@extends('adminlte::page')

@section('title', 'Iassis ORL')

@section('content_header')
    <h1>Νέος Ασθενής</h1>
@stop

@section('content')
			<div class="box box-primary">
                {!! Form::open(['url' => 'patients/create']) !!}
				<div class="box-body">

					 <!-- left column -->
					<div class="col-md-6">
						<div class="form-group row">
							{!! Form::label('lastname', 'Επώνυμο:',['class'=>'col-sm-2 col-form-label']) !!}
							<div class="col-sm-10">
							{!! Form::text('lastname',null,['class'=>'form-control input-sm','required'=>'required']) !!}
							</div>
						</div>
						<div class="form-group row">
							{!! Form::label('firstname', 'Όνομα:',['class'=>'col-sm-2 col-form-label']) !!}
							<div class="col-sm-10">
								<input list="listname" id="firstname" class="form-control input-sm" name="firstname" value="" >
								<datalist id="listname">
									@foreach ($listname as $list) 
									<option value="{{ $list }}">						 
									@endforeach
								</datalist>					
							</div>
						</div>
						<div class="form-group row">
							{!! Form::label('Address', 'Διέυθυνση:',['class'=>'col-sm-2 col-form-label']) !!}
							<div class="col-sm-10">
							{!! Form::text('address',null,['class'=>'form-control input-sm']) !!}
							</div>
						</div>
						<div class="form-group row">
							{!! Form::label('city', 'Πόλη:',['class'=>'col-sm-2 col-form-label']) !!}
							<div class="col-sm-10">
								<input list="listcity" id="city" class="form-control input-sm" name="city" value="" >
								<datalist id="listcity">
									@foreach ($listcity as $list) 
									<option value="{{ $list }}">						 
									@endforeach
								</datalist>					
							</div>
						</div>
						<div class="form-group row">
							{!! Form::label('tk', 'ΤΚ:',['class'=>'col-sm-2 col-form-label']) !!}
							<div class="col-sm-10">
							{!! Form::text('tk',null,['class'=>'form-control input-sm']) !!}
							</div>
						</div>
						<div class="form-group row">
							{!! Form::label('amka', 'ΑΜΚΑ:',['class'=>'col-sm-2 col-form-label']) !!}
							<div class="col-sm-10">
							{!! Form::text('amka',null,['class'=>'form-control input-sm']) !!}
							</div>
						</div>
						<div class="form-group row">
							{!! Form::label('birthdate', 'Ημ. Γέννησης:',['class'=>'col-sm-2 col-form-label']) !!}
							<div class="col-sm-10">
							{!! Form::date('birthdate',null,['class'=>'form-control input-sm']) !!}
							</div>
						</div>
						<div class="form-group row">
							{!! Form::label('phone', 'Τηλέφωνο:',['class'=>'col-sm-2 col-form-label']) !!}
							<div class="col-sm-10">
							{!! Form::text('phone',null,['class'=>'form-control input-sm']) !!}
							</div>
						</div>
						<div class="form-group row">
							{!! Form::label('mobile', 'Κινητό:',['class'=>'col-sm-2 col-form-label']) !!}
							<div class="col-sm-10">
							{!! Form::text('mobile',null,['class'=>'form-control input-sm']) !!}
							</div>
						</div>
						<div class="form-group row">
							{!! Form::label('email', 'Email:',['class'=>'col-sm-2 col-form-label']) !!}
							<div class="col-sm-10">
							{!! Form::text('email',null,['class'=>'form-control input-sm']) !!}
							</div>
						</div>
						<div class="form-group row">
							{!! Form::label('tameio', 'Ταμείο:',['class'=>'col-sm-2 col-form-label']) !!}
							<div class="col-sm-10">
								<input list="listtameio" id="tameio" class="form-control input-sm" name="tameio" value="" >
								<datalist id="listtameio">
									@foreach ($listtameio as $list) 
									<option value="{{ $list }}">						 
									@endforeach
								</datalist>					
							</div>
						</div>
						<div class="form-group row">
							{!! Form::label('origin', 'Προέλευση:',['class'=>'col-sm-2 col-form-label']) !!}
							<div class="col-sm-10">
								<input list="listorigin" id="origin" class="form-control input-sm" name="origin" value="" >
								<datalist id="listorigin">
									@foreach ($listorigin as $list) 
									<option value="{{ $list }}">						 
									@endforeach
								</datalist>					
							</div>
						</div>
						<div class="form-group row">
							{!! Form::label('parapompi', 'Παραπομπή:',['class'=>'col-sm-2 col-form-label']) !!}
							<div class="col-sm-10">
								<input list="listparapompi" id="parapompi" class="form-control input-sm" name="parapompi" value="" >
								<datalist id="listparapompi">
									@foreach ($listparapompi as $list) 
									<option value="{{ $list }}">						 
									@endforeach
								</datalist>					
							</div>
						</div>
						<div class="form-group row">
							{!! Form::label('gp', 'GP:',['class'=>'col-sm-2 col-form-label']) !!}
							<div class="col-sm-10">
								<input list="listgp" id="gp" class="form-control input-sm" name="gp" value="" >
								<datalist id="listgp">
									@foreach ($listgp as $list) 
									<option value="{{ $list }}">						 
									@endforeach
								</datalist>					
							</div>
						</div>
					</div>

					 <!-- right column -->
					<div class="col-md-6">
						<div class="form-group row">
							{!! Form::label('smoking', 'Smoking:',['class'=>'col-sm-2 col-form-label']) !!}
							<div class="col-sm-10">
								<input list="listsmoking" id="smoking" class="form-control input-sm" name="smoking" value="" >
								<datalist id="listsmoking">
									@foreach ($listsmoking as $list) 
									<option value="{{ $list }}">						 
									@endforeach
								</datalist>					
							</div>
						</div>
						<div class="form-group row">
							{!! Form::label('eth', 'Eth:',['class'=>'col-sm-2 col-form-label']) !!}
							<div class="col-sm-10">
								<input list="listeth" id="eth" class="form-control input-sm" name="eth" value="" >
								<datalist id="listeth">
									@foreach ($listeth as $list) 
									<option value="{{ $list }}">						 
									@endforeach
								</datalist>					
							</div>
						</div>
						<div class="form-group row">
							{!! Form::label('tameio_aeroporia', 'Ταμειο Αεροπ.:',['class'=>'col-sm-3 input-group-sm']) !!}
							<div class="col-sm-5">
								{!! Form::radio('tameio_aeroporia', 'ΝΑΙ') !!} ΝΑΙ &nbsp;
								{!! Form::radio('tameio_aeroporia', 'ΟΧΙ') !!} ΟΧΙ
							</div>
						</div>
						<div class="form-group row">
							{!! Form::label('history', 'Ιστορικό:',['class'=>'col-sm-2 input-group-sm']) !!}
							<div class="col-sm-10">
							  <div class="input-group input-group-sm">
								<input id="tagsistoriko" name="tagsistoriko" class="form-control input-sm">
									<span class="input-group-btn">
									  <button type="button" id="categorybtn" class="btn btn-info btn-flat" onClick="addtext('tagsistoriko', 'history', '100');">ADD</button>
									</span>
							  </div>
							{!! Form::textarea('history',null,['class'=>'form-control', 'rows'=>6]) !!}
							</div>
						</div>
						<div class="form-group row">
							{!! Form::label('history_drug', 'Drug History - Drug Allergy:',['class'=>'col-sm-2 input-group-sm']) !!}
							<div class="col-sm-10">
							  <div class="input-group input-group-sm">
								<input id="tagsistorikoDrug" name="tagsistorikoDrug" class="form-control input-sm">
									<span class="input-group-btn">
									  <button type="button" id="categorybtn" class="btn btn-info btn-flat" onClick="addtext('tagsistorikoDrug', 'history_drug', '101');">ADD</button>
									</span>
							  </div>
							{!! Form::textarea('history_drug',null,['class'=>'form-control', 'rows'=>6]) !!}
							</div>
						</div>
						<div class="form-group row">
							{!! Form::label('comments', 'Παρατηρήσεις:',['class'=>'col-sm-2 input-group-sm']) !!}
							<div class="col-sm-10">
							{!! Form::textarea('comments',null,['class'=>'form-control', 'rows'=>3]) !!}
							</div>
						</div>
					</div>


				</div>
                <div class="box-footer">
                    {!! Form::submit('Αποθήκευση', ['class' => 'btn btn-primary']) !!}
                    <a href="{{url('/patients')}}" class="btn btn-danger">Άκυρο</a>
                </div>
                {!! Form::close() !!}
			</div>


@stop

@section('css')
    <link rel="stylesheet" href="../css/admin_custom.css">
  <!-- DataTables 
  <link rel="stylesheet" href="../../plugins/datatables/dataTables.bootstrap.css">
  -->
  <link href="../css/jquery-ui.css" rel="stylesheet" type="text/css" />
@stop

@section('js')
    <script> console.log('Hi!'); </script>
	<script src="../vendor/tinymce/jquery.tinymce.min.js"></script>
	<script src="../js/jquery/jquery-ui.js"></script>
	<script src="../vendor/tinymce/tinymce.min.js"></script>
	<script src="../js/myfunctions.js"></script>
	<script>
				tinymce.init({selector:"textarea",
				menubar : false,
				language : "el",
				entity_encoding : "raw",
				statusbar : false,
				content_css : "../css/custom_content_tinymce.css"
				});
	</script>
    <script>$(function() {var availableTags = [ @foreach ($listHistory as $list) "{{ $list }}", @endforeach ""];$( "#tagsistoriko" ).autocomplete({
		  source: availableTags
			});
		});
	</script>
    <script>$(function() {var availableTags = [ @foreach ($listHistoryDrug as $list) "{{ $list }}", @endforeach ""];$( "#tagsistorikoDrug" ).autocomplete({
		  source: availableTags
			});
		});
	</script>
@stop