{% extends 'admin/master.html' %}
{% load static %}

{% block content %}
<style>
    .dark-font {
        color: #454545;
    }

    .form-group {
        position: relative;
    }

    .badge-inside {
        position: absolute;
        top: 50%;
        left: 30px;
        transform: translateY(-50%);
        background-color: #ffaa16;
        color: rgb(31, 29, 29);
    }

    .form-control {
        padding-right: 80px;
    }

    .card-header {
        display: flex;
        justify-content: space-between;
        align-items: center;
    }

    .card-header .btn {
        margin-left: 10px;
    }

</style>

<div class="content-body">
    <div class="container-fluid">
        <div class="row page-titles mx-0">
            <div class="col-sm-6 p-md-0">
                <div class="welcome-text">
                    <h4>Hi, welcome back!</h4>
                    <span class="ml-1">Edit Hospital Insurance</span>
                </div>
            </div>
            <div class="col-sm-6 p-md-0 justify-content-sm-end mt-2 mt-sm-0 d-flex">
                <ol class="breadcrumb">
                    <li class="breadcrumb-item"><a href="javascript:void(0)">Form</a></li>
                    <li class="breadcrumb-item active"><a href="javascript:void(0)">Edit Hospital Insurance</a></li>
                </ol>
            </div>
        </div>

        <div class="row">
            <div class="col-xl-6 col-xxl-12">
                <div class="card">
                    <div class="card-header">
                        <h4 class="card-title">Edit Hospital Insurance</h4>
                        <div>
                            <a href="/admin/hospital_insurances/">
                                <button title="list" type="button" class="btn btn-rounded btn-outline-success">
                                    <span><i class="fa fa-list"></i></span>
                                </button>
                            </a>
                        </div>
                    </div>
                    <div class="card-body">
                        <div class="basic-form">
                            <!-- Hospital Insurance Form -->
                            <form method="POST" enctype="multipart/form-data">
                                {% csrf_token %}
                                <div class="form-group row">
                                    <label class="col-sm-2 col-form-label">Hospital</label>
                                    <div class="col-sm-10">
                                        <select id="hospital" class="form-control" name="hospital">
                                            <option selected>Choose...</option>
                                            {% for hospital in hospitals %}
                                            <option value="{{ hospital.id }}" {% if hospital.id == hospital_insurance.hospital_id %}selected{% endif %}>{{ hospital.hospital_name }}</option>
                                            {% endfor %}
                                        </select>
                                    </div>
                                </div>

                                <div class="form-group row">
                                    <label class="col-sm-2 col-form-label">Insurance</label>
                                    <div class="col-sm-10">
                                        <select id="insurance" class="form-control" name="insurance">
                                            <option selected>Choose...</option>
                                            {% for insurance in insurances %}
                                            <option value="{{ insurance.id }}" {% if insurance.id == hospital_insurance.insurance_id %}selected{% endif %}>{{ insurance.insurance_name }}</option>
                                            {% endfor %}
                                        </select>
                                    </div>
                                </div>

                                <div class="form-group row">
                                    <label class="col-sm-2 col-form-label">Status</label>
                                    <div class="col-sm-10">
                                        <select id="status" class="form-control" name="status">
                                            <option value="1" {% if hospital_insurance.status == 1 %}selected{% endif %}>Active</option>
                                            <option value="0" {% if hospital_insurance.status == 0 %}selected{% endif %}>Inactive</option>
                                        </select>
                                    </div>
                                </div>

                                <div class="form-group row">
                                    <div class="col-sm-10 offset-sm-2">
                                        <button type="submit" class="btn btn-primary">Submit</button>
                                    </div>
                                </div>
                            </form>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
</div>
{% endblock content %}