@include('header')
<style type="text/css">
    fieldset legend {
        background: inherit;
        font-family: "Lato", sans-serif;
        color: #650812;
        font-size: 15px;
        left: 10px;
        padding: 0 10px;
        position: absolute;
        top: -12px;
        font-weight: 400;
        width: auto !important;
        border: none !important;
    }

    fieldset {
        background: #ffffff;
        border: 1px solid #C43853;
        border-radius: 5px;
        margin: 20px 0 1px 0;
        padding: 25px;
        position: relative;
    }

    .form-control {
        min-height: 1px;
        height: 25px;
    }

    .table th,
    .table td {
        padding: 0.325rem;
    }

    .col-sm-12,
    .col-sm,
    .col-sm-auto,
    .col-md-1,
    .col-md-2,
    .col-md-3,
    .col-md-4,
    .col-md-5,
    .col-md-6,
    .col-md-7,
    .col-md-8,
    .col-md-9,
    .col-md-10,
    .col-md-11,
    .col-md-12,
    .col-md,
    .col-md-auto,
    .col-lg-1,
    .col-lg-2,
    .col-lg-3,
    .col-lg-4,
    .col-lg-5,
    .col-lg-6,
    .col-lg-7,
    .col-lg-8,
    .col-lg-9,
    .col-lg-10,
    .col-lg-11,
    .col-lg-12,
    .col-lg,
    .col-lg-auto,
    .col-xl-1,
    .col-xl-2,
    .col-xl-3,
    .col-xl-4,
    .col-xl-5,
    .col-xl-6,
    .col-xl-7,
    .col-xl-8,
    .col-xl-9,
    .col-xl-10,
    .col-xl-11,
    .col-xl-12,
    .col-xl,
    .col-xl-auto {
        position: relative;
        width: 100%;
        padding-right: 1px;
        padding-left: 6px;
    }
    </style>
<div class="container-fluid flex-grow-1 container-p-y">
    <h4 class="font-weight-bold py-3 mb-0">Add OT Content</h4>
    <form id="validation-form" novalidate="novalidate" method="POST" enctype="multipart/form-data" autocomplete="off"
        action="">
        <input type="hidden" name="action" id="actionvalue" value="Save">
        <input type="hidden" name="saveid" id="saveid" value="">
        @csrf
        <div class="row">
            
            <div class="col-md-12">



                <div class="card mb-2">


                    <div class="table-responsive" style="overflow-x:auto;">
                        <table class="table table-bordered table-striped mb-0">
                            <thead>

                                <tr>

                                    <th width="30" align="center" valign="top">Consent Type</th>
                                    <th width="80" align="center" valign="top">
                                        <select class="form-control" style="height:31px;" name="ConsentType" id="ConsentType">
                                            <option value="1">Guarded Visual Prognosis consent</option>
                                            <option value="2">High Risk Consent</option>
                                        </select>
                                        <div class="clearfix"></div>
                                    </th>

                                    <th width="30" align="center" valign="top">Language</th>
                                    <th width="80" align="center" valign="top">
                                        <select class="form-control" style="height:31px;" name="Language" id="Language">
                                            <option value="Marathi">Marathi</option>
                                            <option value="Hindi">Hindi</option>
                                            <option value="English">English</option>
                                        </select>
                                        <div class="clearfix"></div>
                                    </th>
                                   
                                    <th width="30" align="center" valign="top">Date & Time</th>
                                    <th width="80" align="center" valign="top">
                                        <input type="date" name="dtentrydate"
                                            class="form-control" id="dtentrydate" value="{{date('Y-m-d')}}">
                                        </th>
                                            <th width="80" align="center" valign="top">
                                            <input type="time" name="dtentrytime"
                                            class="form-control" id="dtentrytime" value="{{date('H:i')}}">
                                        <div class="clearfix"></div>
                                    </th>
                                                                                                        
                                  
                                    <th width="30" align="center" valign="top">Place</th>
                                    <th width="80" align="center" valign="top">
                                        <input class="form-control" type="text" list="emails2" style="overflow-x:auto;"
                                            name="txtplace" id="txtplace">


                                        <div class="clearfix"></div>
                                    </th>
                                    
                                   
                                </tr>

                            </thead>
                            <tbody>
                            </tbody>
                        </table>
                    </div>


                </div>



            </div>

        </div>
        <div class="row">
            <div class="col-md-12 mb-1">


                <div class="card mb-2">


                    <div class="table-responsive" style="overflow-x:auto;">
                        <table class="table table-bordered table-striped mb-0">
                            <thead>


                                <tr>


                                    <th width="10" align="center" valign="top">Mrd.No </th>
                                    <th width="50" align="center" valign="top"><input type="text" class="form-control"
                                            placeholder="" id="MrdNo" name="txtmrdno" value="" required oninput="getPatientDetails()">
                                        <div class="clearfix"></div>
                                    </th>
                                    <th width="30" align="center" valign="top">Patient Name </th>
                                    <th width="180" align="center" valign="top"><input type="text" class="form-control"
                                            placeholder="" name="txtptname" id="PatientName" value="">
                                        <div class="clearfix"></div>
                                    </th>
                                    <th width="30" align="center" valign="top">Age </th>
                                    <th width="80" align="center" valign="top"><input type="text" class="form-control"
                                            placeholder="" id="Age" name="txtage" value="">
                                    <th width="30" align="center" valign="top">Mobile</th>
                                    <th width="80" align="center" valign="top"><input type="text" class="form-control"
                                            placeholder="" id="Phone" name="txtmobile" value="">
                                        <div class="clearfix"></div>
                                    </th>
                                    <th width="30" align="center" valign="top">Address</th>
                                    <th width="80" align="center" valign="top"><input type="text" class="form-control"
                                            placeholder="" id="Address" name="txtaddress" value="">
                                        <div class="clearfix"></div>
                                    </th>
                                </tr>

                            </thead>
                            <tbody>
                            </tbody>
                        </table>
                    </div>
                      <div class="table-responsive" style="overflow-x:auto;">
                        <table class="table table-bordered table-striped mb-0">
                            <thead>


                                <tr>


                                    <th width="50" align="center" valign="top">Witness 1 Name  </th>
                                    <th width="150" align="center" valign="top"><input type="text" class="form-control"
                                            placeholder="" id="MrdNo" name="txtwitness1" value="">
                                        <div class="clearfix"></div>
                                    </th>
                                    <th width="30" align="center" valign="top">Contact NO </th>
                                    <th width="50" align="center" valign="top"><input type="text" class="form-control"
                                            placeholder="" name="txtcontactno1" id="PatientName" value="">
                                        <div class="clearfix"></div>
                                    </th>
                                    <th width="30" align="center" valign="top">Relationship </th>
                                    <th width="80" align="center" valign="top"><input type="text" class="form-control"
                                            placeholder="" id="Age" name="txtrelationship1" value="">
                                   
                                   
                                </tr>
                                   <tr>


                                   <th width="50" align="center" valign="top">Witness 2 Name  </th>
                                    <th width="150" align="center" valign="top"><input type="text" class="form-control"
                                            placeholder="" id="MrdNo" name="txtwitness2" value="">
                                        <div class="clearfix"></div>
                                    </th>
                                    <th width="30" align="center" valign="top">Contact NO </th>
                                    <th width="50" align="center" valign="top"><input type="text" class="form-control"
                                            placeholder="" name="txtcontactno2" id="PatientName" value="">
                                        <div class="clearfix"></div>
                                    </th>
                                    <th width="30" align="center" valign="top">Relationship </th>
                                    <th width="80" align="center" valign="top"><input type="text" class="form-control"
                                            placeholder="" id="Age" name="txtrelationship2" value="">
                                   
                                   
                                </tr>
                            </thead>
                            <tbody>
                            </tbody>
                        </table>
                    </div>

                </div>


            </div>
        </div>
        <div class="row">
            <div class="col-md-12">
                <div class="row">
                    <div class="col-md-6">
                        <div class="col-md-12">
                            <fieldset>
                                <legend>Proposed Treatment Surgery</legend>
                                <div class="row">
                                    <div class="col-lg-10">
                                        <div class="form-group">
                                            <textarea class="form-control" placeholder="Search for..."
                                                name="txtsurgerytreatment" id="txtsurgerytreatment"></textarea>

                                        </div>
                                    </div>
                                    <div class="col-lg-2">
                                        <span class="input-group-append">
                                            <button class="btn btn-secondary" type="button" data-toggle="modal"
                                                data-target="#modal-report" id="add_button"
                                                onclick="getValue('SurgeryTreatment','txtsurgerytreatment')">...</button>
                                        </span>
                                    </div>
                                </div>


                            </fieldset>
                        </div>
                        <div class="col-md-12">
                            <fieldset>
                                <legend>Diagnosis</legend>
                                <div class="row">
                                    <div class="col-lg-10">
                                        <div class="form-group">
                                            <textarea class="form-control" placeholder="Search for..."
                                                name="txtdiagnosis" id="txtdiagnosis"></textarea>

                                        </div>
                                    </div>
                                    <div class="col-lg-2">
                                        <span class="input-group-append">
                                            <button class="btn btn-secondary" type="button" data-toggle="modal"
                                                data-target="#modal-report" id="add_button"
                                                onclick="getValue('Diagnosis','txtdiagnosis')">...</button>
                                        </span>
                                    </div>
                                </div>


                            </fieldset>
                        </div>
                        </div>
                        <div class="col-md-6">
                        <div class="col-md-12">
                            <fieldset>
                                <legend>Investigation / Diagnostic Test Performed</legend>
                                <div class="row">
                                    <div class="col-lg-10">
                                        <div class="form-group">
                                            <textarea class="form-control" placeholder="Search for..." name="txtinvestigation"
                                                id="txtinvestigation"></textarea>

                                        </div>
                                    </div>
                                    <div class="col-lg-2">
                                        <span class="input-group-append">
                                            <button class="btn btn-secondary" type="button" data-toggle="modal"
                                                data-target="#modal-report" id="add_button"
                                                onclick="getValue('Investigation','txtinvestigation')">...</button>
                                        </span>
                                    </div>
                                </div>


                            </fieldset>
                        </div>
                        <div class="col-md-12">
                            <fieldset>
                                <legend>Prognosis / Possible Complication / Nature of Risk</legend>
                                <div class="row">
                                    <div class="col-lg-10">
                                        <div class="form-group">
                                            <textarea class="form-control" placeholder="Search for..."
                                                name="txtprognosis" id="txtprognosis"></textarea>

                                        </div>
                                    </div>
                                    <div class="col-lg-2">
                                        <span class="input-group-append">
                                            <button class="btn btn-secondary" type="button" data-toggle="modal"
                                                data-target="#modal-report" id="add_button"
                                                onclick="getValue('Prognosis','txtprognosis')">...</button>
                                        </span>
                                    </div>
                                </div>


                            </fieldset>
                        </div>
                    </div>
                   
                </div>





                <div class="row">
                    <div class="col-md-6">
                        
                       

                        <div class="col-md-12 mb-4">
                            <fieldset>
                                <legend></legend>
                                <div class="col-sm-12">
                                    <button class="btn btn-primary" id="submit" type="submit"
                                        name="submit">Save</button>
                                    <button class="btn btn-success" onclick="printOt()" id="printbtn" type="button"
                                        disabled>Print</button>
                                 
                                </div>
                            </fieldset>
                        </div>
                    </div>

                    <div class="col-md-6">
                            <fieldset>
                                <legend>Fitness for treatment / Surgery given by</legend>
                                <div class="row">
                                    <div class="col-lg-10">
                                        <div class="form-group">
                                            <textarea class="form-control" placeholder="Search for..."
                                                name="txtfitness" id="txtfitness"></textarea>

                                        </div>
                                    </div>
                                    <div class="col-lg-2">
                                        <span class="input-group-append">
                                            <button class="btn btn-secondary" type="button" data-toggle="modal"
                                                data-target="#modal-report" id="add_button"
                                                onclick="getValue('Fitness','txtfitness')">...</button>
                                        </span>
                                    </div>
                                </div>


                            </fieldset>
                        </div>

                    
                    <div>
                        <div>


                        </div>

                    </div>
                </div>
            </div>
        </div>

        <input type="hidden" id="CurrDate" value="2022-06-04">






    </form>
</div>
<script src="{{url('assets/js/jquery-3.6.0.min.js')}}"></script>
@include('masters/inccommonmodal')

@include('footerscript')
<script>
    function printOt() {
    var id = $('#saveid').val();
    setTimeout(function() {
        window.open(
            '/{{projectUrl()}}printOtConsent/' + id, 'popUpWindow2',
            'height=1000,width=1500,left=0,top=0,resizable=no,scrollbars=no,toolbar=no,menubar=no,location=no,directories=no,status=no'
        );
    }, 1);
}
function getValue(val, idval) {
    $('#ModalValue').val(val);
    $('#ValueId').val(idval);
    $('#OldValue').val('');
    desc_lists(val);
}

function getPatientDetails() {
    var MrdNo = $('#MrdNo').val();
    $.ajax({
        url: "{{ url('getPatientDetails') }}",
        method: "POST",
        data: {
            _token: '{{csrf_token()}}',
            id: MrdNo
        },
        dataType: "json",
        success: function(data) {
            var AgeGender = data.Age + "/" + data.Gender;
            $('#MrdNo').val(data.MrdNo);
            $('#PatientName').val(data.PatientName);
            $('#Age').val(AgeGender);
            //$('#Gender').val(data.Gender);
            $('#Phone').val(data.Phone);
            $('#Address').val(data.Address);
        }
    });
}

$(document).ready(function() {
    $('#validation-form').on('submit', function(e) {
        e.preventDefault();
        if ($('#validation-form').valid()) {
            $.ajax({
                url: "{{ url('saveOtConsent') }}",
                method: "POST",
                data: new FormData(this),
                contentType: false,
                processData: false,
                beforeSend: function() {
                    $('#submit').attr('disabled', 'disabled');
                    $('#submit').text('Please Wait...');
                },
                success: function(data) {
                    $('#actionvalue').val('Edit');
                    $('#saveid').val(data);
                    $('#printbtn').attr("disabled", false);
                    $('#discbtn').attr("disabled", false);
                    $('#submit').attr('disabled', false);
                    $('#submit').text('Submit');

                }
            });
        }
    });
    });
        
</script>