@extends('layouts.dental')
@section('title', isset($patient) ? 'Editar Paciente' : 'Novo Paciente')
@section('content')
<div style="max-width:680px;margin:0 auto">
<form method="POST" action="{{ isset($patient) ? route('patients.update', $patient) : route('patients.store') }}">
@csrf
@if(isset($patient)) @method('PUT') @endif

<div style="background:#fff;border-radius:16px;border:1px solid #e5e7eb;overflow:hidden;box-shadow:0 1px 8px rgba(0,0,0,.06);margin-bottom:16px">
<div style="padding:16px 20px;border-bottom:1px solid #f3f4f6;font-weight:600;color:#111827;font-size:15px">Dados do Paciente</div>
<div style="padding:20px;display:flex;flex-direction:column;gap:14px">

<div>
<label style="font-size:12px;font-weight:500;color:#6b7280;display:block;margin-bottom:4px">Nome completo *</label>
<input type="text" name="name" value="{{ old('name', $patient->name ?? '') }}" required
style="width:100%;padding:10px 14px;border:1.5px solid #e5e7eb;border-radius:10px;font-size:14px;color:#111827;box-sizing:border-box;outline:none"
onfocus="this.style.borderColor='#2563eb'" onblur="this.style.borderColor='#e5e7eb'">
</div>

<div style="display:grid;grid-template-columns:1fr 1fr;gap:14px">
<div>
<label style="font-size:12px;font-weight:500;color:#6b7280;display:block;margin-bottom:4px">Sexo</label>
<select name="gender" style="width:100%;padding:10px 14px;border:1.5px solid #e5e7eb;border-radius:10px;font-size:14px;color:#111827;background:#fff;box-sizing:border-box">
<option value="">Selecione</option>
<option value="M" {{ old('gender',$patient->gender??'')==='M'?'selected':'' }}>Masculino</option>
<option value="F" {{ old('gender',$patient->gender??'')==='F'?'selected':'' }}>Feminino</option>
<option value="O" {{ old('gender',$patient->gender??'')==='O'?'selected':'' }}>Outro</option>
</select>
</div>
<div>
<label style="font-size:12px;font-weight:500;color:#6b7280;display:block;margin-bottom:4px">Data de Nascimento</label>
<input type="date" name="birth_date" value="{{ old('birth_date', isset($patient) ? optional($patient->birth_date)->format('Y-m-d') : '') }}"
style="width:100%;padding:10px 14px;border:1.5px solid #e5e7eb;border-radius:10px;font-size:14px;color:#111827;box-sizing:border-box">
</div>
</div>

<div style="display:grid;grid-template-columns:1fr 1fr;gap:14px">
<div>
<label style="font-size:12px;font-weight:500;color:#6b7280;display:block;margin-bottom:4px">CPF</label>
<input type="text" name="cpf" value="{{ old('cpf', $patient->cpf ?? '') }}" placeholder="000.000.000-00"
style="width:100%;padding:10px 14px;border:1.5px solid #e5e7eb;border-radius:10px;font-size:14px;color:#111827;box-sizing:border-box">
</div>
<div>
<label style="font-size:12px;font-weight:500;color:#6b7280;display:block;margin-bottom:4px">Celular (WhatsApp)</label>
<input type="text" name="phone" value="{{ old('phone', $patient->phone ?? '') }}" placeholder="(84) 99999-9999"
style="width:100%;padding:10px 14px;border:1.5px solid #e5e7eb;border-radius:10px;font-size:14px;color:#111827;box-sizing:border-box">
</div>
</div>

<div style="display:grid;grid-template-columns:1fr 1fr;gap:14px">
<div>
<label style="font-size:12px;font-weight:500;color:#6b7280;display:block;margin-bottom:4px">E-mail</label>
<input type="email" name="email" value="{{ old('email', $patient->email ?? '') }}"
style="width:100%;padding:10px 14px;border:1.5px solid #e5e7eb;border-radius:10px;font-size:14px;color:#111827;box-sizing:border-box">
</div>
<div>
<label style="font-size:12px;font-weight:500;color:#6b7280;display:block;margin-bottom:4px">Como chegou à clínica</label>
<select name="how_arrived" style="width:100%;padding:10px 14px;border:1.5px solid #e5e7eb;border-radius:10px;font-size:14px;color:#111827;background:#fff;box-sizing:border-box">
<option value="">Selecione</option>
<option value="indicacao" {{ old('how_arrived',$patient->how_arrived??'')==='indicacao'?'selected':'' }}>Indicação</option>
<option value="instagram" {{ old('how_arrived',$patient->how_arrived??'')==='instagram'?'selected':'' }}>Instagram</option>
<option value="facebook" {{ old('how_arrived',$patient->how_arrived??'')==='facebook'?'selected':'' }}>Facebook</option>
<option value="google" {{ old('how_arrived',$patient->how_arrived??'')==='google'?'selected':'' }}>Google</option>
<option value="outros" {{ old('how_arrived',$patient->how_arrived??'')==='outros'?'selected':'' }}>Outros</option>
</select>
</div>
</div>

<div>
<label style="font-size:12px;font-weight:500;color:#6b7280;display:block;margin-bottom:4px">Observações</label>
<textarea name="notes" rows="3" style="width:100%;padding:10px 14px;border:1.5px solid #e5e7eb;border-radius:10px;font-size:14px;color:#111827;resize:none;box-sizing:border-box">{{ old('notes', $patient->notes ?? '') }}</textarea>
</div>

</div>
</div>

<div style="background:#fff;border-radius:16px;border:1px solid #e5e7eb;overflow:hidden;box-shadow:0 1px 8px rgba(0,0,0,.06);margin-bottom:16px">
<div style="padding:16px 20px;border-bottom:1px solid #f3f4f6;font-weight:600;color:#111827;font-size:15px">Dados do Responsável <span style="font-weight:400;color:#9ca3af;font-size:13px">(para menores)</span></div>
<div style="padding:20px;display:grid;grid-template-columns:1fr 1fr;gap:14px">
<div>
<label style="font-size:12px;font-weight:500;color:#6b7280;display:block;margin-bottom:4px">Nome do Responsável</label>
<input type="text" name="guardian_name" value="{{ old('guardian_name', $patient->guardian_name ?? '') }}"
style="width:100%;padding:10px 14px;border:1.5px solid #e5e7eb;border-radius:10px;font-size:14px;color:#111827;box-sizing:border-box">
</div>
<div>
<label style="font-size:12px;font-weight:500;color:#6b7280;display:block;margin-bottom:4px">Celular do Responsável</label>
<input type="text" name="guardian_phone" value="{{ old('guardian_phone', $patient->guardian_phone ?? '') }}"
style="width:100%;padding:10px 14px;border:1.5px solid #e5e7eb;border-radius:10px;font-size:14px;color:#111827;box-sizing:border-box">
</div>
</div>
</div>

<div style="display:flex;gap:12px;justify-content:flex-end">
<a href="{{ route('patients.index') }}" style="padding:10px 24px;border:1.5px solid #d1d5db;border-radius:10px;font-size:14px;font-weight:500;color:#374151;text-decoration:none;background:#fff">Cancelar</a>
<button type="submit" style="background:#2563eb;color:#fff;padding:10px 28px;border-radius:10px;font-size:14px;font-weight:600;border:none;cursor:pointer">
{{ isset($patient) ? 'Salvar Alterações' : 'Cadastrar Paciente' }}
</button>
</div>
</form>
</div>
@endsection