@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="3-1">


      <div class="multiple-form dashboard-radio">
        <h4>Care if permanently unconscious</h4>
        <p>If you are permanently unconscious 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" data-bs-content="<p>Life-sustaining treatment 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="c_lst-y" class="form-check-input" name="c_life_sustaining_treatment" type="radio" value="yes" {{ isset($livingWillForm->p_sustaining_treatment) &&  $livingWillForm->p_sustaining_treatment == "yes" ? 'checked' : ''}}>
                        <label for="c_lst-y">
                         <p>I want to receive this treatment</p>
                         </label>
                      </div>
                      <div class="form-check">
                        <input id="c_lst-n" class="form-check-input" name="c_life_sustaining_treatment" type="radio" value="no" {{ isset($livingWillForm->p_sustaining_treatment) &&  $livingWillForm->p_sustaining_treatment == "no" ? 'checked' : ''}}>
                        <label for="c_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="c_apfw-y" class="form-check-input" name="c_apfw" type="radio" value="yes" {{ isset($livingWillForm->p_artificially_food) &&  $livingWillForm->p_artificially_food == "yes" ? 'checked' : ''}}>
                        <label for="c_apfw-y">
                         <p>I want to receive this treatment</p>
                         </label>
                      </div>
                      <div class="form-check">
                        <input id="c_apfw-n" class="form-check-input" name="c_apfw" type="radio" value="no" {{ isset($livingWillForm->p_artificially_food) &&  $livingWillForm->p_artificially_food == "no" ? 'checked' : ''}}>
                        <label for="c_apfw-n">
                         <p>I do not want to receive this treatment</p>
                         </label>
                      </div>
                </div>
             </div>
          </div>
        </div>
      </div>

      <!-- start previous / next buttons -->
      <div class="submit-button-multiple">
                
            <button type="button" onclick="window.location.href = '{{ route('livingwill.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 -->
    </form>

    <div class="faq-box d-none">
      <div class="title">Frequently Asked Questions</div>
      <div class="tooltip">
        <p>What does permanent unconsciousness mean?</p>
        <span class="tooltiptext">Permanent unconsciousness is when your doctor and another doctor agree that, within a reasonable degree of medical certainty, you can no longer think, feel anything, knowingly move, or be aware of being alive. They believe this condition will last indefinitely without hope for improvement and have watched you long enough to make that decision. At least one of these doctors must be qualified to make such a diagnosis</span>
      </div>
      <div class="tooltip">
        <p>What is life-sustaining treatment?</p>
        <span class="tooltiptext">Life-sustaining treatment includes any life-prolonging procedure that helps to restore, replace, or maintain a spontaneous and vital bodily function. For example, assistance with maintaining breathing or blood pressure.
          <br><br>
          Life support does not include medical treatment performed in a pre-hospital situation or artificially administered food/water or pain relief.</span>
      </div>
      <div class="tooltip">
        <p>What is artificially provided food and water?</p>
        <span class="tooltiptext">Artificially provided food and water means that if you become permanently unconscious you may need to be given food and water through a tube or an IV to keep you alive if you can no longer chew or swallow on your own or with someone helping you.</span>
      </div>
    </div>




@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