@include('pretests.patient_info')
<div class="row mt-4">
    <div id="form-date-group" class="form-group col-12 mb-4">
        <label for="form-date" class="col-form-label required">{{ __('pretests.form_date') }}</label>
        <div class="input-group date" id="form-date" data-target-input="nearest">
            <input type="text" name="form-date" class="form-control datetimepicker-input" data-target="#form-date" value="{{ $answers['form-date'] }}">
            <div class="input-group-append" data-target="#form-date" data-toggle="datetimepicker">
                <div class="input-group-text"><i class="fas fa-calendar"></i></div>
            </div>
        </div>
    </div>
    <div id="q1-group" class="form-group col-12 mb-4">
        <label for="q1" class="form-label font-weight-bold">
            {{ __('pretests.laser_removal_questions.q1') }}
        </label><br>
        <input type="text" name="q1" class="form-control" value="{{ $answers['q1'] }}">
    </div>
    <div id="q2-group" class="form-group col-12 mb-4">
        <label for="q2" class="form-label font-weight-bold">
            {{ __('pretests.laser_removal_questions.q2') }}
        </label><br>
        <input type="text" name="q2" class="form-control" value="{{ $answers['q2'] }}">
    </div>
    <div id="q3-group" class="form-group col-12 mb-4">
        <label for="q3" class="form-label font-weight-bold">
            {{ __('pretests.laser_removal_questions.q3') }}
        </label><br>
        <input type="text" name="q3" class="form-control" value="{{ $answers['q3'] }}">
    </div>
    <div id="q4-group" class="form-group col-12 mb-4">
        <label for="q4" class="form-label font-weight-bold">
            {{ __('pretests.laser_removal_questions.q4') }}
        </label><br>
        <input type="text" name="q4" class="form-control" value="{{ $answers['q4'] }}">
    </div>
    <div id="q5-group" class="form-group col-12 mb-4">
        <label for="q5" class="form-label font-weight-bold">
            {{ __('pretests.laser_removal_questions.q5') }}
        </label><br>
        <input type="text" name="q5" class="form-control" value="{{ $answers['q5'] }}">
    </div>
    <div id="q6-group" class="form-group col-12 mb-4">
        <label for="q6" class="form-label font-weight-bold">
            {{ __('pretests.laser_removal_questions.q6') }}
        </label><br>
        <input type="text" name="q6" class="form-control" value="{{ $answers['q6'] }}">
    </div>
    <div id="q7-group" class="form-group col-12 mb-4">
        <label for="notes" class="form-label font-weight-bold">
            {{ __('pretests.laser_removal_questions.notes') }}
        </label><br>
        <textarea name="notes" class="form-control" rows="5">{{ $answers['notes'] }}</textarea>
    </div>
    @if( array_key_exists('attachment',$answers))
    <div class="form-group col-12 mb-4">
        <span class="font-weight-bold my-auto ml-auto mr-3">
            {{ __('admin/complaints.form.attachment') }}
        </span>
        <a href="{{ route('admin.pretests.download',[ $patient->id, $answers['attachment'] ] ) }}" class="btn btn-sm btn-info"
            target="_blank">
            <i class="fas fa-file-download"></i>
        </a>
    </div>
    @endif
    <div class="form-group mb-4 col-12">
        <label for="pretest-attachment" class="form-label font-weight-bold">
            {{ __('admin/complaints.form.attachment') }}
            <small class="text-muted">(5 MB maximum)</small>
        </label>
        <div class="input-group">
            <div class="custom-file">
                <input type="file" name="attachment" class="custom-file-input" id="pretest-attachment"aria-describedby="pretest-attachment">
                <label class="custom-file-label " for="pretest-attachment">
                    {{ __('admin/complaints.form.browse') }}
                </label>
            </div>
        </div>
    </div>
    <x-admin.form.save-button title="{{ __('admin/common.buttons.save') }}" />
</div>