@extends('layouts.app')
@section('title', 'إضافة تأمين طبي')
@section('content')
<div class="page-header">
    <div>
        <h1 class="page-title">إضافة تأمين طبي</h1>
        <p class="page-subtitle">تسجيل وثيقة تأمين طبي جديدة</p>
    </div>
    <div class="page-actions">
        <a href="{{ route('medical-insurance.index') }}" class="btn btn-ghost"><i class="fas fa-arrow-right"></i> رجوع</a>
    </div>
</div>
<div class="card" style="max-width:900px">
    <div class="card-body">
        <form method="POST" action="{{ route('medical-insurance.store') }}" enctype="multipart/form-data">
            @csrf
            <div class="form-grid cols-2">
                <div class="form-group">
                    <label class="form-label required">الموظف</label>
                    <select name="employee_id" class="form-select" required>
                        <option value="">اختر الموظف</option>
                        @foreach($employees as $emp)
                        <option value="{{ $emp->id }}" {{ old('employee_id')==$emp->id?'selected':'' }}>{{ $emp->full_name }} ({{ $emp->employee_code }})</option>
                        @endforeach
                    </select>
                </div>
                <div class="form-group">
                    <label class="form-label required">مقدم خدمة التأمين</label>
                    <input type="text" name="provider" value="{{ old('provider') }}" class="form-input" placeholder="مثال: بوبا، ميدغلف، التعاونية" required>
                </div>
            </div>
            <div class="form-grid cols-3">
                <div class="form-group">
                    <label class="form-label">رقم الوثيقة</label>
                    <input type="text" name="policy_number" value="{{ old('policy_number') }}" class="form-input">
                </div>
                <div class="form-group">
                    <label class="form-label required">فئة التأمين</label>
                    <select name="insurance_class" class="form-select" required>
                        <option value="A" {{ old('insurance_class')=='A'?'selected':'' }}>A</option>
                        <option value="B" {{ old('insurance_class','B')=='B'?'selected':'' }}>B</option>
                        <option value="C" {{ old('insurance_class')=='C'?'selected':'' }}>C</option>
                        <option value="VIP" {{ old('insurance_class')=='VIP'?'selected':'' }}>VIP</option>
                    </select>
                </div>
                <div class="form-group">
                    <label class="form-label required">نوع التغطية</label>
                    <select name="coverage_type" class="form-select" required>
                        <option value="individual" {{ old('coverage_type','individual')=='individual'?'selected':'' }}>فردي</option>
                        <option value="family" {{ old('coverage_type')=='family'?'selected':'' }}>عائلي</option>
                    </select>
                </div>
            </div>
            <div class="form-grid cols-3">
                <div class="form-group">
                    <label class="form-label required">تاريخ البداية</label>
                    <input type="date" name="start_date" value="{{ old('start_date', date('Y-m-d')) }}" class="form-input" required>
                </div>
                <div class="form-group">
                    <label class="form-label required">تاريخ النهاية</label>
                    <input type="date" name="end_date" value="{{ old('end_date') }}" class="form-input" required>
                </div>
                <div class="form-group">
                    <label class="form-label required">القسط السنوي (ر.س)</label>
                    <input type="number" name="premium_amount" value="{{ old('premium_amount') }}" class="form-input" step="0.01" min="0" required>
                </div>
            </div>
            <div class="form-grid cols-2">
                <div class="form-group">
                    <label class="form-label">عدد المعالين</label>
                    <input type="number" name="dependents_count" value="{{ old('dependents_count', 0) }}" class="form-input" min="0">
                </div>
                <div class="form-group">
                    <label class="form-label required">الحالة</label>
                    <select name="status" class="form-select" required>
                        <option value="active" {{ old('status','active')=='active'?'selected':'' }}>ساري</option>
                        <option value="pending_renewal" {{ old('status')=='pending_renewal'?'selected':'' }}>بانتظار التجديد</option>
                    </select>
                </div>
            </div>
            <div class="form-group">
                <label class="form-label">ملاحظات</label>
                <textarea name="notes" class="form-textarea" rows="3">{{ old('notes') }}</textarea>
            </div>
            <div class="form-group">
                <label class="form-label">مرفق</label>
                <input type="file" name="attachment" class="form-input" accept=".pdf,.jpg,.jpeg,.png">
                <small class="form-hint">PDF أو صورة - الحد الأقصى 5 ميجابايت</small>
            </div>
            <div class="form-actions">
                <button type="submit" class="btn btn-primary btn-lg"><i class="fas fa-save"></i> حفظ</button>
                <a href="{{ route('medical-insurance.index') }}" class="btn btn-ghost btn-lg">إلغاء</a>
            </div>
        </form>
    </div>
</div>
@endsection