@extends('layouts.app')

@section('header')
<div class="card borderless-card">
    <div class="card-block primary-breadcrumb">
        <div class="breadcrumb-header">
            <h5>Case Manager</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('casemanager') }}">List Case Manager</a>
                </li>
                <li class="breadcrumb-item"><a href="#">Add Case Manager</a>
                </li>
            </ul>
        </div>
    </div>
</div>

@endsection

@section('content')

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

            <div class="form-group row">
                 <label for="dname" class="col-sm-2 col-form-label">Patient Name <i class="text-danger">*</i></label>
                <div class="col-sm-10">
                    <select class="col-sm-10" id="pname" name="patient_id" data-parsley-required data-parsley-error-message="Select one option"></select>
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">Ref. Doctor Name</label>
                <div class="col-sm-10">
                    <input type="text" id="rdname" name="rdname" class="form-control">
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">Hospital Name</label>
                <div class="col-sm-10">
                    <input type="text" id="hname" name="hname" class="form-control">
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">Hospital Address</label>
                <div class="col-sm-10">
                    <textarea id="address" name="address" class="form-control"></textarea> 
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">Doctor Name <i class="text-danger">*</i></label>
                <div class="col-sm-10">
                    <input type="text" id="dname" name="dname" class="form-control" data-parsley-required>
                </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">Save</button>
                </div>
            </div>

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

@endsection

@section('scripts')

<script type="text/javascript">
$(document).ready(function() {

    var patients_raw_data = '{!! $patients !!}';
    var patients_data = JSON.parse(patients_raw_data);

    $("#pname").select2({
        data: patients_data
    });  
});

</script>

@endsection