@include('includes/header_start')

<!-- Plugins css -->
<link href="{{ asset('assets/plugins/bootstrap-colorpicker/css/bootstrap-colorpicker.min.css') }}" rel="stylesheet">
<link href="{{ asset('assets/plugins/bootstrap-datepicker/css/bootstrap-datepicker.min.css') }}" rel="stylesheet">
<link href="{{ asset('assets/plugins/select2/css/select2.min.css') }}" rel="stylesheet" type="text/css" />
<link href="{{ asset('assets/plugins/bootstrap-touchspin/css/jquery.bootstrap-touchspin.min.css') }}" rel="stylesheet" />

@include('physicians/elements/header_end')

                            <!-- 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">Edit Profile</h3>
                                </li>
                            </ul>

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

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

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

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


                        <div class="row">
                            <div class="col-md-10 offset-md-1">
                                <div class="card m-b-20">
                                    <h4 class="card-header mt-0">Edit Profile</h4>
                                    <div class="card-body">

{{--                                        @include('patients.medications.elements.form')--}}

                                        <form action="{{ isset($id) ?  route('profile.edit.physician.store', ['id' => $id]) :  route('profile.edit.physician.store') }} " method="POST" enctype="multipart/form-data" autocomplete="off">
                                            @csrf

                                            <div class="row">
                                                <div class="col-md-6">

                                                    <div class="form-group">
                                                        <label>First Name</label>
                                                        <input type="text" class="form-control" name="first_name" value="{{ old('first_name', $profile->first_name) }}">

                                                        @if ($errors->has('first_name'))
                                                            <span class="badge badge-danger">{{ $errors->first('first_name') }}</span>
                                                        @endif

                                                    </div>

                                                </div>
                                                <div class="col-md-6">

                                                    <div class="form-group">
                                                        <label>Last Name</label>
                                                        <input type="text" class="form-control" name="last_name" value="{{ old('last_name', $profile->last_name) }}">

                                                        @if ($errors->has('last_name'))
                                                            <span class="badge badge-danger">{{ $errors->first('last_name') }}</span>
                                                        @endif

                                                    </div>

                                                </div>
                                            </div>

                                            <div class="row">
                                                <div class="col-md-6">

                                                    <div class="form-group">
                                                        <label>Address1</label>
                                                        <input type="text" class="form-control" name="address1" value="{{ old('address1', $profile->address1) }}">

                                                        @if ($errors->has('address1'))
                                                            <span class="badge badge-danger">{{ $errors->first('address1') }}</span>
                                                        @endif

                                                    </div>

                                                </div>
                                                <div class="col-md-6">

                                                    <div class="form-group">
                                                        <label>City</label>
                                                        <input type="text" class="form-control" name="city" value="{{ old('city', $profile->city) }}">

                                                        @if ($errors->has('city'))
                                                            <span class="badge badge-danger">{{ $errors->first('city') }}</span>
                                                        @endif

                                                    </div>

                                                </div>
                                            </div>

                                            <div class="row">
                                                <div class="col-md-6">

                                                    <div class="form-group">
                                                        <label>State</label>
                                                        <input type="text" class="form-control" name="state" value="{{ old('state', $profile->state) }}">

                                                        @if ($errors->has('state'))
                                                            <span class="badge badge-danger">{{ $errors->first('state') }}</span>
                                                        @endif

                                                    </div>

                                                </div>
                                                <div class="col-md-6">

                                                    <div class="form-group">
                                                        <label>Zipcode</label>
                                                        <input type="text" class="form-control" name="zip_code" value="{{ old('zip_code', $profile->zip_code) }}">

                                                        @if ($errors->has('zip_code'))
                                                            <span class="badge badge-danger">{{ $errors->first('zip_code') }}</span>
                                                        @endif

                                                    </div>

                                                </div>
                                            </div>

                                            <div class="form-group">
                                                <label for="exampleInputFile">Profile Image</label>
                                                <input type="file" id="exampleInputFile" name="image">
                                                <input type="hidden" class="form-control" name="old_image" value="{{ old('image', $profile->image) }}">

                                            </div>

                                            <div class="row">
                                                <div class="col-md-12">
                                                    <button type="submit" class="btn btn-primary btn-flat pull-right">Submit</button>
                                                </div>
                                            </div>

                                        </form>

                                        <form action="{{route('profile.edit.physician.store.password') }} " method="POST" enctype="multipart/form-data" autocomplete="off">
                                            @csrf
                                            @include('auth.elements.update-password')
                                        </form>


                                    </div>
                                </div>
                            </div>
                        </div>

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


@include('includes/footer_start')

<script src="{{ asset('assets/plugins/bootstrap-filestyle/js/bootstrap-filestyle.min.js') }}" type="text/javascript"></script>
<!-- Plugins Init js -->
<script src="{{ asset('assets/pages/form-advanced.js') }}"></script>

@include('includes/footer_end')