@extends('web_site.layouts.master')

@section('content')
    <main class="main">
        @include('web_site.partials.alerts')
        <section class="py-100">
            <div class="container">
                <div class="site-heading">
                    <span class="site-title-tagline">{{ trans('clinic.patient_profile.tagline') }}</span>
                    <h1 class="site-title">{{ trans('clinic.patient_profile.title') }}</h1>
                </div>

                <form id="PatientProfileForm" action="{{ route('clinic.profile.medical.update') }}" method="POST" class="p-4 border rounded">
                    @csrf
                    @method('PUT')

                    <h4 class="mb-3">{{ trans('clinic.patient_profile.basic_info') }}</h4>
                    <div class="row g-3 mb-4">
                        <div class="col-md-4">
                            <label class="form-label">{{ trans('clinic.patient_profile.date_of_birth') }}</label>
                            <input type="date" name="date_of_birth" value="{{ old('date_of_birth', $profile?->date_of_birth?->format('Y-m-d')) }}" class="form-control">
                        </div>
                        <div class="col-md-4">
                            <label class="form-label">{{ trans('clinic.patient_profile.gender') }}</label>
                            <select name="gender" class="form-select">
                                <option value="">—</option>
                                <option value="male" @selected(old('gender', $profile?->gender) === 'male')>{{ trans('clinic.patient_profile.male') }}</option>
                                <option value="female" @selected(old('gender', $profile?->gender) === 'female')>{{ trans('clinic.patient_profile.female') }}</option>
                            </select>
                        </div>
                        <div class="col-md-4">
                            <label class="form-label">{{ trans('clinic.patient_profile.occupation') }}</label>
                            <input type="text" name="occupation" value="{{ old('occupation', $profile?->occupation) }}" class="form-control">
                        </div>
                    </div>

                    @php($medicalHistory = old('medical_history', $profile?->medical_history ?? []))
                    <h4 class="mb-3">{{ trans('clinic.patient_profile.medical_history') }}</h4>
                    <div class="row g-3 mb-4">
                        @foreach ($conditionOptions as $conditionOption)
                            <div class="col-md-4">
                                <div class="form-check">
                                    <input type="checkbox" class="form-check-input" id="medical_{{ $conditionOption->code }}" name="medical_history[{{ $conditionOption->code }}]" value="1" @checked(!empty($medicalHistory[$conditionOption->code] ?? false))>
                                    <label class="form-check-label" for="medical_{{ $conditionOption->code }}">{{ $conditionOption->name }}</label>
                                </div>
                            </div>
                        @endforeach
                        <div class="col-12">
                            <label class="form-label">{{ trans('clinic.patient_profile.other') }}</label>
                            <input type="text" name="medical_history[other]" value="{{ $medicalHistory['other'] ?? '' }}" class="form-control">
                        </div>
                    </div>

                    @php($surgicalHistory = old('surgical_history', $profile?->surgical_history ?? []))
                    <h4 class="mb-3">{{ trans('clinic.patient_profile.surgical_history') }}</h4>
                    <div class="row g-3 mb-4">
                        <div class="col-12">
                            <div class="form-check mb-2">
                                <input type="checkbox" class="form-check-input" id="had_surgery" name="surgical_history[had_surgery]" value="1" @checked(!empty($surgicalHistory['had_surgery'] ?? false))>
                                <label class="form-check-label" for="had_surgery">{{ trans('clinic.patient_profile.had_surgery') }}</label>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label class="form-label">{{ trans('clinic.patient_profile.surgery_type') }}</label>
                            <input type="text" name="surgical_history[type]" value="{{ $surgicalHistory['type'] ?? '' }}" class="form-control">
                        </div>
                        <div class="col-md-4">
                            <label class="form-label">{{ trans('clinic.patient_profile.surgery_date') }}</label>
                            <input type="date" name="surgical_history[date]" value="{{ $surgicalHistory['date'] ?? '' }}" class="form-control">
                        </div>
                        <div class="col-md-4">
                            <label class="form-label">{{ trans('clinic.patient_profile.hospital') }}</label>
                            <input type="text" name="surgical_history[hospital]" value="{{ $surgicalHistory['hospital'] ?? '' }}" class="form-control">
                        </div>
                        <div class="col-12">
                            <label class="form-label">{{ trans('clinic.patient_profile.notes') }}</label>
                            <textarea name="surgical_history[notes]" rows="2" class="form-control">{{ $surgicalHistory['notes'] ?? '' }}</textarea>
                        </div>
                    </div>

                    @php($medicationHistory = old('medication_history', $profile?->medication_history ?? []))
                    <h4 class="mb-3">{{ trans('clinic.patient_profile.medication_history') }}</h4>
                    <div class="row g-3 mb-4">
                        @foreach ($medicationOptions as $medicationOption)
                            <div class="col-md-4">
                                <div class="form-check">
                                    <input type="checkbox" class="form-check-input" id="medication_{{ $medicationOption->code }}" name="medication_history[{{ $medicationOption->code }}]" value="1" @checked(!empty($medicationHistory[$medicationOption->code] ?? false))>
                                    <label class="form-check-label" for="medication_{{ $medicationOption->code }}">{{ $medicationOption->name }}</label>
                                </div>
                            </div>
                        @endforeach
                        <div class="col-md-6">
                            <label class="form-label">{{ trans('clinic.patient_profile.other') }}</label>
                            <input type="text" name="medication_history[other]" value="{{ $medicationHistory['other'] ?? '' }}" class="form-control">
                        </div>
                        <div class="col-12">
                            <label class="form-label">{{ trans('clinic.patient_profile.notes') }}</label>
                            <textarea name="medication_history[notes]" rows="2" class="form-control">{{ $medicationHistory['notes'] ?? '' }}</textarea>
                        </div>
                    </div>

                    <h4 class="mb-3">{{ trans('clinic.patient_profile.allergies') }}</h4>
                    <div class="row g-3 mb-4">
                        <div class="col-md-4">
                            <label class="form-label">{{ trans('clinic.patient_profile.allergy_type') }}</label>
                            <select name="allergy_type" class="form-select">
                                <option value="">—</option>
                                <option value="drug" @selected(old('allergy_type', $profile?->allergy_type) === 'drug')>{{ trans('clinic.patient_profile.allergy_types.drug') }}</option>
                                <option value="food" @selected(old('allergy_type', $profile?->allergy_type) === 'food')>{{ trans('clinic.patient_profile.allergy_types.food') }}</option>
                                <option value="other" @selected(old('allergy_type', $profile?->allergy_type) === 'other')>{{ trans('clinic.patient_profile.allergy_types.other') }}</option>
                            </select>
                        </div>
                        <div class="col-md-4">
                            <label class="form-label">{{ trans('clinic.patient_profile.allergy_substance') }}</label>
                            <input type="text" name="allergy_substance" value="{{ old('allergy_substance', $profile?->allergy_substance) }}" class="form-control">
                        </div>
                        <div class="col-md-4">
                            <label class="form-label">{{ trans('clinic.patient_profile.allergy_severity') }}</label>
                            <select name="allergy_severity" class="form-select">
                                <option value="">—</option>
                                <option value="mild" @selected(old('allergy_severity', $profile?->allergy_severity) === 'mild')>{{ trans('clinic.patient_profile.severities.mild') }}</option>
                                <option value="moderate" @selected(old('allergy_severity', $profile?->allergy_severity) === 'moderate')>{{ trans('clinic.patient_profile.severities.moderate') }}</option>
                                <option value="severe" @selected(old('allergy_severity', $profile?->allergy_severity) === 'severe')>{{ trans('clinic.patient_profile.severities.severe') }}</option>
                            </select>
                        </div>
                        <div class="col-12">
                            <label class="form-label">{{ trans('clinic.patient_profile.notes') }}</label>
                            <textarea name="allergy_notes" rows="2" class="form-control">{{ old('allergy_notes', $profile?->allergy_notes) }}</textarea>
                        </div>
                    </div>

                    <button class="theme-btn" type="submit">{{ trans('clinic.common.save') }}</button>
                </form>
            </div>
        </section>
    </main>
@endsection

@section('js')
    @include('partials.jsvalidation', ['request' => 'App\Http\Requests\Site\Clinic\StorePatientProfileRequest', 'selector' => '#PatientProfileForm'])
@endsection