{% extends base_layout %} {% load i18n %} {% load static %} {% block title %}{{ _("New Complaint")}} - PX360{% endblock %} {% block extra_css %} {% endblock %} {% block content %}
{% if source_user %} {{ _("Back to My Complaints")}} {% else %} {{ _("Back to Complaints")}} {% endif %}

{{ _("Create New Complaint")}}

{{ _("File a new patient complaint with SLA tracking")}}

{% csrf_token %}
{{ _("Feedback Type")}}
{{ _("Complaint")}}
{{ _("Report an issue or concern")}}
{{ _("Appreciation")}}
{{ _("Share positive feedback")}}
{{ _("Patient Information")}}
{{ form.relation_to_patient }} {% if form.relation_to_patient.errors %}
{% for error in form.relation_to_patient.errors %} {{ error }} {% endfor %}
{% endif %}
{{ form.patient_name }} {% if form.patient_name.errors %}
{% for error in form.patient_name.errors %} {{ error }} {% endfor %}
{% endif %}
{{ form.national_id }} {% if form.national_id.errors %}
{% for error in form.national_id.errors %} {{ error }} {% endfor %}
{% endif %}
{{ form.incident_date }} {% if form.incident_date.errors %}
{% for error in form.incident_date.errors %} {{ error }} {% endfor %}
{% endif %}
{{ form.encounter_id }}
{{ _("Organization & Location")}}
{{ form.complaint_source_type }} {% if form.complaint_source_type.errors %}
{% for error in form.complaint_source_type.errors %} {{ error }} {% endfor %}
{% endif %}
{{ form.hospital }} {% if form.hospital.errors %}
{% for error in form.hospital.errors %} {{ error }} {% endfor %}
{% endif %}
{{ form.department }} {% if form.department.errors %}
{% for error in form.department.errors %} {{ error }} {% endfor %}
{% endif %}
{{ form.location }} {% if form.location.errors %}
{% for error in form.location.errors %} {{ error }} {% endfor %}
{% endif %}
{{ form.main_section }} {% if form.main_section.errors %}
{% for error in form.main_section.errors %} {{ error }} {% endfor %}
{% endif %}
{{ form.subsection }} {% if form.subsection.errors %}
{% for error in form.subsection.errors %} {{ error }} {% endfor %}
{% endif %}
{{ form.staff }} {% if form.staff.errors %}
{% for error in form.staff.errors %} {{ error }} {% endfor %}
{% endif %}
{{ form.staff_name }} {% if form.staff_name.errors %}
{% for error in form.staff_name.errors %} {{ error }} {% endfor %}
{% endif %}
{{ _("Complaint Details")}}
{{ form.description }} {% if form.description.errors %}
{% for error in form.description.errors %} {{ error }} {% endfor %}
{% endif %}
{{ form.expected_result }} {% if form.expected_result.errors %}
{% for error in form.expected_result.errors %} {{ error }} {% endfor %}
{% endif %}
{{ _("AI Classification")}}

{{ _("AI will automatically analyze and classify your feedback:")}}

  • {{ _("Title") }}: {{ _("AI-generated title")}}
  • {{ _("Category") }}: {{ _("AI-determined category")}}
  • {{ _("Severity") }}: {{ _("AI-calculated severity")}}
  • {{ _("Priority") }}: {{ _("AI-calculated priority")}}
{{ _("SLA Information")}}

{{ _("SLA deadline will be automatically calculated based on severity")}}:

  • {{ _("Critical") }}: {{ _("4 hours")}}
  • {{ _("High") }}: {{ _("24 hours")}}
  • {{ _("Medium") }}: {{ _("72 hours")}}
  • {{ _("Low") }}: {{ _("168 hours (7 days)")}}
{% if source_user %} {{ _("Cancel") }} {% else %} {{ _("Cancel") }} {% endif %}
{% endblock %} {% block extra_js %} {% endblock %}