@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::Row-->
                                <div id="get_balance" class="row">
                                </div>
                                <!--End::Row-->

                                <!--begin::Card-->
                                <div class="card card-custom gutter-b">
                                    <div class="card-header">
                                        <div class="card-title">
                                            <h3 class="card-label">{{ Str::upper($submenu) }}</h3>
                                        </div>
                                    </div>
                                    <div class="card-body">
                                        <form class="needs-validation" action="{{ route('ClinicAddRegisterPatient') }}" method="POST">
                                            @csrf

                                            <div class="row" style="margin-bottom: -10px;">
                                                <div class="col-12 col-md-12">
                                                    <div class="form-group">
                                                        <label><b>Nama Pekerja</b> <small><font color="red">*</font></small></label>
                                                        <select class="form-control form-control-solid SelectStaffRegisterPatient GetRelationship GetBalance" data-link="{{ route("ClinicGetRelationship", ":id") }}" data-balance="{{ route("ClinicGetBalance", ":id") }}" data-width="100%" name="user_no" required>
                                                            <option value="">Pilih Nama Pekerja</option>
                                                            @foreach ($query_staff as $data_staff)
                                                                <option value="{{ $data_staff->user_no }}"> {{ Str::upper($data_staff->user_name) }}</option>
                                                            @endforeach
                                                        </select>

                                                        @error('user_no')
                                                            <font color="#ff0000">{{ $message }}</font>
                                                        @enderror
                                                    </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> <small><font color="red">*</font></small></label>
                                                        <select class="form-control form-control-solid SelectRelationshipRegisterPatient" data-width="100%" required>
                                                            <option value="">Pilih Hubungan Dengan Pekerja</option>
                                                        </select>

                                                        @error('id_relationship')
                                                            <font color="#ff0000">{{ $message }}</font>
                                                        @enderror
                                                    </div>
                                                </div>
                                                <div id="get_family" class="col-12 col-md-6">
                                                    <div class="form-group">
                                                        <label><b>Nama Keluarga</b> <small><font color="red">*</font></small></label>
                                                        <select class="form-control form-control-solid SelectRelationshipRegisterPatient" data-width="100%" required>
                                                            <option value="">Pilih Nama Keluarga</option>
                                                        </select>

                                                        @error('id_family')
                                                            <font color="#ff0000">{{ $message }}</font>
                                                        @enderror
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="row" style="margin-bottom: -10px;">
                                                <div class="col-12 col-md-6">
                                                    <div class="form-group">
                                                        <label><b>Nama Klinik</b> <small><font color="red">*</font></small></label>
                                                        <input type="text" name="bill" class="form-control form-control-solid" placeholder="Masukkan Nama Klinik" value="{{ Str::upper($data_clinic->name_clinic.' ('.$data_clinic->add_1.' '.$data_clinic->add_2.' '.$data_clinic->add_3.' '.$data_clinic->name_postcode.' '.$data_clinic->city.' '.$data_clinic->name_state.')') }}" readonly />
                                                        <input type="hidden" name="id_clinic" value="{{ Auth::guard('clinic')->user()->id }}"/>

                                                        @error('id_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> <small><font color="red">*</font></small></label>
                                                        <input type="hidden" name="date" class="form-control form-control-solid"  placeholder="Enter Name" value="{{ date('Y-m-d') }}"/>
                                                        <input type="text" class="form-control form-control-solid"  placeholder="Enter Name" value="{{ date('d/m/Y') }}" readonly/>

                                                        @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="{{ old('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="{{ old('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>{{ old('prescription') }}</textarea>

                                                        @error('prescription')
                                                            <font color="#ff0000">{{ $message }}</font>
                                                        @enderror
                                                    </div>
                                                </div>
                                            </div>
                                            
                                            <center>
                                                <button type="submit" class="btn btn-danger mt-3">
                                                    <i class="fa-sharp-duotone fa-solid fa-floppy-disk fa-2xs"></i> Daftar Pesakit
                                                </button>
                                            </center>

                                        </form>

                                    </div>

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

                    @include('footer')