@extends('layouts.frontend')

@section('title', '| Free Living Will')

@section('content')
@include('frontend.forms.Living-Will.stepIndicator')
 <!-- start -->
<div class="container">
    <form action="{{route('LivingWillFormStore')}}" method="POST" id="signUpForm">
      @csrf
      <input type="hidden" id="stepInput" name="step" value="5-2">
      <div class="card">
         <div class="card-body">
            <!-- step 1 -->
            <div class="step" style="display: block">
               <div class="row">
                 <div class="col-md-10 col-lg-8 order-1 order-md-1 order-lg-1">
                   <div class="card-title">Health Care Proxy Authority</div>
                   <div class="card-sub-title">How much authority do you want your health care proxy to have?</div>
                   <div class="custom-m-status">
 
                     <input id="1" name="proxy_authority" type="radio" value="Limited to following the directions listed in this document" {{ !isset($livingWillForm->proxy_authority) ||  $livingWillForm->proxy_authority == "Limited to following the directions listed in this document" ? 'checked' : ''}}>
                     <label for="1" class="marital-box" id="1">
                       <p>Limited to following the directions listed in this document</p>
                     </label>
                     <input id="2" name="proxy_authority" type="radio" value="Must follow my listed directions but is also able to make decisions not covered in this document" {{ isset($livingWillForm->proxy_authority) &&  $livingWillForm->proxy_authority == "Must follow my listed directions but is also able to make decisions not covered in this document" ? 'checked' : ''}}>
                     <label for="2" class="marital-box" id="2">
                       <p>Must follow my listed directions but is also able to make decisions not covered in this document</p>
                     </label>
                     <input id="3" name="proxy_authority" type="radio" value="Complete authority to make decisions even if they contradict this document" {{ isset($livingWillForm->proxy_authority) &&  $livingWillForm->proxy_authority == "Complete authority to make decisions even if they contradict this document" ? 'checked' : ''}}>
                     <label for="3" class="marital-box" id="3">
                       <p>Complete authority to make decisions even if they contradict this document</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 is a Healthcare proxy?</p>
                          <span class="tooltiptext">A Healthcare proxy is a legal document that allows you to appoint someone as your healthcare agent or proxy. This person is authorized to make medical decisions if they cannot do so due to incapacitation.</span>
                      </div>
                  </div>   
                </div>
                <!-- 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('livingwill.create.step.five_1') }}'" 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/living-will-multi-step.js?v=10.1') }}"></script>
<script src="{{ url('frontend/assets/js/forms/custom.js?v=10.3') }}"></script>

@endsection