@php /** @var \App\Models\RefugeeFamily[] $family */ @endphp
{{--ID--}} @include('components.form.static_text_row', [ 'name' => 'id', 'label' => 'ID', 'validation' => 'maxLength="4" pattern="^[A-Z1-9]?\d{3}$"', 'label_class' => 'col-md-4', 'input_class' => 'col-md-8', 'value' => $family->id, ])
@include('components.form.input_toggle_radio_static_row', [ 'label' => 'Gender', 'name' => 'gender_id', 'value' => $family->gender_id, 'label_class' => 'col-md-4', 'input_class' => 'col-md-8', 'items' => [ [ 'label' => 'Male', 'value' => '0', ], [ 'label' => 'Female', 'value' => '1', ], ], ])
{{--Name--}}
@include('components.form.input_row', [ 'name' => 'first_name', 'label' => 'First Name', 'validation' => 'maxLength="30"', 'label_class' => 'col-md-4', 'input_class' => 'col-md-8', 'value' => $family->first_name, ])
@include('components.form.input_row', [ 'name' => 'last_name', 'label' => 'Last Name', 'validation' => 'maxLength="30"', 'label_class' => 'col-md-4', 'input_class' => 'col-md-8', 'value' => $family->last_name, ])
{{--Country of Origin & Race--}}
{{ $errors->first('country_id', ':message') }}
{{ $errors->first('race_id', ':message') }}
{{--Date of Birth & Phone Number--}}
@include('components.form.input_row', [ 'type' => 'date', 'name' => 'date_of_birth', 'label' => 'Date of Birth', 'validation' => 'max="' . date('Y-m-d') . '"', 'label_class' => 'col-md-4', 'input_class' => 'col-md-8', 'value' => $family->date_of_birth, ])
@include('components.form.input_row', [ 'type' => 'tel', 'name' => 'phone_number', 'label' => 'Phone No.', 'validation' => 'maxLength="10" placeholder="4694537777"', 'label_class' => 'col-md-4', 'input_class' => 'col-md-8', 'optional' => true, 'value' => $family->phone_number, ])
{{--Address--}} @include('components.form.input_address', [ 'states' => $states, 'address_line1' => 'address_line1', 'address_line2' => 'address_line2', 'city' => 'city', 'state' => 'state_id', 'country' => 'country', 'zip' => 'zip', 'value' => [ 'address_line1' => $family->address_line1, 'address_line2' => $family->address_line2, 'city' => $family->city, 'state' => $family->state_id, 'country' => $family->country, 'zip' => $family->zip, ] ]) {{--Pregnant--}}
@php($is_pregnant = old('is_pregnant', $family->pregnant_due_date ?? '') ? 'yes' : 'no') @include('components.form.input_toggle_radio_static_row', [ 'label' => 'Pregnant', 'name' => 'is_pregnant', 'label_class' => 'col-md-4', 'input_class' => 'col-md-8', 'value' => $is_pregnant, 'items' => [ [ 'label' => 'No', 'value' => 'no', ], [ 'label' => 'Yes', 'value' => 'yes', ], ], ])
{{ $errors->first('pregnant_due_date', ':message') }}
{{--Additional Notes--}} @include('components.form.textarea_row', [ 'name' => 'note', 'label' => 'Additional Notes', 'validation' => 'maxLength="170"', 'label_class' => 'col-md-2', 'input_class' => 'col-md-10', 'optional' => true, 'rows' => 3, 'value' => $family->note, ])