@extends('layouts.app')

@section('content')


<div class="layout-wrapper layout-content-navbar">
    <div class="layout-container">
      <!-- Menu -->

      @include('includes.usersidebar')
      <!-- / Menu -->

      <!-- Layout container -->
      <div class="layout-page">
        <!-- Navbar -->

        @include('includes.header')

        <!-- / Navbar -->

        <!-- Content wrapper -->
        <div class="content-wrapper">
            <!-- Content -->
            {{-- @dd($contents) --}}
            <div class="container-xxl flex-grow-1 container-p-y">
                <h4 class="fw-bold py-3 mb-4"><span class="text-muted fw-light">{{$user->first_name}} {{$user->last_name}}/</span> Professionals Involved</h4>
  
                <!-- Basic Layout -->
                <div class="row">
                  <div class="col-xl">
                    <div class="card mb-4">
                      <div class="card-header d-flex justify-content-between align-items-center">
                        <h5 class="mb-0">Relative, Friend and Local Authority Involved</h5>
                        {{-- <small class="text-muted float-end">Default label</small> --}}
                      </div>
                      <div class="card-body">
                        <form method="post" action="{{url('/usereditothers', $user->id)}}">
                            @csrf
                          <div class="divider text-start divider-success">
                            <div class="divider-text"><h5>GP</h5></div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="gp_name">Full Name</label>
                                <input type="text" name="gp_name" value="{{$user->gp_name}}" class="form-control" id="gp_name"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="gp_phone">Phone</label>
                                <input type="text" name="gp_phone" value="{{$user->gp_phone}}" class="form-control" id="gp_phone" />
                            </div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="gp_email">Email</label>
                                <input type="text" name="gp_email" value="{{$user->gp_email}}" class="form-control" id="gp_email"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="gp_address">Address</label>
                                <input type="text" name="gp_address" value="{{$user->gp_address}}" class="form-control" id="gp_address" />
                            </div>
                          </div>
                          <div class="divider text-start divider-success" style="margin-top:62px;">
                            <div class="divider-text"><h5>Hospital Specialist</h5></div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="hospital_name">Full Name</label>
                                <input type="text" name="hospital_name" value="{{$user->hospital_name}}" class="form-control" id="hospital_name"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="hospital_phone">Phone</label>
                                <input type="text" name="hospital_phone" value="{{$user->hospital_phone}}" class="form-control" id="hospital_phone" />
                            </div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="hospital_email">Email</label>
                                <input type="text" name="hospital_email" value="{{$user->hospital_email}}" class="form-control" id="hospital_email"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="hospital_address">Address</label>
                                <input type="text" name="hospital_address" value="{{$user->hospital_address}}" class="form-control" id="hospital_address" />
                            </div>
                          </div>
                          <div class="divider text-start divider-success" style="margin-top:62px;">
                            <div class="divider-text"><h5>Dentist</h5></div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="dentist_name">Name</label>
                                <input type="text" name="dentist_name" value="{{$user->dentist_name}}" class="form-control" id="dentist_name"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="dentist_phone">Phone</label>
                                <input type="text" name="dentist_phone" value="{{$user->dentist_phone}}" class="form-control" id="dentist_phone" />
                            </div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="dentist_email">Email</label>
                                <input type="text" name="dentist_email" value="{{$user->dentist_email}}" class="form-control" id="dentist_email"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="dentist_address">Address</label>
                                <input type="text" name="dentist_address" value="{{$user->dentist_address}}" class="form-control" id="dentist_address" />
                            </div>
                          </div>
                          <div class="divider text-start divider-success" style="margin-top:62px;">
                            <div class="divider-text"><h5>Optician</h5></div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="optician_name">Full Name</label>
                                <input type="text" name="optician_name" value="{{$user->optician_name}}" class="form-control" id="optician_name"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="optician_phone">Phone</label>
                                <input type="text" name="optician_phone" value="{{$user->optician_phone}}" class="form-control" id="optician_phone" />
                            </div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="optician_email">Email</label>
                                <input type="text" name="optician_email" value="{{$user->optician_email}}" class="form-control" id="optician_email"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="optician_address">Address</label>
                                <input type="text" name="optician_address" value="{{$user->optician_address}}" class="form-control" id="optician_address" />
                            </div>
                          </div>
                          <div class="divider text-start divider-success" style="margin-top:62px;">
                            <div class="divider-text"><h5>Podiatrist</h5></div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="podiatrist_name">Full Name</label>
                                <input type="text" name="podiatrist_name" value="{{$user->podiatrist_name}}" class="form-control" id="podiatrist_name"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="podiatrist_phone">Phone</label>
                                <input type="text" name="podiatrist_phone" value="{{$user->podiatrist_phone}}" class="form-control" id="podiatrist_phone" />
                            </div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="podiatrist_email">Email</label>
                                <input type="text" name="podiatrist_email" value="{{$user->podiatrist_email}}" class="form-control" id="podiatrist_email"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="podiatrist_address">Address</label>
                                <input type="text" name="podiatrist_address" value="{{$user->podiatrist_address}}" class="form-control" id="podiatrist_address" />
                            </div>
                          </div>
                          <div class="divider text-start divider-success" style="margin-top:62px;">
                            <div class="divider-text"><h5>Payment arrangements (Is the applicant/will they be:)</h5></div>
                          </div>
                          <div class="row mb-3">
                            <div class="col-4">
                                <div class="col-md">
                                    <small class="form-label d-block">Funded by the local authority/NHS</small>
                                    <div class="form-check form-check-inline mt-3">
                                      <input class="form-check-input" type="radio" name="nhs_funded" id="nhs_fundedno" value="No" {{ $user->nhs_funded == 'No'?'checked':'' }}>
                                      <label class="form-check-label" for="nhs_fundedno">No</label>
                                    </div>
                                    <div class="form-check form-check-inline">
                                      <input class="form-check-input" type="radio" name="nhs_funded" id="nhs_fundedyes" value="Yes" {{ $user->nhs_funded == 'Yes'?'checked':'' }}>
                                      <label class="form-check-label" for="nhs_fundedyes">Yes</label>
                                    </div>
                                </div>
                            </div>
                            <div class="col-4">
                                <div class="col-md">
                                    <small class="form-label d-block">Privately funded (self-funding) with or without third-party help</small>
                                    <div class="form-check form-check-inline mt-3">
                                      <input class="form-check-input" type="radio" name="private_funded" id="private_fundedno" value="No" {{ $user->private_funded == 'No'?'checked':'' }}>
                                      <label class="form-check-label" for="private_fundedno">No</label>
                                    </div>
                                    <div class="form-check form-check-inline">
                                      <input class="form-check-input" type="radio" name="private_funded" id="private_fundedyes" value="Yes" {{ $user->private_funded == 'Yes'?'checked':'' }}>
                                      <label class="form-check-label" for="private_fundedyes">Yes</label>
                                    </div>
                                </div>
                            </div>
                            <div class="col-4">
                                <div class="col-md">
                                    <small class="form-label d-block">Using local authority personal/individual budgets awarded to them</small>
                                    <div class="form-check form-check-inline mt-3">
                                      <input class="form-check-input" type="radio" name="local_authority" id="local_authorityno" value="No" {{ $user->local_authority == 'No'?'checked':'' }}>
                                      <label class="form-check-label" for="local_authorityno">No</label>
                                    </div>
                                    <div class="form-check form-check-inline">
                                      <input class="form-check-input" type="radio" name="local_authority" id="local_authorityyes" value="Yes" {{ $user->local_authority == 'Yes'?'checked':'' }}>
                                      <label class="form-check-label" for="local_authorityyes">Yes</label>
                                    </div>
                                </div>
                            </div>
                          </div>
                          <div class="divider text-start divider-success" style="margin-top:62px;">
                            <div class="divider-text"><h5>Mental capacity issues</h5></div>
                          </div>
                          <div class="row mb-3">
                            <div class="col-4">
                                <div class="col-md">
                                    <small class="form-label d-block">Is the application being made by the person themselves?</small>
                                    <div class="form-check form-check-inline mt-3">
                                      <input class="form-check-input" type="radio" name="self_application" id="self_applicationno" value="No" {{ $user->self_application == 'No'?'checked':'' }}>
                                      <label class="form-check-label" for="self_applicationno">No</label>
                                    </div>
                                    <div class="form-check form-check-inline">
                                      <input class="form-check-input" type="radio" name="self_application" id="self_applicationyes" value="Yes" {{ $user->self_application == 'Yes'?'checked':'' }}>
                                      <label class="form-check-label" for="self_applicationyes">Yes</label>
                                    </div>
                                </div>
                            </div>
                            <div class="col-4">
                                <div class="col-md">
                                    <small class="form-label d-block">With their full consent?</small>
                                    <div class="form-check form-check-inline mt-3">
                                      <input class="form-check-input" type="radio" name="full_consent" id="full_consentno" value="No" {{ $user->full_consent == 'No'?'checked':'' }}>
                                      <label class="form-check-label" for="full_consentno">No</label>
                                    </div>
                                    <div class="form-check form-check-inline">
                                      <input class="form-check-input" type="radio" name="full_consent" id="full_consentyes" value="Yes" {{ $user->full_consent == 'Yes'?'checked':'' }}>
                                      <label class="form-check-label" for="full_consentyes">Yes</label>
                                    </div>
                                </div>
                            </div>
                            <div class="col-4">
                                <div class="col-md">
                                    <small class="form-label d-block">Or is the application being made as a result of a best-interest decision?</small>
                                    <div class="form-check form-check-inline mt-3">
                                      <input class="form-check-input" type="radio" name="interest_decision" id="interest_decisionno" value="No" {{ $user->interest_decision == 'No'?'checked':'' }}>
                                      <label class="form-check-label" for="interest_decisionno">No</label>
                                    </div>
                                    <div class="form-check form-check-inline">
                                      <input class="form-check-input" type="radio" name="interest_decision" id="interest_decisionyes" value="Yes" {{ $user->interest_decision == 'Yes'?'checked':'' }}>
                                      <label class="form-check-label" for="interest_decisionyes">Yes</label>
                                    </div>
                                </div>
                            </div>
                          </div>
                          <div class="divider text-start divider-success" style="margin-top:62px;">
                            <div class="divider-text"><h5>Describe any particular service conditions needed, eg:</h5></div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="specific_services">Specific services to be carried out in addition to general support</label>
                                <input type="text" name="specific_services" value="{{$user->specific_services}}" class="form-control" id="specific_services"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="additional_features">Additional features of the required service</label>
                                <input type="text" name="additional_features" value="{{$user->additional_features}}" class="form-control" id="additional_features" />
                            </div>
                          </div>
                          <button type="submit" class="btn btn-primary">Submit</button>
                        </form>
                      </div>
                    </div>
                  </div>
                  
                </div>
              </div>
            
            <!-- / Content -->

            <!-- Footer -->
            @include('includes.footer')
            <!-- / Footer -->

            <div class="content-backdrop fade"></div>
        </div>
        <!-- Content wrapper -->
      </div>
      <!-- / Layout page -->
    </div>

    <!-- Overlay -->
    <div class="layout-overlay layout-menu-toggle"></div>
</div>
@endsection