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

{% block title %}Edit Hospital 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">Edit Hospital Details</h3>
					</div>

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

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

					<div class="form-group row">
						{{ form_label(form.regNum, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

						<div class="col-5">
							{{ form_widget(form.regNum, {'attr': { 'class': 'form-control','min':'1', 'maxlength':'10','oninput':"this.value = this.value.replace(/[^0-9]/g, '')"}}) }}
							{{ form_errors(form.regNum) }}
						</div>
					</div>

					<div class="form-group row">
						{{ form_label(form.regDate, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

						<div class="col-5">
							{{ form_widget(form.regDate, {'attr': { 'class': 'form-control' }}) }}
							{{ form_errors(form.regDate) }}
						</div>
					</div>

					<div class="form-group row">
						{{ form_label(form.abhaNum, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

						<div class="col-5">
							{{ form_widget(form.abhaNum, {'attr': { 'class': 'form-control','min':'1', 'maxlength':'20','oninput':"this.value = this.value.replace(/[^0-9]/g, '')" }}) }}
							{{ form_errors(form.abhaNum) }}
						</div>
					</div>

					<div class="form-group row">
						{{ form_label(form.abhaDate, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

						<div class="col-5">
							{{ form_widget(form.abhaDate, {'attr': { 'class': 'form-control' }}) }}
							{{ form_errors(form.abhaDate) }}
						</div>
					</div>

					<div class="form-group row">
						{{ form_label(form.name, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

						<div class="col-5">
							{{ form_widget(form.name, {'attr': { 'class': 'form-control','min':'1','maxlength':'50','oninput':"this.value = this.value.replace(/[^0-9a-zA-Z]/g, '')"}}) }}
							{{ form_errors(form.name) }}
						</div>
					</div>

					<div class="form-group row">
						{{ form_label(form.phone, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

						<div class="col-5">
							{{ form_widget(form.phone, {'attr': { 'class': 'form-control','min':'1', 'onkeydown':"return /[0-9]/i.test(event.key)"}}) }}
							{{ form_errors(form.phone) }}
						</div>
					</div>

					<div class="form-group row">
						{{ form_label(form.email, '', {'label_attr': { 'class': 'col-2 col-form-label font-weight-bold' }}) }}

						<div class="col-5">
							{{ form_widget(form.email, {'attr': { 'class': 'form-control' }}) }}
							{{ form_errors(form.email) }}
						</div>
					</div>
				</div>
			</div>
		</div>
	{{ form_end(form) }}}
{% endblock %}

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

	<script>
		$('#hospital_regDate, #hospital_abhaDate').datepicker({
			rtl: KTUtil.isRTL(),
			todayHighlight: true,
			autoclose: true,
			orientation: "bottom left",
			templates: {
				leftArrow: '<i class="la la-angle-left"></i>',
				rightArrow: '<i class="la la-angle-right"></i>'
			},
			endDate: '+0d',
			format: 'yyyy-mm-dd'
		});
	</script>
{% endblock %}