@extends('layouts.app')

@section('content')
    <div class="container">
        <div class="row justify-content-center">
            <div class="col-md-10">        
              {{ Breadcrumbs::render('disaster.request.confirm',$id) }}
                <div class="shadow card">
                    <div class="shadow-sm card-header fs-3">労保連労働災害保険金請求書起票確認画面</div>
                        <form id="entryForm" method="POST" action="{{ route('disaster.request.store',['id' => $id]) }}">
                            @csrf
                            <div class="card-body">
                            <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>
                                    @php
                                    $input = session('dsr_input', []);
                                    $LIN = explode('-',$app->LINumber);
                                    @endphp
                                    <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">事業場名</span>
                                    <input type="text" value="{{ $ins->workspace }}" name="workplacename" 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">被災者氏名</span>
                                        <input type="text" value="{{ $ds->victim }}" class="form-control fs-5 non" 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</span>
                                        <input id="happen_date" name="happen_date" type="datetime-local"
                                            value="{{ $ds->incident_at }}"
                                            class="form-control fs-5 text-center non @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">保険の型</span>
                                    <input type="text" value="{{ $ins->pattern }}" class="form-control fs-5 non" disabled>
                                </div>
                                <div class="d-flex">
                                    <div class="col-5">
                                    <div class="shadow-sm input-group mb-3">
                                        <span class="input-group-text bg-secondary-subtle fs-5 col-3">請求内容</span>
                                        <select id="kind" name="kind" class="form-control fs-5" onchange="kChange()" disabled>
                                        <option value="未確定" {{ $input['kind'] == "未確定" ? 'selected' : '' }}>未確定</option>
                                        <option value="死亡保険金" {{ $input['kind'] == "死亡保険金" ? 'selected' : '' }}>死亡保険金・死亡弔慰金</option>
                                        <option value="障害保険金" {{ $input['kind'] == "障害保険金" ? 'selected' : '' }}>障害保険金</option>
                                        <option value="休業保険金" {{ $input['kind'] == "休業保険金" ? 'selected' : '' }}>休業保険金</option>
                                        </select>
                                    </div>
                                    </div>
                                    <div id="dy" class="col-3 ps-1 d-none">
                                    <div class="shadow-sm input-group mb-3">
                                        <span class="input-group-text bg-secondary-subtle fs-5 col-5">障害等級</span>
                                        <input type="number" value="{{ $input['grade'] ?? '' }}" id="grade" name="grade" class="form-control fs-5" disabled>
                                        <span class="input-group-text bg-secondary-subtle fs-5 col-3">級</span>
                                    </div>
                                    </div>
                                    <div id="dt1" class="col-3 ps-1 d-none">
                                    <div class="shadow-sm input-group mb-3">
                                        <span class="input-group-text bg-secondary-subtle fs-5">休業日数</span>
                                        <input type="text" value="{{ $input['downTime'] ?? '' }}" id="downTime" name="downTime" class="form-control fs-5" disabled>
                                        <span class="input-group-text bg-secondary-subtle fs-5">日</span>
                                    </div>
                                    </div>
                                </div>
                                <div id="dt2" class="d-flex d-none">
                                    <div class="col-7">
                                    <div class="shadow-sm input-group mb-3">
                                        <span class="input-group-text bg-secondary-subtle fs-5 col-3">休業期間</span>
                                        <input type="date" value="{{ $input['startDate'] ?? '' }}" id="startDate" name="startDate" class="form-control fs-5" disabled>
                                        <span class="input-group-text bg-secondary-subtle fs-5">～</span>
                                        <input type="date" value="{{ $input['endDate'] ?? '' }}" id="endDate" name="endDate" class="form-control fs-5" disabled>
                                    </div>
                                    </div>
                                    <div class="col-5 ps-1">
                                    <div class="shadow-sm input-group mb-3">
                                        <span class="input-group-text bg-secondary-subtle fs-5">休業期間内の休業日数</span>
                                        <input type="text" value="{{ $input['inDownTime'] ?? '' }}" id="inDownTime" name="inDownTime" class="form-control fs-5">
                                        <span class="input-group-text bg-secondary-subtle fs-5">日</span>
                                    </div>
                                    </div>
                                </div>
                                <div class="d-flex">
                                    <a href="{{ route('home') }}" class="fs-5 btn btn-secondary shadow-sm">一覧に戻る</a>
                                    <button type="submit" class="fs-5 btn btn-secondary shadow-sm"
                                        style="margin:auto 0px auto auto" onClick="submitAfterValidate();">起票する</button>
                                </div>
                            </div>
                        </form>
                    </div>
                </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>
    <script>
        function submitAfterValidate() {
            const form = document.getElementById('entryForm');
            form.submit();
        }
                function kChange() {
          const sel = document.getElementById('kind');
          const dy = document.getElementById("dy");
          const dt1 = document.getElementById("dt1");
          const dt2 = document.getElementById("dt2");
          const gr = document.getElementById("grade");
          const sd = document.getElementById("startDate");
          const ed = document.getElementById("endDate");
          const dtime = document.getElementById("downTime");
          const idtime = document.getElementById("inDownTime");
          if (sel.value == "休業保険金") {
              dy.classList.add('d-none');
              dy.classList.remove('d-block');
              dt1.classList.remove('d-none');
              dt1.classList.add('d-block');
              dt2.classList.remove('d-none');
              dt2.classList.add('d-block');
          } else if(sel.value == "障害保険金") {
              dy.classList.remove('d-none');
              dy.classList.add('d-block');
              dt1.classList.add('d-none');
              dt1.classList.remove('d-block');
              dt2.classList.add('d-none');
              dt2.classList.remove('d-block');
          } else {
              dy.classList.add('d-none');
              dy.classList.remove('d-block');
              dt1.classList.add('d-none');
              dt1.classList.remove('d-block');
              dt2.classList.add('d-none');
              dt2.classList.remove('d-block');
          }
        }
        kChange()
    </script>
@endsection