

<?php $__env->startSection('content'); ?>
<div class="container py-4">
    <!-- Main Header with Right-Aligned Button -->
    <div class="main-header mb-4 d-flex justify-content-between align-items-center">
        <h1 class="h2">PTSD Checklist for DSM-5 (PCL-5)</h1>
        <button type="button" class="btn btn-sm btn-outline-secondary show-view" data-view="dashboard">
            <i class="bi bi-arrow-left"></i> Back to Dashboard
        </button>
    </div>

    <!-- Instructions Section -->
    <h2 class="h5">Instructions</h2>
    <p>
    Below is a list of problems that people sometimes have in response to a very stressful experience. Please read each problem carefully and then circle one of the numbers to the right to indicate how much you have been bothered by that problem in the past month.

In the past month, how much were you bothered by:
    </p>
</div>
<form id="questionForm" onsubmit="submitForm(event)" class="ajax-form forms-sample" method="post" action="<?php echo e(route('mentalHealth.pcl5Store')); ?>" data-redirect="<?php echo e(route('mentalHealth.dashboard')); ?>">     
<!-- Centered Content with Card and Progress Bar --> 
<div class="d-flex justify-content-center min-vh-75 align-items-center">
    <div class="col-sm-12 col-xl-6">  

        <!-- Progress Bar -->
        <div class="progress mb-4">
  <div class="progress-bar bg-primary" id="progress-bar" role="progressbar" style="width: 0%;" 
       aria-valuenow="0" aria-valuemin="0" aria-valuemax="100">0%</div>
</div>
    

<!-- Question 1 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question" data-question="1">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
    Repeated, disturbing, and unwanted memories of the stressful experience?
    </h6>
    <input type="hidden" name="question" value="Repeated, disturbing, and unwanted memories of the stressful experience?">
    
    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question1" id="question1_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question1_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 2 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="2">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
        Repeated, disturbing dreams of the stressful experience?
    </h6>
    <input type="hidden" name="question" value="Repeated, disturbing dreams of the stressful experience?">

    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question2" id="question2_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question2_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 3 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="3">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
        Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?
    </h6>
    <input type="hidden" name="question" value="Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?">

    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question3" id="question3_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question3_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 4 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="4">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
        Feeling very upset when something reminded you of the stressful experience?
    </h6>
    <input type="hidden" name="question" value="Feeling very upset when something reminded you of the stressful experience?">

    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question4" id="question4_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question4_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>



<!-- Question 5 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="5">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
        Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?
    </h6>
    <input type="hidden" name="question" value="Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?">

    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question5" id="question5_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question5_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 6 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="6">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
        Avoiding memories, thoughts, or feelings related to the stressful experience?
    </h6>
    <input type="hidden" name="question" value="Avoiding memories, thoughts, or feelings related to the stressful experience?">

    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question6" id="question6_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question6_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 7 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="7">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
        Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?
    </h6>
    <input type="hidden" name="question" value="Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?">

    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question7" id="question7_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question7_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 8 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="8">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
        Trouble remembering important parts of the stressful experience?
    </h6>
    <input type="hidden" name="question" value="Trouble remembering important parts of the stressful experience?">

    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question8" id="question8_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question8_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 9 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="9">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
        Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)?
    </h6>
    <input type="hidden" name="question" value="Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)?
">

    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question9" id="question9_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question9_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 10 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="10">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
        Blaming yourself or someone else for the stressful experience or what happened after it?
    </h6>
    <input type="hidden" name="question" value="Blaming yourself or someone else for the stressful experience or what happened after it?">

    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question10" id="question10_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question10_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 11 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="11">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
        Having strong negative feelings such as fear, horror, anger, guilt, or shame?
    </h6>
    <input type="hidden" name="question" value="Having strong negative feelings such as fear, horror, anger, guilt, or shame?">

    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question11" id="question11_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question11_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 12 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="12">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
        Loss of interest in activities that you used to enjoy?
    </h6>
    <input type="hidden" name="question" value="Loss of interest in activities that you used to enjoy?">

    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question12" id="question12_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question12_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 13 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="13">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
        Feeling distant or cut off from other people?
    </h6>
    <input type="hidden" name="question" value="Feeling distant or cut off from other people?">

    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question13" id="question13_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question13_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 14 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="14">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
        Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?
    </h6>
    <input type="hidden" name="question" value="Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?">

    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question14" id="question14_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question14_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 15 to 20 follow the same format -->


<!-- Question 15 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="15">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
        Irritable behavior, angry outbursts, or acting aggressively?
    </h6>
    <input type="hidden" name="question" value="Irritable behavior, angry outbursts, or acting aggressively?">

    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question15" id="question15_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question15_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 16 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="16">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
        Taking too many risks or doing things that could cause you harm?
    </h6>
    <input type="hidden" name="question" value="Taking too many risks or doing things that could cause you harm?">

    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question16" id="question16_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question16_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 17 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="17">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
        Being "superalert" or watchful or on guard?
    </h6>
    <input type="hidden" name="question" value="Being 'superalert' or watchful or on guard?">

    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question17" id="question17_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question17_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 18 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="18">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
        Feeling jumpy or easily startled?
    </h6>
    <input type="hidden" name="question" value="Feeling jumpy or easily startled?">

    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question18" id="question18_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question18_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 19 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="19">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
        Having difficulty concentrating?
    </h6>
    <input type="hidden" name="question" value="Having difficulty concentrating?">

    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question19" id="question19_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question19_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 20 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="20">
    <h2>Problem</h2>
    <h6 class="mb-4 text-white">
        Trouble falling or staying asleep?
    </h6>
    <input type="hidden" name="question" value="Trouble falling or staying asleep?">

    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question20" id="question20_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question20_<?php echo e($i); ?>">
                <?php echo e(['Not at all', 'A little bit', 'Moderately', 'Quite a bit', 'Extremely'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <div class="d-flex justify-content-between mt-4">
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