@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-v-3">
      <div class="multiple-form dashboard-radio">
         <h4>Additional instructions</h4>
         <p>Do you wish to include any other instructions regarding your visitation?</p>

         <div class="form">
            <div class="row">
               <div class="col-12">
                  <div class="dashboard-radio-form">
                     <div class="form-check">
                        <input id="visitation_instructions-y" class="form-check-input" name="visitation_instructions" value="yes" type="radio" {{ isset($endoflifePlanForm->visitation_instructions_status) &&  $endoflifePlanForm->visitation_instructions_status == "yes" ? 'checked' : ''}}>
                        <label for="visitation_instructions-y"><p>Yes</p></label>
                     </div>
                     <div class="form-check">
                        <input id="visitation_instructions-n" class="form-check-input" name="visitation_instructions" value="no" type="radio" {{ isset($endoflifePlanForm->visitation_instructions_status) &&  $endoflifePlanForm->visitation_instructions_status == "no" ? 'checked' : ''}}>
                        <label for="visitation_instructions-n"><p>No</p></label>
                     </div>
                  </div>
               </div>
            </div>
            <div class="row">
               <div id="additional_instructions_holder" class="child-card-holder">
                  <div id="additional_instructions">
                     @php
                     $visitation_instructionsArray = json_decode($endoflifePlanForm->visitation_instructions, true)
                     @endphp
                     @if(!empty($visitation_instructionsArray) && count($visitation_instructionsArray) > 0)                                 
                     @foreach($visitation_instructionsArray as $index => $details)
                        <div class="card list mt-4" id="child">
                           <div class="card-header">
                              <div class="card-sub-title m-0">Describe your wishes in complete sentences:</div>
                              <a class="r-button" onclick="removetList(this)">
                                 <span class="fas fa-times"></span>
                                 <span class="remove">Remove</span>
                              </a>
                           </div> 
                           <div class="form-group my-3">
                           <input type="text"  value="{{$details['detail']}}" name="visitation_describe[]" aria-describedby="visitationDescribe" placeholder="" id = "visitation_describe_{{$index}}">
                           <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>
                     @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="form-group my-3">
                        <input type="text"  name="visitation_describe[]" aria-describedby="visitationDescribe" placeholder="" id="visitation_describe">
                        <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>
                     @endif
                  </div>
                  <div class="add-child">
                     <a href="#" class="add-another" id="add-another-child" onclick="clone('additional_instructions')" class="add-button">Add another instruction</a>
                  </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.five_visitation-2') }}'">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