@extends('layouts.app')
@section('content')
<h2>My Patient Profile</h2>
<div class="card shadow-sm"><div class="card-body">
<form method="POST" action="{{ route('patient-profile.update') }}">
@csrf @method('PUT')
<div class="row">
<div class="col-md-3 mb-3"><label class="form-label">Age</label><input type="number" name="age" value="{{ old('age',$patient->age) }}" class="form-control"></div>
<div class="col-md-3 mb-3"><label class="form-label">Gender</label><input name="gender" value="{{ old('gender',$patient->gender) }}" class="form-control"></div>
<div class="col-md-3 mb-3"><label class="form-label">DOB</label><input type="date" name="dob" value="{{ old('dob',$patient->dob?->format('Y-m-d')) }}" class="form-control"></div>
<div class="col-md-3 mb-3"><label class="form-label">Blood Group</label><input name="blood_group" value="{{ old('blood_group',$patient->blood_group) }}" class="form-control"></div>
<div class="col-md-6 mb-3"><label class="form-label">Mobile</label><input name="mobile" value="{{ old('mobile',$patient->mobile) }}" class="form-control"></div>
<div class="col-md-6 mb-3"><label class="form-label">WhatsApp Number</label><input name="whatsapp_number" value="{{ old('whatsapp_number',$patient->whatsapp_number) }}" class="form-control"></div>
<div class="col-md-6 mb-3"><label class="form-label">Emergency Contact</label><input name="emergency_contact" value="{{ old('emergency_contact',$patient->emergency_contact) }}" class="form-control"></div>
<div class="col-md-6 mb-3"><label class="form-label">Address</label><textarea name="address" class="form-control">{{ old('address',$patient->address) }}</textarea></div>
<div class="col-md-6 mb-3"><label class="form-label">Medical History</label><textarea name="medical_history" class="form-control">{{ old('medical_history',$patient->medical_history) }}</textarea></div>
<div class="col-md-6 mb-3"><label class="form-label">Allergies</label><textarea name="allergies" class="form-control">{{ old('allergies',$patient->allergies) }}</textarea></div>
</div>
<button class="btn btn-primary">Update Profile</button>
</form>
</div></div>
@endsection