@extends('master')

<script type="text/javascript">
	$(document).foundation();
</script>
@section('content')
    <div class="row">
      	<div class="large-12 columns">
        	<h1>Provider Data</h1>
      	</div>
    </div>

    <div class="row">
        <div class="small-12 medium-6 large-6 columns">
            <h4>Place Holder</h4>
        </div>
    </div>


    <div class="row">

    	<!-- <form action="{{{ URL::to('provider') }}}" method="post" data-abide> -->

    	<!-- <form action="{{{ URL::to('//localhost/ChE/ChE/public/provider/accepted') }}}" method="post" data-abide> -->
    	<!-- <form action="{{{ URL::to('//208.89.211.101/ChE/provider/accepted') }}}" method="post" data-abide> -->
    	<form action="{{{ URL::to('provider/accepted') }}}" method="post" data-abide>

			<div class="small-12 medium-12 large-12  columns">
        
	        <!-- <form> -->

	        <input hidden id="provider_ID" name="provider_ID" value="{{{$providerData->id}}}" readonly/>

		         <div class="row">
	                <div class="small-12 medium-10 large-10 columns">
	                  <label>First Name</label>
	                  <strong> {{{ $providerData->fname }}} </strong>
	                  <input type="hidden" id="first_name" name="first_name" placeholder="" required pattern="[a-zA-Z]+" value="{{{$providerData->fname}}}" readonly/>
	                  <small class="error" data-error-message>First Name is required and must be a string.</small>
	                </div>
	                <div class="small-4 medium-2 large-2 columns">
	                  <label>Middle Name</label>
	                  <strong> {{{ $providerData->mname }}} </strong>
	                  <input type="hidden" id="middle_name" name="middle_name" placeholder="" pattern="[a-zA-Z]+" value="{{{$providerData->mname}}}" readonly/>
	                  <small class="error" data-error-message>Must be a string.</small>
	                </div>
	                
	            </div>

	            <div class="row">
	            	<div class="small-12 medium-6 large-6 columns">
	                  <label>Last Name</label>
	                  <strong> {{{ $providerData->lname }}} </strong>
	                  <input type="hidden" id="last_name" name="last_name" placeholder="" required pattern="[a-zA-Z]+" value="{{{$providerData->lname}}}" readonly/>
	                  <small class="error" data-error-message>Last Name is required and must be a string.</small>
	                </div>
	                <div class="small-4 medium-2 large-2 columns">
	                  <label>Title</label>
	                  <strong> {{{ $providerData->title }}} </strong>
	                  <input type="hidden" id="provider_title" name="provider_title" placeholder="" pattern="[a-zA-Z]+" value="{{{$providerData->title}}}" readonly/>
	                  <small class="error" data-error-message>Must be a string.</small>
	                </div>
	            </div>

	            <div class="row">
	            	<div class="small-12 medium-6 large-6 columns">
	            		<label>Email / Username</label>
	            		<strong> {{{ $providerData->username }}} </strong>
	            		<input type="hidden" id="provider_email" name="provider_email" placeholder="" required value="{{{$providerData->username}}}" readonly/>
	            	</div>
	            </div>

	            <div class="row">
	            	<div class="small-12 medium-6 large-6 columns">
	            		<label>ChE User Role</label>
	            		@if($providerData->userRole === 'Administrator')

							<strong> {{{ 'Administrator' }}} </strong>
	            			<input type="hidden" id="user_role" name="user_role" placeholder="" required value="Administrator" readonly/>

	            		@elseif($providerData->userRole === 'Provider')

							<strong> {{{ 'Provider' }}} </strong>
	            			<input type="hidden" id="user_role" name="user_role" placeholder="" required value="Provider" readonly/>

	            		@elseif($providerData->userRole === 'Staff')

							<strong> {{{ 'Staff' }}} </strong>
	            			<input type="hidden" id="user_role" name="user_role" placeholder="" required value="Staff" readonly/>

	            		@endif
	            		
	            	</div>
	            </div>
	            

	            <div class="row">
	                <div class="large-12 columns">
	                  <hr>
	                  <h2>Address</h2>
	                </div>
	            </div>


		        <div id="address">

	              <div class="row">
	                  <div class="small-12 medium-12 large-12 columns">
	                    <label>Address 1</label>
	                    <strong> {{{ $providerData->address1 }}} </strong>
	                    <input type="hidden" id="address1" name="address1" placeholder="" required  value="{{{$providerData->address1}}}" readonly/>
	                    <small class="error" data-error-message>Street is required and must be a string.</small>
	                  </div>
	                  <div class="small-12 medium-12 large-12 end columns">
	                    <label>Address 2</label>
	                    <strong> {{{ $providerData->address2 }}} </strong>
	                    <input type="hidden" id="address2" name="address2" placeholder="" required  value="{{{$providerData->address2}}}" readonly/>
	                    <small class="error" data-error-message>Street is required and must be a string.</small>
	                  </div>
	              </div>
	              <div class="row">
	                  <div class="small-12 medium-4 large-4 columns">
	                    <label>City</label>
	                    <strong> {{{ $providerData->city }}} </strong>
	                    <input type="hidden" id="city" name="city" placeholder="" value="{{{$providerData->city}}}" readonly />
	                    <small class="error" data-error-message>Must be a string.</small>
	                  </div>
	                  <div class="small-12 medium-4 large-4 columns">
	                    <label>State</label>
	                    <strong> {{{ $providerData->state }}} </strong>
	                    <input type="hidden" id="state" name="state" placeholder="" value="{{{$providerData->state}}}" readonly/>
	                    <small class="error" data-error-message>Must be a string.</small>
	                  </div>
	                  <div class="small-12 medium-4 large-4 columns">
	                    <label>Zipcode</label>
	                    <strong> {{{ $providerData->zip }}} </strong>
	                    <input type="hidden" id="postal_code" name="postal_code" placeholder="" required value="{{{$providerData->zip}}}" readonly/>
	                    <small class="error" data-error-message>Zipcode is required.</small>
	                  </div>
	                  
	                  <div class="large-12 columns">
	                    <hr>
	                  </div>
	              </div>

	            </div>

		

		        <div class="row">
	                <div class="small-12 medium-4 large-4 columns">
	                  <label>Phone</label>
	                  <strong> {{{ $providerData->phone }}} </strong>
	                  <input type="hidden" id="phone" name="phone" placeholder="" value="{{{$providerData->phone}}}" readonly />
	                </div>
	                <!-- <div class="small-12 medium-4 large-4 end columns">
	                  <label>Email</label>
	                  <input type="email" id="email" name="email" required placeholder="" value="{{{$providerData->email}}}" readonly/>
	                  <small class="error" data-error-message>Email is required with email format.</small>
	                </div> -->
	            </div>

		        <div class="row">
		            <div class="small-12 medium-4 large-4 columns">
			            <label>License</label>
			            <strong> {{{ $providerData->license }}} </strong>
			            <input type="hidden" id="license" name="license" placeholder="" pattern="([A-Za-z]{1})[0-9]+" required value="{{{$providerData->license}}}" readonly/>
			            <small class="error" data-error-message>License is required with one letter and numbers.</small>
		            </div>
		            <div class="small-12 medium-4 large-4 end columns">
			            <label>Preferred Lab Id</label>
			            <strong> {{{ $providerData->labName }}} </strong>
			            <input type="hidden" id="preferred_lab" name="preferred_lab" placeholder="" required value="{{{$providerData->preferred_lab}}}" readonly/>
		            </div>
		        </div>

		        <div class="row">
		        	<div class="small-12 medium-4 large-4 columns">
		        		<label>OEHHA</label>
		        		<input type="checkbox" {{ $providerData->oehha ? 'checked' : '' }} disabled>
		        		<input type="hidden" name="oehha" value="{{ $providerData->oehha ? '1' : '0' }}">
		        	</div>
		        </div>

		        <div class="row">
				<hr>
		        	@if($providerData->status === "Waiting")

		                <div class="small-12 medium-4 large-4 columns">
		                	<button class="expand">Approve</button>
		                </div>

		                <div class="small-12 medium-4 large-4 columns">
		                	<a href="{{{URL::to('provider/reject/' . $providerData->id)}}}" class="button expand">Reject</a>
		                </div>

		            @endif

	                <div class="small-12 medium-4 large-4 end columns">
	                  <a href="{{{ URL::to('provider') }}}" class="button expand">Back</a>
	                </div>
	            </div>
 
	        <!-- </form> -->

			</div>


      	</form>

    </div>

    
@stop