streamline-emr/docker/streamline-src/Modules/Insurance/Resources/views/insurance_members/edit.blade.php

@extends('layouts.main')

@push('styles')
    <link href="{{ asset('elite/bower_components/select2/select2.min.css') }}" rel="stylesheet" />
    <link href="{{ asset('elite/bower_components/icheck/skins/all.css') }}" rel="stylesheet">
    <link href="{{ asset('elite/bower_components/bootstrap-datepicker/bootstrap-datepicker.min.css') }}" rel="stylesheet" type="text/css"/>
@endpush

@section('content')

    <div class="row bg-title">
        <div class="col-md-6">
            <h4 class="page-title">{{ __('insurance_members.edit_insurance_details_for') }} ({!! insurance_flag($insurance_member->patient_id) !!})</h4>
        </div>
        <div class="col-md-6">
            <ol class="breadcrumb">
                <li><a href="{{ route('home') }}">{{ __('insurance_members.dashboard') }}</a></li>
                <li><a href="/insurance/scheme_administration">{{ __('insurance.scheme_administration') }}</a></li>
                <li><a href="/insurance_members/">{{ __('insurance_members.insurance_members') }}</a></li>
                <li class="active">{{ __('insurance_members.edit') }}</li>
            </ol>
        </div>
    </div>

    @include('flash::message')

    @include('insurance::insurance_members.menu')

    {{ Form::model($insurance_member, ['method' => 'PUT', 'route' => ['insurance_members.update',$insurance_member], 'files' => 'required']) }}

    <div class="white-box">
        <div class="row">
            <div class="col-md-6">
                <div class="form-group">
                    {{ 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')))
                        <div class="help-block with-errors alert alert-danger">
                            @foreach ($errors->get('duplicate_research_id') as $message)
                                {{ $message }}
                            @endforeach
                        </div>
                    @endif
                </div>

                <div class="form-group">
                    {{ Form::label('is_family_head',__('insurance_members.is_member_head_of_family')) }}
                    <br>
                    {{ Form::radio('is_family_head', 1, $insurance_member->is_family_head == 1, ["required",'onclick'=>'displayFamilies(1)']) }} Yes &nbsp;&nbsp;
                    {{ Form::radio('is_family_head', 0, $insurance_member->is_family_head == 0, ["required",'onclick'=>'displayFamilies(0)']) }} No
                </div>

                <div class="form-group family_div" @if($insurance_member->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']) }}
                </div>

                <div class="form-group">
                    {{ 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']) }}
                </div>

                <div class="form-group">
                    {{ 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']) }}
                </div>

                <div class="form-group">
                    {{ 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']) }}
                </div>

                {{-- <div class="form-group">
                    {{ Form::label('other_plan', __('insurance.other_plan')) }}
                    {{ Form::select('other_plan', $chi_plans, $insurance_member->other_plan, ['class' => 'form-control']) }}
                </div> --}}

                <div class="form-group">
                    {{ 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']) }}
                    <div class="help-block with-errors"></div>
                </div>

                <div class="form-group">
                    {{ Form::label('member_premium', __('insurance.member_premium')) }}
                    {{ Form::text('member_premium', $insurance_member->premium, ['class' => 'form-control compulsory', 'required']) }}
                </div>

                @if( Auth::user()->can('register-chi-members-with-pre-existing-premiums'))
                    <div class="form-group">
                        {{ Form::label('does_member_have_existing_premium',__('insurance_members.does_member_have_existing_premium')) }}
                        <br>
                        {{ Form::radio('does_member_have_existing_premium', 1, false, ["required",'onclick'=>'displayPremiumActiveDateDiv(1)']) }} {{ __('insurance_members.yes') }} &nbsp;&nbsp;
                        {{ Form::radio('does_member_have_existing_premium', 0, true, ["required",'onclick'=>'displayPremiumActiveDateDiv(0)']) }} {{ __('insurance_members.no') }}
                    </div>

                    <div class="existing_premiums_dates_div" style="display: none">
                        <div class="form-group">
                            {{ Form::label('existing_premium_start_date', __('insurance_members.existing_premium_start_date')) }}
                            <div class="input-group">
                                {{ Form::text('existing_premium_start_date',$insurance_member->existing_premium_start_date,['class' => 'form-control','readonly','id'=>'existing_premium_start_date']) }}
                                <span class="input-group-addon"><i class="icon-calender"></i></span>
                            </div>
                            <div class="help-block with-errors"></div>
                        </div>

                        <div class="form-group">
                            {{ Form::label('existing_premium_end_date', __('insurance_members.existing_premium_end_date')) }}
                            <div class="input-group">
                                {{ Form::text('existing_premium_end_date', $insurance_member->existing_premium_end_date,['class' => 'form-control','readonly','id'=>'existing_premium_end_date']) }}
                                <span class="input-group-addon"><i class="icon-calender"></i></span>
                            </div>
                            <div class="help-block with-errors"></div>
                        </div>
                    </div>
                @endif
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    {{ Form::label('title', __('insurance.title')) }}
                    {{ Form::select('title', $person_titles, $insurance_member->title, ['class' => 'form-control compulsory', 'required']) }}
                </div>

                <div class="form-group">
                    {{ Form::label('photo',__('insurance_members.photo')) }}
                    {{ Form::file('photo',['class' => 'form-control']) }}
                </div>

                <div class="form-group">
                    {{ Form::label('membership_start_date', __('insurance.membership_start_date')) }}
                    <div class="input-group">
                        {{ Form::text('membership_start_date',$insurance_member->membership_start_date,['class' => 'form-control','readonly','id'=>'membership_start_date']) }}
                        <span class="input-group-addon"><i class="icon-calender"></i></span>
                    </div>
                    <div class="help-block with-errors"></div>
                </div>

                <div class="form-group">
                    {{ Form::label('membership_registration_date', __('insurance.membership_registration_date')) }}
                    <div class="input-group">
                        {{ Form::text('membership_registration_date',$insurance_member->membership_registration_date,['class' => 'form-control','readonly','id'=>'membership_registration_date']) }}
                        <span class="input-group-addon"><i class="icon-calender"></i></span>
                    </div>
                    <div class="help-block with-errors"></div>
                </div>

                <div class="form-group">
                    {{ Form::label('social_security_number', __('insurance.social_security_number')) }}
                    {{ Form::text('social_security_number', $insurance_member->social_security_number, ['class' => 'form-control']) }}
                </div>

                <div class="form-group">
                    {{ Form::label('research_id', __('insurance.research_id')) }}
                    {{ Form::text('research_id',  $insurance_member->research_id, ['class' => 'form-control']) }}
                    @if (!empty($errors->get('research_id')))
                        <div class="help-block with-errors alert alert-danger">
                            @foreach ($errors->get('research_id') as $message)
                                {{ $message }}
                            @endforeach
                        </div>
                    @endif
                </div>

                <div class="form-group">
                    {{ Form::label('next_anniversary_date', __('insurance.next_anniversary_date_bracket_moved_with_rollover')) }}
                    <div class="input-group">
                        {{ Form::text('next_anniversary_date', $insurance_member->next_anniversary_date,['class' => 'form-control','readonly','id'=>'next_anniversary_date']) }}
                        <span class="input-group-addon"><i class="icon-calender"></i></span>
                    </div>
                    <div class="help-block with-errors"></div>
                </div>
            </div>
        </div>

        {{ 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']) }}
    </div>

    {{ Form::close() }}
@endsection

@push('scripts')
    <script src="{{ asset('elite/bower_components/select2/select2.min.js') }}"></script>
    <script src="{{ asset('elite/bower_components/bootstrap-datepicker/bootstrap-datepicker.min.js') }}"></script>

    <script>
        $(document).ready(function() {
            $('#membership_start_date,#membership_registration_date,#next_anniversary_date,#existing_premium_start_date,#existing_premium_end_date').datepicker({
                autoclose: true,
                todayHighlight: true,
                format: 'yyyy-mm-dd',

            });

            $('.family_id').change(function(){
                let family_id = $(this).val();

                $.ajax({
                    method: 'GET',
                    url: '/get_family_group_id/' + family_id,
                    success: function(response){
                        $('#group_id').val(response).attr("selected","selected");
                    },
                    error: function (error) {
                        console.log(error);
                    }
                });
            });

            $('.risk_id,.family_id').select2({
                placeholder: "Select",
                width: "100%"
            });
        });

        function displayPremiumActiveDateDiv(option){
            if (option == 0){
                document.querySelector(".existing_premiums_dates_div").style.display = "none";
            } else {
                document.querySelector(".existing_premiums_dates_div").style.display = "block";
            }
        }

        function displayFamilies(option){
            if (option == 0) {
                $('.family_div').show();
            } else {
                $('.family_div').hide();
            }
        }
    </script>
@endpush