@section('sub-title','Pengajuan')
@section('title', 'Klaim')
<div class="clearfix row">
    <div class="col-lg-12">
        <div class="card">
            <div class="body">
                <form wire:submit.prevent="save">
                    <div class="row">
                        <div class="col-md-6">
                            <div class="row">
                                <div class="form-group col-md-6">
                                    <div class="form-group" wire:ignore>
                                        <label>No Polis</label>
                                        <select class="form-control" id="polis_id" wire:model="polis_id">
                                            <option value=""> -- Select Polis -- </option>
                                            @foreach($polis as $item)
                                                <option value="{{$item['id']}}">{{$item['no_polis']}} / {{$item['nama']}}</option>
                                            @endforeach
                                        </select>
                                        @error('polis_id')
                                            <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                        @enderror
                                    </div>
                                </div>
                                <div class="form-group col-md-6">
                                    <div wire:ignore>
                                        <label>Peserta</label>
                                        <select class="form-control" id="kepesertaan_id" wire:model="kepesertaan_id">
                                            <option value=""> -- Select Peserta -- </option>
                                        </select>
                                    </div>
                                    @error('kepesertaan_id')
                                        <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                    @enderror
                                </div>
                            </div>
                            <div class="row">
                                <div class="form-group col-md-4">
                                    <label>Tanggal Meninggal</label>
                                    <input type="date" class="form-control" wire:model="tanggal_meninggal" />
                                    @error('tanggal_meninggal')
                                        <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                    @enderror
                                </div>
                                <div class="form-group col-md-4">
                                    <label>Nilai Pengajuan Klaim</label>
                                    <input type="number" class="form-control" wire:model="nilai_klaim" />
                                    @error('nilai_klaim')
                                        <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                    @enderror
                                </div>
                                <div class="form-group col-md-4">
                                    <label>Jenis Klaim</label>
                                    <select class="form-control" wire:model="jenis_klaim">
                                        <option value=""> -- Pilih -- </option>
                                        @foreach(\App\Models\KlaimJenis::get() as $item)
                                            <option>{{$item->name}}</option>
                                        @endforeach
                                    </select>
                                    @error('jenis_klaim')
                                        <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                    @enderror
                                </div>
                            </div>
                            <div class="row">
                                <div class="form-group col-md-6">
                                    <label>Tempat Klaim</label>
                                    <input type="text" class="form-control" wire:model="tempat_dan_sebab" readonly />
                                    @error('tempat_dan_sebab')
                                        <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                    @enderror
                                </div>
                                <div class="form-group col-md-6">
                                    <label>Sebab Klaim</label>
                                    <input type="text" class="form-control" wire:model="sebab" />
                                    @error('sebab')
                                        <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                    @enderror
                                </div>
                            </div>
                            <!-- <div class="row">
                                <div class="form-group col-md-6">
                                    <label>Kategori Penyakit</label>
                                    <select class="form-control" wire:model="kategori_penyakit">
                                        <option value=""> -- Pilih -- </option>
                                        @foreach(\App\Models\KlaimKategoriPenyakit::get() as $item)
                                            <option>{{$item->name}}</option>
                                        @endforeach
                                    </select>
                                    @error('kategori_penyakit')
                                        <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                    @enderror
                                </div>
                                <div class="form-group col-md-6">
                                    <label>Organ yang mencakup</label>
                                    <select class="form-control" wire:model="organ_yang_mencakup">
                                        <option value=""> -- Pilih -- </option>
                                        @foreach(\App\Models\KlaimOrgan::get() as $item)
                                            <option>{{$item->name}}</option>
                                        @endforeach
                                    </select>
                                    @error('organ_yang_mencakup')
                                        <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                    @enderror
                                </div>
                            </div> -->
                            <div class="row">
                                <div class="form-group col-md-6">
                                    <label>Provinsi</label>
                                    <select class="form-control" wire:model="provinsi_id">
                                        <option value=""> -- Pilih -- </option>
                                        @foreach($provinsi as $item)
                                            <option value="{{$item->id}}">{{$item->nama}}</option>
                                        @endforeach
                                    </select>
                                    @error('provinsi_id')
                                        <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                    @enderror
                                </div>
                                <div class="form-group col-md-6">
                                    <label>Kabupaten</label>
                                    <select class="form-control" wire:model="kabupaten_id">
                                        <option value=""> -- Pilih -- </option>
                                        @foreach($kabupaten as $item)
                                            <option value="{{$item->id}}">{{$item->name}}</option>
                                        @endforeach
                                    </select>
                                    @error('kabupaten_id')
                                        <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                    @enderror
                                </div>
                            </div>
							  </div>
							
                                <div class="col-md-6">
                            <h6><i class="fa fa-circle text-info"></i> Data Peserta</h6>
                            <table class="table ml-2">
							 <tr>
                                    <td>Id Loan</td>
                                    <td> :  {{isset($peserta->polis->nama)?$peserta->polis->nama : '-'}}</td>
                                </tr>
                                <tr>
                                    <td style="width:30%">Nomor Polis</td>
                                    <td style="width:70%"> : {{isset($peserta->polis->no_polis)?$peserta->polis->no_polis : '-'}}</td>
                                </tr>
                                <tr>
                                    <td>Pemegang Polis</td>
                                    <td> :  {{isset($peserta->polis->nama)?$peserta->polis->nama : '-'}}</td>
                                </tr>
                                <tr>
                                    <td>Produk As</td>
                                    <td> :  {{isset($peserta->polis->produk->singkatan)?$peserta->polis->produk->singkatan : '-'}}</td>
                                </tr>
                                <tr>
                                    <td>No Peserta</td>
                                    <td> : {{isset($peserta->no_peserta)?$peserta->no_peserta:'-'}}</td>
                                </tr>
                                <tr>
                                    <td>Nama Peserta</td>
                                    <td> : {{isset($peserta->nama)?$peserta->nama:'-'}}</td>
                                </tr>
                                <tr>
                                    <td>Tanggal Lahir</td>
                                    <td> : {{isset($peserta->tanggal_lahir)?date('d-F-Y',strtotime($peserta->tanggal_lahir)):'-'}}</td>
                                </tr>
                                <tr>
                                    <td>Usia Masuk As</td>
                                    <td> : {{isset($peserta->tanggal_lahir) ? hitung_umur($peserta->tanggal_lahir,1,$peserta->tanggal_mulai) .' Tahun' : '-'}}</td>
                                </tr>
                                <tr>
                                    <td>Masa Asuransi</td>
                                    <td> : {{isset($peserta->masa_bulan)?$peserta->masa_bulan .' Bulan':'-'}}</td>
                                </tr>
                                <tr>
                                    <td>Periode As</td>
                                    <td> : 
                                        @if(isset($peserta->tanggal_mulai))
                                            {{date('d F Y',strtotime($peserta->tanggal_mulai))}} sd {{date('d F Y',strtotime($peserta->tanggal_akhir))}}
                                        @else
                                            -
                                        @endif
                                    </td>
                                </tr>
                                <tr>
                                    <td>Uang Asuransi</td>
                                    <td> : {{isset($peserta->basic) ? format_idr($peserta->basic) : '-'}}</td>
                                </tr>
                            </table>
                        </div>
                        <div class="col-md-12">
                            <ul class="nav nav-tabs">
                                <li class="nav-item"><a class="nav-link active show" data-toggle="tab" href="#tab_data_klaim">Ditransfer ke</a></li>
                                <li class="nav-item"><a class="nav-link" data-toggle="tab" href="#tab_dokumen_pendukung">Dokumen Pendukung</a></li>
                            </ul>
                            <div class="tab-content px-0">
                                <div class="tab-pane active show" id="tab_data_klaim">
                                    <div class="row">
                                        <div class="col-md-6">
                                            <table class="table">
                                                <tr>
                                                    <td>Nomor Rekening</td>
                                                    <td>
                                                        <input type="text" class="form-control" wire:model="bank_nomor_rekening" />
                                                        @error('bank_nomor_rekening')
                                                            <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                                        @enderror
                                                    </td>
                                                </tr>
                                                <tr>
                                                    <td>Bank Cabang</td>
                                                    <td>
                                                        <input type="text" class="form-control" wire:model="bank_cabang" />
                                                        @error('bank_cabang')
                                                            <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                                        @enderror
                                                    </td>
                                                </tr>
                                                <tr>
                                                    <td>Atas Nama</td>
                                                    <td>
                                                        <input type="text" class="form-control" wire:model="bank_atas_nama" />
                                                        @error('bank_atas_nama')
                                                            <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                                        @enderror
                                                    </td>
                                                </tr>
                                                <tr>
                                                    <td>Mata Uang</td>
                                                    <td>
                                                        <input type="text" class="form-control" wire:model="bank_mata_uang" />
                                                        @error('bank_mata_uang')
                                                            <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                                        @enderror
                                                    </td>
                                                </tr>
                                            </table>
                                        </div>
                                    </div>
                                </div>
                                <div class="tab-pane" id="tab_dokumen_pendukung">
                                    <div class="row">
                                        <div class="col-md-6">  
                                            <table class="table ml-2">
                                                <tr>
                                                    <td>1. Formulir Pengajuan Klaim </td>
                                                    <td>
                                                        <span wire:loading wire:target="formulir_pengajuan_klaim">
                                                            <i class="fa fa-spinner fa-pulse fa-2x fa-fw"></i>
                                                            <span class="sr-only">{{ __('Loading...') }}</span> Upload...
                                                        </span>
                                                        <input type="file" class="form-control" wire:loading.remove wire:target="formulir_pengajuan_klaim" wire:model="formulir_pengajuan_klaim" />
                                                        @error('formulir_pengajuan_klaim')
                                                            <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                                        @enderror

                                                    </td>
                                                </tr>
                                                <tr>
                                                    <td>2. Surat Keterangan Meninggal dari Kelurahan/Kades</td>
                                                    <td>
                                                        <span wire:loading wire:target="surat_keterangan_meninggal_kelurahan">
                                                            <i class="fa fa-spinner fa-pulse fa-2x fa-fw"></i>
                                                            <span class="sr-only">{{ __('Loading...') }}</span> Upload...
                                                        </span>
                                                        <input type="file" class="form-control" wire:loading.remove wire:target="surat_keterangan_meninggal_kelurahan" wire:model="surat_keterangan_meninggal_kelurahan" />
                                                        @error('surat_keterangan_meninggal_kelurahan')
                                                            <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                                        @enderror
                                                    </td>
                                                </tr>
                                                <tr>
                                                    <td>3. Surat Keterangan Meninggal Dunia dari RS</td>
                                                    <td>
                                                        <span wire:loading wire:target="surat_keterangan_meninggal_rs">
                                                            <i class="fa fa-spinner fa-pulse fa-2x fa-fw"></i>
                                                            <span class="sr-only">{{ __('Loading...') }}</span> Upload...
                                                        </span>
                                                        <input type="file" class="form-control" wire:loading.remove wire:target="surat_keterangan_meninggal_rs" wire:model="surat_keterangan_meninggal_rs" />
                                                        @error('surat_keterangan_meninggal_rs')
                                                            <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                                        @enderror
                                                    </td>
                                                </tr>
                                                <tr>
                                                    <td>3. Copy Identitas Peserta Asuransi (KTP/kartu pst)</td>
                                                    <td>
                                                        <span wire:loading wire:target="copy_ktp">
                                                            <i class="fa fa-spinner fa-pulse fa-2x fa-fw"></i>
                                                            <span class="sr-only">{{ __('Loading...') }}</span> Upload...
                                                        </span>
                                                        <input type="file" class="form-control" wire:loading.remove wire:target="copy_ktp" wire:model="copy_ktp" />
                                                        @error('copy_ktp')
                                                            <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                                        @enderror
                                                    </td>
                                                </tr>
                                                <tr>
                                                    <td>4. Copy Identitas Ahli Waris (KTP,KK)</td>
                                                    <td>
                                                        <span wire:loading wire:target="copy_ktp_ahli_waris">
                                                            <i class="fa fa-spinner fa-pulse fa-2x fa-fw"></i>
                                                            <span class="sr-only">{{ __('Loading...') }}</span> Upload...
                                                        </span>
                                                        <input type="file" class="form-control" wire:loading.remove wire:target="copy_ktp_ahli_waris" wire:model="copy_ktp_ahli_waris" />
                                                        @error('copy_ktp_ahli_waris')
                                                            <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                                        @enderror
                                                    </td>
                                                </tr>
                                                <tr>
                                                    <td>5. Resume Medis/Surat Keterangan Dokter</td>
                                                    <td>
                                                        <span wire:loading wire:target="resume_medis">
                                                            <i class="fa fa-spinner fa-pulse fa-2x fa-fw"></i>
                                                            <span class="sr-only">{{ __('Loading...') }}</span> Upload...
                                                        </span>
                                                        <input type="file" class="form-control" wire:loading.remove wire:target="resume_medis" wire:model="resume_medis" />
                                                        @error('resume_medis')
                                                            <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                                        @enderror
                                                    </td>
                                                </tr>
                                                <tr>
                                                    <td>6. Daftar Angsuran/Baki Debet</td>
                                                    <td>
                                                        <span wire:loading wire:target="daftar_angsuran">
                                                            <i class="fa fa-spinner fa-pulse fa-2x fa-fw"></i>
                                                            <span class="sr-only">{{ __('Loading...') }}</span> Upload...
                                                        </span>
                                                        <input type="file" class="form-control" wire:loading.remove wire:target="daftar_angsuran" wire:model="daftar_angsuran" />
                                                        @error('daftar_angsuran')
                                                            <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                                        @enderror
                                                    </td>
                                                </tr>
                                            </table>
                                        </div>
                                        <div class="col-md-6">  
                                            <table class="table ml-2">
                                                <tr>
                                                    <td>7. Copy Akad Pembiayaan</td>
                                                    <td>
                                                        <span wire:loading wire:target="copy_akad_pembiayaan">
                                                            <i class="fa fa-spinner fa-pulse fa-2x fa-fw"></i>
                                                            <span class="sr-only">{{ __('Loading...') }}</span> Upload...
                                                        </span>
                                                        <input type="file" class="form-control" wire:loading.remove wire:target="copy_akad_pembiayaan" wire:model="copy_akad_pembiayaan" />
                                                        @error('copy_akad_pembiayaan')
                                                            <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                                        @enderror
                                                    </td>
                                                </tr>
                                                
                                                <tr>
                                                    <td>8. Surat dari Pemegang Polis</td>
                                                    <td>
                                                        <span wire:loading wire:target="surat_dari_pemegang_polis">
                                                            <i class="fa fa-spinner fa-pulse fa-2x fa-fw"></i>
                                                            <span class="sr-only">{{ __('Loading...') }}</span> Upload...
                                                        </span>
                                                        <input type="file" class="form-control" wire:loading.remove wire:target="surat_dari_pemegang_polis" wire:model="surat_dari_pemegang_polis" />
                                                        @error('surat_dari_pemegang_polis')
                                                            <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                                        @enderror
                                                    </td>
                                                </tr>
                                                <tr>
                                                    <td>9. Dokumen Lainnya</td>
                                                    <td>
                                                        <span wire:loading wire:target="dokumen_lain">
                                                            <i class="fa fa-spinner fa-pulse fa-2x fa-fw"></i>
                                                            <span class="sr-only">{{ __('Loading...') }}</span> Upload...
                                                        </span>
                                                        <input type="text" class="form-control" wire:model="dokumen_lain_keterangan" placeholder="Nama Dokumen Pendukung" />
                                                        <input type="file" class="form-control" wire:loading.remove wire:target="dokumen_lain" wire:model="dokumen_lain" />
                                                        @error('dokumen_lain')
                                                            <ul class="parsley-errors-list filled" id="parsley-id-29"><li class="parsley-required">{{ $message }}</li></ul>
                                                        @enderror
                                                    </td>
                                                </tr>
                                            </table>
                                        </div>
                                    </div>
                                </div>
                            </div>
                        </div>
                        <div class="form-group col-md-12">
                            <span wire:loading>
                                <i class="fa fa-spinner fa-pulse fa-2x fa-fw"></i>
                                <span class="sr-only">{{ __('Loading...') }}</span>
                            </span>
                            <button type="submit" wire:loading.remove class="btn btn-info"><i class="fa fa-check-circle"></i> Submit Pengajuan</button>
                        </div>
                    </div>
                </form>
            </div>
        </div>
    </div>
    @push('after-scripts')
        <link rel="stylesheet" href="{{ asset('assets/vendor/select2/css/select2.min.css') }}"/>
        <script src="{{ asset('assets/vendor/select2/js/select2.min.js') }}"></script>
        <style>
            .select2-container .select2-selection--single {height:36px;padding-left:10px;}
            .select2-container .select2-selection--single .select2-selection__rendered{padding-top:3px;}
            .select2-container--default .select2-selection--single .select2-selection__arrow{top:4px;right:10px;}
            .select2-container {width: 100% !important;}
        </style>
        <script>
            Livewire.on('reload-kepesertaan',(polis_id)=>{
                setTimeout(function(){
                    select_2_peserta = $('#kepesertaan_id').select2({
                            ajax: {
                                dataType: 'json',
                                url: '{{route('api.get-kepesertaan')}}',
                                data: function (params) {
                                    var query = {
                                        search: params.term,
                                        polis_id : polis_id ? polis_id : polis_id,
                                        klaim_id: 1
                                    }
                                    return query;
                                },
                                processResults: function (data) {
                                    console.log(data);
                                    return {
                                        results: data.items
                                    };
                                }
                            }
                        }
                    );

                    $('#kepesertaan_id').on('change', function (e) {
                        var data = $(this).select2("val");
                        @this.set('kepesertaan_id', data);
                    });

                    var selected_kepesertaan = $('#kepesertaan_id').find(':selected').val();
                    if(selected_kepesertaan !="") select_2_peserta.val(selected_kepesertaan);
                },1000);            
            });
            select__2 = $('#polis_id').select2();
            $('#polis_id').on('change', function (e) {
                var data = $(this).select2("val");
                @this.set('polis_id', data);
            });
            var selected__ = $('#polis_id').find(':selected').val();
            if(selected__ !="") select__2.val(selected__);
            Livewire.on('modal_show_double', (msg) => {
                $('#modal_show_double').modal('show');
            });
        </script>
    @endpush

</div>