@extends('frontend.dashboard.layouts.app')

@section('content')
    <script src="https://ajax.googleapis.com/ajax/libs/jquery/3.6.1/jquery.min.js"></script>
    <div class="page-content">
        <div class="page-breadcrumb d-none d-sm-flex align-items-center mb-3">
            <div class="breadcrumb-title pe-3">Birth Verification</div>
            <div class="ps-3">
                <nav aria-label="breadcrumb">
                    <ol class="breadcrumb mb-0 p-0">
                        <li class="breadcrumb-item"><a href="javascript:;"><i class="bx bx-home-alt"></i></a>
                        </li>
                        <li class="breadcrumb-item active" aria-current="page">Add Birth</li>
                    </ol>
                </nav>
            </div>
        </div>
        <div class="container">
            <div class="main-body">
                <div class="row">
                    <div class="col-lg-12">
                        <div class="card">
                            <div class="card-body">
                                <!-- Display Session Success Message -->
                                @if(session('success'))
                                    <div class="alert alert-success alert-dismissible fade show" role="alert">
                                        {{ session('success') }}
                                        <button type="button" class="btn-close" data-bs-dismiss="alert" aria-label="Close"></button>
                                    </div>
                                @endif

                                <!-- Display Session Error Message -->
                                @if(session('error'))
                                    <div class="alert alert-danger alert-dismissible fade show" role="alert">
                                        {{ session('error') }}
                                        <button type="button" class="btn-close" data-bs-dismiss="alert" aria-label="Close"></button>
                                    </div>
                                @endif

                                <!-- Display Validation Errors Summary -->
                                @if($errors->any())
                                    <div class="alert alert-danger alert-dismissible fade show" role="alert">
                                        <strong>Error!</strong> Please fix the following issues:
                                        <ul class="mb-0 mt-2">
                                            @foreach($errors->all() as $error)
                                                <li>{{ $error }}</li>
                                            @endforeach
                                        </ul>
                                        <button type="button" class="btn-close" data-bs-dismiss="alert" aria-label="Close"></button>
                                    </div>
                                @endif

                                <form method="post" action="{{ route('birth.store') }}" class="needs-validation" novalidate id="birth-form">
                                    @csrf

                                    <div class="card-header">
                                        <h4>Add Birth Verification</h4>
                                    </div>
                                    <div class="card-body">
                                        <div class="row">

                                            <!-- Subject -->
                                            <div class="form-group col-md-12 col-12 mb-3">
                                                <label>विषय</label>
                                                <input type="text" class="form-control @error('subject') is-invalid @enderror"
                                                    name="subject" value="Birth Verification" readonly>
                                                @error('subject')
                                                    <div class="invalid-feedback">{{ $message }}</div>
                                                @enderror
                                            </div>

                                            <!-- Send To Address -->
                                            <div class="form-group col-md-6 col-6 mb-3">
                                                <label>साविक वडा नं/Previous Ward No</label>
                                                <input type="number" class="form-control @error('previous_ward_no') is-invalid @enderror"
                                                    name="previous_ward_no" value="{{ old('previous_ward_no') }}">
                                                @error('previous_ward_no')
                                                    <div class="invalid-feedback">{{ $message }}</div>
                                                @else
                                                    <div class="invalid-feedback">कृपया ठेगना भर्नुहोस्</div>
                                                @enderror
                                            </div>

                                            <!-- Municipality -->
                                            <div class="form-group col-md-6 col-6 mb-3">
                                                <label>नगरपालिका/Municipality</label>
                                                <select name="municipality_id" class="form-control @error('municipality_id') is-invalid @enderror">
                                                    <option value="{{ Auth()->user()->municipality_id }}">
                                                        {{ Auth::user()->municipality->name }}
                                                    </option>
                                                </select>
                                                @error('municipality_id')
                                                    <div class="invalid-feedback">{{ $message }}</div>
                                                @enderror
                                            </div>

                                            <!-- Ward No -->
                                            <div class="form-group col-md-6 col-6 mb-3">
                                                <label>वडा नं/Ward No</label>
                                                <select name="ward_id" class="form-control @error('ward_id') is-invalid @enderror">
                                                    <option value="{{ Auth()->user()->ward_id }}">
                                                        {{ Auth::user()->ward->name }}
                                                    </option>
                                                </select>
                                                @error('ward_id')
                                                    <div class="invalid-feedback">{{ $message }}</div>
                                                @enderror
                                            </div>

                                            <div class="form-group col-md-6 col-6 mb-3">
                                                <label>जिल्ला/District</label>
                                                <input type="text" class="form-control @error('district') is-invalid @enderror"
                                                    name="district" value="Bhaktapur" readonly>
                                                @error('district')
                                                    <div class="invalid-feedback">{{ $message }}</div>
                                                @else
                                                    <div class="invalid-feedback">कृपया जिल्ला भर्नुहोस्</div>
                                                @enderror
                                            </div>

                                            <div class="form-group col-md-6 col-6 mb-3">
                                                <label>प्रदेश/Province</label>
                                                <input type="text" class="form-control @error('provinance') is-invalid @enderror"
                                                    name="provinance" value="Bagmati Province" readonly>
                                                @error('provinance')
                                                    <div class="invalid-feedback">{{ $message }}</div>
                                                @else
                                                    <div class="invalid-feedback">कृपया प्रदेश भर्नुहोस्</div>
                                                @enderror
                                            </div>

                                            <!-- Applicant Name -->
                                            <div class="form-group col-md-6 col-6 mb-3">
                                                <label>निवेदक/Applicant</label>
                                                <input type="text" class="form-control @error('applicant_name') is-invalid @enderror"
                                                    name="applicant_name" value="{{ old('applicant_name', Auth::user()->name) }}" required>
                                                @error('applicant_name')
                                                    <div class="invalid-feedback">{{ $message }}</div>
                                                @else
                                                    <div class="invalid-feedback">कृपया निवेदकको नाम भर्नुहोस्</div>
                                                @enderror
                                            </div>

                                            <div class="form-group col-md-6 col-6 mb-3">
                                                <label>लिङ्ग/Gender</label>
                                                <select name="gender" class="form-control @error('gender') is-invalid @enderror" required>
                                                    <option value="">--Select--</option>
                                                    <option value="Male" {{ old('gender') == 'Male' ? 'selected' : '' }}>Male</option>
                                                    <option value="Female" {{ old('gender') == 'Female' ? 'selected' : '' }}>Female</option>
                                                </select>
                                                @error('gender')
                                                    <div class="invalid-feedback">{{ $message }}</div>
                                                @else
                                                    <div class="invalid-feedback">कृपया लिङ्ग चयन गर्नुहोस्</div>
                                                @enderror
                                            </div>

                                            <div class="form-group col-md-6 col-6 mb-3">
                                                <label>विवाहित/Marital Status</label>
                                                <select name="marital_status" class="form-control @error('marital_status') is-invalid @enderror" required>
                                                    <option value="">--Select--</option>
                                                    <option value="Married" {{ old('marital_status') == 'Married' ? 'selected' : '' }}>Married</option>
                                                    <option value="Unmarried" {{ old('marital_status') == 'Unmarried' ? 'selected' : '' }}>Unmarried</option>
                                                </select>
                                                @error('marital_status')
                                                    <div class="invalid-feedback">{{ $message }}</div>
                                                @else
                                                    <div class="invalid-feedback">कृपया वैवाहिक स्थिति चयन गर्नुहोस्</div>
                                                @enderror
                                            </div>

                                            <div class="form-group col-md-6 col-6 mb-3">
                                                <label>निवेदककाे जन्म मिति/Date of Birth</label>
                                                <input type="text" class="form-control @error('birth_date_in_nepali') is-invalid @enderror"
                                                    id="nepali-datepicker" name="birth_date_in_nepali" value="{{ old('birth_date_in_nepali') }}" required>
                                                @error('birth_date_in_nepali')
                                                    <div class="invalid-feedback">{{ $message }}</div>
                                                @else
                                                    <div class="invalid-feedback">कृपया निवेदकको मिति भर्नुहोस्</div>
                                                @enderror
                                            </div>

                                            <div class="form-group col-md-6 col-6 mb-3">
                                                <label>निवेदककाे नागरिकता नं/Applicant Citizenship No</label>
                                                <input type="text" class="form-control @error('applicant_citizen') is-invalid @enderror"
                                                    name="applicant_citizen" value="{{ old('applicant_citizen') }}" required>
                                                @error('applicant_citizen')
                                                    <div class="invalid-feedback">{{ $message }}</div>
                                                @else
                                                    <div class="invalid-feedback">कृपया निवेदकको नागरिकता नं भर्नुहोस्</div>
                                                @enderror
                                            </div>

                                            <div class="form-group col-md-6 col-6 mb-3">
                                                <label>निवेदककाे राष्ट्रिय परिचय नं/Applicant NIN No</label>
                                                <input type="text" class="form-control @error('applicant_id_no') is-invalid @enderror"
                                                    name="applicant_id_no" value="{{ old('applicant_id_no') }}">
                                                @error('applicant_id_no')
                                                    <div class="invalid-feedback">{{ $message }}</div>
                                                @enderror
                                            </div>

                                            <div class="form-group col-md-6 col-6 mb-3">
                                                <label>निवेदककाे राहदानी नं/Applicant Passport No</label>
                                                <input type="text" class="form-control @error('applicant_passport') is-invalid @enderror"
                                                    name="applicant_passport" value="{{ old('applicant_passport') }}">
                                                @error('applicant_passport')
                                                    <div class="invalid-feedback">{{ $message }}</div>
                                                @enderror
                                            </div>

                                            <div class="form-group col-md-6 col-6 mb-3">
                                                <label>निवेदककाे हजुरबुवाको नाम/Grandfather Name</label>
                                                <input type="text" class="form-control @error('applicant_grandfather') is-invalid @enderror"
                                                    name="applicant_grandfather" value="{{ old('applicant_grandfather') }}" required>
                                                @error('applicant_grandfather')
                                                    <div class="invalid-feedback">{{ $message }}</div>
                                                @else
                                                    <div class="invalid-feedback">कृपया निवेदकको हजुरबुवाको नाम भर्नुहोस्</div>
                                                @enderror
                                            </div>

                                            <div class="form-group col-md-6 col-6 mb-3">
                                                <label>निवेदककाे बुवाको नाम/Father Name</label>
                                                <input type="text" class="form-control @error('applicant_father') is-invalid @enderror"
                                                    name="applicant_father" value="{{ old('applicant_father') }}" required>
                                                @error('applicant_father')
                                                    <div class="invalid-feedback">{{ $message }}</div>
                                                @else
                                                    <div class="invalid-feedback">कृपया निवेदकको बुवाको नाम भर्नुहोस्</div>
                                                @enderror
                                            </div>

                                            <div class="form-group col-md-6 col-6 mb-3">
                                                <label>निवेदककाे आमाको नाम/Mother Name</label>
                                                <input type="text" class="form-control @error('applicant_mother') is-invalid @enderror"
                                                    name="applicant_mother" value="{{ old('applicant_mother') }}" required>
                                                @error('applicant_mother')
                                                    <div class="invalid-feedback">{{ $message }}</div>
                                                @else
                                                    <div class="invalid-feedback">कृपया निवेदकको आमाको नाम भर्नुहोस्</div>
                                                @enderror
                                            </div>

                                        </div>
                                    </div>
                                    <div class="card-footer text-right">
                                        <button type="submit" class="btn btn-primary">सुरक्षित गर्नुहोस्</button>
                                        <button type="reset" class="btn btn-secondary">रद्द गर्नुहोस्</button>
                                    </div>
                                </form>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
@endsection

@push('scripts')
    <script>
        $(document).ready(function() {
            // Remove validation error on input change
            $('input, select').on('input change', function() {
                $(this).removeClass('is-invalid');
                $(this).next('.invalid-feedback').hide();
            });

            // Client-side validation before submit
            $('#birth-form').on('submit', function(e) {
                let isValid = true;
                $(this).find('[required]').each(function() {
                    if (!$(this).val()) {
                        $(this).addClass('is-invalid');
                        isValid = false;
                    }
                });
                if (!isValid) {
                    e.preventDefault();
                    $('html, body').animate({
                        scrollTop: $('.is-invalid:first').offset().top - 100
                    }, 500);
                }
            });
        });
    </script>
@endpush