@extends('template.index')

@section('css')
<!-- DataTables -->
<link rel="stylesheet" href="{{ asset('template/plugins/datatables-bs4/css/dataTables.bootstrap4.min.css') }}">
<link rel="stylesheet" href="{{ asset('template/plugins/datatables-responsive/css/responsive.bootstrap4.min.css') }}">
<link rel="stylesheet" href="{{ asset('template/plugins/datatables-buttons/css/buttons.bootstrap4.min.css') }}">
@endsection

@section('content')
<div class="col-lg-12">
    <div class="card card-primary card-outline">
        <div class="card-header">
            <h3 class="card-title">List of Follow-up Patients</h3>
        </div>
        <div class="card-body">
            <table id="followup_table" class="table table-bordered table-hover">
                <thead>
                    <th>Follow-up Date</th>
                    <th>Name</th>
                    <th>Contact</th>
                    <th>Action</th>
                </thead>
            </table>
        </div>
    </div>
</div>
<!-- /.col-md-6 -->

<div class="modal fade" id="fillup_form" data-backdrop="static" data-keyboard="false">
    <div class="modal-dialog">
        <div class="modal-content">
        <form id="patient_form" method="post">
                <div class="modal-header">
                    <h4 class="modal-title">{{ $add }} Form</h4>
                    <button type="button" class="close" data-dismiss="modal" aria-label="Close">
                        <span aria-hidden="true">&times;</span>
                    </button>
                </div>
                <div class="modal-body">
                    <div class="form-group row">
                        <label for="firstname" class="col-sm-4 col-form-label">First Name</label>
                        <div class="col-sm-8">
                            <input type="text" id="firstname" name="firstname" class="form-control" placeholder="First Name">
                        </div>
                    </div>
                    <div class="form-group row">
                        <label for="middlename" class="col-sm-4 col-form-label">Middle Name</label>
                        <div class="col-sm-8">
                            <input type="text" id="middlename" name="middlename" class="form-control" placeholder="Middle Name">
                        </div> 
                    </div>
                    <div class="form-group row">
                        <label for="lastname" class="col-sm-4 col-form-label">Last Name</label>
                        <div class="col-sm-8">
                            <input type="text" id="lastname" name="lastname" class="form-control" placeholder="Last Name">
                        </div>
                    </div>
                    <div class="form-group row">
                        <label for="birthdate" class="col-sm-4 col-form-label">Birth date</label>
                        <div class="col-sm-8">
                            <input type="date" id="birthdate" name="birthdate" class="form-control" placeholder="Birth date">
                        </div>
                    </div>
                    <div class="form-group row">
                        <label for="gender" class="col-sm-4 col-form-label">Gender</label>
                        <div class="col-sm-8">
                            <select id="gender" name="gender" class="form-control select2bs4" style="width: 100%;">
                                <option value="">Select Gender</option>
                                <option value="Male">Male</option>
                                <option value="Female">Female</option>
                            </select>
                        </div>
                    </div>
                    <div class="form-group row">
                        <label for="contact" class="col-sm-4 col-form-label">Contact</label>
                        <div class="col-sm-8">
                            <input type="number" id="contact" name="contact" class="form-control" placeholder="(Ex. 9191234567)">
                        </div>
                    </div>
                    <div class="form-group row">
                        <label for="province" class="col-sm-4 col-form-label">Province</label>
                        <div class="col-sm-8">
                            <select id="province" name="province" class="select2bs4 form-control" style="width: 100%;">
                                
                            </select>
                        </div>
                    </div>
                    <div class="form-group row">
                        <label for="municipality" class="col-sm-4 col-form-label">Municipality</label>
                        <div class="col-sm-8">
                            <select id="municipality" name="municipality" class="form-control select2bs4" style="width: 100%;">
                                
                            </select>
                        </div>
                    </div>

                    <input type="hidden" name="hidden_id" id="hidden_id" />
                </div>
                <div class="modal-footer justify-content-between">
                    <button type="button" id="btn_cancel" class="btn btn-default" data-dismiss="modal">Cancel</button>
                    <input type="submit" id="btn_action" name="btn_action" data-action="add" class="btn btn-primary" value="">
                </div>
        </form>
        </div>
        <!-- /.modal-content -->
    </div>
    <!-- /.modal-dialog -->
</div>
<!-- /.modal -->
@endsection

@section('js')
<!-- DataTables  & Plugins -->
<script src="{{ asset('template/plugins/datatables/jquery.dataTables.min.js') }}"></script>
<script src="{{ asset('template/plugins/datatables-bs4/js/dataTables.bootstrap4.min.js') }}"></script>
<script src="{{ asset('template/plugins/datatables-responsive/js/dataTables.responsive.min.js') }}"></script>
<script src="{{ asset('template/plugins/datatables-responsive/js/responsive.bootstrap4.min.js') }}"></script>
<script src="{{ asset('template/plugins/datatables-buttons/js/dataTables.buttons.min.js') }}"></script>
<script src="{{ asset('template/plugins/datatables-buttons/js/buttons.bootstrap4.min.js') }}"></script>
<script src="{{ asset('template/plugins/jszip/jszip.min.js') }}"></script>
<script src="{{ asset('template/plugins/pdfmake/pdfmake.min.js') }}"></script>
<script src="{{ asset('template/plugins/pdfmake/vfs_fonts.js') }}"></script>
<script src="{{ asset('template/plugins/datatables-buttons/js/buttons.html5.min.js') }}"></script>
<script src="{{ asset('template/plugins/datatables-buttons/js/buttons.print.min.js') }}"></script>
<script src="{{ asset('template/plugins/datatables-buttons/js/buttons.colVis.min.js') }}"></script>
<script src="{{ asset('js/patient/followup.js') }}"></script>
@endsection