{% extends "layouts/base.html" %} {% load i18n %} {% load static %} {% block title %}{% trans "New Observation" %} - PX360{% endblock %} {% block content %}
{% trans "Back to Observations" %}

{% trans "Report an Observation" %}

{% trans "Help us improve by reporting issues you notice" %}

{% if messages %} {% for message in messages %}
{{ message }}
{% endfor %} {% endif %}
{% csrf_token %} {% if communication_request %} {% endif %}
{{ form.hospital }} {% if form.hospital.errors %}

{{ form.hospital.errors.0 }}

{% endif %}
{{ form.location_type }} {% if form.location_type.errors %}

{{ form.location_type.errors.0 }}

{% endif %}
{{ form.area }} {% if form.area.errors %}

{{ form.area.errors.0 }}

{% endif %}
{{ form.assigned_department }}
{{ form.section }}
{{ form.title }}
{{ form.description }}

{% trans "Please describe what you observed in detail." %}

{% if form.description.errors %}

{{ form.description.errors.0 }}

{% endif %}
{{ form.location_text }}
{{ form.incident_datetime }}
{{ form.px_source }}

{% trans "Fill in if this observation involves a specific patient." %}

{{ form.patient_name }}
{{ form.patient_national_id }}
{{ form.patient_phone }}
{{ form.patient_email }}
{% trans "Cancel" %}
{% endblock %} {% block extra_js %} {% endblock %}