143 lines
9.5 KiB
PHP
143 lines
9.5 KiB
PHP
@extends('layouts.app')
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@section('content')
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<div class="container py-4">
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<div class="row justify-content-center">
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<div class="col-md-8">
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<div class="card shadow-sm">
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<div class="card-header bg-white">
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<h4 class="mb-0">Edit Family Member</h4>
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</div>
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<div class="card-body">
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<form method="POST" action="{{ route('family.update', $relationship->dependent->id) }}">
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@csrf
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@method('PUT')
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<div class="mb-3">
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<label for="full_name" class="form-label">Full Name</label>
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<input type="text" class="form-control @error('full_name') is-invalid @enderror" id="full_name" name="full_name" value="{{ old('full_name', $relationship->dependent->full_name) }}" required>
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@error('full_name')
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<div class="invalid-feedback">{{ $message }}</div>
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@enderror
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</div>
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<div class="mb-3">
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<label for="email" class="form-label">Email Address <span class="text-muted">(Optional for children)</span></label>
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<input type="email" class="form-control @error('email') is-invalid @enderror" id="email" name="email" value="{{ old('email', $relationship->dependent->email) }}">
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@error('email')
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<div class="invalid-feedback">{{ $message }}</div>
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@enderror
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</div>
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<div class="row mb-3">
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<div class="col-md-6">
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<label for="gender" class="form-label">Gender</label>
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<select class="form-select @error('gender') is-invalid @enderror" id="gender" name="gender" required>
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<option value="">Select Gender</option>
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<option value="m" {{ old('gender', $relationship->dependent->gender) == 'm' ? 'selected' : '' }}>Male</option>
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<option value="f" {{ old('gender', $relationship->dependent->gender) == 'f' ? 'selected' : '' }}>Female</option>
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</select>
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@error('gender')
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<div class="invalid-feedback">{{ $message }}</div>
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@enderror
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</div>
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<div class="col-md-6">
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<label for="birthdate" class="form-label">Birthdate</label>
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<input type="date" class="form-control @error('birthdate') is-invalid @enderror" id="birthdate" name="birthdate" value="{{ old('birthdate', $relationship->dependent->birthdate->format('Y-m-d')) }}" required>
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@error('birthdate')
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<div class="invalid-feedback">{{ $message }}</div>
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@enderror
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</div>
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</div>
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<div class="row mb-3">
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<div class="col-md-6">
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<label for="blood_type" class="form-label">Blood Type</label>
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<select class="form-select @error('blood_type') is-invalid @enderror" id="blood_type" name="blood_type">
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<option value="">Select Blood Type</option>
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<option value="A+" {{ old('blood_type', $relationship->dependent->blood_type) == 'A+' ? 'selected' : '' }}>A+</option>
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<option value="A-" {{ old('blood_type', $relationship->dependent->blood_type) == 'A-' ? 'selected' : '' }}>A-</option>
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<option value="B+" {{ old('blood_type', $relationship->dependent->blood_type) == 'B+' ? 'selected' : '' }}>B+</option>
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<option value="B-" {{ old('blood_type', $relationship->dependent->blood_type) == 'B-' ? 'selected' : '' }}>B-</option>
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<option value="AB+" {{ old('blood_type', $relationship->dependent->blood_type) == 'AB+' ? 'selected' : '' }}>AB+</option>
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<option value="AB-" {{ old('blood_type', $relationship->dependent->blood_type) == 'AB-' ? 'selected' : '' }}>AB-</option>
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<option value="O+" {{ old('blood_type', $relationship->dependent->blood_type) == 'O+' ? 'selected' : '' }}>O+</option>
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<option value="O-" {{ old('blood_type', $relationship->dependent->blood_type) == 'O-' ? 'selected' : '' }}>O-</option>
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<option value="Unknown" {{ old('blood_type', $relationship->dependent->blood_type) == 'Unknown' ? 'selected' : '' }}>Unknown</option>
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</select>
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@error('blood_type')
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<div class="invalid-feedback">{{ $message }}</div>
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@enderror
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</div>
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<div class="col-md-6">
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<x-country-dropdown
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name="nationality"
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id="nationality"
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:value="old('nationality', $relationship->dependent->nationality)"
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:required="true"
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:error="$errors->first('nationality')" />
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</div>
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</div>
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<div class="row mb-3">
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<div class="col-md-6">
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<label for="relationship_type" class="form-label">Relationship</label>
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<select class="form-select @error('relationship_type') is-invalid @enderror" id="relationship_type" name="relationship_type" required>
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<option value="">Select Relationship</option>
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<option value="son" {{ old('relationship_type', $relationship->relationship_type) == 'son' ? 'selected' : '' }}>Son</option>
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<option value="daughter" {{ old('relationship_type', $relationship->relationship_type) == 'daughter' ? 'selected' : '' }}>Daughter</option>
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<option value="spouse" {{ old('relationship_type', $relationship->relationship_type) == 'spouse' ? 'selected' : '' }}>Spouse</option>
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<option value="sponsor" {{ old('relationship_type', $relationship->relationship_type) == 'sponsor' ? 'selected' : '' }}>Sponsor</option>
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<option value="other" {{ old('relationship_type', $relationship->relationship_type) == 'other' ? 'selected' : '' }}>Other</option>
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</select>
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@error('relationship_type')
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<div class="invalid-feedback">{{ $message }}</div>
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@enderror
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</div>
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</div>
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<div class="mb-3 form-check">
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<input type="checkbox" class="form-check-input" id="is_billing_contact" name="is_billing_contact" value="1" {{ old('is_billing_contact', $relationship->is_billing_contact) ? 'checked' : '' }}>
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<label class="form-check-label" for="is_billing_contact">Is Billing Contact</label>
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</div>
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<div class="d-flex justify-content-between">
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<a href="{{ route('family.dashboard') }}" class="btn btn-outline-secondary">Cancel</a>
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<div>
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<button type="button" class="btn btn-danger me-2" data-bs-toggle="modal" data-bs-target="#deleteModal">
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Remove
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</button>
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<button type="submit" class="btn btn-primary">Update Family Member</button>
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</div>
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</div>
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</form>
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</div>
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</div>
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</div>
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</div>
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</div>
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<!-- Delete Confirmation Modal -->
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<div class="modal fade" id="deleteModal" tabindex="-1" aria-labelledby="deleteModalLabel" aria-hidden="true">
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<div class="modal-dialog">
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<div class="modal-content">
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<div class="modal-header">
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<h5 class="modal-title" id="deleteModalLabel">Confirm Removal</h5>
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<button type="button" class="btn-close" data-bs-dismiss="modal" aria-label="Close"></button>
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</div>
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<div class="modal-body">
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Are you sure you want to remove {{ $relationship->dependent->full_name }} from your family?
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</div>
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<div class="modal-footer">
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<button type="button" class="btn btn-secondary" data-bs-dismiss="modal">Cancel</button>
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<form action="{{ route('family.destroy', $relationship->dependent->id) }}" method="POST">
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@csrf
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@method('DELETE')
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<button type="submit" class="btn btn-danger">Remove</button>
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</form>
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</div>
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</div>
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</div>
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</div>
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@endsection
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