@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="3-1">
      <div class="card">
         <div class="card-body">
            <!-- step 1 -->
            <div class="step" style="display: block;">
                @if(isset($endoflifePlanForm->announcement) &&  $endoflifePlanForm->announcement == "no" )
                <div id="organ-donor" >
                      <div class="card-title">Organ Donation</div>
                      <div class="card-sub-title">
                         Are you a registered organ donor?
                         <div class="tooltip">
                            <span>
                               <ion-icon name="help-circle"></ion-icon>
                            </span>
                            <span class="tooltiptext">Note that you cannot simply state your desire to be an organ donor in this document. You must also register to be an organ donor at your local DMV or online.</span>
                         </div>
                      </div>
                      <div class="custom-button-yn mb-5">
                         <input type="radio" id="organDonor-y" name="organDonor" value="yes" {{ isset($donor['organ_donor']) && $donor['organ_donor']  == "yes"  ? 'checked' : 'checked' }}>
                         <label for="organDonor-y">Yes</label>
                         <input type="radio" id="organDonor-n" name="organDonor" value="no" {{ isset($donor['organ_donor']) && $donor['organ_donor']  == "no"  ? 'checked' : '' }}>
                         <label for="organDonor-n">No</label>
                      </div>
                   <div id="organDonor-state">
                      <div class="card-sub-title">Where are you registered as a donor?</div>
                      <div class="form-group mb-3">
                         <label for="state">State:</label>
                         <input type="text" class="form-control modified-input" name="organDonorstate" id="organDonorstate" placeholder="State" value="{{ isset($donor['state']) ? $donor['state'] : '' }}">
                      </div>
                   </div>

                </div>
                @endif
                @if(isset($endoflifePlanForm->announcement) &&  $endoflifePlanForm->announcement == "death" )
                    <div id="publication">
                        <div class="row">
                            <div class="col-md-8">
                                <div class="card-title">Publication</div>
                                <div class="card-sub-title">Where would you like your death notice to be published?</div>
                                <div id="publication-container">
                                   
                                   @php
                                   $death_publicationArray = json_decode($endoflifePlanForm->death_publication, true);
                                   @endphp
                                  @if(!empty($endoflifePlanForm->death_publication) && count($death_publicationArray) > 0)
                                        @foreach($death_publicationArray as $index => $publication)
                                        <div class="card list mb-3" id="child">
                                            <div class="card-header d-flex justify-content-between">
                                                <div class="card-title m-0">publication</div>
                                                <a class="r-button" onclick="removetList(this)">
                                                    <span class="fas fa-times"></span>
                                                    <span class="remove">Remove</span>
                                                </a>
                                            </div>
                                            <div class="card-body">
                                                <div class="form-group mb-3">
                                                    <label for="publication_full_name">Publication:</label>
                                                    <input type="text" value="{{ $publication['publication_name'] }}" class="form-control modified-input" name="publication[]" placeholder="Publication">
                                                </div>
                                                <div class="form-group mb-3">
                                                    <label for="publication_city">City/Town:</label>
                                                    <input type="text" value="{{ $publication['publication_city']}}" class="form-control modified-input" name="publication_city[]" placeholder="City/Town">
                                                </div>
                                            </div>
                                        </div>
                                        @endforeach
                                    @else
                                    <div class="card list mb-3" id="child">
                                        <div class="card-header d-flex justify-content-between">
                                            <div class="card-title m-0">publication</div>
                                            <a class="r-button" onclick="removetList(this)">
                                                <span class="fas fa-times"></span>
                                                <span class="remove">Remove</span>
                                            </a>
                                        </div>
                                        <div class="card-body">
                                            <div class="form-group mb-3">
                                                <label for="publication_full_name">Publication:</label>
                                                <input type="text"  class="form-control modified-input" name="publication[]" placeholder="Publication">
                                            </div>
                                            <div class="form-group mb-3">
                                                <label for="publication_city">City/Town:</label>
                                                <input type="text"  class="form-control modified-input" name="publication_city[]" placeholder="City/Town">
                                            </div>
                                        </div>
                                    </div>
                                    @endif
                                </div>
                                <div class="add-child">
                                    <a href="#" id="add-publication-button" onclick="clone('publication-container')">
                                    <span class="fas fa-plus"></span>Add another publication</a>
                                </div>
                            </div>
                            <div class="col-md-4">
                                <div class="faq-box">
                                    <div class="title">FAQ’s</div>
                                    <div class="tooltip">
                                    <p>Where should I publish my death notice?</p>
                                    <span class="tooltiptext">
                                    Death notices are generally published, in local newspapers, funeral home websites, and social media platforms. You can also put it in places easily accessible to your loved ones and the community.
                                    </span>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                @endif
                @if(isset($endoflifePlanForm->announcement) &&  $endoflifePlanForm->announcement == "obituary" )
                    <div id="obituary-sec">
                        <div class="row">
                            <div class="col-md-8">
                                <div class="card-title">Publication</div>
                                <div class="card-sub-title">Where would you like your obituary to be published?</div>
                                <div id="obituary-container">
                                    @php
                                    $obituary_publicationArray = json_decode($endoflifePlanForm->obituary_publication, true)
                                    @endphp
                                    @if(!empty($endoflifePlanForm->obituary_publication) && count($obituary_publicationArray) > 0)                                 
                                        @foreach($obituary_publicationArray as $index => $obpublication)
                                            <div class="card list mb-3" id="child">
                                                <div class="card-header d-flex justify-content-between">
                                                    <div class="card-title m-0">Publication</div>
                                                    <a class="r-button" onclick="removetList(this)">
                                                        <span class="fas fa-times"></span>
                                                        <span class="remove">Remove</span>
                                                    </a>
                                                </div>
                                                <div class="card-body">
                                                    <div class="form-group mb-3">
                                                        <label for="publication_full_name">Publication:</label>
                                                        <input type="text" value="{{ $obpublication['publication_name'] }}" class="form-control modified-input" name="obituary_publication[]" placeholder="Publication">
                                                        <small id="nameHelp" class="form-text text-muted">e.g. The Hanover Gazette, www.legacy.com</small>
                                                    </div>
                                                    <div class="form-group mb-3">
                                                        <label for="publication_city">City/Town:</label>
                                                        <input type="text" value="{{$obpublication['publication_city']}}"  class="form-control modified-input" name="obituary_publication_city[]" placeholder="City/Town">
                                                        <small id="nameHelp" class="form-text text-muted">e.g. Hanover, New Hampshire</small>
                                                    </div>
                                                </div>
                                            </div>
                                        @endforeach
                                    @else  
                                    <div class="card list mb-3" id="child">
                                        <div class="card-header d-flex justify-content-between">
                                            <div class="card-title m-0">Publication</div>
                                            <a class="r-button" onclick="removetList(this)">
                                                <span class="fas fa-times"></span>
                                                <span class="remove">Remove</span>
                                            </a>
                                        </div>
                                        <div class="card-body">
                                            <div class="form-group mb-3">
                                                <label for="publication_full_name">Publication:</label>
                                                <input type="text" class="form-control modified-input" name="obituary_publication[]" placeholder="Publication">
                                            </div>
                                            <div class="form-group mb-3">
                                                <label for="publication_city">City/Town:</label>
                                                <input type="text" class="form-control modified-input" name="obituary_publication_city[]" placeholder="City/Town">
                                            </div>
                                        </div>
                                    </div>
                                    @endif  
                                </div>
                                <div class="add-child">
                                    <a href="#" id="add-obituary-button" onclick="clone('obituary-container')">
                                    <span class="fas fa-plus"></span>
                                    Add another publication
                                    </a>
                                </div>
                            </div>
                            <div class="col-md-4">
                                <div class="faq-box">
                                    <div class="title">FAQ’s</div>
                                    <div class="tooltip">
                                    <p>Where should I publish my death notice?</p>
                                    <span class="tooltiptext">
                                        Death notices are generally published, in local newspapers, funeral home websites, and social media platforms. You can also put it in places easily accessible to your loved ones and the community.
                                    </span>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                @endif
            </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.three') }}'" 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>

@endsection