@extends('crudbooster::admin_template')
@section('content')

<h1>Laporkan Warga Atas Nama <strong> {{ $nama_lgkp }} </strong></h1>
<form class="form-horizontal" method="post" id="form" enctype="multipart/form-data" action="https://siapkk.banjarbarukota.go.id/admin/warga_bjb_daftar_penerima_bansos/laporkan">
    <input type="hidden" name="_token" value="{{ csrf_token() }}"/>
	<input type="hidden"  name="pelapor_id" id="pelapor_id" value="{{ $pelapor }}">
	<input type="hidden" name="terlapor_id" id="terlapor_id" value="{{ $terlapor }}">
	<div class="box-body" id="parent-form-area">
	
	<div class="form-group header-group-0 " id="form-group-jk" style="">

    <div class="col-sm-8">
    

        @foreach($laporkan as $lp)
            @if($lp->isian==0)
    	    <div class=" ">
    			<label class="radio-inline">
    				<input type="radio" name="selected_laporkan" value="{{ $lp->id }} ">{{ $lp->item_pilihan }}
    			</label>
            </div>
            @elseif($lp->isian==1)
            <div class=" ">
    			<label class="radio-inline">
    				<input type="radio" name="selected_laporkan" value="{{ $lp->id }} ">{{ $lp->item_pilihan }}
    			   <input type="text" name="isian" class="form-control" maxlength="255">
    			</label>
            </div>
            @endif
    	@endforeach
        
        <div class="text-danger"></div>
        	<p class="help-block"></p>
        	</div>
        </div>
        
    	
    <div class="box-footer" style="background: #F5F5F5">						
    	<div class="form-group">
    		<label class="control-label col-sm-2"></label>
    		<div class="col-sm-10">
    			<a href="https://siapkk.banjarbarukota.go.id/admin/warga_bjb_daftar_penerima_bansos" class="btn btn-default"><i class="fa fa-chevron-circle-left"></i> Kembali</a>
    			<input type="submit" name="submit" value="Kirim" class="btn btn-success">																			
    		</div>
    	</div>
    </div>
    
</div></form>


@endsection