@extends('doctor.layout')

@section('cssFiles')
    <link rel="stylesheet" href="{{ asset('css/patient-details.css?2') }}">
@endsection

@php($title = 'Create Patient Profile')

@section('content')
    <div class="container mb-4">
        <h1>Create Patient Profile</h1>
        @if (session('success'))
            <div class="alert alert-success">{!!  session('success') !!}</div>
        @endif
        <form action="{{ route('account.store-profile') }}" method="POST">
            @csrf
            <div class="row mb-md-3">
                <div class="col-md-6">
                    <label for="name" class="form-label">Name</label>
                    <input type="text" class="form-control" id="name" name="name" value="{{ old('name') }}" required>
                    @error('name') <small class="text-danger">{{ $message }}</small> @enderror
                </div>
                <div class="col-md-6">
                    <label for="national_id" class="form-label">National ID</label>
                    <input type="text" class="form-control" id="national_id" name="national_id" value="{{ old('national_id') }}" required>
                    @error('national_id') <small class="text-danger">{{ $message }}</small> @enderror
                </div>
            </div>
            <div class="row mb-md-3">
                <div class="col-md-6">
                    <label for="address" class="form-label">Address</label>
                    <input type="text" class="form-control" id="address" name="address" value="{{ old('address') }}">
                    @error('address') <small class="text-danger">{{ $message }}</small> @enderror
                </div>
                <div class="col-md-6">
                    <label for="birth_date" class="form-label">Birth Date</label>
                    <input type="date" class="form-control" id="birth_date" name="birth_date" value="{{ old('birth_date') }}" required>
                    @error('birth_date') <small class="text-danger">{{ $message }}</small> @enderror
                </div>
            </div>
            <div class="row mb-md-3">
                <div class="col-md-6">
                    <label for="sex" class="form-label">Sex</label>
                    <select class="form-select" id="sex" name="sex" required>
                        <option value="1" {{ old('sex') === '1' ? 'selected' : '' }}>Male</option>
                        <option value="0" {{ old('sex') === '0' ? 'selected' : '' }}>Female</option>
                    </select>
                    @error('sex') <small class="text-danger">{{ $message }}</small> @enderror
                </div>
                <div class="col-md-6">
                    <label for="social_state" class="form-label">Social State</label>
                    <input type="text" class="form-control" id="social_state" name="social_state" value="{{ old('social_state') }}" required>
                    @error('social_state') <small class="text-danger">{{ $message }}</small> @enderror
                </div>
            </div>
            <div class="row mb-md-3">
                <div class="col-md-6">
                    <label for="job" class="form-label">job</label>
                    <input type="text" class="form-control" id="job" name="job" value="{{ old('job') }}">
                    @error('job') <small class="text-danger">{{ $message }}</small> @enderror
                </div>
                <div class="col-md-6">
                    <label for="blood_type" class="form-label">Blood Type</label>
                    <input type="text" class="form-control" id="blood_type" name="blood_type" value="{{ old('blood_type') }}" required>
                    @error('blood_type') <small class="text-danger">{{ $message }}</small> @enderror
                </div>
            </div>
            <div class="mb-md-3">
                <label for="phone" class="form-label">Phone</label>
                <input type="text" class="form-control" id="phone" name="phone" value="{{ old('phone') }}" required>
                @error('phone') <small class="text-danger">{{ $message }}</small> @enderror
            </div>
            <div class="row mb-md-3">
                <div class="col-md-6">
                    <label for="smoker" class="form-label">Smoker</label>
                    <select class="form-select" id="smoker" name="smoker" required>
                        <option value="0" {{ old('smoker') === '0' ? 'selected' : '' }}>No</option>
                        <option value="1" {{ old('smoker') === '1' ? 'selected' : '' }}>Yes</option>
                    </select>
                    @error('smoker') <small class="text-danger">{{ $message }}</small> @enderror
                </div>
                <div class="col-md-6">
                    <label for="email" class="form-label">Email</label>
                    <input type="email" class="form-control" id="email" name="email" value="{{ old('email') }}" required>
                    @error('email') <small class="text-danger">{{ $message }}</small> @enderror
                </div>
            </div>
            <div class="mb-md-3">
                <label for="password" class="form-label">Password</label>
                <input type="password" class="form-control" id="password" name="password" required>
                @error('password') <small class="text-danger">{{ $message }}</small> @enderror
            </div>
            <button type="submit" class="btn btn-primary">Create Profile</button>
        </form>
    </div>
@endsection