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

@section('title', '| Free Living Will')

@section('content')
@include('frontend.forms.v2.Living-Will.stepIndicator')
 <!-- start -->
<div class="container">
    <form action="{{route('LivingWillFormStore')}}" method="POST" id="signUpForm" class="multiple-form">
      @csrf
      <input type="hidden" id="stepInput" name="step" value="3">



      <div class="multiple-form dashboard-radio">
        <h4>Care if in terminal condition</h4>
        <p>If you are in a terminal condition with no hope of recovery, which of the following treatments do you want:</p>

        <div class="form">
           <div class="row">
              <div class="col-12">
                <p class="sub-title">
                    Life-Sustaining Treatment
                    <a tabindex="0" class="info-icon" role="button" data-bs-toggle="popover" data-bs-html="true" data-bs-trigger="focus" title="Life-Sustaining Treatment Info" data-bs-content="<p> Refers to any medical intervention that helps restore, replace, or maintain essential bodily functions, such as supporting breathing or stabilizing blood pressure. It does not include emergency care provided before reaching the hospital, nor does it encompass artificially administered nutrition, hydration, or pain management.</p>">?</a>
                </p>

                 <div class="dashboard-radio-form">
                  
                       <div class="form-check">
                        <input id="lst-y" class="form-check-input" name="life_sustaining_treatment" type="radio" value="yes" {{ isset($livingWillForm->sustaining_treatment) &&  $livingWillForm->sustaining_treatment == "yes" ? 'checked' : ''}}>
                          <label for="lst-y">
                          <p>I want to receive this treatment</p>
                          </label>
                       </div>
                       <div class="form-check">
                        <input id="lst-n" class="form-check-input" name="life_sustaining_treatment" type="radio" value="no" {{ isset($livingWillForm->sustaining_treatment) &&  $livingWillForm->sustaining_treatment == "no" ? 'checked' : ''}}>
                          <label for="lst-n">
                          <p>I do not want to receive this treatment</p>
                          </label>
                       </div>
                 </div>



                 <p class="mt-5 sub-title">
                    Artificially Provided Food and Water:
                    <a tabindex="0" class="info-icon" role="button" data-bs-toggle="popover" data-bs-html="true" data-bs-trigger="focus" title="Artificial Nutrition and Hydration" data-bs-content="<p>Artificially provided food and water refers to the use of a feeding tube or IV to supply nutrition and hydration when you are unable to chew or swallow on your own, especially in the case of a terminal condition.</p>">?</a>
                </p>
                 <div class="dashboard-radio-form">
                  
                       <div class="form-check">
                        <input id="apfw-y" class="form-check-input" name="apfw" type="radio" value="yes" {{ isset($livingWillForm->artificially_food) &&  $livingWillForm->artificially_food == "yes" ? 'checked' : ''}}>
                        <label for="apfw-y">
                          <p>I want to receive this treatment</p>
                          </label>
                       </div>
                       <div class="form-check">
                        <input id="apfw-n" class="form-check-input" name="apfw" type="radio" value="no" {{ isset($livingWillForm->artificially_food) &&  $livingWillForm->artificially_food == "no" ? 'checked' : ''}}>
                        <label for="apfw-n">
                          <p>I do not want to receive this treatment</p>
                          </label>
                       </div>
                 </div>
              </div>
           </div>
        </div>
     </div>

      <div class="faq-box d-none">
        <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>
 
        <!-- start previous / next buttons -->
        <div class="submit-button-multiple">
            
              <button type="button" onclick="window.location.href = '{{ route('livingwill.create.step.two') }}'">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 -->
    </form>

@endsection
@section('page-js')
<script src="{{ url('frontend/assets/js/forms/living-will-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