@extends('layouts.app_layout')

@section('title')
    All Students
@endsection

@section('content')
    <div class="px-5">
        <div class=" text-start mb-3 ">
            Add student
        </div>
        <div class=" bg-white rounded shadow-sm p-3">
            <ul class="nav nav-pills mb-3 border-bottom" id="pills-tab" role="tablist">
                <li class="nav-item" role="presentation">
                    <button class="nav-link active" id="pills-home-tab" data-bs-toggle="pill" data-bs-target="#pills-home"
                        type="button" role="tab" aria-controls="pills-home" aria-selected="true">
                        معلومات عن الهوية
                        الشخصية
                    </button>
                </li>
                <li class="nav-item" role="presentation">
                    <button class="nav-link" id="pills-profile-tab" data-bs-toggle="pill"
                        data-bs-target="#pills-profile" type="button" role="tab" aria-controls="pills-profile"
                        aria-selected="false">
                        معلومات عن الشكوى
                        الاساسيه
                    </button>
                </li>
                <li class="nav-item" role="presentation">
                    <button class="nav-link" id="pills-history-tab" data-bs-toggle="pill"
                        data-bs-target="#pills-history" type="button" role="tab" aria-controls="pills-history"
                        aria-selected="false">
                        معلومات عن التاريخ الاسري
                    </button>
                </li>
                <li class="nav-item" role="presentation">
                    <button class="nav-link" id="pills-level-tab" data-bs-toggle="pill" data-bs-target="#pills-level"
                        type="button" role="tab" aria-controls="pills-level" aria-selected="false">
                        المستوي المعيشي للاسرة
                    </button>
                </li>

            </ul>
            <div class="tab-content" id="pills-tabContent">
                <div class="tab-pane fade show active p-3" id="pills-home" role="tabpanel" aria-labelledby="pills-home-tab">


                    <form class="row g-3 needs-validation flex-row-reverse text-end" novalidate>

                        <div class="col-md-4">
                            <label for="student_name" class="form-label">اسم الحالة</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend"> <i
                                        class="fa-regular fa-user"></i></span>
                                <input type="text" class="form-control" id="student_name" name="student_name"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a student_name.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="dob" class="form-label">العمر</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">@</span>
                                <input type="number" class="form-control" id="dob" name="dob"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a Age.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="validationCustomUserDateOfBirth" class="form-label">تاريخ الميلاد</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">
                                    <i class="fa-solid fa-calendar-day"></i>
                                </span>
                                <input type="date" class="form-control" id="validationCustomUserDateOfBirth"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a DateOfBirth.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="birth_address" class="form-label">محل الميلاد</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="birth_address" name="birth_address">
                                    <i class="fa-solid fa-address-card"></i>
                                </span>
                                <input type="text" class="form-control" id="birth_address"
                                    aria-describedby="inputGroupPrepend" required>
                            </div>

                        </div>
                        <div class="col-md-2">
                            <label for="height" class="form-label">الطول</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">@</span>
                                <input type="number" class="form-control" id="height" name="height"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a Height.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-2">
                            <label for="weight" class="form-label">الوزن</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">@</span>
                                <input type="number" class="form-control" id="weight" name="weight"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a Weight.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="address" class="form-label">العنوان</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="address" name="address">
                                    <i class="fa-solid fa-address-card"></i>
                                </span>
                                <input type="text" class="form-control" id="address" aria-describedby="inputGroupPrepend"
                                    required>
                            </div>

                        </div>
                        <div class="col-md-4">
                            <label for="home_phone" class="form-label">تليفون المنزل</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend"><i
                                        class="fa-solid fa-phone"></i></span>
                                <input type="number" class="form-control" id="home_phone" name="home_phone"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a PhoneNumber.
                                </div>
                            </div>
                        </div>


                        <div class="col-md-4">
                            <label for="validationCustomParent" class="form-label">اسم الوالد</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend"> <i
                                        class="fa-regular fa-user "></i></span>
                                <input type="text" class="form-control" id="validationCustomParent"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a Parent Name.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="validationCustomParent" class="form-label">الوظيفة</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">@</span>
                                <input type="text" class="form-control" id="validationCustomParent"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a Parent Name.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="validationCustomUserPhoneNumber" class="form-label">رقم الجوال</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend"><i
                                        class="fa-solid fa-phone"></i></span>
                                <input type="number" class="form-control" id="validationCustomUserPhoneNumber"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a PhoneNumber.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="birth_address" class="form-label">العنوان</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="birth_address" name="birth_address">
                                    <i class="fa-solid fa-address-card"></i>
                                </span>
                                <input type="text" class="form-control" id="birth_address"
                                    aria-describedby="inputGroupPrepend" required>
                            </div>

                        </div>
                        <div class="col-md-4">
                            <label for="validationCustomParent" class="form-label">اسم الوالدة</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend"> <i
                                        class="fa-regular fa-user "></i></span>
                                <input type="text" class="form-control" id="validationCustomParent"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a Parent Name.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="validationCustomParent" class="form-label">الوظيفة</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">@</span>
                                <input type="text" class="form-control" id="validationCustomParent"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a Parent Name.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="validationCustomUserPhoneNumber" class="form-label"> رقم الجوال</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend"><i
                                        class="fa-solid fa-phone"></i></span>
                                <input type="number" class="form-control" id="validationCustomUserPhoneNumber"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a PhoneNumber.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4 offset-2 switchParent">
                            <div class="form-check form-switch">
                                <input class="form-check-input " type="checkbox" role="switch" id="flexSwitchCheckChecked">
                                <label class="form-check-label" for="flexSwitchCheckChecked">في حالة عدم تواجد
                                    الوالد او الوالدة</label>
                            </div>
                        </div>
                        <div class="w-100 d-none noParents" id="noParents1">
                            <div class="row g-3 flex-row-reverse">
                                <div class="col-md-4">
                                    <label for="validationCustomParent" class="form-label">اسم ولي األمر</label>
                                    <div class="input-group has-validation">
                                        <span class="input-group-text" id="inputGroupPrepend"> <i
                                                class="fa-regular fa-user "></i></span>
                                        <input type="text" class="form-control" id="validationCustomParent"
                                            aria-describedby="inputGroupPrepend" required>
                                        <div class="invalid-feedback">
                                            Please choose a Parent Name.
                                        </div>
                                    </div>
                                </div>
                                <div class="col-md-4">
                                    <label for="validationCustomParent" class="form-label">وظيفته</label>
                                    <div class="input-group has-validation">
                                        <span class="input-group-text" id="inputGroupPrepend">@</span>
                                        <input type="text" class="form-control" id="validationCustomParent"
                                            aria-describedby="inputGroupPrepend" required>
                                        <div class="invalid-feedback">
                                            Please choose a Parent Name.
                                        </div>
                                    </div>
                                </div>
                                <div class="col-md-4">
                                    <label for="validationCustomUserPhoneNumber" class="form-label"> رقم الجوال</label>
                                    <div class="input-group has-validation">
                                        <span class="input-group-text" id="inputGroupPrepend"><i
                                                class="fa-solid fa-phone"></i></span>
                                        <input type="number" class="form-control" id="validationCustomUserPhoneNumber"
                                            aria-describedby="inputGroupPrepend" required>
                                        <div class="invalid-feedback">
                                            Please choose a PhoneNumber.
                                        </div>
                                    </div>
                                </div>
                                <div class="col-md-4">
                                    <label for="validationCustomUserPhoneNumber" class="form-label"> العنوان</label>
                                    <div class="input-group has-validation">
                                        <span class="input-group-text" id="inputGroupPrepend"> <i
                                                class="fa-solid fa-address-card"></i></span>
                                        <input type="text" class="form-control" id="validationCustomUserPhoneNumber"
                                            aria-describedby="inputGroupPrepend" required>
                                        <div class="invalid-feedback">
                                            Please choose a PhoneNumber.
                                        </div>
                                    </div>
                                </div>
                                <div class="col-md-4">
                                    <label for="validationCustomUserPhoneNumber" class="form-label"> درجة
                                        القرابة</label>
                                    <div class="input-group has-validation">
                                        <span class="input-group-text" id="inputGroupPrepend">
                                            <i class="fa-regular fa-user "></i>
                                        </span>
                                        <input type="text" class="form-control" id="validationCustomUserPhoneNumber"
                                            aria-describedby="inputGroupPrepend" required>
                                        <div class="invalid-feedback">
                                            Please choose a PhoneNumber.
                                        </div>
                                    </div>
                                </div>

                            </div>
                        </div>
                        <div class="col-12">
                            <button class="btn btn-outline-primary" type="submit">save</button>
                        </div>
                    </form>
                </div>
                <div class="tab-pane fade" id="pills-profile" role="tabpanel" aria-labelledby="pills-profile-tab">

                    <form class="row g-3 needs-validation flex-row-reverse text-end" novalidate>
                        <div class="col-md-4">
                            <div class="mb-3">
                                <label for="exampleFormControlTextarea1" class="form-label">الشكوى الاساسيه</label>
                                <textarea class="form-control" id="exampleFormControlTextarea1" rows="2"></textarea>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <div class="mb-3">
                                <label for="exampleFormControlTextarea1" class="form-label">تاريخ الشعور
                                    بالمشكلة</label>
                                <textarea class="form-control" id="exampleFormControlTextarea1" rows="2"></textarea>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <div class="mb-3">
                                <label for="exampleFormControlTextarea1" class="form-label">
                                    الاوقات التي يزيد
                                    فيها الشعور
                                    بالمشكلة
                                </label>
                                <textarea class="form-control" id="exampleFormControlTextarea1" rows="2"></textarea>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <div class="mb-3">
                                <label for="exampleFormControlTextarea1" class="form-label">
                                    الاوقات التي يقل
                                    فيها الشعور
                                    بالمشكلة
                                </label>
                                <textarea class="form-control " id="exampleFormControlTextarea1" rows="2"></textarea>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <div class="mb-3">
                                <label for="exampleFormControlTextarea1" class="form-label">
                                    المشكلة كما يراها الطفل
                                </label>
                                <textarea class="form-control" id="exampleFormControlTextarea1" rows="2"></textarea>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <div class="mb-3">
                                <label for="exampleFormControlTextarea1" class="form-label">
                                    المشكلة كما
                                    تلاحظها الام
                                </label>
                                <textarea class="form-control" id="exampleFormControlTextarea1" rows="2"></textarea>
                            </div>
                        </div>
                        <div class="col-md-4 offset-4">
                            <div class="mb-3">
                                <label for="exampleFormControlTextarea1" class="form-label">
                                    اسباب المشكلة
                                </label>
                                <textarea class="form-control" id="exampleFormControlTextarea1" rows="2"></textarea>
                            </div>
                        </div>
                        <div class="d-flex align-items-end flex-column">
                            <div class="col-md-4 switchParent">
                                <div class="form-check form-switch">
                                    <input class="form-check-input " type="checkbox" role="switch"
                                        id="flexSwitchCheckChecked">
                                    <label class="form-check-label" for="flexSwitchCheckChecked">أمراض اصابت الحالة ولها
                                        عالقة
                                        بالمشكلة</label>
                                </div>
                            </div>
                            <div class="w-100 d-none noParents" id="noParents2">
                                <div class="row g-3 flex-row-reverse align-items-end mb-2">
                                    <div class="col-md-3">
                                        <label for="validationCustomParent" class="form-label">المرض</label>
                                        <div class="input-group has-validation">
                                            <span class="input-group-text" id="inputGroupPrepend"> <i
                                                    class="fa-regular fa-user "></i></span>
                                            <input type="text" class="form-control" id="validationCustomParent"
                                                aria-describedby="inputGroupPrepend" required>
                                            <div class="invalid-feedback">
                                                Please choose a Parent Name.
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-3">
                                        <label for="validationCustomParent" class="form-label">العمر عند
                                            اإلصابة</label>
                                        <div class="input-group has-validation">
                                            <span class="input-group-text" id="inputGroupPrepend">@</span>
                                            <input type="text" class="form-control" id="validationCustomParent"
                                                aria-describedby="inputGroupPrepend" required>
                                            <div class="invalid-feedback">
                                                Please choose a Parent Name.
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-3">
                                        <label for="validationCustomUserPhoneNumber" class="form-label"> مدة
                                            المرض</label>
                                        <div class="input-group has-validation">
                                            <span class="input-group-text" id="inputGroupPrepend"><i
                                                    class="fa-solid fa-phone"></i></span>
                                            <input type="number" class="form-control"
                                                id="validationCustomUserPhoneNumber" aria-describedby="inputGroupPrepend"
                                                required>
                                            <div class="invalid-feedback">
                                                Please choose a PhoneNumber.
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-2">
                                        <label for="validationCustomUserPhoneNumber" class="form-label"> شدته</label>
                                        <div class="input-group has-validation">
                                            <span class="input-group-text" id="inputGroupPrepend"> <i
                                                    class="fa-solid fa-address-card"></i></span>
                                            <input type="text" class="form-control" id="validationCustomUserPhoneNumber"
                                                aria-describedby="inputGroupPrepend" required>
                                            <div class="invalid-feedback">
                                                Please choose a PhoneNumber.
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-1 d-flex justify-content-end">
                                        <i class="fa-regular fa-plus  icons bg-success text-white"
                                            onclick="problems_fields();"></i>
                                    </div>

                                </div>
                            </div>
                        </div>




                        
                        <div class="d-flex align-items-end  flex-column">
                            <div class="col-md-4 switchParent">
                                <div class="form-check form-switch">
                                    <input class="form-check-input " type="checkbox" role="switch"
                                        id="flexSwitchCheckChecked">
                                    <label class="form-check-label" for="flexSwitchCheckChecked">
                                        الجهود العالجية السابقة</label>
                                </div>
                            </div>
                            <div class="w-100 d-none noParents" id="noParents3">
                                <div class="row g-3 flex-row-reverse align-items-end my-3">
                                    <div class="col-md-3">
                                        <label for="validationCustomParent" class="form-label">اسم المؤسسة
                                            الطبية</label>
                                        <div class="input-group has-validation">
                                            <span class="input-group-text" id="inputGroupPrepend"> <i
                                                    class="fa-regular fa-user "></i></span>
                                            <input type="text" class="form-control" id="validationCustomParent"
                                                aria-describedby="inputGroupPrepend" required>
                                            <div class="invalid-feedback">
                                                Please choose a Parent Name.
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-3">
                                        <label for="validationCustomParent" class="form-label">الخدمة الطبية
                                            المقدمة</label>
                                        <div class="input-group has-validation">
                                            <span class="input-group-text" id="inputGroupPrepend">@</span>
                                            <input type="text" class="form-control" id="validationCustomParent"
                                                aria-describedby="inputGroupPrepend" required>
                                            <div class="invalid-feedback">
                                                Please choose a Parent Name.
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-4">
                                        <label for="validationCustomUserPhoneNumber" class="form-label d-block"> التغير بعد
                                            تقديم
                                            الخدمة</label>
                                        <div class="d-flex justify-content-around mt-3">
                                            <div class="form-check">
                                                <input class="form-check-input" type="radio" name="exampleRadios"
                                                    id="exampleRadios1" value="option" checked>
                                                <label class="form-check-label" for="exampleRadios1">
                                                    سلبي
                                                </label>
                                            </div>
                                            <div class="form-check">
                                                <input class="form-check-input" type="radio" name="exampleRadios"
                                                    id="exampleRadios2" value="option">
                                                <label class="form-check-label" for="exampleRadios2">
                                                    ايجابي
                                                </label>
                                            </div>
                                        </div>
                                    </div>

                                    <div class="col-md-1 d-flex justify-content-end">
                                        <i class="fa-regular fa-plus  icons bg-success text-white"
                                            onclick="efforts_fields();"></i>
                                    </div>

                                </div>
                            </div>
                        </div>
                        <div class="d-flex align-items-end flex-column">
                            <div class="col-md-4 switchParent">
                                <div class="form-check form-switch">
                                    <input class="form-check-input " type="checkbox" role="switch"
                                        id="flexSwitchCheckChecked">
                                    <label class="form-check-label" for="flexSwitchCheckChecked">
                                        الامراض الجسمية الوراثية في الاسرة
                                    </label>
                                </div>
                            </div>
                            <div class="w-100 d-none noParents" id="noParents4">
                                <div class="row g-3 flex-row-reverse align-items-end mb-2">
                                    <div class="col-md-3">
                                        <label for="validationCustomParent" class="form-label">الاسم</label>
                                        <div class="input-group has-validation">
                                            <span class="input-group-text" id="inputGroupPrepend"> <i
                                                    class="fa-regular fa-user "></i></span>
                                            <input type="text" class="form-control" id="validationCustomParent"
                                                aria-describedby="inputGroupPrepend" required>
                                            <div class="invalid-feedback">
                                                Please choose a Parent Name.
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-3">
                                        <label for="validationCustomParent" class="form-label">العمر عند
                                            الاصابة</label>
                                        <div class="input-group has-validation">
                                            <span class="input-group-text" id="inputGroupPrepend">@</span>
                                            <input type="text" class="form-control" id="validationCustomParent"
                                                aria-describedby="inputGroupPrepend" required>
                                            <div class="invalid-feedback">
                                                Please choose a Parent Name.
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-3">
                                        <label for="validationCustomUserPhoneNumber" class="form-label"> درجة
                                            القرابة</label>
                                        <div class="input-group has-validation">
                                            <span class="input-group-text" id="inputGroupPrepend"><i
                                                    class="fa-solid fa-phone"></i></span>
                                            <input type="number" class="form-control"
                                                id="validationCustomUserPhoneNumber" aria-describedby="inputGroupPrepend"
                                                required>
                                            <div class="invalid-feedback">
                                                Please choose a PhoneNumber.
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-2">
                                        <label for="validationCustomUserPhoneNumber" class="form-label"> المرض</label>
                                        <div class="input-group has-validation">
                                            <span class="input-group-text" id="inputGroupPrepend"> <i
                                                    class="fa-solid fa-address-card"></i></span>
                                            <input type="text" class="form-control" id="validationCustomUserPhoneNumber"
                                                aria-describedby="inputGroupPrepend" required>
                                            <div class="invalid-feedback">
                                                Please choose a PhoneNumber.
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-1 d-flex justify-content-end">
                                        <i class="fa-regular fa-plus  icons bg-success text-white"
                                            onclick="body_problems_fields();"></i>
                                    </div>

                                </div>
                            </div>
                        </div>
                        <div class="d-flex align-items-end flex-column">
                            <div class="col-md-4 switchParent">
                                <div class="form-check form-switch">
                                    <input class="form-check-input " type="checkbox" role="switch"
                                        id="flexSwitchCheckChecked">
                                    <label class="form-check-label" for="flexSwitchCheckChecked">
                                        الاصابات والجروح السابقة
                                    </label>
                                </div>
                            </div>
                            <div class="w-100 d-none noParents" id="noParents5">
                                <div class="row g-3 flex-row-reverse align-items-end mb-2">
                                    <div class="col-md-3">
                                        <label for="validationCustomParent" class="form-label">الاصابه</label>
                                        <div class="input-group has-validation">
                                            <span class="input-group-text" id="inputGroupPrepend"> <i
                                                    class="fa-regular fa-user "></i></span>
                                            <input type="text" class="form-control" id="validationCustomParent"
                                                aria-describedby="inputGroupPrepend" required>
                                            <div class="invalid-feedback">
                                                Please choose a Parent Name.
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-3">
                                        <label for="validationCustomParent" class="form-label">العمر عند
                                            الاصابة</label>
                                        <div class="input-group has-validation">
                                            <span class="input-group-text" id="inputGroupPrepend">@</span>
                                            <input type="text" class="form-control" id="validationCustomParent"
                                                aria-describedby="inputGroupPrepend" required>
                                            <div class="invalid-feedback">
                                                Please choose a Parent Name.
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-3">
                                        <label for="validationCustomUserPhoneNumber" class="form-label">العيادة</label>
                                        <div class="input-group has-validation">
                                            <span class="input-group-text" id="inputGroupPrepend"><i
                                                    class="fa-solid fa-phone"></i></span>
                                            <input type="number" class="form-control"
                                                id="validationCustomUserPhoneNumber" aria-describedby="inputGroupPrepend"
                                                required>
                                            <div class="invalid-feedback">
                                                Please choose a PhoneNumber.
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-2">
                                        <label for="validationCustomUserPhoneNumber" class="form-label">النتائج</label>
                                        <div class="input-group has-validation">
                                            <span class="input-group-text" id="inputGroupPrepend"> <i
                                                    class="fa-solid fa-address-card"></i></span>
                                            <input type="text" class="form-control" id="validationCustomUserPhoneNumber"
                                                aria-describedby="inputGroupPrepend" required>
                                            <div class="invalid-feedback">
                                                Please choose a PhoneNumber.
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-1 d-flex justify-content-end">
                                        <i class="fa-regular fa-plus  icons bg-success text-white"
                                            onclick="Injuries_problems_fields();"></i>
                                    </div>

                                </div>
                            </div>
                        </div>
                        <div class="col-12">
                            <button class="btn btn-outline-primary" type="submit">save</button>
                        </div>
                    </form>


                </div>
                <div class="tab-pane fade" id="pills-history" role="tabpanel" aria-labelledby="pills-history-tab">


                    <form class="row g-3 needs-validation flex-row-reverse text-end" novalidate>
                        <h4>الوالد</h4>
                        <div class="col-md-4">
                            <label for="student_name" class="form-label">العمر عند التقديم</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend"> <i
                                        class="fa-regular fa-user"></i></span>
                                <input type="number" class="form-control" id="student_name" name="student_name"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a student_name.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="dob" class="form-label">العمر عند ميالد الحالة</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">@</span>
                                <input type="number" class="form-control" id="dob" name="dob"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a Age.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="validationCustomUserDateOfBirth" class="form-label">المستوي التعليمي</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">
                                    <i class="fa-solid fa-calendar-day"></i>
                                </span>
                                <input type="date" class="form-control" id="validationCustomUserDateOfBirth"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a DateOfBirth.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="birth_address" class="form-label">المهنة</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="birth_address" name="birth_address">
                                    <i class="fa-solid fa-address-card"></i>
                                </span>
                                <input type="text" class="form-control" id="birth_address"
                                    aria-describedby="inputGroupPrepend" required>
                            </div>

                        </div>
                        <div class="col-md-2">
                            <label for="height" class="form-label">العمر عند الزواج</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">@</span>
                                <input type="number" class="form-control" id="height" name="height"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a Height.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-2">
                            <label for="weight" class="form-label">الاهتمامات</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">@</span>
                                <input type="number" class="form-control" id="weight" name="weight"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a Weight.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="address" class="form-label">علاقته بالطفل</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="address" name="address">
                                    <i class="fa-solid fa-address-card"></i>
                                </span>
                                <input type="text" class="form-control" id="address" aria-describedby="inputGroupPrepend"
                                    required>
                            </div>

                        </div>
                        <div class="col-md-4">
                            <label for="home_phone" class="form-label">اتجاهات الحالة
                                نحو االب</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend"><i
                                        class="fa-solid fa-phone"></i></span>
                                <input type="number" class="form-control" id="home_phone" name="home_phone"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a PhoneNumber.
                                </div>
                            </div>
                        </div>
                        <h4>الوالدة</h4>
                        <div class="col-md-4">
                            <label for="student_name" class="form-label">العمر عند التقديم</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend"> <i
                                        class="fa-regular fa-user"></i></span>
                                <input type="number" class="form-control" id="student_name" name="student_name"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a student_name.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="dob" class="form-label">العمر عند ميالد الحالة</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">@</span>
                                <input type="number" class="form-control" id="dob" name="dob"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a Age.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="validationCustomUserDateOfBirth" class="form-label">المستوي التعليمي</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">
                                    <i class="fa-solid fa-calendar-day"></i>
                                </span>
                                <input type="date" class="form-control" id="validationCustomUserDateOfBirth"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a DateOfBirth.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="birth_address" class="form-label">المهنة</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="birth_address" name="birth_address">
                                    <i class="fa-solid fa-address-card"></i>
                                </span>
                                <input type="text" class="form-control" id="birth_address"
                                    aria-describedby="inputGroupPrepend" required>
                            </div>

                        </div>
                        <div class="col-md-2">
                            <label for="height" class="form-label">العمر عند الزواج</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">@</span>
                                <input type="number" class="form-control" id="height" name="height"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a Height.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-2">
                            <label for="weight" class="form-label">الاهتمامات</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">@</span>
                                <input type="number" class="form-control" id="weight" name="weight"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a Weight.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="address" class="form-label">علاقته بالطفل</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="address" name="address">
                                    <i class="fa-solid fa-address-card"></i>
                                </span>
                                <input type="text" class="form-control" id="address" aria-describedby="inputGroupPrepend"
                                    required>
                            </div>

                        </div>
                        <div class="col-md-4">
                            <label for="home_phone" class="form-label">اتجاهات الحالة
                                نحو االب</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend"><i
                                        class="fa-solid fa-phone"></i></span>
                                <input type="number" class="form-control" id="home_phone" name="home_phone"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a PhoneNumber.
                                </div>
                            </div>
                        </div>
                        <h4>العلاقة بين الوالدين</h4>
                        <div class="col-md-4 offset-8">
                            <label for="validationCustomUserPhoneNumber" class="form-label d-block">
                                نوع العلاقة
                            </label>
                            <div class="d-flex justify-content-around mt-3">
                                <div class="form-check">
                                    <input class="form-check-input" type="radio" name="exampleRadios" id="exampleRadios1"
                                        value="option" checked>
                                    <label class="form-check-label" for="exampleRadios1">
                                        جيده
                                    </label>
                                </div>
                                <div class="form-check">
                                    <input class="form-check-input" type="radio" name="exampleRadios" id="exampleRadios2"
                                        value="option">
                                    <label class="form-check-label" for="exampleRadios2">
                                        عادية
                                    </label>
                                </div>
                                <div class="form-check">
                                    <input class="form-check-input" type="radio" name="exampleRadios" id="exampleRadios2"
                                        value="option">
                                    <label class="form-check-label" for="exampleRadios2">
                                        مضطربة
                                    </label>
                                </div>
                                <div class="form-check">
                                    <input class="form-check-input" type="radio" name="exampleRadios" id="exampleRadios2"
                                        value="option">
                                    <label class="form-check-label" for="exampleRadios2">
                                        طالق
                                    </label>
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="birth_address" class="form-label">
                                أهم المشكلات بين
                                الوالدين
                            </label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="birth_address" name="birth_address">
                                    <i class="fa-solid fa-address-card"></i>
                                </span>
                                <textarea class="form-control" id="exampleFormControlTextarea1" rows="2"></textarea>
                            </div>

                        </div>
                        <div class="col-md-4">
                            <label for="birth_address" class="form-label">
                                اتجاه الطفل من
                                المشكلات االسريه
                            </label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="birth_address" name="birth_address">
                                    <i class="fa-solid fa-address-card"></i>
                                </span>
                                <textarea class="form-control" id="exampleFormControlTextarea1" rows="2"></textarea>
                            </div>

                        </div>
                        <h4>الاخوه والاخوات بالترتيب</h4>
                        <div class="d-flex align-items-end  flex-column">
                            <div class="w-100  noParents" id="noParents6">
                                <div class="row g-3 flex-row-reverse align-items-end my-3">
                                    <div class="col-md-2">
                                        <label for="validationCustomParent" class="form-label">الاسم</label>
                                        <div class="input-group has-validation">

                                            <input type="text" class="form-control" id="validationCustomParent"
                                                aria-describedby="inputGroupPrepend" required>
                                            <div class="invalid-feedback">
                                                Please choose a Parent Name.
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-1">
                                        <label for="validationCustomParent" class="form-label">العمر</label>
                                        <input type="text" class="form-control" id="validationCustomParent"
                                            aria-describedby="inputGroupPrepend" required>

                                    </div>

                                    <div class="col-md-1">
                                        <label for="validationCustomParent" class="form-label">الجنس</label>
                                        <div class="input-group has-validation">

                                            <input type="text" class="form-control" id="validationCustomParent"
                                                aria-describedby="inputGroupPrepend" required>
                                            <div class="invalid-feedback">
                                                Please choose a Parent Name.
                                            </div>
                                        </div>
                                    </div>

                                    <div class="col-md-1">
                                        <label for="validationCustomParent" class="form-label">المهنة</label>
                                        <div class="input-group has-validation">

                                            <input type="text" class="form-control" id="validationCustomParent"
                                                aria-describedby="inputGroupPrepend" required>
                                            <div class="invalid-feedback">
                                                Please choose a Parent Name.
                                            </div>
                                        </div>
                                    </div>

                                    <div class="col-md-2">
                                        <label for="validationCustomParent" class="form-label">الحالة
                                            الاجتماعيه</label>
                                        <div class="input-group has-validation">

                                            <input type="text" class="form-control" id="validationCustomParent"
                                                aria-describedby="inputGroupPrepend" required>
                                            <div class="invalid-feedback">
                                                Please choose a Parent Name.
                                            </div>
                                        </div>
                                    </div>

                                    <div class="col-md-2">
                                        <label for="validationCustomParent" class="form-label">
                                            المستوي
                                            التعليمي</label>
                                        <div class="input-group has-validation">

                                            <input type="text" class="form-control" id="validationCustomParent"
                                                aria-describedby="inputGroupPrepend" required>
                                            <div class="invalid-feedback">
                                                Please choose a Parent Name.
                                            </div>
                                        </div>
                                    </div>

                                    <div class="col-md-1">
                                        <label for="validationCustomParent" class="form-label">
                                            علاقته
                                            بالطفل
                                        </label>
                                        <div class="input-group has-validation">

                                            <input type="text" class="form-control" id="validationCustomParent"
                                                aria-describedby="inputGroupPrepend" required>
                                            <div class="invalid-feedback">
                                                Please choose a Parent Name.
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-1">
                                        <label for="validationCustomParent" class="form-label">
                                            علاقه
                                            الطفل به
                                        </label>
                                        <div class="input-group has-validation">

                                            <input type="text" class="form-control" id="validationCustomParent"
                                                aria-describedby="inputGroupPrepend" required>
                                            <div class="invalid-feedback">
                                                Please choose a Parent Name.
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-1 d-flex justify-content-end">
                                        <i class="fa-regular fa-plus  icons bg-success text-white"
                                            onclick="siblings_fields();"></i>
                                    </div>

                                </div>
                            </div>
                        </div>
                        <div class="col-md-4 offset-5">
                            <label for="birth_address" class="form-label">
                                تعليقات اضافية
                            </label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="birth_address" name="birth_address">
                                    <i class="fa-solid fa-address-card"></i>
                                </span>
                                <textarea class="form-control" id="exampleFormControlTextarea1" rows="2"></textarea>
                            </div>

                        </div>
                        <div class="col-md-4">
                            <label for="validationCustomUserPhoneNumber" class="form-label d-block">
                                هل يوجد اقارب اخرين يعيشون مع الاسرة
                            </label>
                            <div class="d-flex justify-content-around mt-3">
                                <div class="form-check">
                                    <input class="form-check-input" type="radio" name="otherRelatives" id="exampleRadios2"
                                        value="no" checked>
                                    <label class="form-check-label" for="exampleRadios2">
                                        لا
                                    </label>
                                </div>
                                <div class="form-check">
                                    <input class="form-check-input" type="radio" name="otherRelatives" id="exampleRadios1"
                                        value="yes">
                                    <label class="form-check-label" for="exampleRadios1">
                                        نعم
                                    </label>
                                </div>

                            </div>
                        </div>
                        <div class="w-100 d-none noParents" id="noParents7">
                            <div class="row g-3 flex-row-reverse align-items-end mb-2">
                                <div class="col-md-3">
                                    <label for="validationCustomParent" class="form-label">الاسم</label>
                                    <div class="input-group has-validation">
                                        <span class="input-group-text" id="inputGroupPrepend"> <i
                                                class="fa-regular fa-user "></i></span>
                                        <input type="text" class="form-control" id="validationCustomParent"
                                            aria-describedby="inputGroupPrepend" required>
                                        <div class="invalid-feedback">
                                            Please choose a Parent Name.
                                        </div>
                                    </div>
                                </div>
                                <div class="col-md-3">
                                    <label for="validationCustomParent" class="form-label">العمر</label>
                                    <div class="input-group has-validation">
                                        <span class="input-group-text" id="inputGroupPrepend">@</span>
                                        <input type="text" class="form-control" id="validationCustomParent"
                                            aria-describedby="inputGroupPrepend" required>
                                        <div class="invalid-feedback">
                                            Please choose a Parent Name.
                                        </div>
                                    </div>
                                </div>
                                <div class="col-md-3">
                                    <label for="validationCustomUserPhoneNumber" class="form-label"> درجة
                                        القرابة</label>
                                    <div class="input-group has-validation">
                                        <span class="input-group-text" id="inputGroupPrepend"><i
                                                class="fa-solid fa-phone"></i></span>
                                        <input type="number" class="form-control" id="validationCustomUserPhoneNumber"
                                            aria-describedby="inputGroupPrepend" required>
                                        <div class="invalid-feedback">
                                            Please choose a PhoneNumber.
                                        </div>
                                    </div>
                                </div>
                                <div class="col-md-2">
                                    <label for="validationCustomUserPhoneNumber" class="form-label"> المستوي
                                        التعليمي</label>
                                    <div class="input-group has-validation">
                                        <span class="input-group-text" id="inputGroupPrepend"> <i
                                                class="fa-solid fa-address-card"></i></span>
                                        <input type="text" class="form-control" id="validationCustomUserPhoneNumber"
                                            aria-describedby="inputGroupPrepend" required>
                                        <div class="invalid-feedback">
                                            Please choose a PhoneNumber.
                                        </div>
                                    </div>
                                </div>
                                <div class="col-md-2">
                                    <label for="validationCustomUserPhoneNumber" class="form-label">
                                        علاقته
                                        بالطفل
                                    </label>
                                    <div class="input-group has-validation">
                                        <span class="input-group-text" id="inputGroupPrepend"> <i
                                                class="fa-solid fa-address-card"></i></span>
                                        <input type="text" class="form-control" id="validationCustomUserPhoneNumber"
                                            aria-describedby="inputGroupPrepend" required>
                                        <div class="invalid-feedback">
                                            Please choose a PhoneNumber.
                                        </div>
                                    </div>
                                </div>
                                <div class="col-md-2">
                                    <label for="validationCustomUserPhoneNumber" class="form-label">
                                        علاقه
                                        الطفل به
                                    </label>
                                    <div class="input-group has-validation">
                                        <span class="input-group-text" id="inputGroupPrepend"> <i
                                                class="fa-solid fa-address-card"></i></span>
                                        <input type="text" class="form-control" id="validationCustomUserPhoneNumber"
                                            aria-describedby="inputGroupPrepend" required>
                                        <div class="invalid-feedback">
                                            Please choose a PhoneNumber.
                                        </div>
                                    </div>
                                </div>
                                <div class="col-md-1 d-flex justify-content-end">
                                    <i class="fa-regular fa-plus  icons bg-success text-white"
                                        onclick="if_yes_fields();"></i>
                                </div>

                            </div>
                        </div>
                        <div class="col-12">
                            <button class="btn btn-outline-primary" type="submit">save</button>
                        </div>
                    </form>
                </div>
                <div class="tab-pane fade" id="pills-level" role="tabpanel" aria-labelledby="pills-level-tab">


                    <form class="row g-3 needs-validation flex-row-reverse text-end" novalidate>

                        <div class="col-md-4">
                            <label for="student_name" class="form-label">
                                الوضع االقتصادي
                                للاسرة
                            </label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend"> <i
                                        class="fa-regular fa-user"></i></span>
                                <input type="number" class="form-control" id="student_name" name="student_name"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a student_name.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="dob" class="form-label">متوسط الدخل
                                الشهري</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">@</span>
                                <input type="number" class="form-control" id="dob" name="dob"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a Age.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="validationCustomUserDateOfBirth" class="form-label">متوسط النفقات
                                الشهرية</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">
                                    <i class="fa-solid fa-calendar-day"></i>
                                </span>
                                <input type="date" class="form-control" id="validationCustomUserDateOfBirth"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a DateOfBirth.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="birth_address" class="form-label">المشكلات
                                الاقتصاديه للاسرة</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="birth_address" name="birth_address">
                                    <i class="fa-solid fa-address-card"></i>
                                </span>
                                <input type="text" class="form-control" id="birth_address"
                                    aria-describedby="inputGroupPrepend" required>
                            </div>

                        </div>
                        <div class="col-md-3">
                            <label for="height" class="form-label">مدي تقبل للاسرة
                                للطفل</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">@</span>
                                <input type="number" class="form-control" id="height" name="height"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a Height.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-2">
                            <label for="weight" class="form-label">نوع السكن</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">@</span>
                                <input type="number" class="form-control" id="weight" name="weight"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a Weight.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-3">
                            <label for="address" class="form-label">عدد الافراد
                                بالحجرة</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="address" name="address">
                                    <i class="fa-solid fa-address-card"></i>
                                </span>
                                <input type="text" class="form-control" id="address" aria-describedby="inputGroupPrepend"
                                    required>
                            </div>

                        </div>
                        <div class="col-md-4 offset-5">
                            <label for="home_phone" class="form-label">
                                هل للطفل حجرة
                                مستقلة</label>
                            <div class="form-check">
                                <input class="form-check-input" type="radio" name="exampleRadios" id="exampleRadios1"
                                    value="option" checked>
                                <label class="form-check-label" for="exampleRadios1">
                                    نعم
                                </label>
                            </div>
                            <div class="form-check">
                                <input class="form-check-input" type="radio" name="exampleRadios" id="exampleRadios2"
                                    value="option">
                                <label class="form-check-label" for="exampleRadios2">
                                    لا
                                </label>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="student_name" class="form-label">عدد مرات زواج
                                الاب</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend"> <i
                                        class="fa-regular fa-user"></i></span>
                                <input type="number" class="form-control" id="student_name" name="student_name"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a student_name.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4 ">
                            <label for="dob" class="form-label">عدد مرات زواج الام</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">@</span>
                                <input type="number" class="form-control" id="dob" name="dob"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a Age.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="validationCustomUserDateOfBirth" class="form-label">حالات الطلاق
                                بالاسرة</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">
                                    <i class="fa-solid fa-calendar-day"></i>
                                </span>
                                <input type="number" class="form-control" id="validationCustomUserDateOfBirth"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a DateOfBirth.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="birth_address" class="form-label">معلومات اخري</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="birth_address" name="birth_address">
                                    <i class="fa-solid fa-address-card"></i>
                                </span>
                                <input type="text" class="form-control" id="birth_address"
                                    aria-describedby="inputGroupPrepend" required>
                            </div>

                        </div>
                        <div class="col-md-3">
                            <label for="height" class="form-label">مصادر التوتر
                                بالاسرة</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">@</span>
                                <input type="number" class="form-control" id="height" name="height"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a Height.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-3">
                            <label for="weight" class="form-label">اهم الوسائل
                                الترويحية للاسرة</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend">@</span>
                                <input type="number" class="form-control" id="weight" name="weight"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a Weight.
                                </div>
                            </div>
                        </div>
                        <div class="col-md-4">
                            <label for="address" class="form-label">مدي مشاركة
                                الطفل فيها</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="address" name="address">
                                    <i class="fa-solid fa-address-card"></i>
                                </span>
                                <input type="text" class="form-control" id="address" aria-describedby="inputGroupPrepend"
                                    required>
                            </div>

                        </div>
                        <div class="col-md-4">
                            <label for="home_phone" class="form-label">صف أي ظروف
                                نفسية واجتماعية
                                تؤثرعلي الطفل</label>
                            <div class="input-group has-validation">
                                <span class="input-group-text" id="inputGroupPrepend"><i
                                        class="fa-solid fa-phone"></i></span>
                                <input type="number" class="form-control" id="home_phone" name="home_phone"
                                    aria-describedby="inputGroupPrepend" required>
                                <div class="invalid-feedback">
                                    Please choose a PhoneNumber.
                                </div>
                            </div>
                        </div>

                        <div class="col-12">
                            <button class="btn btn-outline-primary" type="submit">save</button>
                        </div>
                    </form>
                </div>

            </div>
        </div>
    </div>
@endsection