@csrf

<div class="mb-3">
    <label>Nama</label>
    <input type="text" name="name" class="form-control"
           value="{{ old('name', $patient->name ?? '') }}" required>
</div>

<div class="mb-3">
    <label>Telepon</label>
    <input type="text" name="phone" class="form-control"
           value="{{ old('phone', $patient->phone ?? '') }}" required
           placeholder="08xxxxxxxxxx">
</div>

<div class="mb-3">
    <label>Email</label>
    <input type="email" name="email" class="form-control"
           value="{{ old('email', $patient->email ?? '') }}">
</div>

<div class="mb-3">
    <label>Password Login Aplikasi</label>
    <input type="password" name="password" class="form-control" required>
    <small class="text-muted">Minimal 6 karakter</small>
</div>

<div class="mb-3">
    <label>Tanggal Lahir</label>
    <input type="date" name="dob" class="form-control"
           value="{{ old('dob', $patient->dob ?? '') }}">
</div>

<div class="mb-3">
    <label>Jenis Kelamin</label>
    <select name="gender" class="form-control">
        <option value="">- Pilih -</option>
        <option value="male" {{ old('gender',$patient->gender ?? '')=='male'?'selected':'' }}>
            Laki-laki
        </option>
        <option value="female" {{ old('gender',$patient->gender ?? '')=='female'?'selected':'' }}>
            Perempuan
        </option>
    </select>
</div>

<div class="mb-3">
    <label>Alamat</label>
    <textarea name="address" class="form-control" rows="3">{{ old('address', $patient->address ?? '') }}</textarea>
</div>


<button class="btn btn-success">
    Simpan
</button>

<a href="{{ route('patients.index') }}" class="btn btn-secondary">
    Kembali
</a>