@extends('layouts.frontend')

@section('title', '| FREE END-OF-LIFE PLAN')

@section('content')
@include('frontend.forms.End-Of-Life-Plan.stepIndicator')
 <!-- start -->
<div class="container">
    <form action="{{route('EndoflifePlanFormStore')}}" method="POST" id="signUpForm">
      @csrf
      <input type="hidden" id="stepInput" name="step" value="4-1">
      <div class="card">
         <div class="card-body">
            <!-- step 1 -->
            <div class="step" style="display: block">
            <div class="row">
            @if(isset($endoflifePlanForm->remains) &&  $endoflifePlanForm->remains == "burial")
                    <div class="col-md-8">
                        <div class="row">
                            <div class="col-md-8">
                                <div class="card-title">Burial Instructions</div>
                                <div class="card-sub-title">
                                    Would you like to leave specific instructions for your burial now?
                                    <div class="tooltip">
                                        <div class="iccon">?</div>
                                        <span class="tooltiptext">
                                            If you select No, you can add your specific instructions later, after printing or downloading this End-of-Life Plan.
                                        </span>
                                    </div>
                                </div>
                                @php 
                                $selectedBurialTypes = json_decode($endoflifePlanForm->burialin_type, true);
                                @endphp
                                <div class="custom-button-yn">
                                    <input id="burialin-y" name="burialin" type="radio" value="yes" {{ !isset($selectedBurialTypes['burialin']) || $selectedBurialTypes['burialin'] === 'yes' ? 'checked' : '' }}>
                                    <label for="burialin-y">Yes</label>
                                    <input id="burialin-n" name="burialin" type="radio" value="no" {{ isset($selectedBurialTypes['burialin']) && $selectedBurialTypes['burialin'] === 'no' ? 'checked' : '' }}>
                                    <label for="burialin-n">No</label>
                                </div>

                                <div id="burialin-sec" class="form-check-list">
                                    <div class="card-sub-title">What details do you want to provide? (Select all that apply.)</div>
                                    <div class="form-check mb-3">
                                        <label class="form-check-label">
                                            <input {{ isset($selectedBurialTypes['type']) && in_array('Final Resting Place', $selectedBurialTypes['type']) ? 'checked' : '' }} type="checkbox" class="form-check-input" name="burialintype[]" value="Final Resting Place">
                                            <p>Final Resting Place</p>
                                        </label>
                                        <div class="tooltip">
                                            <div class="iccon">?</div>
                                            <span class="tooltiptext">
                                            Your final resting place is where your body will be laid to rest, e.g. buried in an urn garden or cemetery plot.
                                            </span>
                                        </div>
                                    </div>
                                    <div class="form-check mb-3">
                                        <label class="form-check-label">
                                            <input {{ isset($selectedBurialTypes['type']) && in_array('Embalmment', $selectedBurialTypes['type']) ? 'checked' : '' }} type="checkbox" class="form-check-input" name="burialintype[]" value="Embalmment">
                                            <p>Embalmment</p>
                                        </label>
                                        <div class="tooltip">
                                            <div class="iccon">?</div>
                                            <span class="tooltiptext">
                                            Embalmment is the act of temporarily preserving a body by treating it with chemical solutions, generally for public display or transportation.
                                            </span>
                                        </div>
                                    </div>
                                    <div class="form-check mb-3">
                                        <label class="form-check-label">
                                            <input {{ isset($selectedBurialTypes['type']) &&  in_array('Casket', $selectedBurialTypes['type']) ? 'checked' : '' }} type="checkbox" class="form-check-input" name="burialintype[]" value="Casket">
                                            <p>Casket</p>
                                        </label>
                                    </div>
                                    {{-- <div class="form-check mb-3">
                                        <label class="form-check-label">
                                            <input {{ isset($selectedBurialTypes['type']) &&  in_array('urn', $selectedBurialTypes['type']) ? 'checked' : '' }} type="checkbox" class="form-check-input" name="burialintype[]" value="Urn">
                                            <p>Urn</p>
                                        </label>
                                    </div>
                                    <div class="form-check mb-3">
                                        <label class="form-check-label">
                                            <input {{ isset($selectedBurialTypes['type']) &&  in_array('Grave Marker', $selectedBurialTypes['type']) ? 'checked' : '' }} type="checkbox" class="form-check-input" name="burialintype[]" value="Grave Marker">
                                            <p>Grave Marker</p>
                                        </label>
                                    </div> --}}
                                    <div class="form-check mb-3">
                                        <label class="form-check-label">
                                            <input {{ isset($selectedBurialTypes['type']) &&  in_array('Headstone', $selectedBurialTypes['type']) ? 'checked' : '' }} type="checkbox" class="form-check-input" name="burialintype[]" value="Headstone">
                                            <p>Headstone</p>
                                        </label>
                                    </div>
                                    <div class="form-check mb-3">
                                        <label class="form-check-label">
                                            <input {{ isset($selectedBurialTypes['type']) &&  in_array('Epitaph', $selectedBurialTypes['type']) ? 'checked' : '' }} type="checkbox" class="form-check-input" name="burialintype[]" value="Epitaph">
                                            <p>Epitaph</p>
                                        </label>
                                    </div>
                                    <div class="form-check mb-3">
                                        <label class="form-check-label">
                                            <input {{ isset($selectedBurialTypes['type']) &&  in_array('Other', $selectedBurialTypes['type']) ? 'checked' : '' }} type="checkbox" class="form-check-input" name="burialintype[]" value="Other">
                                            <p>Other</p>
                                        </label>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
            @endif
            @if(isset($endoflifePlanForm->remains) &&  $endoflifePlanForm->remains == "mausoleum")
                @php 
                $selectedMausoleumTypes = json_decode($endoflifePlanForm->entombment_type, true);
                @endphp
                    <div class="col-md-8">
                        <div class="card-title">Entombment Instructions</div>
                        <div class="card-sub-title">
                            Would you like to leave specific instructions for your entombment now?
                            <div class="tooltip">
                                <div class="iccon">?</div>
                                <span class="tooltiptext">
                                If you select No, you can add your specific instructions later, after printing or downloading this End-of-Life Plan.
                                </span>
                            </div>
                        </div>
                        <div class="custom-button-yn">
                            <input id="entombment-y" name="entombment" type="radio" value="yes" {{ !isset($selectedMausoleumTypes['entombment']) || $selectedMausoleumTypes['entombment'] === 'yes' ? 'checked' : '' }}>
                            <label for="entombment-y">Yes</label>
                            <input id="entombment-n" name="entombment" type="radio" value="no" {{ isset($selectedMausoleumTypes['entombment']) && $selectedMausoleumTypes['entombment'] === 'no' ? 'checked' : '' }}>
                            <label for="entombment-n">No</label>
                        </div>
                        <div id="entombment-sec" class="form-check-list">
                            <div class="card-sub-title">What details do you want to provide? (Select all that apply.)</div>
                            <div class="form-check mb-3">
                                <label class="form-check-label">
                                    <input type="checkbox" class="form-check-input" name="entombmenttype[]" value="Final Resting Place" {{ isset($selectedMausoleumTypes['type']) && in_array('Final Resting Place', $selectedMausoleumTypes['type']) ? 'checked' : '' }}>
                                    <p>Final Resting Place</p>
                                </label>
                                <div class="tooltip">
                                    <div class="iccon">?</div>
                                    <span class="tooltiptext">
                                    Your final resting place is where your body will be laid to rest, e.g. a mausoleum or tomb.
                                    </span>
                                </div>
                            </div>
                            <div class="form-check mb-3">
                                <label class="form-check-label">
                                    <input type="checkbox" class="form-check-input" name="entombmenttype[]" value="Embalmment" {{ isset($selectedMausoleumTypes['type']) && in_array('Embalmment', $selectedMausoleumTypes['type']) ? 'checked' : '' }}>
                                    <p>Embalmment</p>
                                </label>
                                <div class="tooltip">
                                    <div class="iccon">?</div>
                                    <span class="tooltiptext">
                                    Embalmment is the act of temporarily preserving a body by treating it with chemical solutions, generally for public display or transportation.
                                    </span>
                                </div>
                            </div>
                            <div class="form-check mb-3">
                                <label class="form-check-label">
                                    <input type="checkbox" class="form-check-input" name="entombmenttype[]" value="Casket" {{ isset($selectedMausoleumTypes['type']) && in_array('Casket', $selectedMausoleumTypes['type']) ? 'checked' : '' }}>
                                    <p>Casket</p>
                                </label>
                            </div>
                            <div class="form-check mb-3">
                                <label class="form-check-label">
                                    <input type="checkbox" class="form-check-input" name="entombmenttype[]" value="Epitaph" {{ isset($selectedMausoleumTypes['type']) && in_array('Epitaph', $selectedMausoleumTypes['type']) ? 'checked' : '' }}>
                                    <p>Epitaph</p>
                                </label>
                            </div>
                            <div class="form-check mb-3">
                                <label class="form-check-label">
                                    <input type="checkbox" class="form-check-input" name="entombmenttype[]" value="Other"  {{ isset($selectedMausoleumTypes['type']) && in_array('Other', $selectedMausoleumTypes['type']) ? 'checked' : '' }}>
                                    <p>Other</p>
                                </label>
                            </div>
                        </div>
                    </div>
            @endif
            @if(isset($endoflifePlanForm->remains) &&  $endoflifePlanForm->remains == "cremation")
                    <div class="col-md-10 col-lg-8 order-1 order-md-1 order-lg-1">
                    <div class="card-title">Your Remains</div>
                    <div class="card-sub-title">What do you want done with your ashes?</div>
                    <div class="custom-m-status">
                        <input id="ashesnopreference" name="remainsashes" type="radio" value="nopreference" checked>
                        <label for="ashesnopreference" class="marital-box" id="ashesnopreferencelabel">
                            <p>No preference</p>
                        </label>
                        <input id="ashesburial" name="remainsashes" type="radio" value="burial">
                        <label for="ashesburial" class="marital-box" id="ashesburiallabel">
                            <p>Burial</p>
                        </label>
                        <input id="ashescolumbarium" name="remainsashes" type="radio" value="columbarium">
                        <label for="ashescolumbarium" class="marital-box" id="ashescolumbariumlabel">
                            <p>Held in a columbarium</p>
                        </label>
                        <input id="ashescremation" name="remainsashes" type="radio" value="loved">
                        <label for="ashescremation" class="marital-box" id="ashescremationlabel">
                            <p>Given to a loved one</p>
                        </label>
                        <input id="ashesdonationscience" name="remainsashes" type="radio" value="donationscience">
                        <label for="ashesdonationscience" class="marital-box" id="ashesdonationsciencelabel">
                            <p>Scattered</p>
                        </label>
                        <input id="ashesrother" name="remainsashes" type="radio" value="rother">
                        <label for="ashesrother" class="marital-box" id="ashesrotherlabel">
                            <p>Other</p>
                        </label>
                    </div>
                    </div>
                    <div class="col-md-8 col-lg-4 order-3 order-md-3 order-lg-2">
                    <div class="faq-box">
                        <div class="title">Frequently Asked Questions</div>
                        <div class="tooltip">
                            <p>What are my burial options?</p>
                            <span class="tooltiptext">While you can opt to be buried in a traditional cemetery burial plot, some cemeteries have an urn or cremation garden offering individual urn burial plots. Your ashes can also be buried in a private plot, subject to municipal approval.</span>
                        </div>
                        <div class="tooltip">
                            <p>What is a columbarium?</p>
                            <span class="tooltiptext">A columbarium is an above-ground structure for the storage of cremated remains. They are usually built in cemeteries and are sometimes attached to a cemetery's mausoleum or crematorium. In a columbarium, urns are stored on small shelves called niches.</span>
                        </div>
                    </div>
                    </div>
            @endif
            @if(isset($endoflifePlanForm->remains) &&  $endoflifePlanForm->remains == "donationscience")
                @php 
                $donation_organization = json_decode($endoflifePlanForm->donation_organization, true);
                $donation_alternate = json_decode($endoflifePlanForm->donation_alternate, true);
                @endphp
                    <div class="col-md-10 col-lg-8 order-1 order-md-1 order-lg-1">
                    <div class="card-title">Donation Details</div>
                    <div class="card-sub-title">Do you want to name an alternate choice in case your original executor is unavailable?</div>
                    <div class="custom-button-yn mb-5">
                        <input id="donation-y" name="donation" type="radio" value="yes"  {{ !isset($donation_alternate['alternate']) || $donation_alternate['alternate'] === 'yes' ? 'checked' : '' }}>
                        <label for="donation-y">Yes</label>
                        <input id="donation-n" name="donation" type="radio" value="no"  {{ isset($donation_alternate['alternate']) && $donation_alternate['alternate'] === 'no' ? 'checked' : '' }}>
                        <label for="donation-n">No</label>
                    </div>

                    <div id="donation-sec">
                        <div class="card mb-3" id="child">
                            <div class="card-body">
                                <div class="form-group mb-3">
                                    <label>Name</label>
                                <input type="text" placeholder="Name" class="form-control" name="donation_name" id="donation_name" aria-describedby="nameHelp" value="{{ isset($donation_alternate['name']) ?  $donation_alternate['name'] : '' }}">
                                </div>
                                <div class="form-group mb-3">
                                <label>Address </label>
                                <input type="text" class="form-control" name="donation_address" id="donation_address" aria-describedby="cityHelp" placeholder="Address " value="{{ isset($donation_alternate['address']) ?  $donation_alternate['address'] : '' }}">
                                <small id="cityHelp" class="form-text text-muted">e.g. Street, City, State ZIP Code</small>
                                </div>
                                <div class="form-group mb-3">
                                    <label>Phone Number </label>   
                                <input type="text" class="form-control"  name="donation_phone" id="donation_phone" placeholder="Phone Number " value="{{ isset($donation_alternate['phone']) ?  $donation_alternate['phone'] : '' }}">
                                </div>
                                <div class="form-group mb-3">
                                    <label>Email </label>
                                <input type="text" class="form-control"  name="donation_email" id="donation_email" placeholder="Email " value="{{ isset($donation_alternate['email']) ?  $donation_alternate['email'] : '' }}">
                                </div>
                            </div>
                        </div>
                    </div>
                    <div id="organization-holder">
                        <div id="organization">
                            <div class="card-sub-title">Do you have a preferred program or organization?</div>
                            <div class="custom-button-yn mb-5">
                                <input id="organization-y" name="organization" type="radio" value="yes" {{ isset($donation_organization['organization']) && $donation_organization['organization'] === 'yes' ? 'checked' : '' }}>
                                <label for="organization-y">Yes</label>
                                <input id="organization-n" name="organization" type="radio" value="no" {{ !isset($donation_organization['organization']) || $donation_organization['organization'] === 'no' ? 'checked' : '' }}>
                                <label for="organization-n">No</label>
                            </div>
                        </div>
                        <div id="organization-sec">
                            <div class="card mb-3" id="child">
                                <div class="card-body">
                                    <div class="form-group mb-3">
                                        <label>Name</label>
                                        <input type="text" placeholder="Name" class="form-control" name="organization_name" id="organization_name" aria-describedby="nameHelp" value="{{isset($donation_organization['name']) ?  $donation_organization['name'] : '' }}">
                                    </div>
                                    <div class="form-group mb-3">
                                        <label>Address </label>
                                        <input type="text" class="form-control" name="organization_address" id="organization_address" aria-describedby="cityHelp" placeholder="Address " value="{{isset($donation_organization['address']) ?  $donation_organization['address'] : '' }}">
                                        <small id="cityHelp" class="form-text text-muted">e.g. Street, City, State ZIP Code</small>
                                    </div>
                                    <div class="form-group mb-3">
                                        <label>Phone Number </label>
                                        <input type="text" class="form-control"  name="organization_phone" id="organization_phone" placeholder="Phone Number " value="{{isset($donation_organization['phone']) ?  $donation_organization['phone'] : '' }}">
                                    </div>
                                    <div class="form-group mb-3">
                                        <label>Email </label>
                                        <input type="text" class="form-control"  name="organization_email" id="organization_email" placeholder="Email " value="{{isset($donation_organization['email']) ?  $donation_organization['email'] : '' }}" >
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-md-8 col-lg-4 order-3 order-md-3 order-lg-2">
                    <div class="faq-box">
                        <div class="title">Frequently Asked Questions</div>
                        <div class="tooltip">
                        <p>How do I donate my body to science?</p>
                        <span class="tooltiptext">
                        Donating your body to science involves arranging things with a medical or research institution in advance. You'll typically need to contact the institution, complete the necessary paperwork, and provide your consent. Specific requirements and procedures may vary by location and institution.
                        </span>
                        </div>
                    </div>
                    </div>
            @endif
            @if(isset($endoflifePlanForm->remains) &&  $endoflifePlanForm->remains == "other")
                    <div class="col-md-8">
                    <div class="card-title">Remains Wishes</div>
                    <div class="card-sub-title">
                        How would you like your body to be disposed of?
                        <div class="tooltip">
                            <div class="iccon">?</div>
                            <span class="tooltiptext">
                            Not all methods of disposal are legal, so consult the laws of the area where you wish to be laid to rest.
                            </span>
                        </div>
                    </div>
                    <div class="form-group mb-3">
                        <input type="text" class="form-control" name="remains_wishes" id="remains_wishes" aria-describedby="nameHelp" value="{{isset($endoflifePlanForm->body_disposed ) ? $endoflifePlanForm->body_disposed  : ''}}">
                        <small id="cityHelp" class="form-text text-muted">e.g. Upon my death, I want my body to be laid to rest at sea.</small>
                    </div>
                    </div>
            @endif
            <!-- start previous / next buttons -->
            <div class="col-md-12 order-2 order-md-2 order-lg-3">
            <div id="buttonsection">
                <div class="form-footer d-flex justify-content-between">
                    <div>
                  <button type="button" onclick="window.location.href = '{{ route('endoflifePlan.create.step.four') }}'" class="btn btn-light btn-lg back-btn">Back</button>
                  <button type="submit" class="btn btn-light btn-lg">Save and Continue</button>
                </div>
                <button type="submit" class="btn btn-light btn-lg" name="preview_submit" value="preview">{{env('PREVIEW_BUTTON_TEXT')}}</button>
                  <button type="button" class="btn btn-light btn-lg skip-btn d-none">Skip Step</button>
               </div>
            </div>
            </div>
            <!-- end previous / next buttons -->
            </div>
            
            </div>
         </div>
      </div>
</div>

@endsection
@section('page-js')
<script src="{{ url('frontend/assets/js/forms/end-of-life-plan-multi-step.js?v=10.1.1') }}"></script>
<script src="{{ url('frontend/assets/js/forms/custom.js?v=10.3') }}"></script>

@endsection