@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="3-1">
      <div class="multiple-form dashboard-radio">
            @if(isset($endoflifePlanForm->announcement) &&  $endoflifePlanForm->announcement == "no" )
                <h4>Organ donation</h4>
                <p>Are you a registered organ donor?</p>
                <div class="tooltip d-none">
                    <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 class="form">
                    <div class="row">
                        <div class="col-12">
                            <div id="organ-donor" >

                                <div class="dashboard-radio-form">
                                    <div class="form-check">
                                        <input class="form-check-input" type="radio" id="organDonor-y" name="organDonor" value="yes" {{ isset($donor['organ_donor']) && $donor['organ_donor']  == "yes"  ? 'checked' : 'checked' }}>
                                        <label for="organDonor-y"><p>Yes</p></label>
                                    </div>
                                    <div class="form-check">
                                        <input class="form-check-input" type="radio" id="organDonor-n" name="organDonor" value="no" {{ isset($donor['organ_donor']) && $donor['organ_donor']  == "no"  ? 'checked' : '' }}>
                                        <label for="organDonor-n"><p>No</p></label>
                                    </div>
                                </div>
            
                                <div>
                                    <!-- <p>Where are you registered as a donor?</p> -->
                                    <div class="form-group mb-3">
                                        <label for="state">State:</label>
                                        <input type="text"  name="organDonorstate" id="organDonorstate" value="{{ isset($donor['state']) ? $donor['state'] : '' }}">
                                    </div>
                                </div>
            
                            </div>
                        </div>
                    </div>
                </div>
            @endif
            @if(isset($endoflifePlanForm->announcement) &&  $endoflifePlanForm->announcement == "death" )

                            <h4>Publication</h4>
                            <p>Where would you like your death notice to be published?</p>
                            <div class="form">
                                <div class="row">
                                   <div class="col-12">
                                        <div id="publication-container" class="child-card-holder">
                                        
                                            @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">
                                                            <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="{{ $publication['publication_name'] }}"  name="publication[]" id = "publication__{{$index}}" class="remove_space">
                                                            </div>
                                                            <div class="form-group mb-3">
                                                                <label for="publication_city">City/Town:</label>
                                                                <input type="text" value="{{ $publication['publication_city']}}"  name="publication_city[]" id = "publication_city_{{$index}}" class="validate_text" >
                                                            </div>
                                                        </div>
                                                    </div>
                                                    @endforeach
                                                @else
                                                <div class="card list mb-3" id="child">
                                                    <div class="card-header">
                                                        <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="remove_space" name="publication[]" id = "publication">
                                                        </div>
                                                        <div class="form-group mb-3">
                                                            <label for="publication_city">City/Town:</label>
                                                            <input type="text"  class="validate_text" name="publication_city[]" id = "publication_city">
                                                        </div>
                                                    </div>
                                                </div>
                                                @endif
                                            </div>
                                            <div class="add-child">
                                                <a href="#" class="add-another" id="add-publication-button" onclick="clone('publication-container')">
                                                Add another publication</a>
                                            </div>
                                    </div>
                                </div>
                            </div>

         
                            <div class="faq-box d-none">
                                <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>

            @endif
            @if(isset($endoflifePlanForm->announcement) &&  $endoflifePlanForm->announcement == "obituary" )
                <div id="obituary-sec">

                            <h4>Publication</h4>
                            <p>Where would you like your obituary to be published?</p>

                            <div id="obituary-container" class="child-card-holder">
                                @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">
                                                <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="{{ $obpublication['publication_name'] }}"  name="obituary_publication[]" id = "obituary_publication_{{$index}}">
                                                    <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="{{$obpublication['publication_city']}}"   name="obituary_publication_city[]" id = "obituary_publication_city_{{$index}}">
                                                    <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">
                                            <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"  name="obituary_publication[]"  id = "obituary_publication">
                                            </div>
                                            <div class="form-group mb-3">
                                                <label for="publication_city">City/Town:</label>
                                                <input type="text"  name="obituary_publication_city[]" id = "obituary_publication_city">
                                            </div>
                                        </div>
                                    </div>
                                @endif  
                            </div>
                            <div class="add-child">
                                <a href="#" id="add-obituary-button" class="add-another" onclick="clone('obituary-container')">
                                
                                Add another publication
                                </a>
                            </div>
                        </div>
  
                        <div class="faq-box d-none">
                            <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>
    
            @endif


        <!-- start previous / next buttons -->
        <div id="buttonsection" class="submit-button-multiple">
            <button type="button" onclick="window.location.href = '{{ route('endoflifePlan.create.step.three') }}'">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>

<script>
    // Initialize all tooltips
document.addEventListener('DOMContentLoaded', function () {
    var tooltipTriggerList = [].slice.call(document.querySelectorAll('[data-bs-toggle="tooltip"]'));
    tooltipTriggerList.map(function (tooltipTriggerEl) {
        return new bootstrap.Tooltip(tooltipTriggerEl);
    });
});
    </script>
@endsection