@extends('admin.layouts.layout')

@section('content')
<div class="container-fluid">
  <!-- Breadcrumb-->
  <div class="row pt-2 pb-2">
    <div class="col-sm-9">
      <h4 class="page-title">{{ $page_mode == 'create' ? 'Add Claim Outstanding' : 'Edit Claim Outstanding' }}</h4>
    </div>
    <div class="col-sm-3">
      @if($page_mode == 'create')
      <div class="pull-right mb-2">
        <a class="btn btn-success" href="{{ route('claim-outstanding.index') }}"> Claim Outstanding List</a>
      </div>
      @endif
    </div>
  </div>
  <!-- End Breadcrumb-->
	
  <div class="row">
    <div class="col-lg-12">
      <div class="card">
        <div class="card-body">
          @include("admin.layouts.message")

          <form action="{{ $page_mode == 'create' ? route('claim-outstanding.store') : route('claim-outstanding.update', isset($data) ? $data->id : '') }}" method="POST" enctype="multipart/form-data">
            @csrf
            @if($page_mode == 'edit')
            @method('PUT')
            @endif
				
            <div class="form-group row">
              <label for="serial" class="col-sm-3 col-form-label">Serial{{ $page_mode == 'edit' ? ' :' : '' }}</label>
              <div class="col-sm-9">
                <input type="number" id="serial" class="form-control" name="serial" value="{{ old('serial', $page_mode == 'edit' && isset($data) ? $data->serial : '') }}" placeholder="Enter serial number">
              </div>
            </div>

            <div class="form-group row">
              <label for="name" class="col-sm-3 col-form-label">Name{{ $page_mode == 'edit' ? ' :' : '' }} <span class="text-danger">*</span></label>
              <div class="col-sm-9">
                <textarea id="name" class="form-control" name="name" rows="3" required>{{ old('name', $page_mode == 'edit' && isset($data) ? $data->name : '') }}</textarea>
              </div>
            </div>

            <div class="form-group row">
              <label for="claim_amount" class="col-sm-3 col-form-label">Claim Amount{{ $page_mode == 'edit' ? ' :' : '' }} <span class="text-danger">*</span></label>
              <div class="col-sm-9">
                <input type="number" id="claim_amount" class="form-control" name="claim_amount" step="0.01" min="0" value="{{ old('claim_amount', $page_mode == 'edit' && isset($data) ? $data->claim_amount : '') }}" required placeholder="0.00">
              </div>
            </div>

            <div class="form-group row">
              <label for="insurance_amount" class="col-sm-3 col-form-label">Insurance Amount{{ $page_mode == 'edit' ? ' :' : '' }} <span class="text-danger">*</span></label>
              <div class="col-sm-9">
                <input type="number" id="insurance_amount" class="form-control" name="insurance_amount" step="0.01" min="0" value="{{ old('insurance_amount', $page_mode == 'edit' && isset($data) ? $data->insurance_amount : '') }}" required placeholder="0.00">
              </div>
            </div>

            <div class="form-group row">
              <label for="insurance_category" class="col-sm-3 col-form-label">Insurance Category{{ $page_mode == 'edit' ? ' :' : '' }}</label>
              <div class="col-sm-9">
                <input type="text" id="insurance_category" class="form-control" name="insurance_category" value="{{ old('insurance_category', $page_mode == 'edit' && isset($data) ? $data->insurance_category : '') }}" placeholder="e.g., অগ্নি">
              </div>
            </div>

            <div class="form-group row">
              <label for="claim_number" class="col-sm-3 col-form-label">Claim Number{{ $page_mode == 'edit' ? ' :' : '' }} <span class="text-danger">*</span></label>
              <div class="col-sm-9">
                <input type="text" id="claim_number" class="form-control" name="claim_number" value="{{ old('claim_number', $page_mode == 'edit' && isset($data) ? $data->claim_number : '') }}" required>
              </div>
            </div>

            <div class="form-group row">
              <label for="progress" class="col-sm-3 col-form-label">Progress{{ $page_mode == 'edit' ? ' :' : '' }}</label>
              <div class="col-sm-9">
                <textarea id="progress" class="form-control" name="progress" rows="2">{{ old('progress', $page_mode == 'edit' && isset($data) ? $data->progress : '') }}</textarea>
              </div>
            </div>

            <div class="form-group row">
              <label for="input-10" class="col-sm-3 col-form-label">Status</label>
              <div class="col-sm-9">
                <input type="checkbox" id="md_checkbox_16" name="status" value="1" class="filled-in chk-col-success" 
                  @if($page_mode == 'create') checked @elseif($page_mode == 'edit' && isset($data) && $data->status == 1) checked @endif />
                <label for="md_checkbox_16">
                  @if($page_mode == 'create')
                    Active
                  @elseif($page_mode == 'edit' && isset($data))
                    {{ $data->status == 1 ? 'Active' : 'Inactive' }}
                  @endif
                </label>
              </div>
            </div>

            <div class="form-group row">
              <label for="placeholder-input" class="col-sm-3 col-form-label"></label>
              <div class="col-sm-9">
                <button type="submit" name="action" value="SAVE" class="btn btn-primary">Submit</button>
              </div>
            </div>
          </form>
        </div>
      </div>
    </div>
  </div><!--End Row-->
</div>
<!-- End container-fluid-->
@endsection