@extends('master')
@section('title')
Reclamo - gastos medicos
@endsection
@section('breadcrumb')
<li class="breadcrumb-item">
        <a href="{{url('/claims/list')}}">
        <i class="bi bi-file-earmark-medical"></i>
            Reclamos
        </a>
    </li>
    <li class="breadcrumb-item">
    <a href="{{url('/claims/create-list')}}">
        <i class="bi bi-file-earmark-medical"></i>
            Creación nuevo reclamo
        </a>
    </li>
@endsection
@section('link')
<link rel="stylesheet" href="{{url('/static/css/select2.min.css?v='.time())}}">
@endsection
@section('body')
    <div class="col wrapper  ">

        <div class="row">
            <div class=" col-12 mtop16  mb-5">
                <div class="row">
                        <div class=" col-12 ">
                            <div class="panel myshadow">
                                <div class="mypanel">
                                    <div class="title mb-3">
                                        <p><i class="bi bi-plus-circle"></i> Nuevo Reclamo Daños</p>
                                    </div>
                                    <form action="{{ url('/claims/create-damage') }}" method="POST" class="my-forms" enctype="multipart/form-data">
                                        @csrf
                                        <div class="row">
                                            <!-- Grupo: Información del Reclamo -->
                                            <small class="my-2">Información del Reclamo</small>
                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <select required class="form-select js-pick-ticket-id" id="ticket_id" name="ticket_id">
                                                        <option value="">Seleccionar N° Gestión</option>
                                                        @foreach ($tickets as $ticket)
                                                        <option value="{{ $ticket->id }}">NG-{{ $ticket->id }}</option>
                                                        @endforeach
                                                    </select>
                                                    <label for="ticket_id">Número de Gestión</label>
                                                </div>
                                            </div>

                                            <!-- Grupo: Información del Cliente y Seguro -->
                                            <small class="my-2">Información del Cliente y Seguro</small>
                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('client_id') }}" required readonly type="text" class="form-control" id="client_id" name="client_id">
                                                    <label for="client_id">Cliente</label>
                                                </div>
                                            </div>

                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('policy_id') }}" required readonly type="text" class="form-control" id="policy_id" name="policy_id">
                                                    <label for="policy_id">Póliza</label>
                                                </div>
                                            </div>

                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('insurance_id') }}" required readonly type="text" class="form-control" id="insurance_id" name="insurance_id">
                                                    <label for="insurance_id">Aseguradora</label>
                                                </div>
                                            </div>

                                            <!-- Inputs ocultos -->
                                            <input value="{{ old('insurer_id_hidden') }}" type="hidden" id="insurer_id_hidden" name="insurer_id_hidden">
                                            <input value="{{ old('policy_id_hidden') }}" type="hidden" id="policy_id_hidden" name="policy_id_hidden">
                                            <input value="{{ old('client_id_hidden') }}" type="hidden" id="client_id_hidden" name="client_id_hidden">
                                            <input value="{{ old('insurance_id_hidden') }}" type="hidden" id="insurance_id_hidden" name="insurance_id_hidden">
                                            <input value="{{ old('ramo_id_hidden') }}" type="hidden" id="ramo_id_hidden" name="ramo_id_hidden">
                                            <input value="{{ old('product_type') }}" type="hidden" id="product_type" name="product_type">
                                            <input value="3" type="hidden" id="claim_type" name="claim_type">

                                            <!-- Titular -->
                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('insurer_id') }}" required readonly type="text" class="form-control" id="insurer_id" name="insurer_id">
                                                    <label for="insurer_id">Titular</label>
                                                </div>
                                            </div>

                                            <!-- Dependiente -->
                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <select required class="form-select js-pick-insurer-dependient" id="insurer_dependient_id" name="insurer_dependient_id">
                                                        <option value="">Seleccione un dependiente</option>
                                                    </select>
                                                    <label for="insurer_dependient_id">Dependiente del Asegurador</label>
                                                </div>
                                            </div>

                                            <!-- Ramo -->
                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('ramo_id') }}" readonly type="text" class="form-control" id="ramo_id" name="ramo_id">
                                                    <label for="ramo_id">Ramo</label>
                                                </div>
                                            </div>

                                            <!-- Información del Reclamo -->
                                            <small class="my-2">Información del Reclamo</small>
                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('claim_number') }}" required type="text" class="form-control" id="claim_number" name="claim_number">
                                                    <label for="claim_number">Número de Reclamo</label>
                                                </div>
                                            </div>

                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('date_infinity_receive') }}" type="date" class="form-control" id="date_infinity_receive" name="date_infinity_receive">
                                                    <label for="date_infinity_receive">Fecha Recibido en Infinity</label>
                                                </div>
                                            </div>

                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('incident_date') }}" required type="date" class="form-control" id="incident_date" name="incident_date">
                                                    <label for="incident_date">Fecha del Siniestro</label>
                                                </div>
                                            </div>
                                        </div>

                                        <div class="row">
                                            <!-- Grupo: Valores Monetarios -->
                                            <small class="my-2">Valores Monetarios</small>
                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('compensation_value') }}" type="number" step="0.01" class="form-control" id="compensation_value" name="compensation_value">
                                                    <label for="compensation_value">Valor de la Compensación</label>
                                                </div>
                                            </div>

                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('own_damage_value') }}" type="number" step="0.01" class="form-control" id="own_damage_value" name="own_damage_value">
                                                    <label for="own_damage_value">Valor de Daños Propios</label>
                                                </div>
                                            </div>

                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('third_party_damage_value') }}" type="number" step="0.01" class="form-control" id="third_party_damage_value" name="third_party_damage_value">
                                                    <label for="third_party_damage_value">Valor de Daños a Terceros</label>
                                                </div>
                                            </div>

                                            <!-- Deducibles -->
                                            <small class="my-2">Deducibles</small>
                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('deductible_paid_deductible_1') }}" type="date" class="form-control" id="deductible_paid_deductible_1" name="deductible_paid_deductible_1">
                                                    <label for="deductible_paid_deductible_1">Deducible Pagado 1</label>
                                                </div>
                                            </div>

                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('deductible_paid_deductible_2') }}" type="date" class="form-control" id="deductible_paid_deductible_2" name="deductible_paid_deductible_2">
                                                    <label for="deductible_paid_deductible_2">Deducible Pagado 2</label>
                                                </div>
                                            </div>

                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('deductible_paid_deductible_3') }}" type="date" class="form-control" id="deductible_paid_deductible_3" name="deductible_paid_deductible_3">
                                                    <label for="deductible_paid_deductible_3">Deducible Pagado 3</label>
                                                </div>
                                            </div>

                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('deductible_paid_value_1') }}" type="number" step="0.01" class="form-control" id="deductible_paid_value_1" name="deductible_paid_value_1">
                                                    <label for="deductible_paid_value_1">Valor del Deducible 1</label>
                                                </div>
                                            </div>

                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('deductible_paid_value_2') }}" type="number" step="0.01" class="form-control" id="deductible_paid_value_2" name="deductible_paid_value_2">
                                                    <label for="deductible_paid_value_2">Valor del Deducible 2</label>
                                                </div>
                                            </div>

                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('deductible_paid_value_3') }}" type="number" step="0.01" class="form-control" id="deductible_paid_value_3" name="deductible_paid_value_3">
                                                    <label for="deductible_paid_value_3">Valor del Deducible 3</label>
                                                </div>
                                            </div>

                                            <!-- Grupo: Detalles Adicionales -->
                                            <small class="my-2">Detalles Adicionales</small>
                                            <div class="col-lg-6 col-md-6 col-sm-6 col-12 mb-2">
                                                <div class="form-floating">
                                                    <textarea class="form-control" id="pending_case_details" name="pending_case_details" rows="4">{{ old('pending_case_details') }}</textarea>
                                                    <label for="pending_case_details">Detalles del Caso Pendiente</label>
                                                </div>
                                            </div>

                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <select class="form-select" id="settlement_status_id" name="settlement_status_id">
                                                        <option value="">Seleccionar Estado del Finiquito</option>
                                                        <option value="1" @if(old('settlement_status_id') == 1) selected @endif>FINIQUITO ENVIADO AL CLIENTE</option>
                                                        <option value="2" @if(old('settlement_status_id') == 2) selected @endif>FINIQUITO FIRMADO POR CLIENTE</option>
                                                        <option value="3" @if(old('settlement_status_id') == 3) selected @endif>FINIQUITO PENDIENTE CIA</option>
                                                    </select>
                                                    <label for="settlement_status_id">Estado del Finiquito</label>
                                                </div>
                                            </div>

                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('case_closure_date') }}" type="date" class="form-control" id="case_closure_date" name="case_closure_date">
                                                    <label for="case_closure_date">Fecha de Cierre del Caso</label>
                                                </div>
                                            </div>

                                            <!-- Información Adicional del Reclamo -->
                                            <small class="my-2">Información Adicional del Reclamo</small>
                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('claim_reference_number') }}" type="text" class="form-control" id="claim_reference_number" name="claim_reference_number">
                                                    <label for="claim_reference_number">N. Reclamo CIA</label>
                                                </div>
                                            </div>

                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <select required class="form-select" id="incident_type" name="incident_type">
                                                        <option value="">Seleccionar tipo de siniestro</option>
                                                        @foreach (incidentTypes() as $typeId => $typeName)
                                                        <option value="{{ $typeId }}" @if(old('incident_type') == $typeId) selected @endif>{{ $typeName }}</option>
                                                        @endforeach
                                                    </select>
                                                    <label for="incident_type">Tipo de Siniestro</label>
                                                </div>
                                            </div>

                                            <small class="my-2">Datos del Conductor</small>

                                            <!-- Nombre del Conductor -->
                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('driver_name') }}" type="text" class="form-control" id="driver_name" name="driver_name">
                                                    <label for="driver_name">Nombre del Conductor</label>
                                                </div>
                                            </div>

                                            <!-- Celular del Conductor -->
                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('driver_phone') }}" type="number" class="form-control" id="driver_phone" name="driver_phone">
                                                    <label for="driver_phone">Celular del Conductor</label>
                                                </div>
                                            </div>

                                            <small class="my-2">Audiencia</small>

                                            <!-- Fecha de Audiencia -->
                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('hearing_date') }}" type="date" class="form-control" id="hearing_date" name="hearing_date">
                                                    <label for="hearing_date">Fecha de Audiencia</label>
                                                </div>
                                            </div>

                                            <!-- Motorista -->
                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('driver_comments') }}" type="text" class="form-control" id="driver_comments" name="driver_comments">
                                                    <label for="driver_comments">Motorista</label>
                                                </div>
                                            </div>

                                            <!-- Fecha de Entrega del Parte -->
                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('report_delivery_date') }}" type="date" class="form-control" id="report_delivery_date" name="report_delivery_date">
                                                    <label for="report_delivery_date">Fecha de Entrega del Parte</label>
                                                </div>
                                            </div>

                                            <!-- Culpables o No Culpables Audiencia de DNVT -->
                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('hearing_verdict') }}" type="text" class="form-control" id="hearing_verdict" name="hearing_verdict">
                                                    <label for="hearing_verdict">Culpables o No Culpables Audiencia de DNVT</label>
                                                </div>
                                            </div>

                                            <!-- Fecha de Notificación CIA -->
                                            <div class="col-lg-4 col-md-4 col-sm-4 col-12 mb-2">
                                                <div class="form-floating">
                                                    <input value="{{ old('notification_date') }}" type="date" class="form-control" id="notification_date" name="notification_date">
                                                    <label for="notification_date">Fecha de Notificación CIA</label>
                                                </div>
                                            </div>



                                        </div>

                                        <div class="row" style="display: none;">
                                            <!-- <small class="my-2">Agregar Documentos</small> -->

                                            <div id="document-container" class="col-lg-12 col-md-12 col-sm-12 col-12 mb-2">
                                                <div class="row document-entry">
                                                    <div class="col-lg-3 col-md-3 col-sm-4 col-12 mb-2">
                                                        <div class="form-floating">
                                                            <select class="form-select" name="document_type[]" aria-label="Tipo de Documento">
                                                                <option value="">Seleccionar tipo de documento</option>
                                                                @foreach (ClaimDocumentTypeList() as $cdtl_id => $cdtl_name)
                                                                <option value="{{ $cdtl_id }}">{{ $cdtl_name }}</option>
                                                                @endforeach
                                                            </select>
                                                            <label for="document_type">Tipo de Documento</label>
                                                        </div>
                                                    </div>

                                                    <div class="col-lg-3 col-md-3 col-sm-4 col-12 mb-2">
                                                        <div class="form-floating">
                                                            <input type="file" class="form-control" name="document_file[]">
                                                            <label for="document_file">Subir Documento</label>
                                                        </div>
                                                    </div>

                                                    <div class="col-lg-3 col-md-3 col-sm-4 col-12 mb-2">
                                                        <div class="form-floating">
                                                            <input type="number" step="0.01" class="form-control document-value" name="document_value[]" placeholder="Valor">
                                                            <label for="document_value">Valor</label>
                                                        </div>
                                                    </div>

                                                    <div class="col-lg-3 col-md-3 col-sm-4 col-12 mb-2 d-flex align-items-center">
                                                        <button type="button" class="btn btn-danger remove-document">Eliminar</button>
                                                    </div>
                                                </div>
                                            </div>

                                            <div class="col-lg-12 col-md-12 col-sm-12 col-12 mb-2">
                                                <button type="button" class="btn btn-primary" id="add-document">Agregar más documentos</button>
                                            </div>

                                            <div class="col-lg-12 col-md-12 col-sm-12 col-12 mb-2">
                                                <input type="hidden" id="documents_json" name="documents_json" value="[]">
                                            </div>
                                        </div>


                                        <button class="btn btn-success send-form mt-5" type="submit">Crear Reclamo</button>

                                    </form>


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

        </div>
    </div>


@endsection

@section('script')
<script src="{{url('/static/js/select2.min.js?v='.time())}}"></script>

<script src="{{url('/static/js/claim_creation.js?v='.time())}}"></script>
<script>
    $(document).ready(function() {

        $('.js-pick-ticket-id').select2().on('change', function(){
            getInfoClaimsFromTicket(this.value);
        });
    });

</script>

@endsection