

<?php $__env->startSection('content'); ?>

<style>

  .d-flex {
        display: flex;
        align-items: center;
    }

    .form-group {
        margin-right: 20px;
    }

    .education-row button {
        margin-left: 10px;
        height: 38px;
        align-self: flex-end;
    }
    
input#password {
    width: 90%;
}
.password_icon {
    float: right;
    background-color: #a9b7c3;
    padding: 7px;
    padding-left: 39px;
    padding-right: 12px;
}
.ladder{
    display:flex;
}
i.mdi.mdi-key-variant {
    margin-right: 15px;
    margin-left: -15px;
    top: 22%;
    position: relative;
    font-size: 20px;
    cursor:pointer;
}
i#togglePassword{
    position: relative;
    top: 22%;
    font-size: 20px;
    margin-right: 20px;
    margin-left: 15px;
    cursor:pointer;
}
</style>

<div class="col-12 grid-margin stretch-card">
    <div class="card">
        <div class="card-body">
            <h4 class="card-title">Add HCP</h4>
            <p class="card-description">
            </p>
            <form id="add_hcp" class="forms-sample" method="post" action="<?php echo e(route('admin.hcpcreate')); ?>" enctype="multipart/form-data">
                <?php echo csrf_field(); ?>
                <div class="row">
                    <div class="col-md-6">
                        <div class="form-group">
                            <label for="title">Title</label>
                            <input type="text" class="form-control <?php $__errorArgs = ['title'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?> is-invalid <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>" id="title" name="title" placeholder="Title">
                            <?php $__errorArgs = ['title'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                            <span class="text-danger"><?php echo e($message); ?></span>
                            <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                        </div>
                        <div class="form-group">
                            <label for="first_name">First Name</label>
                            <input type="text" class="form-control <?php $__errorArgs = ['first_name'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?> is-invalid <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>" id="first_name" name="first_name" placeholder="First Name">
                            <?php $__errorArgs = ['first_name'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                            <span class="text-danger"><?php echo e($message); ?></span>
                            <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                        </div>
                        <div class="form-group">
                            <label for="middle_name">Middle Name</label>
                            <input type="text" class="form-control <?php $__errorArgs = ['middle_name'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?> is-invalid <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>" id="middle_name" name="middle_name" placeholder="Middle Name">
                            <?php $__errorArgs = ['middle_name'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                            <span class="text-danger"><?php echo e($message); ?></span>
                            <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                        </div>
                        <div class="form-group">
                            <label for="last_name">last_name</label>
                            <input type="text" class="form-control <?php $__errorArgs = ['last_name'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?> is-invalid <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>" id="last_name" name="last_name" placeholder="Last Name">
                            <?php $__errorArgs = ['last_name'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                            <span class="text-danger"><?php echo e($message); ?></span>
                            <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                        </div>
                        <div class="form-group">
                            <label for="contact_phone_office">Contact Phone Office</label>
                            <input type="text" class="form-control <?php $__errorArgs = ['contact_phone_office'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?> is-invalid <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>" id="contact_phone_office" name="contact_phone_office" placeholder="Contact Phone Office">
                            <?php $__errorArgs = ['contact_phone_office'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                            <span class="text-danger"><?php echo e($message); ?></span>
                            <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                        </div>
                        <div class="form-group">
                            <label for="contact_phone_personal">Contact Phone Personal</label>
                            <input type="text" class="form-control <?php $__errorArgs = ['contact_phone_personal'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?> is-invalid <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>" id="contact_phone_personal" name="contact_phone_personal" placeholder="Contact Phone Personal">
                            <?php $__errorArgs = ['contact_phone_personal'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                            <span class="text-danger"><?php echo e($message); ?></span>
                            <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                        </div>
                        
                                <div id="education-container">
        <div class="education-row d-flex">
            <div class="form-group">
                <label>Degree</label>
                <input type="text" name="degree[]" class="form-control" />
            </div>
            <div class="form-group">
                <label>Specialization</label>
                <input type="text" name="specialization[]" class="form-control" />
            </div>
            <div class="form-group">
                <label>Awarded Year</label>
                <input type="text" name="awarded_year[]" class="form-control" />
            </div>
            
              <div class="form-group">
                <label>Document Image</label>
                <input type="file" name="document_image[]" class="form-control" />
            </div>
            <button type="button" class="btn btn-success" onclick="addEducation()">Add More</button>
        </div>
    </div>
                    </div>
                    <div class="col-md-6">
                        <div class="form-group">
                            <label for="email">Email</label>
                            <input type="email" class="form-control <?php $__errorArgs = ['email'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?> is-invalid <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>" id="email" name="email" placeholder="Email">
                            <?php $__errorArgs = ['email'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                            <span class="text-danger"><?php echo e($message); ?></span>
                            <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                        </div>
                        
                          <div class="form-group">
                            <label for="Password">Password</label>
                            <div class="ladder">
                               <input type="password" class="form-control <?php $__errorArgs = ['password'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?> is-invalid <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>" id="password" name="password" placeholder="Password">
                               <?php $__errorArgs = ['password'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                               <span class="text-danger"><?php echo e($message); ?></span>
                               <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                               <div class="password_icon">
                               <i class="mdi mdi-key-variant" title="Generate Password" onclick="generatePassword()"></i>
                               <i class="mdi mdi-eye" title="Show Password" id="togglePassword" onclick="togglePassword()"></i> <!-- Show password icon -->
                               </div>
                           </div>

                        </div>
                        
                        <div class="form-group">
                            <label for="address">Address</label>
                            <textarea id="address" name="address" class="form-control <?php $__errorArgs = ['address'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?> is-invalid <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>" placeholder="Address"></textarea>
                            <?php $__errorArgs = ['address'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                            <span class="text-danger"><?php echo e($message); ?></span>
                            <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                        </div>
                      
                        <div class="form-group">
                            <label for="school_graduated">School Graduated</label>
                            <input type="text" class="form-control <?php $__errorArgs = ['school_graduated'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?> is-invalid <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>" id="school_graduated" name="school_graduated" placeholder="School Graduated">
                            <?php $__errorArgs = ['school_graduated'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                            <span class="text-danger"><?php echo e($message); ?></span>
                            <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                        </div>
                        <div class="form-group">
                            <label for="overall_rating">Overall Rating</label>
                            <input type="number" class="form-control <?php $__errorArgs = ['overall_rating'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?> is-invalid <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>" id="overall_rating" name="overall_rating" placeholder="Overall Rating">
                            <?php $__errorArgs = ['overall_rating'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                            <span class="text-danger"><?php echo e($message); ?></span>
                            <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                        </div>
                        
                            <div class="form-group">
                            <label for="image">Image</label>
                            <input type="file" class="form-control <?php $__errorArgs = ['image'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?> is-invalid <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>" id="image" name="image">
                            <?php $__errorArgs = ['image'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                            <span class="text-danger"><?php echo e($message); ?></span>
                            <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                        </div>
                        
                                <div id="licenses-container">
        <div class="licenses-row d-flex">
            <div class="form-group">
                <label>License Number</label>
                <input type="text" name="license_number[]" class="form-control" />
            </div>
            <div class="form-group">
                <label>Issuing Authority</label>
                <input type="text" name="issuing_authority[]" class="form-control" />
            </div>
             <div class="form-group">
                <label>Issue Date</label>
                <input type="date" name="issue_date[]" class="form-control" />
            </div>
            <div class="form-group">
                <label>Expiry Date</label>
                <input type="date" name="expiry_date[]" class="form-control" />
            </div>
              <div class="form-group">
                <label>Document Image</label>
                <input type="file" name="lic_document_image[]" class="form-control" />
            </div>
            <button type="button" class="btn btn-success" onclick="addLicenses()">Add More</button>
        </div>
    </div>
                    </div>
                    
  
                </div>
                <button type="submit" class="btn btn-primary me-2">Submit</button>
                <a href="<?php echo e(route('admin.hcp')); ?>" class="btn btn-light">Cancel</a>
            </form>
        </div>
    </div>
</div>

<?php $__env->stopSection(); ?>;
<?php echo $__env->make('admin.layouts.app', array_diff_key(get_defined_vars(), ['__data' => 1, '__path' => 1]))->render(); ?><?php /**PATH /var/www/html/resources/views/admin/hcp/create.blade.php ENDPATH**/ ?>