@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="1.1">
      <div class="multiple-form dashboard-radio">
         <h4>Your details</h4>
         <p>Who is this End-of-Life Plan for?</p>

         <div class="form">
            <div class="row">
               <div class="col-12">
                  <div class="checkbox-item form-check-input-child mb-3">
                     <input class="custom-checkbox" type="checkbox" value="" id="userCheckbox">
                     <label class="form-check-label" for="flexCheckDefault">
                       <p>Auto fill your previous information</p> 
                     </label>
                  </div>
                  <div class="form-group mb-3">
                     <label for="name">Name</label>
                     <input type="text"  name="full_name" id="full_name" aria-describedby="nameHelp" value="{{ isset($plan_for['full_name']) ? $plan_for['full_name'] : '' }}" >
                  </div>
                  <div class="form-group mb-3">
                     <label for="street">Street Address1</label>
                     <input type="text"  name="street_1" id="street" value="{{ isset($plan_for['street_1']) ? $plan_for['street_1'] : '' }}" >
                  </div>
                  <div class="form-group mb-3">
                     <label for="street">Street Address2</label>
                     <input type="text"  name="street_2" id="street2" value="{{ isset($plan_for['street_2']) ? $plan_for['street_2'] : '' }}" >
                  </div>
                  
                  <div class="row">
                     <div class="col-md-6">
                        <div class="form-group mb-3">
                           <label for="city">City/Town</label>
                           <input type="text"  name="city" id="city" aria-describedby="cityHelp" value="{{ isset($plan_for['city']) ? $plan_for['city'] : '' }}" >
                        </div>
                     </div>
                     <div class="col-md-6">
                        <div class="form-group mb-3">
                           <label for="country">Country</label>
                            {{-- <input type="text"  name="country" id="country" value="{{ isset($plan_for['country']) ? $plan_for['country'] : 'United States' }}">  --}}
                            <input type="hidden" id="country_code_value">
                           <input type="hidden" name="country_value" id="country_value" value="{{ isset($plan_for['country']) ? $plan_for['country'] : 'United States' }}"/>
                           <select id="country_dropdown_a" name="country" class="form-control" data-country-dropdown data-country-value="country_value" data-state-dropdown="state_dropdown_a" data-state-value="state_value" data-userdefined-country-code="country_code_value">
                              <option value="">Select Country</option>
                           </select>
                           {{-- <input id="country_abbreviation" type="hidden"  name="country_abbreviation" value=""> --}}
                        </div>
                     </div>
                  </div>

                  <div class="row">
                     <div class="col-md-6">
                        <div class="form-group mb-3">
                           <label for="state">State</label>
                           {{-- <input type="text"  name="state" id="state"  value="{{ isset($plan_for['state']) ? $plan_for['state'] : '' }}">  --}}

                           <input type="hidden" name="state_value" id="state_value"  value="{{ isset($plan_for['state']) ? $plan_for['state'] : '' }}"/>
                           <select id="state_dropdown_a" name="state" class="form-control" data-state-dropdown>
                              <option value="">Select State</option>
                           </select>
                           {{-- <input id="state_abbreviation" type="hidden"  name="state_abbreviation" value=""> --}}
                        </div>
                     </div>
                     <div class="col-md-6">
                        <div class="form-group mb-3">
                        <input type="hidden" id="userdefinedCountryCode" value="US" />
                           <label for="zip">ZIP Code</label>
                           <input type="text"  name="zip_code" id="zip" value="{{ isset($plan_for['zip_code']) ? $plan_for['zip_code'] : '' }}" data-zipcode-input maxlength="5" data-message-element="zipcode_message" data-userdefined-country-code="userdefinedCountryCode" data-country-dropdown="country_dropdown_a" data-state-dropdown="state_dropdown_a">
                           <span class="invalid-zipcode invalid-feedback d-block text-danger" id="zipcode_message" role="alert"></span>
                           </div>
                     </div>
                  </div>

               </div>
            </div>
         </div>
         <!-- start previous / next buttons -->
         <div id="buttonsection" class="submit-button-multiple">
            <button type="button" onclick="window.location.href = '{{ route('endoflifePlan.create.step.one') }}'" class="back-btn">Back</button>
            <button type="submit" class="submit-btn">Save and Continue</button>
            <button type="submit" name="preview_submit" class="d-none" 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>
{{-- 
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>
   <script src="{{ url('v2/js/form-validation.js') }}?v={{ time() }}"></script>
 <!-- END - autopopulating from zipcode-->
@endsection