{% extends "base.html" %}
{% set active_nav = "clinicians" %}

{% block title %}Edit {{ clinician.first_name }} {{ clinician.last_name }} - LSMC Hub{% endblock %}

{% block content %}
<div class="page-header">
    <div>
        <nav class="breadcrumb">
            <a href="/clinicians">Clinicians</a>
            <span>/</span>
            <a href="/clinicians/{{ clinician.id }}">{{ clinician.first_name }} {{ clinician.last_name }}</a>
            <span>/</span>
            <span>Edit</span>
        </nav>
        <h1 class="page-title">Edit Clinician</h1>
        <p class="page-subtitle">Changes create a new revision (append-only)</p>
    </div>
</div>

<div class="card">
    <form method="post" action="/clinicians/{{ clinician.id }}/edit">
        <input type="hidden" name="csrf_token" value="{{ csrf_token }}">
        
        <div class="card-body">
            <h3 class="form-section-title">Professional Information</h3>
            
            <div class="form-grid">
                <div class="form-group">
                    <label class="form-label" for="first_name">First Name *</label>
                    <input type="text" id="first_name" name="first_name" class="form-input" 
                           value="{{ clinician.first_name }}" required>
                </div>
                
                <div class="form-group">
                    <label class="form-label" for="last_name">Last Name *</label>
                    <input type="text" id="last_name" name="last_name" class="form-input" 
                           value="{{ clinician.last_name }}" required>
                </div>
                
                <div class="form-group">
                    <label class="form-label" for="credentials">Credentials</label>
                    <input type="text" id="credentials" name="credentials" class="form-input" 
                           value="{{ clinician.credentials or '' }}" placeholder="MD, DO, PhD, etc.">
                </div>
                
                <div class="form-group">
                    <label class="form-label" for="npi">NPI</label>
                    <input type="text" id="npi" name="npi" class="form-input" 
                           value="{{ clinician.npi or '' }}" placeholder="10-digit NPI">
                </div>

                <div class="form-group">
                    <label class="form-label" for="site_id">Site{% if site_options|length > 1 %} *{% endif %}</label>
                    <select id="site_id" name="site_id" class="form-select" {% if site_options|length > 1 %}required{% endif %}>
                        {% if site_options|length != 1 %}
                        <option value="">Select...</option>
                        {% endif %}
                        {% for site in site_options %}
                        <option value="{{ site.id }}" {% if selected_site_id == site.id %}selected{% endif %}>
                            {{ site.name }}{% if site.site_code %} ({{ site.site_code }}){% endif %}
                        </option>
                        {% endfor %}
                    </select>
                </div>
                
                <div class="form-group col-span-2">
                    <label class="form-label" for="specialty">Specialty</label>
                    <input type="text" id="specialty" name="specialty" class="form-input" 
                           value="{{ clinician.specialty or '' }}">
                </div>
            </div>

            <h3 class="form-section-title mt-lg">Contact Information</h3>
            
            <div class="form-grid">
                <div class="form-group">
                    <label class="form-label" for="email">Email</label>
                    <input type="email" id="email" name="email" class="form-input" 
                           value="{{ clinician.email or '' }}">
                </div>
                
                <div class="form-group">
                    <label class="form-label" for="phone">Phone</label>
                    <input type="tel" id="phone" name="phone" class="form-input" 
                           value="{{ clinician.phone or '' }}">
                </div>
                
                <div class="form-group">
                    <label class="form-label" for="fax">Fax</label>
                    <input type="tel" id="fax" name="fax" class="form-input" 
                           value="{{ clinician.fax or '' }}">
                </div>
            </div>

            <h3 class="form-section-title mt-lg">Status</h3>
            
            <div class="form-group">
                <label class="form-checkbox">
                    <input type="checkbox" name="is_active" value="true" 
                           {% if clinician.is_active %}checked{% endif %}>
                    <span>Active</span>
                </label>
                <p class="form-help">Inactive clinicians won't appear in dropdowns for new orders</p>
            </div>

            <h3 class="form-section-title mt-lg">Revision Note</h3>
            
            <div class="form-group">
                <label class="form-label" for="note">Note (optional)</label>
                <input type="text" id="note" name="note" class="form-input" 
                       placeholder="Reason for this update...">
                <p class="form-help">This note will be recorded in the revision history</p>
            </div>
        </div>
        
        <div class="card-footer flex justify-between">
            <a href="/clinicians/{{ clinician.id }}" class="btn btn-ghost">Cancel</a>
            <button type="submit" class="btn btn-primary">Save Changes</button>
        </div>
    </form>
</div>
{% endblock %}