@extends('layouts.app')

@section('content')
    <div class="container">
        <div class="row justify-content-center">
            <div class="col-md-10">
                <div class="shadow card">
                    <div class="shadow-sm card-header fs-3">保険確認画面</div>
                    <form id="entryForm" method="POST" action="{{ route('approval.store') }}" onsubmit="return false;">
                        @csrf
                        <input type="hidden" name="application_id" value="{{ $app->application_id }}">
                        <input type="hidden" id="approval_status" name="approval_status">
                        <div class="card-body">
                            @php($input = $app)
                            @if (session('status'))
                                <div class="alert alert-success" role="alert">
                                    {{ session('status') }}
                                </div>
                            @endif
                            <ul>
                                @foreach ($errors->all() as $error)
                                    <li class="fs-6 text-danger">{{ $error }}</li>
                                @endforeach
                            </ul>
                            <div class="fs-5 mb-3 red text-center text-danger">この内容を確認済にします。よろしいでしょうか？</div>
                            <div class="d-flex">
                                <div class="shadow-sm input-group mb-3">
                                    <span class="input-group-text bg-secondary-subtle fs-5 col-3">保険期間</span>
                                    <input id="st_date" type="date"
                                        value="{{ $input['st_date'] }}"
                                        class="form-control fs-5 text-center"
                                        pattern="[0-9]{4}-[0-9]{2}" onchange="dateChange()" disabled>
                                    <span class="input-group-text text-center col-2 fs-5 bg-secondary-subtle">午前０時</span>
                                    <span class="input-group-text bg-secondary-subtle">～</span>
                                    <span id="ed_date"
                                        class="form-control fs-5 text-center bg-secondary-subtle">{{ old('ed_date') }}</span>
                                    <span class="input-group-text text-center col-2 fs-5 bg-secondary-subtle">午前０時</span>
                                </div>
                            </div>
                            <div class="shadow-sm input-group mb-3">
                                <span class="input-group-text bg-secondary-subtle fs-5">労働保険番号</span>
                                <div class="form-floating">
                                    <input type="text"
                                        class="form-control fs-5"
                                        id="floatingInput1" maxlength="2" value="{{ $input['prefecture'] }}"
                                        placeholder="99" disabled>
                                    <label for="floatingInput1">府県</label>
                                </div>
                                <div class="form-floating">
                                    <input type="text" class="form-control fs-5"
                                        id="floatingInput2" maxlength="1" value="*"
                                        placeholder="9" disabled>
                                    <label for="floatingInput2">所掌</label>
                                </div>
                                <div class="form-floating">
                                    <input type="text"
                                        class="form-control fs-5"
                                        id="floatingInput3" maxlength="2"
                                        value="**" placeholder="99" disabled>
                                    <label for="floatingInput3">管轄</label>
                                </div>
                                <div class="form-floating col-2">
                                    <input type="text"
                                        class="form-control fs-5"
                                        id="floatingInput4" maxlength="6"
                                        value="{{ $input['core_number'] }}" placeholder="999999" disabled>
                                    <label for="floatingInput4">基幹番号</label>
                                </div>
                                <div class="form-floating">
                                    <input type="text"
                                        class="form-control fs-5"
                                        id="floatingInput5" maxlength="3"
                                        value="{{ $input['branch_number'] }}" placeholder="999" disabled>
                                    <label for="floatingInput5">枝番号</label>
                                </div>
                                <div class="form-floating">
                                    <input type="text"
                                        class="form-control fs-5"
                                        id="floatingInput6" maxlength="2"
                                        value="{{ $input['serial_number'] }}" placeholder="99" disabled>
                                    <label for="floatingInput6">追番</label>
                                </div>
                            </div>
                            <div class="shadow-sm input-group mb-3">
                                <span class="input-group-text bg-secondary-subtle fs-5">事業場の名称</span>
                                <input type="text" class="form-control fs-5"
                                    value="{{ $input['workspace'] }}" disabled>
                            </div>
                            <div class="d-flex">
                                <div class="col-6">
                                    <div class="shadow-sm input-group mb-3">
                                        <span class="input-group-text bg-secondary-subtle fs-5">事業主の氏名</span>
                                        <input type="text" class="form-control fs-5"
                                            value="{{ $input['name'] }}" disabled>
                                    </div>
                                </div>
                                <div class="col-6 ps-1">
                                    <div class="shadow-sm input-group mb-3">
                                        <span class="input-group-text bg-secondary-subtle fs-5 col-3">申込日</span>
                                        <input type="date" value="{{ $input['appl_date'] }}"
                                            class="form-control fs-5 text-center" disabled>
                                    </div>
                                </div>
                            </div>
                            <div class="d-flex">
                                <div class="col-4">
                                    <div class="shadow-sm input-group mb-3">
                                        <span class="input-group-text bg-secondary-subtle fs-5">郵便番号</span>
                                        <input type="text"
                                            class="form-control fs-5"
                                            maxlength="3" value="{{ $input['post_number_1'] }}" disabled>
                                        <span class="input-group-text bg-secondary-subtle">―</span>
                                        <input type="text"
                                            class="form-control fs-5"
                                            maxlength="4" value="{{ $input['post_number_2'] }}" disabled>
                                    </div>
                                </div>
                                <div class="col-4">
                                    <div class="shadow-sm input-group mb-3 ms-1">
                                        <span class="input-group-text bg-secondary-subtle fs-5">電話番号</span>
                                        <input type="tel"
                                            class="form-control fs-5"
                                            value="{{ $input['tel'] }}" disabled>
                                    </div>
                                </div>
                            </div>
                            <div class="shadow-sm input-group mb-3">
                                <span class="input-group-text bg-secondary-subtle fs-5">メールアドレス</span>
                                <input type="email" class="form-control fs-5"
                                    value="{{ $input['email'] }}" disabled>
                            </div>
                            <div class="shadow-sm input-group mb-3">
                                <span class="input-group-text bg-secondary-subtle fs-5">事業場の所在地</span>
                                <input type="text" class="form-control fs-5"
                                    value="{{ $input['address1'] }} {{ $input['address2'] }}" disabled>
                            </div>
                            <div class="shadow-sm input-group mb-3">
                                <span class="input-group-text bg-secondary-subtle fs-5">事業コード</span>
                                <select id="code" class="form-control fs-5" disabled>
                                    <option value="{{$input['code']}}" selected>{{$input['code']}}</option>
                                </select>
                                <span class="input-group-text col-9 bg-secondary-subtle fs-5" id="code_label">{{$input['code_name']}}</span>
                            </div>
                            <div class="shadow-sm input-group mb-3">
                                <span class="input-group-text bg-secondary-subtle fs-5">割引適用事業場</span>
                                <input type="text" class="form-control fs-5 " value="{{ $input['sale'] }}" disabled>
                            </div>
                            <div class="d-flex">
                                <div class="col-4">
                                    <div class="shadow-sm input-group mb-3">
                                        <span class="input-group-text bg-secondary-subtle fs-5">基礎賃金総額</span>
                                        <input id="basic" type="text" class="form-control fs-5 " value="{{ $input['total_wage'] }}" disabled>
                                        <span class="input-group-text bg-secondary-subtle fs-5">千円</span>
                                    </div>
                                </div>
                                <div class="col-6 ms-3">
                                    <div class="d-flex">
                                        <span class="input-group-text bg-secondary-subtle fs-5">特別加入者の有無</span>
                                        <div class="form-check fs-5 my-2 ms-2">
                                            <input
                                                class="form-check-input"
                                                type="radio" value="0" id="flexRadioDefault1"
                                                {{ $input['special_enrollee'] == '0' ? 'checked' : '' }} disabled>
                                            <label class="form-check-label" for="flexRadioDefault1">なし</label>
                                        </div>
                                        <div class="form-check fs-5 my-2 ms-2">
                                            <input
                                                class="form-check-input"
                                                type="radio" value="1" id="flexRadioDefault2"
                                                {{ $input['special_enrollee'] == '1' ? 'checked' : '' }} disabled>
                                            <label class="form-check-label" for="flexRadioDefault2">あり</label>
                                        </div>
                                    </div>
                                </div>
                            </div>
                            <div id="sp" class="d-none">
                                <div class="d-flex">
                                    <div class="">
                                        <div class="shadow-sm input-group mb-3">
                                            <span class="input-group-text bg-secondary-subtle fs-5">特別加入者01</span>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"
                                                    id="sp_name_1" value="{{ $input['name1'] }}"
                                                    placeholder="氏名" disabled>
                                                <label for="sp_name_1">氏名</label>
                                            </div>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"
                                                    id="sp_val_1" value="{{ $input['value1'] }}"
                                                    placeholder="給付基礎日額" onchange="sumChange()" disabled>
                                                <label for="sp_val_1">給付基礎日額</label>
                                            </div>
                                            <span class="input-group-text bg-secondary-subtle fs-5">円</span>
                                        </div>
                                    </div>
                                    <div class="ms-1">
                                        <div class="shadow-sm input-group mb-3">
                                            <span class="input-group-text bg-secondary-subtle fs-5">特別加入者02</span>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"
                                                    id="sp_name_2" value="{{ $input['name2'] }}"
                                                    placeholder="氏名" disabled>
                                                <label for="sp_name_2">氏名</label>
                                            </div>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"
                                                    id="sp_val_2" value="{{ $input['value2'] }}"
                                                    placeholder="給付基礎日額" onchange="sumChange()" disabled>
                                                <label for="sp_val_2">給付基礎日額</label>
                                            </div>
                                            <span class="input-group-text bg-secondary-subtle fs-5">円</span>
                                        </div>
                                    </div>
                                </div>
                                <div class="d-flex">
                                    <div class="">
                                        <div class="shadow-sm input-group mb-3">
                                            <span class="input-group-text bg-secondary-subtle fs-5">特別加入者03</span>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"
                                                    id="sp_name_3" value="{{ $input['name3'] }}"
                                                    placeholder="氏名" disabled>
                                                <label for="sp_name_3">氏名</label>
                                            </div>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"
                                                    id="sp_val_3" value="{{ $input['value3'] }}"
                                                    placeholder="給付基礎日額" onchange="sumChange()" disabled>
                                                <label for="sp_val_3">給付基礎日額</label>
                                            </div>
                                            <span class="input-group-text bg-secondary-subtle fs-5">円</span>
                                        </div>
                                    </div>
                                    <div class="ms-1">
                                        <div class="shadow-sm input-group mb-3">
                                            <span class="input-group-text bg-secondary-subtle fs-5">特別加入者04</span>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"
                                                    id="sp_name_4" value="{{ $input['name4'] }}"
                                                    placeholder="氏名" disabled>
                                                <label for="sp_name_4">氏名</label>
                                            </div>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"
                                                    id="sp_val_4" value="{{ $input['value4'] }}"
                                                    placeholder="給付基礎日額" onchange="sumChange()" disabled>
                                                <label for="sp_val_4">給付基礎日額</label>
                                            </div>
                                            <span class="input-group-text bg-secondary-subtle fs-5">円</span>
                                        </div>
                                    </div>
                                </div>
                                <div class="d-flex">
                                    <div class="">
                                        <div class="shadow-sm input-group mb-3">
                                            <span class="input-group-text bg-secondary-subtle fs-5">特別加入者05</span>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"
                                                    id="sp_name_5" value="{{ $input['name5'] }}"
                                                    placeholder="氏名" disabled>
                                                <label for="sp_name_5">氏名</label>
                                            </div>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"
                                                    id="sp_val_5" value="{{ $input['value5'] }}"
                                                    placeholder="給付基礎日額" onchange="sumChange()" disabled>
                                                <label for="sp_val_5">給付基礎日額</label>
                                            </div>
                                            <span class="input-group-text bg-secondary-subtle fs-5">円</span>
                                        </div>
                                    </div>
                                    <div class="ms-1">
                                        <div class="shadow-sm input-group mb-3">
                                            <span class="input-group-text bg-secondary-subtle fs-5">特別加入者06</span>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"
                                                    id="sp_name_6" value="{{ $input['name6'] }}"
                                                    placeholder="氏名" disabled>
                                                <label for="sp_name_6">氏名</label>
                                            </div>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"
                                                    id="sp_val_6" value="{{ $input['value6'] }}"
                                                    placeholder="給付基礎日額" onchange="sumChange()" disabled>
                                                <label for="sp_val_6">給付基礎日額</label>
                                            </div>
                                            <span class="input-group-text bg-secondary-subtle fs-5">円</span>
                                        </div>
                                    </div>
                                </div>
                                <div class="d-flex">
                                    <div class="">
                                        <div class="shadow-sm input-group mb-3">
                                            <span class="input-group-text bg-secondary-subtle fs-5">特別加入者07</span>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"
                                                    id="sp_name_7" value="{{ $input['name7'] }}"
                                                    placeholder="氏名" disabled>
                                                <label for="sp_name_7">氏名</label>
                                            </div>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"
                                                    id="sp_val_7" value="{{ $input['value7'] }}"
                                                    placeholder="給付基礎日額" onchange="sumChange()" disabled>
                                                <label for="sp_val_7">給付基礎日額</label>
                                            </div>
                                            <span class="input-group-text bg-secondary-subtle fs-5">円</span>
                                        </div>
                                    </div>
                                    <div class="ms-1">
                                        <div class="shadow-sm input-group mb-3">
                                            <span class="input-group-text bg-secondary-subtle fs-5">特別加入者08</span>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"
                                                    id="sp_name_8" value="{{ $input['name8'] }}"
                                                    placeholder="氏名" disabled>
                                                <label for="sp_name_8">氏名</label>
                                            </div>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"                                                
                                                    id="sp_val_8" value="{{ $input['value8'] }}"
                                                    placeholder="給付基礎日額" onchange="sumChange()" disabled>
                                                <label for="sp_val_8">給付基礎日額</label>
                                            </div>
                                            <span class="input-group-text bg-secondary-subtle fs-5">円</span>
                                        </div>
                                    </div>
                                </div>
                                <div class="d-flex">
                                    <div class="">
                                        <div class="shadow-sm input-group mb-3">
                                            <span class="input-group-text bg-secondary-subtle fs-5">特別加入者09</span>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"
                                                    id="sp_name_9" value="{{ $input['name9'] }}"
                                                    placeholder="氏名" disabled>
                                                <label for="sp_name_9">氏名</label>
                                            </div>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"
                                                    id="sp_val_9" value="{{ $input['value9'] }}"
                                                    placeholder="給付基礎日額" onchange="sumChange()" disabled>
                                                <label for="sp_val_9">給付基礎日額</label>
                                            </div>
                                            <span class="input-group-text bg-secondary-subtle fs-5">円</span>
                                        </div>
                                    </div>
                                    <div class="ms-1">
                                        <div class="shadow-sm input-group mb-3">
                                            <span class="input-group-text bg-secondary-subtle fs-5">特別加入者10</span>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"
                                                    id="sp_name_10" value="{{ $input['name10'] }}"
                                                    placeholder="氏名" disabled>
                                                <label for="sp_name_10">氏名</label>
                                            </div>
                                            <div class="form-floating">
                                                <input type="text"
                                                    class="form-control fs-5"
                                                    id="sp_val_10" value="{{ $input['value10'] }}"
                                                    placeholder="給付基礎日額" onchange="sumChange()" disabled>
                                                <label for="sp_val_10">給付基礎日額</label>
                                            </div>
                                            <span class="input-group-text bg-secondary-subtle fs-5">円</span>
                                        </div>
                                    </div>
                                </div>
                            </div>
                            <div class="d-flex">
                                <div class="col-6">
                                    <div class="shadow-sm input-group mb-3">
                                        <span
                                            class="input-group-text bg-secondary-subtle fs-5 col-8">特別加入者保険料算定基礎額合計</span>
                                        <span id="sum_val_v"
                                            class="input-group-text bg-secondary-subtle fs-5 col-2 text-end d-block">{{ $input['sep_bt_amount'] }}</span>
                                            <input type="hidden" id="sum_val" value="{{ $input['sep_bt_amount'] }}">
                                        <span class="input-group-text bg-secondary-subtle fs-5 col-2">千円</span>
                                    </div>
                                </div>
                                <div class="col-6 ms-1">
                                    <div class="shadow-sm input-group mb-3 col-12">
                                        <span class="input-group-text bg-secondary-subtle fs-5 col-8">保険料算出基礎賃金総額</span>
                                        <span id="sum_basic_val_v"
                                            class="input-group-text bg-secondary-subtle fs-5 col-2 text-end d-block">{{ $input['pcb_wt_amount'] }}</span>
                                            <input type="hidden" id="sum_basic_val" value="{{ $input['pcb_wt_amount'] }}">
                                        <span class="input-group-text bg-secondary-subtle fs-5 col-2">千円</span>
                                    </div>
                                </div>
                            </div>
                            <div class="col-6 d-none">
                                <div class="d-flex mb-3">
                                    <span class="input-group-text bg-secondary-subtle fs-5">脳・心臓疾患等の補償</span>
                                    <div class="form-check fs-5 my-2 ms-2">
                                        <input class="form-check-input"
                                            type="radio" value="0" id="compensation1" disabled>
                                        <label class="form-check-label" for="compensation1">なし</label>
                                    </div>
                                    <div class="form-check fs-5 my-2 ms-2">
                                        <input class="form-check-input"
                                            type="radio" value="1" id="compensation2"
                                            checked disabled>
                                        <label class="form-check-label" for="compensation2">あり</label>
                                    </div>
                                </div>
                            </div>
                            <div class="form-control">
                                <div class="col-12">
                                    <div class="d-flex input-group">
                                        <span class="input-group-text bg-secondary-subtle fs-5">保険料:</span>
                                        <span class="input-group-text bg-secondary-subtle fs-5">休業補償あり（1日当たり給付基礎日額の20%）、障害補償、死亡補償</span>
                                    </div>
                                </div>
                                <div class="d-flex mb-3 input-group">
                                    <div class="list-group flex-fill text-center">
                                        <label class="h-100 list-group-item justify-content-between align-items-center"
                                            for="flexRadioDefault1-1">
                                            <input class="form-check-input" type="radio" value="IA"
                                                id="flexRadioDefault1-1"
                                                {{ $app->pattern == 'IA' ? 'checked' : '' }} disabled>
                                            <div>
                                                <div class="fw-bold">死亡保障</div>
                                                <div class="fw-bold">600日</div>
                                                <div class="fw-bold fs-6">Ⅰ型Ａ</div>
                                                <div class="fw-bold fs-6"><br></div>
                                                <div class="fw-bold fs-6"><br></div>
                                                <span id="IA">{{ $app->IA }}</span>円
                                            </div>
                                        </label>
                                    </div>
                                    <div class="list-group flex-fill text-center">
                                        <label class="h-100 list-group-item justify-content-between align-items-center"
                                            for="flexRadioDefault1-2">
                                            <input class="form-check-input" type="radio" value="IIA"
                                                id="flexRadioDefault1-2"
                                                {{ $app->pattern == 'IIA' ? 'checked' : '' }} disabled>
                                            <div>
                                                <div class="fw-bold">死亡保障</div>
                                                <div class="fw-bold">800日</div>
                                                <div class="fw-bold fs-6">Ⅱ型Ａ</div>
                                                <div class="fw-bold fs-6"><br></div>
                                                <div class="fw-bold fs-6"><br></div>
                                                <span id="IIA">{{ $app->IIA }}</span>円
                                            </div>
                                        </label>
                                    </div>
                                    <div class="list-group flex-fill text-center">
                                        <label class="h-100 list-group-item justify-content-between align-items-center"
                                            for="flexRadioDefault1-3">
                                            <input class="form-check-input" type="radio" value="IIIA"
                                                id="flexRadioDefault1-3"
                                                {{ $app->pattern == 'IIIA' ? 'checked' : '' }} disabled>
                                            <div>
                                                <div class="fw-bold">死亡保障</div>
                                                <div class="fw-bold">1,000日</div>
                                                <div class="fw-bold fs-6">Ⅲ型Ａ</div>
                                                <div class="fw-bold fs-6"><br></div>
                                                <div class="fw-bold fs-6"><br></div>
                                                <span id="IIIA">{{ $app->IIIA }}</span>円
                                            </div>
                                        </label>
                                    </div>
                                    <div class="list-group flex-fill text-center">
                                        <label class="h-100 list-group-item justify-content-between align-items-center"
                                            for="flexRadioDefault1-4">
                                            <input class="form-check-input" type="radio" value="IAIB"
                                                id="flexRadioDefault1-4"
                                                {{ $app->pattern == 'IAIB' ? 'checked' : '' }} disabled>
                                            <div>
                                                <div class="fw-bold">死亡保障</div>
                                                <div class="fw-bold">1,200日</div>
                                                <div class="fw-bold fs-6">Ⅰ型Ａ</div>
                                                <div class="fw-bold fs-6">Ⅰ型Ｂ</div>
                                                <div class="fw-bold fs-6"><br></div>
                                                <span id="IAIB">{{ $app->IAIB }}</span>円
                                            </div>
                                        </label>
                                    </div>
                                    <div class="list-group flex-fill text-center">
                                        <label class="h-100 list-group-item justify-content-between align-items-center"
                                            for="flexRadioDefault1-5">
                                            <input class="form-check-input" type="radio" value="IIAIIB"
                                                id="flexRadioDefault1-5"
                                                {{ $app->pattern == 'IIAIIB' ? 'checked' : '' }} disabled>
                                            <div>
                                                <div class="fw-bold">死亡保障</div>
                                                <div class="fw-bold">1,600日</div>
                                                <div class="fw-bold fs-6">Ⅱ型Ａ</div>
                                                <div class="fw-bold fs-6">Ⅱ型Ｂ</div>
                                                <div class="fw-bold fs-6"><br></div>
                                                <span id="IIAIIB">{{ $app->IIAIIB }}</span>円
                                            </div>
                                        </label>
                                    </div>
                                    <div class="list-group flex-fill text-center">
                                        <label class="h-100 list-group-item justify-content-between align-items-center"
                                            for="flexRadioDefault1-6">
                                            <input class="form-check-input" type="radio"
                                                value="IIIAIIIB" id="flexRadioDefault1-6"
                                                {{ $app->pattern == 'IIIAIIIB' ? 'checked' : '' }} disabled>
                                            <div>
                                                <div class="fw-bold">死亡保障</div>
                                                <div class="fw-bold">2,000日</div>
                                                <div class="fw-bold fs-6">Ⅲ型Ａ</div>
                                                <div class="fw-bold fs-6">Ⅲ型Ｂ</div>
                                                <div class="fw-bold fs-6"><br></div>
                                                <span id="IIIAIIIB">{{ $app->IIIAIIIB }}</span>円
                                            </div>
                                        </label>
                                    </div>
                                    <div class="list-group flex-fill text-center">
                                        <label class="list-group-item justify-content-between align-items-center"
                                            for="flexRadioDefault1-7">
                                            <input class="form-check-input" type="radio" value="IAIB2"
                                                id="flexRadioDefault1-7"
                                                {{ $app->pattern == 'IAIB2' ? 'checked' : '' }} disabled>
                                            <div>
                                                <div class="fw-bold">死亡保障</div>
                                                <div class="fw-bold">1,800日</div>
                                                <div class="fw-bold fs-6">Ⅰ型Ａ</div>
                                                <div class="fw-bold fs-6">Ⅰ型Ｂ</div>
                                                <div class="fw-bold fs-6">Ⅰ型Ｂ</div>
                                                <span id="IAIB2">{{ $app->IAIBIB }}</span>円
                                            </div>
                                        </label>
                                    </div>
                                    <div class="list-group flex-fill text-center">
                                        <label class="list-group-item justify-content-between align-items-center"
                                            for="flexRadioDefault1-8">
                                            <input class="form-check-input" type="radio"
                                                value="IIAIIB2" id="flexRadioDefault1-8"
                                                {{ $app->pattern == 'IIAIIB2' ? 'checked' : '' }} disabled>
                                            <div>
                                                <div class="fw-bold">死亡保障</div>
                                                <div class="fw-bold">2,400日</div>
                                                <div class="fw-bold fs-6">Ⅱ型Ａ</div>
                                                <div class="fw-bold fs-6">Ⅱ型Ｂ</div>
                                                <div class="fw-bold fs-6">Ⅱ型Ｂ</div>
                                                <span id="IIAIIB2">{{ $app->IIAIIBIIB }}</span>円
                                            </div>
                                        </label>
                                    </div>
                                    <div class="list-group flex-fill text-center">
                                        <label class="list-group-item justify-content-between align-items-center"
                                            for="flexRadioDefault1-9">
                                            <input class="form-check-input" type="radio"
                                                value="IIIAIIIB2" id="flexRadioDefault1-9"
                                                {{ $app->pattern == 'IIIAIIIB2' ? 'checked' : '' }} disabled>
                                            <div>
                                                <div class="fw-bold">死亡保障</div>
                                                <div class="fw-bold">3,000日</div>
                                                <div class="fw-bold fs-6">Ⅲ型Ａ</div>
                                                <div class="fw-bold fs-6">Ⅲ型Ｂ</div>
                                                <div class="fw-bold fs-6">Ⅲ型Ｂ</div>
                                                <span id="IIIAIIIB2">{{ $app->IIIAIIIBIIIB }}</span>円
                                            </div>
                                        </label>
                                    </div>
                                </div>
                                <div class="col-6">
                                    <div class="d-flex input-group">
                                        <span class="input-group-text bg-secondary-subtle fs-5">保険料:</span>
                                        <span class="input-group-text bg-secondary-subtle fs-5">休業補償なし、障害補償、死亡補償</span>
                                    </div>
                                </div>
                                <div class="d-flex mb-3 input-group @error('amount') is-invalid @enderror">
                                    <div class="list-group flex-fill text-center">
                                        <label class="list-group-item justify-content-between align-items-center"
                                            for="flexRadioDefault2-1">
                                            <input class="form-check-input" type="radio" value="IB"
                                                id="flexRadioDefault2-1"
                                                {{ $app->pattern == 'IB' ? 'checked' : '' }} disabled>
                                            <div class="ms-2 me-auto">
                                                <div class="fw-bold">死亡保障</div>
                                                <div class="fw-bold">600日</div>
                                                <div class="fw-bold fs-6">Ⅰ型Ｂ</div>
                                                <div class="fw-bold fs-6"><br></div>
                                                <div class="fw-bold fs-6"><br></div>
                                                <span id="IB">{{ $app->IB }}</span>円
                                            </div>
                                        </label>
                                    </div>
                                    <div class="list-group flex-fill text-center">
                                        <label class="list-group-item justify-content-between align-items-center"
                                            for="flexRadioDefault2-2">
                                            <input class="form-check-input" type="radio" value="IIB"
                                                id="flexRadioDefault2-2"
                                                {{ $app->pattern == 'IIB' ? 'checked' : '' }} disabled>
                                            <div class="ms-2 me-auto">
                                                <div class="fw-bold">死亡保障</div>
                                                <div class="fw-bold">800日</div>
                                                <div class="fw-bold fs-6">Ⅱ型Ｂ</div>
                                                <div class="fw-bold fs-6"><br></div>
                                                <div class="fw-bold fs-6"><br></div>
                                                <span id="IIB">{{ $app->IIB }}</span>円
                                            </div>
                                        </label>
                                    </div>
                                    <div class="list-group flex-fill text-center">
                                        <label class="list-group-item justify-content-between align-items-center"
                                            for="flexRadioDefault2-3">
                                            <input class="form-check-input" type="radio" value="IIIB"
                                                id="flexRadioDefault2-3"
                                                {{ $app->pattern == 'IIIB' ? 'checked' : '' }} disabled>
                                            <div class="ms-2 me-auto">
                                                <div class="fw-bold">死亡保障</div>
                                                <div class="fw-bold">1,000日</div>
                                                <div class="fw-bold fs-6">Ⅲ型Ｂ</div>
                                                <div class="fw-bold fs-6"><br></div>
                                                <div class="fw-bold fs-6"><br></div>
                                                <span id="IIIB">{{ $app->IIIB }}</span>円
                                            </div>
                                        </label>
                                    </div>
                                    <div class="list-group flex-fill text-center">
                                        <label class="h-100 list-group-item justify-content-between align-items-center"
                                            for="flexRadioDefault2-4">
                                            <input class="form-check-input" type="radio" value="IB2"
                                                id="flexRadioDefault2-4"
                                                {{ $app->pattern == 'IB2' ? 'checked' : '' }} disabled>
                                            <div class="ms-2 me-auto">
                                                <div class="fw-bold">死亡保障</div>
                                                <div class="fw-bold">1,200日</div>
                                                <div class="fw-bold fs-6">Ⅰ型Ｂ</div>
                                                <div class="fw-bold fs-6">Ⅰ型Ｂ</div>
                                                <div class="fw-bold fs-6"><br></div>
                                                <span id="IB2">{{ $app->IBIB }}</span>円
                                            </div>
                                        </label>
                                    </div>
                                    <div class="list-group flex-fill text-center">
                                        <label class="h-100 list-group-item justify-content-between align-items-center"
                                            for="flexRadioDefault2-5">
                                            <input class="form-check-input" type="radio" value="IIB2"
                                                id="flexRadioDefault2-5"
                                                {{ $app->pattern == 'IIB2' ? 'checked' : '' }} disabled>
                                            <div>
                                                <div class="fw-bold">死亡保障</div>
                                                <div class="fw-bold">1,600日</div>
                                                <div class="fw-bold fs-6">Ⅱ型Ｂ</div>
                                                <div class="fw-bold fs-6">Ⅱ型Ｂ</div>
                                                <div class="fw-bold fs-6"><br></div>
                                                <span id="IIB2">{{ $app->IIBIIB }}</span>円
                                            </div>
                                        </label>
                                    </div>
                                    <div class="list-group flex-fill text-center">
                                        <label class="h-100 list-group-item justify-content-between align-items-center"
                                            for="flexRadioDefault2-6">
                                            <input class="form-check-input" type="radio" value="IIIB2"
                                                id="flexRadioDefault2-6"
                                                {{ $app->pattern == 'IIIB2' ? 'checked' : '' }} disabled>
                                            <div>
                                                <div class="fw-bold">死亡保障</div>
                                                <div class="fw-bold">2,000日</div>
                                                <div class="fw-bold fs-6">Ⅲ型Ｂ</div>
                                                <div class="fw-bold fs-6">Ⅲ型Ｂ</div>
                                                <div class="fw-bold fs-6"><br></div>
                                                <span id="IIIB2">{{ $app->IIIBIIIB }}</span>円
                                            </div>
                                        </label>
                                    </div>
                                    <div class="list-group flex-fill text-center">
                                        <label class="list-group-item justify-content-between align-items-center"
                                            for="flexRadioDefault2-7">
                                            <input class="form-check-input" type="radio" value="IB3"
                                                id="flexRadioDefault2-7"
                                                {{ $app->pattern == 'IB3' ? 'checked' : '' }} disabled>
                                            <div>
                                                <div class="fw-bold">死亡保障</div>
                                                <div class="fw-bold">1,800日</div>
                                                <div class="fw-bold fs-6">Ⅰ型Ｂ</div>
                                                <div class="fw-bold fs-6">Ⅰ型Ｂ</div>
                                                <div class="fw-bold fs-6">Ⅰ型Ｂ</div>
                                                <span id="IB3">{{ $app->IBIBIB }}</span>円
                                            </div>
                                        </label>
                                    </div>
                                    <div class="list-group flex-fill text-center">
                                        <label class="list-group-item justify-content-between align-items-center"
                                            for="flexRadioDefault2-8">
                                            <input class="form-check-input" type="radio" value="IIB3"
                                                id="flexRadioDefault2-8"
                                                {{ $app->pattern == 'IIB3' ? 'checked' : '' }} disabled>
                                            <div>
                                                <div class="fw-bold">死亡保障</div>
                                                <div class="fw-bold">2,400日</div>
                                                <div class="fw-bold fs-6">Ⅱ型Ｂ</div>
                                                <div class="fw-bold fs-6">Ⅱ型Ｂ</div>
                                                <div class="fw-bold fs-6">Ⅱ型Ｂ</div>
                                                <span id="IIB3">{{ $app->IIBIIBIIB }}</span>円
                                            </div>
                                        </label>
                                    </div>
                                    <div class="list-group flex-fill text-center">
                                        <label class="list-group-item justify-content-between align-items-center"
                                            for="flexRadioDefault2-9">
                                            <input class="form-check-input" type="radio" value="IIIB3"
                                                id="flexRadioDefault2-9"
                                                {{ $app->pattern == 'IIIB3' ? 'checked' : '' }} disabled>
                                            <div>
                                                <div class="fw-bold">死亡保障</div>
                                                <div class="fw-bold">3,000日</div>
                                                <div class="fw-bold fs-6">Ⅲ型Ｂ</div>
                                                <div class="fw-bold fs-6">Ⅲ型Ｂ</div>
                                                <div class="fw-bold fs-6">Ⅲ型Ｂ</div>
                                                <span id="IIIB3">{{ $app->IIIBIIIBIIIB }}</span>円
                                            </div>
                                        </label>
                                    </div>
                                </div>
                            </div>
                            <div class="col-6">
                                <div class="d-flex mb-3">
                                    <span class="input-group-text bg-secondary-subtle fs-5">払込回数</span>
                                    <div class="form-check fs-5 my-2 ms-2">
                                        <input class="form-check-input"
                                            type="radio" id="first_p" value="1"
                                            {{ $app->count == '1' ? 'checked' : '' }} disabled>
                                        <label class="form-check-label" for="first_p">一括払</label>
                                    </div>
                                    <div class="form-check fs-5 my-2 ms-2">
                                        <input class="form-check-input"
                                            type="radio" id="second_p" value="2"
                                            {{ $app->count == '2' ? 'checked' : '' }} disabled>
                                        <label class="form-check-label" for="second_p">２回払</label>
                                    </div>
                                    <div class="form-check fs-5 my-2 ms-2">
                                        <input class="form-check-input"
                                            type="radio" id="third_p" value="3"
                                            {{ $app->count == '3' ? 'checked' : '' }} disabled>
                                        <label class="form-check-label" for="third_p">３回払</label>
                                    </div>
                                </div>
                            </div>
                            <div class="d-flex">
                                <div class="col-4">
                                    <div class="shadow-sm input-group mb-3 col-4">
                                        <span class="input-group-text bg-secondary-subtle fs-5 col-4">１回目</span>
                                        <span id="first"
                                            class="input-group-text bg-secondary-subtle fs-5 col-6 text-end d-block">{{ !empty($app->ta1) ? $app->ta1 : 0 }}</span>
                                        <span class="input-group-text bg-secondary-subtle fs-5 col-2">円</span>
                                    </div>
                                </div>
                                <div class="col-4 ms-1">
                                    <div class="shadow-sm input-group mb-3 col-4">
                                        <span class="input-group-text bg-secondary-subtle fs-5 col-4">２回目</span>
                                        <span id="second"
                                            class="input-group-text bg-secondary-subtle fs-5 col-6 text-end d-block">{{ !empty($app->ta2) ? $app->ta2 : 0 }}</span>
                                        <span class="input-group-text bg-secondary-subtle fs-5 col-2">円</span>
                                    </div>
                                </div>
                                <div class="col-4 ms-1">
                                    <div class="shadow-sm input-group mb-3 col-4">
                                        <span class="input-group-text bg-secondary-subtle fs-5 col-4">３回目</span>
                                        <span id="third"
                                            class="input-group-text bg-secondary-subtle fs-5 col-6 text-end d-block">{{ !empty($app->ta3) ? $app->ta3 : 0 }}</span>
                                        <span class="input-group-text bg-secondary-subtle fs-5 col-2">円</span>
                                    </div>
                                </div>
                            </div>
                            <div class="d-flex">
                                <button onclick="history.back();" class="fs-5 btn btn-secondary shadow-sm">入力画面に戻る</button>
                                <button type="submit" class="fs-5 btn btn-secondary shadow-sm"  data-bs-toggle="modal" data-bs-target="#approveModal_{{ $app->application_id }}"
                                     value="1" style="margin:auto 0px auto auto">確認済にする</button>
                                <button type="submit" class="fs-5 btn btn-secondary shadow-sm"  data-bs-toggle="modal" data-bs-target="#rejectModal_{{ $app->application_id }}"
                                     value="0" style="margin:auto 0px auto 20px">修正依頼を出す</button>
                            </div>
                        </div>
                    </form>
                    <div class="modal fade" id="approveModal_{{ $app->application_id }}" tabindex="-1" aria-hidden="true">
        <div class="modal-dialog modal-dialog-centered">
            <div class="modal-content pt-3 px-3 fs-5">
                この内容で確認済にします。よろしいでしょうか？
                <div class="modal-footer">
                    <button type="button" class="btn btn-sm btn-light border" data-bs-dismiss="modal">キャンセル</button>
                    
                    <button type="submit" 
                            form="entryForm" 
                            name="approval_status" 
                            value="approve" 
                            class="btn btn-sm btn-success" 
                            onclick="submitAfterValidate(1)"
                            >
                        実行
                    </button>
                </div>
            </div>
        </div>
    </div>

    <div class="modal fade" id="rejectModal_{{ $app->application_id  }}" tabindex="-1" aria-hidden="true">
        <div class="modal-dialog modal-dialog-centered">
            <div class="modal-content pt-3 px-3 fs-5">
                この内容を修正依頼します。よろしいでしょうか？
                <div class="modal-footer">
                    <button type="button" class="btn btn-sm btn-light border" data-bs-dismiss="modal">キャンセル</button>
                    
                    <button type="submit" 
                            form="entryForm" 
                            name="approval_status" 
                            value="reject" 
                            class="btn btn-sm btn-danger" 
                            onclick="submitAfterValidate(0)"
                            >
                        実行
                    </button>
                </div>
            </div>
        </div>
    </div>
                </div>
            </div>
        </div>
    </div>
    </div>
    <style>
        label:has(input[type="radio"]:checked) {
            background: #86b7fe;
        }
        .form-control:disabled{
          background-color: unset;
        }
        .form-check-input:disabled,.form-check-input[disabled]~.form-check-label, .form-check-input:disabled~.form-check-label{
          opacity:1;
        }
    </style>
    <script>
        function submitAfterValidate(status) {
            const form = document.getElementById('entryForm');
            if (!form.reportValidity()) {
                return false;
            } else {
                document.getElementById('approval_status').value = status;
                form.submit();
            }
        }
    </script>
@endsection