@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> Relative and Others</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', $user->id)}}">
                            @csrf
                          <div class="divider text-start divider-success">
                            <div class="divider-text"><h5>Family</h5></div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="family_name">Full Name</label>
                                <input type="text" name="family_name" value="{{$user->family_name}}" class="form-control" id="family_name"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="family_phone">Phone</label>
                                <input type="text" name="family_phone" value="{{$user->family_phone}}" class="form-control" id="family_phone" />
                            </div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="family_email">Email</label>
                                <input type="text" name="family_email" value="{{$user->family_email}}" class="form-control" id="family_email"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="family_address">Address</label>
                                <input type="text" name="family_address" value="{{$user->family_address}}" class="form-control" id="family_address" />
                            </div>
                          </div>
                          <div class="divider text-start divider-success" style="margin-top:62px;">
                            <div class="divider-text"><h5>Friend</h5></div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="friend_name">Full Name</label>
                                <input type="text" name="friend_name" value="{{$user->friend_name}}" class="form-control" id="friend_name"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="friend_phone">Phone</label>
                                <input type="text" name="friend_phone" value="{{$user->friend_phone}}" class="form-control" id="friend_phone" />
                            </div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="friend_email">Email</label>
                                <input type="text" name="friend_email" value="{{$user->friend_email}}" class="form-control" id="friend_email"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="friend_address">Address</label>
                                <input type="text" name="friend_address" value="{{$user->friend_address}}" class="form-control" id="friend_address" />
                            </div>
                          </div>
                          <div class="divider text-start divider-success" style="margin-top:62px;">
                            <div class="divider-text"><h5>Next Of Kin</h5></div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="nok_name">Name</label>
                                <input type="text" name="nok_name" value="{{$user->nok_name}}" class="form-control" id="nok_name"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="nok_phone">Phone</label>
                                <input type="text" name="nok_phone" value="{{$user->nok_phone}}" class="form-control" id="nok_phone" />
                            </div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="nok_email">Email</label>
                                <input type="text" name="nok_email" value="{{$user->nok_email}}" class="form-control" id="nok_email"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="nok_address">Address</label>
                                <input type="text" name="nok_address" value="{{$user->nok_address}}" class="form-control" id="nok_address" />
                            </div>
                          </div>
                          <div class="divider text-start divider-success" style="margin-top:62px;">
                            <div class="divider-text"><h5>Names of legal representative(s), if any, e.g., Power of Attorney</h5></div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="legal_name">Full Name</label>
                                <input type="text" name="legal_name" value="{{$user->legal_name}}" class="form-control" id="legal_name"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="legal_phone">Phone</label>
                                <input type="text" name="legal_phone" value="{{$user->legal_phone}}" class="form-control" id="legal_phone" />
                            </div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="legal_email">Email</label>
                                <input type="text" name="legal_email" value="{{$user->legal_email}}" class="form-control" id="legal_email"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="legal_address">Address</label>
                                <input type="text" name="legal_address" value="{{$user->legal_address}}" class="form-control" id="legal_address" />
                            </div>
                          </div>
                          <div class="divider text-start divider-success" style="margin-top:62px;">
                            <div class="divider-text"><h5>Names of social workers/healthcare professionals involved in the application (if any)</h5></div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="social_name">Full Name</label>
                                <input type="text" name="social_name" value="{{$user->social_name}}" class="form-control" id="social_name"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="social_phone">Phone</label>
                                <input type="text" name="social_phone" value="{{$user->social_phone}}" class="form-control" id="social_phone" />
                            </div>
                          </div>
                          <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="form-label" for="social_email">Email</label>
                                <input type="text" name="social_email" value="{{$user->social_email}}" class="form-control" id="social_email"  />
                            </div>
                            <div class="col-md-6">
                                <label class="form-label" for="social_address">Address</label>
                                <input type="text" name="social_address" value="{{$user->social_address}}" class="form-control" id="social_address" />
                            </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