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themodernpk/add-practice.blade.php

Created August 14, 2018 13:06
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add-practice.blade.php
@extends('se::layouts.master')
<!---page specific head-->
@section("page_specific_head")
<link rel="stylesheet" href="{{assetsCoreMmenu()}}/examples/css/forms/masks.min.css?v4.0.2">
@endsection
<!--/page specific head-->
<!---page specific footer-->
@section("page_specific_footer")
<script src="{{assetsCoreGlobalVendor()}}/formatter/jquery.formatter.min.js?v4.0.2"></script>
<script src="{{assetsCoreGlobal()}}/js/Plugin/formatter.min.js?v4.0.2"></script>
<script src="{{moduleAssetsUrl('se', '/frontend/practice/add-practice.js')}}"></script>
@endsection
<!--/page specific footer-->
@section('content')
<div id="app">
<div class="page">
<div class="page-content">
<!---dashborad banner-->
@include("se::partials.banner")
<!---/dashborad banner-->
<div class="container">
<div class="inner-warp">
<div class="inner-heading">
<h3>Add a Practice</h3>
<input type="text" class="form-control" id="inputPhone" data-plugin="formatter" data-pattern="([[999]]) [[999]]-[[9999]]">
</div>
<div class="panel">
<div class="inner-content">
<div class="panel-repeat">
<form autocomplete="off" class="common-form">
<div class="row">
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">Practice Name</label>
<input v-model="practice.name" v-on:change="store($event, 'name')" type="text" class="form-control" required placeholder="Practice Name">
</div>
</div>
</div>
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">Account Number</label>
<input type="text" class="form-control" required v-model="practice.account_no" v-on:change="store($event, 'account_no')" placeholder="Account Number">
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">Vantage Customer Number (Internal Only)</label>
<input type="text" class="form-control" required v-model="practice.vantage_customer" v-on:change="store($event, 'vantage_customer')" placeholder="Vantage Number">
</div>
</div>
</div>
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">Phone</label>
<input type="text" v-model="practiceMobile"
class="form-control" v-on:change="store($event, 'phone')"
required placeholder="(xxx) xxx-xxxx"
>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">Description</label>
<input type="text" v-model="practice.description" class="form-control" v-on:change="store($event, 'description')" required placeholder="Practice Description">
</div>
</div>
</div>
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">Sales Tax Rate (%)</label>
<input type="text" v-on:change="store($event, 'sales_tax')" v-model="practice.sales_tax" class="form-control" required placeholder="Sales Tax Rate">
</div>
</div>
</div>
</div>
</form>
</div>
<div v-if="locations.length > 0" class="panel-repeat">
<div class="panel-heading">
<h4>Location</h4>
</div>
<div v-for="(location, index) in locations" class="panel-bordered">
<form autocomplete="off" class="common-form">
<div class="row">
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">Location Name</label>
<input type="text" class="form-control" required v-model="location.name" placeholder="Location Name" v-on:change="storeFields($event, 'name', location, 'pr_locations')">
</div>
</div>
</div>
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">Location Email Address</label>
<input type="text" class="form-control" required v-model="location.email" v-on:change="storeFields($event, 'email', location, 'pr_locations')" placeholder="Location Email Address">
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">Address 1</label>
<input type="text" class="form-control" v-model="location.address_line_one" v-on:change="storeFields($event, 'address_line_one', location, 'pr_locations')" required placeholder="Address 1">
</div>
</div>
</div>
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">Address 2</label>
<input type="text" class="form-control" v-model="location.address_line_two" v-on:change="storeFields($event, 'address_line_two', location, 'pr_locations')" required placeholder="Address 2">
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">City</label>
<input placeholder="City" required class="form-control" v-model="location.city" v-on:change="storeFields($event, 'city', location, 'pr_locations')">
</div>
</div>
</div>
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">State</label>
<select class="form-control" v-model="location.state" v-on:change="storeFields($event, 'state', location, 'pr_locations')">
<option value="" selected="selected">Select a State</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District Of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select >
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">Zip Code</label>
<input type="text" class="form-control" v-model="location.postal_code" v-on:change="storeFields($event, 'postal_code', location, 'pr_locations')" required placeholder="Zip Code">
</div>
</div>
</div>
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">Location ID</label>
<input type="text" class="form-control" v-model="location.location_id" v-on:change="storeFields($event, 'location_id', location, 'pr_locations')" required placeholder="Location ID">
</div>
</div>
</div>
</div>
</form>
<div v-if="index === 0" class="bottom-action">
<button v-on:click="storeFields($event, 'new', '', 'pr_locations')" class="btn-link"><i>+</i>Add Location</button>
</div>
<div v-else class="bottom-action">
<button v-on:click="deleteItem($event, location.id, 'pr_locations')" class="btn-link color-danger"><i class="icon-delete"></i>Delete Location</button>
</div>
</div>
</div>
<div class="panel-repeat" v-if="doctors.length > 0">
<div class="panel-heading">
<h4>Doctor</h4>
</div>
<div class="panel-bordered" v-for="(doctor, index) in doctors">
<form autocomplete="off" class="common-form">
<div class="row">
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-3 col-sm-4">
<label class="form-control-label">Prefix</label>
<select class="form-control" v-model="doctor.prefix" v-on:change="storeFields($event, 'prefix', doctor, 'pr_user_profiles')">
<option v-for="(pre, index) in prefix" :value="pre.id">@{{ pre.name }}</option>
</select>
</div>
<div class="col-md-9 col-sm-8">
<label class="form-control-label">First Name</label>
<input type="text" class="form-control" required placeholder="First Name" v-model="doctor.first_name" v-on:change="storeFields($event, 'first_name', doctor, 'pr_user_profiles')">
</div>
</div>
</div>
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-9 col-sm-8">
<label class="form-control-label">Last Name</label>
<input type="text" class="form-control" required placeholder="Last Name" v-model="doctor.last_name" v-on:change="storeFields($event, 'last_name', doctor, 'pr_user_profiles')">
</div>
<div class="col-md-3 col-sm-4">
<label class="form-control-label">Suffix</label>
<select class="form-control" v-model="doctor.suffix" v-on:change="storeFields($event, 'suffix', doctor, 'pr_user_profiles')">
<option v-for="(suf, index) in suffix" :value="suf.id">@{{ suf.name }}</option>
</select>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-4 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-6">
<label class="form-control-label">Role</label>
<select class="form-control" v-model="doctor.role" v-on:change="storeFields($event, 'role', doctor, 'pr_user_profiles')">
<option v-for="(role, i) in roles" :value="role.slug">@{{ role.name }}</option>
</select>
</div>
</div>
</div>
<div class="col-md-4 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">Email Address</label>
<input type="text" class="form-control" required placeholder="Email Address" v-model="doctor.email" v-on:change="storeFields($event, 'email', doctor, 'pr_user_profiles')">
</div>
</div>
</div>
<div class="col-md-4 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">Phone</label>
<input type="text" class="form-control phone-formatter"
data-plugin="formatter" data-pattern="([[999]]) [[999]]-[[9999]]"
required placeholder="(xxx) xxx-xxxx" v-model="doctor.mobile" v-on:change="storeFields($event, 'mobile', doctor, 'pr_user_profiles')">
</div>
</div>
</div>
</div>
</form>
<div class="bottom-action" v-if="index===0">
<button class="btn-link" v-on:click="storeFields($event, 'new', '', 'pr_user_profiles')"><i>+</i>Add Doctor</button>
</div>
<div class="bottom-action" v-else>
<button class="btn-link color-danger" v-on:click="deleteItem($event, doctor.id, 'pr_user_profiles')"><i class="icon-delete"></i>Delete Doctor</button>
</div>
</div>
</div>
<div class="panel-repeat">
<form autocomplete="off" class="common-form">
<div class="row">
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">Add Product Line for Practice</label>
<select class="form-control" v-on:change="store($event, 'product_line_id')" v-model="practice.product_line_id">
<option disabled value="">Select a Product Line</option>
<option v-for="(lines, index) in product_lines" :value="lines.id">@{{ lines.name }}</option>
<option value="99">Both</option>
</select>
</div>
</div>
</div>
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">Website Url</label>
<input type="text" class="form-control" required v-model="practice.website_url" v-on:change="store($event, 'website_url')" placeholder="Website URL">
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">Unique Landingpage URL with Portal </label>
<div class="web-url">
<span>http://www.synergeyesdailies.com/</span>
<input type="text" class="form-control" required v-model="practice.landing_page_url" v-on:change="store($event, 'landing_page_url')" placeholder="URL">
</div>
</div>
</div>
</div>
<div class="col-md-6 col-sm-12">
<div class="form-group row">
<div class="col-md-12 col-sm-12">
<label class="form-control-label">Practice Logo</label>
{{--<div class="file-upload">
<input type="text" class="form-control" required placeholder="Only .jpg and .png are allowed">
<div class="btn-file">
<input type="file" name="">
<span>Browse</span>
</div>
</div>--}}
<div class="file-upload">
<input type="text" class="form-control" v-on:change="uploadFile($event)" v-model="image_name" required placeholder="Only .jpg and .png are allowed">
<div class="btn-file">
<input type="file" id="file" ref="files" v-on:change="handleImage($event)">
<span>Browse</span>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-12 col-sm-12 text-md-right">
<button type="button" class="btn btn-primary" v-on:click="submit($event)">Submit</button>
</div>
</div>
</form>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
@stop
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