@csrf

<div class="row">
    <div class="col-md-6 mb-3">
        <label for="family_id" class="form-label">Target Family / Household</label>
        <select class="form-select @error('family_id') is-invalid @enderror" id="family_id" name="family_id" required data-choices>
            <option value="">Select Family</option>
            @foreach ($families as $fam)
                <option value="{{ $fam->id }}" {{ old('family_id', $visit->family_id ?? request()->query('family_id')) == $fam->id ? 'selected' : '' }}>
                    {{ $fam->name }} (Code: {{ $fam->family_code }})
                </option>
            @endforeach
        </select>
        @error('family_id')
            <div class="invalid-feedback">{{ $message }}</div>
        @enderror
    </div>

    <div class="col-md-6 mb-3">
        <label for="doctor_id" class="form-label">Assigned Medical Practitioner</label>
        <select class="form-select @error('doctor_id') is-invalid @enderror" id="doctor_id" name="doctor_id" required data-choices>
            <option value="">Select Practitioner</option>
            @foreach ($doctors as $doc)
                <option value="{{ $doc->id }}" {{ old('doctor_id', $visit->doctor_id ?? '') == $doc->id ? 'selected' : '' }}>
                    {{ $doc->user->name }} ({{ $doc->district->name }})
                </option>
            @endforeach
        </select>
        @error('doctor_id')
            <div class="invalid-feedback">{{ $message }}</div>
        @enderror
    </div>
</div>

<div class="row">
    <div class="col-md-6 mb-3">
        <label for="scheduled_at" class="form-label">Scheduled Date & Time</label>
        <input type="datetime-local" class="form-control @error('scheduled_at') is-invalid @enderror" id="scheduled_at" name="scheduled_at" value="{{ old('scheduled_at', isset($visit) ? $visit->scheduled_at->format('Y-m-d\TH:i') : '') }}" required>
        @error('scheduled_at')
            <div class="invalid-feedback">{{ $message }}</div>
        @enderror
    </div>

    <div class="col-md-6 mb-3">
        <label for="status" class="form-label">Status</label>
        <select class="form-select @error('status') is-invalid @enderror" id="status" name="status" required>
            <option value="scheduled" {{ old('status', $visit->status ?? 'scheduled') == 'scheduled' ? 'selected' : '' }}>Scheduled</option>
            <option value="completed" {{ old('status', $visit->status ?? 'scheduled') == 'completed' ? 'selected' : '' }}>Completed</option>
            <option value="missed" {{ old('status', $visit->status ?? 'scheduled') == 'missed' ? 'selected' : '' }}>Missed</option>
        </select>
        @error('status')
            <div class="invalid-feedback">{{ $message }}</div>
        @enderror
    </div>
</div>

<div class="mb-3">
    <label for="notes" class="form-label">Coordination Notes / Directions</label>
    <textarea class="form-control @error('notes') is-invalid @enderror" id="notes" name="notes" rows="3" placeholder="e.g. Schedule for routine prenatal check, morning visit...">{{ old('notes', $visit->notes ?? '') }}</textarea>
    @error('notes')
        <div class="invalid-feedback">{{ $message }}</div>
    @enderror
</div>

<div class="mt-3">
    <button type="submit" class="btn btn-primary">Save Home Visit</button>
    <a href="{{ route('visits.index') }}" class="btn btn-light">Cancel</a>
</div>