@extends('layouts.app')

@section('content')
    <div class="min-vh-100 bg-light py-5">
        <div class="container" style="max-width: 56rem;">

            <!-- Step Indicator -->
            <div class="mb-5">
                <div class="d-flex align-items-center justify-content-between mb-4">
                    <div class="d-flex align-items-center gap-3">
                        <div class="rounded-circle bg-success text-white d-flex align-items-center justify-content-center fw-bold shadow" style="width: 3rem; height: 3rem; font-size: 1.25rem;">
                            4
                        </div>
                        <div>
                            <p class="small text-secondary fw-medium mb-0">STEP 4 OF 4</p>
                            <h1 class="fs-4 fw-bold text-dark mb-0">Pharmacy & Logistics</h1>
                        </div>
                    </div>
                </div>

                <!-- Progress Bar -->
                <div class="progress" style="height: 0.5rem;">
                    <div class="progress-bar bg-success" role="progressbar" style="width: 100%" aria-valuenow="100" aria-valuemin="0" aria-valuemax="100"></div>
                </div>
            </div>

            <!-- Main Content -->
            <div class="card border rounded-4 shadow-sm">
                <div class="card-body p-5">

                    <div class="mb-5">
                        <h2 class="fs-1 fw-bold text-dark mb-2">Pharmacy & Logistics</h2>
                        <p class="fs-5 text-secondary">Select your preferred pharmacy</p>
                    </div>

                    <form action="{{ route('intake.step4.store') }}" method="POST" class="vstack gap-4">
                        @csrf

                        <!-- Preferred Pharmacy Section -->
                        <div class="card bg-light border-0 p-4">
                            <h4 class="fw-semibold text-dark mb-3">Preferred Pharmacy</h4>
                            
                            <!-- Pharmacy Search -->
                            <div class="mb-4">
                                <label for="pharmacy_search" class="form-label fw-semibold text-dark mb-3">Search: Enter your Zip Code to find your pharmacy</label>
                                <div class="position-relative">
                                    <span class="position-absolute top-50 start-0 translate-middle-y ms-3">
                                        <svg xmlns="http://www.w3.org/2000/svg" fill="none" viewBox="0 0 24 24" stroke-width="2" stroke="currentColor" class="text-secondary" width="20" height="20">
                                            <path stroke-linecap="round" stroke-linejoin="round" d="M21 21l-5.197-5.197m0 0A7.5 7.5 0 105.196 5.196a7.5 7.5 0 0010.607 10.607z" />
                                        </svg>
                                    </span>
                                    <input type="text" id="pharmacy_search" name="pharmacy_search" class="form-control form-control-lg ps-5 py-3 border-2 rounded-3" placeholder="Enter ZIP code...">
                                </div>
                            </div>

                            <!-- Pharmacy Selection -->
                            <div>
                                <label class="form-label fw-semibold text-dark mb-3">Select Pharmacy</label>
                                <div class="vstack gap-3">
                                    <label class="card border rounded-3 cursor-pointer">
                                        <div class="card-body p-3">
                                            <div class="d-flex align-items-start">
                                                <input type="radio" name="pharmacy" value="CVS Pharmacy - Main St" class="form-check-input mt-1 me-3" style="width: 1rem; height: 1rem;" checked>
                                                <div class="flex-grow-1">
                                                    <div class="d-flex align-items-center justify-content-between mb-1">
                                                        <span class="fw-semibold text-dark">CVS Pharmacy</span>
                                                        <span class="badge bg-success bg-opacity-25 text-success">Open 24/7</span>
                                                    </div>
                                                    <p class="small text-secondary mb-1">123 Main St, New York, NY 10001</p>
                                                    <p class="small text-secondary mb-0">0.5 miles away • (555) 123-4567</p>
                                                </div>
                                            </div>
                                        </div>
                                    </label>

                                    <label class="card border rounded-3 cursor-pointer">
                                        <div class="card-body p-3">
                                            <div class="d-flex align-items-start">
                                                <input type="radio" name="pharmacy" value="Walgreens - 5th Ave" class="form-check-input mt-1 me-3" style="width: 1rem; height: 1rem;">
                                                <div class="flex-grow-1">
                                                    <div class="d-flex align-items-center justify-content-between mb-1">
                                                        <span class="fw-semibold text-dark">Walgreens</span>
                                                        <span class="badge bg-primary bg-opacity-25 text-primary">Open till 10 PM</span>
                                                    </div>
                                                    <p class="small text-secondary mb-1">456 5th Ave, New York, NY 10002</p>
                                                    <p class="small text-secondary mb-0">1.2 miles away • (555) 234-5678</p>
                                                </div>
                                            </div>
                                        </div>
                                    </label>

                                    <label class="card border rounded-3 cursor-pointer">
                                        <div class="card-body p-3">
                                            <div class="d-flex align-items-start">
                                                <input type="radio" name="pharmacy" value="Rite Aid - Broadway" class="form-check-input mt-1 me-3" style="width: 1rem; height: 1rem;">
                                                <div class="flex-grow-1">
                                                    <div class="d-flex align-items-center justify-content-between mb-1">
                                                        <span class="fw-semibold text-dark">Rite Aid</span>
                                                        <span class="badge bg-primary bg-opacity-25 text-primary">Open till 9 PM</span>
                                                    </div>
                                                    <p class="small text-secondary mb-1">789 Broadway, New York, NY 10003</p>
                                                    <p class="small text-secondary mb-0">2.1 miles away • (555) 345-6789</p>
                                                </div>
                                            </div>
                                        </div>
                                    </label>
                                </div>
                            </div>
                        </div>

                        <!-- Consent Section -->
                        <div class="card bg-light border-0 p-4">
                            <h4 class="fw-semibold text-dark mb-3">Consent & Confirmation</h4>
                            
                            <p class="small text-secondary mb-3">
                                I confirm that all the information I have provided is true, accurate, and complete to the best of my knowledge. I understand that providing false or misleading information may result in delays, denial of service, or other consequences as outlined in the terms of use.
                            </p>

                            <div class="form-check">
                                <input class="form-check-input" type="checkbox" id="consent_checkbox" name="consent_confirmed" style="width: 1.25rem; height: 1.25rem;">
                                <label class="form-check-label ms-2 fw-semibold text-dark" for="consent_checkbox">
                                    I confirm that all inputted information is accurate and truthful.
                                </label>
                            </div>
                        </div>

                        <!-- Action Buttons -->
                        <div class="pt-4">
                            <div class="row g-3">
                                <div class="col-md-4">
                                    <a href="{{ route('intake.step3') }}" class="btn btn-outline-secondary btn-lg w-100 py-3 fs-5 fw-semibold rounded-3">
                                        ← Back
                                    </a>
                                </div>
                                <div class="col-md-8">
                                    <button type="submit" class="btn btn-success btn-lg w-100 py-3 fs-5 fw-semibold rounded-3 shadow">
                                        Submit Request →
                                    </button>
                                </div>
                            </div>
                        </div>
                    </form>
                </div>
            </div>

            <!-- Help Link -->
            <div class="mt-4 text-center">
                <p class="text-secondary mb-0">
                    Need help? <a href="#" class="text-success fw-medium text-decoration-underline">Contact Support</a>
                </p>
            </div>
        </div>
    </div>
@endsection