@php $visit = $visit ?? null; $withFees = $withFees ?? false; @endphp
<div class="row g-3">
    <div class="col-md-4">
        <label class="form-label">Visit Date <span class="text-danger">*</span></label>
        <input type="date" name="visit_date" value="{{ old('visit_date', optional($visit)->visit_date?->format('Y-m-d') ?? now()->format('Y-m-d')) }}" class="form-control" required>
    </div>
    <div class="col-md-4">
        <label class="form-label">Doctor Name</label>
        <input type="text" name="doctor_name" value="{{ old('doctor_name', optional($visit)->doctor_name) }}" class="form-control">
    </div>
    <div class="col-md-4">
        <label class="form-label">Status <span class="text-danger">*</span></label>
        <select name="status" class="form-select" required>
            @foreach(['active','follow_up','completed','cancelled'] as $s)
                <option value="{{ $s }}" @selected(old('status', optional($visit)->status ?? 'active')===$s)>{{ ucwords(str_replace('_',' ',$s)) }}</option>
            @endforeach
        </select>
    </div>
    <div class="col-md-6">
        <label class="form-label">Disease / Health Issue</label>
        <input type="text" name="disease" value="{{ old('disease', optional($visit)->disease) }}" class="form-control">
    </div>
    <div class="col-md-6">
        <label class="form-label">Follow-up Date</label>
        <input type="date" name="follow_up_date" value="{{ old('follow_up_date', optional($visit)->follow_up_date?->format('Y-m-d')) }}" class="form-control">
    </div>

    @if($withFees)
    {{-- ---- Visit fee (repeat visit) ---- --}}
    <div class="col-6 col-md-3">
        <label class="form-label">Patient Fee <span class="text-danger">*</span></label>
        <input type="number" step="0.01" min="0" name="patient_fee" id="v_patient_fee" value="{{ old('patient_fee', optional($visit)->patient_fee ?? 0) }}" class="form-control @error('patient_fee') is-invalid @enderror" required>
        @error('patient_fee')<div class="invalid-feedback">{{ $message }}</div>@enderror
    </div>
    <div class="col-6 col-md-3">
        <label class="form-label">Received Fee <span class="text-danger">*</span></label>
        <input type="number" step="0.01" min="0" name="received_fee" id="v_received_fee" value="{{ old('received_fee', optional($visit)->received_fee ?? 0) }}" class="form-control @error('received_fee') is-invalid @enderror" required>
        @error('received_fee')<div class="invalid-feedback">{{ $message }}</div>@enderror
    </div>
    <div class="col-12 col-md-3">
        <label class="form-label">Balance Type <span class="text-danger">*</span></label>
        <select name="balance_type" id="v_balance_type" class="form-select" required>
            <option value="remaining" @selected(old('balance_type', optional($visit)->balance_type ?? 'remaining')==='remaining')>Remaining Fee</option>
            <option value="discount" @selected(old('balance_type', optional($visit)->balance_type)==='discount')>Discount Fee</option>
        </select>
    </div>
    <div class="col-6 col-md-3">
        <label class="form-label">Remaining</label>
        <input type="text" id="v_remaining_fee" class="form-control bg-light" value="{{ old('remaining_fee', optional($visit)->remaining_fee ?? 0) }}" readonly>
    </div>
    <div class="col-6 col-md-3">
        <label class="form-label">Discount</label>
        <input type="text" id="v_discount_fee" class="form-control bg-light" value="{{ old('discount_fee', optional($visit)->discount_fee ?? 0) }}" readonly>
    </div>
    @endif

    <div class="col-12">
        <label class="form-label">Notes</label>
        <textarea name="notes" rows="2" class="form-control">{{ old('notes', optional($visit)->notes) }}</textarea>
    </div>
    <div class="col-12">
        <label class="form-label">Prescription / Medicine Slip (image or PDF, max 5 MB)</label>
        <input type="file" name="prescription" accept=".jpg,.jpeg,.png,.webp,.pdf" class="form-control">
        <small class="text-muted d-block">Allowed: PDF, JPG, JPEG, PNG, WEBP (max 8 MB).</small>
        @if($visit && $visit->prescriptionUrl())
            <small class="text-muted">Current: <a href="{{ $visit->prescriptionUrl() }}" target="_blank">view slip</a> — uploading a new file replaces it.</small>
        @endif
    </div>
</div>

@if($withFees)
<script>
(function () {
    var pf = document.getElementById('v_patient_fee'),
        rf = document.getElementById('v_received_fee'),
        bt = document.getElementById('v_balance_type'),
        rem = document.getElementById('v_remaining_fee'),
        df = document.getElementById('v_discount_fee');
    function recalc() {
        var b = (parseFloat(pf.value) || 0) - (parseFloat(rf.value) || 0);
        if (b < 0) b = 0;
        if (bt.value === 'discount') { df.value = b.toFixed(2); rem.value = '0.00'; }
        else { rem.value = b.toFixed(2); df.value = '0.00'; }
    }
    if (pf && rf && bt) {
        [pf, rf].forEach(function (el) { el.addEventListener('input', recalc); });
        bt.addEventListener('change', recalc);
        recalc();
    }
})();
</script>
@endif