@extends('layouts.contentLayoutMaster')
{{-- page title --}}
@section('title','Criar Entidade')
{{-- vendor styles --}}
@section('vendor-styles')
<link rel="stylesheet" type="text/css" href="{{asset('css/plugins/forms/validation/form-validation.css')}}">
<link rel="stylesheet" type="text/css" href="{{asset('vendors/css/forms/select/select2.min.css')}}">
<link rel="stylesheet" type="text/css" href="{{asset('vendors/css/pickers/pickadate/pickadate.css')}}">
@endsection

{{-- page styles --}}
@section('page-styles')
@endsection

@section('content')
<!-- users edit start -->
<section class="users-edit">
  <div class="card">
    <div class="card-content">
      <div class="card-body">
        <ul class="nav nav-tabs mb-2" role="tablist">
          <li class="nav-item">
              <a class="nav-link d-flex align-items-center active" id="account-tab" data-toggle="tab"
                  href="#account" aria-controls="account" role="tab" aria-selected="true">
                  <i class="bx bx-user mr-25"></i><span class="d-none d-sm-block">Dados do Entidade</span>
              </a>
          </li>
        </ul>
        <div class="tab-content">
          @if ($message = Session::get('success'))
          <div class="alert alert-success alert-block">
              <button type="button" class="close" data-dismiss="alert">×</button>
              <strong>{{ $message }}</strong>
          </div>
          @endif
          @if (count($errors) > 0)
            <div class="alert alert-danger">
              <strong>Ops!</strong> Ouve algum problema com o Upload.
              <ul>
                @foreach ($errors->all() as $error)
                  <li>{{ $error }}</li>
                @endforeach
              </ul>
            </div>
          @endif
          <div class="tab-pane active fade show" id="account" aria-labelledby="account-tab" role="tabpanel">
            <!-- users edit account form start -->
            <form action="{{ route('patient.store') }}" method="post">
              @csrf
              <div class="row">
                <div class="col-12 col-sm-6">
                  <div class="form-group">
                    <div class="controls">
                      <label>Nome Completo</label>
                      <input type="text" name="name" class="form-control" placeholder="Nome do Entidade" value="">
                    </div>
                  </div>
                  <div class="form-group">
                    <div class="controls row">
                      <div class="col-6">
                        <label>RG</label>
                        <input type="text" name="rg" class="form-control rg" placeholder="Digite o RG" value="">
                      </div>
                      <div class="col-6">
                        <label>CPF</label>
                        <input type="text" name="cpf" class="form-control cpf" placeholder="Digite CPF" value="">
                      </div>
                    </div>
                    <div class="controls row">
                      <div class="col-6">
                        <label>CNPJ</label>
                        <input type="text" name="cnpj" class="form-control cnpj" placeholder="Digite o CNPJ" value="">
                      </div>
                      <div class="col-6">
                        <label>IE</label>
                        <input type="text" name="ie" class="form-control ie" placeholder="Digite a IE" value="">
                      </div>
                    </div>
                  </div>
                  <div class="form-group row">
                    <div class="controls col-6">
                      <label>Data de Nascimento</label>
                      <input type="date" name="date" class="form-control" placeholder="Digite o Endereço" value="">
                    </div>
                    <div class="controls col-6">
                      <label>Sexo</label>
                      <select name="sex" class="form-control">
                        <option value=""></option>
                        <option value="Masculino">Masculino</option>
                        <option value="Feminino">Feminino</option>
                      </select>
                    </div>
                  </div>
                  <div class="form-group">
                    <div class="controls">
                      <label>Endereço</label>
                      <input type="text" name="address" class="form-control" placeholder="Digite a Endereço" value="">
                    </div>
                  </div>
                  <div class="form-group row">
                    <div class="controls col-6">
                        <label>Cidade</label>
                        <input type="text" name="city" class="form-control" placeholder="Digite o Cidade" value="">
                    </div>
                    <div class="controls col-6">
                      <label>Estado</label>
                      <select name="state" class="form-control">
                        <option value="AC">Acre</option>
                        <option value="AL">Alagoas</option>
                        <option value="AP">Amapá</option>
                        <option value="AM">Amazonas</option>
                        <option value="BA">Bahia</option>
                        <option value="CE">Ceará</option>
                        <option value="DF">Distrito Federal</option>
                        <option value="ES">Espírito Santo</option>
                        <option value="GO">Goiás</option>
                        <option value="MA">Maranhão</option>
                        <option value="MT">Mato Grosso</option>
                        <option value="MS">Mato Grosso do Sul</option>
                        <option value="MG">Minas Gerais</option>
                        <option value="PA">Pará</option>
                        <option value="PB">Paraíba</option>
                        <option value="PR">Paraná</option>
                        <option value="PE">Pernambuco</option>
                        <option value="PI">Piauí</option>
                        <option value="RJ">Rio de Janeiro</option>
                        <option value="RN">Rio Grande do Norte</option>
                        <option value="RS" selected>Rio Grande do Sul</option>
                        <option value="RO">Rondônia</option>
                        <option value="RR">Roraima</option>
                        <option value="SC">Santa Catarina</option>
                        <option value="SP">São Paulo</option>
                        <option value="SE">Sergipe</option>
                        <option value="TO">Tocantins</option>
                      </select>
                    </div>
                  </div>
                  <div class="form-group">
                    <div class="controls">
                      <label>CEP</label>
                      <input type="text" name="zipcode" class="form-control zipcode" placeholder="Digite o CEP" value="">
                    </div>
                  </div>
                </div>
                <div class="col-12 col-sm-6">
                  <div class="form-group">
                    <div class="controls">
                      <label>Estado Civil</label>
                      <select name="civil" class="form-control">
                        <option value=""></option>
                        <option value="solteiro">Solteiro</option>
                        <option value="casado">Casado</option>
                        <option value="separado">Separado</option>
                        <option value="divorciado">Divorciado</option>
                        <option value="viúvo">Viúvo</option>
                      </select>
                    </div>
                  </div>
                  <div class="form-group">
                    <div class="controls">
                      <label>Celular</label>
                      <input type="text" name="celphone" class="form-control celphone" placeholder="Digite o Celular" value="">
                    </div>
                  </div>
                  <div class="form-group">
                    <div class="controls">
                      <label>Telefone</label>
                      <input type="text" name="phone" class="form-control phone" placeholder="Digite o Telefone" value="">
                    </div>
                  </div>
                  <div class="form-group">
                    <div class="controls">
                      <label>Profissão</label>
                      <input type="text" name="profession" class="form-control" placeholder="Digite o Profissão" value="">
                    </div>
                  </div>
                  <div class="form-group">
                    <div class="controls">
                        <label>email</label>
                        <input type="text" name="email" class="form-control" placeholder="Digite um e-mail" value="">
                    </div>
                  </div>
                  <div class="form-group">
                    <div class="controls">
                        <label>Observação</label>
                        <input type="text" name="obs" class="form-control" placeholder="Digite um observação" value="">
                    </div>
                  </div>
                </div>
                <div class="col-12 d-flex flex-sm-row flex-column justify-content-end mt-1">
                  <button type="submit" class="btn btn-primary glow mb-1 mb-sm-0 mr-0 mr-sm-1">Salvar</button>
                </div>
              </div>
            </form>
          </div>
        </div>
      </div>
    </div>
  </div>
</section>
@endsection
{{-- vendor scripts --}}
@section('vendor-scripts')
<script src="{{asset('vendors/js/forms/select/select2.full.min.js')}}"></script>
<script src="{{asset('vendors/js/forms/validation/jqBootstrapValidation.js')}}"></script>
<script src="{{asset('vendors/js/pickers/pickadate/picker.js')}}"></script>
<script src="{{asset('vendors/js/pickers/pickadate/picker.date.js')}}"></script>
<script src="{{asset('vendors/js/pickers/pickadate/picker.time.js')}}"></script>

<script type="text/javascript" src="https://cdnjs.cloudflare.com/ajax/libs/jquery.mask/1.14.0/jquery.mask.js"></script>
@endsection

{{-- page scripts --}}
@section('page-scripts')
<script>
$(document).ready(function(){
  $('.zipcode').mask('00000-000');
  $('.rg').mask('0000000000');
  $('.cpf').mask('000.000.000-00');
  $('.cnpj').mask('00.000.000/0000-00');
  $('.phone').mask("(99) 9999-9999");
  $('.celphone').mask("(99) 99999-9999");
});
</script>
<script src="{{asset('js/scripts/navs/navs.js')}}"></script>
@endsection