@extends('layouts.app')
@section('css')
<style>
   .m-portlet__head-text{
   display: table-cell;
   vertical-align: middle;
   font-size: 1.3rem;
   font-weight: 500;
   font-family: Roboto;
   }
   .m-form .m-form__section.m-form__section--first, .m-form .m-form__section:first-child {
   margin-top: 40px!important;
   }
   .m-form.m-form--group-seperator-dashed .m-form__group {
   border-bottom: 0px!important;
   }
   .m-form.m-form--group-seperator .m-form__group, .m-form.m-form--group-seperator-dashed .m-form__group {
    padding-top: 5px!important;
    padding-bottom: 5px!important;
   }
   .m-body .m-content {
    padding: 15px 15px!important;
   }
   .form-control{
   border: 1px solid #E6E7E8!important;
   overflow: hidden!important;
   border-radius: .40rem!important;
   font-family: sans-serif,Arial!important; 
   color: #575962!important;  
   font-size: 1rem!important;
   line-height: 1.25!important;
   background-color: #fff!important;
   }
   .m-form .m-form__heading .m-form__heading-title {
   color: #716aca;
   font-weight: 500;
   font-size: 1.3rem;
   }
   .m-form .m-form__section {
    font-size: 1.1rem!important;
   }
   .hidethis{
   display:none;
   }
   .borderseparatorline{
    border-top: 1px dashed #949494;
   }
   .form-control:focus,
   .form-control:active{
   border-color: #3273dc!important;;
   box-shadow: 0 0 0 0.125em rgba(50, 115, 220, 0.25)!important;
   }
   .noresize{
   resize: none;
   }
   .placeitrighthandside{
   text-align: right;
   }
   .tablebutton{
   font-family:'Myriad Pro';
   font-weight: normal;   
   font-size: 15px;
   }
   .labelwarning{
   color: red!important;
   font-size: 13px!important;
   font-family:'Myriad Pro'!important;
   font-weight: normal!important;  
   }
</style>
@endsection
@section('content')
<!-- {{$ipr}}
<hr>
{{$profile}}
<hr>
{{$pasangans}}
<hr>
{{$anaks}}
<hr> -->
<form class="m-form m-form--fit m-form--label-align-right m-form--group-seperator-dashed" action="{{ url('cluster/kesihatan/'.$ipr->name) }}" method="POST" enctype="multipart/form-data">
   @csrf
   <div class="m-content">
      <div class="row">
         <div class="col-lg-12">
        <div id="cardskimpedulisihat" class="m-portlet">
               <div class="m-portlet__head" >
                  <div class="m-portlet__head-caption">
                     <div class="m-portlet__head-title">
                        <span class="m-portlet__head-icon m--hide">
                        <i class="la la-gear"></i>
                        </span>
                        <h3 id="skimpedulisihat" class="m-portlet__head-text"  >
                           SKIM PEDULI SIHAT
                        </h3>
                     </div>
                  </div>
               </div>
               <div class="m-portlet__body">
                  <div class="m-form__section m-form__section--first maklumatperibadi">
                     <div class="m-form__heading">
                        <h3 id="maklumatperibadi" class="m-form__heading-title">
                           Maklumat Peribadi:
                        </h3>
                     </div>
                     <div class="form-group m-form__group row">
                        <div class="col-lg-3">
                           <label class="col-form-label">
                           <span style="color: red">* </span>
                           Kategori:
                           </label><br /><br />
                           <div class="m-checkbox-inline">
                              <label class="form-check-label">
                              <input name="kategori" id="keluarga" value="1" type="checkbox">
                              Keluarga                              
                              </label>
                              <label class="form-check-label">
                              <input name="kategori" id="individu" value="2" type="checkbox">
                              Individu
                              </label>
                           </div>
                        </div>
                        <div class="col-lg-3">
                           <label class="col-form-label">
                              <span style="color: red">* </span>
                              KHAS Category:
                           </label><br /><br />
                           <select class="form-control" id="khasddl" name="khasddl">
                              <option value="Sila pilih" hidden selected>Sila pilih</option>
                              <option value="0">TIDAK BERKENAAN</option>
                              <option value="1">ANAK YATIM</option>
                              <option value="2">OKU</option>
                              <option value="3">WARGA EMAS</option>
                              <option value="4">POLIGAMI</option>
                           </select>
                        </div>
                        <div class="col-lg-6">
                           <label class="col-form-label">
                              <span style="color: red">* </span>Pejabat Ahli Dewan Negeri atau Pejabat Penyelaras Ahli Dewan Negeri:
                           </label>                           
                           <select name="Member_location_id" id="Member_location_id" class="form-control">
                              <option value="">Sila Pilih</option>
                              @if(count($locations) > 0 )
                                 @foreach($locations as $location)
                                    <option value="{{$location['id']}}" >{{$location['description']}}</option>
                                 @endforeach
                              @endif
                           </select>
                        </div>
                     </div>
                     <div class="form-group row">
                        
                     </div>
                  </div>
                  <div class="m-form__seperator m-form__seperator--dashed pemohon"></div>
                  <div class="m-form__section m-form__section--middle pemohon">
                     <div class="m-form__heading">
                        <h3 class="m-form__heading-title">
                           Maklumat Pemohon:
                        </h3>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Nama Penuh:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="namapenuhpemohon" name="namapenuhpemohon" value="{{ Auth::user()->name }}" readonly>
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Jantina:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" id="jantinapemohon" name="jantinapemohon" class="text-capitalize form-control m-input" value="{{$profile->jantina}}" readonly> 
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Status Perkahwinan:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" id="statusperkahwinanpemohon" name="statusperkahwinanpemohon" value="{{$profile->status_perkahwinan}}" class="form-control m-input" readonly> 
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>No.Kad Pengenalan:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="nokadpengenalanpemohon" name="nokadpengenalanpemohon" value="{{ Auth::user()->username }}" readonly>
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Tarikh Lahir:
                        </label>
                        <div class="col-lg-4"> 
                                 <input type="text" id="tarikhlahirpemohon" name="tarikhlahirpemohon" class="form-control m-input" value="{{$profile->tarikh_lahir}}" readonly>
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Negeri Kelahiran:
                        </label>
                        <div class="col-lg-4">
                        <select class="form-control m-input" id="negerikelahiranpemohon" name="negerikelahiranpemohon">
                           <option value="" hidden="" selected="">Sila pilih negeri</option>
                              @if(count($birthstates) > 0 )
                                 @foreach($birthstates as $birthstate)
                                    <option value="{{$birthstate['id']}}">{{$birthstate['name']}}</option>
                                 @endforeach
                              @endif
                        </select>
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Alamat:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="text-capitalize form-control m-input" id="alamat_1sekolahpemohon" name="alamat_1sekolahpemohon" value="{{$profile->alamat_1}}" readonly>
                        </div>
                        <label class="col-lg-2 col-form-label">
                        Alamat 2:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="text-capitalize form-control m-input"  id="alamat_2sekolahpemohon" name="alamat_2sekolahpemohon" value="{{$profile->alamat_2}}" readonly>
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Poskod:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="poskodsekolahpemohon" name="poskodsekolahpemohon" value="{{$profile->poskod}}" readonly>
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Daerah:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="daerahsekolahpemohon"  name="daerahsekolahpemohon" value="{{$profile->daerah}}" readonly>
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Tempoh Menetap Di Selangor:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="tempohmenetapdiselangorpemohon" name="tempohmenetapdiselangorpemohon"  value="{{$profile->tempoh_mastautin ?? ''}}" readonly>
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Warganegara Malaysia:
                        </label>
                        <div class="col-lg-4">
                           <select class="form-control m-input" id="warganegarapemohon" name="warganegarapemohon" onchange="getWarganegaraPemohon($(this).val())">
                              <option value="" hidden selected>Sila pilih</option>
                              <option value="MY">Ya</option>
                              <option value="NON MALAYSIAN">Tidak</option>
                           </select>
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>No Telefon Bimbit:
                        </label> 
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="notelefonbimbitpemohon" name="notelefonbimbitpemohon" value="{{$profile->tel_bimbit ?? ''}}" readonly>
                        </div>
                        <label class="col-lg-2 col-form-label">
                        No Telefon Rumah:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="notelefonrumahpemohon" name="notelefonrumahpemohon" value="{{$profile->tel_rumah ?? ''}}" readonly>
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        Emel:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="emelpemohon" name="emelpemohon" value="{{$profile->email ?? ''}}" readonly>
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Bangsa:
                        </label>
                        <div class="col-lg-4">
                           <select class="form-control m-input" id="bangsapemohon" name="bangsapemohon" readonly>
                              <option value="" hidden selected>Sila pilih</option>
                              <option value="MALAY"  @if($profile->bangsa == 'Melayu'){{'selected'}}@endif>Melayu</option>
                              <option value="INDIAN" @if($profile->bangsa == 'India'){{'selected'}}@endif>India</option>
                              <option value="CHINESE" @if($profile->bangsa == 'Cina'){{'selected'}}@endif>Cina</option>
                              <option value="OTHERS" @if($profile->bangsa == 'Lain-lain'){{'selected'}}@endif>Lain-Lain</option>
                           </select>
                        </div>
                     </div>
                  </div>
                  <div id="maklumatpasanganline" class="borderseparatorline hidethis"></div>
                  <div class="m-form__section m-form__section--middle maklumatpasangan hidethis">
                     <div class="m-form__heading">
                        <h3 class="m-form__heading-title">
                           Maklumat Pasangan:
                        </h3>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Nama Penuh:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="namapenuhpasangan" name="namapenuhpasangan" value="{{$pasangans->nama}}" readonly placeholder="Sila masukan nama penuh">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Jantina:
                        </label>
                        <div class="col-lg-4">
                            <select class="form-control m-input" id="jantinapasangan" name="jantinapasangan">
                              <option value="" hidden selected>Sila pilih</option>
                              <option value="M">Lelaki</option>
                              <option value="F">Perempuan</option>
                           </select> 
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Tarikh Lahir:
                        </label>
                        <div class="col-lg-4">
                           <input type="date" data-date="" id="tarikhlahirpasangan" name="tarikhlahirpasangan" class="form-control m-input" value="{{$pasangans->tarikh_lahir}}">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>No.Kad Pengenalan / No.Polis / No.Tentera:
                        </label>
                        <div class="input-group m-input-group col-lg-4">
                           <input type="text" class="form-control m-input" id="nokadpengenalanpasangan" name="nokadpengenalanpasangan" placeholder="Sila masukan no kad pengenalan" value="{{$pasangans->ic_pasangan}}" readonly>
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Negeri Kelahiran:
                        </label>
                        <div class="col-lg-4">
                           <select class="form-control m-input" id="negeripasangan" name="negeripasangan" onchange="getNegeriSuamiIsteri($(this).val())">
                              <option value="" hidden selected>Sila pilih negeri</option>
                              @if(count($birthstates) > 0 )
                                 @foreach($birthstates as $birthstate)
                                    <option value="{{$birthstate['id']}}" >{{$birthstate['name']}}</option>
                                 @endforeach
                              @endif
                           </select>
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Tempoh Menetap Di Selangor:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="tempohmenetapdiselangorpasangan" name="tempohmenetapdiselangorpasangan" placeholder="Sila masukan tahun">
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>No Telefon Bimbit:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="notelefonbimbitpasangan" name="notelefonbimbitpasangan" placeholder="Sila masukan no telefon bimbit" value="{{$pasangans->no_tel_bimbit}}" readonly> 
                        </div>
                        <label class="col-lg-2 col-form-label">
                        No Telefon Rumah:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="notelefonrumahpasangan" name="notelefonrumahpasangan" placeholder="Sila masukan no telefon rumah">
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        Emel:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="emelpasangan" name="emelpasangan" placeholder="Sila masukkan emel" value="{{$pasangans->emel}}" onblur="checkEmail($(this))" >
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Warganegara Malaysia:
                        </label>
                        <div class="col-lg-4">
                           <select class="form-control m-input" id="warganegarapasangan" name="warganegarapasangan" onchange="getWarganegara($(this).val())">
                              <option value="" hidden selected>Sila pilih</option>
                              <option value="MY">Ya</option>
                              <option value="NON MALAYSIAN">Tidak</option>
                           </select>
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Bangsa:
                        </label>
                        <div class="col-lg-4">
                           <select class="form-control m-input" id="bangsapasangan" name="bangsapasangan" >
                              <option value="" hidden selected>Sila pilih</option>
                              <option value="MALAY">Melayu</option>
                              <option value="INDIAN">India</option>
                              <option value="CHINESE">Cina</option>
                              <option value="OTHERS">Lain-Lain</option>
                           </select>
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <div class="col-lg-2">
                       </div>
                       <div class="col-lg-4">
                        <input type="text" class="form-control m-input hidethis" id="bangsalainlain" name="bangsalainlain" placeholder="Sila masukkan bangsa">
                      </div>
                    </div>
                  </div>
                  <div class="m-form__seperator m-form__seperator--dashed pemohon"></div>
                  <div class="m-form__section m-form__section--middle pemohon">
                     <div class="m-form__heading">
                        <h3 class="m-form__heading-title">
                           Maklumat Pendapatan Pemohon:
                        </h3>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Nama Majikan:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="namamajikanpemohon" name="namamajikanpemohon" placeholder="Sila masukan nama majikan">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Jenis Pekerjaan:
                        </label>
                        <div class="input-group m-input-group col-lg-4">
                           <select class="form-control m-input" id="jenispekerjaanpemohon" name="jenispekerjaanpemohon" onchange="getJenisPekerjaan($(this).val())">
                              <option value="" hidden selected>Sila pilih jenis pekerjaan</option>
                              <option value="1">SEKTOR KERAJAAN</option>
                              <option value="2">SEKTOR SWASTA</option>
                              <option value="3">BEKERJA SENDIRI</option>
                              <option value="4">RETIRE ARMY / POLIS</option>
                              <option value="5">TIDAK BEKERJA</option>
                           </select>
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>No Telefon Majikan:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="notelefonmajikanpemohon" name="notelefonmajikanpemohon" placeholder="Sila masukan no telefon majikan">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Jumlah Pendapatan:
                        </label>
                        <div class="input-group m-input-group col-lg-4">
                           <span class="input-group-addon">
                           RM
                           </span>
                           <input type="text" class="form-control m-input" id="jumlahpendapatanpemohon" name="jumlahpendapatanpemohon" placeholder="Sila masukan pendapatan bulanan" value="{{$profile->pendapatan}}" readonly>
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Adakah anda mempunyai kemudahan kad pesakit luar?:
                        </label>
                        <div class="col-lg-4">
                           <select class="form-control m-input" id="kemudahankadpesakitluarpemohon" name="kemudahankadpesakitluarpemohon">
                              <option value="" hidden selected>Sila pilih</option>
                              <option value="Ya">Ya</option>
                              <option value="Tidak">Tidak</option>
                           </select>
                        </div>
                        <label id="jikayapemohon" class="col-lg-2 col-form-label hidethis">
                            <span style="color: red">* </span>Jika Ya(Nyatakan):
                        </label>
                        <div class="col-lg-4"> 
                            <input  id="jikayanyatakanpemohon" name="jikayanyatakanpemohon" class="form-control m-input hidethis">
                        </div>
                     </div>
                  </div>
                  <div id="maklumatpendapatanpasanganline" class="borderseparatorline hidethis"></div>
                  <div class="m-form__section m-form__section--middle maklumatpendapatanpasangan hidethis">
                     <div class="m-form__heading">
                        <h3 class="m-form__heading-title">
                           Maklumat Pendapatan Pasangan:
                        </h3>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Nama Majikan:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="namamajikanpasangan" name="namamajikanpasangan" placeholder="Sila masukan nama majikan">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Jenis Pekerjaan:
                        </label>
                        <div class="input-group m-input-group col-lg-4">
                           <select class="form-control m-input" id="jenispekerjaanpasangan" name="jenispekerjaanpasangan" onchange="getJenisPekerjaan($(this).val())">
                              <option value="" hidden selected>Sila pilih jenis pekerjaan</option>
                              <option value="SEKTOR KERAJAAN">SEKTOR KERAJAAN</option>
                              <option value="SEKTOR SWASTA">SEKTOR SWASTA</option>
                              <option value="BEKERJA SENDIRI">BEKERJA SENDIRI</option>
                              <option value="PESARA">PESARA</option>
                              <option value="TIDAK BEKERJA">TIDAK BEKERJA</option>
                           </select>
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>No Telefon Majikan:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="notelefonmajikanpasangan" name="notelefonmajikanpasangan" placeholder="Sila masukan no telefon majikan">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Jumlah Pendapatan:
                        </label>
                        <div class="input-group m-input-group col-lg-4">
                           <span class="input-group-addon">
                           RM
                           </span>
                           <input type="text" class="form-control m-input" id="jumlahpendapatanpasangan" name="jumlahpendapatanpasangan" placeholder="Sila masukan pendapatan bulanan" value="{{$pasangans->pendapatan}}" readonly>
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Adakah anda mempunyai kemudahan kad pesakit luar?:
                        </label>
                        <div class="col-lg-4">
                           <select class="form-control m-input" id="kemudahankadpesakitluarpasangan" name="kemudahankadpesakitluarpasangan" onchange="getKemudahanKadPesakitLuar($(this).val())">
                              <option value="" hidden selected>Sila pilih</option>
                              <option value="Ya">Ya</option>
                              <option value="Tidak">Tidak</option>
                           </select>
                        </div>
                        <label id="jikayapasangan" class="col-lg-2 col-form-label hidethis">
                            <span style="color: red">* </span>Jika Ya(Nyatakan):
                        </label>
                        <div class="col-lg-4"> 
                            <input  id="jikayanyatakanpasangan" name="jikayanyatakanpasangan" class="form-control m-input hidethis">
                        </div>
                     </div>
                  </div>
                  <div id="maklumattanggunggananakpemohonline" class="borderseparatorline hidethis"></div>
                  <div class="m-form__section m-form__section--middle maklumattanggunggananakpemohon hidethis">
                     <div class="m-form__heading">
                        <h3 id="maklumatanakpemohon" class="m-form__heading-title">
                           Maklumat Tanggunggan/Anak (Umur Kurang dari 21 tahun):
                        </h3>
                     </div>
                     <div class="form-group m-form__group row">
                        <div class="col-lg-12">
                           <input name="anakcount"  type="hidden" value="{{count($anaks)}}"/>
                           <table id="maklumattanggunggananakpemohontable" class="table order table-responsive">
                              <thead >
                                 <tr>
                                    <td id="namapenuh" >Nama</td>
                                    <td id="noidentiti" >No Identiti</td>
                                    <td id="hubungan">Hubungan</td>
                                    <td id="tarikhlahir">Tarikh Lahir</td>
                                    <td id="warganegara">Warganegara</td>
                                    <td id="bangsa">Bangsa</td>
                                    <td id="pendapatanbulanan">Gaji Bulanan</td>
                                 </tr>
                              </thead>
                              <tbody>
                                 @if(isset($anaks) && count($anaks) > 0)
                                    @php $counter = 0; @endphp
                                    @foreach($anaks as $anak)
                                       @php $counter = $counter + 1; @endphp
                                       <tr>
                                          <td id="rowinputnama">
                                             <input id="anaknama{{$counter}}" name="anaknama[]" placeholder="Nama"  type="text" class="form-control m-input"  value="{{$anak->nama}}" readonly/>
                                          </td>
                                          <td id="rowinputnoidentiti">
                                             <input id="anaknoidentiti{{$counter}}" name="anaknoidentiti[]" placeholder="No.kp"  type="text" class="form-control m-input"  value="{{$anak->ic_anak}}" readonly />
                                          </td>
                                          <td id="rowanakthubungan">
                                             <select input id="anakthubungan{{$counter}}" name="anakthubungan[]" class="form-control m-input" >
                                                <option value="" hidden selected>Sila pilih</option>
                                                <option value="3">Anak</option>
                                                <option value="5">Tanggunggan</option>
                                             </select>
                                          </td>
                                          <td id="rowanaktarikhlahir">
                                             <input id="anaktarikhlahir{{$counter}}" name="anaktarikhlahir[]" placeholder="Tarikh Lahir" type="text" class="form-control m-input" value="{{$anak->tarikh_lahir}}" readonly />
                                          </td>
                                          <td id="rowanakwargakurangupaya">
                                             <div class="m-checkbox-inline" style="text-align:center">
                                                <select id="anakwarganegara{{$counter}}" name="anakwarganegara[]" class="form-control m-input" onchange="getWarganegaraMalaysia($(this).val())">
                                                   <option value="" hidden selected>Sila pilih</option>
                                                   <option value="MY">Ya</option>
                                                   <option value="NON MALAYSIAN">Tidak</option>
                                                </select>
                                             </div>
                                          </td>
                                          <td id="rowanakbangsa">
                                             <div class="m-checkbox-inline" style="text-align:center">
                                                <select id="anakbangsa{{$counter}}" name="inputanakbangsawarganegara[]" class="form-control m-input" onchange="getWarganegaraMalaysia($(this).val())">
                                                   <option value="" hidden selected>Sila pilih</option>
                                                   <option value="MALAY">Melayu</option>
                                                   <option value="INDIAN">India</option>
                                                   <option value="CHINESE">Cina</option>
                                                   <option value="OTHERS">Lain-Lain</option>
                                                </select>
                                             </div>
                                          </td>
                                          <td id="rowanakpendapatanbulanan">
                                             <div class="m-checkbox-inline" style="text-align:center">
                                                <input id="anakpendapatanbulanan{{$counter}}" name="anakpendapatanbulanan[]" placeholder="Pendapatan Bulanan"  type="text" class="form-control m-input"/>
                                             </div>
                                          </td>
                                       </tr>
                                    @endforeach
                                 @endif
                              </tbody>
                           </table>
                        </div>
                     </div>
                  </div>
                 
                  <div class="m-form__seperator m-form__seperator--dashed"></div>
                  <div class="m-form__section m-form__section--last">
                     <div class="m-form__heading">
                        <h3 class="m-form__heading-title">
                           Senarai Semak Dokumen:
                        </h3>
                     </div>
                     <div class="form-group m-form__group row">
                        <div class="col-lg-12">
                           <table class="table  order table-responsive">
                              <thead>
                                 <tr>
                                    <th width="70%">Dokumen</th>
                                    <th width="30%"></th>
                                 </tr>
                              </thead>
                              <tbody>
                                 <tr>
                                    <td>Salinan Kad Pengenalan</td>
                                    <td><input class="form-control m-input" type="file" id="kad_pengenalan" name="kad_pengenalan"></td>
                                 </tr>
                                 <tr>
                                    <td>Salinan Kad Pengenalan, MyKid atau Surat Kelahiran</td>
                                    <td><input class="form-control m-input" type="file" id="surat_kelahiran" name="surat_kelahiran"></td>
                                 </tr>
                                 <tr>
                                    <td>Salinan slip gaji / pencen (untuk penjawat awam / bekerja sendiri)</td>
                                    <td><input class="form-control m-input" type="file" id="slip_gaji" name="slip_gaji"></td>
                                 </tr>
                                 <tr>
                                    <td>Salinan penyata EA* atau KWSP* (untuk pekerja swasta / bekerja sendiri)</td>
                                    <td><input class="form-control m-input" type="file" id="penyata_kwsp" name="penyata_kwsp"></td>
                                 </tr>
                                 <tr>
                                    <td>Salinan Sijil Kematian/Bercerai (untuk ibu tunggal/bapa tunggal)</td>
                                    <td><input class="form-control m-input" type="file" id="sijil_kematian" name="sijil_kematian"></td>
                                 </tr>
                                 <tr>
                                    <td>Bukti penerima BSH atau gologan miskin tegar dalam pangkalan data eKasih</td>
                                    <td><input class="form-control m-input" type="file" id="penerima_bsh" name="penerima_bsh"></td>
                                 </tr>
                              </tbody>
                           </table>
                        </div>
                     </div>
                  </div> 
            </div>
            <div class="m-portlet__foot m-portlet__foot--fit">
                    <div class="m-form__actions m-form__actions">
                        <div class="row">
                            <div class="col-lg-5"></div>
                            <div class="col-lg-6">
                                <button type="submit" class="btn btn-primary">
                                    Hantar
                                </button>
                                <button type="reset" class="btn btn-secondary">
                                    Kembali
                                </button>
                            </div>
                        </div>
                    </div>
                </div>
         </div>
      </div>
   </div>
   </div>
</form>
@endsection
@section('js')
<script src="../../../assets/vendors/base/vendors.bundle.js" type="text/javascript"></script>
<script src="../../../assets/demo/default/base/scripts.bundle.js" type="text/javascript"></script>
<script>
   $("#nokadpengenalanpemohon,#nokadpengenalanpasangan").inputmask({mask: "999999999999", placeholder: ""});   
   $("#poskodsekolahpemohon").inputmask({mask: "99999", placeholder: ""});   
    $('#notelefonbimbitpemohon,#notelefonbimbitpasangan,#notelefonmajikanpasangan,#notelefonmajikanpemohon').inputmask({mask: "9999999999999", placeholder: ""}); 
   $("#pendapatanbulananpemohon,#pendapatanbulananpasangan").inputmask({mask: "9999999",placeholder: ""});
   /* $('#notelefonrumahpemohon,#notelefonrumahpasangan').inputmask('Regex', { regex: "^(03)[0-9]{8}$"});    */
   $("#notelefonrumahpemohon,#notelefonrumahpasangan").inputmask({mask: "9999999999999", placeholder: ""});  
   $("#tempohmenetapdiselangorpasangan,#tempohmenetapdiselangorpemohon").inputmask({mask: "99",placeholder: ""});   
   $("#jumlahpendapatanpasangan, #jumlahpendapatanpemohon").inputmask({mask: "9999999",placeholder: ""});   
   function checkEmail(x) {
       var email_format = /^(([^<>()\[\]\\.,;:\s@"]+(\.[^<>()\[\]\\.,;:\s@"]+)*)|(".+"))@((\[[0-9]{1,3}\.[0-9]{1,3}\.[0-9]{1,3}\.[0-9]{1,3}\])|(([a-zA-Z\-0-9]+\.)+[a-zA-Z]{2,}))$/;
   
           x.next().remove();
               
           if(x.val().match(email_format)) {
                   x.next().remove();
               } else if(x.val() == '') {
                   x.next().remove();
               } else {
                   x.after("<small style='color: #f4516c'>Sila masukkan format emel yang betul.</small>");
                   x.focus();
               }
           }
   
           $(document).ready(function(){
               $statusperkahwinanpemohon = $('#statusperkahwinanpemohon').val();
               if ( $statusperkahwinanpemohon == 'Berkahwin')
               {
                  $(".maklumatpasangan,.maklumatpendapatanpasangan, .maklumattanggunggananakpemohon, #maklumatpasanganline, #maklumatpendapatanpasanganline, #maklumattanggunggananakpemohonline").show('slow');
               }
               else if ($statusperkahwinanpemohon == 'Duda/Janda') 
               {
                  $(".maklumattanggunggananakpemohon, #maklumattanggunggananakpemohonline").show('slow');

                  $(".maklumatpasangan, .maklumatpendapatanpasangan, #maklumatpasanganline, #maklumatpendapatanpasanganline").hide('slow')
               }
               else 
               {
                  $(".maklumatpasangan, .maklumatpendapatanpasangan, .maklumattanggunggananakpemohon, #maklumatpasanganline, #maklumatpendapatanpasanganline, #maklumattanggunggananakpemohonline").hide('slow')
               }

        });
     
           $(document).ready(function () {
            /*  var counter = 0;
         
             $("#tambahmaklumattanggunggananakpemohon").on("click", function () {
                 var newRow = $("<tr>");
                 var cols = "";
                 
                 cols += '<td id="rowinputnamapenuh"><input id="inputnamapenuh" name="inputnamapenuh[]" placeholder="Nama" type="text" class="form-control m-input"/></td>';
                 cols += '<td id="rowinputnoidentiti"><input id="inputnoidentiti" name="inputnoidentiti[]" placeholder="No.kp"  type="text" class="form-control m-input"/></td>';
                 cols += '<td id="rowinputhubungan"><select input id="inputhubungan" name="inputhubungan[]" class="form-control m-input" onchange="getHubungan($(this).val())"><option value="" hidden selected>Sila pilih</option><option value="Anak">Anak</option><option value="Tanggunggan">Tanggunggan</option></select></td>';
                 cols += '<td id="rowinputtarikhlahir"><input id="inputtarikhlahir" name="inputtarikhlahir[]" placeholder="Tarikh Lahir" type="text" class="form-control m-input"/></td>';
                 cols += '<td id="rowinputwarganegara"><select id="inputwarganegara" name="inputwarganegara[]" class="form-control m-input" onchange="getWarganegaraMalaysia($(this).val())"><option value="" hidden selected>Sila pilih</option><option value="Ya">Ya</option><option value="Tidak">Tidak</option></select></td>';
                 cols += '<td id="rowinputbangsa"><select id="inputbangsa" name="inputbangsa[]" class="form-control m-input" onchange="getbangsa($(this).val())"><option value="" hidden selected>Sila pilih</option><option value="Melayu">Melayu</option><option value="India">India</option><option value="Cina">Cina</option></select></td>';
                 cols += '<td id="rowinputpendapatanbulanan"><span class="input-group-addon">RM</span><input id="inputpendapatanbulanan" name="inputpendapatanbulanan[]" placeholder="Pendapatan Bulanan"  type="text" class="form-control m-input"/></td>';
                 cols += '<td id="rowinputemptyrow"><div id="padammaklumattanggunggananakpemohon" class="btn-sm btn btn-warning m-btn m-btn--icon m-btn--pill"><span><i class="la la-trash-o"></i><span id="padammaklumatanakpemohon" class="tablebutton">Padam</span></span></div></td>';
                 newRow.append(cols);
                 $("#maklumattanggunggananakpemohontable").append(newRow);
                 counter++;
             }); */
         });
   
         $(document).ready(function () {
            
             /* $("#maklumattanggunggananakpemohontable").on("click", "#padammaklumattanggunggananakpemohon", function (event) {
   
                 $(this).closest("tr").remove();       
             }); */
             
         });
   
         $(document).ready(function(){
             $('#kemudahankadpesakitluarpemohon').on('change', function() {
               if ( this.value == 'Ya')
               {   
                 $("#jikayanyatakanpemohon, #jikayapemohon").show('slow');  
               }
               else
               {
                 $("#jikayanyatakanpemohon, #jikayapemohon").hide('slow'); 

                 $("#jikayanyatakanpemohon").val('');
               }
             });
         });

         $(document).ready(function(){
             $('#kemudahankadpesakitluarpasangan').on('change', function() {
               if ( this.value == 'Ya')
               {   
                 $("#jikayanyatakanpasangan, #jikayapasangan").show('slow');  
               }
               else
               {
                 $("#jikayanyatakanpasangan, #jikayapasangan").hide('slow'); 

                 $("#jikayanyatakanpasangan").val('');
               }
             });
         });

         $(document).ready(function(){

         $('input:checkbox[value=Khas]').change(function() 
          {
           if(this.checked) 
           {
             $("#khasddl").show();
           }
           else
           {
             $("#khasddl").hide();
             $("#khasddl").val('Sila pilih');
           }
         });
      });

      $(document).ready(function(){
             $('#bangsapasangan').on('change', function() {
               if ( this.value == 'Lain-Lain')
               {
                 $("#bangsalainlain").show('slow');     
               }
               else
               {
                 $("#bangsalainlain").hide('slow');
                 $("#bangsalainlain").val('');
               }
             });
         });
      
</script>
@endsection