@push('styles') @endpush

{{ $isEditing ? 'Edit Clinic Change Request' : 'Request Clinic Change' }}

{{ $isEditing ? 'Update your clinic change request details.' : 'Submit a request to change your assigned clinic.' }}

@for($i = 1; $i <= $maxStep; $i++)
{{ $i }}

@switch($i) @case(1) Current Details @break @case(2) New Clinic Request @break @case(3) Declarations @break @case(4) Review & Submit @break @endswitch

@if($i < $maxStep)
@endif
@endfor
@if($step === 1)

Current Details

{{ $expectantMother->mother_full_name ?? $user->name }}
@if($expectantMother && $expectantMother->ic_passport)
{{ $expectantMother->ic_passport }}
@endif
{{ $user->email }}
{{ $currentClinic->name }}
{{ $currentClinic->address }}
@if($expectantMother && $expectantMother->current_color_code)
{{ $expectantMother->current_color_code }}
@endif @if($expectantMother && $expectantMother->edd)
{{ $expectantMother->edd->format('M j, Y') }} ({{ $expectantMother->edd->diffInWeeks(now()) }} weeks)
@endif @if($nextAppointment)
{{ $nextAppointment->appointment_date->format('M j, Y \a\t g:i A') }}
{{ $nextAppointment->clinic->name ?? $currentClinic->name }}
@endif
@endif @if($step === 2)

New Clinic Request

@error('requested_clinic_id')

{{ $message }}

@enderror
@error('reason')

{{ $message }}

@else

Minimum 30 characters required

@enderror

{{ strlen($reason) }}/500

Leave blank for earliest feasible date

@error('preferred_effective_date')

{{ $message }}

@enderror

or drag and drop

PDF, JPG, JPEG, PNG up to 5MB each (max 3 files)

Uploading files...
@error('attachments.*')

{{ $message }}

@enderror
@if(!empty($attachments) || !empty($existingAttachments))

Attached Files

@foreach($attachments as $index => $file) @if($file)

{{ $file->getClientOriginalName() }}

{{ number_format($file->getSize() / 1024, 1) }} KB

@endif @endforeach @foreach($existingAttachments as $attachment)

{{ $attachment->original_name }}

{{ $attachment->human_size }}

@endforeach
@endif
@endif @if($step === 3)

Declarations

Information Accuracy

By submitting this request, you confirm that all information provided is accurate and complete. Any false or misleading information may result in the rejection of your request.

@error('confirm_information')

{{ $message }}

@enderror

Service Continuation

Please understand that your medical services will continue at your current clinic until your request is approved and the effective date is reached. You should continue attending all scheduled appointments at your current clinic during this period.

@error('confirm_services')

{{ $message }}

@enderror

Important Notes

  • Clinic change requests are reviewed by the Clinic Admin and typically processed within 1-3 business days.
  • You will receive email notifications about the status of your request.
  • If approved, your medical records will be transferred to the new clinic automatically.
  • You can withdraw your request at any time before it is approved or rejected.
@endif @if($step === 4)

Review & Submit

Request Summary

From Clinic:

{{ $currentClinic->name }}

To Clinic:

@if($requested_clinic_id) {{ $availableClinics->find($requested_clinic_id)->name ?? 'Not selected' }} @else Not selected @endif

Urgency:

{{ $urgency }}

Preferred Date:

{{ $preferred_effective_date ? \Carbon\Carbon::parse($preferred_effective_date)->format('M j, Y') : 'Earliest feasible' }}

Reason for Change:

{{ $reason ?: 'No reason provided' }}

@if($urgency === 'URGENT' && $urgency_justification)

Urgency Justification:

{{ $urgency_justification }}

@endif @if(!empty($attachments) || !empty($existingAttachments))

Supporting Documents:

@foreach($attachments as $file) @if($file)
{{ $file->getClientOriginalName() }}
@endif @endforeach @foreach($existingAttachments as $attachment)
{{ $attachment->original_name }}
@endforeach
@endif

Ready to Submit

Please review all information above. Once submitted, you will not be able to edit this request unless additional information is requested by the Clinic Admin.

@endif