@extends("backend.layouts2.master")

@section("title")
    Rekam Medis - 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 media="screen">
  .label-green{
    background-color: rgba(40,167,69,.1)!important;
    color: #28a745!important;
  }
  .card-profile{
    font-size: 13px;
  }
  .text-profile{
    margin-bottom: 0!important;
  }
  .li-profile{
    padding: 0.5rem 1.25rem;
  }
  .label-profile{
    font-size: 90%;
  }

</style>
@endpush

@section ('content')



<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">Rekam Medis</li>
            <li class="breadcrumb-item active">Form</li>
          </ol>
      </div>
    </div><!-- /.container-fluid -->

    @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 ($errors->any())
        <div class="alert alert-danger">
            <ul>
                @foreach ($errors->all() as $error)
                    <li>{{ $error }}</li>
                @endforeach
            </ul>
        </div>
    @endif

    @if(session()->has('messages'))
      <div class="alert alert-success">
          {{ session()->get('messages') }}
      </div>
    @endif
  </section>
  <!-- Page Heading -->
  <div class="row">
    <div class="col-md-3">

      <div class="card card-profile card-primary card-outline mb-2">
        <div class="card-body box-profile">
          <div class="text-center">
            @if($row->pasien->foto_filepath != null)
            <img class="profile-user-img img-fluid rounded-circle"
                 src="{{asset($row->pasien->foto_filepath)}}"
                 alt="User profile picture" style="height:100px!important; width:100px!important">
            @else
            <img class="profile-user-img img-fluid img-circle"
                 src="{{asset('avatar-default.jpg')}}"
                 alt="User profile picture" style="height:100px!important">
            @endif
            <!-- <input type="file" name="image" id="image"> -->

          </div>

          <h6 class="profile-username text-center mt-2"><a href="{{route('dashboard.master.pasien.profile', $row->patient_id)}}" target="_blank">{{$row->pasien->nama}}</a></h6>

          @if($row->pasien->status == 1)
          <p class="text-center"> <label class="badge badge-success-soft text-center label-green">
            <i class="fas fa-check"></i> Aktif
           </label></p>
          @else
          <p class="text-center"> <label class="badge badge-danger-soft text-center label-green">
            s<i class="fas fa-x"></i> Non Aktif
           </label></p>

          @endif

          <ul class="list-group list-group-unbordered mb-3">
            <li class="list-group-item li-profile">
              <b>No RM</b> <a class="float-right">{{$row->pasien->no_rm}}</a>
            </li>
            <li class="list-group-item li-profile">
              <b>Program</b> <a class="float-right"><label class="badge label-profile badge-success-soft text-center label-green">{{$row->register->program->nama ?? ""}}</label></a>
            </li>
            <li class="list-group-item li-profile">
              <b>Paket</b> <a class="float-right"><label class="badge label-profile badge-success-soft text-center label-green">{{$row->register->paket->nama ?? ""}}</label></a>
            </li>


          </ul>

        </div>
        <!-- /.card-body -->
      </div>

    </div>

    <div class="col-md-9">
      <div class="card shadow mb-4">
          <div class="card-header py-3">
            <div class="row">
              <div class="col-5">
                <h6 class="m-0 font-weight-bold text-primary w-00">
                  <a href="{{url('/dashboard/layanan/rekam-medis/')}}" class="btn btn-primary btn-xs"><i class="fas fa-arrow-circle-left"></i></a>
                  <!-- </h6> -->
                  &nbsp; Rekam Medis</h6>
              </div>
              <div class="col-7">
                @canany(["layanan_fisio-layanan-create", "layanan_fisio-layanan-edit"])

                  @if(isset($row) && $row["layanan_fisio"])
                    <a type="button" href="{{route('dashboard.layanan-fisio.layanan.edit', $row->layanan_fisio->id)}}" class="btn btn-primary btn-sm float-right"><i class="fa fa-plus"></i> Edit Layanan</a>

                  @else
                    <a type="button" href="{{route('dashboard.layanan-fisio.layanan.create', $row->id)}}" class="btn btn-primary btn-sm float-right"><i class="fa fa-plus"></i> Create Layanan</a>

                  @endif
                @endcan
                <a type="button" href="{{route('dashboard.layanan.rekam_medis.pdf', $row->id)}}" class="btn btn-info btn-sm float-right mr-1"><i class="fa fa-print"></i> Print</a>
                <!-- <a type="button" href="{{route('dashboard.layanan.rekam_medis.edit-parent', $row->id)}}" class="btn btn-success btn-sm float-right mr-1"><i class="fa fa-print"></i> Rekam Medis Utama</a> -->

              </div>

            </div>
          </div>
          <form action="{{ ($action === "UPDATE") ? route('dashboard.layanan.' . $module. '.update', [$row->id]) : route('dashboard.layanan.' . $module. '.store') }}" method="POST" enctype="multipart/form-data">

          @if ($action === "UPDATE")
              @method('PUT')
          @endif

          @csrf

            <div class="card-body">
              <input type="hidden" name="tgl_rekam_medis" id="tgl_rekam_medis" value="{{ old('tgl_rekam_medis', (isset($row) && $row['tgl_rekam_medis'] ? $row['tgl_rekam_medis'] : \Carbon\Carbon::now()->format('Y-m-d')) ) }}">
              <input type="hidden" name="doctor_id" value="{{ $row['doctor_id'] ?? '' }}">
              <!-- <input type="hidden" name="diagnosa_id"  value="{{ $row['diagnosa_id'] ?? ''}}"> -->
              <input type="hidden" name="no_rm"  value="{{ $row['no_rm'] ?? ''}}">
              <input type="hidden" name="patient_id"  value="{{ $row['patient_id'] ?? ''}}">

              <div class="row">
                <div class="col-md-4">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Status</label>
                    <select  name="status" id="status" class="form-control">
                        <option value="1" {{ old('status', (isset($row) && $row['status'] == '1' ? 'selected' : '') ) }}>Completed</option>
                        <option value="0" {{ old('status', (isset($row) && $row['status'] == '0' ? 'selected' : '') ) }}>Pending</option>
                    </select>
                    @if ($errors->has('status'))
                      <span class="form-feedback text-danger">{{ $errors->first('status') }}</span>
                    @endif
                  </div>
                </div>

              </div>


              <div class="row" style="display:none;">
                <div class="col-md-6">
                  <div class="form-group">
                    <label for="exampleInputEmail1">No Rekam Medis</label>
                    <select class="form-control" name="no_rm" id="no_rm"></select>
                    @if ($errors->has('no_rm'))
                      <span class="form-feedback text-danger">{{ $errors->first('no_rm') }}</span>
                    @endif
                  </div>
                </div>
                <div class="col-md-6" >
                  <div class="form-group">
                    <label for="exampleInputEmail1">Nama Pasien</label>
                    <select class="form-control"  name="patient_id" id="patient_id">
                      @foreach ($patients as $val)
                      <option value="{{$val->id}}" {{ old('patient_id', (isset($row) && $row['patient_id'] == $val->id ? 'selected' : '') ) }}>{{$val->nama}}</option>
                      @endforeach
                    </select>
                    @if ($errors->has('no_hp'))
                      <span class="form-feedback text-danger">{{ $errors->first('patient_id') }}</span>
                    @endif
                  </div>
                </div>

              </div>

              <div class="row">

                <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Keluhan Utama</label>
                    <textarea class="form-control" name="keluhan_utama" id="keluhan_utama">{{ old('keluhan_utama', (isset($row) && $row['keluhan_utama'] ? $row['keluhan_utama'] : '') ) }}</textarea>
                    @if ($errors->has('keluhan_utama'))
                      <span class="form-feedback text-danger">{{ $errors->first('keluhan_utama') }}</span>
                    @endif
                  </div>
                </div>

                <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Penyakit Penyerta</label>
                    <textarea class="form-control" name="penyakit_penyerta" id="penyakit_penyerta">{{ old('penyakit_penyerta', (isset($row) && $row['penyakit_penyerta'] ? $row['penyakit_penyerta'] : '') ) }}</textarea>
                    @if ($errors->has('penyakit_penyerta'))
                      <span class="form-feedback text-danger">{{ $errors->first('penyakit_penyerta') }}</span>
                    @endif
                  </div>
                </div>

              </div>

                <div class="form-group">
                  <label for="exampleInputEmail1">Diagnosis Medis</label>
                  <textarea type="text" class="form-control" name="diagnosa_id" rows="3" cols="80"id="diagnosa_id">{{ old('diagnosa_id', (isset($row) && $row['diagnosa_id'] ? $row['diagnosa_id'] : '') ) }}</textarea>
                  @if ($errors->has('diagnosa_id'))
                    <span class="form-feedback text-danger">{{ $errors->first('diagnosa_id') }}</span>
                  @endif
                </div>

              <div class="form-group d-none">
                <label for="exampleInputEmail1">Deskripsi Diagnosis Medis</label>
                <textarea class="form-control" name="deskripsi_diagnosa" rows="3" cols="80" id="deskripsi">{{ old('deskripsi_diagnosa', (isset($row) && $row['deskripsi_diagnosa'] ? $row['deskripsi_diagnosa'] : '') ) }}</textarea>
              </div>

              <hr>
              <label for="exampleInputEmail1"><strong>Vital Sign</strong> </label>

              <div class="row">

                <!-- <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Vital Sign</label>
                    <input type="text" class="form-control" name="vital_sign" id="vital_sign" value="{{ old('vital_sign', (isset($row) && $row['vital_sign'] ? $row['vital_sign'] : '') ) }}">
                    @if ($errors->has('vital_sign'))
                      <span class="form-feedback text-danger">{{ $errors->first('vital_sign') }}</span>
                    @endif
                  </div>
                </div> -->

              </div>

              <div class="row" >
                <div class="col-md-2" >
                  <div class="form-group">
                    <label for="exampleInputEmail1">Berat Badan </label>
                    <input class="form-control" name="bb" id="bb" value="{{ old('bb', (isset($row) && $row['pasien']['bb'] ? $row['pasien']['bb'] : '') ) }}">
                    @if ($errors->has('bb'))
                      <span class="form-feedback text-danger">{{ $errors->first('bb') }}</span>
                    @endif
                  </div>
                </div>

                <div class="col-md-2" >
                  <div class="form-group">
                    <label for="exampleInputEmail1">Tinggi Badan {{$row['tb']}}</label>
                    <input class="form-control" name="tb" id="tb" value="{{ old('tb', (isset($row)&& $row['pasien']['tb'] ? $row['pasien']['tb'] : '') ) }}">
                    @if ($errors->has('tb'))
                      <span class="form-feedback text-danger">{{ $errors->first('tb') }}</span>
                    @endif
                  </div>
                </div>

                <div class="col-md-2" >
                  <div class="form-group">
                    <label for="exampleInputEmail1">Tensi</label>
                    <input class="form-control" name="tensi" id="tensi" value="{{ old('tensi', (isset($row) && $row && $row['pasien']['tensi'] ? $row['pasien']['tensi'] : '') ) }}">
                    @if ($errors->has('tensi'))
                      <span class="form-feedback text-danger">{{ $errors->first('tensi') }}</span>
                    @endif
                  </div>
                </div>

                <div class="col-md-2" >
                  <div class="form-group">
                    <label for="exampleInputEmail1">Suhu</label>
                    <input class="form-control" name="suhu" id="tensi" value="{{ old('suhu', (isset($row) && $row['suhu'] ? $row['suhu'] : '') ) }}">
                    @if ($errors->has('suhu'))
                      <span class="form-feedback text-danger">{{ $errors->first('suhu') }}</span>
                    @endif
                  </div>
                </div>

                <div class="col-md-2" >
                  <div class="form-group">
                    <label for="exampleInputEmail1">Nadi</label>
                    <input class="form-control" name="nadi" id="nadi" value="{{ old('nadi', (isset($row) && $row['nadi'] ? $row['nadi'] : '') ) }}">
                    @if ($errors->has('nadi'))
                      <span class="form-feedback text-danger">{{ $errors->first('nadi') }}</span>
                    @endif
                  </div>
                </div>

                <div class="col-md-2" >
                  <div class="form-group">
                    <label for="exampleInputEmail1">Respirasi</label>
                    <input class="form-control" name="respirasi" id="respirasi" value="{{ old('respirasi', (isset($row) && $row['respirasi'] ? $row['respirasi'] : '') ) }}">
                    @if ($errors->has('respirasi'))
                      <span class="form-feedback text-danger">{{ $errors->first('respirasi') }}</span>
                    @endif
                  </div>
                </div>

              </div>
              <hr>

              <label for="exampleInputEmail1"><strong>Pemeriksaan Nyeri</strong> </label>

              <div class="row">

                <div class="col-md-3">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Nyeri Tekan</label>
                    <select class="form-control" name="nyeri_tekan" id="nyeri_tekan">
                      @for ($i=0; $i <= 10; $i++)
                      <option value="{{ $i }}" {{ old('nyeri_tekan', (isset($row) && $row['nyeri_tekan'] == $i ? "selected" : '') ) }}>{{ $i }}</option>
                      @endfor
                    </select>
                    @if ($errors->has('nyeri_tekan'))
                      <span class="form-feedback text-danger">{{ $errors->first('nyeri_tekan') }}</span>
                    @endif
                  </div>
                </div>

                <div class="col-md-3">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Nyeri Gerak</label>

                    <select class="form-control" name="nyeri_gerak" id="nyeri_gerak">
                      @for ($j=0; $j <= 10; $j++)
                      <option value="{{ $j }}" {{ old('nyeri_gerak', (isset($row) && $row['nyeri_gerak'] == $j ? "selected" : '') ) }}>{{ $j }}</option>
                      @endfor
                    </select>
                    @if ($errors->has('nyeri_gerak'))
                      <span class="form-feedback text-danger">{{ $errors->first('nyeri_gerak') }}</span>
                    @endif
                  </div>
                </div>

                <div class="col-md-3">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Nyeri Diam</label>

                    <select class="form-control" name="nyeri_diam" id="nyeri_diam">
                      @for ($k=0; $k <= 10; $k++)
                      <option value="{{ $k }}" {{ old('nyeri_diam', (isset($row) && $row['nyeri_diam'] == $k ? "selected" : '') ) }}>{{ $k }}</option>
                      @endfor
                    </select>
                    @if ($errors->has('nyeri_diam'))
                      <span class="form-feedback text-danger">{{ $errors->first('nyeri_diam') }}</span>
                    @endif
                  </div>
                </div>



              </div>

              <div class="row">
                <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Palpasi</label>
                    <textarea class="form-control" name="palpasi" id="palpasi">{{ old('palpasi', (isset($row) && $row['palpasi'] ? $row['palpasi'] : '') ) }}</textarea>
                    <!-- <select class="form-control" name="palpasi" id="palpasi">
                      @for ($l=0; $l <= 5; $l++)
                      <option value="{{ $l }}" {{ old('palpasi', (isset($row) && $row['palpasi'] == $l ? "selected" : '') ) }}>{{ $l }}</option>
                      @endfor
                    </select> -->
                    @if ($errors->has('palpasi'))
                      <span class="form-feedback text-danger">{{ $errors->first('palpasi') }}</span>
                    @endif
                  </div>
                </div>
              </div>

              <div class="row">

                <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Luas Gerak Sendi</label>
                    <textarea class="form-control" name="luas_gerak_sendi" id="luas_gerak_sendi">{{ old('luas_gerak_sendi', (isset($row) && $row['luas_gerak_sendi'] ? $row['luas_gerak_sendi'] : '') ) }}</textarea>
                    @if ($errors->has('luas_gerak_sendi'))
                      <span class="form-feedback text-danger">{{ $errors->first('luas_gerak_sendi') }}</span>
                    @endif
                  </div>
                </div>
              </div>

              <div class="row">
                <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Kekuatan Otot</label>
                    <textarea class="form-control" name="kekuatan_otot" id="kekuatan_otot">{{ old('kekuatan_otot', (isset($row) && $row['kekuatan_otot'] ? $row['kekuatan_otot'] : '') ) }}</textarea>
                    @if ($errors->has('kekuatan_otot'))
                      <span class="form-feedback text-danger">{{ $errors->first('kekuatan_otot') }}</span>
                    @endif
                  </div>
                </div>

              </div>

              <div class="row">

                <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Antropometri</label>
                    <textarea class="form-control" name="antropometri" id="antropometri">{{ old('antropometri', (isset($row) && $row['antropometri'] ? $row['antropometri'] : '') ) }}</textarea>
                    @if ($errors->has('antropometri'))
                      <span class="form-feedback text-danger">{{ $errors->first('antropometri') }}</span>
                    @endif
                  </div>
                </div>

              </div>

              <hr>

              <label for="exampleInputEmail1"><strong>Inspeksi</strong> </label>

              <div class="row">

                <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Statis</label>
                    <textarea class="form-control" name="statis" id="statis">{{ old('statis', (isset($row) && $row['statis'] ? $row['statis'] : '') ) }}</textarea>
                    @if ($errors->has('statis'))
                      <span class="form-feedback text-danger">{{ $errors->first('statis') }}</span>
                    @endif
                  </div>
                </div>

              </div>

              <div class="row">
                <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Dinamis</label>
                    <textarea class="form-control" name="dinamis" id="dinamis">{{ old('dinamis', (isset($row) && $row['dinamis'] ? $row['dinamis'] : '') ) }}</textarea>
                    @if ($errors->has('dinamis'))
                      <span class="form-feedback text-danger">{{ $errors->first('dinamis') }}</span>
                    @endif
                  </div>
                </div>

              </div>

              <div class="row">
                <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Kognitif</label>
                  <textarea class="form-control" name="kognitif" id="kognitif">{{ old('kognitif', (isset($row) && $row['kognitif'] ? $row['kognitif'] : '') ) }}</textarea>
                    @if ($errors->has('kognitif'))
                      <span class="form-feedback text-danger">{{ $errors->first('kognitif') }}</span>
                    @endif
                  </div>
                </div>

              </div>

              <div class="row">
                <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Aukultasi</label>
                    <textarea class="form-control" name="aukultasi" id="aukultasi">{{ old('aukultasi', (isset($row) && $row['aukultasi'] ? $row['aukultasi'] : '') ) }}</textarea>
                    @if ($errors->has('aukultasi'))
                      <span class="form-feedback text-danger">{{ $errors->first('aukultasi') }}</span>
                    @endif
                  </div>
                </div>

              </div>

              <hr>

              <label for="exampleInputEmail1"><strong>Hasil Pemeriksaan</strong> </label>

              <div class="row">

                <div class="col-md-6">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Pemeriksaan Khusus</label>
                    <textarea rows="3" cols="80" class="form-control" name="pemeriksaan_khusus" id="pemeriksaan_khusus">{{ old('pemeriksaan_khusus', (isset($row) && $row['pemeriksaan_khusus'] ? $row['pemeriksaan_khusus'] : '') ) }}</textarea>
                    @if ($errors->has('pemeriksaan_khusus'))
                      <span class="form-feedback text-danger">{{ $errors->first('pemeriksaan_khusus') }}</span>
                    @endif
                  </div>
                </div>
                <div class="col-md-6">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Pemeriksaan Penunjang</label>
                    <textarea rows="3" cols="80" class="form-control" name="pemeriksaan_penunjang" id="pemeriksaan_penunjang">{{ old('pemeriksaan_penunjang', (isset($row) && $row['pemeriksaan_penunjang'] ? $row['pemeriksaan_penunjang'] : '') ) }}</textarea>
                    @if ($errors->has('pemeriksaan_penunjang'))
                      <span class="form-feedback text-danger">{{ $errors->first('pemeriksaan_penunjang') }}</span>
                    @endif
                  </div>
                </div>

              </div>

              <hr>

              <label for="exampleInputEmail1"><strong>Diagnosa Fisioterapis</strong> </label>

              <div class="row">

                <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Impairment</label>
                    <textarea rows="3" cols="80" class="form-control" name="impairment" id="impairment">{{ old('impairment', (isset($row) && $row['impairment'] ? $row['impairment'] : '') ) }}</textarea>
                    @if ($errors->has('impairment'))
                      <span class="form-feedback text-danger">{{ $errors->first('impairment') }}</span>
                    @endif
                  </div>
                </div>
              </div>

              <div class="row">
                <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Disability</label>
                    <textarea class="form-control" name="disability" id="disability">{{ old('disability', (isset($row) && $row['disability'] ? $row['disability'] : '') ) }}</textarea>
                    @if ($errors->has('disability'))
                      <span class="form-feedback text-danger">{{ $errors->first('disability') }}</span>
                    @endif
                  </div>
                </div>
              </div>

              <div class="row">

                <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Fungsional Limitation</label>
                    <textarea class="form-control" name="fungsional_limitation" id="fungsional_limitation">{{ old('fungsional_limitation', (isset($row) && $row['fungsional_limitation'] ? $row['fungsional_limitation'] : '') ) }}</textarea>
                    @if ($errors->has('fungsional_limitation'))
                      <span class="form-feedback text-danger">{{ $errors->first('fungsional_limitation') }}</span>
                    @endif
                  </div>
                </div>
              </div>

              <hr>

              <label for="exampleInputEmail1"><strong>Rencana Intervensi Fisioterapis</strong> </label>

              <div class="row">

                <div class="col-md-6">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Jangka Pendek</label>
                    <textarea rows="3" cols="80" class="form-control" name="jangka_pendek" id="jangka_pendek">{{ old('jangka_pendek', (isset($row) && $row['jangka_pendek'] ? $row['jangka_pendek'] : '') ) }}</textarea>
                    @if ($errors->has('jangka_pendek'))
                      <span class="form-feedback text-danger">{{ $errors->first('jangka_pendek') }}</span>
                    @endif
                  </div>
                </div>
                <div class="col-md-6">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Jangka Panjang</label>
                    <textarea rows="3" cols="80" class="form-control" name="jangka_panjang" id="jangka_panjang">{{ old('jangka_panjang', (isset($row) && $row['jangka_panjang'] ? $row['jangka_panjang'] : '') ) }}</textarea>
                    @if ($errors->has('jangka_panjang'))
                      <span class="form-feedback text-danger">{{ $errors->first('jangka_panjang') }}</span>
                    @endif
                  </div>
                </div>

              </div>

              <hr>

              <div class="row">

                <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1"><b>Tindakan Fisioterapi</b></label>


                    @foreach($tindakan as $val)
                    <div class="form-check">
                      @if($row['tindakan_fisioterapis'] != null)
                        <input class="form-check-input" type="checkbox" name="tindakan_fisioterapis[]" value="{{ $val->id }}" {{ old('tindakan_fisioterapis', (isset($row) && in_array($val->id, json_decode($row['tindakan_fisioterapis'])) ? "checked" : '') ) }} id="flexCheckDefault">
                      @else
                        <input class="form-check-input" type="checkbox" name="tindakan_fisioterapis[]" value="{{ $val->id }}" id="flexCheckDefault">
                      @endif
                      <label class="form-check-label" for="flexCheckDefault">
                        {{ $val->nama }}
                      </label>
                    </div>
                    @endforeach

                    <!-- <textarea class="form-control" name="tindakan_fisioterapis" id="tindakan_fisioterapis"></textarea> -->
                    @if ($errors->has('tindakan_fisioterapis'))
                      <span class="form-feedback text-danger">{{ $errors->first('tindakan_fisioterapis') }}</span>
                    @endif
                  </div>
                </div>

              </div>

              <div class="row">

                <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1"><b>Edukasi</b></label>
                    <textarea class="form-control" name="edukasi" id="edukasi">{{ old('edukasi', (isset($row) && $row['edukasi'] ? $row['edukasi'] : '') ) }}</textarea>
                    @if ($errors->has('edukasi'))
                      <span class="form-feedback text-danger">{{ $errors->first('edukasi') }}</span>
                    @endif
                  </div>
                </div>

              </div>

              <div class="row">

                <!-- <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1"><b>Rencana Evaluasi</b></label>
                    <textarea class="form-control" name="rencana_evaluasi" id="rencana_evaluasi">{{ old('rencana_evaluasi', (isset($row) && $row['rencana_evaluasi'] ? $row['rencana_evaluasi'] : '') ) }}</textarea>
                    @if ($errors->has('rencana_evaluasi'))
                      <span class="form-feedback text-danger">{{ $errors->first('rencana_evaluasi') }}</span>
                    @endif
                  </div>
                </div> -->

              </div>

              <!-- <div class="row">

                <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Prognosis</label>
                    <textarea class="form-control" name="prognosis" id="prognosis">{{ old('prognosis', (isset($row) && $row['prognosis'] ? $row['prognosis'] : '') ) }}</textarea>
                    @if ($errors->has('prognosis'))
                      <span class="form-feedback text-danger">{{ $errors->first('prognosis') }}</span>
                    @endif
                  </div>
                </div>

              </div> -->
              <h6><b>Prognosis</b></h6>

              <div class="row">
                <div class="col-md-3">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Quo ad vitam</label>
                    <select  name="quo_ad_vitam" id="quo_ad_vitam" class="form-control">
                        <option value="Bonam" {{ old('quo_ad_vitam', (isset($row) && $row['quo_ad_vitam'] == 'Bonam' ? 'selected' : '') ) }}>Bonam</option>
                        <option value="Dubia at Bonam" {{ old('quo_ad_vitam', (isset($row) && $row['quo_ad_vitam'] == 'Dubia at Bonam' ? 'selected' : '') ) }}>Dubia at Bonam</option>
                    </select>
                    @if ($errors->has('quo_ad_vitam'))
                      <span class="form-feedback text-danger">{{ $errors->first('quo_ad_vitam') }}</span>
                    @endif
                  </div>
                </div>
                <div class="col-md-3">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Quo ad sanam</label>
                    <select  name="quo_ad_sanam" id="quo_ad_sanam" class="form-control">
                        <option value="Bonam" {{ old('quo_ad_sanam', (isset($row) && $row['quo_ad_sanam'] == 'Bonam' ? 'selected' : '') ) }}>Bonam</option>
                        <option value="Dubia at Bonam" {{ old('quo_ad_sanam', (isset($row) && $row['quo_ad_sanam'] == 'Dubia at Bonam' ? 'selected' : '') ) }}>Dubia at Bonam</option>
                    </select>
                    @if ($errors->has('quo_ad_sanam'))
                      <span class="form-feedback text-danger">{{ $errors->first('quo_ad_sanam') }}</span>
                    @endif
                  </div>
                </div>
                <div class="col-md-3">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Quo ad qosmeticam </label>
                    <select  name="quo_ad_qosmeticam" id="quo_ad_qosmeticam" class="form-control">
                        <option value="Bonam" {{ old('quo_ad_qosmeticam', (isset($row) && $row['quo_ad_qosmeticam'] == 'Bonam' ? 'selected' : '') ) }}>Bonam</option>
                        <option value="Dubia at Bonam" {{ old('quo_ad_qosmeticam', (isset($row) && $row['quo_ad_qosmeticam'] == 'Dubia at Bonam' ? 'selected' : '') ) }}>Dubia at Bonam</option>
                    </select>
                    @if ($errors->has('quo_ad_qosmeticam'))
                      <span class="form-feedback text-danger">{{ $errors->first('quo_ad_qosmeticam') }}</span>
                    @endif
                  </div>
                </div>
                <div class="col-md-3">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Quo ad Fungsionam </label>
                    <select  name="quo_ad_fungsionam" id="quo_ad_fungsionam" class="form-control">
                        <option value="Bonam" {{ old('quo_ad_fungsionam', (isset($row) && $row['quo_ad_fungsionam'] == 'Bonam' ? 'selected' : '') ) }}>Bonam</option>
                        <option value="Dubia at Bonam" {{ old('quo_ad_fungsionam', (isset($row) && $row['quo_ad_fungsionam'] == 'Dubia at Bonam' ? 'selected' : '') ) }}>Dubia at Bonam</option>
                    </select>
                    @if ($errors->has('quo_ad_fungsionam'))
                      <span class="form-feedback text-danger">{{ $errors->first('quo_ad_fungsionam') }}</span>
                    @endif
                  </div>
                </div>
              </div>

              <div class="row">

                <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1"><b>Evaluasi</b></label>
                    <textarea class="form-control" name="evaluasi" id="evaluasi">{{ old('evaluasi', (isset($row) && $row['evaluasi'] ? $row['evaluasi'] : '') ) }}</textarea>
                    @if ($errors->has('evaluasi'))
                      <span class="form-feedback text-danger">{{ $errors->first('evaluasi') }}</span>
                    @endif
                  </div>
                </div>

              </div>

              <div class="row">

                <!-- <div class="col-md-12">
                  <div class="form-group">
                    <label for="exampleInputEmail1"><b>Evaluasi Akhir</b></label>
                    <textarea class="form-control" name="evaluasi_akhir" id="evaluasi_akhir">{{ old('evaluasi_akhir', (isset($row) && $row['evaluasi_akhir'] ? $row['evaluasi_akhir'] : '') ) }}</textarea>
                    @if ($errors->has('evaluasi_akhir'))
                      <span class="form-feedback text-danger">{{ $errors->first('evaluasi_akhir') }}</span>
                    @endif
                  </div>
                </div> -->

              </div>


              <div class="row">
                <div class="col-md-6">
                  <div class="form-group">
                    <label for="exampleInputFile">File</label>
                    <div class="input-group">
                      <div class="custom-file">
                        <input type="file" name="file" class="custom-file-input" id="input-file">
                        <label class="custom-file-label" for="exampleInputFile">Choose file</label>
                      </div>
                      <div class="input-group-append">
                        <span class="input-group-text">Upload</span>
                      </div>

                    </div>
                    @if ($errors->has('file'))
                      <span class="form-feedback text-danger">{{ $errors->first('file') }}</span>
                    @endif
                  </div>

                </div>

              </div>

              <div class="row">
                <div class="col-md-6" id="file-content">
                  @if(isset($row) && $row["filename"] && $row["filepath"])
                    <p><a href='/{{$row["filepath"]}}' target="_blank" >{{$row["filename"]}}</a> </p>
                  @endif
                </div>
              </div>
            </div>
            <!-- /.card-body -->

            <div class="card-footer">
               <button type="submit" class="btn btn-primary">Submit</button>
            </div>
          </form>
        </div>
    </div>
  </div>

  <!-- DataTales Example -->


</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(isset($row))
//   var set_rm = new Option("{{$row['pasien']['no_rm']}} - {{$row['pasien']['nama']}}", "{{$row['patient_id']}}", false, true)
//   var set_diagnosa = new Option("{{$row['diagnosis']['kode'] ?? 0}}", "{{$row['diagnosa_id'] ?? 0}}", false, true)
//
//   $('#no_rm').append(set_rm).trigger('change')
//   $('#diagnosa_id').append(set_diagnosa).trigger('change')
// @endif

var noRM = "";

    $('#no_rm').on('change', function() {
      noRM = $("#no_rm option:selected").val();

      $.ajax({
          url:"{{ route('dashboard.master.pasien.getPasien') }}?noRM="+noRM,
          method:"GET",
          success:function(data){
            // console.log(data);
            $('#patient_id').val(data.id).trigger("change")
            $('#tb').val(data.tb)
            $('#bb').val(data.bb)

          }
        })


    })

    // $('#diagnosa_id').on('change', function() {
    //   diagnosaID = $("#diagnosa_id option:selected").val();
    //
    //   $.ajax({
    //       url:"{{ route('dashboard.master.diagnosa.getDiagnosaDeskripsi') }}?diagnosaID="+diagnosaID,
    //       method:"GET",
    //       success:function(data){
    //         // console.log(data);
    //         $('#deskripsi').val(data.deskripsi)
    //
    //       }
    //     })
    //
    //
    // })

    $("#no_rm").select2({
        placeholder:"Pilih No RM",
        ajax:
        {
          url: "{{ route('dashboard.master.pasien.getNoRm') }}",
          processResults: function (data) {
            // console.log(data);
            return {
              results: data.results
            };
          }
        }
    })

    // $("#diagnosa_id").select2({
    //     placeholder:"Pilih Diagnosa",
    //     ajax:
    //     {
    //       url: "{{ route('dashboard.master.diagnosa.getDiagnosa') }}",
    //       processResults: function (data) {
    //         // console.log(data);
    //         return {
    //           results: data.results
    //         };
    //       }
    //     }
    // })

    $('#input-sim').on('change', function() {
        imagesPreview(this, '#sim-content');

    });

    var imagesPreview = function(input, placeToInsertImagePreview) {

            if (input.files) {
                var filesAmount = input.files.length;

                for (i = 0; i < filesAmount; i++) {
                    var reader = new FileReader();

                    reader.onload = function(event) {
                        var html = '<div class="images-box">';
                        html+= '<img src="' + event.target.result + '" width="100px" />';
                        html+='</div>';

                        $(placeToInsertImagePreview).html(html);
                    }

                    reader.readAsDataURL(input.files[i]);
                }
            }

        };

  $(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