<?php $page = 'patient-dependant-details'; ?>
@extends('layout.mainlayout')
@section('content')
    <div class="left-panel">
        <div class="onboarding-logo text-center">  
            <a href="{{ url('/') }}"><img src="{{ URL::asset('/assets/img/onboard-img/onb-logo.png') }}" class="img-fluid"
                    alt="kafu-logo"></a>
        </div>
        <div class="onboard-img">
            <img src="{{ URL::asset('/assets/img/onboard-img/onb-slide-img.png') }}" class="img-fluid" alt="onboard-slider">
        </div>
        <div class="onboarding-slider">
            <!-- Slider -->
            <div id="onboard-slider" class="owl-carousel owl-theme onboard-slider slider">
                <!-- Slider Item -->
                <div class="onboard-item text-center">
                    <div class="onboard-content">
                        <h3>Welcome to Kafu</h3>
                        <p>
                            Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor
                            incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam.
                        </p>
                    </div>
                </div>
                <!-- /Slider Item -->
                <!-- Slider Item -->
                <div class="onboard-item text-center">
                    <div class="onboard-content">
                        <h3>Welcome to Kafu</h3>
                        <p>
                            Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor
                            incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam.
                        </p>
                    </div>
                </div>
                <!-- /Slider Item -->
                <!-- Slider Item -->
                <div class="onboard-item text-center">
                    <div class="onboard-content">
                        <h3>Welcome to Kafu</h3>
                        <p>
                            Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor
                            incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam.
                        </p>
                    </div>
                </div>
                <!-- /Slider Item -->

            </div>
            <!-- /Slider -->
        </div>
    </div>
    <div class="right-panel">
        <div class="container">
            <div class="row">
                <div class="col-lg-12 p-0">
                    <div class="right-panel-title text-center">
                        <a href="{{ url('/') }}"> <img src="{{ URL::asset('/assets/img/onboard-img/onb-logo.png') }}"
                                alt="kafu-logo"></a>
                    </div>
                </div>
                <div class="col-lg-4 col-md-12">
                    <div class="on-board-wizard">
                        <ul>
                            <li>
                                <a href="{{ url('patient-email') }}">
                                    <div class="onboarding-progress active">
                                        <span>1</span>
                                    </div>
                                    <div class="onboarding-list">
                                        <h6>Registration</h6>
                                        <p>Enter Details for Register </p>
                                    </div>
                                </a>
                            </li>
                            <li>
                                <a href="{{ url('patient-Personalize') }}">
                                    <div class="onboarding-progress active">
                                        <span>2</span>
                                    </div>
                                    <div class="onboarding-list">
                                        <h6>Profile Picture</h6>
                                        <p>Upload Profile picture</p>
                                    </div>
                                </a>
                            </li>
                            <li>
                                <a href="{{ url('patient-details') }}">
                                    <div class="onboarding-progress active">
                                        <span>3</span>
                                    </div>
                                    <div class="onboarding-list">
                                        <h6>Personal Details</h6>
                                        <p>Enter your Personal Details</p>
                                    </div>
                                </a>
                            </li>
                            <li>
                                <a href="{{ url('patient-family-details') }}">
                                    <div class="onboarding-progress active">
                                        <span>4</span>
                                    </div>
                                    <div class="onboarding-list">
                                        <h6>Select Members</h6>
                                        <p>Enter Details for Register </p>
                                    </div>
                                </a>
                            </li>
                            <li>
                                <a href="{{ url('patient-dependant-details') }}">
                                    <div class="onboarding-progress active">
                                        <span>5</span>
                                    </div>
                                    <div class="onboarding-list">
                                        <h6>Dependant details</h6>
                                        <p>Dependants Profile</p>
                                    </div>
                                </a>
                            </li>
                            <li>
                                <a href="{{ url('patient-other-details') }}">
                                    <div class="onboarding-progress">
                                        <span>6</span>
                                    </div>
                                    <div class="onboarding-list">
                                        <h6>Other Detail</h6>
                                        <p>More information</p>
                                    </div>
                                </a>
                            </li>
                        </ul>
                    </div>
                </div>
                <div class="col-lg-8 col-md-12">
                    <div class="onboarding-content-box content-wrap">
                        <div class="onborad-set">
                            <div class="onboarding-title">
                                <h2>Dependant details<span>*</span></h2>
                                <h6>Add age & Photo of the each members</h6>
                            </div>
                            <div class="onboarding-content passcode-wrap mail-box">
                                <div class="row">
                                    <div class="col-lg-12">
                                        <div class="accordion" id="accordionPanelsStayOpenExample">
                                            <div class="accordion-item">
                                                <h2 class="accordion-header" id="panelsStayOpen-headingOne">
                                                    <button class="accordion-button" type="button"
                                                        data-bs-toggle="collapse"
                                                        data-bs-target="#panelsStayOpen-collapseOne" aria-expanded="true"
                                                        aria-controls="panelsStayOpen-collapseOne">
                                                        Child
                                                    </button>
                                                </h2>
                                                <div id="panelsStayOpen-collapseOne"
                                                    class="accordion-collapse collapse show"
                                                    aria-labelledby="panelsStayOpen-headingOne">
                                                    <div class="accordion-body">
                                                        <div class="row">
                                                            <div class="col-lg-12">
                                                                <div class="mb-3 ">
                                                                    <div class="passcode-wrap input-placeholder form-focus">
                                                                        <label class="focus-label">Name</label>
                                                                        <input type="text" class="form-control floating"
                                                                            required="">
                                                                    </div>
                                                                </div>
                                                            </div>
                                                            <div class="col-lg-12">
                                                                <div class="mb-3 ">
                                                                    <div class="passcode-wrap input-placeholder form-focus">
                                                                        <label class="focus-label">Age
                                                                            <span>*</span></label>
                                                                        <input type="text" class="form-control floating"
                                                                            required="">
                                                                    </div>
                                                                </div>
                                                            </div>
                                                            <div class="col-lg-12">
                                                                <div class="mb-3">
                                                                    <div class="relative-form">
                                                                        <span>Upload Photo</span>
                                                                        <label class="relative-file-upload">
                                                                            File Upload <input type="file">
                                                                        </label>
                                                                    </div>
                                                                </div>
                                                            </div>
                                                        </div>
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="accordion-item">
                                                <h2 class="accordion-header" id="panelsStayOpen-headingTwo">
                                                    <button class="accordion-button collapsed" type="button"
                                                        data-bs-toggle="collapse"
                                                        data-bs-target="#panelsStayOpen-collapseTwo" aria-expanded="false"
                                                        aria-controls="panelsStayOpen-collapseTwo">
                                                        Spouse
                                                    </button>
                                                </h2>
                                                <div id="panelsStayOpen-collapseTwo" class="accordion-collapse collapse"
                                                    aria-labelledby="panelsStayOpen-headingTwo">
                                                    <div class="accordion-body">
                                                        <div class="row">
                                                            <div class="col-lg-12">
                                                                <div class="mb-3 ">
                                                                    <div
                                                                        class="passcode-wrap input-placeholder form-focus">
                                                                        <label class="focus-label">Name</label>
                                                                        <input type="text"
                                                                            class="form-control floating" required="">
                                                                    </div>
                                                                </div>
                                                            </div>
                                                            <div class="col-lg-12">
                                                                <div class="mb-3 ">
                                                                    <div
                                                                        class="passcode-wrap input-placeholder form-focus">
                                                                        <label class="focus-label">Age
                                                                            <span>*</span></label>
                                                                        <input type="text"
                                                                            class="form-control floating" required="">
                                                                    </div>
                                                                </div>
                                                            </div>
                                                            <div class="col-lg-12">
                                                                <div class="mb-3">
                                                                    <div class="relative-form">
                                                                        <span>Upload Photo</span>
                                                                        <label class="relative-file-upload">
                                                                            File Upload <input type="file">
                                                                        </label>
                                                                    </div>
                                                                </div>
                                                            </div>
                                                        </div>
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="accordion-item">
                                                <h2 class="accordion-header" id="panelsStayOpen-headingThree">
                                                    <button class="accordion-button collapsed" type="button"
                                                        data-bs-toggle="collapse"
                                                        data-bs-target="#panelsStayOpen-collapseThree"
                                                        aria-expanded="false"
                                                        aria-controls="panelsStayOpen-collapseThree">
                                                        Father
                                                    </button>
                                                </h2>
                                                <div id="panelsStayOpen-collapseThree" class="accordion-collapse collapse"
                                                    aria-labelledby="panelsStayOpen-headingThree">
                                                    <div class="accordion-body">
                                                        <div class="row">
                                                            <div class="col-lg-12">
                                                                <div class="mb-3 ">
                                                                    <div
                                                                        class="passcode-wrap input-placeholder form-focus">
                                                                        <label class="focus-label">Name</label>
                                                                        <input type="text"
                                                                            class="form-control floating" required="">
                                                                    </div>
                                                                </div>
                                                            </div>
                                                            <div class="col-lg-12">
                                                                <div class="mb-3 ">
                                                                    <div
                                                                        class="passcode-wrap input-placeholder form-focus">
                                                                        <label class="focus-label">Age
                                                                            <span>*</span></label>
                                                                        <input type="text"
                                                                            class="form-control floating" required="">
                                                                    </div>
                                                                </div>
                                                            </div>
                                                            <div class="col-lg-12">
                                                                <div class="mb-3">
                                                                    <div class="relative-form">
                                                                        <span>Upload Photo</span>
                                                                        <label class="relative-file-upload">
                                                                            File Upload <input type="file">
                                                                        </label>
                                                                    </div>
                                                                </div>
                                                            </div>
                                                        </div>
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="accordion-item">
                                                <h2 class="accordion-header" id="panelsStayOpen-headingfour">
                                                    <button class="accordion-button collapsed" type="button"
                                                        data-bs-toggle="collapse"
                                                        data-bs-target="#panelsStayOpen-collapsefour"
                                                        aria-expanded="false" aria-controls="panelsStayOpen-collapsefour">
                                                        Mother
                                                    </button>
                                                </h2>
                                                <div id="panelsStayOpen-collapsefour" class="accordion-collapse collapse"
                                                    aria-labelledby="panelsStayOpen-headingfour">
                                                    <div class="accordion-body">
                                                        <div class="row">
                                                            <div class="col-lg-12">
                                                                <div class="mb-3 ">
                                                                    <div
                                                                        class="passcode-wrap input-placeholder form-focus">
                                                                        <label class="focus-label">Name</label>
                                                                        <input type="text"
                                                                            class="form-control floating" required="">
                                                                    </div>
                                                                </div>
                                                            </div>
                                                            <div class="col-lg-12">
                                                                <div class="mb-3 ">
                                                                    <div
                                                                        class="passcode-wrap input-placeholder form-focus">
                                                                        <label class="focus-label">Age
                                                                            <span>*</span></label>
                                                                        <input type="text"
                                                                            class="form-control floating" required="">
                                                                    </div>
                                                                </div>
                                                            </div>
                                                            <div class="col-lg-12">
                                                                <div class="mb-3">
                                                                    <div class="relative-form">
                                                                        <span>Upload Photo</span>
                                                                        <label class="relative-file-upload">
                                                                            File Upload <input type="file">
                                                                        </label>
                                                                    </div>
                                                                </div>
                                                            </div>
                                                        </div>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                    </div>
                                </div>
                            </div>
                        </div>
                        <div class="onboarding-btn">
                            <a href="{{ url('patient-other-details') }}">Continue</a>
                        </div>
                    </div>
                </div>
            </div>
        </div>

    </div>
@endsection
