@php($p = $patient)
<div class="form-grid">
    <div class="field" style="grid-column:1 / -1;">
        <label for="name">Full name</label>
        <input id="name" class="input" name="name" value="{{ old('name', $p->name) }}" required>
        @error('name')<div class="error">{{ $message }}</div>@enderror
    </div>

    <div class="field">
        <label for="date_of_birth">Date of birth</label>
        <input id="date_of_birth" class="input" type="date" name="date_of_birth" value="{{ old('date_of_birth', optional($p->date_of_birth)->format('Y-m-d')) }}">
        @error('date_of_birth')<div class="error">{{ $message }}</div>@enderror
    </div>

    <div class="field">
        <label for="gender">Sex</label>
        <select id="gender" class="select" name="gender">
            <option value="">—</option>
            @foreach(['male'=>'Male','female'=>'Female','other'=>'Other'] as $v=>$lbl)
                <option value="{{ $v }}" @selected(old('gender', $p->gender)===$v)>{{ $lbl }}</option>
            @endforeach
        </select>
    </div>

    <div class="field">
        <label for="phone">Phone</label>
        <input id="phone" class="input" name="phone" value="{{ old('phone', $p->phone) }}">
    </div>

    <div class="field">
        <label for="email">Email <span class="hint">(optional)</span></label>
        <input id="email" class="input" type="email" name="email" value="{{ old('email', $p->email) }}">
        @error('email')<div class="error">{{ $message }}</div>@enderror
    </div>

    <div class="field">
        <label for="blood_group">Blood group</label>
        <select id="blood_group" class="select" name="blood_group">
            <option value="">—</option>
            @foreach(['A+','A-','B+','B-','AB+','AB-','O+','O-'] as $bg)
                <option value="{{ $bg }}" @selected(old('blood_group', $p->blood_group)===$bg)>{{ $bg }}</option>
            @endforeach
        </select>
    </div>

    <div class="field">
        <label for="emergency_contact_name">Emergency contact</label>
        <input id="emergency_contact_name" class="input" name="emergency_contact_name" value="{{ old('emergency_contact_name', $p->emergency_contact_name) }}" placeholder="Name">
    </div>

    <div class="field">
        <label for="emergency_contact_phone">Emergency phone</label>
        <input id="emergency_contact_phone" class="input" name="emergency_contact_phone" value="{{ old('emergency_contact_phone', $p->emergency_contact_phone) }}">
    </div>

    <div class="field" style="grid-column:1 / -1;">
        <label for="address">Address</label>
        <textarea id="address" class="input" name="address" rows="2">{{ old('address', $p->address) }}</textarea>
    </div>

    <div class="field" style="grid-column:1 / -1;">
        <label for="notes">Clinical notes <span class="hint">(background, ongoing concerns)</span></label>
        <textarea id="notes" class="input" name="notes">{{ old('notes', $p->notes) }}</textarea>
    </div>
</div>