@extends('layouts.main') @push('styles') @endpush @section('content')

{{ __('insurance_members.edit_insurance_details_for') }} ({!! insurance_flag($insurance_member->patient_id) !!})

@include('flash::message') @include('insurance::insurance_members.menu') {{ Form::model($insurance_member, ['method' => 'PUT', 'route' => ['insurance_members.update',$insurance_member], 'files' => 'required']) }}
{{ Form::label('duplicate_research_id', __('insurance.research_id')) }} {{ Form::text('duplicate_research_id', $insurance_member->research_id, ['class' => 'form-control']) }} @if (!empty($errors->get('duplicate_research_id')))
@foreach ($errors->get('duplicate_research_id') as $message) {{ $message }} @endforeach
@endif
{{ Form::label('is_family_head',__('insurance_members.is_member_head_of_family')) }}
{{ Form::radio('is_family_head', 1, $insurance_member->is_family_head == 1, ["required",'onclick'=>'displayFamilies(1)']) }} Yes    {{ Form::radio('is_family_head', 0, $insurance_member->is_family_head == 0, ["required",'onclick'=>'displayFamilies(0)']) }} No
is_family_head == 1) style="display: none" @endif> {{ Form::label('family_id', __('insurance_members.select_family')) }} {{ Form::select('family_id', $families, $insurance_member->family_id, ['class' => 'form-control compulsory family_id']) }}
{{ Form::label('relationship_to_head', __('insurance_members.relationship_to_head')) }} {{ Form::select('relationship_to_head', $relations, $insurance_member->relationship_to_head, ['class' => 'form-control compulsory']) }}
{{ Form::label('group_id', __('insurance_members.insurance_group')) }} {{ Form::select('group_id', $insurance_groups, $insurance_member->group_id, ['class' => 'form-control compulsory', 'required', 'id' => 'group_id']) }}
{{ Form::label('chi_plan', __('insurance.chi_plan')) }} {{ Form::select('chi_plan', $chi_plans, $insurance_member->chi_plan, ['class' => 'form-control compulsory', 'required', 'id' => 'chi_plan']) }}
{{--
{{ Form::label('other_plan', __('insurance.other_plan')) }} {{ Form::select('other_plan', $chi_plans, $insurance_member->other_plan, ['class' => 'form-control']) }}
--}}
{{ Form::label('risk_id',__('insurance.risk')) }} @php $risk_ids_array = is_null($insurance_member->risk_ids) ? [] : explode(",", $insurance_member->risk_ids); @endphp {{ Form::select('risk_id[]', $chi_risks, $risk_ids_array,['class' => 'form-control compulsory risk_id', 'data-error'=>'Select the risk', 'required', 'multiple']) }}
{{ Form::label('member_premium', __('insurance.member_premium')) }} {{ Form::text('member_premium', $insurance_member->premium, ['class' => 'form-control compulsory', 'required']) }}
@if( Auth::user()->can('register-chi-members-with-pre-existing-premiums'))
{{ Form::label('does_member_have_existing_premium',__('insurance_members.does_member_have_existing_premium')) }}
{{ Form::radio('does_member_have_existing_premium', 1, false, ["required",'onclick'=>'displayPremiumActiveDateDiv(1)']) }} {{ __('insurance_members.yes') }}    {{ Form::radio('does_member_have_existing_premium', 0, true, ["required",'onclick'=>'displayPremiumActiveDateDiv(0)']) }} {{ __('insurance_members.no') }}
@endif
{{ Form::label('title', __('insurance.title')) }} {{ Form::select('title', $person_titles, $insurance_member->title, ['class' => 'form-control compulsory', 'required']) }}
{{ Form::label('photo',__('insurance_members.photo')) }} {{ Form::file('photo',['class' => 'form-control']) }}
{{ Form::label('membership_start_date', __('insurance.membership_start_date')) }}
{{ Form::text('membership_start_date',$insurance_member->membership_start_date,['class' => 'form-control','readonly','id'=>'membership_start_date']) }}
{{ Form::label('membership_registration_date', __('insurance.membership_registration_date')) }}
{{ Form::text('membership_registration_date',$insurance_member->membership_registration_date,['class' => 'form-control','readonly','id'=>'membership_registration_date']) }}
{{ Form::label('social_security_number', __('insurance.social_security_number')) }} {{ Form::text('social_security_number', $insurance_member->social_security_number, ['class' => 'form-control']) }}
{{ Form::label('research_id', __('insurance.research_id')) }} {{ Form::text('research_id', $insurance_member->research_id, ['class' => 'form-control']) }} @if (!empty($errors->get('research_id')))
@foreach ($errors->get('research_id') as $message) {{ $message }} @endforeach
@endif
{{ Form::label('next_anniversary_date', __('insurance.next_anniversary_date_bracket_moved_with_rollover')) }}
{{ Form::text('next_anniversary_date', $insurance_member->next_anniversary_date,['class' => 'form-control','readonly','id'=>'next_anniversary_date']) }}
{{ Form::button(__('insurance_members.submit'),['type'=>'submit','class'=>'btn btn-success waves-effect waves-light m-r-10']) }} {{ Form::button(__('insurance_members.cancel'),['type'=>'reset','class'=>'btn btn-default waves-effect waves-light']) }}
{{ Form::close() }} @endsection @push('scripts') @endpush