@extends('admin.main')
@section('content')
    <link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/bootstrap/4.3.1/css/bootstrap.min.css">
    <script src="https://code.jquery.com/jquery-3.6.0.min.js"></script>
    <link rel="stylesheet" href="https://cdn.jsdelivr.net/npm/sweetalert2@10">
    <script src="https://cdn.jsdelivr.net/npm/sweetalert2@10"></script>
    {{-- <link href="https://cdn.jsdelivr.net/npm/select2@4.1.0-rc.0/dist/css/select2.min.css" rel="stylesheet" />
    <script src="https://cdn.jsdelivr.net/npm/select2@4.1.0-rc.0/dist/js/select2.min.js"></script> --}}
    <meta name="csrf-token" content="{{ csrf_token() }}">


    <style>
        body {
            margin: 30px;
            background-color: aliceblue;
        }

        .step {
            display: none;
        }

        .step.active {
            display: block;
        }

        h1 {
            text-align: center;
        }

        .height::after,
        .weight::after {
            margin-left: -75px;
            font-size: 14px;
            font-weight: bold;
            color: #1c3866;
        }

        .width-100 {
            width: 100%;
        }

        #comment {
            background-color: rgb(242, 240, 240);
            padding: 30px;
            border-radius: 10px;
            box-shadow: 0 10px 20px rgba(0, 0, 0, 0.2);
        }

        .error-border {
            border: 2px solid #dc3545 !important;
        }

        .nav-tabs .nav-link.active {
            background-color: #1c3866 !important;
            color: #fff !important;
            border-color: transparent transparent #f5f7fa;
        }

        .nav-tabs li a {
            padding: 8px 26px !important;
        }

        .nav-tabs .nav-link {
            border: 1px solid #dfdfdf;
            background-color: #ededed;
        }
        body {
            margin: 30px;
            background-color: aliceblue;
        }

        .step {
            display: none;
        }

        .step.active {
            display: block;
        }

        h1 {
            text-align: center;
        }

        .height::after,
        .weight::after {
            margin-left: -75px;
            font-size: 14px;
            font-weight: bold;
            color: #1c3866;
        }

        .width-100 {
            width: 100%;
        }

        #comment {
            background-color: rgb(242, 240, 240);
            padding: 30px;
            border-radius: 10px;
            box-shadow: 0 10px 20px rgba(0, 0, 0, 0.2);
        }

        .error-border {
            border: 2px solid #dc3545 !important;
        }

        .nav-tabs .nav-link.active {
            background-color: #1c3866 !important;
            color: #fff !important;
            border-color: transparent transparent #f5f7fa;
        }

        .nav-tabs li a {
            padding: 8px 26px !important;
        }

        .nav-tabs .nav-link {
            border: 1px solid #dfdfdf;
            background-color: #ededed;
        }

        .font_bold {
            font-weight: bold;
        }

        .select2-container {
            width: 100% !important;
            /* border: 1px solid red; */

        }

        .select2-container .selection .select2-selection {
            padding: 5px 6px 8px !important;
            background-color: #e9ecef !important;
            background-clip: padding-box !important;
            border: 1px solid #1c3866 !important;
            border-radius: .25rem !important;
            box-shadow: inset 0 1px 1px rgba(39, 44, 51, .075) !important;
        }

        .select2-container .selection .select2-selection textarea {
            margin: 0px;
        }

        .dark-mode body {
            background-color: #ffffff;
            overflow-x: hidden;
        }
    </style>



    <div class="container">
        <h1 class="my-2">Medical History</h1>


        @if (Session::has('error_message'))
            <div class="alert alert-secondary dark alert-dismissible fade show" role="alert">
                {{-- <strong>Error ! </strong> --}}
                {{ Session::get('error_message') }}.
                {{-- <button class="btn-close" type="button" data-bs-dismiss="alert" aria-label="Close"
                                    data-bs-original-title="" title=""></button> --}}
            </div>
        @endif

        @if (Session::has('success_message'))
            <div class="alert alert-success dark alert-dismissible fade show" role="alert">
                {{-- <strong>Success ! </strong> --}}
                {{ Session::get('success_message') }}.
                {{-- <button class="btn-close" type="button" data-bs-dismiss="alert" aria-label="Close"
                                    data-bs-original-title="" title=""></button> --}}
            </div>
        @endif

        @if ($errors->any())
            <div class="alert alert-danger">
                <ul>
                    @foreach ($errors->all() as $error)
                        <li>{{ $error }}</li>
                    @endforeach
                </ul>
            </div>
        @endif

        {{-- <p id="timer">Time: 0 seconds</p> --}}
        
        <form id="multiStepForm"
            @if (!empty($StudentBiodata)) action="{{ route('medicalhistorydata') }}"  @else action="{{ route('StudentBiodata') }}" @endif
            form method="POST">

            <!-- Step-one -->
            <input type="hidden" name="_token" value="{{ csrf_token() }}">
            <div class="step active mb-5" id="step1">
                <h3>Student Biodata</h3>
                <div class="form-row">
                     @foreach ($StudentBiodata as $student)
                    <div class="form-group col-md-6">
                        <div class="form-group">
                            <label for="name">Name</label>
                            <input placeholder="Name" type="text" class="form-control" id="name" name="name"
                                value="{{ $student->name }}" readonly>
                        </div>
                    </div>
            
    


                    <div class="form-group col-md-6">
                        <div class="form-group">
                            <label for="GRNo">GR Number</label> 
                            <input  placeholder="GR Number" type="number"  class="form-control" id="GRNo" name="GRNo"
                            value="{{ $student->GRNo }}" readonly>

                        </div>
                    </div>
                    @endforeach

                    <div class="form-group col-md-6">
                        <div class="form-group">
                            <label for="class">Class</label>
                            <input  placeholder="Class" type="number" class="form-control" id="class" name="class"
                            value="{{ $student->class }}" readonly>

                        </div>
                    </div>

                    <div class="form-group col-md-6">
                        <div class="form-group">
                            <label for="dob">Date Of Birth</label>
                                <input  type="date" class="form-control" id="dob" name="dob"
                                value="{{ $student->dob }}" readonly>
                        </div>
                    </div>

                    <div class="form-group col-md-6">
                        <div class="form-group">
                            <label for="B_Form_Number">B-Form Number</label>
                            <input  placeholder="B Form Number" type="number" class="form-control" id="B_Form_Number"
                            value="{{ $student->B_Form_Number }}" readonly>

                        </div>
                    </div>
                    <div class="form-group col-md-6">
                        <div class="form-group">
                            <label for="age">Age</label>
                                <input   placeholder="Age" type="number" class="form-control" id="age" name="age"
                                value="{{ $student->age }}" readonly>
                        </div>
                    </div>

                    <div class="form-group col-md-6">
                        <div class="form-group">
                            <label for="gender">Gender</label>
                            <input placeholder="Gender" type="text" class="form-control" id="gender" name="gender"
                                value="{{ $student->gender }}" readonly>
                        </div>
                    </div>

                    <div class="form-group col-md-6">
                        <div class="form-group">
                            <label for="School_Name">School Name</label>
                                <input placeholder="School Name" type="text" class="form-control" id="School_Name"
                                name="School_Name"
                                value="{{ $student->School_Name }}" readonly>

                        </div>
                    </div>

                    <div class="form-group col-md-6">
                        <div class="form-group">
                            <label for="Emergency_Contact_Number">Emergency Contact Number</label>
                                <input placeholder="Emergency Contact Number" type="text" class="form-control"
                                id="Emergency_Contact_Number" name="Emergency_Contact_Number"
                                value="{{ $student->Emergency_Contact_Number }}" readonly>
                        </div>
                    </div>
                </div>

                <div class="row">
                    <div class="form-group col-md-6">
                        <div class="form-group">
                            <label for="type_of_encounter">Type Of Encounter</label>
                            <input  class="form-control" id="type_of_encounter" name="type_of_encounter" class="form-control"
                            id="Emergency_Contact_Number" name="Emergency_Contact_Number"
                            value="{{ $student->type_of_encounter }}" readonly>
                        </div>
                    </div>
                </div>

                {{-- <button type="submit" class="btn btn-primary ">Next</button> --}}



            </div>



        </form>

    </div>

   




  

    
    <div class="container">
        <h1 class="my-2">Medical History</h1>
        {{-- <p id="timer">Time: 0 seconds</p> --}}


        @if (Session::has('error_message'))
            <div class="alert alert-secondary dark alert-dismissible fade show" role="alert">
                {{-- <strong>Error ! </strong> --}}
                {{ Session::get('error_message') }}.
                {{-- <button class="btn-close" type="button" data-bs-dismiss="alert" aria-label="Close"
                                    data-bs-original-title="" title=""></button> --}}
            </div>
        @endif

        @if (Session::has('success_message'))
            <div class="alert alert-success dark alert-dismissible fade show" role="alert">
                {{-- <strong>Success ! </strong> --}}
                {{ Session::get('success_message') }}.
                {{-- <button class="btn-close" type="button" data-bs-dismiss="alert" aria-label="Close"
                                    data-bs-original-title="" title=""></button> --}}
            </div>
        @endif

        @if ($errors->any())
            <div class="alert alert-danger">
                <ul>
                    @foreach ($errors->all() as $error)
                        <li>{{ $error }}</li>
                    @endforeach
                </ul>
            </div>
        @endif



        <!-- Step-one -->
        <input type="hidden" name="_token" value="{{ csrf_token() }}">
        <div class="step active mb-5" id="step2">
            {{-- <h3>Vitals/BMI</h3> --}}
            <div class="row">
                <div class="form-group col-md-12 my-3">
                    <ul class="nav nav-tabs justify-content-center mx-auto" id="myTab" role="tablist">
                        <li class="nav-item">
                            <a class="nav-link active" id="home-tab" data-toggle="tab" href="#home" role="tab"
                                aria-controls="home" aria-selected="true">School Health Physician</a>
                        </li>
                        <li class="nav-item">
                            <a class="nav-link" id="profile-tab" data-toggle="tab" href="#profile" role="tab"
                                aria-controls="profile" aria-selected="false">Nutritionist</a>
                        </li>
                        <li class="nav-item">
                            <a class="nav-link" id="contact-tab" data-toggle="tab" href="#contact" role="tab"
                                aria-controls="contact" aria-selected="false">Psychologist</a>
                        </li>
                    </ul>
                    <div class="tab-content mb-5" id="myTabContent">

                        {{-- School Health Physician Tab --}}



                        <div class="tab-pane fade show active py-4" id="home" role="tabpanel"
                            aria-labelledby="home-tab">

                            <form id="multiStepForm" action="{{ route('SchoolHealthPhysician') }}" method="POST">

                                @csrf
                                <h3 class="text-center my-2">School Health Physician</h3>
                                <h4 class="mt-3">Medical History</h4>

                                {{-- <input type="text" name="StudentBiodataId" value="{{$StudentBiodataId}}" readonly > --}}
                                <div class="row">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Chief_Complaints1">Chief Complaints</label>
                                            <input placeholder="Chief Complaints" name="Chief_Complaints1" required
                                                id="Chief_Complaints1" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Chief_Complaints1'])) value="{{ $SchoolHealthPhysician['Chief_Complaints1'] }}"
                                                @else
                                                value="{{ old('Chief_Complaints1') }}" @endif />

{{-- 
                                         <input placeholder="Emergency Contact Number" type="text" class="form-control"
                                        id="Emergency_Contact_Number" name="Emergency_Contact_Number"
                                        value="{{ $student->Emergency_Contact_Number }}" readonly> --}}
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="History_of_Presenting_Complaints1">History of Presenting
                                                Complaints</label>
                                            <input placeholder="History of Presenting Complaints" required
                                                name="History_of_Presenting_Complaints1"
                                                id="History_of_Presenting_Complaints1" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['History_of_Presenting_Complaints1'])) value="{{ $SchoolHealthPhysician['History_of_Presenting_Complaints1'] }}"
                                                @else
                                                value="{{ old('History_of_Presenting_Complaints1') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Review_of_Systems">Review of Systems</label>
                                            <input placeholder="Review of Systems" name="Review_of_Systems" required
                                                id="Review_of_Systems" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Review_of_Systems'])) value="{{ $SchoolHealthPhysician['Review_of_Systems'] }}"
                                                @else
                                                value="{{ old('Review_of_Systems') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="General">General</label>
                                            <input placeholder="General" name="General" id="General" required
                                                class="form-control"
                                                @if (!empty($SchoolHealthPhysician['General'])) value="{{ $SchoolHealthPhysician['General'] }}"
                                                @else
                                                value="{{ old('General') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Eyes">Eyes</label>
                                            <input placeholder="Eyes" name="Eyes" id="Eyes" class="form-control"
                                                required
                                                @if (!empty($SchoolHealthPhysician['Eyes'])) value="{{ $SchoolHealthPhysician['Eyes'] }}"
                                                @else
                                                value="{{ old('Eyes') }}" @endif />



                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Ears_Nose_and_Throat">Ears, Nose and Throat</label>
                                            <input placeholder="Ears, Nose and Throat" name="Ears_Nose_and_Throat"
                                                required id="Ears_Nose_and_Throat" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Ears_Nose_and_Throat'])) value="{{ $SchoolHealthPhysician['Ears_Nose_and_Throat'] }}"
                                                @else
                                                value="{{ old('Ears_Nose_and_Throat') }}" @endif />



                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Teeth">Teeth</label>
                                            <input placeholder="Teeth" name="Teeth" id="Teeth"
                                                class="form-control" required
                                                @if (!empty($SchoolHealthPhysician['Teeth'])) value="{{ $SchoolHealthPhysician['Teeth'] }}"
                                                @else
                                                value="{{ old('Teeth') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Cardiorespiratory">Cardiorespiratory</label>
                                            <input placeholder="Cardiorespiratory" name="Cardiorespiratory" required
                                                id="Cardiorespiratory" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Cardiorespiratory'])) value="{{ $SchoolHealthPhysician['Cardiorespiratory'] }}"
                                                @else
                                                value="{{ old('Cardiorespiratory') }}" @endif />



                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Gastrointestinal">Gastrointestinal</label>
                                            <input placeholder="Gastrointestinal" name="Gastrointestinal" required
                                                id="Gastrointestinal" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Gastrointestinal'])) value="{{ $SchoolHealthPhysician['Gastrointestinal'] }}"
                                                @else
                                                value="{{ old('Gastrointestinal') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Genitourinary">Genitourinary</label>
                                            <input placeholder="Genitourinary" name="Genitourinary" id="Genitourinary"
                                                required class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Genitourinary'])) value="{{ $SchoolHealthPhysician['Genitourinary'] }}"
                                                @else
                                                value="{{ old('Genitourinary') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Neuromuscular">Neuromuscular</label>
                                            <input placeholder="Neuromuscular" name="Neuromuscular" id="Neuromuscular"
                                                required class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Neuromuscular'])) value="{{ $SchoolHealthPhysician['Neuromuscular'] }}"
                                                @else
                                                value="{{ old('Neuromuscular') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Endocrine">Endocrine</label>
                                            <input placeholder="Endocrine" name="Endocrine" id="Endocrine" required
                                                class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Endocrine'])) value="{{ $SchoolHealthPhysician['Endocrine'] }}"
                                                @else
                                                value="{{ old('Endocrine') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Hematologic">Hematologic</label>
                                            <input placeholder="Hematologic" name="Hematologic" id="Hematologic" required
                                                class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Hematologic'])) value="{{ $SchoolHealthPhysician['Hematologic'] }}"
                                                @else
                                                value="{{ old('Hematologic') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Rheumatologic">Rheumatologic</label>
                                            <input placeholder="Rheumatologic" name="Rheumatologic" id="Rheumatologic"
                                                required class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Rheumatologic'])) value="{{ $SchoolHealthPhysician['Rheumatologic'] }}"
                                                @else
                                                value="{{ old('Rheumatologic') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Skin">Skin</label>
                                            <input placeholder="Skin" name="Skin" id="Skin" required
                                                class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Skin'])) value="{{ $SchoolHealthPhysician['Skin'] }}"
                                                @else
                                                value="{{ old('Skin') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Investigations_Laboratory_Test_Reports1">Investigations /
                                                Laboratory
                                                Test Reports</label>
                                            <input placeholder="Investigations / Laboratory Test Reports" required
                                                name="Investigations_Laboratory_Test_Reports1"
                                                id="Investigations_Laboratory_Test_Reports1" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Investigations_Laboratory_Test_Reports1'])) value="{{ $SchoolHealthPhysician['Investigations_Laboratory_Test_Reports1'] }}"
                                                @else
                                                value="{{ old('Investigations_Laboratory_Test_Reports1') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Medication_History">Medication History</label>
                                            <input placeholder="Medication History" name="Medication_History" required
                                                id="Medication_History" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Medication_History'])) value="{{ $SchoolHealthPhysician['Medication_History'] }}"
                                                @else
                                                value="{{ old('Medication_History') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Allergies">Allergies</label>
                                            <input placeholder="Allergies" name="Allergies" id="Allergies" required
                                                class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Allergies'])) value="{{ $SchoolHealthPhysician['Allergies'] }}"
                                                @else
                                                value="{{ old('Allergies') }}" @endif />



                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Past_Medical_History">Past Medical History</label>
                                            <input placeholder="Past Medical History" name="Past_Medical_History" required
                                                id="Past_Medical_History" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Past_Medical_History'])) value="{{ $SchoolHealthPhysician['Past_Medical_History'] }}"
                                                @else
                                                value="{{ old('Past_Medical_History') }}" @endif />



                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Past_Surgical_History">Past Surgical History</label>
                                            <input placeholder="Past Surgical History" name="Past_Surgical_History"
                                                required id="Past_Surgical_History" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Past_Surgical_History'])) value="{{ $SchoolHealthPhysician['Past_Surgical_History'] }}"
                                                @else
                                                value="{{ old('Past_Surgical_History') }}" @endif />



                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Birth_History">Birth History</label>
                                            <input placeholder="Birth History" name="Birth_History" id="Birth_History"
                                                required class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Birth_History'])) value="{{ $SchoolHealthPhysician['Birth_History'] }}"
                                                @else
                                                value="{{ old('Birth_History') }}" @endif />



                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Immunizatio_History">Immunization History</label>
                                            <input placeholder="Immunization History" name="Immunizatio_History" required
                                                id="Immunizatio_History" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Immunizatio_History'])) value="{{ $SchoolHealthPhysician['Immunizatio_History'] }}"
                                                @else
                                                value="{{ old('Immunizatio_History') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Growth_Development_Puberty_changes">Growth & Development / Puberty
                                                changes</label>
                                            <input placeholder="Growth & Development / Puberty changes" required
                                                name="Growth_Development_Puberty_changes"
                                                id="Growth_Development_Puberty_changes" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Growth_Development_Puberty_changes'])) value="{{ $SchoolHealthPhysician['Growth_Development_Puberty_changes'] }}"
                                                @else
                                                value="{{ old('Growth_Development_Puberty_changes') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Nutrition_History">Nutrition History</label>
                                            <input placeholder="Nutrition History" name="Nutrition_History" required
                                                id="Nutrition_History" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Nutrition_History'])) value="{{ $SchoolHealthPhysician['Nutrition_History'] }}"
                                                @else
                                                value="{{ old('Nutrition_History') }}" @endif />




                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Family_History1">Family History</label>
                                            <input placeholder="Family History" name="Family_History1"
                                                id="Family_History1" required class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Family_History1'])) value="{{ $SchoolHealthPhysician['Family_History1'] }}"
                                                @else
                                                value="{{ old('Family_History1') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Personal_Social_History1">Personal & Social History</label>
                                            <input placeholder="Personal & Social History" name="Personal_Social_History1"
                                                required id="Personal_Social_History1" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Personal_Social_History1'])) value="{{ $SchoolHealthPhysician['Personal_Social_History1'] }}"
                                                @else
                                                value="{{ old('Personal_Social_History1') }}" @endif />
                                        </div>
                                    </div>
                                </div>

                                <h4 class="text-center mt-3">PHYSICAL EXAMINATION</h4>
                                <p class="font-weight-bolder">Vital Signs and Measurements</p>


                                <div class="form-row">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Blood_pressure">Blood pressure</label>
                                            <input placeholder="Blood pressure" name="Blood_pressure" id="Blood_pressure"
                                                class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Blood_pressure'])) value="{{ $SchoolHealthPhysician['Blood_pressure'] }}"
                                                @else
                                                value="{{ old('Blood_pressure') }}" @endif
                                                required />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Temperature">Temperature</label>
                                            <input placeholder="Temperature" name="Temperature" id="Temperature"
                                                class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Temperature'])) value="{{ $SchoolHealthPhysician['Temperature'] }}"
                                                @else
                                                value="{{ old('Temperature') }}" @endif
                                                required />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Pulse_rate">Pulse rate</label>
                                            <input placeholder="Pulse rate" name="Pulse_rate" id="Pulse_rate"
                                                class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Pulse_rate'])) value="{{ $SchoolHealthPhysician['Pulse_rate'] }}"
                                                @else
                                                value="{{ old('Pulse_rate') }}" @endif
                                                required />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Respiratory_Rate">Respiratory Rate</label>
                                            <input placeholder="Respiratory Rate" name="Respiratory_Rate"
                                                id="Respiratory_Rate" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Respiratory_Rate'])) value="{{ $SchoolHealthPhysician['Respiratory_Rate'] }}"
                                                @else
                                                value="{{ old('Respiratory_Rate') }}" @endif
                                                required />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Weight">Weight <span id="Weight1Response1"></span></label>
                                            <input placeholder="Weight" name="Weight" id="Weight" type="number"
                                                step="any" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Weight'])) value="{{ $SchoolHealthPhysician['Weight'] }}"
                                                @else
                                                value="{{ old('Weight') }}" @endif
                                                required />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Height">Height <span id="height1Response1"></span> </label>
                                            <input placeholder="Height" name="Height" id="Height" type="number"
                                                step="any" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Height'])) value="{{ $SchoolHealthPhysician['Height'] }}"
                                                @else
                                                value="{{ old('Height') }}" @endif
                                                required />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="BMI">BMI <span id="bmi_result_1">
                                                </span> </label>
                                            <input placeholder="BMI" name="BMI" id="BMI" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['BMI'])) value="{{ $SchoolHealthPhysician['BMI'] }}"
                                            @else
                                            value="{{ old('BMI') }}" @endif
                                                required readonly />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="General_Appearance">General Appearance</label>
                                            <input placeholder="General Appearance" name="General_Appearance"
                                                id="General_Appearance" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['General_Appearance'])) value="{{ $SchoolHealthPhysician['General_Appearance'] }}"
                                                @else
                                                value="{{ old('General_Appearance') }}" @endif
                                                required />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Skin">Skin</label>
                                            <input placeholder="Skin" name="Skin" id="Skin" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Skin'])) value="{{ $SchoolHealthPhysician['Skin'] }}"
                                            @else
                                            value="{{ old('Skin') }}" @endif
                                                required />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Lymph Nodes">Lymph Nodes</label>
                                            <input placeholder="Lymph Nodes" name="Lymph_Nodes" id="Lymph_Nodes"
                                                class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Lymph_Nodes'])) value="{{ $SchoolHealthPhysician['Lymph_Nodes'] }}"
                                                @else
                                                value="{{ old('Lymph_Nodes') }}" @endif
                                                required />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Head">Head </label>
                                            <input placeholder="Head" name="Head" id="Head" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Head'])) value="{{ $SchoolHealthPhysician['Head'] }}"
                                            @else
                                            value="{{ old('Head') }}" @endif
                                                required />



                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Eyes">Eyes</label>
                                            <input placeholder="Eyes" name="Eyes" id="Eyes" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Eyes'])) value="{{ $SchoolHealthPhysician['Eyes'] }}"
                                            @else
                                            value="{{ old('Eyes') }}" @endif
                                                required />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="ENT">ENT</label>
                                            <input placeholder="ENT" name="ENT" id="ENT" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['ENT'])) value="{{ $SchoolHealthPhysician['ENT'] }}"
                                            @else
                                            value="{{ old('ENT') }}" @endif
                                                required />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Chest">Chest</label>
                                            <input placeholder="Chest" name="Chest" id="Chest"
                                                class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Chest'])) value="{{ $SchoolHealthPhysician['Chest'] }}"
                                                @else
                                                value="{{ old('Chest') }}" @endif
                                                required />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Heart">Heart</label>
                                            <input placeholder="Heart" name="Heart" id="Heart"
                                                class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Heart'])) value="{{ $SchoolHealthPhysician['Heart'] }}"
                                                @else
                                                value="{{ old('Heart') }}" @endif
                                                required />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Abdomen">Abdomen</label>
                                            <input placeholder="Abdomen" name="Abdomen" id="Abdomen"
                                                class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Abdomen'])) value="{{ $SchoolHealthPhysician['Abdomen'] }}"
                                                @else
                                                value="{{ old('Abdomen') }}" @endif
                                                required />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Extremities">Extremities</label>
                                            <input placeholder="Extremities" name="Extremities" id="Extremities"
                                                class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Extremities'])) value="{{ $SchoolHealthPhysician['Extremities'] }}"
                                                @else
                                                value="{{ old('Extremities') }}" @endif
                                                required />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Neurologic_Examination">Neurologic Examination</label>
                                            <input placeholder="Neurologic Examination" name="Neurologic_Examination"
                                                id="Neurologic_Examination" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Neurologic_Examination'])) value="{{ $SchoolHealthPhysician['Neurologic_Examination'] }}"
                                                @else
                                                value="{{ old('Neurologic_Examination') }}" @endif
                                                required />
                                        </div>
                                    </div>
                                </div>

                                <h4 class="text-center mt-3">Diagnosis, Impression and Plan</h4>

                                <div class="form-row">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Problem_List">Problem List</label>
                                            <input placeholder="Problem List" name="Problem_List" id="Problem_List"
                                                required class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Problem_List'])) value="{{ $SchoolHealthPhysician['Problem_List'] }}"
                                                @else
                                                value="{{ old('Problem_List') }}" @endif />



                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Impression">Impression</label>
                                            <input placeholder="Impression" name="Impression" id="Impression" required
                                                class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Impression'])) value="{{ $SchoolHealthPhysician['Impression'] }}"
                                                @else
                                                value="{{ old('Impression') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Provisional_Diagnosis">Provisional Diagnosis </label>
                                            @php
                                                $provisionalArray = [];
                                                if (!empty($SchoolHealthPhysician['Provisional_Diagnosis'])) {
                                                    $provisionalArray = explode(
                                                        '|',
                                                        $SchoolHealthPhysician['Provisional_Diagnosis'] ?? '',
                                                    );

                                                    // echo "<PRE>";print_r($provisionalArray);exit;
                                                }
                                            @endphp

                                            <select id="Provisional_Diagnosis" name="Provisional_Diagnosis[]" required
                                                class="form-control js-states select_multi py-3" multiple>

                                                <option value="H10.9 Unspecified conjunctivitis"
                                                    {{ in_array('H10.9 Unspecified conjunctivitis', $provisionalArray) ? 'selected' : '' }}>
                                                    H10.9 Unspecified conjunctivitis</option>
                                                <option value="H10.32 Unspecified acute conjunctivitis, left eye"
                                                    {{ in_array('H10.32 Unspecified acute conjunctivitis, left eye', $provisionalArray) ? 'selected' : '' }}>
                                                    H10.32 Unspecified acute conjunctivitis, left eye</option>
                                                <option value="H52.11 Myopia, right eye"
                                                    {{ in_array('H52.11 Myopia, right eye', $provisionalArray) ? 'selected' : '' }}>
                                                    H52.11 Myopia, right eye</option>
                                                <option value="H52.12 Myopia, left eye"
                                                    {{ in_array('H52.12 Myopia, left eye', $provisionalArray) ? 'selected' : '' }}>
                                                    H52.12 Myopia, left eye</option>
                                                <option value="H52.13 Myopia, bilateral"
                                                    {{ in_array('H52.13 Myopia, bilateral', $provisionalArray) ? 'selected' : '' }}>
                                                    H52.13 Myopia, bilateral</option>

                                            </select>


                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Investigations_Recommended">Investigations Recommended</label>

                                            <select id="Investigations_Recommended" name="Investigations_Recommended"
                                                class="form-control" required>
                                                <option value="Labs" @if (
                                                    !empty($SchoolHealthPhysician['Investigations_Recommended']) &&
                                                        $SchoolHealthPhysician['Investigations_Recommended'] == 'Labs') selected @endif>
                                                    Labs
                                                </option>
                                                <option value="Radiology"
                                                    @if (
                                                        !empty($SchoolHealthPhysician['Investigations_Recommended']) &&
                                                            $SchoolHealthPhysician['Investigations_Recommended'] == 'Radiology') selected @endif>
                                                    Radiology
                                                </option>
                                            </select>


                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="General_Advice">General Advice & Management Plan</label>
                                            <input placeholder="General Advice & Management Plan" name="General_Advice"
                                                id="General_Advice" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['General_Advice'])) value="{{ $SchoolHealthPhysician['General_Advice'] }}"
                                                @else
                                                value="{{ old('General_Advice') }}" @endif
                                                required />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="First_Aid_Given">First Aid Given</label>

                                            <select id="First_Aid_Given" name="First_Aid_Given" class="form-control"
                                                required>
                                                <option value="Yes" @if (!empty($SchoolHealthPhysician['First_Aid_Given']) && $SchoolHealthPhysician['First_Aid_Given'] == 'Yes') selected @endif>
                                                    Yes
                                                </option>
                                                <option value="No" @if (!empty($SchoolHealthPhysician['First_Aid_Given']) && $SchoolHealthPhysician['First_Aid_Given'] == 'No') selected @endif>
                                                    No
                                                </option>
                                            </select>


                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Follow_up_Required">Follow-up Required</label>

                                            <select id="Follow_up_Required" class="form-control" onchange="followUp()"
                                                name="Follow_up_Required" required>
                                                <option value="" @if (empty($SchoolHealthPhysician['Follow_up_Required'])) selected @endif>
                                                    Select</option>
                                                <option value="Yes" @if (!empty($SchoolHealthPhysician['Follow_up_Required']) && $SchoolHealthPhysician['Follow_up_Required'] == 'Yes') selected @endif>
                                                    Yes</option>
                                                <option value="No" @if (!empty($SchoolHealthPhysician['Follow_up_Required']) && $SchoolHealthPhysician['Follow_up_Required'] == 'No') selected @endif>
                                                    No</option>
                                            </select>


                                        </div>
                                    </div>


                                </div>
                                <div class="form-row d-none" id="follow_up_show">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Reason_for_Follow_up">Reason for Follow-up</label>
                                            <input placeholder="Reason for Follow-up" name="Reason_for_Follow_up"
                                                id="Reason_for_Follow_up" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Reason_for_Follow_up'])) value="{{ $SchoolHealthPhysician['Reason_for_Follow_up'] }}"
                                                @else
                                                value="{{ old('Reason_for_Follow_up') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Follow_up_Date">Follow-up Date</label>
                                            <input type="date" placeholder="Reason for Follow-up"
                                                name="Follow_up_Date" id="Follow_up_Date" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Follow_up_Date'])) value="{{ $SchoolHealthPhysician['Follow_up_Date'] }}"
                                                @else
                                                value="{{ old('Follow_up_Date') }}" @endif />
                                        </div>
                                    </div>
                                </div>

                                <h3>Refferals</h3>

                                <div class="form-row">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="internal_referrals">Internal Referrals</label>

                                            @php
                                                $internal_referralsArr = [];
                                                if (!empty($SchoolHealthPhysician['internal_referrals'])) {
                                                    $internal_referralsArr = explode(
                                                        '|',
                                                        $SchoolHealthPhysician['internal_referrals'] ?? '',
                                                    );

                                                    // echo "<PRE>";print_r($internal_referralsArr);exit;
                                                }
                                            @endphp

                                            <select id="internal_referrals" name="internal_referrals[]"
                                                class="form-control js-states select_multi py-3" multiple required>
                                                <option value="Nutritionist"
                                                    @if (in_array('Nutritionist', $internal_referralsArr)) selected @endif>
                                                    Nutritionist
                                                </option>
                                                <option value="Psychologist"
                                                    @if (in_array('Psychologist', $internal_referralsArr)) selected @endif>
                                                    Psychologist
                                                </option>
                                            </select>


                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="external_referrals">External Referrals</label>

                                            @php
                                                $external_referralsArr = [];
                                                if (!empty($SchoolHealthPhysician['external_referrals'])) {
                                                    $external_referralsArr = explode(
                                                        '|',
                                                        $SchoolHealthPhysician['external_referrals'] ?? '',
                                                    );
                                                }
                                            @endphp


                                            <select id="external_referrals" name="external_referrals[]"
                                                class="form-control js-states select_multi py-3" multiple required
                                                onchange="showReasonForReferral()">
                                                <option value="Allery and Immunology"
                                                    @if (in_array('Allery and Immunology', $external_referralsArr)) selected @endif>Allery and
                                                    Immunology</option>
                                                <option value="Cardiology"
                                                    @if (in_array('Cardiology', $external_referralsArr)) selected @endif>Cardiology</option>
                                                <option value="Clinical Psychology"
                                                    @if (in_array('Clinical Psychology', $external_referralsArr)) selected @endif>Clinical Psychology
                                                </option>
                                                <option value="Dentistry"
                                                    @if (in_array('Dentistry', $external_referralsArr)) selected @endif>Dentistry</option>
                                                <option value="Dermatology"
                                                    @if (in_array('Dermatology', $external_referralsArr)) selected @endif>Dermatology</option>
                                            </select>
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6 d-none" id="reasonForReferralSection">
                                        <div class="form-group">
                                            <label for="Reason_for_Referral">Reason for Referral</label>
                                            <input placeholder="Reason for Referral" name="Reason_for_Referral"
                                                id="Reason_for_Referral" class="form-control"
                                                @if (!empty($SchoolHealthPhysician['Reason_for_Referral'])) value="{{ $SchoolHealthPhysician['Reason_for_Referral'] }}"
                                                @else
                                                value="{{ old('Reason_for_Referral') }}" @endif
                                                required />
                                        </div>
                                    </div>

                                </div>

                                {{-- <a href="{{ Route('StudentBiodata') }}">
                                    <button type="button" class="btn btn-primary prevStep">Previous</button>
                                </a>

                                <button type="submit" name="submit" class="btn btn-primary">Submit</button> --}}


                            </form>

                        </div>






                        <div class="tab-pane fade" id="profile" role="tabpanel" aria-labelledby="profile-tab">

                            <form id="multiStepForm1" action="{{ route('NutritionistHistoryEvaluationSection') }}"
                                method="POST">

                                @csrf

                                <h3 class="text-center mt-4">Nutritionist History & Evaluation Section</h3>
                                <h4 class="mt-4">Anthropometric Measurements</h4>


                                <div class="form-row">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="height">Height (cm) <span id="height1Response"></label>
                                            <input placeholder="Height (cm)" name="height" required id="height1"
                                                class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['height'])) value="{{ $NutritionistHistoryEvaluationSection['height'] }}"
                                                @else
                                                value="{{ old('height') }}" @endif />
                                        </div>
                                    </div>
                                    <div>
                                        <input type="hidden" name="hidden_age" id="hidden_age"
                                            @if (!empty($monthsDifference)) value="{{ $monthsDifference }}" @endif
                                            readonly>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Weight">Weight (kg) <span id="Weight1Response"> </span></label>
                                            <input placeholder="Weight (kg)" name="Weight" required id="Weight1"
                                                class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['Weight'])) value="{{ $NutritionistHistoryEvaluationSection['Weight'] }}"
                                                @else
                                                value="{{ old('Weight') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="BMI">BMI (auto-generated) <span id="bmi_result">
                                                </span> </label>
                                            <input placeholder="BMI (auto-generated)" name="BMI" required
                                                id="BMI1" class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['BMI'])) value="{{ $NutritionistHistoryEvaluationSection['BMI'] }}"
                                                @else
                                                value="{{ old('BMI') }}" @endif
                                                readonly />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="MUAC">MUAC</label>
                                            <input placeholder="MUAC" name="MUAC" required id="MUAC"
                                                class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['MUAC'])) value="{{ $NutritionistHistoryEvaluationSection['MUAC'] }}"
                                                @else
                                                value="{{ old('MUAC') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Ideal_Body_Weight">Ideal Body Weight (IBW)</label>
                                            <input placeholder="Ideal Body Weight (IBW)" name="Ideal_Body_Weight" required
                                                id="Ideal_Body_Weight" class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['Ideal_Body_Weight'])) value="{{ $NutritionistHistoryEvaluationSection['Ideal_Body_Weight'] }}"
                                                @else
                                                value="{{ old('Ideal_Body_Weight') }}" @endif />
                                        </div>
                                    </div>


                                </div>

                                <h4 class="mt-4">Estimated Nutrition Requirements</h4>

                                <div class="form-row">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Physical_Activity_Level">Physical Activity Level</label>
                                            <input readonly value="Physical Activity Levels"
                                                placeholder="Physical Activity Level" name="Physical_Activity_Level"
                                                required id="Physical_Activity_Level" class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['Physical_Activity_Level'])) value="{{ $NutritionistHistoryEvaluationSection['Physical_Activity_Level'] }}"
                                                @else
                                                value="{{ old('Physical_Activity_Level') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Estimated_Energy_Requirement">Estimated Energy Requirement</label>
                                            <input readonly value="Estimated Energy Requirement"
                                                placeholder="Estimated Energy Requirement"
                                                name="Estimated_Energy_Requirement" required
                                                id="Estimated_Energy_Requirement" class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['Estimated_Energy_Requirement'])) value="{{ $NutritionistHistoryEvaluationSection['Estimated_Energy_Requirement'] }}"
                                                @else
                                                value="{{ old('Estimated_Energy_Requirement') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Daily_Protein_Requirement">Daily Protein Requirement</label>
                                            <input readonly value="Daily Protein Requirement"
                                                placeholder="Daily Protein Requirement" name="Daily_Protein_Requirement"
                                                required id="Daily_Protein_Requirement" class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['Daily_Protein_Requirement'])) value="{{ $NutritionistHistoryEvaluationSection['Daily_Protein_Requirement'] }}"
                                                @else
                                                value="{{ old('Daily_Protein_Requirement') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Daily_Carbohydrate_Requirement">Daily Carbohydrate
                                                Requirement</label>
                                            <input readonly value="Daily Carbohydrate Requirement"
                                                placeholder="Daily_Carbohydrate_Requirement"
                                                name="Daily_Carbohydrate_Requirement" required
                                                id="Daily_Carbohydrate_Requirement" class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['Daily_Carbohydrate_Requirement'])) value="{{ $NutritionistHistoryEvaluationSection['Daily_Carbohydrate_Requirement'] }}"
                                                @else
                                                value="{{ old('Daily_Carbohydrate_Requirement') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Daily_Fat_Requirement">Daily Fat Requirement</label>
                                            <input readonly value="Daily Fat Requirement"
                                                placeholder="Daily_Fat_Requirement" name="Daily_Fat_Requirement" required
                                                id="Daily_Fat_Requirement" class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['Daily_Fat_Requirement'])) value="{{ $NutritionistHistoryEvaluationSection['Daily_Fat_Requirement'] }}"
                                                @else
                                                value="{{ old('Daily_Fat_Requirement') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Daily_Fluid_Requirement">Daily Fluid Requirement</label>
                                            <input readonly value="Daily Fluid Requirement"
                                                placeholder="Daily Fluid Requirement" name="Daily_Fluid_Requirement"
                                                required id="Daily_Fluid_Requirement" class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['Daily_Fluid_Requirement'])) value="{{ $NutritionistHistoryEvaluationSection['Daily_Fluid_Requirement'] }}"
                                                @else
                                                value="{{ old('Daily_Fluid_Requirement') }}" @endif />
                                        </div>
                                    </div>
                                </div>

                                <h4 class="mt-4">Dietary Evaluation</h4>

                                <div class="form-row">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Chief_Complaints2">Chief Complaints</label>
                                            <input value="Chief Complaints" placeholder="Chief Complaints"
                                                name="Chief_Complaints2" required id="Chief_Complaints2"
                                                class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['Chief_Complaints2'])) value="{{ $NutritionistHistoryEvaluationSection['Chief_Complaints2'] }}"
                                                @else
                                                value="{{ old('Chief_Complaints2') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="History_of_Presenting_Complains">History of Presenting
                                                Complains</label>
                                            <input value="History of Presenting Complains"
                                                placeholder="History of Presenting Complains"
                                                name="History_of_Presenting_Complains" required
                                                id="History_of_Presenting_Complains" class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['History_of_Presenting_Complains'])) value="{{ $NutritionistHistoryEvaluationSection['History_of_Presenting_Complains'] }}"
                                                @else
                                                value="{{ old('History_of_Presenting_Complains') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Past_Medical_History">Past Medical History</label>
                                            <input value="Past Medical History" placeholder="Past Medical History"
                                                name="Past_Medical_History" required id="Past_Medical_History"
                                                class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['Past_Medical_History'])) value="{{ $NutritionistHistoryEvaluationSection['Past_Medical_History'] }}"
                                                @else
                                                value="{{ old('Past_Medical_History') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label
                                                for="Medication_Supplements_Allergies_History">Medication/Supplements/Allergies
                                                History</label>
                                            <input value="Medication/Supplements/Allergies History"
                                                placeholder="Medication/Supplements/Allergies History"
                                                name="Medication_Supplements_Allergies_History" required
                                                id="Medication_Supplements_Allergies_History" class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['Medication_Supplements_Allergies_History'])) value="{{ $NutritionistHistoryEvaluationSection['Medication_Supplements_Allergies_History'] }}"
                                                @else
                                                value="{{ old('Medication_Supplements_Allergies_History') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Family_History2">Family History</label>
                                            <input value="Family History" placeholder="Family History"
                                                name="Family_History2" required id="Family_History2" class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['Family_History2'])) value="{{ $NutritionistHistoryEvaluationSection['Family_History2'] }}"
                                                @else
                                                value="{{ old('Family_History2') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Personal_Social_History2">Personal & Social History</label>
                                            <input placeholder="Personal & Social History" name="Personal_Social_History2"
                                                required id="Personal_Social_History2" class="form-control"
                                                value="{{ !empty($NutritionistHistoryEvaluationSection['Personal_Social_History2']) ? $NutritionistHistoryEvaluationSection['Personal_Social_History2'] : old('Personal_Social_History2') }}" />

                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Food_Allergies_and_Intolerances">Food Allergies and
                                                Intolerances</label>
                                            <input placeholder="Food Allergies and Intolerances"
                                                name="Food_Allergies_and_Intolerances" required
                                                id="Food_Allergies_and_Intolerances" class="form-control"
                                                value="{{ !empty($NutritionistHistoryEvaluationSection['Food_Allergies_and_Intolerances']) ? $NutritionistHistoryEvaluationSection['Food_Allergies_and_Intolerances'] : old('Food_Allergies_and_Intolerances') }}" />

                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Appetite">Appetite</label>
                                            <input placeholder="Appetite" name="Appetite" required id="Appetite"
                                                class="form-control"
                                                value="{{ !empty($NutritionistHistoryEvaluationSection['Appetite']) ? $NutritionistHistoryEvaluationSection['Appetite'] : old('Appetite') }}" />
                                        </div>
                                    </div>


                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Recent_Weight_Changes_Weight_History">Recent Weight Changes &
                                                Weight History</label>
                                            <input placeholder="Recent Weight Changes & Weight History"
                                                name="Recent_Weight_Changes_Weight_History" required
                                                id="Recent_Weight_Changes_Weight_History" class="form-control"
                                                value="{{ !empty($NutritionistHistoryEvaluationSection['Recent_Weight_Changes_Weight_History']) ? $NutritionistHistoryEvaluationSection['Recent_Weight_Changes_Weight_History'] : old('Recent_Weight_Changes_Weight_History') }}" />

                                        </div>
                                    </div>
                                </div>

                                <h4 class="mt-4">24- hour Dietary Recall</h4>

                                <div class="form-row">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Breakfast">Breakfast</label>

                                            <select id="Breakfast" class="form-control" onchange="showBreakFast()"
                                                name="Breakfast" required>
                                                <option value="">Select</option>
                                                <option value="Yes"
                                                    @if (
                                                        !empty($NutritionistHistoryEvaluationSection['Breakfast']) &&
                                                            $NutritionistHistoryEvaluationSection['Breakfast'] == 'Yes') selected 
                                                    @elseif(old('Breakfast') == 'Yes') 
                                                        selected @endif>
                                                    Yes</option>
                                                <option value="No"
                                                    @if (
                                                        !empty($NutritionistHistoryEvaluationSection['Breakfast']) &&
                                                            $NutritionistHistoryEvaluationSection['Breakfast'] == 'No') selected 
                                                    @elseif(old('Breakfast') == 'No') 
                                                        selected @endif>
                                                    No</option>
                                            </select>

                                        </div>
                                    </div>

                                    <div class="form-group col-md-6 d-none" id="showBreakFastDetail">
                                        <div class="form-group">
                                            <label for="breakfast_detail">Detail</label>
                                            <input placeholder="Detail" name="breakfast_detail" id="breakfast_detail"
                                                class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['breakfast_detail'])) value="{{ $NutritionistHistoryEvaluationSection['breakfast_detail'] }}"
                                                @else
                                                value="{{ old('breakfast_detail') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Mid_day_Snack">Mid-day Snack</label>
                                            <select id="Mid_day_Snack" name="Mid_day_Snack" class="form-control"
                                                onchange="showMidDaySnack()" required>
                                                <option value="">Select</option>
                                                <option value="Yes"
                                                    @if (
                                                        !empty($NutritionistHistoryEvaluationSection['Mid_day_Snack']) &&
                                                            $NutritionistHistoryEvaluationSection['Mid_day_Snack'] == 'Yes') selected 
                                                    @elseif(old('Mid_day_Snack') == 'Yes') 
                                                        selected @endif>
                                                    Yes</option>
                                                <option value="No"
                                                    @if (
                                                        !empty($NutritionistHistoryEvaluationSection['Mid_day_Snack']) &&
                                                            $NutritionistHistoryEvaluationSection['Mid_day_Snack'] == 'No') selected 
                                                    @elseif(old('Mid_day_Snack') == 'No') 
                                                        selected @endif>
                                                    No</option>
                                            </select>
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6 d-none" id="showMidDaySnackDetail">
                                        <div class="form-group">
                                            <label for="MidDaySnackDetail">Detail</label>
                                            <input placeholder="Detail" name="MidDaySnackDetail" id="MidDaySnackDetail"
                                                class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['MidDaySnackDetail'])) value="{{ $NutritionistHistoryEvaluationSection['MidDaySnackDetail'] }}"
                                                @else
                                                value="{{ old('MidDaySnackDetail') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Lunch">Lunch</label>
                                            <select id="Lunch" class="form-control" onchange="showLunchFunc()"
                                                name="Lunch" required>
                                                <option value="">Select</option>
                                                <option value="Yes"
                                                    @if (!empty($NutritionistHistoryEvaluationSection['Lunch']) && $NutritionistHistoryEvaluationSection['Lunch'] == 'Yes') selected 
                                                    @elseif(old('Lunch') == 'Yes') 
                                                        selected @endif>
                                                    Yes</option>
                                                <option value="No"
                                                    @if (!empty($NutritionistHistoryEvaluationSection['Lunch']) && $NutritionistHistoryEvaluationSection['Lunch'] == 'No') selected 
                                            @elseif(old('Lunch') == 'No') 
                                                selected @endif>
                                                    No</option>
                                            </select>
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6 d-none" id="showlunchdetail">
                                        <div class="form-group">
                                            <label for="lunchDetail">Detail</label>
                                            <input placeholder="Detail" name="lunchDetail" id="lunchDetail"
                                                class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['lunchDetail'])) value="{{ $NutritionistHistoryEvaluationSection['lunchDetail'] }}"
                                                @else
                                                value="{{ old('lunchDetail') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Evening_Snack">Evening Snack</label>
                                            <select id="Evening_Snack" class="form-control" name="Evening_Snack"
                                                onchange="showEveningSnackFunc()" required>
                                                <option value="">Select</option>
                                                <option value="Yes"
                                                    @if (
                                                        !empty($NutritionistHistoryEvaluationSection['Evening_Snack']) &&
                                                            $NutritionistHistoryEvaluationSection['Evening_Snack'] == 'Yes') selected 
                                            @elseif(old('Evening_Snack') == 'Yes') 
                                                selected @endif>
                                                    Yes</option>
                                                <option value="No"
                                                    @if (
                                                        !empty($NutritionistHistoryEvaluationSection['Evening_Snack']) &&
                                                            $NutritionistHistoryEvaluationSection['Evening_Snack'] == 'No') selected 
                                            @elseif(old('Evening_Snack') == 'No') 
                                                selected @endif>
                                                    No</option>
                                            </select>
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6 d-none" id="showEveningSnackDetail">
                                        <div class="form-group">
                                            <label for="EveningSnackDetail">Detail</label>
                                            <input placeholder="Detail" name="EveningSnackDetail" id="EveningSnackDetail"
                                                class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['EveningSnackDetail'])) value="{{ $NutritionistHistoryEvaluationSection['EveningSnackDetail'] }}"
                                                @else
                                                value="{{ old('EveningSnackDetail') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Dinner">Dinner</label>
                                            <select id="Dinner" class="form-control" onchange="showDinnerFunc()"
                                                name="Dinner" required>
                                                <option value="">Select</option>
                                                <option value="Yes"
                                                    @if (!empty($NutritionistHistoryEvaluationSection['Dinner']) && $NutritionistHistoryEvaluationSection['Dinner'] == 'Yes') selected 
                                            @elseif(old('Dinner') == 'Yes') 
                                                selected @endif>
                                                    Yes</option>
                                                <option value="No"
                                                    @if (!empty($NutritionistHistoryEvaluationSection['Dinner']) && $NutritionistHistoryEvaluationSection['Dinner'] == 'No') selected 
                                            @elseif(old('Dinner') == 'No') 
                                                selected @endif>
                                                    No</option>
                                            </select>
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6 d-none" id="showDinner">
                                        <div class="form-group">
                                            <label for="Dinner">Detail</label>
                                            <input placeholder="Detail" name="DinnerDetails" id="DinnerDetails"
                                                class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['DinnerDetails'])) value="{{ $NutritionistHistoryEvaluationSection['DinnerDetails'] }}"
                                                @else
                                                value="{{ old('DinnerDetails') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Bed_time_snack">Bed-time snack</label>
                                            <select id="Bed_time_snack" class="form-control" name="Bed_time_snack"
                                                required>
                                                <option value="">Select</option>
                                                <option value="Yes"
                                                    @if (
                                                        !empty($NutritionistHistoryEvaluationSection['Bed_time_snack']) &&
                                                            $NutritionistHistoryEvaluationSection['Bed_time_snack'] == 'Yes') selected 
                                            @elseif(old('Bed_time_snack') == 'Yes') 
                                                selected @endif>
                                                    Yes</option>
                                                <option value="No"
                                                    @if (
                                                        !empty($NutritionistHistoryEvaluationSection['Bed_time_snack']) &&
                                                            $NutritionistHistoryEvaluationSection['Bed_time_snack'] == 'No') selected 
                                            @elseif(old('Bed_time_snack') == 'No') 
                                                selected @endif>
                                                    No</option>
                                            </select>
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Biochemical_Laboratory_test_Reports">Biochemical / Laboratory Test
                                                Reports</label>
                                            <input placeholder="Biochemical / Laboratory Test Reports"
                                                name="Biochemical_Laboratory_test_Reports"
                                                id="Biochemical_Laboratory_test_Reports" class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['Biochemical_Laboratory_test_Reports'])) value="{{ $NutritionistHistoryEvaluationSection['Biochemical_Laboratory_test_Reports'] }}"
                                                @else
                                                value="{{ old('Biochemical_Laboratory_test_Reports') }}" @endif />
                                        </div>
                                    </div>

                                </div>

                                <h4 class="mt-4">Clinical Examination</h4>

                                <h5 class="mt-4 text-center">Physical Appearance</h5>

                                <div class="form-row">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Skin">Skin</label>
                                            <select id="Skin" class="form-control" name="Skin" required>
                                                <option value="">Select</option>
                                                <option value="Normal"
                                                    @if (!empty($NutritionistHistoryEvaluationSection['Skin']) && $NutritionistHistoryEvaluationSection['Skin'] == 'Normal') selected 
                                            @elseif(old('Skin') == 'Normal') 
                                                selected @endif>
                                                    Normal</option>
                                                <option value="Dry"
                                                    @if (!empty($NutritionistHistoryEvaluationSection['Skin']) && $NutritionistHistoryEvaluationSection['Skin'] == 'Dry') selected 
                                            @elseif(old('Skin') == 'Dry') 
                                                selected @endif>
                                                    Dry</option>
                                                <option value="Scaly"
                                                    @if (!empty($NutritionistHistoryEvaluationSection['Skin']) && $NutritionistHistoryEvaluationSection['Skin'] == 'Scaly') selected 
                                            @elseif(old('Skin') == 'Scaly') 
                                                selected @endif>
                                                    Scaly</option>
                                            </select>
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Eyes">Eyes</label>
                                            <select id="Eyes" name="Eyes" class="form-control" required>
                                                <option value="">Select</option>
                                                <option value="Normal"
                                                    @if (!empty($NutritionistHistoryEvaluationSection['Eyes']) && $NutritionistHistoryEvaluationSection['Eyes'] == 'Normal') selected 
                                            @elseif(old('Eyes') == 'Normal') 
                                                selected @endif>
                                                    Normal</option>
                                                <option value="Pale"
                                                    @if (!empty($NutritionistHistoryEvaluationSection['Eyes']) && $NutritionistHistoryEvaluationSection['Eyes'] == 'Pale') selected 
                                            @elseif(old('Eyes') == 'Pale') 
                                                selected @endif>
                                                    Pale</option>
                                                <option value="Redness"
                                                    @if (!empty($NutritionistHistoryEvaluationSection['Eyes']) && $NutritionistHistoryEvaluationSection['Eyes'] == 'Redness') selected 
                                            @elseif(old('Eyes') == 'Redness') 
                                                selected @endif>
                                                    Redness</option>
                                                <option value="Yellow"
                                                    @if (!empty($NutritionistHistoryEvaluationSection['Eyes']) && $NutritionistHistoryEvaluationSection['Eyes'] == 'Yellow') selected 
                                            @elseif(old('Eyes') == 'Yellow') 
                                                selected @endif>
                                                    Yellow</option>
                                            </select>
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Lips">Lips</label>
                                            <select id="Lips" name="Lips" class="form-control" required>
                                                <option value="">Select</option>
                                                <option value="Normal"
                                                    @if (!empty($NutritionistHistoryEvaluationSection['Lips']) && $NutritionistHistoryEvaluationSection['Lips'] == 'Normal') selected 
                                            @elseif(old('Lips') == 'Normal') 
                                                selected @endif>
                                                    Normal</option>
                                                <option value="Dry"
                                                    @if (!empty($NutritionistHistoryEvaluationSection['Lips']) && $NutritionistHistoryEvaluationSection['Lips'] == 'Dry') selected 
                                            @elseif(old('Lips') == 'Dry') 
                                                selected @endif>
                                                    Dry</option>
                                                <option value="Dark Colored"
                                                    @if (
                                                        !empty($NutritionistHistoryEvaluationSection['Lips']) &&
                                                            $NutritionistHistoryEvaluationSection['Lips'] == 'Dark Colored') selected 
                                            @elseif(old('Lips') == 'Dark Colored') 
                                                selected @endif>
                                                    Dark Colored</option>
                                            </select>
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Nails">Nails</label>
                                            <select id="Nails" name="Nails" class="form-control" required>
                                                <option value="">Select</option>
                                                <option value="Normal"
                                                    @if (
                                                        !empty($NutritionistHistoryEvaluationSection['Nails']) &&
                                                            $NutritionistHistoryEvaluationSection['Nails'] == 'Normal') selected 
                                            @elseif(old('Nails') == 'Normal') 
                                                selected @endif>
                                                    Normal</option>
                                                <option value="Brittle"
                                                    @if (
                                                        !empty($NutritionistHistoryEvaluationSection['Nails']) &&
                                                            $NutritionistHistoryEvaluationSection['Nails'] == 'Brittle') selected 
                                            @elseif(old('Nails') == 'Brittle') 
                                                selected @endif>
                                                    Brittle</option>
                                                <option value="Translucent"
                                                    @if (
                                                        !empty($NutritionistHistoryEvaluationSection['Nails']) &&
                                                            $NutritionistHistoryEvaluationSection['Nails'] == 'Translucent') selected 
                                            @elseif(old('Nails') == 'Translucent') 
                                                selected @endif>
                                                    Translucent</option>
                                            </select>
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Hair">Hair</label>
                                            <select id="Hair" name="Hair" class="form-control" required>
                                                <option value="">Select</option>
                                                <option value="Normal"
                                                    @if (!empty($NutritionistHistoryEvaluationSection['Hair']) && $NutritionistHistoryEvaluationSection['Hair'] == 'Normal') selected 
                                            @elseif(old('Hair') == 'Normal') 
                                                selected @endif>
                                                    Normal</option>
                                                <option value="Dry"
                                                    @if (!empty($NutritionistHistoryEvaluationSection['Hair']) && $NutritionistHistoryEvaluationSection['Hair'] == 'Dry') selected 
                                            @elseif(old('Hair') == 'Dry') 
                                                selected @endif>
                                                    Dry</option>
                                                <option value="Brittle"
                                                    @if (!empty($NutritionistHistoryEvaluationSection['Hair']) && $NutritionistHistoryEvaluationSection['Hair'] == 'Brittle') selected 
                                            @elseif(old('Hair') == 'Brittle') 
                                                selected @endif>
                                                    Brittle</option>
                                            </select>
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Scalp">Scalp</label>
                                            <select id="Scalp" name="Scalp" class="form-control" required>
                                                <option value="">Select</option>
                                                <option value="Normal"
                                                    @if (
                                                        !empty($NutritionistHistoryEvaluationSection['Scalp']) &&
                                                            $NutritionistHistoryEvaluationSection['Scalp'] == 'Normal') selected 
                                                    @elseif (old('Scalp') == 'Normal') 
                                                        selected @endif>
                                                    Normal
                                                </option>
                                                <option value="Dry"
                                                    @if (!empty($NutritionistHistoryEvaluationSection['Scalp']) && $NutritionistHistoryEvaluationSection['Scalp'] == 'Dry') selected 
                                                    @elseif (old('Scalp') == 'Dry') 
                                                        selected @endif>
                                                    Dry
                                                </option>
                                                <option value="Scaly"
                                                    @if (!empty($NutritionistHistoryEvaluationSection['Scalp']) && $NutritionistHistoryEvaluationSection['Scalp'] == 'Scaly') selected 
                                                    @elseif (old('Scalp') == 'Scaly') 
                                                        selected @endif>
                                                    Scaly
                                                </option>
                                                <option value="Oily"
                                                    @if (!empty($NutritionistHistoryEvaluationSection['Scalp']) && $NutritionistHistoryEvaluationSection['Scalp'] == 'Oily') selected 
                                                    @elseif (old('Scalp') == 'Oily') 
                                                        selected @endif>
                                                    Oily
                                                </option>
                                            </select>
                                        </div>
                                    </div>
                                </div>


                                <h4 class="text-center mt-3">Diagnosis, Impression and Plan</h4>

                                <div class="form-row">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Problem_List1">Problem List</label>
                                            <input placeholder="Problem List" name="Problem_List1" id="Problem_List1"
                                                required class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['Problem_List1'])) value="{{ $NutritionistHistoryEvaluationSection['Problem_List1'] }}"
                                                @else
                                                value="{{ old('Problem_List1') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Impression1">Impression</label>
                                            <input placeholder="Impression" name="Impression1" id="Impression1" required
                                                class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['Impression1'])) value="{{ $NutritionistHistoryEvaluationSection['Impression1'] }}"
                                                @else
                                                value="{{ old('Impression1') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Provisional_Diagnosis1">Provisional Diagnosis</label><br>
                                            @php
                                                $provisionalArray = [];
                                                if (
                                                    !empty(
                                                        $NutritionistHistoryEvaluationSection['Provisional_Diagnosis1']
                                                    )
                                                ) {
                                                    $provisionalArray = explode(
                                                        '|',
                                                        $NutritionistHistoryEvaluationSection['Provisional_Diagnosis1'],
                                                    );
                                                }
                                            @endphp
                                            <select id="Provisional_Diagnosis1" name="Provisional_Diagnosis1[]" required
                                                class="form-control js-states select_multi py-3" multiple>
                                                <option value="H10.9 Unspecified conjunctivitis"
                                                    {{ in_array('H10.9 Unspecified conjunctivitis', $provisionalArray) ? 'selected' : '' }}>
                                                    H10.9 Unspecified conjunctivitis
                                                </option>
                                                <option value="H10.32 Unspecified acute conjunctivitis, left eye"
                                                    {{ in_array('H10.32 Unspecified acute conjunctivitis, left eye', $provisionalArray) ? 'selected' : '' }}>
                                                    H10.32 Unspecified acute conjunctivitis, left eye
                                                </option>
                                                <option value="H52.11 Myopia, right eye"
                                                    {{ in_array('H52.11 Myopia, right eye', $provisionalArray) ? 'selected' : '' }}>
                                                    H52.11 Myopia, right eye
                                                </option>
                                                <option value="H52.12 Myopia, left eye"
                                                    {{ in_array('H52.12 Myopia, left eye', $provisionalArray) ? 'selected' : '' }}>
                                                    H52.12 Myopia, left eye
                                                </option>
                                                <option value="H52.13 Myopia, bilateral"
                                                    {{ in_array('H52.13 Myopia, bilateral', $provisionalArray) ? 'selected' : '' }}>
                                                    H52.13 Myopia, bilateral
                                                </option>
                                            </select>
                                        </div>

                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="General_Advice1">General Advice & Management Plan</label>
                                            <input placeholder="General Advice & Management Plan" name="General_Advice1"
                                                id="General_Advice1" class="form-control" required
                                                @if (!empty($NutritionistHistoryEvaluationSection['General_Advice1'])) value="{{ $NutritionistHistoryEvaluationSection['General_Advice1'] }}"
                                                @else
                                                value="{{ old('General_Advice1') }}" @endif />
                                        </div>
                                    </div>


                                </div>

                                <h4 class="mt-4 text-center">Diet Plan</h4>

                                <div class="form-row">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="diet_breakfast">Breakfast</label>
                                            <input placeholder="Breakfast" name="diet_breakfast" id="diet_breakfast"
                                                class="form-control" required
                                                @if (!empty($NutritionistHistoryEvaluationSection['diet_breakfast'])) value="{{ $NutritionistHistoryEvaluationSection['diet_breakfast'] }}"
                                                @else
                                                value="{{ old('diet_breakfast') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="diet_snack">Snack</label>
                                            <input placeholder="Snack" name="diet_snack" id="diet_snack"
                                                class="form-control" required
                                                @if (!empty($NutritionistHistoryEvaluationSection['diet_snack'])) value="{{ $NutritionistHistoryEvaluationSection['diet_snack'] }}"
                                                @else
                                                value="{{ old('diet_snack') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="diet_lunch">Lunch</label>
                                            <input placeholder="Lunch" name="diet_lunch" id="diet_lunch"
                                                class="form-control" required
                                                @if (!empty($NutritionistHistoryEvaluationSection['diet_lunch'])) value="{{ $NutritionistHistoryEvaluationSection['diet_lunch'] }}"
                                                @else
                                                value="{{ old('diet_lunch') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="diet_dinner">Dinner</label>
                                            <input placeholder="Dinner" name="diet_dinner" id="diet_dinner"
                                                class="form-control" required
                                                @if (!empty($NutritionistHistoryEvaluationSection['diet_dinner'])) value="{{ $NutritionistHistoryEvaluationSection['diet_dinner'] }}"
                                                @else
                                                value="{{ old('diet_dinner') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="diet_bedtime">Bedtime</label>
                                            <input type="text" placeholder="Bedtime" name="diet_bedtime"
                                                id="diet_bedtime" class="form-control" required
                                                @if (!empty($NutritionistHistoryEvaluationSection['diet_bedtime'])) value="{{ $NutritionistHistoryEvaluationSection['diet_bedtime'] }}"
                                                @else
                                                value="{{ old('diet_bedtime') }}" @endif />
                                        </div>
                                    </div>
                                </div>

                                <hr>


                                <div class="form-row">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Follow_up_Required1">Follow-up Required</label>
                                            <select id="Follow_up_Required1" name="Follow_up_Required1"
                                                class="form-control" onchange="followUp1()" required>
                                                <option value="">Select</option>
                                                <option value="Yes"
                                                    @if (
                                                        !empty($NutritionistHistoryEvaluationSection['Follow_up_Required1']) &&
                                                            $NutritionistHistoryEvaluationSection['Follow_up_Required1'] == 'Yes') selected 
                                            @elseif(old('Follow_up_Required1') == 'Yes') 
                                                selected @endif>
                                                    Yes</option>
                                                <option value="No"
                                                    @if (
                                                        !empty($NutritionistHistoryEvaluationSection['Follow_up_Required1']) &&
                                                            $NutritionistHistoryEvaluationSection['Follow_up_Required1'] == 'No') selected 
                                            @elseif(old('Follow_up_Required1') == 'No') 
                                                selected @endif>
                                                    No</option>
                                            </select>
                                        </div>
                                    </div>
                                </div>

                                <div class="form-row d-none" id="follow_up_show1">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Reason_for_Follow_up1">Reason for Follow-up</label>
                                            <input placeholder="Reason for Follow-up" name="Reason_for_Follow_up1"
                                                id="Reason_for_Follow_up1" class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['Reason_for_Follow_up1'])) value="{{ $NutritionistHistoryEvaluationSection['Reason_for_Follow_up1'] }}"
                                                @else
                                                value="{{ old('Reason_for_Follow_up1') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Follow_up_Date1">Follow-up Date</label>
                                            <input type="date" placeholder="Reason for Follow-up"
                                                name="Follow_up_Date1" id="Follow_up_Date1" class="form-control"
                                                @if (!empty($NutritionistHistoryEvaluationSection['Follow_up_Date1'])) value="{{ $NutritionistHistoryEvaluationSection['Follow_up_Date1'] }}"
                                                @else
                                                value="{{ old('Follow_up_Date1') }}" @endif />
                                        </div>
                                    </div>
                                </div>

                                <h3>Refferals</h3>

                                <div class="form-row">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="internal_referrals1">Internal Referrals</label>

                                            <select id="internal_referrals1" name="internal_referrals1[]" required
                                                class="form-control js-states select_multi py-3" multiple>


                                                @php
                                                    $selectedValues = [];
                                                    if (
                                                        !empty(
                                                            $NutritionistHistoryEvaluationSection['internal_referrals1']
                                                        )
                                                    ) {
                                                        $selectedValues = explode(
                                                            '|',
                                                            $NutritionistHistoryEvaluationSection[
                                                                'internal_referrals1'
                                                            ] ?? '',
                                                        );
                                                    }
                                                @endphp


                                                <option value="Nutritionist"
                                                    @if (in_array('Nutritionist', $selectedValues)) selected @endif>Nutritionist
                                                </option>
                                                <option value="Psychologist"
                                                    @if (in_array('Psychologist', $selectedValues)) selected @endif>Psychologist
                                                </option>
                                                <option value="School Health Physician"
                                                    @if (in_array('School Health Physician', $selectedValues)) selected @endif>School Health
                                                    Physician</option>
                                                <option value="Not Required"
                                                    @if (in_array('Not Required', $selectedValues)) selected @endif>Not Required
                                                </option>
                                            </select>


                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="external_referrals1">External Referrals</label>
                                            <select id="external_referrals1" name="external_referrals1[]" required
                                                class="form-control js-states select_multi py-3" multiple
                                                onchange="showReasonForReferral1()">
                                                @php
                                                    $selectedValues = [];
                                                    if (
                                                        !empty(
                                                            $NutritionistHistoryEvaluationSection['external_referrals1']
                                                        )
                                                    ) {
                                                        $selectedValues = explode(
                                                            '|',
                                                            $NutritionistHistoryEvaluationSection[
                                                                'external_referrals1'
                                                            ] ?? '',
                                                        );
                                                    }
                                                @endphp

                                                <option value="Allery and Immunology"
                                                    @if (in_array('Allery and Immunology', $selectedValues)) selected @endif>
                                                    Allery and Immunology</option>
                                                <option value="Cardiology"
                                                    @if (in_array('Cardiology', $selectedValues)) selected @endif>
                                                    Cardiology</option>
                                                <option value="Clinical Psychology"
                                                    @if (in_array('Clinical Psychology', $selectedValues)) selected @endif>
                                                    Clinical Psychology</option>
                                                <option value="Dentistry"
                                                    @if (in_array('Dentistry', $selectedValues)) selected @endif>
                                                    Dentistry</option>
                                                <option value="Dermatology"
                                                    @if (in_array('Dermatology', $selectedValues)) selected @endif>
                                                    Dermatology</option>
                                            </select>
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6 d-none" id="reasonForReferralSection1">
                                        <div class="form-group">
                                            <label for="Reason_for_Referral1">Reason for Referral</label>
                                            <input placeholder="Reason for Referral" name="Reason_for_Referral1"
                                                id="Reason_for_Referral1" class="form-control" required
                                                @if (!empty($NutritionistHistoryEvaluationSection['Reason_for_Referral1'])) value="{{ $NutritionistHistoryEvaluationSection['Reason_for_Referral1'] }}"
                                                @else
                                                value="{{ old('Reason_for_Referral1') }}" @endif />
                                        </div>
                                    </div>

                                </div>


                                <a href="{{ Route('StudentBiodata') }}">
                                    <button type="button" class="btn btn-primary prevStep">Previous</button>
                                </a>

                                <button type="submit" name="submit" class="btn btn-primary">Submit</button>


                            </form>

                        </div>



                        <div class="tab-pane fade" id="contact" role="tabpanel" aria-labelledby="contact-tab">

                            <form id="multiStepForm" action="{{ route('PsychologistHistoryAssessmentSection') }}"
                                method="POST">
                                @csrf
                                <h3 class="text-center mt-4">Psychologist History & Assessment Section</h3>

                                <div class="form-row mt-5">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Identifying_Personal_Information">Identifying Personal
                                                Information</label>
                                            <input placeholder="Identifying Personal Information"
                                                name="Identifying_Personal_Information"
                                                id="Identifying_Personal_Information" class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Identifying_Personal_Information'])) value="{{ $PsychologistHistoryAssessmentSection['Identifying_Personal_Information'] }}"
                                                @else
                                                value="{{ old('Identifying_Personal_Information') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Referral_Source">Referral Source</label>
                                            <input placeholder="Referral Source" name="Referral_Source"
                                                id="Referral_Source" class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Referral_Source'])) value="{{ $PsychologistHistoryAssessmentSection['Referral_Source'] }}"
                                                @else
                                                value="{{ old('Referral_Source') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Chief_Complaints3">Chief Complaints</label>
                                            <input placeholder="Chief Complaints" name="Chief_Complaints3"
                                                id="Chief_Complaints3" class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Chief_Complaints3'])) value="{{ $PsychologistHistoryAssessmentSection['Chief_Complaints3'] }}"
                                                @else
                                                value="{{ old('Chief_Complaints3') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="History_of_Presenting_Complaints2">History of Presenting
                                                Complaints</label>
                                            <input placeholder="History of Presenting Complaints"
                                                name="History_of_Presenting_Complaints2"
                                                id="History_of_Presenting_Complaints2" class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['History_of_Presenting_Complaints2'])) value="{{ $PsychologistHistoryAssessmentSection['History_of_Presenting_Complaints2'] }}"
                                                @else
                                                value="{{ old('History_of_Presenting_Complaints2') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Investigations_Laboratory_Test_Reports2">Investigations /
                                                Laboratory Test Reports</label>
                                            <input placeholder="Investigations / Laboratory Test Reports"
                                                name="Investigations_Laboratory_Test_Reports2"
                                                id="Investigations_Laboratory_Test_Reports2" class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Investigations_Laboratory_Test_Reports2'])) value="{{ $PsychologistHistoryAssessmentSection['Investigations_Laboratory_Test_Reports2'] }}"
                                                @else
                                                value="{{ old('Investigations_Laboratory_Test_Reports2') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Past_Medical_Psychiatric_History">Past Medical & Psychiatric
                                                History</label>
                                            <input placeholder="Past Medical & Psychiatric History"
                                                name="Past_Medical_Psychiatric_History"
                                                id="Past_Medical_Psychiatric_History" class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Past_Medical_Psychiatric_History'])) value="{{ $PsychologistHistoryAssessmentSection['Past_Medical_Psychiatric_History'] }}"
                                                @else
                                                value="{{ old('Past_Medical_Psychiatric_History') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Medication_History_Allergies">Medication History &
                                                Allergies</label>
                                            <input placeholder="Medication History & Allergies"
                                                name="Medication_History_Allergies" id="Medication_History_Allergies"
                                                class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Medication_History_Allergies'])) value="{{ $PsychologistHistoryAssessmentSection['Medication_History_Allergies'] }}"
                                                @else
                                                value="{{ old('Past_Medical_Psychiatric_History') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Family_History3">Family History</label>
                                            <input placeholder="Family History" name="Family_History3"
                                                id="Family_History3" class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Medication_History_Allergies'])) value="{{ $PsychologistHistoryAssessmentSection['Medication_History_Allergies'] }}"
                                                @else
                                                value="{{ old('Past_Medical_Psychiatric_History') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Personal_Social_History3">Personal & Social History</label>
                                            <input placeholder="Personal & Social History"
                                                name="Personal_Social_History3" id="Personal_Social_History3"
                                                class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Personal_Social_History3'])) value="{{ $PsychologistHistoryAssessmentSection['Personal_Social_History3'] }}"
                                                @else
                                                value="{{ old('Personal_Social_History3') }}" @endif />
                                        </div>
                                    </div>
                                </div>

                                <h4 class="text-center mt-4">Mental Status Examination</h4>

                                <div class="form-row">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Appearance_Behavior">Appearance & Behavior</label>
                                            <input placeholder="Appearance & Behavior" name="Appearance_Behavior"
                                                id="Appearance_Behavior" class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Appearance_Behavior'])) value="{{ $PsychologistHistoryAssessmentSection['Appearance_Behavior'] }}"
                                                @else
                                                value="{{ old('Appearance_Behavior') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Attitude_toward_the_examiner">Attitude toward the examiner</label>
                                            <input placeholder="Attitude toward the examiner"
                                                name="Attitude_toward_the_examiner" id="Attitude_toward_the_examiner"
                                                class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Attitude_toward_the_examiner'])) value="{{ $PsychologistHistoryAssessmentSection['Attitude_toward_the_examiner'] }}"
                                                @else
                                                value="{{ old('Attitude_toward_the_examiner') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Speech">Speech</label>
                                            <input placeholder="Speech" name="Speech" id="Speech"
                                                class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Speech'])) value="{{ $PsychologistHistoryAssessmentSection['Speech'] }}"
                                                @else
                                                value="{{ old('Attitude_toward_the_examiner') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Mood">Mood</label>
                                            <input placeholder="Mood" name="Mood" id="Mood"
                                                class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Mood'])) value="{{ $PsychologistHistoryAssessmentSection['Mood'] }}"
                                                @else
                                                value="{{ old('Mood') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Affect">Affect</label>
                                            @php
                                                $selectedValues = [];
                                                if (!empty($PsychologistHistoryAssessmentSection['Affect'])) {
                                                    $selectedValues = explode(
                                                        '|',
                                                        $PsychologistHistoryAssessmentSection['Affect'],
                                                    );
                                                }
                                            @endphp

                                            <select class="form-control" id="Affect" name="Affect">
                                                <option value="Expansive (Contagious)"
                                                    @if (in_array('Expansive (Contagious)', $selectedValues)) selected @endif>
                                                    Expansive (Contagious)
                                                </option>
                                                <option value="Euthymic (Normal)"
                                                    @if (in_array('Euthymic (Normal)', $selectedValues)) selected @endif>
                                                    Euthymic (Normal)
                                                </option>
                                                <option value="Constricted (Limited Variation)"
                                                    @if (in_array('Constricted (Limited Variation)', $selectedValues)) selected @endif>
                                                    Constricted (Limited Variation)
                                                </option>
                                                <option value="Blunted (Minimal Variation)"
                                                    @if (in_array('Blunted (Minimal Variation)', $selectedValues)) selected @endif>
                                                    Blunted (Minimal Variation)
                                                </option>
                                                <option value="Flat (No Variation)"
                                                    @if (in_array('Flat (No Variation)', $selectedValues)) selected @endif>
                                                    Flat (No Variation)
                                                </option>
                                                <option value="Inappropriate"
                                                    @if (in_array('Inappropriate', $selectedValues)) selected @endif>
                                                    Inappropriate
                                                </option>
                                            </select>

                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Thought_process_content">Thought Process & Content</label>
                                            <input placeholder="Thought Process & Content"
                                                name="Thought_process_content" id="Thought_process_content"
                                                class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Thought_process_content'])) value="{{ $PsychologistHistoryAssessmentSection['Thought_process_content'] }}"
                                                @else
                                                value="{{ old('Thought_process_content') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Perceptions">Perceptions</label>
                                            <input placeholder="Perceptions" name="Perceptions" id="Perceptions"
                                                class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Perceptions'])) value="{{ $PsychologistHistoryAssessmentSection['Perceptions'] }}"
                                                @else
                                                value="{{ old('Perceptions') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Delusions">Delusions</label>
                                            <input placeholder="Delusions" name="Delusions" id="Delusions"
                                                class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Delusions'])) value="{{ $PsychologistHistoryAssessmentSection['Delusions'] }}"
                                                @else
                                                value="{{ old('Delusions') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Cognitive_Function">Cognitive Function</label>
                                            <input placeholder="Cognitive Function" name="Cognitive_Function"
                                                id="Cognitive_Function" class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Cognitive_Function'])) value="{{ $PsychologistHistoryAssessmentSection['Cognitive_Function'] }}"
                                                @else
                                                value="{{ old('Cognitive_Function') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Insight">Insight</label>
                                            <input placeholder="Insight" name="Insight" id="Insight"
                                                class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Insight'])) value="{{ $PsychologistHistoryAssessmentSection['Insight'] }}"
                                                @else
                                                value="{{ old('Insight') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Judgement">Judgement</label>
                                            <input placeholder="Judgement" name="Judgement" id="Judgement"
                                                class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Judgement'])) value="{{ $PsychologistHistoryAssessmentSection['Judgement'] }}"
                                                @else
                                                value="{{ old('Judgement') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Impulsivity">Impulsivity</label>
                                            <input placeholder="Impulsivity" name="Impulsivity" id="Impulsivity"
                                                class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Impulsivity'])) value="{{ $PsychologistHistoryAssessmentSection['Impulsivity'] }}"
                                                @else
                                                value="{{ old('Impulsivity') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Reliability">Reliability</label>
                                            <input placeholder="Reliability" name="Reliability" id="Reliability"
                                                class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Reliability'])) value="{{ $PsychologistHistoryAssessmentSection['Reliability'] }}"
                                                @else
                                                value="{{ old('Reliability') }}" @endif />
                                        </div>
                                    </div>
                                </div>

                                <h4 class="text-center mt-3">Diagnosis, Impression and Plan</h4>

                                <div class="form-row">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Problem_List2">Problem List</label>
                                            <input placeholder="Problem List" name="Problem_List2" id="Problem_List2"
                                                required class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Problem_List2'])) value="{{ $PsychologistHistoryAssessmentSection['Problem_List2'] }}"
                                                @else
                                                value="{{ old('Problem_List2') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Impression2">Impression</label>
                                            <input placeholder="Impression" name="Impression2" id="Impression2"
                                                required class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Impression2'])) value="{{ $PsychologistHistoryAssessmentSection['Impression2'] }}"
                                                @else
                                                value="{{ old('Impression2') }}" @endif />
                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Provisional_Diagnosis2">Provisional Diagnosis</label><br>
                                            <select name="Provisional_Diagnosis2[]" id="Provisional_Diagnosis2" required
                                                class="form-control js-states select_multi py-3" multiple>
                                                @php
                                                    $selectedDiagnosis = [];
                                                    if (
                                                        !empty(
                                                            $PsychologistHistoryAssessmentSection[
                                                                'Provisional_Diagnosis2'
                                                            ]
                                                        )
                                                    ) {
                                                        $selectedDiagnosis = explode(
                                                            '|',
                                                            $PsychologistHistoryAssessmentSection[
                                                                'Provisional_Diagnosis2'
                                                            ],
                                                        );
                                                    }
                                                @endphp
                                                <option
                                                    value="H10.9 Unspecified conjunctivitis"{{ in_array('H10.9 Unspecified conjunctivitis', $selectedDiagnosis) ? ' selected' : '' }}>
                                                    H10.9 Unspecified conjunctivitis</option>
                                                <option
                                                    value="H10.32 Unspecified acute conjunctivitis, left eye"{{ in_array('H10.32 Unspecified acute conjunctivitis, left eye', $selectedDiagnosis) ? ' selected' : '' }}>
                                                    H10.32 Unspecified acute conjunctivitis, left eye</option>
                                                <option
                                                    value="H52.11 Myopia, right eye"{{ in_array('H52.11 Myopia, right eye', $selectedDiagnosis) ? ' selected' : '' }}>
                                                    H52.11 Myopia, right eye</option>
                                                <option
                                                    value="H52.12 Myopia, left eye"{{ in_array('H52.12 Myopia, left eye', $selectedDiagnosis) ? ' selected' : '' }}>
                                                    H52.12 Myopia, left eye</option>
                                                <option
                                                    value="H52.13 Myopia, bilateral"{{ in_array('H52.13 Myopia, bilateral', $selectedDiagnosis) ? ' selected' : '' }}>
                                                    H52.13 Myopia, bilateral</option>
                                            </select>


                                        </div>
                                    </div>

                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="General_Advice2">General Advice & Management Plan</label>
                                            <input placeholder="General Advice & Management Plan" name="General_Advice2"
                                                id="General_Advice2" class="form-control" required
                                                @if (!empty($PsychologistHistoryAssessmentSection['General_Advice2'])) value="{{ $PsychologistHistoryAssessmentSection['General_Advice2'] }}"
                                                @else
                                                value="{{ old('General_Advice2') }}" @endif />
                                        </div>
                                    </div>


                                </div>


                                <div class="form-row">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Follow_up_Required2">Follow-up Required</label>
                                            <select name="Follow_up_Required2" id="Follow_up_Required2"
                                                class="form-control" onchange="followUp2()" required>
                                                <option value="">Select</option>
                                                <option value="Yes"
                                                    @if (
                                                        !empty($PsychologistHistoryAssessmentSection['Follow_up_Required2']) &&
                                                            $PsychologistHistoryAssessmentSection['Follow_up_Required2'] == 'Yes') selected 
                                                @elseif(old('Follow_up_Required2') == 'Yes') 
                                                    selected @endif>
                                                    Yes</option>
                                                <option value="No"
                                                    @if (
                                                        !empty($PsychologistHistoryAssessmentSection['Follow_up_Required2']) &&
                                                            $PsychologistHistoryAssessmentSection['Follow_up_Required2'] == 'No') selected 
                                                @elseif(old('Follow_up_Required2') == 'No') 
                                                    selected @endif>
                                                    No</option>
                                            </select>
                                        </div>
                                    </div>
                                </div>

                                <div class="form-row d-none" id="follow_up_show2">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Reason_for_Follow_up2">Reason for Follow-up</label>
                                            <input placeholder="Reason for Follow-up" name="Reason_for_Follow_up2"
                                                id="Reason_for_Follow_up2" class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Reason_for_Follow_up2'])) value="{{ $PsychologistHistoryAssessmentSection['Reason_for_Follow_up2'] }}"
                                                @else
                                                value="{{ old('Reason_for_Follow_up2') }}" @endif />
                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="Follow_up_Date2">Follow-up Date</label>
                                            <input type="date" placeholder="Reason for Follow-up"
                                                name="Follow_up_Date2" id="Follow_up_Date2" class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Follow_up_Date2'])) value="{{ $PsychologistHistoryAssessmentSection['Follow_up_Date2'] }}"
                                                @else
                                                value="{{ old('Follow_up_Date2') }}" @endif />
                                        </div>
                                    </div>
                                </div>

                                <h3>Refferals</h3>

                                <div class="form-row">
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="internal_referrals2">Internal Referrals</label>
                                            <select name="internal_referrals2[]" id="internal_referrals2"
                                                class="form-control js-states select_multi py-3" multiple>
                                                @php
                                                    $selectedValues = [];
                                                    if (
                                                        !empty(
                                                            $PsychologistHistoryAssessmentSection['internal_referrals2']
                                                        )
                                                    ) {
                                                        $selectedValues = explode(
                                                            '|',
                                                            $PsychologistHistoryAssessmentSection[
                                                                'internal_referrals2'
                                                            ] ?? '',
                                                        );
                                                    }
                                                @endphp

                                                <option value="Nutritionist"
                                                    @if (in_array('Nutritionist', $selectedValues)) selected @endif>Nutritionist
                                                </option>
                                                <option value="Psychologist"
                                                    @if (in_array('Psychologist', $selectedValues)) selected @endif>Psychologist
                                                </option>
                                                <option value="School Health Physician"
                                                    @if (in_array('School Health Physician', $selectedValues)) selected @endif>School Health
                                                    Physician</option>
                                                <option value="Not Required"
                                                    @if (in_array('Not Required', $selectedValues)) selected @endif>Not Required
                                                </option>
                                            </select>


                                        </div>
                                    </div>
                                    <div class="form-group col-md-6">
                                        <div class="form-group">
                                            <label for="external_referrals2">External Referrals</label>
                                            <select name="external_referrals2[]" id="external_referrals2"
                                                class="form-control js-states select_multi py-3" multiple
                                                onchange="showReasonForReferral2()">
                                                @php
                                                    $selectedValues = !empty(
                                                        $PsychologistHistoryAssessmentSection['external_referrals2']
                                                    )
                                                        ? explode(
                                                            '|',
                                                            $PsychologistHistoryAssessmentSection[
                                                                'external_referrals2'
                                                            ],
                                                        )
                                                        : [];
                                                @endphp

                                                <option
                                                    value="Allery and Immunology"{{ in_array('Allery and Immunology', $selectedValues) ? ' selected' : '' }}>
                                                    Allery and Immunology</option>
                                                <option
                                                    value="Cardiology"{{ in_array('Cardiology', $selectedValues) ? ' selected' : '' }}>
                                                    Cardiology</option>
                                                <option
                                                    value="Clinical Psychology"{{ in_array('Clinical Psychology', $selectedValues) ? ' selected' : '' }}>
                                                    Clinical Psychology</option>
                                                <option
                                                    value="Dentistry"{{ in_array('Dentistry', $selectedValues) ? ' selected' : '' }}>
                                                    Dentistry</option>
                                                <option
                                                    value="Dermatology"{{ in_array('Dermatology', $selectedValues) ? ' selected' : '' }}>
                                                    Dermatology</option>
                                            </select>

                                        </div>
                                    </div>
                                    <div class="form-group col-md-6 d-none" id="reasonForReferralSection2">
                                        <div class="form-group">
                                            <label for="Reason_for_Referral2">Reason for Referral</label>
                                            <input placeholder="Reason for Referral" name="Reason_for_Referral2"
                                                id="Reason_for_Referral2" class="form-control"
                                                @if (!empty($PsychologistHistoryAssessmentSection['Reason_for_Referral2'])) value="{{ $PsychologistHistoryAssessmentSection['Reason_for_Referral2'] }}"
                                                @else
                                                value="{{ old('Reason_for_Referral2') }}" @endif />
                                        </div>
                                    </div>

                                </div>



                                <a href="{{ Route('StudentBiodata') }}">
                                    <button type="button" class="btn btn-primary prevStep">Previous</button>
                                </a>

                                <button type="submit" name="submit" class="btn btn-primary">Submit</button>


                            </form>


                        </div>


                    </div>
                </div>
            </div>

            {{-- <a href="{{ Route('StudentBiodata') }}">
                    <button type="button" class="btn btn-primary prevStep">Previous</button>
                </a>
                <button type="submit" class="btn btn-primary prevStep">Submit</button> --}}

        </div>
        <!-- ADD  Step -->




    </div>
        {{-- <script src="https://code.jquery.com/jquery-3.3.1.slim.min.js"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/popper.js/1.14.7/umd/popper.min.js"></script>
<script src="https://stackpath.bootstrapcdn.com/bootstrap/4.3.1/js/bootstrap.min.js"></script> --}}

<link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/bootstrap/4.3.1/css/bootstrap.min.css">
<script src="https://code.jquery.com/jquery-3.6.0.min.js"></script>
{{-- <link rel="stylesheet" href="https://cdn.jsdelivr.net/npm/sweetalert2@10"> --}}
{{-- <script src="https://cdn.jsdelivr.net/npm/sweetalert2@10"></script> --}}
    <link href="https://cdn.jsdelivr.net/npm/select2@4.1.0-rc.0/dist/css/select2.min.css" rel="stylesheet" />
    <script src="https://cdn.jsdelivr.net/npm/select2@4.1.0-rc.0/dist/js/select2.min.js"></script>
    <script>
            $.ajaxSetup({
                        headers: {
                            'X-CSRF-TOKEN': $('meta[name="csrf-token"]').attr('content')
                        }
                    });
        $(document).ready(function() {

            var currentDate = new Date().toISOString().split('T')[0];
            $('#dob').attr('max', currentDate);

            $('.prevStep').click(function() {
                var currentStep = $(this).closest('.step');
                var prevStep = currentStep.prev('.step');

                // Move to the previous step
                currentStep.removeClass('active');
                prevStep.addClass('active');
            });

            $('.form-group').on('blur change', '.error-border', function() {
                if ($(this).val()) {
                    $(this).removeClass('error-border').closest('.form-group').find('.error-text').remove();
                }
            })

            function validate(e, isLastStep = false) {
                $('.error-text').remove()
                let closestDiv = isLastStep ? '.last-step' : '.step';
                var currentStep = $(e.target).closest(closestDiv);
                var nextStep = currentStep.next('.step');
                var checkboxes = $('.form-group input[type="checkbox"]');
                var isValid = true;

                var fieldErrors = [];
                // Check if all required fields in the current step are filled
                currentStep.find('input[required], select[required], input[type="checkbox"]:checked').each(
                    function() {
                        if ($(this).val() == '' || $(this).val() == null) {
                            fieldErrors.push($(this).attr('id'))
                            isValid = false;
                            // return false; // Exit the loop if a required field is empty
                        }
                    });


                if (isValid && !isLastStep) {
                    currentStep.removeClass('active');
                    nextStep.addClass('active');
                } else {
                    for (fieldError of fieldErrors) {
                        $('#' + fieldError)
                            .addClass('error-border')
                            .closest('.form-group')
                            .append('<small class="text-danger error-text">This field is required</small>');
                    }
                }
                return isValid;
            }
            $('.nextStep').click(validate)
            // });

            // $("#height").on("keyup change", function(e) {
            //     var height = $('#height').val();
            //     if (height != '') {
            //         $('#weight').removeAttr("disabled");
            //     } else {
            //         $('#weight').attr("disabled", true);
            //     }

            // });

            $("#Weight, #Height").on("keyup change", function(e) {
                var height = $('#Height').val();
                var weight = $('#Weight').val();
                var bmi = $('#BMI');

                if (height != '' && height > 0 && weight != '' && weight > 0) {

                    var result = (weight / height / height) * 10000;
                    $('#BMI').val(result.toFixed(2));

                

                    var hidden_age = $("#hidden_age").val();
                    var bmi = $("#BMI").val(toFixed(2));

                    var dataToSend = {
                        bmi: bmi,
                        hidden_age: hidden_age,

                    };

                    $.ajax({
                        type: 'POST',
                        data: dataToSend,
                        url: "{{ route('BmiRange') }}",
                        success: function(data) {
                            console.log("data " + data);
                            if (data.status) {
                                var bmi_result = $('#bmi_result_1');
                                // console.log(data.result.P3);
                                if (bmi < data.result.P3) {
                                    bmi_result.css('color', 'red');
                                    bmi_result.text('Low BMI')
                                } else if (bmi >= data.result.P3 && bmi <= data.result.P5) {
                                    bmi_result.css('color', 'green');
                                    bmi_result.text('Normal BMI')
                                } else if (bmi > data.result.P5) {
                                    bmi_result.css('color', 'red');
                                    bmi_result.text('High BMI')
                                }

                                // bmi_result
                            }
                        }

                    });




                }


                /*  Weight1Response */

                if (weight > 0) {

                    weight = parseFloat(weight);

                    var Weight1ResponseUrl = '{!! Route('Weight1Response') !!}';
                    // console.log("Weight1ResponseUrl " + Weight1ResponseUrl);

                    $.ajax({
                        url: Weight1ResponseUrl,
                        type: "post",
                        data: {
                            "_token": "{{ csrf_token() }}",
                            hidden_age: $("#hidden_age").val(),

                        },

                        dataType: 'json',
                        beforeSend: function() {

                            // console.log("----------- beforeSend -------------");
                        },

                        success: function(resp) {

                            // console.log("----------- Response -------------");

                            // console.log("resp " + resp);
                            // console.log("resp " + JSON.stringify(resp));

                            if (resp['status'] === true) {

                                var result_3rd = resp['result']['3rd'];
                                // console.log("result_3rd " + result_3rd);


                                result_3rd = parseFloat(result_3rd);

                                if (!isNaN(weight) && !isNaN(result_3rd)) {

                                    if (weight >= result_3rd) {
                                        $('#Weight1Response1').css('color', 'green');
                                        $('#Weight1Response1').text('Normal ')
                                    } else if (weight < result_3rd) {
                                        $('#Weight1Response1').css('color', 'red');
                                        $('#Weight1Response1').text('Low ')
                                    } else {

                                        $('#Weight1Response1').html('');

                                    }

                                } else {
                                    $('#Weight1Response1').html('Invalid input');
                                }



                            } else {

                                $('#Weight1Response1').html('');

                            }



                        }
                    });


                } else {
                    $('#Weight1Response1').html('');

                }


                /*  height1Response */

                if (height > 0) {

                    height = parseFloat(height);

                    var height1ResponseUrl = '{!! Route('height1Response') !!}';
                    console.log("height1ResponseUrl " + height1ResponseUrl);

                    $.ajax({
                        url: height1ResponseUrl,
                        type: "post",
                        data: {
                            "_token": "{{ csrf_token() }}",
                            hidden_age: $("#hidden_age").val(),

                        },

                        dataType: 'json',
                        beforeSend: function() {

                            console.log("----------- beforeSend -------------");
                        },

                        success: function(resp) {

                            console.log("----------- Response -------------");

                            console.log("resp " + resp);
                            console.log("resp " + JSON.stringify(resp));

                            if (resp['status'] === true) {

                                var result_3rd = resp['result']['3rd'];
                                console.log("result_3rd " + result_3rd);

                                result_3rd = parseFloat(result_3rd);

                                if (!isNaN(height) && !isNaN(result_3rd)) {

                                    if (height >= result_3rd) {
                                        $('#height1Response1').css('color', 'green');
                                        $('#height1Response1').text('Normal ')
                                    } else if (height < result_3rd) {
                                        $('#height1Response1').css('color', 'red');
                                        $('#height1Response1').text('Low ')
                                    } else {

                                        $('#height1Response1').html('');

                                    }

                                } else {
                                    $('#height1Response1').html('Invalid input');
                                }



                            } else {

                                $('#height1Response1').html('');

                            }



                        }
                    });


                } else {
                    $('#height1Response1').html('');

                }


            });

            $("#Weight1, #height1").on("keyup change", function(e) {
                var height = $('#height1').val();
                var weight = $('#Weight1').val();
                console.log("height" + height);

                var bmi = $('#BMI1');
                if (height != '' && height > 0 && weight != '' && weight > 0) {

                    var result = (weight / height / height) * 10000;
                    $('#BMI1').val(result.toFixed(2));

                    $.ajaxSetup({
                        headers: {
                            'X-CSRF-TOKEN': $('meta[name="csrf-token"]').attr('content')
                        }
                    });

                    var hidden_age = $("#hidden_age").val();
                    var bmi = $("#BMI1").val();

                    var dataToSend = {
                        bmi: bmi,
                        hidden_age: hidden_age,

                    };

                    $.ajax({
                        type: 'POST',
                        data: dataToSend,
                        url: '{{ route('BmiRange') }}',
                        success: function(data) {
                            // console.log("data " + data);
                            if (data.status) {
                                var bmi_result = $('#bmi_result');
                                // console.log(data.result.P3);
                                if (bmi < data.result.P3) {
                                    bmi_result.css('color', 'red');
                                    bmi_result.text('Low BMI')
                                } else if (bmi >= data.result.P3 && bmi <= data.result.P5) {
                                    bmi_result.css('color', 'green');
                                    bmi_result.text('Normal BMI')
                                } else if (bmi > data.result.P5) {
                                    bmi_result.css('color', 'red');
                                    bmi_result.text('High BMI')
                                }

                                // bmi_result
                            }
                        }

                    });


                }


                /*  Weight1Response */

                if (weight > 0) {

                    weight = parseFloat(weight);

                    var Weight1ResponseUrl = '{!! Route('Weight1Response') !!}';
                    // console.log("Weight1ResponseUrl " + Weight1ResponseUrl);

                    $.ajax({
                        url: Weight1ResponseUrl,
                        type: "post",
                        data: {
                            "_token": "{{ csrf_token() }}",
                            hidden_age: $("#hidden_age").val(),

                        },

                        dataType: 'json',
                        beforeSend: function() {

                            // console.log("----------- beforeSend -------------");
                        },

                        success: function(resp) {

                            // console.log("----------- Response -------------");

                            // console.log("resp " + resp);
                            // console.log("resp " + JSON.stringify(resp));

                            if (resp['status'] === true) {

                                var result_3rd = resp['result']['3rd'];
                                // console.log("result_3rd " + result_3rd);


                                result_3rd = parseFloat(result_3rd);

                                if (!isNaN(weight) && !isNaN(result_3rd)) {

                                    if (weight >= result_3rd) {
                                        $('#Weight1Response').css('color', 'green');
                                        $('#Weight1Response').text('Normal ')
                                    } else if (weight < result_3rd) {
                                        $('#Weight1Response').css('color', 'red');
                                        $('#Weight1Response').text('Low ')
                                    } else {

                                        $('#Weight1Response').html('');

                                    }

                                } else {
                                    $('#Weight1Response').html('Invalid input');
                                }



                            } else {

                                $('#Weight1Response').html('');

                            }



                        }
                    });


                } else {
                    $('#Weight1Response').html('');

                }


                /*  height1Response */

                if (height > 0) {

                    height = parseFloat(height);

                    var height1ResponseUrl = '{!! Route('height1Response') !!}';
                    console.log("height1ResponseUrl " + height1ResponseUrl);

                    $.ajax({
                        url: height1ResponseUrl,
                        type: "post",
                        data: {
                            "_token": "{{ csrf_token() }}",
                            hidden_age: $("#hidden_age").val(),

                        },

                        dataType: 'json',
                        beforeSend: function() {

                            console.log("----------- beforeSend -------------");
                        },

                        success: function(resp) {

                            console.log("----------- Response -------------");

                            console.log("resp " + resp);
                            console.log("resp " + JSON.stringify(resp));

                            if (resp['status'] === true) {

                                var result_3rd = resp['result']['3rd'];
                                console.log("result_3rd " + result_3rd);

                                result_3rd = parseFloat(result_3rd);

                                if (!isNaN(height) && !isNaN(result_3rd)) {

                                    if (height >= result_3rd) {
                                        $('#height1Response').css('color', 'green');
                                        $('#height1Response').text('Normal ')
                                    } else if (height < result_3rd) {
                                        $('#height1Response').css('color', 'red');
                                        $('#height1Response').text('Low ')
                                    } else {

                                        $('#height1Response').html('');

                                    }

                                } else {
                                    $('#height1Response').html('Invalid input');
                                }



                            } else {

                                $('#height1Response').html('');

                            }



                        }
                    });


                } else {
                    $('#height1Response').html('');

                }





            });


            @if (
                !empty($NutritionistHistoryEvaluationSection) &&
                    !empty($NutritionistHistoryEvaluationSection['height']) &&
                    !empty($NutritionistHistoryEvaluationSection['Weight']))


                $("#Weight1, #height1").change();
            @endif


            $("#Question_No_6_Blood_Pressure_Diastolic, #Question_No_6_Blood_Pressure_Systolic").on("keyup change",
                function(e) {
                    var diastolic = $('#Question_No_6_Blood_Pressure_Diastolic').val();
                    var systolic = $('#Question_No_6_Blood_Pressure_Systolic').val();
                    var age = $('#age').val();

                    if (age >= 3 && age <= 5) {
                        if (systolic <= 90 || systolic >= 121) {
                            $("#Question_No_6_Blood_Pressure_Systolic").addClass("bg-danger");
                        } else {
                            $("#Question_No_6_Blood_Pressure_Systolic").removeClass("bg-danger");
                        }
                        if (diastolic <= 45 || diastolic >= 81) {
                            $("#Question_No_6_Blood_Pressure_Diastolic").addClass("bg-danger");
                        } else {
                            $("#Question_No_6_Blood_Pressure_Diastolic").removeClass("bg-danger");
                        }
                    } else if (age >= 6 && age <= 12) {
                        if (systolic <= 95 || systolic >= 132) {
                            // console.log(age + '-' + systolic);                                                    
                            $("#Question_No_6_Blood_Pressure_Systolic").addClass("bg-danger");
                        } else {
                            $("#Question_No_6_Blood_Pressure_Systolic").removeClass("bg-danger");
                        }
                        if (diastolic <= 54 || diastolic >= 63) {
                            // console.log(age + '-' + diastolic);                                                                         
                            $("#Question_No_6_Blood_Pressure_Diastolic").addClass("bg-danger");
                        } else {
                            $("#Question_No_6_Blood_Pressure_Diastolic").removeClass("bg-danger");
                        }
                    } else if (age >= 13 && age <= 17) {
                        if (systolic <= 107 || systolic >= 146) {
                            console.log(age + '-' + systolic);
                            $("#Question_No_6_Blood_Pressure_Systolic").addClass("bg-danger");
                        } else {
                            $("#Question_No_6_Blood_Pressure_Systolic").removeClass("bg-danger");
                        }
                        if (diastolic <= 61 || diastolic >= 95) {
                            console.log(age + '-' + diastolic);
                            $("#Question_No_6_Blood_Pressure_Diastolic").addClass("bg-danger");
                        } else {
                            $("#Question_No_6_Blood_Pressure_Diastolic").removeClass("bg-danger");
                        }
                    }
                });
            $("#Question_No_7_Pulse").on("keyup change", function(e) {
                var pulse = $('#Question_No_7_Pulse').val();
                var age = $('#age').val();

                if (age >= 3 && age <= 5) {
                    if (pulse <= 79 || pulse >= 121) {
                        $("#Question_No_7_Pulse").addClass("bg-danger");
                    } else {
                        $("#Question_No_7_Pulse").removeClass("bg-danger");
                    }
                } else if (age >= 6 && age <= 12) {
                    if (pulse <= 74 || pulse >= 119) {
                        $("#Question_No_7_Pulse").addClass("bg-danger");
                    } else {
                        $("#Question_No_7_Pulse").removeClass("bg-danger");
                    }
                } else if (age >= 13 && age <= 17) {
                    if (pulse <= 59 || pulse >= 101) {
                        $("#Question_No_7_Pulse").addClass("bg-danger");
                    } else {
                        $("#Question_No_7_Pulse").removeClass("bg-danger");
                    }
                }
            });



            $('#any_neck_swelling').on('change', function() {
                var result = $(this).val();
                if (result === 'Yes') {
                    $('.any_neck_swelling_specify').removeClass('d-none');
                } else {
                    $('.any_neck_swelling_specify').addClass('d-none');
                }

            });

            $('#any_history_of_abdominal_pain').on('change', function() {
                var result = $(this).val();
                if (result === 'Yes') {
                    $('.any_history_of_abdominal_pain_specify').removeClass('d-none');
                } else {
                    $('.any_history_of_abdominal_pain_specify').addClass('d-none');
                }

            });
            $('#any_menstrual_abnormality').on('change', function() {
                var result = $(this).val();
                if (result === 'Yes') {
                    $('.any_menstrual_abnormality_specify').removeClass('d-none');
                } else {
                    $('.any_menstrual_abnormality_specify').addClass('d-none');
                }

            });

            $('#limitations_range_motion').on('change', function() {
                var result = $(this).val();
                if (result === 'Yes') {
                    $('.limitations_range_motion_specify').removeClass('d-none');
                } else {
                    $('.limitations_range_motion_specify').addClass('d-none');
                }

            });

            $('#lymph_node').on('change', function() {
                var result = $(this).val();
                if (result === 'abnormal') {
                    $('.lymph_node_specify').removeClass('d-none');
                } else {
                    $('.lymph_node_specify').addClass('d-none');
                }

            });

            $('#do_you_have_any_Allergies').on('change', function() {
                var result = $(this).val();
                if (result === 'Yes') {
                    $('.do_you_have_any_Allergies_specify').removeClass('d-none');
                } else {
                    $('.do_you_have_any_Allergies_specify').addClass('d-none');
                }

            });

            $('#menarche_age').on('change', function() {
                var result = $(this).val();
                if (result === 'none_of_the_above') {
                    $('.menarche_age_specify').removeClass('d-none');
                    $(".menstrual_abnormality option[value='']").attr('selected', 'selected');

                } else {
                    $('.menarche_age_specify').addClass('d-none');
                    $('.menstrual_abnormality_specify').addClass('d-none');

                }
            });
            // $('#followup_required').on('change', function() {
            //     var result = $(this).val();
            //     if (result === 'Yes') {
            //         $('.reffered').removeClass('d-none');
            //         $(".reffered option[value='']").attr('selected', 'selected');

            //     } else {
            //         $('.reffered').addClass('d-none');                   

            //     }
            // });
            $('#followup_required').on('change', function() {
                var result = $(this).val();
                if (result === 'Yes') {
                    $('.reffered').removeClass('d-none');
                    $(".reffered option[value='']").attr('selected', 'selected');
                } else {
                    $('#referred_by').val('');
                    $('.reffered').addClass('d-none');
                }
            });

            $('#menstrual_abnormality').on('change', function() {
                var result = $(this).val();
                if (result === 'Yes') {
                    $('.menstrual_abnormality_specify').removeClass('d-none');
                } else {
                    $('.menstrual_abnormality_specify').addClass('d-none');
                }

            });

            $('#immunization_card').on('change', function() {
                var result = $(this).val();
                if (result === 'No') {
                    $('.immunization_card_specify').removeClass('d-none');
                } else {
                    $('.immunization_card_specify').addClass('d-none');
                }

            });

            $("#dob").on("change", function() {

                var dob = $(this).val();
                if (dob) {
                    var today = new Date();
                    var birthDate = new Date(dob);
                    var age = today.getFullYear() - birthDate.getFullYear();
                    var monthDiff = today.getMonth() - birthDate.getMonth();
                    if (monthDiff < 0 || (monthDiff === 0 && today.getDate() < birthDate.getDate())) {
                        age--;
                    }
                    $("#age").val(age);
                } else {

                    $("#age").val("");
                }
            });

            $('#submit').on('click', function(e) {

                if (!validate(e, true)) return;
                //    console.log(validate());
                var form = $('#multiStepForm');
                var formData = form.serializeArray();
                var secondsOnSubmit;


                var endTime = new Date();
                var timeDiff = endTime - startTime;
                secondsOnSubmit = Math.round(timeDiff / 1000);

                var formData = $('#multiStepForm').serializeArray();


                $.each(formData, function(index, field) {
                    var fieldId = field['name'];
                    var fieldValue = field['value'];

                });
                let _token = $('meta[name="csrf-token"]').attr('content');
                formData.push({
                    name: 'duration',
                    value: secondsOnSubmit
                });
                $.ajax({
                    type: "post",
                    url: "{{ url('post_data') }}",
                    data: {
                        _token: _token,
                        formData: formData

                    },
                    dataType: "json",
                    beforeSend: function() {

                    },
                    success: function(response) {
                        // alert(response);
                        // console.log(response);
                        Swal.fire({
                            title: 'Success!',
                            text: 'Enrollment has been submitted successfully!',
                            icon: 'success',
                            confirmButtonText: 'OK',
                            timer: 2000, // Set the timer to 2 seconds (in milliseconds)
                            timerProgressBar: true, // Show a progress bar during the timer
                            showConfirmButton: false // Hide the "OK" button
                        }).then(() => {
                            window.location.href = "{{ route('admin.form.index') }}"
                        });

                    },
                    error: function(err) {
                        console.log(err);
                    }
                });
            });

            var form = $('#multiStepForm');
            var startTime;
            var timerInterval;
            var secondsOnSubmit;

            form.one('focusin', function() {
                // Set the start time when any form field is focused
                startTime = new Date();

                // Start a timer interval to update the display every second
                timerInterval = setInterval(function() {
                    var currentTime = new Date();
                    var timeDiff = currentTime - startTime;
                    var seconds = Math.round(timeDiff / 1000);
                    $('#timer').text('Time: ' + seconds + ' seconds');
                }, 1000);
            });
        });

        // Select the dropdown element
        const selectElement = document.getElementById(
            'Question_No66_Does_the_child_have_any_history_of_substances_abuse_or_addiction_to');

        // Select the container of the second form group
        // const addictionContainer = document.getElementById('addictionContainer');

        // // Add change event listener to the dropdown
        // selectElement.addEventListener('change', function() {
        //     // If 'Yes' is selected, show the second form group; otherwise, hide it
        //     if (this.value === 'Yes') {
        //         addictionContainer.classList.remove('d-none');
        //     } else {
        //         addictionContainer.classList.add('d-none');
        //     }
        // });

        // const selectElement_addict = document.getElementById('addiction');
        // // Select the container of the textarea
        // const otherAddictionContainer = document.getElementById('otherAddictionContainer');

        // // Add change event listener to the dropdown
        // selectElement_addict.addEventListener('change', function() {
        //     // If 'other' is selected, show the textarea; otherwise, hide it
        //     if (this.value === 'other') {
        //         otherAddictionContainer.classList.remove('d-none');
        //     } else {
        //         otherAddictionContainer.classList.add('d-none');
        //     }
        // });


        // const food_allergies = document.getElementById('food_allergies');
        // // Select the container of the textarea
        // const food_allergiesContainer = document.getElementById('food_allergiesContainer');

        // // Add change event listener to the dropdown
        // food_allergies.addEventListener('change', function() {
        //     // If 'other' is selected, show the textarea; otherwise, hide it
        //     if (this.value === 'Yes') {
        //         food_allergiesContainer.classList.remove('d-none');
        //     } else {
        //         food_allergiesContainer.classList.add('d-none');
        //     }
        // });




        function showBreakFast() {
            let Breakfast = document.getElementById("Breakfast");
            let selectedValue = Breakfast.value;
            if (selectedValue === "Yes") {
                let showBreakFastDetail = document.getElementById('showBreakFastDetail');
                showBreakFastDetail.classList.remove('d-none');
                $("#breakfast_detail").attr("required", true)
            } else {
                let showBreakFastDetail = document.getElementById('showBreakFastDetail');
                showBreakFastDetail.classList.add('d-none');
                $("#breakfast_detail").attr("required", false)
            }
        }




        @if (
            !empty($NutritionistHistoryEvaluationSection['Breakfast']) &&
                $NutritionistHistoryEvaluationSection['Breakfast'] == 'Yes')

            showBreakFast()
        @endif



        function showMidDaySnack() {
            let Mid_day_Snack = document.getElementById("Mid_day_Snack");
            let selectedValue = Mid_day_Snack.value;
            if (selectedValue === "Yes") {
                let showMidDaySnackDetail = document.getElementById('showMidDaySnackDetail');
                showMidDaySnackDetail.classList.remove('d-none');
                $("#MidDaySnackDetail").attr("required", true)
            } else {
                let showMidDaySnackDetail = document.getElementById('showMidDaySnackDetail');
                showMidDaySnackDetail.classList.add('d-none');
                $("#MidDaySnackDetail").attr("required", false)
            }
        }

        function showLunchFunc() {
            let Lunch = document.getElementById("Lunch");
            let selectedValue = Lunch.value;
            if (selectedValue === "Yes") {
                let showlunchdetail = document.getElementById('showlunchdetail');
                showlunchdetail.classList.remove('d-none');
                $("#lunchDetail").attr("required", true)
            } else {
                let showlunchdetail = document.getElementById('showlunchdetail');
                showlunchdetail.classList.add('d-none');
                $("#lunchDetail").attr("required", false)
            }
        }


        @if (!empty($NutritionistHistoryEvaluationSection['Lunch']) && $NutritionistHistoryEvaluationSection['Lunch'] == 'Yes')

            showLunchFunc()
        @endif


        function showEveningSnackFunc() {
            let Evening_Snack = document.getElementById("Evening_Snack");
            let selectedValue = Evening_Snack.value;
            if (selectedValue === "Yes") {
                let showEveningSnackDetail = document.getElementById('showEveningSnackDetail');
                showEveningSnackDetail.classList.remove('d-none');
                $("#EveningSnackDetail").attr("required", true)
            } else {
                let showEveningSnackDetail = document.getElementById('showEveningSnackDetail');
                showEveningSnackDetail.classList.add('d-none');
                $("#EveningSnackDetail").attr("required", false)
            }
        }

        function showDinnerFunc() {
            let Dinner = document.getElementById("Dinner");
            let selectedValue = Dinner.value;
            if (selectedValue === "Yes") {
                let showDinner = document.getElementById('showDinner');
                showDinner.classList.remove('d-none');
                $("#Dinner").attr("required", true)
            } else {
                let showDinner = document.getElementById('showDinner');
                showDinner.classList.add('d-none');
                $("#Dinner").attr("required", false)
            }
        }


        function followUp() {
            var follow_up_Required = document.getElementById("Follow_up_Required");
            var selectedValue = follow_up_Required.value;
            if (selectedValue === "Yes") {
                var follow_up_show = document.getElementById('follow_up_show');
                follow_up_show.classList.remove('d-none');



                $("#Reason_for_Follow_up").attr('required', true);
                $("#Follow_up_Date").attr('required', true);

            } else {
                var follow_up_show = document.getElementById('follow_up_show');
                follow_up_show.classList.add('d-none');


                $("#Reason_for_Follow_up").attr('required', false);
                $("#Follow_up_Date").attr('required', false);

            }
        }



        @if (!empty($SchoolHealthPhysician['Follow_up_Required']) && $SchoolHealthPhysician['Follow_up_Required'] == 'Yes')

            followUp()
        @endif

        @if (!empty($SchoolHealthPhysician['Follow_up_Required']) && $SchoolHealthPhysician['Follow_up_Required'] == 'No')

            $("#Reason_for_Follow_up").val("");
            $("#Follow_up_Date").val("");
        @endif


        function showReasonForReferral() {
            var selectElement = document.getElementById("external_referrals");
            var selectedOptions = selectElement.selectedOptions;
            var reasonForReferralSection = document.getElementById("reasonForReferralSection");

            if (selectedOptions.length > 0) {
                reasonForReferralSection.classList.remove('d-none');
            } else {
                reasonForReferralSection.classList.add('d-none');
            }
        }


        @if (!empty($SchoolHealthPhysician['Reason_for_Referral']))

            var reasonForReferralSection = document.getElementById("reasonForReferralSection");

            reasonForReferralSection.classList.remove('d-none');
        @endif









        // for tab 2

        function followUp1() {
            let follow_up_Required1 = document.getElementById("Follow_up_Required1");
            let selectedValue = follow_up_Required1.value;
            if (selectedValue === "Yes") {
                let follow_up_show1 = document.getElementById('follow_up_show1');
                follow_up_show1.classList.remove('d-none');

                $("#Reason_for_Follow_up1").attr('required', true);
                $("#Follow_up_Date1").attr('required', true);

            } else {
                let follow_up_show1 = document.getElementById('follow_up_show1');
                follow_up_show1.classList.add('d-none');

                $("#Reason_for_Follow_up1").attr('required', false);
                $("#Follow_up_Date1").attr('required', false);
            }
        }
        @if (
            !empty($NutritionistHistoryEvaluationSection['Follow_up_Required1']) &&
                $NutritionistHistoryEvaluationSection['Follow_up_Required1'] == 'Yes')

            showBreakFast()
        @endif
        function showReasonForReferral1() {
            let selectElement = document.getElementById("external_referrals1");
            let selectedOptions = selectElement.selectedOptions;
            let reasonForReferralSection1 = document.getElementById("reasonForReferralSection1");

            if (selectedOptions.length > 0) {
                reasonForReferralSection1.classList.remove('d-none');
            } else {
                reasonForReferralSection1.classList.add('d-none');
            }
        }




        @if (!empty($NutritionistHistoryEvaluationSection['Reason_for_Referral1']))

            var reasonForReferralSection1 = document.getElementById("reasonForReferralSection1");

            reasonForReferralSection1.classList.remove('d-none');
        @endif



        // for tab 3

        function followUp2() {
            let follow_up_Required2 = document.getElementById("Follow_up_Required2");
            let selectedValue = follow_up_Required2.value;
            if (selectedValue === "Yes") {
                let follow_up_show2 = document.getElementById('follow_up_show2');
                follow_up_show2.classList.remove('d-none');
                $("#Follow_up_Date2").attr("required", true)
                $("#Reason_for_Follow_up2").attr("required", true)
            } else {
                let follow_up_show2 = document.getElementById('follow_up_show2');
                follow_up_show2.classList.add('d-none');
                $("#Follow_up_Date2").attr("required", false);
                $("#Reason_for_Follow_up2").attr("required", false)

            }
        }

        function showReasonForReferral2() {
            let selectElement = document.getElementById("external_referrals2");
            let selectedOptions = selectElement.selectedOptions;
            let reasonForReferralSection2 = document.getElementById("reasonForReferralSection2");

            if (selectedOptions.length > 0) {

                reasonForReferralSection2.classList.remove('d-none');
                $("#Reason_for_Referral2").attr("required", true)


            } else {
                reasonForReferralSection2.classList.add('d-none');
                $("#Reason_for_Referral2").attr("required", false)

            }
        }


        @if (
            !empty($PsychologistHistoryAssessmentSection) &&
                !empty($PsychologistHistoryAssessmentSection['Reason_for_Referral2']))

            var reasonForReferralSection2 = document.getElementById("reasonForReferralSection2");

            reasonForReferralSection2.classList.remove('d-none');
        @endif


        $("#Provisional_Diagnosis").select2({
            placeholder: "Select Provisional Diagnosis",
            allowClear: true
        });
        $("#internal_referrals").select2({
            placeholder: "Select Internal Referrals",
            allowClear: true
        });
        $("#external_referrals").select2({
            placeholder: "Select Internal Referrals",
            allowClear: true
        });

        // for tab 2

        $("#Provisional_Diagnosis1").select2({
            placeholder: "Select Provisional Diagnosis",
            allowClear: true
        });
        $("#internal_referrals1").select2({
            placeholder: "Select Internal Referrals",
            allowClear: true
        });
        $("#external_referrals1").select2({
            placeholder: "Select Internal Referrals",
            allowClear: true
        });

        // for tab 3

        $("#Provisional_Diagnosis2").select2({
            placeholder: "Select Provisional Diagnosis",
            allowClear: true
        });
        $("#internal_referrals2").select2({
            placeholder: "Select Internal Referrals",
            allowClear: true
        });
        $("#external_referrals2").select2({
            placeholder: "Select Internal Referrals",
            allowClear: true
        });
        // $("#Clinical_Examination").select2({
        //     placeholder: "Select Physical Appearance",
        //     allowClear: true
        // });
        $(document).ready(function() {

var currentDate = new Date().toISOString().split('T')[0];
$('#dob').attr('max', currentDate);

$('.prevStep').click(function() {
    var currentStep = $(this).closest('.step');
    var prevStep = currentStep.prev('.step');

    // Move to the previous step
    currentStep.removeClass('active');
    prevStep.addClass('active');
});

$('.form-group').on('blur change', '.error-border', function() {
    if ($(this).val()) {
        $(this).removeClass('error-border').closest('.form-group').find('.error-text').remove();
    }
})

function validate(e, isLastStep = false) {
    $('.error-text').remove()
    let closestDiv = isLastStep ? '.last-step' : '.step';
    var currentStep = $(e.target).closest(closestDiv);
    var nextStep = currentStep.next('.step');
    var checkboxes = $('.form-group input[type="checkbox"]');
    var isValid = true;

    var fieldErrors = [];
    // Check if all required fields in the current step are filled
    currentStep.find('input[required], select[required], input[type="checkbox"]:checked').each(
        function() {
            if ($(this).val() == '' || $(this).val() == null) {
                fieldErrors.push($(this).attr('id'))
                isValid = false;
                // return false; // Exit the loop if a required field is empty
            }
        });


    if (isValid && !isLastStep) {
        currentStep.removeClass('active');
        nextStep.addClass('active');
    } else {
        for (fieldError of fieldErrors) {
            $('#' + fieldError)
                .addClass('error-border')
                .closest('.form-group')
                .append('<small class="text-danger error-text">This field is required</small>');
        }
    }
    return isValid;
}
$('.nextStep').click(validate)
// });

$("#height").on("keyup change", function(e) {
    var height = $('#height').val();
    if (height != '') {
        $('#weight').removeAttr("disabled");
    } else {
        $('#weight').attr("disabled", true);
    }

});

$("#weight, #height").on("keyup change", function(e) {
    var height = $('#height').val();
    var weight = $('#weight').val();
    var bmi = $('#bmi');
    if (height != '' && height > 0 && weight != '' && weight > 0) {
        var result = (weight / height / height) * 10000;
        $('#bmi').val(result.toFixed(2));
        if (result <= 18.4 || result >= 24.10) {
            $("#bmi").addClass("bg-danger");
        } else {
            $("#bmi").removeClass("bg-danger");
        }
    }
});

$("#Question_No_6_Blood_Pressure_Diastolic, #Question_No_6_Blood_Pressure_Systolic").on("keyup change",
    function(e) {
        var diastolic = $('#Question_No_6_Blood_Pressure_Diastolic').val();
        var systolic = $('#Question_No_6_Blood_Pressure_Systolic').val();
        var age = $('#age').val();

        if (age >= 3 && age <= 5) {
            if (systolic <= 90 || systolic >= 121) {
                $("#Question_No_6_Blood_Pressure_Systolic").addClass("bg-danger");
            } else {
                $("#Question_No_6_Blood_Pressure_Systolic").removeClass("bg-danger");
            }
            if (diastolic <= 45 || diastolic >= 81) {
                $("#Question_No_6_Blood_Pressure_Diastolic").addClass("bg-danger");
            } else {
                $("#Question_No_6_Blood_Pressure_Diastolic").removeClass("bg-danger");
            }
        } else if (age >= 6 && age <= 12) {
            if (systolic <= 95 || systolic >= 132) {
                // console.log(age + '-' + systolic);                                                    
                $("#Question_No_6_Blood_Pressure_Systolic").addClass("bg-danger");
            } else {
                $("#Question_No_6_Blood_Pressure_Systolic").removeClass("bg-danger");
            }
            if (diastolic <= 54 || diastolic >= 63) {
                // console.log(age + '-' + diastolic);                                                                         
                $("#Question_No_6_Blood_Pressure_Diastolic").addClass("bg-danger");
            } else {
                $("#Question_No_6_Blood_Pressure_Diastolic").removeClass("bg-danger");
            }
        } else if (age >= 13 && age <= 17) {
            if (systolic <= 107 || systolic >= 146) {
                console.log(age + '-' + systolic);
                $("#Question_No_6_Blood_Pressure_Systolic").addClass("bg-danger");
            } else {
                $("#Question_No_6_Blood_Pressure_Systolic").removeClass("bg-danger");
            }
            if (diastolic <= 61 || diastolic >= 95) {
                console.log(age + '-' + diastolic);
                $("#Question_No_6_Blood_Pressure_Diastolic").addClass("bg-danger");
            } else {
                $("#Question_No_6_Blood_Pressure_Diastolic").removeClass("bg-danger");
            }
        }
    });
$("#Question_No_7_Pulse").on("keyup change", function(e) {
    var pulse = $('#Question_No_7_Pulse').val();
    var age = $('#age').val();

    if (age >= 3 && age <= 5) {
        if (pulse <= 79 || pulse >= 121) {
            $("#Question_No_7_Pulse").addClass("bg-danger");
        } else {
            $("#Question_No_7_Pulse").removeClass("bg-danger");
        }
    } else if (age >= 6 && age <= 12) {
        if (pulse <= 74 || pulse >= 119) {
            $("#Question_No_7_Pulse").addClass("bg-danger");
        } else {
            $("#Question_No_7_Pulse").removeClass("bg-danger");
        }
    } else if (age >= 13 && age <= 17) {
        if (pulse <= 59 || pulse >= 101) {
            $("#Question_No_7_Pulse").addClass("bg-danger");
        } else {
            $("#Question_No_7_Pulse").removeClass("bg-danger");
        }
    }
});



$('#any_neck_swelling').on('change', function() {
    var result = $(this).val();
    if (result === 'Yes') {
        $('.any_neck_swelling_specify').removeClass('d-none');
    } else {
        $('.any_neck_swelling_specify').addClass('d-none');
    }

});

$('#any_history_of_abdominal_pain').on('change', function() {
    var result = $(this).val();
    if (result === 'Yes') {
        $('.any_history_of_abdominal_pain_specify').removeClass('d-none');
    } else {
        $('.any_history_of_abdominal_pain_specify').addClass('d-none');
    }

});
$('#any_menstrual_abnormality').on('change', function() {
    var result = $(this).val();
    if (result === 'Yes') {
        $('.any_menstrual_abnormality_specify').removeClass('d-none');
    } else {
        $('.any_menstrual_abnormality_specify').addClass('d-none');
    }

});

$('#limitations_range_motion').on('change', function() {
    var result = $(this).val();
    if (result === 'Yes') {
        $('.limitations_range_motion_specify').removeClass('d-none');
    } else {
        $('.limitations_range_motion_specify').addClass('d-none');
    }

});

$('#lymph_node').on('change', function() {
    var result = $(this).val();
    if (result === 'abnormal') {
        $('.lymph_node_specify').removeClass('d-none');
    } else {
        $('.lymph_node_specify').addClass('d-none');
    }

});

$('#do_you_have_any_Allergies').on('change', function() {
    var result = $(this).val();
    if (result === 'Yes') {
        $('.do_you_have_any_Allergies_specify').removeClass('d-none');
    } else {
        $('.do_you_have_any_Allergies_specify').addClass('d-none');
    }

});

$('#menarche_age').on('change', function() {
    var result = $(this).val();
    if (result === 'none_of_the_above') {
        $('.menarche_age_specify').removeClass('d-none');
        $(".menstrual_abnormality option[value='']").attr('selected', 'selected');

    } else {
        $('.menarche_age_specify').addClass('d-none');
        $('.menstrual_abnormality_specify').addClass('d-none');

    }
});
// $('#followup_required').on('change', function() {
//     var result = $(this).val();
//     if (result === 'Yes') {
//         $('.reffered').removeClass('d-none');
//         $(".reffered option[value='']").attr('selected', 'selected');

//     } else {
//         $('.reffered').addClass('d-none');                   

//     }
// });
$('#followup_required').on('change', function() {
    var result = $(this).val();
    if (result === 'Yes') {
        $('.reffered').removeClass('d-none');
        $(".reffered option[value='']").attr('selected', 'selected');
    } else {
        $('#referred_by').val('');
        $('.reffered').addClass('d-none');
    }
});

$('#menstrual_abnormality').on('change', function() {
    var result = $(this).val();
    if (result === 'Yes') {
        $('.menstrual_abnormality_specify').removeClass('d-none');
    } else {
        $('.menstrual_abnormality_specify').addClass('d-none');
    }

});

$('#immunization_card').on('change', function() {
    var result = $(this).val();
    if (result === 'No') {
        $('.immunization_card_specify').removeClass('d-none');
    } else {
        $('.immunization_card_specify').addClass('d-none');
    }

});

$("#dob").on("change", function() {

    var dob = $(this).val();
    if (dob) {
        var today = new Date();
        var birthDate = new Date(dob);
        var age = today.getFullYear() - birthDate.getFullYear();
        var monthDiff = today.getMonth() - birthDate.getMonth();
        if (monthDiff < 0 || (monthDiff === 0 && today.getDate() < birthDate.getDate())) {
            age--;
        }
        $("#age").val(age);
    } else {

        $("#age").val("");
    }
});

$('#submit').on('click', function(e) {

    if (!validate(e, true)) return;
    //    console.log(validate());
    var form = $('#multiStepForm');
    var formData = form.serializeArray();
    var secondsOnSubmit;


    var endTime = new Date();
    var timeDiff = endTime - startTime;
    secondsOnSubmit = Math.round(timeDiff / 1000);

    var formData = $('#multiStepForm').serializeArray();


    $.each(formData, function(index, field) {
        var fieldId = field['name'];
        var fieldValue = field['value'];

    });
    let _token = $('meta[name="csrf-token"]').attr('content');
    formData.push({
        name: 'duration',
        value: secondsOnSubmit
    });
    $.ajax({
        type: "post",
        url: "{{ url('post_data') }}",
        data: {
            _token: _token,
            formData: formData

        },
        dataType: "json",
        beforeSend: function() {

        },
        success: function(response) {
            // alert(response);
            // console.log(response);
            Swal.fire({
                title: 'Success!',
                text: 'Enrollment has been submitted successfully!',
                icon: 'success',
                confirmButtonText: 'OK',
                timer: 2000, // Set the timer to 2 seconds (in milliseconds)
                timerProgressBar: true, // Show a progress bar during the timer
                showConfirmButton: false // Hide the "OK" button
            }).then(() => {
                window.location.href = "{{ route('admin.form.index') }}"
            });

        },
        error: function(err) {
            console.log(err);
        }
    });
});

var form = $('#multiStepForm');
var startTime;
var timerInterval;
var secondsOnSubmit;

form.one('focusin', function() {
    // Set the start time when any form field is focused
    startTime = new Date();

    // Start a timer interval to update the display every second
    timerInterval = setInterval(function() {
        var currentTime = new Date();
        var timeDiff = currentTime - startTime;
        var seconds = Math.round(timeDiff / 1000);
        $('#timer').text('Time: ' + seconds + ' seconds');
    }, 1000);
});
});

// Select the dropdown element
const selectElement = document.getElementById(
'Question_No66_Does_the_child_have_any_history_of_substances_abuse_or_addiction_to');

// Select the container of the second form group
const addictionContainer = document.getElementById('addictionContainer');

// Add change event listener to the dropdown
selectElement.addEventListener('change', function() {
// If 'Yes' is selected, show the second form group; otherwise, hide it
if (this.value === 'Yes') {
    addictionContainer.classList.remove('d-none');
} else {
    addictionContainer.classList.add('d-none');
}
});

const selectElement_addict = document.getElementById('addiction');
// Select the container of the textarea
const otherAddictionContainer = document.getElementById('otherAddictionContainer');

// Add change event listener to the dropdown
selectElement_addict.addEventListener('change', function() {
// If 'other' is selected, show the textarea; otherwise, hide it
if (this.value === 'other') {
    otherAddictionContainer.classList.remove('d-none');
} else {
    otherAddictionContainer.classList.add('d-none');
}
});


const food_allergies = document.getElementById('food_allergies');
// Select the container of the textarea
const food_allergiesContainer = document.getElementById('food_allergiesContainer');

// Add change event listener to the dropdown
food_allergies.addEventListener('change', function() {
// If 'other' is selected, show the textarea; otherwise, hide it
if (this.value === 'Yes') {
    food_allergiesContainer.classList.remove('d-none');
} else {
    food_allergiesContainer.classList.add('d-none');
}
});
    </script>
@endsection
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<script src="https://stackpath.bootstrapcdn.com/bootstrap/4.3.1/js/bootstrap.min.js"></script> --}}