@extends("backend.layouts2.master")

@section("title")
    Odontogram - Sistem Klinik
@endsection

@push('css')

<link rel="stylesheet" href="{{asset('adminlte/plugins/datatables-bs4/css/dataTables.bootstrap4.min.css')}}">
<link rel="stylesheet" href="{{asset('adminlte/plugins/datatables-responsive/css/responsive.bootstrap4.min.css')}}">
<link rel="stylesheet" href="{{asset('adminlte/plugins/datatables-buttons/css/buttons.bootstrap4.min.css')}}">
<style>
  .component {
    /* margin-right: 30px; */
    font-size: 22px;
  }

  .image-component {
    width: 60px;
  }

  .component-blank {
    color: white;
  }

  .component-blank-image {
    height: 60px;
    width: 60px;
    background-color: #fff;
  }
</style>
@endpush

@section ('content')

@if (isset($errors) && count($errors) > 0)
    <div class="alert alert-danger alert-dismissible" role="alert">
        <button type="button" class="close" data-dismiss="alert" aria-label="Close"><span aria-hidden="true">×</span></button>
        <strong>Error!</strong> Please fill all required fields
    </div>
@endif

@if(session()->has('messages'))
  <div class="alert alert-success">
      {{ session()->get('messages') }}
  </div>
@endif

<div class="container-fluid">
  <section class="content-header">
    <div class="container-fluid">
      <div class="row mb-2">

          <ol class="breadcrumb float-sm-left">
            <li class="breadcrumb-item"><a href="#">Home</a></li>
            <li class="breadcrumb-item">Odontogram</li>
            <li class="breadcrumb-item active">Form</li>
          </ol>
      </div>
    </div><!-- /.container-fluid -->
  </section>
  <!-- Page Heading -->

  <!-- DataTales Example -->
  <div class="card shadow mb-4">
      <div class="card-header py-3">
        <div class="row">
          <div class="col-12">
              <h6 class="m-0 font-weight-bold text-primary w-75 p-2"><a href="{{url('/dashboard/layanan/rekam-medis/edit/'.$row->rekam_medis_id)}}" class="btn btn-primary btn-xs"><i class="fas fa-arrow-circle-left"></i></a> Odontogram - {{ $row->pasien->nama }} (No RM : {{ $row->pasien->no_rm }}) (No Pendaftaran : {{ $row->rekam_medis->register_id }})<a href="{{route('dashboard.master.pasien.profile', $row->patient_id)}}"> <i class="fa fa-eye"></i> </a></h6>

          </div>
          <div class="col-4">

          </div>
        </div>
      </div>
      <form action="{{ route('dashboard.layanan.' . $module. '.odontology-edit', $row->id) }}" method="POST" enctype="multipart/form-data">
      @method('PUT')
      @csrf
      <input type="hidden" name="rekam_medis_id" value="{{$row->rekam_medis_id}}">
      <input type="hidden" name="patient_id" value="{{$row->patient_id}}">
      <input type="hidden" name="umur" value="{{$row->umur}}">
      <input type="hidden" name="jenis_kelamin" value="{{$row->jenis_kelamin}}">

        <div class="card-body">

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">11 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_11">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_11', (isset($row) && $row['odon_11'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">21 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_21">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_21', (isset($row) && $row['odon_21'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">12 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_12">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_12', (isset($row) && $row['odon_12'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">22 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_22">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_22', (isset($row) && $row['odon_22'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">13 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_13">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_13', (isset($row) && $row['odon_13'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">23 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_23">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_23', (isset($row) && $row['odon_23'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">14 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_14">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_14', (isset($row) && $row['odon_14'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">24 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_24">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_24', (isset($row) && $row['odon_24'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">15 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_15">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_15', (isset($row) && $row['odon_15'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">25 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_25">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_25', (isset($row) && $row['odon_25'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">16 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_16">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_16', (isset($row) && $row['odon_16'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">26 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_26">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_26', (isset($row) && $row['odon_26'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">17 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_17">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_17', (isset($row) && $row['odon_17'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">27 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_27">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_27', (isset($row) && $row['odon_27'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">18 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_18">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_18', (isset($row) && $row['odon_18'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">28 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_28">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_28', (isset($row) && $row['odon_28'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">51 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_51">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_51', (isset($row) && $row['odon_51'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">61 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_61">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_61', (isset($row) && $row['odon_61'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">52 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_52">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_52', (isset($row) && $row['odon_52'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">62 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_62">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_62', (isset($row) && $row['odon_62'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">53 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_53">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_53', (isset($row) && $row['odon_53'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">63 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_63">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_63', (isset($row) && $row['odon_63'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">54 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_54">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_54', (isset($row) && $row['odon_54'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">64 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_64">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_64', (isset($row) && $row['odon_64'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">55 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_55">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_55', (isset($row) && $row['odon_55'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">65 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_65">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_65', (isset($row) && $row['odon_65'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row mb-2 mt-2 ml-4">
              @include("backend.layanan.rekam-medis.component-odontogram1", ["row" => $row])
            </div>

            <div class="row mb-2 mt-2 ml-4">
              @include("backend.layanan.rekam-medis.component-odontogram2", ["row" => $row])
            </div>

            <div class="row mb-4 mt-2 ml-4">
              @include("backend.layanan.rekam-medis.component-odontogram3", ["row" => $row])
            </div>

            <div class="row mb-4 mt-2 ml-4">
              @include("backend.layanan.rekam-medis.component-odontogram4", ["row" => $row])
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">48 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_48">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_48', (isset($row) && $row['odon_48'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">38 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_38">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_38', (isset($row) && $row['odon_38'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">47 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_47">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_47', (isset($row) && $row['odon_47'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">37 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_37">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_37', (isset($row) && $row['odon_37'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">46 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_46">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_46', (isset($row) && $row['odon_46'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">36 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_36">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_36', (isset($row) && $row['odon_36'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">45 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_45">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_45', (isset($row) && $row['odon_45'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">35 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_35">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_35', (isset($row) && $row['odon_35'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">44 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_44">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_44', (isset($row) && $row['odon_44'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">34 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_34">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_34', (isset($row) && $row['odon_34'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">43 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_43">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_43', (isset($row) && $row['odon_43'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">33 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_33">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_33', (isset($row) && $row['odon_33'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">42 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_42">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_42', (isset($row) && $row['odon_42'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">32 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_32">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_32', (isset($row) && $row['odon_32'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">41 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_41">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_41', (isset($row) && $row['odon_41'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">31 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_31">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_31', (isset($row) && $row['odon_31'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">81 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_81">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_81', (isset($row) && $row['odon_81'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">71 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_71">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_71', (isset($row) && $row['odon_71'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">82 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_82">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_82', (isset($row) && $row['odon_82'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">72 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_72">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_72', (isset($row) && $row['odon_72'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">83 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_83">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_83', (isset($row) && $row['odon_83'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">73 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_73">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_73', (isset($row) && $row['odon_73'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">84 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_84">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_84', (isset($row) && $row['odon_84'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">74 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_74">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_74', (isset($row) && $row['odon_74'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">85 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_85">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_85', (isset($row) && $row['odon_85'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-group row">
                      <label class="col-sm-2 col-form-label">75 <font color="red">*</font> </label>
                      <div class="col-sm-9">
                        <select class="form-control" name="odon_75">
                          @if (count($odontology)>0)
                            @foreach ($odontology as $value)
                              <option value="{{$value->id}}" {{ old('odon_75', (isset($row) && $row['odon_75'] == $value->id ? 'selected' : '') ) }}>{{$value->nama}}</option>
                            @endforeach
                          @endif
                        </select>
                      </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-4">
                <div class="form-group">
                  <label for="exampleInputEmail1">Oklusi</label>
                  <select class="form-control" name="oklusi" id="oklusi">
                    <option value="Normal" {{ old('oklusi', (isset($row) && $row['oklusi'] == 'Normal' ? 'selected' : '') ) }}>Normal</option>
                    <option value="Cross Bite" {{ old('oklusi', (isset($row) && $row['oklusi'] == 'Cross Bite' ? 'selected' : '') ) }}>Cross Bite</option>
                    <option value="Deep Bite" {{ old('oklusi', (isset($row) && $row['oklusi'] == 'Deep Bite' ? 'selected'  : '') ) }}>Deep Bite</option>
                  </select>
                  @if ($errors->has('oklusi'))
                    <span class="form-feedback text-danger">{{ $errors->first('oklusi') }}</span>
                  @endif
                </div>
              </div>
              <div class="col-md-4">
                <div class="form-group">
                  <label for="exampleInputEmail1">Torus Palatinus</label>
                  <select class="form-control" name="torus_palatinus" id="torus_palatinus">
                    <option value="Tidak Ada" {{ old('torus_palatinus', (isset($row) && $row['torus_palatinus'] == 'Tidak Ada' ? 'selected' : '') ) }}>Tidak Ada</option>
                    <option value="Sedang" {{ old('torus_palatinus', (isset($row) && $row['torus_palatinus'] == 'Sedang' ? 'selected' : '') ) }}>Sedang</option>
                    <option value="Kecil" {{ old('torus_palatinus', (isset($row) && $row['torus_palatinus'] == 'Kecil' ? 'selected'  : '') ) }}>Kecil</option>
                    <option value="Besar" {{ old('torus_palatinus', (isset($row) && $row['torus_palatinus'] == 'Besar' ? 'selected'  : '') ) }}>Besar</option>
                    <option value="Multiple" {{ old('torus_palatinus', (isset($row) && $row['torus_palatinus'] == 'Multiple' ? 'selected'  : '') ) }}>Multiple</option>
                  </select>
                  @if ($errors->has('torus_palatinus'))
                    <span class="form-feedback text-danger">{{ $errors->first('torus_palatinus') }}</span>
                  @endif
                </div>
              </div>
              <div class="col-md-4">
                <div class="form-group">
                  <label for="exampleInputEmail1">Torus Mandibularis</label>
                  <select class="form-control" name="torus_mandibularis" id="torus_mandibularis">
                    <option value="Tidak Ada" {{ old('torus_mandibularis', (isset($row) && $row['torus_mandibularis'] == 'Tidak Ada' ? 'selected' : '') ) }}>Tidak Ada</option>
                    <option value="Sisi Kiri" {{ old('torus_mandibularis', (isset($row) && $row['torus_mandibularis'] == 'Sisi Kiri' ? 'selected' : '') ) }}>Sisi Kiri</option>
                    <option value="Sisi Kanan" {{ old('torus_mandibularis', (isset($row) && $row['torus_mandibularis'] == 'Sisi Kanan' ? 'selected'  : '') ) }}>Sisi Kanan</option>
                    <option value="Kedua Sisi" {{ old('torus_mandibularis', (isset($row) && $row['torus_mandibularis'] == 'Kedua Sisi' ? 'selected'  : '') ) }}>Kedua Sisi</option>
                  </select>
                  @if ($errors->has('torus_mandibularis'))
                    <span class="form-feedback text-danger">{{ $errors->first('torus_mandibularis') }}</span>
                  @endif
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-4">
                <div class="form-group">
                  <label for="exampleInputEmail1">Palastum</label>
                  <select class="form-control" name="palastum" id="palastum">
                    <option value="Dalam" {{ old('palastum', (isset($row) && $row['palastum'] == 'Dalam' ? 'selected' : '') ) }}>Dalam</option>
                    <option value="Sedang" {{ old('palastum', (isset($row) && $row['palastum'] == 'Sedang' ? 'selected' : '') ) }}>Sedang</option>
                    <option value="Rendah" {{ old('palastum', (isset($row) && $row['palastum'] == 'Rendah' ? 'selected'  : '') ) }}>Rendah</option>
                  </select>
                  @if ($errors->has('palastum'))
                    <span class="form-feedback text-danger">{{ $errors->first('palastum') }}</span>
                  @endif
                </div>
              </div>
              <div class="col-md-4">
                <div class="form-group">
                  <label for="exampleInputEmail1">Diastema</label>
                  <select class="form-control" name="diastema" id="diastema">
                    <option value="Tidak Ada" {{ old('diastema', (isset($row) && $row['diastema'] == 'Tidak Ada' ? 'selected' : '') ) }}>Tidak Ada</option>
                    <option value="Ada" {{ old('diastema', (isset($row) && $row['diastema'] == 'Ada' ? 'selected' : '') ) }}>Ada</option>
                  </select>
                  @if ($errors->has('diastema'))
                    <span class="form-feedback text-danger">{{ $errors->first('diastema') }}</span>
                  @endif
                </div>
              </div>
              <div class="col-md-4" id="diastema_div">
                <div class="form-group">
                  <label for="exampleInputEmail1">Diastema Ket</label>
                  <input type="text" class="form-control" name="diastema_ada" value="{{ old('diastema_ada', (isset($row) && $row['diastema_ada'] ? $row['diastema_ada'] : '') ) }}">
                  @if ($errors->has('diastema_ada'))
                    <span class="form-feedback text-danger">{{ $errors->first('diastema_ada') }}</span>
                  @endif
                </div>
              </div>
              <div class="col-md-4">
                <div class="form-group">
                  <label for="exampleInputEmail1">Gigi Anomali</label>
                  <select class="form-control" name="gigi_anomali" id="gigi_anomali">
                    <option value="Tidak Ada" {{ old('gigi_anomali', (isset($row) && $row['gigi_anomali'] == 'Tidak Ada' ? 'selected' : '') ) }}>Tidak Ada</option>
                    <option value="Ada" {{ old('gigi_anomali', (isset($row) && $row['gigi_anomali'] == 'Ada' ? 'selected' : '') ) }}>Ada</option>
                  </select>
                  @if ($errors->has('gigi_anomali'))
                    <span class="form-feedback text-danger">{{ $errors->first('gigi_anomali') }}</span>
                  @endif
                </div>
              </div>

              <div class="col-md-4" id="gigi_anomali_div">
                <div class="form-group">
                  <label for="exampleInputEmail1">Gigi Anomali Ket</label>
                  <input type="text" class="form-control" name="gigi_anomali_ada" value="{{ old('gigi_anomali_ada', (isset($row) && $row['gigi_anomali_ada'] ? $row['gigi_anomali_ada'] : '') ) }}">
                  @if ($errors->has('gigi_anomali_ada'))
                    <span class="form-feedback text-danger">{{ $errors->first('gigi_anomali_ada') }}</span>
                  @endif
                </div>
              </div>
            </div>


        </div>

        <div class="card-footer">
          <button type="submit" class="btn btn-primary">Submit</button>
          <a href="{{route('dashboard.layanan.' . $module. '.pdf-odontogram', [$row->rekam_medis_id])}}" target="_blank">
           <button type="button" class="btn btn-success"><i class="fas fa-print"></i> Print</button>
           </a>
        </div>
      </form>
    </div>

</div>


@endsection

@push('js')
<!-- Page level custom scripts -->
<script src="{{asset('adminlte/plugins/datatables/jquery.dataTables.min.js')}}"></script>
<script src="{{asset('adminlte/plugins/datatables-bs4/js/dataTables.bootstrap4.min.js')}}"></script>
<script src="{{asset('adminlte/plugins/datatables-responsive/js/dataTables.responsive.min.js')}}"></script>
<script src="{{asset('adminlte/plugins/datatables-responsive/js/responsive.bootstrap4.min.js')}}"></script>
<script src="{{asset('adminlte/plugins/datatables-buttons/js/dataTables.buttons.min.js')}}"></script>
<script src="{{asset('adminlte/plugins/datatables-buttons/js/buttons.bootstrap4.min.js')}}"></script>
<script src="{{asset('adminlte/plugins/jszip/jszip.min.js')}}"></script>
<script src="{{asset('adminlte/plugins/pdfmake/pdfmake.min.js')}}"></script>
<script src="{{asset('adminlte/plugins/pdfmake/vfs_fonts.js')}}"></script>
<script src="{{asset('adminlte/plugins/datatables-buttons/js/buttons.html5.min.js')}}"></script>
<script src="{{asset('adminlte/plugins/datatables-buttons/js/buttons.print.min.js')}}"></script>
<script src="{{asset('adminlte/plugins/datatables-buttons/js/buttons.colVis.min.js')}}"></script>
<script src="{{asset('adminlte/plugins/toastr/toastr.min.js')}}"></script>

<script>

@if($row && $row['diastema'] == "Ada")
  $("#diastema_div").show()
@else
  $("#diastema_div").hide()
@endif

@if($row && $row['gigi_anomali'] == "Ada")
  $("#gigi_anomali_div").show()
@else
  $("#gigi_anomali_div").hide()
@endif


$("#diastema").on("change", function(){
  if ($(this).val() == "Ada") {
    $("#diastema_div").show()
  }else {
    $("#diastema_div").hide()

  }

})

$("#gigi_anomali").on("change", function(){
  if ($(this).val() == "Ada") {
    $("#gigi_anomali_div").show()
  }else {
    $("#gigi_anomali_div").hide()

  }

})

  $(function () {
    $("#example1").DataTable({
      "responsive": true, "lengthChange": false, "autoWidth": false,
      "buttons": ["copy", "csv", "excel", "pdf", "print", "colvis"]
    }).buttons().container().appendTo('#example1_wrapper .col-md-6:eq(0)');
    $('#example2').DataTable({
      "paging": true,
      "lengthChange": false,
      "searching": false,
      "ordering": true,
      "info": true,
      "autoWidth": false,
      "responsive": true,
    });
  });
</script>
@endpush