@include('includes/header_start')

@include('billers/elements/header_end')
<style type="text/css" media="print">
    @page
    {
        size: auto;   /* auto is the initial value */
        margin: 0mm;  /* this affects the margin in the printer settings */
    }
</style>
<!-- Page title -->
<ul class="list-inline menu-left mb-0">
    <li class="list-inline-item">
        <button type="button" class="button-menu-mobile open-left waves-effect">
            <i class="ion-navicon"></i>
        </button>
    </li>
    <li class="hide-phone list-inline-item app-search">
        <h3 class="page-title">Invoice</h3>
    </li>
</ul>

<div class="clearfix"></div>
</nav>

</div>
<!-- Top Bar End -->

<!-- ==================
     PAGE CONTENT START
     ================== -->

<div class="page-content-wrapper">

    <div class="container-fluid">

        <div class="row">
            <div class="col-12">
                <div class="card m-b-20">
                    <div class="card-body">

                        <div class="row">
                            <div class="col-12">
                                <div class="invoice-title">
{{--                                    <h4 class="pull-right font-16"><strong>Order # 12345</strong></h4>--}}
                                    <div class="row">
                                        <div class="mt-0 col-lg-6">
    {{--                                        <img src="assets/images/logo_dark.png" alt="logo" height="26"/>--}}
                                            <img src="{{ asset('assets/images/h3a-logo-bg.jpg') }}"alt="logo" style="width:200px;">
                                        </div>
                                        <div class="col-lg-6">
                                            <h1 class="m-0 pull-right" style="">Total: {{ "$".$bill->amount_billed }}</h1>
                                        </div>
                                    </div>
                                </div>
                                <hr>
                                <div class="row">
                                    <div class="col-6">
                                        <address>
                                            <strong>Payee Details:</strong><br>
                                            {{ $bill->payee_name }}<br>
                                            {{ $bill->payee_address1 }}<br>
                                            {{ $bill->payee_city }}<br>
                                            {{ $bill->payee_state }}<br>
                                            {{ $bill->payee_zipcode }}<br>
                                            {{ $bill->payee_tel }}
                                        </address>
                                    </div>
                                    <div class="col-6 text-right">
                                        <address>
                                            <strong>Payment Method:</strong><br>
                                            Bank Account Name<br>
                                            {{ $bill->bank_account_name }}<br>
                                            Bank Account Number<br>
                                            {{ $bill->bank_account_number }}
                                        </address>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-12 m-t-30 text-right">
                                        <address>
                                            <strong>Bill Created:</strong><br>
                                            {{ date('jS M Y', strtotime($bill->created_at)) }}<br><br>
                                        </address>
                                    </div>
                                </div>
                            </div>
                        </div>

                        <div class="row">
                            <div class="col-12">
                                <div class="panel panel-default">
                                    <div class="p-2">
                                        <h3 class="panel-title font-20"><strong>Bill Items</strong></h3>
                                    </div>
                                    <div class="">
                                        <div class="table-responsive">
                                            <table class="table m-t-20 mb-0 table-vertical">
                                                <tbody>
                                                @if($bill->items !== NULL)
                                                    @foreach($billItems as $item)
                                                        @foreach($item->codes as $code)
                                                            <tr>
                                                                <td>{{ $code->category }}
                                                                    <p class="m-0 text-muted font-14">Category</p>
                                                                </td>
                                                                <td>{{ $code->cpt_code }}
                                                                    <p class="m-0 text-muted font-14">Code</p>
                                                                </td>
                                                                <td>{{ $code->cpt_description }}
                                                                    <p class="m-0 text-muted font-14">Description</p>
                                                                </td>
                                                            </tr>
                                                        @endforeach
                                                    @endforeach
                                                @else
                                                    <span class="alert alert-success text-center">you have no outstanding bills</span>
                                                @endif
                                                </tbody>
                                            </table>
                                        </div>
                                    </div>
                                </div>
                            </div>
                        </div>

                        <div class="row">
                            <div class="col-12">
                                <div class="panel panel-default">
                                    <div class="p-2">
                                        <h3 class="panel-title font-20"><strong>Physician Comments</strong></h3>
                                    </div>
                                    <div class="">
                                        <div class="table-responsive">
                                            <table class="table">
                                                <thead>
                                                <tr>
                                                    <td><strong>Form</strong></td>
                                                    <td class="text-center"><strong>Physician Comments</strong></td>
                                                    <td class="text-center"><strong></strong></td>
                                                    <td class="text-center"><strong></strong></td>
                                                </tr>
                                                </thead>
                                                <tbody>
                                                <tr>
                                                    <td>General Comments</td>
                                                    <td class="text-center">{!! $bill->general['physician_comments'] !!}  </td>
                                                    <td class="text-center"></td>
                                                    <td class="text-center"></td>
                                                </tr>
                                                <tr>
                                                    <td>Cardiac Comments</td>
                                                    <td class="text-center">{!! $bill->cardiac['physician_comments'] !!}  </td>
                                                    <td class="text-center"></td>
                                                    <td class="text-center"></td>
                                                </tr>
                                                <tr>
                                                    <td>Endocrine Comments</td>
                                                    <td class="text-center">{!! $bill->endocrine['physician_comments'] !!}  </td>
                                                    <td class="text-center"></td>
                                                    <td class="text-center"></td>
                                                </tr>
                                                <tr>
                                                    <td>Gastrointestinal Comments</td>
                                                    <td class="text-center">{!! $bill->gastrointestinal['physician_comments'] !!}  </td>
                                                    <td class="text-center"></td>
                                                    <td class="text-center"></td>
                                                </tr>
                                                <tr>
                                                    <td>Miscellaneous Comments</td>
                                                    <td class="text-center">{!! $bill->misc['physician_comments'] !!}  </td>
                                                    <td class="text-center"></td>
                                                    <td class="text-center"></td>
                                                </tr>
                                                <tr>
                                                    <td>Neurological Comments</td>
                                                    <td class="text-center">{!! $bill->neurological['physician_comments'] !!}  </td>
                                                    <td class="text-center"></td>
                                                    <td class="text-center"></td>
                                                </tr>
                                                <tr>
                                                    <td>Pulmonary Comments</td>
                                                    <td class="text-center">{!! $bill->pulmonary['physician_comments'] !!}  </td>
                                                    <td class="text-center"></td>
                                                    <td class="text-center"></td>
                                                </tr>
                                                <tr>
                                                    <td>Renal Comments</td>
                                                    <td class="text-center">{!! $bill->renal['physician_comments'] !!}  </td>
                                                    <td class="text-center"></td>
                                                    <td class="text-center"></td>
                                                </tr>
                                                <tr>
                                                    <td class="no-line"></td>
                                                    <td class="no-line"></td>
                                                    <td class="no-line pull-right">
                                                        <strong>Total</strong></td>
                                                    <td class="no-line text-right"><h4 class="m-0">{{ "$".$bill->amount_billed }}</h4></td>
                                                </tr>
                                                </tbody>
                                            </table>
                                        </div>

                                        <div class="d-print-none">
                                            <div class="pull-right">
                                                <a href="javascript:window.print()" class="btn btn-success waves-effect waves-light"><i class="fa fa-print"></i></a>
                                                <a href="#" class="btn btn-primary waves-effect waves-light">Send</a>
                                            </div>
                                        </div>
                                    </div>
                                </div>

                            </div>
                        </div> <!-- end row -->

                    </div>
                </div>
            </div> <!-- end col -->
        </div> <!-- end row -->


    </div><!-- container -->

</div> <!-- Page content Wrapper -->

</div> <!-- content -->

@include('includes/footer_start')

@include('includes/footer_end')