@extends('layouts.app')

@section('content')
    <div class="container">
        <div class="row justify-content-center">
            <div class="col-md-10">        
              {{ Breadcrumbs::render('disaster.confirm',$app->application_id) }}
                <div class="shadow card">
                    <div class="shadow-sm card-header fs-3">労働災害発生通報確認画面</div>
                    <form id="entryForm" method="POST" action="{{ route('disaster.store',['id' => $app->application_id]) }}">
                        @csrf
                        <div class="card-body">
                            @php($input2 = session('input2', []))
                            @php($LIN = explode('-',$app->LINumber))
                            @if (session('status'))
                            <div class="alert alert-success" role="alert">
                                {{ session('status') }}
                            </div>
                            @endif
                            <div class="fs-5 mb-3 red text-center text-danger">この内容で登録します。よろしいでしょうか？</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 non"
                                        name="prefecture" id="floatingInput1" maxlength="2" value="{{ $LIN[0] }}"
                                        placeholder="99" disabled>
                                    <label for="floatingInput1">府県</label>
                                </div>
                                <div class="form-floating" style="width: 70px;flex: none;">
                                    <input type="text" class="form-control fs-5 non"
                                        name="remit" id="floatingInput2" maxlength="1" value="*"
                                        placeholder="9" disabled>
                                    <label for="floatingInput2">所掌</label>
                                </div>
                                <div class="form-floating" style="width: 70px;flex: none;">
                                    <input type="text"
                                        class="form-control fs-5 non"
                                        name="jurisdiction" 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 non"
                                        name="core_number" id="floatingInput4" maxlength="6"
                                        value="{{ $LIN[1] }}" placeholder="999999" disabled>
                                    <label for="floatingInput4">基幹番号</label>
                                </div>
                                <div class="form-floating">
                                    <input type="text"
                                        class="form-control fs-5 non"
                                        name="branch_number" id="floatingInput5" maxlength="3"
                                        value="{{ $LIN[2] }}" placeholder="999" disabled>
                                    <label for="floatingInput5">枝番号</label>
                                </div>
                                <div class="form-floating" style="width: 70px;flex: none;">
                                    <input type="text"
                                        class="form-control fs-5 non"
                                        name="" id="floatingInput6" maxlength="2"
                                        value="{{ $LIN[3] }}" 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"
                                    id="inputGroup-sizing-sm">事業場の名称</span>
                                <input type="text" value="{{ $ins->workspace }}" class="form-control fs-5 non" 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 col-4"
                                            id="inputGroup-sizing-sm">被災者の氏名</span>
                                        <input type="text" value="{{ $input2['name'] }}" class="form-control fs-5" disabled>
                                    </div>
                                </div>
                                <div class="col-6 ms-1 pe-1">
                                    <div class="shadow-sm input-group mb-3">
                                        <span class="input-group-text bg-secondary-subtle fs-5 col-4">災害発生日時</span>
                                        <input id="happen_date" name="happen_date" type="datetime-local"
                                            value="{{ $input2['happen_date'] }}"
                                            class="form-control fs-5 text-center @error('happen_date') is-invalid @enderror"
                                            pattern="[0-9]{4}-[0-9]{2}-[0-9]{2} [0-9]{2}:-[0-9]{2}"
                                            max="9999-12-31 23:59" onchange="dateChange()" disabled>
                                    </div>
                                </div>
                            </div>
                            <div class="shadow-sm input-group mb-3">
                                <span class="input-group-text bg-secondary-subtle fs-5 col-3">災害発生状況<br>(240文字)</span>
                                <textarea class="form-control fs-5" aria-label="With textarea" maxlength="150" rows="8" disabled>{{ $input2['summary'] }}</textarea>
                            </div>
                            <div class="d-flex">
                            <a onclick="history.back();" class="fs-5 btn btn-secondary shadow-sm">入力画面に戻る</a>
                            <button type="submit" class="fs-5 btn btn-secondary shadow-sm"  onClick="submitAfterValidate();"
                                style="margin:auto 0px auto auto">登録する</button>
                            </div>
                        </div>
                    </form>
                </div>
            </div>
        </div>
    </div>
    <style>
        .form-control:disabled {
            background-color: unset;
        }
        .non:disabled{
        background-color: var(--bs-secondary-bg);
        }
        label:has(input[type="radio"]:checked) {
            background: #86b7fe;
        }
    </style>
@endsection