@extends('layouts.app')

@section('content')
<div class="container">
    <div class="card shadow-sm mt-4">
        <div class="card-header bg-dark text-white fw-bold">
            Add Cataract Record for {{ $patient->name }}
        </div>
        <div class="card-body">
            <form action="{{ route('patients.cataract-records.store', $patient->id) }}" method="POST">
                @csrf

                <div class="row">
                    <div class="col-md-6">
                        <div class="mb-3">
                            <label for="surgeon_name" class="form-label">Surgeon Name</label>
                            <input type="text" class="form-control" id="surgeon_name" name="surgeon_name" value="{{ old('surgeon_name') }}" required>
                        </div>
                    </div>
                    <div class="col-md-6">
                        <div class="mb-3">
                            <label for="pre_op_evaluation" class="form-label">Pre-op Evaluation</label>
                            <textarea class="form-control" id="pre_op_evaluation" name="pre_op_evaluation" rows="2">{{ old('pre_op_evaluation') }}</textarea>
                        </div>
                    </div>
                </div>

                <div class="row">
                    <div class="col-md-6">
                        <div class="mb-3">
                            <label for="surgery_details" class="form-label">Surgery Details</label>
                            <textarea class="form-control" id="surgery_details" name="surgery_details" rows="2">{{ old('surgery_details') }}</textarea>
                        </div>
                    </div>
                    <div class="col-md-6">
                        <div class="mb-3">
                            <label for="post_op_notes" class="form-label">Post-op Notes</label>
                            <textarea class="form-control" id="post_op_notes" name="post_op_notes" rows="2">{{ old('post_op_notes') }}</textarea>
                        </div>
                    </div>
                </div>

                <div class="mt-3 d-flex justify-content-start">
                    <button type="submit" class="btn btn-success me-2">Save Record</button>
                    <a href="{{ route('patients.cataract-records', $patient->id) }}" class="btn btn-secondary">Cancel</a>
                </div>
            </form>
        </div>
    </div>
</div>
@endsection