@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="3">
      <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">Care if in Terminal Condition</div>
                    <div class="card-sub-title">If you are in a terminal condition with no hope of recovery, which of the following treatments do you want:</div>
                   
                   
                   <div class="card-title mt-3">Life Sustaining Treatment:</div>
                   <div class="custom-m-status">
                     <input id="lst-y" name="life_sustaining_treatment" type="radio" value="yes" {{ isset($livingWillForm->sustaining_treatment) &&  $livingWillForm->sustaining_treatment == "yes" ? 'checked' : 'checked'}}>
                     <label for="lst-y" class="marital-box" id="lst-y">
                       <p>I want to receive this treatment</p>
                     </label>
                     <input id="lst-n" name="life_sustaining_treatment" type="radio" value="no" {{ isset($livingWillForm->sustaining_treatment) &&  $livingWillForm->sustaining_treatment == "no" ? 'checked' : ''}}>
                     <label for="lst-n" class="marital-box" id="lst-n">
                       <p>I do NOT want to receive this treatment</p>
                     </label>
                   </div>
 
                   <div class="card-title mt-3">Artificially Provided Food and Water:</div>
                   <div class="custom-m-status">
                     <input id="apfw-y" name="apfw" type="radio" value="yes" {{ isset($livingWillForm->artificially_food) &&  $livingWillForm->artificially_food == "yes" ? 'checked' : 'checked'}}>
                     <label for="apfw-y" class="marital-box" id="apfw-y">
                       <p>I want to receive this treatment</p>
                     </label>
                     <input id="apfw-n" name="apfw" type="radio" value="no" {{ isset($livingWillForm->artificially_food) &&  $livingWillForm->artificially_food == "no" ? 'checked' : ''}}>
                     <label for="apfw-n" class="marital-box" id="apfw-n">
                       <p>I do NOT want to receive this treatment</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 terminal condition?</p>
                      <span class="tooltiptext">A terminal condition refers to a medical condition or illness expected to result in the patient's death within a relatively short period, often within six months or less, even with available medical treatments.</span>
                    </div>
                    <div class="tooltip">
                      <p>What is life-sustaining treatment?</p>
                      <span class="tooltiptext">Life-sustaining treatment includes medical interventions and procedures aimed at keeping a person alive. It includes mechanical ventilation, artificial nutrition and hydration, cardiopulmonary resuscitation (CPR), and similar measures.</span>
                    </div>
                    <div class="tooltip">
                      <p>What is artificially provided food and water?</p>
                      <span class="tooltiptext">Artificially provided food and water refer to administering nutrients and fluids through medical means, like feeding tubes or intravenous (IV) lines, when a person cannot eat or drink.</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.two') }}'" 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