@csrf
<div class="row"><div class="col-md-8"><div class="card card-primary"><div class="card-header"><h3 class="card-title">Requester and search criteria</h3></div><div class="card-body">
<div class="form-row"><div class="form-group col-md-6"><label>Requester name *</label><input name="requester_name" class="form-control" value="{{ old('requester_name') }}" required></div><div class="form-group col-md-6"><label>Requester type</label><select name="requester_type" class="form-control"><option value="">Select</option>@foreach(['adopted_child'=>'Adopted child','birth_family'=>'Birth family','adoptive_family'=>'Adoptive family','authorized_representative'=>'Authorized representative','other'=>'Other'] as $k=>$v)<option value="{{ $k }}">{{ $v }}</option>@endforeach</select></div></div>
<div class="form-row"><div class="form-group col-md-6"><label>Email</label><input type="email" name="requester_email" class="form-control" value="{{ old('requester_email') }}"></div><div class="form-group col-md-6"><label>Phone</label><input name="requester_phone" class="form-control" value="{{ old('requester_phone') }}"></div></div>
<div class="form-row"><div class="form-group col-md-6"><label>Child name</label><input name="child_name" class="form-control" value="{{ old('child_name') }}"></div><div class="form-group col-md-6"><label>Case ID</label><input name="case_id" class="form-control" value="{{ old('case_id') }}"></div></div>
<div class="form-row"><div class="form-group col-md-6"><label>Birth date</label><input type="date" name="birth_date" class="form-control" value="{{ old('birth_date') }}"></div><div class="form-group col-md-6"><label>Mother name</label><input name="mother_name" class="form-control" value="{{ old('mother_name') }}"></div></div>
<div class="form-group"><label>Father name</label><input name="father_name" class="form-control" value="{{ old('father_name') }}"></div>
<div class="form-group"><label>Information requested *</label><textarea name="request_description" class="form-control" rows="6" required>{{ old('request_description') }}</textarea></div>
</div></div></div><div class="col-md-4"><div class="card card-info"><div class="card-body"><h5>Processing note</h5><p>Record the request even when the requester does not know the Case ID. Staff can search the adoption database using the supplied names and other identifying information.</p></div></div></div></div>
<div class="card"><div class="card-footer text-right"><a href="{{ route('search-requests.index') }}" class="btn btn-secondary">Cancel</a> <button class="btn btn-primary">Register search request</button></div></div>