@include('headeruser')
@include('sweetalerts')

					<!--begin::Content-->
					<div class="content d-flex flex-column flex-column-fluid" id="kt_content">
						<!--begin::Subheader-->
						<div class="subheader py-2 py-lg-4 subheader-solid" id="kt_subheader">
							<div class="container-fluid d-flex align-items-center justify-content-between flex-wrap flex-sm-nowrap">
								<!--begin::Info-->
								<div class="d-flex align-items-center flex-wrap mr-2">
									<!--begin::Page Title-->
									<h5 class="text-dark font-weight-bold mt-2 mb-2 mr-5">{{ $page }}</h5>
									<!--end::Page Title-->
									<!--begin::Actions-->
									
									<div class="subheader-separator subheader-separator-ver mt-2 mb-2 mr-4 bg-gray-200"></div>
									<ul class="breadcrumb breadcrumb-transparent breadcrumb-dot font-weight-bold p-0 my-2 font-size-sm">
										<li class="breadcrumb-item text-muted">
											<a href="" class="text-muted">
												{{ $subpage }}
											</a>
										</li>
										<li class="breadcrumb-item text-muted">
											<a href="" class="text-muted">
												{{ $submenu }}
											</a>
										</li>
									</ul>
									<!--end::Actions-->
								</div>
								<!--end::Info-->
							</div>
						</div>
						<!--end::Subheader-->
						<!--begin::Entry-->
						<div class="d-flex flex-column-fluid">
							<!--begin::Container-->
							<div class="container">
                                <!--begin::Card-->
                                <div class="card card-custom gutter-b">
                                    <div class="card-header">
                                        <div class="card-title">
                                            <h3 class="card-label">{{ Str::upper($submenu) }} ({{ $data_record_not_panel->user_name }})</h3>
                                        </div>
                                    </div>
                                    <div class="card-body">
                                        <form class="needs-validation" action="{{ route('AdminUpdatePatientRecordNotPanel', $data_record_not_panel->id_not_panel) }}" method="POST">
                                            @method('PUT')
                                            @csrf

                                                <input type="hidden" name="RoutePatientRecord" value="RoutePatientRecord">
                                            
                                                <div class="row" style="margin-bottom: -10px;">
                                                    <div class="col-12 col-md-12">
                                                        <div class="form-group">
                                                            <label><b>Nama Pekerja</b></label>
                                                            <p>{{ Str::upper($data_record_not_panel->user_name) }}</p>
                                                        </div>
                                                    </div>
                                                </div>
    
                                                <div class="row" style="margin-bottom: -10px;">
                                                    <div id="get_relationship" class="col-12 col-md-6">
                                                        <div class="form-group">
                                                            <label><b>Nama Hubungan</b></label>
                                                            <p>{{ Str::upper($data_record_not_panel->name_relationship) }}</p>
                                                        </div>
                                                    </div>
                                                    <div id="get_family" class="col-12 col-md-6">
                                                        <div class="form-group">
                                                            <label><b>Nama Keluarga</b></label>
                                                            <p>{{ Str::upper($data_record_not_panel->name_family ?? "-") }}</p>
                                                        </div>
                                                    </div>
                                                </div>
                                                <div class="row" style="margin-bottom: -10px;">
                                                    <div class="col-12 col-md-6">
                                                        <div class="form-group">
                                                            <label><b>Nama Klinik</b></label>
                                                            <input type="text" name="name_clinic" class="form-control form-control-solid"  placeholder="Sila Masukkan Nama Klinik" value="{{ $data_record_not_panel->name_clinic }}" required/>

                                                            @error('name_clinic')
                                                                <font color="#ff0000">{{ $message }}</font>
                                                            @enderror
                                                        </div>
                                                    </div>
                                                    <div class="col-12 col-md-6">
                                                        <div class="form-group">
                                                            <label><b>Tarikh Daftar</b></label>
                                                            <div class="input-group input-group-solid date" id="date_update_register_not_panel" data-target-input="nearest">
                                                                <input type="text" class="form-control form-control-solid datetimepicker-input" name="date" placeholder="Sila Masukkan Tarikh" data-target="#date_update_register_not_panel" value="{{ date('d/m/Y', strtotime($data_record_not_panel->date)) }}" required />
                                                            </div>

                                                            @error('date')
                                                                <font color="#ff0000">{{ $message }}</font>
                                                            @enderror
                                                        </div>
                                                    </div>
                                                </div>
                                                <div class="row" style="margin-bottom: -10px;">
                                                    <div class="col-12 col-md-6">
                                                        <div class="form-group">
                                                            <label><b>Bil Preskrip (RM)</b> <small><font color="red">*</font></small></label>
                                                            <input type="text" name="bill" class="form-control form-control-solid"  placeholder="Masukkan Jumlah Caj Yang Dikenakan" value="{{ $data_record_not_panel->bill }}" required/>
    
                                                            @error('bill')
                                                                <font color="#ff0000">{{ $message }}</font>
                                                            @enderror
                                                        </div>
                                                    </div>
                                                    <div class="col-12 col-md-6">
                                                        <div class="form-group">
                                                            <label><b>Bilangan MC</b> <small><font color="red">(Jika tiada, kosongkan)</font></small></label>
                                                            <input type="text" name="mc" class="form-control form-control-solid" placeholder="Masukkan Bilangan MC" value="{{ $data_record_not_panel->mc }}" />
    
                                                            @error('mc')
                                                                <font color="#ff0000">{{ $message }}</font>
                                                            @enderror
                                                        </div>
                                                    </div>
                                                </div>
                                                <div class="row" style="margin-bottom: -10px;">
                                                    <div class="col-12 col-md-12">
                                                        <div class="form-group">
                                                            <label><b>Deskripsi Preskrip</b> <small><font color="red">*</font></small></label>
                                                            <textarea class="form-control form-control-solid" name="prescription" placeholder="Contoh Preskrip: Paracetamol 3OZ, Alleryi Syr 2OZ, Ampillin 2OZ, Ventamol Syr 2OZ" rows="3" required>{{ $data_record_not_panel->prescription }}</textarea>
    
                                                            @error('prescription')
                                                                <font color="#ff0000">{{ $message }}</font>
                                                            @enderror
                                                        </div>
                                                    </div>
                                                </div>

                                                <center>
                                                    <button type="button" onClick="window.location.href='{{ route('AdminPatientRecord') }}'" class="btn btn-warning mt-3">
                                                        <i class="fa-sharp-duotone fa-solid fa-arrow-turn-down-left fa-2xs"></i> Kembali
                                                    </button>
                                                    <button type="submit" class="btn btn-danger mt-3">
                                                        <i class="fa-sharp-duotone fa-solid fa-floppy-disk fa-2xs"></i> Kemaskini Data Pesakit
                                                    </button>
                                                </center>
                                            
                                        </form>

                                    </div>

                                </div>
                                <!--end::Card-->
							</div>
							<!--end::Container-->
							
						</div>
						<!--end::Entry-->
					</div>
                    <!--end::Content-->

                    @include('footer')