        @extends('layouts.main')
        @section('content')
        
        <!-- Content Wrapper. Contains page content -->
        
        <div class="content-wrapper">
        
        <!-- Content Header (Page header) -->
        
        <section class   = "content-header">
            
            <div class     = "container-fluid">
            
            <div class   = "row mb-2">
              
              <div class = "col-sm-6">
              
                <h1>   Challan For Dead Body Sent For Examination (Regulation 304 / WB - Form No. -5371)  </h1>
              
              </div>
              
              <div class    = "col-sm-6">
              
                <ol class   = "breadcrumb float-sm-right">
              
                  <li class = "breadcrumb-item">    <a href = "#">  Home </a>    </li>
              
                  <li class = "breadcrumb-item active"> WB - Form No. -5371) </li>
              
                </ol>
              
              </div>
              
            </div>
        
        </div> 
        
        <!-- /.container-fluid -->
         
        </section>
    
         @if (session('status'))
        
         <div class="alert alert-success">
            {{ session('status') }}
         </div>
         @endif
    
         <section class = "content">
    
         <div class = "container-fluid">
    
         <div class = "row">
               
              <!-- left column -->
    
              <div class="col-md-12">
                
                <!-- jquery validation -->
    
                <div class = "card card-primary">
    
                <div class = "card-header">
                  
                    <h3 class = "card-title">Add FORM WB 5371 </h3>
                
                </div>
    
              <meta name="viewport" content="width=device-width, initial-scale=1">
    <style>
    .accordion {
      background-color: #33afff;
      color: #fdfdfd;
      cursor: pointer;
      padding: 18px;
      width: 100%;
      border: none;
      text-align: left;
      outline: none;
      font-size: 15px;
      transition: 0.4s;
    }
    
    .active, .accordion:hover {
      background-color: #ccc; 
    }
    
    .panel {
      padding: 0 18px;
      display: none;
      background-color: white;
      overflow: hidden;
    }
    </style>
    </head>
    <body>
    
    <h2></h2>
    
    <button class=""><b> Name & Caste & Details Of Deceased </b>
</button>
    
     <div class="container">
      <div class="row">
          
        <form action = "{{url('save_5371')}}"  method = "post" > 
        @csrf
       
        <div class="col-md-4">
         
         <label for="exampleFormControlInput1" class="form-label"> UD Case No </label>
         
         <input type="TEXT" class="form-control" id="exampleFormControlInput1" name= "ud_case_no" required placeholder="UD Case No">
        
        </div>
        
        <div class="col-md-4">
         
         <label for="exampleFormControlInput1" class="form-label"> Name Of Deceased</label>
         
         <input type="TEXT" class="form-control" id="exampleFormControlInput1" name= "name_deceased" required placeholder="Name Deceased">
        
        </div>
        
          <div class="col-md-4">
         
         <label for="exampleFormControlInput1" class="form-label"> Caste Of Deceased </label>
         
         <input type="TEXT" class="form-control" id="exampleFormControlInput1" name = "caste_deceased" required placeholder =" Caste Deceased" >
        
        </div>
        
        <div class="col-md-4">
         
         <label for="exampleFormControlInput1" class="form-label">  Residence / Address </label>
         
         <input type = "TEXT" class = "form-control" name = "residence" id = "exampleFormControlInput1" required placeholder="Residence">
        
        </div>
        
        <div class = "col-md-4">
            
             <label for = "exampleFormControlInput1" class="form-label">  Where body was found  </label>
             
             <textarea class = "form-control" NAME ="where_body_found"  required rows="3"></textarea>
    
        </div>
        
        <div class = "col-md-4">
            
            <label for  = "exampleFormControlInput1" class="form-label">  DATE  </label>
             
            <input type = "date" class="form-control" NAME ="where_body_found_date"  required  >
    
        </div>
        
        <div class = "col-md-4">
            
            <label for  = "exampleFormControlInput1" class="form-label"> Time  </label>
             
            <input type = "text" class="form-control" NAME ="where_body_found_time"  required  >
    
        </div>
    
        <div class="col-md-4">
    
         <label for="exampleFormControlInput1" class="form-label">  Gender  </label>
        
            <select class="form-select" name="sex_gender" aria-label="Default select example" required>
        
                <option selected>Select Gender</option>
                <option value="Male">Male</option>
                <option value="Female" > Female </option>
                <option value="Transgender" > Transgender </option>
    
            </select>
    
        </div>
        
      </div>
    
    </div>
    
    <div class="row">
    
        <div class="col-md-4">
    
            <label for="exampleFormControlInput1" class="form-label">
        
                Distance From Place Of PM ( Start with kilo meters )   
    
            </label>
    
            <input type="text" class="form-control" name = "place_of_pm" id="place_of_pm" placeholder="Place of PM " required >
    
        </div>
        
        <div class="col-md-4">
         
        <label for="exampleFormControlInput1" class="form-label">  Means of Dispatch </label>
        
            <input type = "text" class="form-control" name ="means_of_dispatch" id="means_of_dispatch" required placeholder="Means of Dispatch">
            
        </div>
        
         <div class    = "col-md-4">
        
         <label for    = "exampleFormControlInput1" class="form-label">  Identyfying Officer </label>
        
         <input type   = "text" class="form-control" name ="identyfying_officer" id="identyfying_officer" required placeholder="  Identyfying Officer ">
            
        </div>
        
         <div class     = "col-md-4">
         <label for     = "exampleFormControlInput1" class="form-label">  Marks On Body   </label>
        
            <input type = "text" class="form-control" name = "body_marks" required id="body_marks" placeholder="Marks on Body">
        </div>
        
        <div class = "col-md-4">
       
            <label for="exampleFormControlInput1" class="form-label">   Cause Of Death As Far As Known 
        
            </label>
        
            <input type="text" class="form-control" name = "cause_of_death" required id="cause_of_death" placeholder="Causes Of Death ">
       
        </div>
        
        <div class="col-md-4">
            
         <label for="exampleFormControlInput1" class="form-label">  Clothes Sent With Body   </label>
        
            <input type="text" class="form-control" name = "cloths_sent_with_body" required  id="cloths_sent_with_body" placeholder="Clothes Sent With Body  ">
         
         </div>
        
         <div class="col-md-4">
            
            <label for="exampleFormControlInput1" class="form-label"> Articles Sent With Body   </label>
        
            <input type="text" class="form-control" name = "article_sent_body" required  id="article_sent_body" placeholder="Articles Sent With Body  ">
         
         </div>
        
        
         <div class="col-md-4">
         
             <label for="exampleFormControlInput1" class="form-label">  Remarks   </label>
        
             <textarea class="form-control" name = "remarks" required  id="remarks" placeholder="Remarks "></textarea>
         
         </div>
        
         <div class="col-md-4">
            
             <input type="submit" class="btn btn-primary" name = "submit" value = "Submit" >
            
          </div>
            
      </div>
    
    </div>
    
    <script>
    
    var acc = document.getElementsByClassName("accordion");
    var i;
    
    for (i = 0; i < acc.length; i++) {
      acc[i].addEventListener("click", function() {
        this.classList.toggle("active");
        var panel = this.nextElementSibling;
        if (panel.style.display === "block") {
          panel.style.display = "none";
        } else {
          panel.style.display = "block";
        }
      });
    }
    </script>
    </div>
    <!-- /.card -->
    </div>
    <!--/.col (left) -->
    <!-- right column -->
    <div class = "col-md-6">
    </div>
    <!--/.col (right) -->
    </div>
    <!-- /.row -->
    </div>
          <!-- /.container-fluid -->
        </section>
        <!-- /.content -->
      </div>
      <!-- /.content-wrapper -->
      @endsection