@extends('backend.layouts.main')

@section('title', 'MLI ATS | Joint Provider Contacts')

@section('content')
    <div class="container px-6 mx-auto grid">
        @include('backend.share.title', ['title' => 'Manage Joint Provider Contacts'])
        <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-provider-contacts.store') }}">
                        @csrf
                        <h3 class="font-semibold text-slate-500 border-b border-gray-200 mb-2">Add Joint Provider Contact
                        </h3>
                        <div class="block text-sm mt-3">
                            <span class="text-slate-500">Select Joint Provider</span>
                            <select
                                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_id" required>
                                <option value="">Please Select</option>
                                @foreach ($jointProviders as $jointProvider)
                                    <option value="{{ $jointProvider->id }}"
                                        {{ old('jp_id') == $jointProvider->id ? 'selected' : '' }}>
                                        {{ $jointProvider->name }}</option>
                                @endforeach
                            </select>
                        </div>
                        @error('jp_id')
                            @include('backend.share.error-message', ['message' => $message])
                        @enderror

                        <div class="block text-sm mt-3">
                            <span class="text-slate-500">Contact 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="contact_name" placeholder="Ex. Lauren Berger" value="{{ old('contact_name') }}"
                                required />
                        </div>
                        @error('contact_name')
                            @include('backend.share.error-message', ['message' => $message])
                        @enderror

                        <div class="block text-sm mt-3">
                            <span class="text-slate-500">Contact Email</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="contact_email" placeholder="Ex. lauren.berger@lls.org"
                                value="{{ old('contact_email') }}" required />
                        </div>
                        @error('contact_email')
                            @include('backend.share.error-message', ['message' => $message])
                        @enderror

                        <div class="block text-sm mt-3">
                            <span class="text-slate-500">Telephone</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="telephone1" placeholder="Ex. (914) 821 - 8750" value="{{ old('telephone1') }}" />
                        </div>
                        @error('telephone1')
                            @include('backend.share.error-message', ['message' => $message])
                        @enderror

                        <div class="block text-sm mt-3">
                            <span class="text-slate-500">Mobile</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="telephone2" placeholder="Ex. (914) 821 - 8750" value="{{ old('telephone2') }}" />
                        </div>
                        @error('telephone2')
                            @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.jp-contact.items.list', ['jpContacts' => $jpContacts])
            </div>
        </div>
    </div>
@endsection