@extends('layouts.app')

@section('header')
<div class="card borderless-card">
    <div class="card-block primary-breadcrumb">
        <div class="breadcrumb-header">
            <h5>Out Patient Billing</h5>
        </div>
        <div class="page-header-breadcrumb">
            <ul class="breadcrumb-title">
                <li class="breadcrumb-item">
                    <a href="{{ \URL::to('/')}}">
                        <i class="fas fa-home"></i>
                    </a>
                </li>
                <li class="breadcrumb-item"><a href="{{ \URL::to('bill') }}">List Bill</a>
                </li>
                <li class="breadcrumb-item"><a href="#">Add Out Patient Billing</a>
                </li>
            </ul>
        </div>
    </div>
</div>

@endsection

@section('content')

<!-- Basic Form Inputs card start -->
<div class="card">
    <div class="card-header">
        <h5>Add Out Patient Billing</h5>
    </div>
    <div class="card-block">
        <form id="paymentForm" method="post" action="{{ \URL::to('bill/save') }}" data-parsley-validate="">
            
            {{ csrf_field() }}

            <input type="hidden" name="patient_type" value="out-patient">
            <input type="hidden" class="search_patient_id" name="patient_id">

            <div class="row">

                <div class="col-xl-6 col-md-6">

                    <div class="form-group">
                        <div class="col-xl-12 col-md-12">
                            <input type="text" id="patient_name" name="patient_name" class="form-control search_patient_name" placeholder="Type here ..." required="">

                            <span class="help-block search_patient_name_empty" style="display: none;">No Results Found ...</span>
                        </div>
                    </div>

                    <div class="form-group">
                        <div class="col-xl-12 col-md-12">
                            <textarea type="text" id="patient_address" name="patient_address" class="form-control search_patient_address" placeholder="Patient Address"></textarea>
                        </div>
                    </div>
                </div>

                <div class="col-xl-6 col-md-6">

                    <div class="form-group">
                        <div class="col-xl-12 col-md-12">
                        <div class="form-group">
                            <div class='input-group date' id='admissionDate'>
                                <input type='text' class="form-control" id="billing_date" name="billing_date" placeholder="Bill Date"  required/>
                                <span class="input-group-addon">
                                    <i class="far fa-calendar-plus"></i>
                                </span>
                            </div>
                        </div>
                        </div>
                    </div>

                    <div class="form-group">
                        <div class="col-xl-12 col-md-12">
                            <input type="text" id="doctor_name" name="doctor_name" class="form-control" placeholder="Doctor Name">
                        </div>
                    </div>
                </div>
            </div>

            <hr>

            <div class="row">
                <div class="col-xl-12 col-md-12">
                    <div class="box box-default">
                        <div class="box-body">
                            <table class="table table-striped">
                                <thead>
                                    <tr>
                                        <th>Service Name</th>
                                        <th>Quantity</th>
                                        <th>Rate</th>
                                        <th>Sub Total</th>
                                    </tr>
                                </thead>
                                <tbody class="billing_container">
                                    <tr>
                                        <td>
                                            <input type="text" class="form-control search_billing_service_name" placeholder="Type here ..." name="billing_service_name[]" autocomplete="off">
                                            <span class="help-block search_billing_service_name_empty" style="display: none;">No Results Found ...</span>
                                        </td>
                                        <td width="250px">
                                            <input type="number" class="form-control change_billing_quantity" name="billing_quantity[]"  min="1">
                                        </td>
                                        <td width="200px">
                                            <input type="number" class="form-control billing_rate change_billing_rate" name="billing_rate[]" step="0.2">
                                        </td>                

                                        <td width="100px">
                                            <input type="text" class="form-control billing_total" name="sub_total[]"  readonly="">
                                        </td>

                                        <td><button type="button" class="btn btn-danger remove_tr">&times;</button></td>
                                    </tr>
                                </tbody>
                                <tfoot>
                                    <tr>
                                        <td colspan="3">
                                            <button type="button" class="btn btn-primary add_billing_product"><i class="fa fa-plus"></i> Add More</button>
                                        </td>
                                        <td></td>
                                    </tr>
                                </tfoot>
                            </table>
                        </div>
                    </div>
                </div>
            </div>

            <div class="row">
              <div class="col-md-offset-4 col-md-4">
                <div class="form-group">
                  <label>Bill total</label><br>
                  <input type="text" class="form-control final_total_bill" readonly="" name="final_total_bill">
                </div>
              </div>
              <div class="col-md-4">
                <div class="form-group">
                  <label>Advance Payment</label><br>
                  <input type="text" class="form-control" id='advance_payment' name="advance_payment" readonly="" value="0">
                </div>
              </div>
              <div class="col-md-4">
                <div class="form-group">
                  <label>Pervious Balance 
                    &nbsp 
                    <a href="#" id="balanceInfo" target="_blank"><i class="fa fa-info-circle"></i></a>
                  </label><br>
                  <input type="text" class="form-control" id='pervious_balance' name="pervious_balance" readonly="" value="0">
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-offset-4 col-md-4">
                <div class="form-group">
                  <label>Discount ( % )</label><br>
                  <input type="number" class="form-control billing_discount_percent" name="discount_percent" step="0.01" min="0" max="100" value="0">
                </div>
              </div>
              <div class="col-md-4">
                <div class="form-group">
                  <label>Discount ( Amount )</label><br>
                  <input type="text" class="form-control billing_discount_amount" name="discount_amount" step="0.01" min="0" value="0" readonly="">
                </div>
              </div>
            </div>

            <div class="row">

              <div class="col-md-4">
                <div class="form-group">
                  <label>GST Description</label><br>
                  <input type="text" class="form-control" name="tax_description">
                </div>
              </div>

              <div class="col-md-4">
                <div class="form-group">
                  <label>GST ( % )</label><br>
                  <input type="number" class="form-control billing_tax_percent" name="tax_percent"  step="0.01" min="0" max="100" value="0">
                </div>
              </div>
              <div class="col-md-4">
                <div class="form-group">
                  <label>GST ( Amount )</label><br>
                  <input type="text" class="form-control billing_tax_amount" name="tax_amount"   step="0.01" min="0" value="0">
                </div>
              </div>
            </div>

            <div class="box box-default">
          <div class="box-body">
            <div class="row">

              <div class="col-sm-2">
                <div class="form-group">
                  <label>Notes</label><br>
                  <textarea class="form-control" style="height: 35px;" name="notes"></textarea>
                </div>
              </div>

              <div class="col-sm-2">
                <div class="form-group">
                  <label>Grand Total</label><br>
                  <input type="text" class="form-control grand_total" name="grand_total" readonly="">
                </div>
              </div>   

              <div class="col-sm-2">
                <div class="form-group">
                  <label>Payment</label><br>
                  <input type="text" class="form-control billing_payment" name="payment">
                </div>
              </div>

              <div class="col-sm-2">
                <div class="form-group">
                  <label>Balance</label><br>
                  <input type="text" class="form-control closing_balance" name="balance_to_pay" readonly="">
                </div>
              </div>

              <div class="col-sm-2">
                <div class="form-group">
                  <label>Due</label><br>
                  <input type="text" class="form-control closing_due" name="closing_due" readonly="">
                </div>
              </div>
              

              <div class="col-sm-2">
                <div class="form-group">
                  <label>Mode</label>
                  <select class="form-control" name="mode">
                    @foreach($payment as $pay)
                        <option value="{{ $pay['id'] }}">{{ $pay['text'] }}</option>
                    @endforeach
                  </select>
                </div>
              </div>

            </div>
          </div>
        </div>


        <div class="row">
            <label class="col-xl-4 col-md-4"></label>
            <div class="col-sm-10">
                <button type="submit" class="btn btn-primary m-b-0 form_submit">Save</button>
            </div>
        </div>
           
        </form>
    </div>
</div>

@endsection

@section('scripts')
    @include('billing.bill.inc.script')
@endsection