{% extends "base.html" %}

{% block title %}{% if contact %}Edit{% else %}Add{% endif %} Contact - Vera Medical CRM{% endblock %}

{% block content %}
<div class="mb-6">
    <h1 class="text-3xl font-bold text-gray-800 mb-2">
        {% if contact %}Edit{% else %}Add{% endif %} Contact / Adjuster
    </h1>
    <p class="text-gray-600">Client contact information</p>
</div>

<div class="bg-white rounded-lg shadow-md overflow-hidden">
    <form method="POST" action="{% if contact %}{{ url_for('contact_edit', client_id=client_id, contact_id=contact['id']) }}{% else %}{{ url_for('contact_new', client_id=client_id) }}{% endif %}">
        <div class="p-6">
            <div class="grid grid-cols-1 md:grid-cols-2 gap-6">
                <div>
                    <label class="block text-sm font-medium text-gray-700 mb-2">First Name *</label>
                    <input type="text" name="first_name" value="{{ contact['first_name'] if contact else '' }}" required
                           class="w-full px-4 py-2 border border-gray-300 rounded-lg focus:ring-2 focus:ring-orange-500">
                </div>
                
                <div>
                    <label class="block text-sm font-medium text-gray-700 mb-2">Last Name *</label>
                    <input type="text" name="last_name" value="{{ contact['last_name'] if contact else '' }}" required
                           class="w-full px-4 py-2 border border-gray-300 rounded-lg focus:ring-2 focus:ring-orange-500">
                </div>
                
                <div>
                    <label class="block text-sm font-medium text-gray-700 mb-2">Title</label>
                    <input type="text" name="title" value="{{ contact['title'] if contact else '' }}"
                           placeholder="e.g., Claims Adjuster"
                           class="w-full px-4 py-2 border border-gray-300 rounded-lg focus:ring-2 focus:ring-orange-500">
                </div>
                
                <div>
                    <label class="block text-sm font-medium text-gray-700 mb-2">Phone</label>
                    <input type="text" name="phone" value="{{ contact['phone'] if contact else '' }}"
                           class="w-full px-4 py-2 border border-gray-300 rounded-lg focus:ring-2 focus:ring-orange-500">
                </div>
            </div>
        </div>
        
        <div class="flex justify-end space-x-4 p-6 bg-gray-50 border-t">
            <a href="{{ url_for('client_view', client_id=client_id) }}" 
               class="px-6 py-2 border border-gray-300 text-gray-700 rounded-lg hover:bg-gray-50 transition">
                Cancel
            </a>
            <button type="submit" 
                    class="px-6 py-2 bg-orange-600 hover:bg-orange-700 text-white rounded-lg font-semibold transition">
                <i class="fas fa-save mr-2"></i>
                {% if contact %}Update{% else %}Create{% endif %} Contact
            </button>
        </div>
    </form>
</div>
{% endblock %}