@csrf
@if($mode === 'edit') @method('PUT') @endif

<div class="row">
    <div class="col-md-8">
        <div class="card card-primary">
            <div class="card-header"><h3 class="card-title">Case information</h3></div>
            <div class="card-body">
                <div class="form-row">
                    <div class="form-group col-md-8">
                        <label>Child full name *</label>
                        <input name="child_full_name" class="form-control" value="{{ old('child_full_name', $children->child_full_name ?? '') }}" required>
                    </div>
                    <div class="form-group col-md-4">
                        <label>Sex *</label>
                        <select name="sex" class="form-control" required>
                            <option value="">Select</option>
                            @foreach(['male','female'] as $sex)
                                <option value="{{ $sex }}" @selected(old('sex', $children->sex ?? '') === $sex)>{{ ucfirst($sex) }}</option>
                            @endforeach
                        </select>
                    </div>
                </div>
                <div class="form-row">
                    <div class="form-group col-md-4">
                        <label>Case ID *</label>
                        <input name="case_id" class="form-control" value="{{ old('case_id', $children->case_id ?? $children->file_number ?? '') }}" required>
                        <small class="form-text text-muted">Used to match the externally transferred PDF.</small>
                    </div>
                    <div class="form-group col-md-4">
                        <label>Birth date</label>
                        <input type="date" name="birthdate" class="form-control" value="{{ old('birthdate', optional($children->birthdate ?? null)->format('Y-m-d')) }}">
                    </div>
                    <div class="form-group col-md-4">
                        <label>Approved/adoption date</label>
                        <input type="date" name="approved_date" class="form-control" value="{{ old('approved_date', optional($children->approved_date ?? null)->format('Y-m-d')) }}">
                    </div>
                </div>
                <div class="form-row">
                    <div class="form-group col-md-6"><label>Birth place</label><input name="birth_place" class="form-control" value="{{ old('birth_place', $children->birth_place ?? '') }}"></div>
                    <div class="form-group col-md-6"><label>Region</label><input name="region" class="form-control" value="{{ old('region', $children->region ?? '') }}"></div>
                </div>
                <div class="form-row">
                    <div class="form-group col-md-6"><label>Mother full name</label><input name="mother_full_name" class="form-control" value="{{ old('mother_full_name', $children->mother_full_name ?? '') }}"></div>
                    <div class="form-group col-md-6"><label>Father full name</label><input name="father_full_name" class="form-control" value="{{ old('father_full_name', $children->father_full_name ?? '') }}"></div>
                </div>
                <div class="form-row">
                    <div class="form-group col-md-6"><label>Family status</label><input name="family_status" class="form-control" value="{{ old('family_status', $children->family_status ?? '') }}"></div>
                    <div class="form-group col-md-6"><label>Caregiver name</label><input name="caregiver_name" class="form-control" value="{{ old('caregiver_name', $children->caregiver_name ?? '') }}"></div>
                </div>
                <div class="form-row">
                    <div class="form-group col-md-6"><label>Caregiver company</label><input name="caregiver_company_name" class="form-control" value="{{ old('caregiver_company_name', $children->caregiver_company_name ?? '') }}"></div>
                    <div class="form-group col-md-6"><label>Agency name</label><input name="agency_name" class="form-control" value="{{ old('agency_name', $children->agency_name ?? '') }}"></div>
                </div>
            </div>
        </div>
    </div>
    <div class="col-md-4">
        <div class="card card-secondary">
            <div class="card-header"><h3 class="card-title">Location & contact</h3></div>
            <div class="card-body">
                <div class="form-group"><label>Country</label><select name="country" class="form-control"><option value="">Select</option>@foreach($countries as $country)<option value="{{ $country->id }}" @selected(old('country', $children->country ?? '') == $country->id || old('country', $children->country ?? '') == $country->name)>{{ $country->name }}</option>@endforeach</select></div>
                <div class="form-group"><label>City</label><input name="city" class="form-control" value="{{ old('city', $children->city ?? '') }}"></div>
                <div class="form-group"><label>Phone</label><input name="phone_no" class="form-control" value="{{ old('phone_no', $children->phone_no ?? '') }}"></div>
                <div class="form-group"><label>Email</label><input type="email" name="email" class="form-control" value="{{ old('email', $children->email ?? '') }}"></div>
                <div class="form-group"><label>Fax</label><input name="fax" class="form-control" value="{{ old('fax', $children->fax ?? '') }}"></div>
                <div class="form-group"><label>Street address</label><textarea name="street_address" class="form-control" rows="3">{{ old('street_address', $children->street_address ?? '') }}</textarea></div>
                <div class="form-group"><label>Photo</label><input type="file" name="photo" class="form-control-file"></div>
            </div>
        </div>
    </div>
</div>
<div class="card">
    <div class="card-body">
        <div class="form-group"><label>Remark</label><textarea name="remark" class="form-control" rows="4">{{ old('remark', $children->remark ?? '') }}</textarea></div>
        <div class="alert alert-info mb-0"><i class="fas fa-file-pdf mr-1"></i> The case PDF is not uploaded here. Place it on the configured file-transfer location using the Case ID.</div>
    </div>
    <div class="card-footer text-right"><a href="{{ route('children.index') }}" class="btn btn-secondary">Cancel</a> <button class="btn btn-primary">{{ $mode === 'edit' ? 'Save & Resubmit' : 'Record & Submit' }}</button></div>
</div>