@extends('layouts.v2.frontend-user-backend')

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

@section('content')
@include('frontend.forms.v2.End-Of-Life-Plan.stepIndicator')
    <form action="{{route('EndoflifePlanFormStore')}}" method="POST" id="signUpForm">
      @csrf
      <input type="hidden" id="stepInput" name="step" value="5-f-5">
      @php
            $aid =  request()->input('aid') ?? 0;
            $typeStep =  request()->input('step') ?? $serviceb['type'][$aid];
      @endphp
      <input type="hidden" id="stepInput" name="aid" value="{{ $aid  }}">
      <div class="multiple-form dashboard-radio">

            @if(isset($serviceb['type']) && in_array('location', $serviceb['type']) && isset($serviceb['type']) && $serviceb['type'][$aid] === 'location')
               <h4>Funeral location</h4>
               <p>Where will your funeral be held?</p>
      
               <div class="form">
                  <div class="row">
                     <div class="col-12">
                           @php
                              $visitation_location = json_decode($endoflifePlanForm->funeral_service_location, true);
                           @endphp
                           <div class="form-group mb-3">
                              <label for="name">Name:</label>
                              <input type="text"  value="{{isset($visitation_location['full_name']) ? $visitation_location['full_name'] : '' }}" name="full_name" aria-describedby="nameHelp">
                              <small id="nameHelp" class="form-text text-muted">e.g. Kendrick Funeral Home, my home</small>
                           </div>
                           <div class="form-group mb-3">
                              <label for="city">Address:</label>
                              <input type="text"  name="address" aria-describedby="addressHelp" value="{{isset($visitation_location['address']) ? $visitation_location['address'] : '' }}">
                              <small id="addressHelp" class="form-text text-muted">e.g. Street, City, State ZIP Code</small>
                           </div>
                     </div>
                  </div>
               </div> 
            @endif
            @if(isset($serviceb['type']) && in_array('officiant', $serviceb['type'])  && isset($serviceb['type']) && $serviceb['type'][$aid] === 'officiant')
               <h4>Officiant</h4>
               <p>Who will be your officiant?</p>
      
               <div class="form">
                  <div class="row">
                     <div class="col-12">
                        @php
                           $officiant = json_decode($endoflifePlanForm->funeral_service_officiant, true);
                        @endphp
                        <div class="form-group mb-3">
                              <label for="name">Name:</label>
                              <input type="text" value="{{isset($officiant['full_name']) ? $officiant['full_name'] : '' }}"  name="full_name" aria-describedby="nameHelp">
                        </div>
                        <div class="form-group mb-3">
                              <label for="city">Email :</label>
                              <input type="text" value="{{isset($officiant['email']) ? $officiant['email'] : '' }}"  name="email" aria-describedby="addressHelp">
                        </div>
                        <div class="form-group mb-3">
                              <label for="city">Phone :</label>
                              <input type="text" value="{{isset($officiant['phone']) ? $officiant['phone'] : '' }}"  name="phone" aria-describedby="addressHelp">
                        </div>
                     </div>
                     <div class="faq-box d-none">
                        <div class="title">Frequently Asked Questions</div>
                        <p>What is an officiant?</p>
                        <span class="tooltiptext">An officiant, sometimes known as a celebrant, functions as the master of ceremonies at a funeral or other service. For those who are religious, an officiant might be a religious leader; however, you can also hire an officiant or ask a friend or family member. An officiant's responsibilities can include greeting guests at the door, conducting the service, and directing guests to the graveside or reception.</span>
                     </div>
                  </div>
               </div>      

            @endif
            @if(isset($serviceb['type']) && in_array('guests', $serviceb['type'])  && isset($serviceb['type']) && $serviceb['type'][$aid] === 'guests')
               @php
                  $receive_your_ashesArray = json_decode($endoflifePlanForm->funeral_service_guests, true)
               @endphp
               <h4>Guests</h4>
               <p>Who may attend your funeral?</p>
      
               <div class="form">
                  <div class="row">
                     <div class="col-12">
                        <div class="dashboard-radio-form">
                           <div class="form-check">
                              <input id="m-visitation" class="form-check-input" name="m-visitation" type="radio" value="anyone" {{isset($receive_your_ashesArray['visitation']) && $receive_your_ashesArray['visitation'] == 'anyone' ? 'checked' : '' }}>
                              <label for="m-visitation" class="marital-box" id="single-label">
                                 <p>Anyone</p>
                              </label>
                           </div>
                           <div class="form-check">
                              <input id="m-visitation-b" class="form-check-input" name="m-visitation" type="radio" value="family" {{isset($receive_your_ashesArray['visitation']) && $receive_your_ashesArray['visitation'] == 'family' ? 'checked' : '' }}>
                              <label for="m-visitation-b" class="marital-box" id="married-label"><p>Family and friends only</p></label>
                           </div>
                        </div>
                        <p class="my-5">Are there any specific individuals you wish to be contacted to attend?</p>
                        <div class="dashboard-radio-form">
                           <div class="form-check">
                              <input id="contacted-y" class="form-check-input" name="contacted" value="yes" type="radio" {{ !empty($receive_your_ashesArray['multipleRecords'] ) ? 'checked' : '' }}>
                              <label for="contacted-y"><p>Yes</p></label>
                           </div>
                           <div class="form-check">
                              <input id="contacted-n" class="form-check-input" name="contacted" value="no" type="radio" {{ empty($receive_your_ashesArray['multipleRecords'] ) ? 'checked' : '' }}>
                              <label for="contacted-n"><p>No</p></label>
                           </div>
                        </div>
                     </div>
                  </div>
                  <div class="row">
                     
                     <div id="receive_your_ashes_holder" class="child-card-holder">
                        <div id="receive_your_ashes">
                           @if(!empty($receive_your_ashesArray['multipleRecords']) && count($receive_your_ashesArray['multipleRecords']) > 0)                                 
                              @foreach($receive_your_ashesArray['multipleRecords'] as $index => $receive_your_ashes)
                              <div class="card list mb-3" id="child">
                                 <div class="card-header">
                                    <div class="card-title m-0">Individual</div>
                                    <a class="r-button" onclick="removetList(this)">
                                    <span class="fas fa-times"></span>
                                    <span class="remove">Remove</span>
                                    </a>
                                 </div>
                                 <div class="card-body">
                                    <div class="form-group mb-3">
                                       <label for="name">Name:</label>
                                       <input type="text"  name="full_name[]" id="full_name_{{$index}}" value="{{$receive_your_ashes['full_name']}}">
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="name">Relationship:</label>
                                       <input type="text"  name="relationship[]" id="relationship_{{$index}}" value="{{$receive_your_ashes['relationship']}}">
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="city">Address :</label>
                                       <input type="text"  name="address[]" id="address_{{$index}}"   value="{{$receive_your_ashes['address']}}">
                                       <small id="cityHelp" class="form-text text-muted d-none">e.g. Street, City, State ZIP Code</small>
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="phone_number">Phone Number :</label>
                                       <input type="text"  name="phone[]" id="phone_number_{{$index}}" value="{{$receive_your_ashes['phone']}}">
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="email">Email :</label>
                                       <input type="text"  name="email[]" id="email_{{$index}}"  value="{{$receive_your_ashes['email']}}">
                                    </div>
                                 </div>
                              </div>
                              @endforeach
                           @else                          
                              <div class="card list mb-3" id="child">
                                 <div class="card-header">
                                    <div class="card-title m-0">Individual</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="name">Name:</label>
                                       <input type="text"  name="full_name[]" id="full_name">
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="name">Relationship:</label>
                                       <input type="text"  name="relationship[]" id="relationship">
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="city">Address :</label>
                                       <input type="text"  name="address[]" id="address">
                                       <small id="cityHelp" class="form-text text-muted d-none">e.g. Street, City, State ZIP Code</small>
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="phone_number">Phone Number :</label>
                                       <input type="text"  name="phone[]" id="phone_number">
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="email">Email :</label>
                                       <input type="text"  name="email[]" id="email">
                                    </div>
                                 </div>
                              </div>
                           @endif
                        </div>
                        <div class="add-child">
                           <a href="#" id="add-another-child" onclick="clone('receive_your_ashes')" class="add-another">Add another individual</a>
                        </div>
                     </div>

                  </div>
               </div>
            @endif 
            @if(isset($serviceb['type']) && in_array('ashes', $serviceb['type'])  && isset($serviceb['type']) && $serviceb['type'][$aid] === 'ashes')
               <h4>Viewing</h4>
               <p>Do you wish to have your ashes present?</p>
      
               <div class="form">
                  <div class="row">
                     <div class="col-12">
                        <div class="dashboard-radio-form">
                           <div class="form-check">
                              <input id="ashes_present-y" class="form-check-input" name="ashes_present" value="yes" type="radio" {{isset($endoflifePlanForm->funeral_ashes_present) && $endoflifePlanForm->funeral_ashes_present  == 'yes' ? "checked" : ''}}>
                              <label for="ashes_present-y"><p>Yes</p></label>
                           </div>
                           <div class="form-check">
                              <input id="ashes_present-n" class="form-check-input" name="ashes_present" value="no" type="radio" {{isset($endoflifePlanForm->funeral_ashes_present) && $endoflifePlanForm->funeral_ashes_present  == 'no' ? "checked" : ''}}>
                              <label for="ashes_present-n"><p>No</p></label>
                           </div>
                        </div>
                     </div>
                  </div>
               </div>
            @endif
            @if(isset($serviceb['type']) && in_array('music', $serviceb['type'])  && isset($serviceb['type']) && $serviceb['type'][$aid] === 'music')       
               @php
               $receive_your_ashesArray = json_decode($endoflifePlanForm->funeral_service_music, true)
               @endphp
               <h4>Funeral details</h4>
               <p></p>

               <div class="form">
                  <div class="row">
                     <div class="col-12">
                        <div class="form-group mb-3">
                           <label for="name">
                              Describe the music that you want played during your funeral:
                              <span class="tooltiptext d-none">Name the song(s), genre, or artist if playing recorded music. Name the song(s), genre, or singer/musician if live music will be played.</span>
                           </label>
                           <input value="{{isset($receive_your_ashesArray['played']) ? $receive_your_ashesArray['played'] : ''}}" type="text"  name="played" aria-describedby="playedHelp">
                           <small id="playedHelp" class="form-text text-muted">e.g. I would like classical music by Beethoven to be playing during the visitation.</small>
                        </div>
                        <div class="form-group mb-3">
                           <label for="name">List the reading(s) and who will perform them:</label>
                           <input value="{{isset($receive_your_ashesArray['perform']) ? $receive_your_ashesArray['perform'] : ''}}" type="text"  name="perform" aria-describedby="performHelp">
                           <small id="performHelp" class="form-text text-muted">e.g. I would like my sister to read "The Dash" by Linda Ellis.</small>
                        </div>
                     </div>
                  </div>
               </div>
            @endif
            @if(isset($serviceb['type']) && in_array('eulogy', $serviceb['type'])  && isset($serviceb['type']) && $serviceb['type'][$aid] === 'eulogy')
               
               <h4>Eulogy</h4>
               <p>Who would you like to speak at your visitation?</p>
      
               <div class="form">
                  <div class="row">
                     <div class="col-12">
                        <div id="eulogist_holder" class="child-card-holder">
                           <div id="eulogist">
                              @php
                                 $speakerArray = json_decode($endoflifePlanForm->funeral_eulogist, true)
                              @endphp
                              @if(!empty($endoflifePlanForm->funeral_eulogist) && count($speakerArray) > 0)                                 
                                 @foreach($speakerArray as $index => $speaker)
                                 <div class="card list mb-3" id="child">
                                    <div class="card-header">
                                       <div class="card-title m-0">Eulogist</div>
                                       <a class="r-button" onclick="removetList(this)">
                                       <span class="fas fa-times"></span>
                                       <span class="remove">Remove</span>
                                       </a>
                                    </div>
                                    <div class="card-body">
                                       <div class="form-group mb-3">
                                          <label for="name">Name:</label>
                                          <input type="text"  name="full_name[]" id="full_name_{{$index}}"  value="{{$speaker['full_name']}}">
                                       </div>
                                       <div class="form-group mb-3">
                                          <label for="name">Relationship:</label>
                                          <input type="text"  name="relationship[]" id="relationship_{{$index}}"  value="{{$speaker['relationship']}}">
                                       </div>
                                       <div class="form-group mb-3">
                                          <label for="city">Address :</label>
                                          <input type="text"  name="address[]" id="address_{{$index}}"   value="{{$speaker['address']}}">
                                          <small id="cityHelp" class="form-text text-muted d-none">e.g. Street, City, State ZIP Code</small>
                                       </div>
                                       <div class="form-group mb-3">
                                          <label for="phone_number">Phone Number :</label>
                                          <input type="text"  name="phone[]" id="phone_number_{{$index}}"  value="{{$speaker['phone']}}">
                                       </div>
                                       <div class="form-group mb-3">
                                          <label for="email">Email :</label>
                                          <input type="text"  name="email[]" id="email_{{$index}}" value="{{$speaker['email']}}">
                                       </div>
                                    </div>
                                 </div>
                                 @endforeach
                              @else                          
                                 <div class="card list mb-3" id="child">
                                    <div class="card-header">
                                       <div class="card-title m-0">Eulogist</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="name">Name:</label>
                                          <input type="text"  name="full_name[]" id="full_name">
                                       </div>
                                       <div class="form-group mb-3">
                                          <label for="name">Relationship:</label>
                                          <input type="text"  name="relationship[]" id="relationship">
                                       </div>
                                       <div class="form-group mb-3">
                                          <label for="city">Address :</label>
                                          <input type="text"  name="address[]" id="address">
                                          <small id="cityHelp" class="form-text text-muted d-none">e.g. Street, City, State ZIP Code</small>
                                       </div>
                                       <div class="form-group mb-3">
                                          <label for="phone_number">Phone Number :</label>
                                          <input type="text"  name="phone[]" id="phone_number">
                                       </div>
                                       <div class="form-group mb-3">
                                          <label for="email">Email :</label>
                                          <input type="text"  name="email[]" id="email">
                                       </div>
                                    </div>
                                 </div>
                              @endif
                           </div>
                           <div class="add-child">
                              <a href="#" id="add-another-child" onclick="clone('eulogist')" class="add-another">Add another individual</a>
                           </div>
                        </div>
                     </div>
                  </div>
               </div>
            @endif
            @if(isset($serviceb['type']) && in_array('reception', $serviceb['type'])  && isset($serviceb['type']) && $serviceb['type'][$aid] === 'reception')
               <h4>Reception</h4>
               <p>What instructions do you have for your post-funeral reception?</p>
               <span class="tooltiptext d-none">You can include instructions for the location (usually the same location as the funeral), flowers, music, food, and drinks.</span>
               <div class="form">
                  <div class="row">
                     <div class="col-12">
                        <div id="additional_instructions_holder_other" class="child-card-holder">
                           <div id="additional_instructions">
                              @php
                              $visitation_instructionsArray = json_decode($endoflifePlanForm->funeral_reception, true)
                              @endphp
                              @if(!empty($visitation_instructionsArray) && count($visitation_instructionsArray) > 0)                                 
                              @foreach($visitation_instructionsArray as $index => $details)
                                 <div class="card list mt-4" id="child">
                                    <div class="card-header">
                                       <div class="card-sub-title m-0">Describe your wishes in complete sentences:</div>
                                       <a class="r-button" onclick="removetList(this)">
                                          <span class="fas fa-times"></span>
                                          <span class="remove">Remove</span>
                                       </a>
                                    </div> 
                                    <div class="card-body">
                                       <div class="form-group my-3">
                                          <input type="text"  value="{{$details['detail']}}" name="funeral_reception_describe[]" id="funeral_reception_describe_{{$index}}" aria-describedby="visitationDescribe" placeholder="">
                                          <div id="funeral_reception_describe_error_{{$index}}" class="a-status-error-message text-danger small fw-bold d-none mb-4"></div>
                                          <small id="visitationDescribe" class="form-text text-muted">e.g. I would like my husband to give a toast and speech at my visitation.</small>
                                       </div>
                                    </div>
                                 </div>
                              @endforeach
                              @else
                              <div class="card list mt-4" id="child">
                                 <div class="card-header">
                                    <div class="card-sub-title m-0">Describe your wishes in complete sentences:</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 my-3"> 
                                       <input type="text"  name="funeral_reception_describe[]" aria-describedby="visitationDescribe" placeholder="">
                                       <div id="funeral_reception_describe_error_0" class="a-status-error-message text-danger small fw-bold d-none mb-4"></div>
                                       <small id="visitationDescribe" class="form-text text-muted">e.g. I would like my husband to give a toast and speech at my visitation.</small>
                                    </div>
                                 </div>
                              </div>
                              @endif
                           </div>
                           <div class="add-child">
                              <a href="#" id="add-another-child" onclick="clone('additional_instructions')" class="add-another">Add another instruction</a>
                           </div>
                        </div>
                     </div>
                  </div>
               </div>      
            @endif
            @if(isset($serviceb['type']) && in_array('other', $serviceb['type'])  && isset($serviceb['type']) && $serviceb['type'][$aid] === 'other')
               <h4>Additional instructions</h4>
               <p>Do you wish to include any other instructions regarding your funeral?</p>
      
               <div class="form">
                  <div class="row">
                     <div class="col-12">
                        <div class="dashboard-radio-form">
                           <div class="form-check">
                              <input id="funeral_additional_instructions-y" class="form-check-input" name="additional_instructions" value="yes" type="radio" {{ isset($endoflifePlanForm->funeral_additional_instructions) ? 'checked' : '' }}>
                              <label for="funeral_additional_instructions-y"><p>Yes</p></label>
                           </div>
                           <div class="form-check">
                              <input id="funeral_additional_instructions-n" class="form-check-input" name="additional_instructions" value="no" type="radio" {{ !isset($endoflifePlanForm->funeral_additional_instructions) ? 'checked' : '' }}>
                              <label for="funeral_additional_instructions-n"><p>No</p></label>
                           </div>
                        </div>
                     </div>
                  </div>
                  <div class="row">
                     <div id="additional_instructions_holder_other" class="child-card-holder">
                        <div id="additional_instructions">
                           @php
                           $visitation_instructionsArray = json_decode($endoflifePlanForm->funeral_additional_instructions, true)
                           @endphp
                           @if(!empty($endoflifePlanForm->funeral_additional_instructions) && count($visitation_instructionsArray) > 0)                                 
                           @foreach($visitation_instructionsArray as $index => $details)
                              <div class="card list mt-4" id="child">
                                 <div class="card-header">
                                    <div class="card-sub-title m-0">Describe your wishes in complete sentences:</div>
                                    <a class="r-button" onclick="removetList(this)">
                                       <span class="fas fa-times"></span>
                                       <span class="remove">Remove</span>
                                    </a>
                                 </div> 
                                 <div class="card-body">
                                    <div class="form-group my-3">
                                       <input type="text"  value="{{$details['detail']}}" name="funeral_reception_describe[]" id="funeral_reception_describe_{{$index}}" aria-describedby="visitationDescribe" placeholder="">
                                       <small id="visitationDescribe" class="form-text text-muted">e.g. I would like my husband to give a toast and speech at my visitation.</small>
                                    </div>
                                 </div>
                              </div>
                           @endforeach
                           @else
                           <div class="card list mt-4" id="child">
                              <div class="card-header">
                                 <div class="card-sub-title m-0">Describe your wishes in complete sentences:</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 my-3">
                                    <input type="text"  name="funeral_reception_describe[]" aria-describedby="visitationDescribe" placeholder="">
                                    <small id="visitationDescribe" class="form-text text-muted">e.g. I would like my husband to give a toast and speech at my visitation.</small>
                                 </div>
                              </div>
                           </div>
                           @endif
                        </div>
                        <div class="add-child">
                           <a href="#" id="add-another-child" onclick="clone('additional_instructions')" class="add-another">Add another instruction</a>
                        </div>
                     </div>
                  </div>
               </div>
            @endif

         <!-- start previous / next buttons -->
         <div id="buttonsection" class="submit-button-multiple">
                  @foreach ($serviceb['type'] as $service)
                     @if ($service === $typeStep)
                        @if ($aid == 0)
                           <button type="button" onclick="window.location.href = '{{ route('endoflifePlan.create.step.five_funeral-4') }}'" >Back</button> 
                        @else
                           <button type="button" onclick="window.location.href = '{{ route('endoflifePlan.create.step.five_funeral-5', ['step' => $serviceb['type'][$aid - 1], 'aid' => $aid - 1]) }}'" >Back</button> 
                        @endif
                     @endif
                  @endforeach
            {{-- <button type="button" onclick="window.location.href = '{{ route('endoflifePlan.create.step.five_funeral-4') }}'" >Back</button> --}}
            <button type="submit" class="submit-btn">Save and Continue</button>
            <button type="submit" class="d-none" name="preview_submit" value="preview">{{env('PREVIEW_BUTTON_TEXT')}}</button>
            <button type="button" class="skip-btn d-none">Skip Step</button>
         </div>
         <!-- end previous / next buttons -->
      </div>
    </form>	  
@endsection
@section('page-js')
<script src="{{ url('frontend/assets/js/forms/end-of-life-plan-multi-step.js') }}?v={{ time() }}"></script>
<script src="{{ url('frontend/assets/js/forms/custom.js?v=10.3') }}"></script>
<script src="{{ url('v2/js/form-validation.js') }}?v={{ time() }}"></script>
@endsection