@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="#">Edit Case Manager</a>
                </li>
            </ul>
        </div>
    </div>
</div>

@endsection

@section('content')

<!-- Basic Form Inputs card start -->
<div class="card">
    <div class="card-header">
        <h5>Edit Case Manager</h5>
    </div>
    <div class="card-block">
        <form method="post" action="{{ \URL::to('casemanager/update') }}" data-parsley-validate="">
            {{ csrf_field() }}
            <input type="hidden" name="caseManager_id" value="{{ $caseManager->id }}">

            <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">
                    <input type="text" id="rdname" name="rdname" class="form-control" value="{{ $caseManager->patient->firstname.' '.$caseManager->patient->lastname }}" readonly>
                </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" value="{{ $caseManager->ref_doctor_name }}">
                </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" value="{{ $caseManager->name }}">
                </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">{{ $caseManager->address }}</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" value="{{ $caseManager->consulting_doc }}" 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">Update</button>
                </div>
            </div>

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

@endsection