@extends('pro.clients.view')
@section('content-inner')

    <div class="form-contents"><div class="failed-form-contents">

    <h4 class="d-flex m-0 p-3 stag-heading stag-heading-modal">
        <div>Edit Demographics</div>
        <div class="ml-auto">
            <a class="text-secondary" href="#" up-close>
                <i class="fa fa-times"></i>
            </a>
        </div>
    </h4>

    <form action="/post-to-api"
          up-target="#main-content" up-history="false" up-fail-target=".failed-form-contents" up-reveal="false"
          method="post" enctype="multipart/form-data"
          class="border-top px-3 pt-3 pb-1 custom-submit">
        @csrf

        @if (session('message'))
            <div class="alert alert-danger">{{ session('message') }}</div>
        @endif

        <input type="hidden" name="_uid" value="{{ $record->uid }}">
        <input type="hidden" name="_api" value="/api/client/editDemographics">
        <input type="hidden" name="_success" value="{{route('clients-view', ['uid' => $record->uid])}}">
        <input type="hidden" name="_return" value="{{route('clients_SINGLE-ACTION_editDemographics', ['uid' => $record->uid])}}">
        <div class='form-group mb-3'>
<label class='control-label'>Sex </label>
<select class='form-control' name='sex' value='{{ old('sex') ? old('sex') : $record->sex }}' >
<option value=''>-- Select --</option>
<option <?= 'M' === (old('sex') ? old('sex') : $record->sex) ? 'selected' : '' ?> value='M'>M</option>
<option <?= 'F' === (old('sex') ? old('sex') : $record->sex) ? 'selected' : '' ?> value='F'>F</option>
</select>
</div>
<div class='form-group mb-3'>
<label class='control-label'>Gender Identity </label>
<input class='form-control' type='text' name='genderIdentity' value='{{ old('genderIdentity') ? old('genderIdentity') : $record->gender_identity }}' >
</div>
<div class='form-group mb-3'>
<label class='control-label'>Sexual Orientation </label>
<input class='form-control' type='text' name='sexualOrientation' value='{{ old('sexualOrientation') ? old('sexualOrientation') : $record->sexual_orientation }}' >
</div>
<div class='form-group mb-3'>
<label class='control-label'>Is Sexually Active </label>
<select class='form-control' name='isSexuallyActive' value='{{ old('isSexuallyActive') ? old('isSexuallyActive') : $record->is_sexually_active }}' >
<option value=''>-- Select --</option>
<option <?= 'YES' === (old('isSexuallyActive') ? old('isSexuallyActive') : $record->is_sexually_active) ? 'selected' : '' ?> value='YES'>YES</option>
<option <?= 'NO' === (old('isSexuallyActive') ? old('isSexuallyActive') : $record->is_sexually_active) ? 'selected' : '' ?> value='NO'>NO</option>
<option <?= 'UKNOWN' === (old('isSexuallyActive') ? old('isSexuallyActive') : $record->is_sexually_active) ? 'selected' : '' ?> value='UKNOWN'>UKNOWN</option>
</select>
</div>
<div class='form-group mb-3'>
<label class='control-label'>Sexually Active Memo </label>
<input class='form-control' type='text' name='sexuallyActiveMemo' value='{{ old('sexuallyActiveMemo') ? old('sexuallyActiveMemo') : $record->sexually_active_memo }}' >
</div>
<div class='form-group mb-3'>
<label class='control-label'>Marital Status </label>
<input class='form-control' type='text' name='maritalStatus' value='{{ old('maritalStatus') ? old('maritalStatus') : $record->marital_status }}' >
</div>
        <div class="form-group mb-3 d-flex justify-content-center">
            <button class="btn btn-sm btn-primary mr-3 px-5">Submit</button>
            <a href="{{route('clients-view', ['uid' => $record->uid])}}" class="btn btn-sm btn-default px-5" up-close>Cancel</a>
        </div>
    </form>

    </div></div>

@endsection
