@extends('layouts.buddy-screens')
@section('content')
<!-- bank partner logo css -->
{{-- <link rel="stylesheet" href="{{asset('assets/dashboard/assets/css/demo_logo.css')}}" /> --}}
		<!-- Content wrapper -->
          <div class="content-wrapper">
            <!-- Content -->

            <div class="container-xxl flex-grow-1 container-p-y">
              <h4 class="fw-bold py-3 mb-4"><span class="text-muted fw-light">Dashboard /</span><span class="text-muted fw-light"> Insurance /</span> Health Insurance</h4>
              @if ($message = Session::get('successHealth_Insurance'))
			<!--<div class="alert alert-success alert-dismissable custom-success-box">
				 <a href="#" class="close" data-dismiss="alert" aria-label="close">&times;</a>
				 {{-- <strong> {{session('success')}} </strong> --}}
			  </div>-->
        <div class="modal" id="smallModal_homeloan" tabindex="-1" aria-hidden="true" style="display:block">
          <div class="modal-dialog" role="document">
            <div class="modal-content">
              <div class="modal-header">
                <h5 class="modal-title" id="exampleModalLabel2">Success</h5>
                <button
                  type="button"
                  class="btn-close"
                  data-bs-dismiss="modal"
                  aria-label="Close"
                  onclick="hide()"
                ></button>
              </div>
              <div class="modal-body" id="body_msg">
              <p>Your query has been raised. We shall get back to you shortly, Thank You.<br> In the meanwhile, you may go through the other products and services available on the platform</p>
              </div>
              <div class="modal-footer">
                {{-- <button type="button" onclick="hide()" class="btn btn-outline-secondary" data-bs-dismiss="modal">
                  Close
                </button> --}}
                <button type="button" onclick="hide()" class="btn btn-primary" data-bs-dismiss="modal">Ok</button>
              </div>
            </div>
          </div>
        </div>
			@endif
			  <!-- Horizontal -->
             <div class="col-lg-12">

                  <div class="nav-align-top mb-4">
                    <ul class="nav nav-pills mb-3 nav-fill" role="tablist">
                      <li class="nav-item">
                        <a
                          href="{{ url('insurance/health_insurance') }}"
                          class="nav-link"
                        >
                          <i class="tf-icons bx bx-home"></i> About Health Insurance 

                        </a>
                      </li>
                      <li class="nav-item">
                        <a
                          href="{{ url('insurance/health_insurance_enquiry') }}"
                          class="nav-link active"
                        >
                          <i class="tf-icons bx bx-user"></i> Generate Enquiry
                        </a>
                      </li>
                      
                    </ul>
                    <div class="tab-content">

                      <div class="tab-pane fade  show active" id="navs-pills-justified-profile" role="tabpanel">
                            <div class="card-body">

                      <form action="{{ url('insurance/health_generateenquery') }}" method="post">
					  @csrf
					  <input type="hidden" class="form-control"  name="userid" id="userid"  value="{{$user_details->id}}" />

                  @if(Auth::user()->role == 'dpuser')
					            <div class="row mb-3" style="display: none;">
                          <label class="col-sm-2 col-form-label" for="basic-default-name">Query For<sup style="color:red;">*</sup></label>
                          <div class="col-sm-10">
                            <select onchange="pmsQueryFornew()" name="query_for" class="form-select" id="query_for" aria-label="Default select example">

                            <option selected value="{{$user_details->id}}">Self </option>
                            @foreach($child_details as $child_detailss)

                              <option value="{{$child_detailss->id}}">{{$child_detailss->name}} {{$child_detailss->role}}</option>
                              @endforeach
                            </select>
                            @if($errors->has('query_for'))
                                <div class="error">{{ $errors->first('query_for') }}</div>
                            @endif
                          </div>
                      </div>
                  @else
                      <div class="row mb-3">
                        <label class="col-sm-2 col-form-label" for="basic-default-name">Query For<sup style="color:red;">*</sup></label>
                        <div class="col-sm-10">
                          <select onchange="pmsQueryFornew()" name="query_for" class="form-select" id="query_for" aria-label="Default select example">

                          <option selected value="{{$user_details->id}}">Self </option>
                          @foreach($child_details as $child_detailss)

                            <option value="{{$child_detailss->id}}">{{$child_detailss->name}} {{$child_detailss->role}}</option>
                            @endforeach
                          </select>
                          @if($errors->has('query_for'))
                              <div class="error">{{ $errors->first('query_for') }}</div>
                          @endif
                        </div>
                    </div>
                    @endif


                        <div class="row mb-3">
                          <label class="col-sm-2 col-form-label" for="basic-default-name">Full Name <sup style="color:red;">*</sup></label>
                          <div class="col-sm-10">
                            <input type="text" value="{{$user_details->name}} {{$user_details->last_name}}" name="full_name" class="form-control" id="full_name" placeholder="" />
							@if($errors->has('full_name'))
									<div class="error">{{ $errors->first('full_name') }}</div>
							@endif
						  </div>
                        </div>

                         <div class="row mb-3">
                          <label class="col-sm-2 col-form-label" for="basic-default-name">Email id <sup style="color:red;">*</sup> </label>
                          <div class="col-sm-10">
                            <input type="email" name="email" class="form-control" value="{{$user_details->email}}"  id="emailid" placeholder="" />
							@if($errors->has('email'))
									<div class="error">{{ $errors->first('email') }}</div>
							@endif
						  </div>
                        </div>

                        <div class="row mb-3">
                          <label class="col-sm-2 col-form-label" for="basic-default-phone">Contact No.<sup style="color:red;">*</sup></label>
                          <div class="col-sm-10">
                            <input
                              type="tel"
                              id="contact_no"
							  name="contact_no"
							  value="{{$user_details->phone}}"
                              class="form-control phone-mask"
                              placeholder=""
                            />
							@if($errors->has('contact_no'))
									<div class="error">{{ $errors->first('contact_no') }}</div>
							@endif
                          </div>
                        </div>
						
						<div class="row mb-3">
                          <label class="col-sm-2 col-form-label" for="basic-default-name">Pin Code<sup style="color:red;">*</sup></label>
                          <div class="col-sm-10">
                            <input
                            type="tel"
                            class="form-control"
                            id="pin_code"
                            name="pin_code"
                            value="{{ old('pin_code') }}"
                            placeholder=""
                            maxlength="6"
                            onkeyup="if (/\D/g.test(this.value)) this.value = this.value.replace(/\D/g,'')"
                          />
							@if($errors->has('pin_code'))
									<div class="error">{{ $errors->first('pin_code') }}</div>
							@endif
						  </div>
                        </div>

                       
                     <div class="row mb-3">
                      <label class="col-sm-2 col-form-label" for="city">Type of Insurance<sup style="color:red;">*</sup></label>
                      <div class="col-sm-10">
                      <select id="type_of_insurance" class="select2 form-select" name="type_of_insurance">
                        <option value="">Select Type of Insurance</option>
                        <option {{ old('type_of_insurance')=='Individual' ? 'selected' : '' }} value="Individual"> Individual </option>
						<option { old('type_of_insurance')=='Family floater' ? 'selected' : '' }} value="Family floater"> Family floater</option>
						<option { old('type_of_insurance')=='Group' ? 'selected' : '' }} value="Group"> Group </option>
                      </select>
                      @if($errors->has('type_of_insurance'))
                        <div class="error">{{ $errors->first('type_of_insurance') }}</div>
                      @endif
                    </div>
                   </div>
						<div class="row mb-3">
                          <label class="col-sm-2 col-form-label" for="basic-default-name">Coverage required<sup style="color:red;">*</sup></label>
                          <div class="col-sm-10">
                            <input type="text" name="coverage_required" value="{{ old('coverage_required') }}" class="form-control" id="basic-default-name" placeholder="" />
							@if($errors->has('coverage_required'))
									<div class="error">{{ $errors->first('coverage_required') }}</div>
							@endif
						  </div>
                        </div>
						
						<div class="row mb-3">
                          <label class="col-sm-2 col-form-label" for="basic-default-name">Age of insured<sup style="color:red;">*</sup></label>
                          <div class="col-sm-10">
                            <input type="text" name="age" value="{{ old('age') }}" class="form-control" id="basic-default-name" placeholder="" />
							@if($errors->has('age'))
									<div class="error">{{ $errors->first('age') }}</div>
							@endif
						  </div>
                        </div>
						
						

                        <div class="row justify-content-end">
                          <div class="col-sm-12">
                            <button type="submit" class="btn btn-primary">Submit</button>
                          </div>
                        </div>
                      </form>
                    </div>
                      </div>

                  </div>
                </div>

        
              <!--/ Card layout -->
            </div>
            <!-- / Content -->
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.6.1/jquery.min.js"></script>
  <script src="https://maxcdn.bootstrapcdn.com/bootstrap/3.4.1/js/bootstrap.min.js"></script>

<script>
  
  // var a = {!! json_encode(session('success')) !!};
  
  // // alert(a);
  //$('#smallModal_1').hide();
  //$('#smallModal_homeloan').hide();
  function hide(){
    $('#smallModal_homeloan').hide();
	  var CURL=  $('#curl').val(); // curl id in buddy-screen
    setTimeout(() => {
      window.location.href = '