@extends('backend.layouts.main')

@section('title', 'MLI ATS | Joint Providers')

@section('content')
    <div class="container px-6 mx-auto grid">
        @include('backend.share.title', ['title' => 'Manage Joint Providers'])
        <div class="md:flex flex-none">
            <div class="px-3 py-3 mb-2 mr-3 bg-white rounded-lg shadow-md w-full lg:w-1/4">
                <div class="p-3">
                    <form method="POST" action="{{ route('admin.joint-providers.store') }}">
                        @csrf
                        <h3 class="font-semibold text-slate-500 border-b border-gray-200 mb-2">Add Joint Provider</h3>
                        <div class="block text-sm mt-3">
                            <span class="text-slate-500">Provider Name</span>
                            <input
                                class="mt-1 px-3 py-2 placeholder-slate-300 text-slate-600 relative bg-white rounded text-sm border border-slate-300 outline-none focus:outline-none focus:ring w-full"
                                name="name" placeholder="Ex. A Better Life Recovey, LLC" value="{{ old('name') }}"
                                required />
                        </div>
                        @error('name')
                            @include('backend.share.error-message', ['message' => $message])
                        @enderror

                        <div class="block text-sm mt-3">
                            <span class="text-slate-500">Provider Code</span>
                            <input
                                class="mt-1 px-3 py-2 placeholder-slate-300 text-slate-600 relative bg-white rounded text-sm border border-slate-300 outline-none focus:outline-none focus:ring w-full"
                                name="jp_code" placeholder="Ex. ABLR" value="{{ old('jp_code') }}" required />
                        </div>
                        @error('jp_code')
                            @include('backend.share.error-message', ['message' => $message])
                        @enderror

                        <div class="block text-sm mt-3">
                            <span class="text-slate-500">Address: 1</span>
                            <input
                                class="mt-1 px-3 py-2 placeholder-slate-300 text-slate-600 relative bg-white rounded text-sm border border-slate-300 outline-none focus:outline-none focus:ring w-full"
                                name="address1" placeholder="Ex. 30310 Rancho Viejo Road" value="{{ old('address1') }}"
                                required />
                        </div>
                        @error('address1')
                            @include('backend.share.error-message', ['message' => $message])
                        @enderror

                        <div class="block text-sm mt-3">
                            <span class="text-slate-500">Address: 2</span>
                            <input
                                class="mt-1 px-3 py-2 placeholder-slate-300 text-slate-600 relative bg-white rounded text-sm border border-slate-300 outline-none focus:outline-none focus:ring w-full"
                                name="address2" placeholder="Ex. 30310 Rancho Viejo Road" value="{{ old('address2') }}" />
                        </div>
                        @error('address2')
                            @include('backend.share.error-message', ['message' => $message])
                        @enderror

                        <div class="block text-sm mt-3">
                            <span class="text-slate-500">City</span>
                            <input
                                class="mt-1 px-3 py-2 placeholder-slate-300 text-slate-600 relative bg-white rounded text-sm border border-slate-300 outline-none focus:outline-none focus:ring w-full"
                                name="city" placeholder="Ex. San Juan Capistrano" value="{{ old('city') }}" required />
                        </div>
                        @error('city')
                            @include('backend.share.error-message', ['message' => $message])
                        @enderror

                        <div class="block text-sm mt-3">
                            <span class="text-slate-500">State</span>
                            <input
                                class="mt-1 px-3 py-2 placeholder-slate-300 text-slate-600 relative bg-white rounded text-sm border border-slate-300 outline-none focus:outline-none focus:ring w-full"
                                name="state" placeholder="Ex. CA" value="{{ old('state') }}" />
                        </div>
                        @error('state')
                            @include('backend.share.error-message', ['message' => $message])
                        @enderror

                        <div class="block text-sm mt-3">
                            <span class="text-slate-500">Zip</span>
                            <input
                                class="mt-1 px-3 py-2 placeholder-slate-300 text-slate-600 relative bg-white rounded text-sm border border-slate-300 outline-none focus:outline-none focus:ring w-full"
                                name="zip" placeholder="Ex. 92675" value="{{ old('zip') }}" />
                        </div>
                        @error('zip')
                            @include('backend.share.error-message', ['message' => $message])
                        @enderror

                        <div class="block mt-10 text-sm">
                            @include('backend.share.add-button', ['name' => 'Add'])
                        </div>
                    </form>
                </div>
            </div>
            <div class="px-3 py-3 mb-2 mr-3 bg-white rounded-lg shadow-md w-full lg:w-3/4">
                @include('backend.joint-provider.items.list', ['jointProviders' => $jointProviders])
            </div>
        </div>
    </div>
@endsection