@extends('layouts.app')

@section('header')
<div class="card borderless-card">
    <div class="card-block primary-breadcrumb">
        <div class="breadcrumb-header">
            <h5>Billing/Treatment </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 Billing/Treatment </a>
                </li>
                <li class="breadcrumb-item"><a href="#">Edit Billing/Treatment </a>
                </li>
            </ul>
        </div>
    </div>
</div>

@endsection

@section('content')

<!-- Basic Form Inputs card start -->
<div class="card">
    <div class="card-header">
        <h5>Edit Billing/Treatment </h5>
    </div>
    <div class="card-block">
        <form method="post" action="{{ \URL::to('bill/update') }}" data-parsley-validate="">

            {{ csrf_field() }}
            <input type="hidden" name="bill_id" value="{{ $bill['id'] }}">
            <input type="hidden" name="patient_type" value="in-patient">

            <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="admission_code" name="admission_code" class="form-control" readonly=""  value="{{ $admission['admission_code'] }}">
                        </div>
                    </div>

                    <div class="form-group">
                        <div class="col-xl-12 col-md-12">
                            <input type="text" id="patient_name" name="patient_name" class="form-control" readonly=""  value="{{ $admission['patient_name'] }}">
                        </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" readonly="">{{ $admission['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"  value="{{ date('d-m-Y', strtotime($bill['billdate'] )) }}" 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="patient_id" name="patient_id" class="form-control" readonly="" value="{{ $admission['patient_id'] }}">
                        </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" readonly="" value="{{ $admission['doctor_name'] }}">
                        </div>
                    </div>
                </div>
            </div>

            <hr>

            <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="admission_date" name="admission_date" class="form-control" readonly="" value="{{ $admission['admission_date'] }}">
                        </div>
                    </div>

                    <div class="form-group">
                        <div class="col-xl-12 col-md-12">
                            <input type="text" id="discharge_date" name="discharge_date" class="form-control" readonly="" value="{{ $admission['discharge_date'] }}">
                        </div>
                    </div>

                </div>

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

                    <div class="form-group">
                        <div class="col-xl-12 col-md-12">
                            <input type="text" id="package_name" name="package_name" class="form-control" readonly="" value="{{ isset($admission['package']['name']) ? $admission['package']['name'] : '' }}">
                        </div>
                    </div>

                    <div class="form-group">
                        <div class="col-xl-12 col-md-12">
                            <input type="text" id="total_days" name="total_days" class="form-control" readonly="" value="{{ $admission['total_days'] }}">
                        </div>
                    </div>

                </div>
            </div>

            <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">
                                    @foreach($billingList as $list)
                                                                        <tr>
                                        <td>
                                            <input type="text" class="form-control search_billing_service_name" placeholder="Type here ..." name="billing_service_name[]" autocomplete="off" value="{{ $list['service_name'] }}">
                                            <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" value="{{ $list['billing_quantity'] }}">
                                        </td>
                                        <td width="200px">
                                            <input type="number" class="form-control billing_rate change_billing_rate" name="billing_rate[]" step="0.2" value="{{ $list['billing_rate'] }}">
                                        </td>                

                                        <td width="100px">
                                            <input type="text" class="form-control billing_total" name="sub_total[]"  readonly="" value="{{ $list['sub_total'] }}">
                                        </td>

                                        <td><button type="button" class="btn btn-danger remove_tr">&times;</button></td>
                                    </tr>
                                    @endforeach
                                </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" value="{{ $bill['billing_total'] }}">
                </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="{{ $bill['advance_payment'] }}">
                </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="{{ $bill['discount_percent'] }}">
                </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="{{ $bill['discount_amount'] }}"  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" value="{{ $bill['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="{{ $bill['tax_percent'] }}">
                </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="{{ $bill['tax_amount'] }}">
                </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">{{ $bill['billing_description'] }}</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="" value="{{ $bill['grand_total'] }}">
                </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" value="{{ $bill['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="" value="{{ $bill['balance_to_pay'] }}">
                </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="" value="{{ $bill['closing_due'] }}">
                </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="{{ $pay['id'] }}" {{ ($bill['mode'] == $pay['id']) ? 'selected' : ''  }}>{{ $pay['text'] }}</option>
                    @endforeach
                  </select>
                </div>
              </div>

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

            <div class="row">
                <label class="col-sm-2"></label>
                <div class="col-sm-10">
                    <button type="submit" class="btn btn-primary m-b-0">Update</button>
                </div>
            </div>

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

@endsection

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