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

{% block title %}Add Injury Details{% 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">Add Injury Details</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>
					<input type="submit" class="btn btn-brand btn-bold">
				</div>
			</div>
		</div>

		<div class="kt-portlet__body">
			<div class="kt-section">
				<div class="kt-section__body p-4">
					{% include 'parts/flash.html.twig' %}

					<h3 class="kt-section__title">Patient Information</h3>

					<div class="form-group row">
						<label class="col-3 col-form-label font-weight-bold">Patient</label>

						<div class="col-6">
							<p class="form-control-plaintext">{{ case.patient }}</p>
						</div>
					</div>

					{% if case.injuredInfo %}
					<div class="form-group row">
						<label class="col-3 col-form-label font-weight-bold">Brought By</label>

						<div class="col-6">
							<p class="form-control-plaintext">{{ case.injuredInfo.broughtBy }}</p>
						</div>
					</div>

					<div class="form-group row">
						<label class="col-3 col-form-label font-weight-bold">Office Letter No. Ref.</label>

						<div class="col-6">
							<p class="form-control-plaintext">{{ case.injuredInfo.officeLetterRef }}</p>
						</div>
					</div>

					<div class="form-group row">
						<label class="col-3 col-form-label font-weight-bold">Date Brought</label>

						<div class="col-6">
							<p class="form-control-plaintext">{{ case.injuredInfo.dateBrought|date('d/m/Y') }}</p>
						</div>
					</div>

					<div class="form-group row">
						<label class="col-3 col-form-label font-weight-bold">Date &amp; Time of Examination</label>

						<div class="col-6">
							<p class="form-control-plaintext">{{ case.injuredInfo.examinedAt|date('d/m/Y g:i a') }}</p>
						</div>
					</div>

					<div class="form-group row">
						<label class="col-3 col-form-label font-weight-bold">Identification Mark 1</label>

						<div class="col-6">
							<p class="form-control-plaintext">{{ case.injuredInfo.idMark1 }}</p>
						</div>
					</div>

					<div class="form-group row">
						<label class="col-3 col-form-label font-weight-bold">Identification Mark 2</label>

						<div class="col-6">
							<p class="form-control-plaintext">{{ case.injuredInfo.idMark2 }}</p>
						</div>
					</div>
					{% else %}
					<div class="form-group row">
						{{ form_label(form.injuredInfo.broughtBy, '', {'label_attr': { 'class': 'col-3 col-form-label
						font-weight-bold' }}) }}

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

					<div class="form-group row">
						{{ form_label(form.injuredInfo.officeLetterRef, '', {'label_attr': { 'class': 'col-3
						col-form-label font-weight-bold' }}) }}

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

					<div class="form-group row">
						{{ form_label(form.injuredInfo.dateBrought, '', {'label_attr': { 'class': 'col-3 col-form-label
						font-weight-bold' }}) }}

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

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

							{{ form_errors(form.injuredInfo.dateBrought) }}
						</div>
					</div>

					<div class="form-group row">
						{{ form_label(form.injuredInfo.examinedAt, '', {'label_attr': { 'class': 'col-3 col-form-label
						font-weight-bold' }}) }}

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

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

							{{ form_errors(form.injuredInfo.examinedAt) }}
						</div>
					</div>

					<div class="form-group row">
						{{ form_label(form.injuredInfo.idMark1, '', {'label_attr': { 'class': 'col-3 col-form-label
						font-weight-bold' }}) }}

						<div class="col-6">
							{{ form_widget(form.injuredInfo.idMark1, {'attr': { 'class': 'form-control' }}) }}
							{{ form_errors(form.injuredInfo.idMark1) }}
						</div>
					</div>

					<div class="form-group row">
						{{ form_label(form.injuredInfo.idMark2, '', {'label_attr': { 'class': 'col-3 col-form-label
						font-weight-bold' }}) }}

						<div class="col-6">
							{{ form_widget(form.injuredInfo.idMark2, {'attr': { 'class': 'form-control' }}) }}
							{{ form_errors(form.injuredInfo.idMark2) }}
						</div>
					</div>
					{% endif %}
				</div>
			</div>

			<div class="kt-section">
				<div class="kt-section__body p-4">
					<h3 class="kt-section__title">Injury Information</h3>

					<div class="form-group row">
						{{ form_label(form.injuryName, '', {'label_attr': { 'class': 'col-3 col-form-label
						font-weight-bold' }}) }}

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

					<div class="form-group row">
						{{ form_label(form.inflictedSidePart, '', {'label_attr': { 'class': 'col-3 col-form-label
						font-weight-bold' }}) }}

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

					<div class="form-group row">
						{{ form_label(form.injurySize, '', {'label_attr': { 'class': 'col-3 col-form-label
						font-weight-bold' }}) }}

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

					<div class="form-group row">
						{{ form_label(form.shapeMargin, '', {'label_attr': { 'class': 'col-3 col-form-label
						font-weight-bold' }}) }}

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

					<div class="form-group row">
						{{ form_label(form.injuryAge, '', {'label_attr': { 'class': 'col-3 col-form-label
						font-weight-bold' }}) }}

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

					<div class="form-group row">
						{{ form_label(form.weaponType, '', {'label_attr': { 'class': 'col-3 col-form-label
						font-weight-bold' }}) }}

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

					<div class="form-group row">
						{{ form_label(form.injuryNature, '', {'label_attr': { 'class': 'col-3 col-form-label
						font-weight-bold' }}) }}

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

					<div class="kt-form__actions text-right">
						<a href="{{ path('medico_add_injury_detail', {'case_id': case.id | nzo_encrypt}) }}" role="button"
							class="btn btn-brand">Add More Injuries</a>
					</div>
				</div>
			</div>
		</div>
	</div>
</div>
{{ form_end(form) }}
{% endblock %}

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

<script>
	$('#injury_detail_injuredInfo_dateBrought').datepicker({
		todayHighlight: true,
		orientation: 'bottom left',
		templates: {
			leftArrow: '<i class="la la-angle-left"></i>',
			rightArrow: '<i class="la la-angle-right"></i>'
		},
		autoclose: true,
		format: 'yyyy-mm-dd'
	});

	$('#injury_detail_injuredInfo_examinedAt').datetimepicker({
		format: "yyyy-mm-dd HH:ii:ss",
		showMeridian: true,
		todayHighlight: true,
		autoclose: true,
		pickerPosition: 'bottom-left'
	});
</script>
{% endblock %}