{{--
    The manual route in, for a code read off paper.

    Not everybody scans. A pharmacist with a fax, or a patient whose phone
    cannot read the square, still needs a way to ask the question — and a
    verification system that only works with a working camera is one that fails
    exactly when somebody is suspicious enough to check.
--}}
<form method="POST" action="{{ route('documents.verify.submit') }}">
    @csrf

    <div class="mb-3">
        <label for="number" class="px-field-label">{{ __('documents.verify.number_label') }}</label>

        <input type="text" id="number" name="number" required maxlength="40"
               value="{{ old('number', $number ?? '') }}"
               autocomplete="off" spellcheck="false"
               class="form-control px-input @error('number') is-invalid @enderror"
               placeholder="LAB-MAIN-2026-000012">

        @error('number')<div class="invalid-feedback d-block">{{ $message }}</div>@enderror
    </div>

    <div class="mb-3">
        <label for="code" class="px-field-label">{{ __('documents.verify.code_label') }}</label>

        <input type="text" id="code" name="code" required maxlength="20"
               autocomplete="off" spellcheck="false"
               class="form-control px-input @error('code') is-invalid @enderror"
               placeholder="7F4K-92M8-XP31">

        @error('code')<div class="invalid-feedback d-block">{{ $message }}</div>@enderror
    </div>

    <button type="submit" class="btn px-btn-primary">{{ __('documents.verify.submit') }}</button>
</form>