{{--
    Shared demographic form for registration and amendment.

    The clinical summary block and the confidentiality block are only rendered
    for the users entitled to them, and the controller validates exactly the
    same subset, so a hidden field can never be blanked out by a save.
--}}

@php
    $isEdit = $patient !== null;
@endphp

<div class="grid gap-6 lg:grid-cols-3">
    <div class="space-y-6 lg:col-span-2">
        <x-card title="Identity" icon="users">
            <div class="grid gap-4 sm:grid-cols-3">
                <x-form.input name="first_name" label="First name" :value="$patient?->first_name" required />
                <x-form.input name="middle_name" label="Middle name" :value="$patient?->middle_name" />
                <x-form.input name="last_name" label="Surname" :value="$patient?->last_name" required />

                <x-form.select name="gender" label="Gender" :options="$genders"
                               :value="$patient?->gender" required />

                <x-form.input name="date_of_birth" type="date" label="Date of birth"
                              :value="$patient?->date_of_birth?->toDateString()"
                              hint="Leave blank if unknown — give an age instead." />

                <x-form.input name="age_years" type="number" label="Age in years"
                              :value="$patient?->age_years" min="0" max="130"
                              hint="Used when the birth date is not known." />

                <x-form.input name="national_id" label="National ID" :value="$patient?->national_id" />
                <x-form.input name="passport_number" label="Passport number" :value="$patient?->passport_number" />
                <x-form.input name="birth_certificate_no" label="Birth certificate no."
                              :value="$patient?->birth_certificate_no" />
            </div>
        </x-card>

        <x-card title="Contact and residence" icon="phone">
            <div class="grid gap-4 sm:grid-cols-3">
                <x-form.input name="phone" label="Mobile phone" :value="$patient?->phone" />
                <x-form.input name="alt_phone" label="Alternative phone" :value="$patient?->alt_phone" />
                <x-form.input name="email" type="email" label="Email" :value="$patient?->email" />

                <x-form.select name="county" label="County" :options="$counties" :value="$patient?->county" />
                <x-form.input name="sub_county" label="Sub-county" :value="$patient?->sub_county" />
                <x-form.input name="town" label="Town / estate" :value="$patient?->town" />

                <x-form.input name="address" label="Postal address" :value="$patient?->address" />
                <x-form.input name="postal_code" label="Postal code" :value="$patient?->postal_code" />
                <x-form.input name="preferred_language" label="Preferred language"
                              :value="$patient?->preferred_language" placeholder="Swahili" />
            </div>
        </x-card>

        <x-card title="Background" icon="clipboard-list">
            <div class="grid gap-4 sm:grid-cols-3">
                <x-form.select name="marital_status" label="Marital status" :options="$maritalStatuses"
                               :value="$patient?->marital_status" />
                <x-form.input name="occupation" label="Occupation" :value="$patient?->occupation" />
                <x-form.input name="religion" label="Religion" :value="$patient?->religion" />
                <x-form.input name="nationality" label="Nationality" :value="$patient?->nationality"
                              placeholder="Kenyan" />

                <x-form.select name="blood_group" label="Blood group" :options="$bloodGroups"
                               :value="$patient?->blood_group" />

                <x-form.select name="rhesus" label="Rhesus"
                               :options="['unknown' => 'Unknown', 'positive' => 'Positive', 'negative' => 'Negative']"
                               :value="$patient?->rhesus" />
            </div>
        </x-card>

        @if ($canRecordClinical)
            <x-card title="Clinical summary" icon="heart-pulse">
                <x-slot:header>Captured once and carried into every future encounter.</x-slot:header>

                <div class="space-y-4">
                    <x-form.textarea name="allergies_summary" label="Known allergies"
                                     :value="$patient?->allergies_summary" rows="2"
                                     placeholder="Penicillin — rash; peanuts — swelling" />
                    <x-form.textarea name="chronic_conditions" label="Chronic conditions"
                                     :value="$patient?->chronic_conditions" rows="2"
                                     placeholder="Hypertension, type 2 diabetes" />
                    <x-form.input name="disability" label="Disability" :value="$patient?->disability"
                                  placeholder="Hearing impairment — uses sign language" />
                </div>
            </x-card>
        @endif

        <x-card title="Next of kin" icon="phone">
            <div class="grid gap-4 sm:grid-cols-3">
                <x-form.input name="next_of_kin_name" label="Full name" :value="$patient?->next_of_kin_name" />
                <x-form.select name="next_of_kin_relationship" label="Relationship" :options="$relationships"
                               :value="$patient?->next_of_kin_relationship" />
                <x-form.input name="next_of_kin_phone" label="Phone" :value="$patient?->next_of_kin_phone" />
            </div>

            @if ($isEdit)
                <p class="hms-hint mt-3">
                    Additional contacts — guarantors, employers, emergency contacts — are managed from the patient record.
                </p>
            @endif
        </x-card>
    </div>

    <div class="space-y-6">
        <x-card title="Visit category" icon="shield-check">
            <div class="space-y-4">
                <x-form.select name="patient_category" label="Category" :options="$categories"
                               :value="$patient?->patient_category ?? 'general'" required
                               hint="Drives queue priority and, for protected categories, who may open the record." />

                @if ($canManageConfidentiality)
                    <div class="rounded-lg border border-amber-200 bg-amber-50/60 p-3"
                         x-data="{ restricted: {{ old('is_confidential', $patient?->is_confidential) ? 'true' : 'false' }} }">
                        <x-form.checkbox name="is_confidential" value="1"
                                         x-model="restricted"
                                         :checked="old('is_confidential', $patient?->is_confidential)"
                                         label="Restrict this record"
                                         hint="Only holders of the restricted-access permission will see the patient in lists or be able to open the record." />

                        <div class="mt-3" x-show="restricted" x-cloak>
                            <x-form.textarea name="confidentiality_reason" label="Reason for restricting"
                                             :value="$patient?->confidentiality_reason" rows="2" required
                                             hint="Recorded on the audit trail when the flag is raised." />
                        </div>
                    </div>
                @elseif ($patient?->isRestricted())
                    <x-alert type="warning">
                        This record is restricted. Only the reason for restriction is visible here.
                        @if ($patient->confidentiality_reason)
                            <div class="mt-1 font-medium">{{ $patient->confidentiality_reason }}</div>
                        @endif
                    </x-alert>
                @endif
            </div>
        </x-card>

        <x-card title="Referral" icon="arrow-right">
            <div class="space-y-4">
                <x-form.input name="referred_by" label="Referred by" :value="$patient?->referred_by"
                              placeholder="Dr. Wanjiru, Kibera Health Centre" />
                <x-form.input name="referral_source" label="Source" :value="$patient?->referral_source"
                              placeholder="Clinic, employer, school…" />
            </div>
        </x-card>

        <x-card title="Notes" icon="document-text">
            <x-form.textarea name="notes" label="Front-desk notes" :value="$patient?->notes" rows="3"
                             placeholder="Anything the next clerk needs to know." />
        </x-card>

        <div class="flex items-center justify-end gap-2">
            <a href="{{ $isEdit ? route('patients.show', $patient) : route('patients.index') }}"
               class="hms-btn-secondary">Cancel</a>
            <button type="submit" class="hms-btn-primary">
                <x-icon name="check" size="sm" />
                {{ $isEdit ? 'Save changes' : 'Register patient' }}
            </button>
        </div>
    </div>
</div>