@extends('layouts.admin')

@section('content')
    <div class="ks-column ks-page">
        <div class="ks-page-header">
            <section class="ks-title">
                <h3>{{tran('Claims')}}</h3>
            </section>
        </div>

        <div class="ks-page-content">
            <div class="ks-page-content-body">
                <div class="ks-nav-body-wrapper">
                    <div class="container-fluid">
                        <div class="row">
                            <div class="col-lg-12 ks-panels-column-section">
                                <div class="card">
                                    <div class="card-block">
                                        <h5 class="card-title">Search By</h5>
                                        <form method="post" action="{{route('assistance-claims.view-search')}}" id="searchForm">
                                            {{ csrf_field() }}
                                            <div class="form-group row">
                                                <label for="record[issue_date]" class="col-2 col-form-label">{{tran('Issued before Date')}}*
                                                    <span class="required"></span>
                                                </label>
                                                <div class="col-md-6">
                                                    <input type="text" name="record[issue_date]" class="form-control ks-daterange-single" required>
                                                </div>
                                            </div>
                                            <div class="form-group row">
                                                <label for="record[payment_status_id]" class="col-2 col-form-label">{{tran('Claim Status')}}
                                                    <span class="required"></span>
                                                </label>
                                                <div class="col-sm-6">
                                                    <select class="form-control ks-select" name="record[claim_status_id]" >
                                                        <option></option>
                                                        @foreach($claim_statuses as $claim_status)
                                                            <option value="{{$claim_status->id}}">{{lang($claim_status->title)}}</option>
                                                        @endforeach
                                                    </select>
                                                </div>
                                            </div>
                                            <div class="form-group row">
                                                <label for="default-input-rounded" class="col-sm-2 form-control-label">Client</label>
                                                <div class="col-sm-6">
                                                    <select class="form-control ks-select" name="record[client_id]" >
                                                        <option></option>
                                                        @foreach($clients as $client)
                                                            <option value="{{$client->id}}">{{lang($client->first_name)}} {{lang($client->last_name)}}</option>
                                                        @endforeach
                                                    </select>
                                                </div>
                                            </div>
                                            <div class="row">
                                                <div class="col-sm-2 offset-md-2">
                                                    <input type="submit" class="btn btn-primary btn-block" value="Submit" onclick=" return formSubmit()">
                                                </div>
                                            </div>
                                        </form>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
@endsection

@section('javascript')
    <script>
		function formSubmit() {
			$('#searchForm').validate();
			$('#searchForm').submit();
		}
    </script>
@endsection