{% 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;
    }

    .category-image {
        max-width: 150px;
        width: 150px;
        height: 150px;
        height: auto;
        margin-right: 20px;
        margin-bottom: 20px;
        box-shadow: 0 4px 8px rgba(0, 0, 0, 0.3);
    }

    .image-container {
        display: flex;
        align-items: center;
        margin-bottom: 20px;
    }

    .image-label {
        margin-right: 10px;
        min-width: 120px;
        text-align: right;
    }
</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>Create Insurance</h4>
                    <span class="ml-1">Fill in the details for the new 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)">Create Insurance</a></li>
                </ol>
            </div>
        </div>

        <div class="row">
            <div class="col-xl-12 col-xxl-12">
                <div class="card">
                    <div class="card-header">
                        <h4 class="card-title">Create Insurance</h4>
                        <div>
                            <a href="{% url 'insurances_list' %}">
                                <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">
                            <form method="POST" enctype="multipart/form-data">
                                {% csrf_token %}

                                <!-- Insurance Details Form -->
                                <h5>Insurance Details</h5>

                                <div class="form-group row">
                                    <label class="col-sm-2 col-form-label">Insurance Name</label>
                                    <div class="col-sm-10">
                                        <input type="text" class="form-control" name="insurance_name" placeholder="Insurance Name" required>
                                    </div>
                                </div>

                                <div class="form-group row">
                                    <label class="col-sm-2 col-form-label">Insurance Logo</label>
                                    <div class="col-sm-10">
                                        <img id="insurance-logo-preview" src="{% static 'images/default_image.png' %}" alt="Insurance Logo" class="category-image">
                                    </div>
                                    <div class="col-sm-10 ml-auto">
                                        <input type="file" class="form-control" id="insurance-logo-input" name="insurance_logo">
                                    </div>
                                </div>

                                <div class="form-group row">
                                    <label class="col-sm-2 col-form-label">Insurance Link</label>
                                    <div class="col-sm-10">
                                        <input type="url" class="form-control" name="insurance_link" placeholder="Insurance Link" required>
                                    </div>
                                </div>

                                <div class="form-group row">
                                    <label class="col-sm-2 col-form-label">Status</label>
                                    <div class="col-sm-10 ml-auto">
                                        <select class="form-control" name="status">
                                            <option value="1">Active</option>
                                            <option value="0">Inactive</option>
                                        </select>
                                    </div>
                                </div>

                                <!-- Submit Button -->
                                <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>

<script>
    document.getElementById('insurance-logo-input').addEventListener('change', function () {
        var input = this;
        var reader = new FileReader();
        reader.onload = function (e) {
            document.getElementById('insurance-logo-preview').src = e.target.result;
        };
        reader.readAsDataURL(input.files[0]);
    });
</script>

{% endblock %}