@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="1.1">
      <div class="card">
         <div class="card-body">
            <!-- step 1 -->
            <div class="step" style="display: block">
               <div class="row">
                  <div class="col-md-8">
                     <div class="card-title">Your Plan</div>
                     <div class="card-sub-title">Who is this End-of-Life Plan for?</div>
                     <div class="form-check mb-3">
                        <input class="form-check-input" type="checkbox" value="" id="userCheckbox">
                        <label class="form-check-label" for="flexCheckDefault">
                           Auto fill your previous information
                        </label>
                     </div>
                     <div class="form-group mb-3">
                        <label for="name">Name</label>
                        <input type="text" class="form-control modified-input" name="full_name" id="full_name" aria-describedby="nameHelp" placeholder="Full Name" value="{{ isset($plan_for['full_name']) ? $plan_for['full_name'] : '' }}">
                     </div>
                     <!-- START - autopopulating from zipcode
                        /*
                        * Author: Gurupriya Solanki
                        * Updated date: 30 May 2024
                        * Description: Updated fields according to edit profile page for autopopulating from zipcode
                        */
                     -->
                     <div class="form-group mb-3">
                        <label for="street">Street Address1</label>
                        <input type="text" class="form-control modified-input" name="street_1" id="street" value="{{ isset($plan_for['street_1']) ? $plan_for['street_1'] : '' }}" placeholder="Street Address">
                     </div>
                     <div class="form-group mb-3">
                        <label for="street">Street Address2</label>
                        <input type="text" class="form-control modified-input" name="street_2" id="street2" value="{{ isset($plan_for['street_2']) ? $plan_for['street_2'] : '' }}" placeholder="Street Address">
                     </div>
                     <div class="form-group mb-3">
                        <label for="city">City/Town</label>
                        <input type="text" class="form-control modified-input" name="city" id="city" aria-describedby="cityHelp" placeholder="Any City" value="{{ isset($plan_for['city']) ? $plan_for['city'] : '' }}">
                     </div>
                     <div class="form-group mb-3">
                        <label for="state">State</label>
                        <input type="text" class="form-control modified-input" name="state" id="state" placeholder="State" value="{{ isset($plan_for['state']) ? $plan_for['state'] : '' }}">
                        <input id="state_abbreviation" type="hidden" class="form-control modified-input" name="state_abbreviation" placeholder="State Abbreviation" value="">
                     </div>
                     <div class="form-group mb-3">
                        <label for="country">Country</label>
                        <input type="text" class="form-control modified-input" name="country" id="country" value="{{ isset($plan_for['country']) ? $plan_for['country'] : 'United States' }}" placeholder="Country">
                        <input id="country_abbreviation" type="hidden" class="form-control modified-input" name="country_abbreviation" placeholder="State Abbreviation" value="">
                     </div>
                     <div class="form-group mb-3">
                        <label for="zip">ZIP Code</label>
                        <input type="text" class="form-control modified-input" name="zip_code" id="zip" value="{{ isset($plan_for['zip_code']) ? $plan_for['zip_code'] : '' }}" placeholder="ZIP Code" maxlength="5">
                        <span class="invalid-zipcode invalid-feedback d-block text-danger" role="alert"></span>
                     </div>
                     <!-- END - autopopulating from zipcode-->
                  </div>
               </div>
            </div>
            <!-- start previous / next buttons -->
            <div id="buttonsection">
               <div class="form-footer d-flex justify-content-between">
                  <div>
                  <button type="button" onclick="window.location.href = '{{ route('endoflifePlan.create.step.one') }}'" 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>
            <!-- end previous / next buttons -->
         </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>
{{-- 
Developer Name: Theshan Thanushka
Date: April 10, 2024
Description: JavaScript code snippet that utilizes jQuery to populate input fields with user data retrieved via AJAX when a checkbox is checked. If the checkbox is unchecked, it clears the input fields. 


Authour : Gurupriya Solanki
Update  Date : 30 May 2024
Description : added address response in the relevent input
--}}

<script>
   $(document).ready(function(){
       $('#userCheckbox').click(function(){
           if($(this).is(":checked")) {
               $.ajax({
                   url: '{{ route('populateUserData', ['form' => '4']) }}',
                   type: 'GET',
                   success: function(response){
                       $('#full_name').val(response.username);
                       $('#street').val(response.street_1);
                       $('#street2').val(response.street_2);
                       $('#state').val(response.state);
                       $('#city').val(response.city);
                       $('#zip').val(response.zip_code);
                       $('#country').val(response.country);
                   },
                   error: function(xhr){
                       console.log(xhr.responseText);
                   }
               });
           } else {
               // Clear the fields if the checkbox is unchecked
               $('#full_name').val('');
               $('#street').val('');
               $('#street2').val('');
               $('#state').val('');
               $('#city').val('');
               $('#zip').val('');
               $('#country').val('United States');
           }
       });
   });
</script>
 <!-- START - autopopulating from zipcode
   /*
   * Author: Gurupriya Solanki
   * Updated date: 30 May 2024
   * Description: Updated fields according to edit profile page for autopopulating from zipcode
   */
   -->
   <script src="{{ url('fetch_complete_address_by_zipcode.js') }}"></script>
 <!-- END - autopopulating from zipcode-->
@endsection