@php $editing = isset($patient) @endphp

<div class="row">
    <x-inputs.group class="col-sm-12 col-md-6">
        <x-inputs.text
            name="first_name"
            label="Prénom"
            :value="old('first_name', ($editing ? $patient->first_name : ''))"
            maxlength="255"
            placeholder="Prénom"
            required
        ></x-inputs.text>
    </x-inputs.group>

    <x-inputs.group class="col-sm-12 col-md-6">
        <x-inputs.text
            name="last_name"
            label="Nom"
            :value="old('last_name', ($editing ? $patient->last_name : ''))"
            maxlength="255"
            placeholder="Nom"
            required
        ></x-inputs.text>
    </x-inputs.group>

    <x-inputs.group class="col-sm-12 col-md-6">
        <x-inputs.date
            name="d_of_birth"
            label="Date de naissance"
            value="{{ old('d_of_birth', ($editing ? optional($patient->d_of_birth)->format('Y-m-d') : '')) }}"
        ></x-inputs.date>
    </x-inputs.group>

    <x-inputs.group class="col-sm-12 col-md-6">
        <x-inputs.text
            name="l_of_birth"
            label="Lieu de naissance"
            :value="old('l_of_birth', ($editing ? $patient->l_of_birth : ''))"
            maxlength="255"
            placeholder="Lieu de naissance"
        ></x-inputs.text>
    </x-inputs.group>

    <x-inputs.group class="col-sm-12 col-md-6">
        <x-inputs.text
            name="primary_address"
            label="Adresse primaire"
            :value="old('primary_address', ($editing ? $patient->primary_address : ''))"
            maxlength="255"
            placeholder="Adresse primaire"
            required
        ></x-inputs.text>
    </x-inputs.group>

    <x-inputs.group class="col-sm-12 col-md-6">
        <x-inputs.text
            name="secondary_address"
            label="Adresse secondaire"
            :value="old('secondary_address', ($editing ? $patient->secondary_address : ''))"
            maxlength="255"
            placeholder="Adresse secondaire"
        ></x-inputs.text>
    </x-inputs.group>

    <x-inputs.group class="col-sm-12 col-md-6">
        <x-inputs.select
            name="country_code_phone"
            label="Indicatif"
        >
            @php $selected = old('country_code_phone', ($editing ? $patient->country_code_phone : '')) @endphp
            <option disabled {{ empty($selected) ? 'selected' : '' }}>Selectionnez l'indicatif</option>
            @foreach($countries as $value => $label)
                <option value="{{ $value }}" {{ $selected == $value ? 'selected' : '' }} >{{ $label }}</option>
            @endforeach
        </x-inputs.select>
    </x-inputs.group>

    <x-inputs.group class="col-sm-12 col-md-6">
        <x-inputs.text
            name="phone"
            label="Téléphone"
            :value="old('phone', ($editing ? $patient->phone : ''))"
            maxlength="255"
            placeholder="Téléphone"
            required
        ></x-inputs.text>
    </x-inputs.group>

    <x-inputs.group class="col-sm-12 col-md-6">
        <x-inputs.text
            name="whatsapp"
            label="Whatsapp"
            :value="old('whatsapp', ($editing ? $patient->whatsapp : ''))"
            maxlength="255"
            placeholder="Whatsapp"
        ></x-inputs.text>
    </x-inputs.group>

    <x-inputs.group class="col-sm-12 col-md-6">
        <x-inputs.select
            name="country_code_whatsapp"
            label="Indicatif Whatsapp"
        >
            @php $selected = old('country_code_whatsapp', ($editing ? $patient->country_code_whatsapp : '')) @endphp
            <option disabled {{ empty($selected) ? 'selected' : '' }}>Selectionnez l'indicatif</option>
            @foreach($countries as $value => $label)
                <option value="{{ $value }}" {{ $selected == $value ? 'selected' : '' }} >{{ $label }}</option>
            @endforeach
        </x-inputs.select>
    </x-inputs.group>

    <x-inputs.group class="col-sm-12 col-md-6">
        <x-inputs.email
            name="email"
            label="Email"
            :value="old('email', ($editing ? $patient->email : ''))"
            maxlength="255"
            placeholder="Email"
        ></x-inputs.email>
    </x-inputs.group>

    <x-inputs.group class="col-sm-12 col-md-6">
        <x-inputs.select
            name="sex"
            label="Sexe"
        >
            @php $selected = old('sex', ($editing ? $patient->sex : '')) @endphp
            <option disabled {{ empty($selected) ? 'selected' : '' }}>Selectionnez le sex</option>
            <option value="male">Masculin</option>
            <option value="female">Féminin</option>
        </x-inputs.select>
    </x-inputs.group>

    <x-inputs.group class="col-sm-12 col-md-6">
        <x-inputs.select
            name="age"
            label="Age"
        >
            @php $selected = old('age', ($editing ? $patient->age : '')) @endphp
            <option disabled {{ empty($selected) ? 'selected' : '' }}>Selectionnez l'age</option>
            <option value="adult">Adulte</option>
            <option value="child">Enfant</option>
        </x-inputs.select>
    </x-inputs.group>

    <x-inputs.group class="col-sm-12 col-md-6">
        <x-inputs.text
            name="postal_code"
            label="Code Postal"
            :value="old('postal_code', ($editing ? $patient->postal_code : ''))"
            maxlength="255"
            placeholder="Code Postal"
        ></x-inputs.text>
    </x-inputs.group>
</div>