@extends('layouts.app')

@section('content')

<div class="container">
    
    <div class="row justify-content-center">
        <div class="col-md-8 main-area">
            <h1 style="text-align: center;">
                反轉代謝新人生 皮蛇疫苗加碼補
            </h1>
        </div>
    </div>
    <div style="height:20px;">&nbsp;</div>
    

    <div class="row justify-content-center">
        <div class="col-md-8 main-area">
            <h2 style="text-align: center;">查詢審核狀態</h2>
            <p>&nbsp;</p>
            <form id="dataForm" method="POST" action="/health_allowance_check" enctype="multipart/form-data" style="font-size: 1.4em; ">
                @csrf
                @if ($errors->any())
                    <div class="text-left mt-3 alert alert-block alert-dismissible alert-danger">
                        <!--<span type="button" class="close" data-bs-dismiss="alert">×</span>-->
                        <ul>
                            @foreach ($errors->all() as $error)
                            @if ($error)
                                <li>{{ $error }}</li>
                            @endif
                            @endforeach
                        </ul>
                    </div>
                @endif
                @if ($message = Session::get('success'))
                    <div class="text-left mt-3 alert alert-block alert-dismissible alert-success ">
                        <!--<span type="button" class="close" data-bs-dismiss="alert">×</span>-->
                        <strong>{{ $message }}</strong>
                    </div>
                @endif
                <div class="card">
                    <div class="card-body">
                        <div class="mb-3">
                            <label for="regIdNumber" class="form-label">身份證字號後4碼</label>
                            <input type="text" class="form-control" id="regTwid" name="twid" required value="{{ old('twid') }}" placeholder="範例：6789">
                        </div>
                        
                        <div class="mb-3">
                            <label for="regPhone" class="form-label">行動電話後4碼</label>
                            <input type="text" class="form-control" id="regPhone" name="phone" required value="{{ old('phone') }}" placeholder="範例：1111">
                        </div>

                        <div class="mb-3">
                            &nbsp;
                        </div>
                        
                        <button type="submit" class="btn btn-primary">送出查詢</button>
                    </div>
                </div>
            </form>
        </div>
    </div>
    
</div>


@endsection