@extends('layouts.app')

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

@endsection

@section('content')

<!-- Basic Form Inputs card start -->
<div class="card">
    <div class="card-header">
        <h5>Edit Case Study</h5>
    </div>
    <div class="card-block">
        <form method="post" action="{{ \URL::to('casestudy/update') }}" data-parsley-validate="">
            {{ csrf_field() }}
            <input type="hidden" name="caseStudy_id" value="{{ $caseStudy->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="{{ $caseStudy->patient->firstname.' '.$caseStudy->patient->lastname }}" readonly>
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">Food Allergies</label>
                <div class="col-sm-10">
                    <input type="text" id="food_allergies" name="food_allergies" class="form-control" value="{{ $caseStudy->food_allergies }}">
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">Tendency Bleed</label>
                <div class="col-sm-10">
                    <input type="text" id="tendency_bleed" name="tendency_bleed" class="form-control" value="{{ $caseStudy->tendency_bleed }}">
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">Heart Disease</label>
                <div class="col-sm-10">
                    <input type="text" id="heart_disease" name="heart_disease" class="form-control" value="{{ $caseStudy->heart_disease }}">
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">High Blood Pressure</label>
                <div class="col-sm-10">
                    <input type="text" id="high_blood_pressure" name="high_blood_pressure" class="form-control" value="{{ $caseStudy->high_blood_pressure }}">
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">Diabetic</label>
                <div class="col-sm-10">
                    <input type="text" id="diabetic" name="diabetic" class="form-control" value="{{ $caseStudy->diabetic }}">
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">Surgery</label>
                <div class="col-sm-10">
                    <input type="text" id="surgery" name="surgery" class="form-control" value="{{ $caseStudy->surgery }}">
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">Accident</label>
                <div class="col-sm-10">
                    <input type="text" id="accident" name="accident" class="form-control" value="{{ $caseStudy->accident }}">
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">Others</label>
                <div class="col-sm-10">
                    <input type="text" id="others" name="others" class="form-control" value="{{ $caseStudy->others }}">
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">Family Medical History</label>
                <div class="col-sm-10">
                    <input type="text" id="family_medical_history" name="family_medical_history" class="form-control" value="{{ $caseStudy->family_medical_history }}">
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">Current Medication</label>
                <div class="col-sm-10">
                    <input type="text" id="current_medication" name="current_medication" class="form-control" value="{{ $caseStudy->current_medication }}">
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">Female Pregnancy</label>
                <div class="col-sm-10">
                    <input type="text" id="female_pregnancy" name="female_pregnancy" class="form-control" value="{{ $caseStudy->female_pregnancy }}">
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">Breast Feeding</label>
                <div class="col-sm-10">
                    <input type="text" id="breast_feeding" name="breast_feeding" class="form-control" value="{{ $caseStudy->breast_feeding }}">
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">Health Insurance</label>
                <div class="col-sm-10">
                    <input type="text" id="health_insurance" name="health_insurance" class="form-control" value="{{ $caseStudy->health_insurance }}">
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">Low Income</label>
                <div class="col-sm-10">
                    <input type="text" id="low_income" name="low_income" class="form-control" value="{{ $caseStudy->low_income }}">
                </div>
            </div>

            <div class="form-group row">
                <label class="col-sm-2 col-form-label">Reference</label>
                <div class="col-sm-10">
                    <input type="text" id="reference" name="reference" class="form-control" value="{{ $caseStudy->reference }}">
                </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