@extends('master')


@section('content')

	<div class="row">
        <div class="large-12 columns">
            <div class="row">
                <div class="small-12 medium-12 large-12 columns">
                    <h4>Post exam provider orders</h4>
                </div>
            </div>
            @if(isset($send) && $send == true)
            <div class="row">
                <div class="small-12 medium-12 large-12 columns">
                    <h4><span style="color:red">The lab report has been requested</span></h4>
                </div>
            </div>
            @endif
            <div class="row">
                <div class="small-12 medium-12 large-12 columns">
                    <p>This screen is for:</p>
                    
                    <ol>
                    	<li>Sending an electronic lab order message</li>
                    	<li>Notifying worker and employer of current work status</li>
                    </ol>
                    
                </div>
            </div>
        </div>
    </div>

    <div class="row">
            
        <div class="small-12 large-4 columns">
            @if(isset($send) && $send == true)
                <a href="#" class='button disabled'>Send To Lab</a>
            @else
                <a href="{{{ URL::to('patients/' . $pid . '/lab/order') }}}" class="button digital-signature">Send To Lab</a>
            @endif
        </div>
    </div>
<form id="actionForm" action="{{{ URL::to('patients/' . $pid . '/manual/notification/preview') }}}" method="GET">
    <div class="row">
        <div class="large-12 columns">
            <div class="row">
                <div class="small-12 medium-6 large-12 columns">
                    <hr>
                    <h5>Notifications - Restrictions and Follow-up</h5>
                    <div class="row">
                        <div class="large-12 columns">
                            <p>
                                <label>
                                    <input type="radio" id="restriction" name="restriction" value="1"/>
                                    Release to work with no restrictions
                                </label>
                            </p>
                        </div>
                    </div>
                    <div class="row">
                        <div class="large-12 columns">
                            <p>
                                <label>
                                    <input type="radio" id="restriction" name="restriction" value="2"/>
                                    Release to work with no restrictions, Employee investigation required
                                </label>
                            </p>
                        </div>
                    </div>
                    <div class="row">
                        <div class="large-12 columns">
                            <p>
                                <label><input type="radio" id="restriction" name="restriction" value="3"/>
                                No handling of ChE inhibiting pesticides until after follow-up testing</label>
                            </p>
                        </div>
                    </div>
                    <div class="row">
                        <div class="large-12 columns">
                            <textarea id="customDate" name="customDate" rows="4" cols="20" placeholder="Please specify test date or approximate interval"></textarea>
                        </div>
                    </div>

                </div>

            </div>
            
        </div>
    </div>
</div>

	<div class="row">
		<div class="small-12 large-4 columns">
			<button class="button expand" href=" {{{ URL::to('patients/' . $pid . '/notification') }}} ">Notification</button>
		</div>

		<div class="small-12 large-4 columns">
			<a class="button expand" href=" {{{ URL::to('patients/' . $pid) }}} ">Return to patients</a>
		</div>
	</div>
</form> 
	 <div id="myModal" class="reveal-modal" data-reveal aria-labelledby="modalTitle" aria-hidden="true" role="dialog">
        <form id="actionForm" action="" method="POST">
			<input hidden name="pid" value="{{{$pid}}}" />
			<input hidden name="examType" value="{{{$examType}}}" />
        </form>
        <form id="signForm" action="" method="GET">
            <div class="row">
              <div class="large-6 columns">
                <label for="password">Please type your digital signature password</label>
                <input type="password" name="password">
                <button class="button">Sign</button>
              </div>
            </div>
        </form>
      <a class="close-reveal-modal" aria-label="Close">&#215;</a>
    </div>

	<script>

    $(document).ready(function(){
        $('#signForm').submit(function(e) {
            e.preventDefault();
            var url = '{{ URL::to("sign") }}';
            var passvalue = $("#signForm").find( "input[name='password']" ).val();
            var formData = {};
            $("#signForm").find("input[name='password']").each(function (index, node) {
                formData[node.name] = node.value;
            });
            $.ajax({
              type: "POST",
              url: url,
              contentType: "application/x-www-form-urlencoded; charset=UTF-8",
              data: formData
            }).done(function(response) {
              if(response==='true'){
                  $("#actionForm").attr("action", $('a.digital-signature').attr("href"));
                  $("#actionForm").submit();
              }
            });
        });
        $('a.digital-signature').on('click', function(e) {
            e.preventDefault();
            $('#myModal').foundation('reveal','open');
        });

       $('#close').foundation('reveal', 'close');
    });

	</script>

    
@stop