{% extends 'base.html.twig' %}

{% block title %}Create Post-mortem Report{% endblock %}

{% block content %}
<div class="kt-subheader kt-grid__item"></div>

{{ form_start(form, { 'attr': { 'class': 'kt-form' }}) }}
<div class="kt-container kt-grid__item kt-grid__item--fluid">
	<div class="kt-portlet kt-portlet--mobile" id="kt_page_portlet">
		<div class="kt-portlet__head kt-portlet__head--lg">
			<div class="kt-portlet__head-label">
				<h3 class="kt-portlet__head-title">Create Post-mortem Report</h3>
			</div>

			<div class="kt-portlet__head-toolbar">
				<div class="kt-portlet__head-wrapper">
					<a href="{{ app.request.uri }}" class="btn btn-secondary btn-bold mr-2">Reset</a>
					<a href="{{ path('case_index') }}" class="btn btn-clean btn-icon-sm mr-2"><i
							class="la la-long-arrow-left"></i>Back</a>
					<button class="btn btn-primary btn-bold">Submit</button>
				</div>
			</div>
		</div>

		<div class="kt-portlet__body">
			<div class="accordion accordion-toggle-arrow" id="pm-details">
				<div class="card">
					<div class="card-header" id="patient-info-header">
						<div class="card-title collapsed" data-toggle="collapse" data-target="#patient-info"
							aria-expanded="true" aria-controls="patient-info">
							Patient Information
						</div>
					</div>

					<div id="patient-info" class="collapse" aria-labelledby="patient-info-label"
						data-parent="#pm-details">
						<div class="card-body">
							{{ render(controller('App\\Controller\\PatientController::personalInfo', {'id':
							post_mortem_report.case.patient.id})) }}
						</div>
					</div>
				</div>

				<div class="card">
					<div class="card-header" id="general-particulars-header">
						<div class="card-title" data-toggle="collapse" data-target="#general-particulars"
							aria-expanded="true" aria-controls="general-particulars">
							General Particulars
						</div>
					</div>

					<div id="general-particulars" class="show" aria-labelledby="general-particulars-label"
						data-parent="#pm-details">
						<div class="card-body">
							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">By whom was the corpse
									sent?</label>

								<div class="col-6">
									{{ form_widget(form.corpseSender, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.corpseSender) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Name of the place from
									which sent</label>

								<div class="col-6">
									{{ form_widget(form.placeCorpseSent, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.placeCorpseSent) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Distance of the place from
									which sent</label>

								<div class="col-6">
									{{ form_widget(form.placeCorpseSentDistance, {'attr': { 'class': 'form-control' }})
									}}
									{{ form_errors(form.placeCorpseSentDistance) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">By whom was the crops
									brought?</label>

								<div class="col-6">
									{{ form_widget(form.corpseBringer, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.corpseBringer) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold">By whom identified?</label>

								<div class="col-6">
									{{ form_widget(form.corpseIdentifier, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.corpseIdentifier) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">The date, hour and minute
									of beginning post-mortem examination</label>

								<div class="col-6">
									<div class="input-group date">
										{{ form_widget(form.examBegunAt, {'attr': { 'class':
										'form-control','autocomplete':'off' }}) }}

										<div class="input-group-append">
											<span class="input-group-text"><i
													class="la la-calendar glyphicon-th"></i></span>
										</div>
									</div>

									{{ form_errors(form.examBegunAt) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">The date, hour and minute
									of ending post-mortem examination</label>

								<div class="col-6">
									<div class="input-group date">
										{{ form_widget(form.examEndedAt, {'attr': { 'class':
										'form-control','autocomplete':'off' }}) }}

										<div class="input-group-append">
											<span class="input-group-text"><i
													class="la la-calendar glyphicon-th"></i></span>
										</div>
									</div>

									{{ form_errors(form.examEndedAt) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold">Substance of accompany Report from
									Police Officer or Magistrate, together with the date of death if known. Supposed
									cause of death or reason, for examination</label>

								<div class="col-6">
									{{ form_widget(form.accompanyReportSubstance, {'attr': { 'class': 'form-control' }})
									}}
									{{ form_errors(form.accompanyReportSubstance) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold">If not examined at Dispensary or
									Hospital &mdash; Name of the place where examined</label>

								<div class="col-6">
									{{ form_widget(form.placeExamined, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.placeExamined) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold">Distance from Dispensary or
									Hospital</label>

								<div class="col-6">
									{{ form_widget(form.distanceFromPlace, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.distanceFromPlace) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold">Reason why the body was not sent to
									Dispensary or Hospital</label>

								<div class="col-6">
									{{ form_widget(form.whyNotSentToHospital, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.whyNotSentToHospital) }}
								</div>
							</div>
						</div>
					</div>
				</div>

				<div class="card">
					<div class="card-header" id="external-examination-header">
						<div class="card-title collapsed" data-toggle="collapse" data-target="#external-examination"
							aria-expanded="true" aria-controls="external-examination">
							External Examination
						</div>
					</div>

					<div id="external-examination" class="collapse" aria-labelledby="external-examination-label"
						data-parent="#pm-details">
						<div class="card-body">
							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Sex, apparent age, race or
									caste</label>

								<div class="col-6">
									{{ form_widget(form.sexApparentAgeRaceCaste, {'attr': { 'class': 'form-control' }})
									}}
									{{ form_errors(form.sexApparentAgeRaceCaste) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Description of clothes and
									of ornaments on the body</label>

								<div class="col-6">
									{{ form_widget(form.descClothOrnam, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.descClothOrnam) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required"><em>Condition of the
										clothes &mdash; </em>Whether wet with water, stained with blood or soiled with
									vomit or foecal matter</label>

								<div class="col-6">
									{{ form_widget(form.condCloth, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.condCloth) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Special marks on the skin
									such as scars, tattooing, etc., any malformations peculiarities, or other marks of
									identification. State of the teeth</label>

								<div class="col-6">
									{{ form_widget(form.specialMarksOnSkin, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.specialMarksOnSkin) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold">In newly born infants, the length
									and (if possible), the weight of the body to be recorded together with the state of
									the hair, nails and umbilical cord, its length, whether placenta is attached or not,
									if present, its size and condition</label>

								<div class="col-6">
									{{ form_widget(form.newlyBornInfantDetails, {'attr': { 'class': 'form-control' }})
									}}
									{{ form_errors(form.newlyBornInfantDetails) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required"><em>Condition of the body
										&mdash; </em>Whetner well-nourished, thin or emaciated , warm or cold</label>

								<div class="col-6">
									{{ form_widget(form.bodyCondition, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.bodyCondition) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required"><em>Regar Mortis &mdash;
									</em>Well-marked, slight or absent; wheter present in the whole body or part
									only</label>

								<div class="col-6">
									{{ form_widget(form.regarMortis, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.regarMortis) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Extent and signs of
									decomposition, present post-mortem lividity of buttocks, loins, back and thighs or
									any other part. Whether bullae present and the nature of their contained fluid.
									Conditon of the cuticle</label>

								<div class="col-6">
									{{ form_widget(form.decompSignsExtents, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.decompSignsExtents) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required"><em>Features &mdash;
									</em>Whether natural or swollen, state of eyes, position of tongue: nature of fluid
									(if any) oozing from mouth, nostrils or ears</label>

								<div class="col-6">
									{{ form_widget(form.features, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.features) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required"><em>Condition of skin
										&mdash; </em>Marks of blood etc. In suspected drowning the presence or absence
									of cutes anserina to be noted</label>

								<div class="col-6">
									{{ form_widget(form.skinCond, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.skinCond) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Injuries to external
									genitals. Indication of purging</label>

								<div class="col-6">
									{{ form_widget(form.externalGenitalsInjuries, {'attr': { 'class': 'form-control' }})
									}}
									{{ form_errors(form.externalGenitalsInjuries) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required"><em>Position of limbs
										&mdash; </em>Especially of arms and of fingers in suspected drowning the
									presence or absence of sand or earth within the nails or on the skin of hands and
									feet</label>

								<div class="col-6">
									{{ form_widget(form.limbPosition, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.limbPosition) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required"><em>Surface wounds and
										injuries &mash; </em>Their nature, position, dimensions (measured) and
									directions to be accurately stated-their probable age and causes to be noted</label>

								<div class="col-6">
									{{ form_widget(form.surfaceWoundsInjuries, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.surfaceWoundsInjuries) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold">If bruises be present what is the
									condition of the subcutaneous tissues?</label>

								<div class="col-6">
									{{ form_widget(form.condSubcutaneousTissues, {'attr': { 'class': 'form-control' }})
									}}
									{{ form_errors(form.condSubcutaneousTissues) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold">Other injuries discovered by
									external examination or palpation as fracture etc.</label>

								<div class="col-6">
									{{ form_widget(form.otherInjuries, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.otherInjuries) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Can you say definitely
									that the injuries shown against serial Nos. 17 and 18 are ante mortem
									injuries?</label>

								<div class="col-6">
									<div class="kt-radio-inline">
										{% for child in form.sureAnteMortem %}
										<label class="kt-radio kt-radio--bold kt-radio--brand">
											{{ form_widget(child, {'attr': { 'class': 'kt-radio' }}) }}
											{{ form_label(child, null, { 'label_attr': { 'class': 'non-req' }}) }}
											{{ form_errors(child) }}
											<span></span>
										</label>
										{% endfor %}
									</div>
								</div>
							</div>
						</div>
					</div>
				</div>

				<div class="card">
					<div class="card-header" id="internal-examination-header">
						<div class="card-title collapsed" data-toggle="collapse" data-target="#internal-examination"
							aria-expanded="true" aria-controls="internal-examination">
							Internal Examination
						</div>
					</div>

					<div id="internal-examination" class="collapse" aria-labelledby="internal-examination-label"
						data-parent="#pm-details">
						<div class="card-body">
							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required"><em>Head &mdash;
									</em>Injuries under the scalp; their nature</label>

								<div class="col-6">
									{{ form_widget(form.headInjuriesUnderScalp, {'attr': { 'class': 'form-control' }})
									}}
									{{ form_errors(form.headInjuriesUnderScalp) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required"><em>Skull &mdash;
									</em>Vault and base-describe fratures, their sites, dimensions, directions
									etc.</label>

								<div class="col-6">
									{{ form_widget(form.skullVaultBase, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.skullVaultBase) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required"><em>Brain &mdash; </em>The
									appearance of its coverings, size, weight and general condition of the organ itself
									and any abnormality found in its examination to be carefully noted (weight M. 3
									grams F 2.75 grams)</label>

								<div class="col-6">
									{{ form_widget(form.brainDetails, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.brainDetails) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required"><em>Thorax &mdash;
									</em>Walls, ribs, cartilages</label>

								<div class="col-6">
									{{ form_widget(form.thoraxWallsRibsCartilages, {'attr': { 'class': 'form-control'
									}}) }}
									{{ form_errors(form.thoraxWallsRibsCartilages) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Pleura</label>

								<div class="col-6">
									{{ form_widget(form.pleura, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.pleura) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Larynx, Trachea and
									Bronchi</label>

								<div class="col-6">
									{{ form_widget(form.larynxTracheaBronchi, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.larynxTracheaBronchi) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Right Lung</label>

								<div class="col-6">
									{{ form_widget(form.rightLung, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.rightLung) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Left Lung</label>

								<div class="col-6">
									{{ form_widget(form.leftLung, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.leftLung) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Pericardium</label>

								<div class="col-6">
									{{ form_widget(form.pericardium, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.pericardium) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Heart with weight</label>

								<div class="col-6">
									{{ form_widget(form.heart, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.heart) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Large vessels</label>

								<div class="col-6">
									{{ form_widget(form.largeVessels, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.largeVessels) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold">Additional remarks</label>

								<div class="col-6">
									{{ form_widget(form.heartAdditionalRemarks, {'attr': { 'class': 'form-control' }})
									}}
									{{ form_errors(form.heartAdditionalRemarks) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required"><em>Abdomen &mdash;
									</em>Walls</label>

								<div class="col-6">
									{{ form_widget(form.abdomenWalls, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.abdomenWalls) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Peritoneum</label>

								<div class="col-6">
									{{ form_widget(form.peritoneum, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.peritoneum) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Cavity</label>

								<div class="col-6">
									{{ form_widget(form.cavity, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.cavity) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Bucal Cavity, teeth,
									tongue and Pharynx</label>

								<div class="col-6">
									{{ form_widget(form.bucalCavityTeethTonguePharynx, {'attr': { 'class':
									'form-control' }}) }}
									{{ form_errors(form.bucalCavityTeethTonguePharynx) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Desophagus</label>

								<div class="col-6">
									{{ form_widget(form.desophagus, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.desophagus) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Stomach and its
									contents</label>

								<div class="col-6">
									{{ form_widget(form.stomach, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.stomach) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Small intestine and its
									contents</label>

								<div class="col-6">
									{{ form_widget(form.smallIntestine, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.smallIntestine) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Large intestine and its
									contents</label>

								<div class="col-6">
									{{ form_widget(form.largeIntestine, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.largeIntestine) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Liver (with weight) and
									gall bladder</label>

								<div class="col-6">
									{{ form_widget(form.liverGallBladder, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.liverGallBladder) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Pancreas and
									Suprarenals</label>

								<div class="col-6">
									{{ form_widget(form.pancreasSuprarenals, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.pancreasSuprarenals) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Spleen with weight</label>

								<div class="col-6">
									{{ form_widget(form.spleen, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.spleen) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Kidneys with
									weight</label>

								<div class="col-6">
									{{ form_widget(form.kidneys, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.kidneys) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Bladder</label>

								<div class="col-6">
									{{ form_widget(form.bladder, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.bladder) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Organs of
									generations</label>

								<div class="col-6">
									{{ form_widget(form.generationsOrgans, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.generationsOrgans) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold">Additional remarks with where
									possible, medical officer's deduction from the state of the contents of the stomach
									as to time of death and last meal</label>

								<div class="col-6">
									{{ form_widget(form.stomachAdditionalRemarks, {'attr': { 'class': 'form-control' }})
									}}
									{{ form_errors(form.stomachAdditionalRemarks) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold">State which viscera (if any) have
									been retained for chemical examination and also quote the numbers on the bottles
									containing the same</label>

								<div class="col-6">
									{{ form_widget(form.retainedVisceraDetails, {'attr': { 'class': 'form-control' }})
									}}
									{{ form_errors(form.retainedVisceraDetails) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold"><em>Spine and Spinal
										Cord</em></label>

								<div class="col-6">
									{{ form_widget(form.spineSpinalCord, {'attr': { 'class': 'form-control' }}) }}
									<small class="form-text text-muted">The Spine Cord need not be examined unless there
										are any indications of disease, Strychnia poisoning or injury.</small>
									{{ form_errors(form.spineSpinalCord) }}
								</div>
							</div>

							<div class="form-group row">
								<label class="col-6 col-form-label font-weight-bold required">Opinion as to the cause,
									probable cause of death</label>

								<div class="col-6">
									{{ form_widget(form.deathCauseOpinion, {'attr': { 'class': 'form-control' }}) }}
									{{ form_errors(form.deathCauseOpinion) }}
								</div>
							</div>
						</div>
					</div>
				</div>
			</div>
		</div>
	</div>
</div>
{{ form_end(form) }}
{% endblock %}

{% block scripts %}
{{ parent() }}

<script>
	$('#post_mortem_report_examBegunAt, #post_mortem_report_examEndedAt').datetimepicker({
		format: "yyyy-mm-dd hh:ii:ss",
		showMeridian: true,
		todayHighlight: true,
		autoclose: true,
		startDate: '-30d',
		endDate: '+0d',
		pickerPosition: 'bottom-left'
	});
</script>
{% endblock %}