }}"  >
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">FH</label>
                            <input type="text" class="form-control form-control-sm" readonly value="{{$referral->obh_fh }}"  >
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">FHR</label>
                            <input type="text" class="form-control form-control-sm" readonly value="{{$referral->obh_fhr }}"  >
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">PELVIC</label>
                            <input type="text" class="form-control form-control-sm" readonly value="{{$referral->obh_pelvic }}">
                        </div>
                    </div>
                </div>
            </div>

            <div class="form-group row bg-warning" >
                <label for="inputPassword3" class="col-sm-2 col-form-label">NEW OB HISTORY</label>
                <div class="col-sm-10 row">
                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">G</label>
                            <input type="text" class="form-control form-control-sm" name="obh_g" value="{{ old('obh_g') }}" placeholder="-">
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">P</label>
                            <input type="text" class="form-control form-control-sm" name="obh_p" value="{{ old('obh_p') }}" placeholder="-">
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">LMP</label>
                            <input type="text" class="form-control form-control-sm" name="obh_lmp" value="{{ old('obh_lmp') }}" placeholder="-">
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">EDC</label>
                            <input type="text" class="form-control form-control-sm" name="obh_edc" value="{{ old('obh_edc') }}" placeholder="-">
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">AOG</label>
                            <input type="text" class="form-control form-control-sm" name="obh_aog" value="{{ old('obh_aog') }}" placeholder="-">
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">FH</label>
                            <input type="text" class="form-control form-control-sm" name="obh_fh" value="{{ old('obh_fh') }}" placeholder="-">
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">FHR</label>
                            <input type="text" class="form-control form-control-sm" name="obh_fhr" value="{{ old('obh_fhr') }}" placeholder="-">
                        </div>
                    </div>

                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="font-weight-normal">PELVIC</label>
                            <input type="text" class="form-control form-control-sm" name="obh_pelvic" value="{{ old('obh_pelvic') }}" placeholder="-">
                        </div>
                    </div>
                </div>
            </div>

            <div class="form-group row">
                <label for="inputPassword3" class="col-sm-2 col-form-label">BRIEF HX & PE</label>
                <div class="col-sm-10">
                    <textarea class="form-control" rows="5" readonly  >{{$referral->hx_n_pe}}</textarea>
                </div>
            </div>

            <div class="form-group row">
                <label for="inputPassword3" class="col-sm-2 col-form-label">IMPRESSION OR DIAGNOSIS</label>
                <div class="col-sm-10">
                    <textarea class="form-control" rows="5" readonly  >{{$referral->diagnosis}}</textarea>
                </div>
            </div>

            <div class="form-group row">
                <label for="inputPassword3" class="col-sm-2 col-form-label">MEDICATION/TREATMENT</label>
                <div class="col-sm-10">
                    <textarea class="form-control" rows="5" readonly  >{{$referral->medication}}</textarea>
                </div>
            </div>

            <div class="form-group row">
                <label for="inputPassword3" class="col-sm-2 col-form-label">REASON FOR REFERRAL</label>
                <div class="col-sm-10 row">
                    <div class="col-sm-4 mb-2">
                        <div class="icheck-success d-inline">
                            <input type="radio" readonly @if($referral->reason == 'Further evaluation and management') checked @endif>
                            <label for="reason1" class="font-weight-normal">
                                Further evaluation and management
                            </label>
                        </div>
                    </div>

                    <div class="col-sm-4 mb-2">
                        <div class="icheck-success d-inline">
                            <input type="radio" readonly @if($referral->reason == 'For Work-up') checked @endif>
                            <label for="reason2" class="font-weight-normal">
                                For Work-up
                            </label>
                        </div>
                    </div>

                    <div class="col-sm-4 mb-2">
                        <div class="icheck-success d-inline">
                            <input type="radio" readonly @if($referral->reason == 'For Medico-legal') checked @endif>
                            <label for="reason3" class="font-weight-normal">
                                For Medico-legal
                            </label>
                        </div>
                    </div>

                    <div class="col-sm-4 mb-2">
                        <div class="icheck-success d-inline">
                            <input type="radio" readonly @if($referral->reason == 'Isolation') checked @endif>
                            <label for="reason4" class="font-weight-normal">
                                Isolation
                            </label>
                        </div>
                    </div>

                    <div class="col-sm-4 mb-2">
                        <div class="icheck-success d-inline">
                            <input type="radio" readonly @if($referral->reason == "Patient's Request") checked @endif>
                            <label for="reason5" class="font-weight-normal">
                                Patient's Request
                            </label>
                        </div>
                    </div>

                    <div class="col-sm-4 mb-2">
                        <div class="icheck-success d-inline">
                            <input type="radio" name="reason" readonly @if($referral->reason == 'OPD Consult') checked @endif>
                            <label for="reason6" class="font-weight-normal">
                                OPD Consult
                            </label>
                        </div>
                    </div>

                    {{-- <div class="col-sm-12">
                        <div class="form-group">
                            <label class="font-weight-normal">OTHERS</label>
                            <textarea class="form-control" rows="3" name="reason" placeholder="-"></textarea>
                        </div>
                    </div> --}}
                    @error('reason')
                        <span>
                            {{ $message }}
                        </span>
                    @enderror
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">PHIC ID NO.</label>
                <div class="col-sm-10">
                    <input type="text" class="form-control" value="{{$referral->phic_id_no}}" readonly  >
                </div>
            </div>

            <div class="form-group row">
                <label for="inputPassword3" class="col-sm-2 col-form-label">REFERRED BY</label>
                <div class="col-sm-10">
                    <input type="text" class="form-control text-capitalize" value="{{$referral->ref_by}}" readonly  >
                </div>
            </div>

            <div class="form-group row mb-4">
                <label for="inputPassword3" class="col-sm-2 col-form-label">CONTACT NO.</label>
                <div class="col-sm-10">
                    <input type="text" class="form-control" value="{{$referral->contact_no}}" readonly  >
                </div>
            </div>

            @if (Auth::user()->role == 1)
                <hr>
                <div class="form-group row mb-4">
                    <label for="inputPassword3" class="col-sm-2 col-form-label">ROOM DETAILS</label>
                    <div class="col-sm-10 mt-2">
                        {{$station->station}} - {{$room->room}} - {{$bed->bed}}
                        <a class="float-right text-decoration-none text-dark font-italic" href="/hospital/{{Auth::user()->hospital_id}}/station/{{$patient->station_id}}/room/{{$patient->room_id}}/bed" target="_blank" rel="noopener noreferrer">
                            View Bed
                        </a>
                    </div>
                </div>
            @endif



        </div>

        <div class="card-footer justify-content-center text-center">
            <button type="submit" class="btn btn-info">UPDATE</button>
            <a href="/referrals" class="btn btn-default">CANCEL</a>
        </div>



    </form>


</div>
@endsection

@section('script')
    <script>
        $(function () {
            //Initialize Select2 Elements
            $('.select2').select2()
        });
    </script>
@endsection