@extends('layouts.master')

@section('title')
	@parent | Provider Search Audit Settings
@stop

@section('content')

	<div class="center clearfix">
		<h2>Provider Search Audit Settings</h2>
		<div id="audit">
			{{ Form::open(array('url' => 'audit/update')) }}

				<div class="form-pair">
					{{ Form::label('audit_date', 'Search Date') }}<br>
					{{ Form::text('audit_date_formatted', date('n/j/Y', strtotime($audit_date)), ['id' => 'audit_date_formatted', 'autocomplete' => 'off']) }}
					{{ Form::hidden('audit_date', $audit_date, ['autocomplete' => 'off']) }}
				</div>

				<div class="form-pair">
					{{ Form::label('tpa_id', 'TPA ID') }}<br>
					{{ Form::select('tpa_id', $tpa_ids, $tpa_id, ['autocomplete' => 'off']) }}
				</div>

				<div class="form-pair">
					{{ Form::label('client_id', 'Client ID') }}<br>
					{{ Form::select('client_id', $client_ids, $client_id, ['autocomplete' => 'off']) }}
				</div>

				<div class="form-pair">
					{{ Form::label('region_id', 'Region(s)') }}<br>
					{{ Form::select('region_id[]', $regions_options, $regions, ['multiple' => 'multiple', 'id' => 'region_id', 'autocomplete' => 'off' ]) }}
				</div>

				{{ Form::submit('Submit', ['id' => 'audit_submit']) }}
			{{ Form::close() }}
		</div>
	</div>

	<script type="text/javascript">
		var tpa_id = '{{ $tpa_id }}',
			client_id = '{{ $client_id }}',
			regions = {{ json_encode(array_keys($regions)) }};
	</script>
@stop