@extends('admin.layouts.app')

@section('title', 'Add Patient')

@section('header')
Add Patient
@endsection

@section('content')

<div class="card shadow-sm">
    <div class="card-body">

        <form method="POST" action="{{ route('admin.patients.store') }}">
            @csrf

            <div class="row">

                <div class="col-md-4 mb-3">
                    <label>First Name</label>
                    <input type="text" name="first_name" class="form-control" value="{{ old('first_name') }}" required>
                </div>

                <div class="col-md-4 mb-3">
                    <label>Middle Name</label>
                    <input type="text" name="middle_name" class="form-control" value="{{ old('middle_name') }}">
                </div>

                <div class="col-md-4 mb-3">
                    <label>Last Name</label>
                    <input type="text" name="last_name" class="form-control" value="{{ old('last_name') }}" required>
                </div>

                <div class="col-md-4 mb-3">
                    <label>Gender</label>
                    <select name="gender" class="form-control" required>
                        <option value="">Select Gender</option>
                        <option value="Male">Male</option>
                        <option value="Female">Female</option>
                    </select>
                </div>

                <div class="col-md-4 mb-3">
                    <label>Date of Birth</label>
                    <input type="date" name="date_of_birth" class="form-control" value="{{ old('date_of_birth') }}">
                </div>

                <div class="col-md-4 mb-3">
                    <label>Phone</label>
                    <input type="text" name="phone" class="form-control" value="{{ old('phone') }}" required>
                </div>

                <div class="col-md-6 mb-3">
                    <label>Email</label>
                    <input type="email" name="email" class="form-control" value="{{ old('email') }}">
                </div>

                <div class="col-md-6 mb-3">
                    <label>National ID</label>
                    <input type="text" name="national_id" class="form-control" value="{{ old('national_id') }}">
                </div>

                <div class="col-md-4 mb-3">
                    <label>Blood Group</label>
                    <select name="blood_group" class="form-control">
                        <option value="">Select Blood Group</option>
                        <option value="A+">A+</option>
                        <option value="A-">A-</option>
                        <option value="B+">B+</option>
                        <option value="B-">B-</option>
                        <option value="AB+">AB+</option>
                        <option value="AB-">AB-</option>
                        <option value="O+">O+</option>
                        <option value="O-">O-</option>
                    </select>
                </div>

                <div class="col-md-4 mb-3">
                    <label>Height (cm)</label>
                    <input type="number" name="height" class="form-control" step="0.1" value="{{ old('height') }}">
                </div>

                <div class="col-md-4 mb-3">
                    <label>Weight (kg)</label>
                    <input type="number" name="weight" class="form-control" step="0.1" value="{{ old('weight') }}">
                </div>

            </div>

            <button class="btn btn-primary">
                Save Patient
            </button>

            <a href="{{ route('admin.patients.index') }}" class="btn btn-secondary">
                Cancel
            </a>

        </form>

    </div>
</div>

@endsection