@extends('layouts.app')

@section('content')
    <h3 class="page-title">@lang('admin.reports.title')</h3>

    {!! Form::model($report, ['method' => 'PUT', 'route' => ['reports.update', $report->id]]) !!}

    <div class="panel panel-default">
        <div class="panel-heading">
            @lang('admin.edit')
        </div>

        <div class="panel-body">
            <div class="row">
                <div class="col-xs-12 form-group">
                    {!! Form::label('user_id', 'Patient Name*', ['class' => 'control-label']) !!}
                    {!! Form::select('user_id', $users, old('user_id'), ['class' => 'form-control select2']) !!}
                    <p class="help-block"></p>
                    @if($errors->has('user_id'))
                        <p class="help-block">
                            {{ $errors->first('user_id') }}
                        </p>
                    @endif
                </div>
            </div>
            <div class="row">
                <div class="col-xs-12 form-group">
                    {!! Form::label('name', 'Name*', ['class' => 'control-label']) !!}
                    {!! Form::text('name', old('name'), ['class' => 'form-control', 'placeholder' => '']) !!}
                    <p class="help-block"></p>
                    @if($errors->has('name'))
                        <p class="help-block">
                            {{ $errors->first('name') }}
                        </p>
                    @endif
                </div>
            </div>
            <div class="row">
                <div class="col-xs-12 form-group">
                    {!! Form::label('details', 'Details', ['class' => 'control-label']) !!}
                    {!! Form::textarea('details', old('details'), ['class' => 'form-control ', 'placeholder' => '']) !!}
                    <p class="help-block"></p>
                    @if($errors->has('details'))
                        <p class="help-block">
                            {{ $errors->first('details') }}
                        </p>
                    @endif
                </div>
            </div>
            <div class="row">
                <div class="col-xs-12 form-group">
                    {!! Form::label('date', 'Date', ['class' => 'control-label']) !!}
                    {!! Form::text('date', old('date'), ['class' => 'form-control datetime', 'placeholder' => '']) !!}
                    <p class="help-block"></p>
                    @if($errors->has('date'))
                        <p class="help-block">
                            {{ $errors->first('date') }}
                        </p>
                    @endif
                </div>
            </div>

        </div>
    </div>

    {!! Form::submit(trans('admin.update'), ['class' => 'btn btn-danger']) !!}
    {!! Form::close() !!}
@stop

@section('javascript')
    @parent
    <script src="{{ url('admin/js') }}/timepicker.js"></script>
    <script src="https://cdnjs.cloudflare.com/ajax/libs/jquery-ui-timepicker-addon/1.4.5/jquery-ui-timepicker-addon.min.js"></script>
    <script src="https://cdn.datatables.net/select/1.2.0/js/dataTables.select.min.js"></script>
    <script>
        $('.datetime').datetimepicker({
            autoclose: true,
            dateFormat: "{{ config('app.date_format_js') }}",
            timeFormat: "hh:mm:ss"
        });
    </script>

@stop