{% extends "layouts/base.html" %}
{% load i18n %}

{% block title %}{% if adverse_action %}{% trans "Edit Adverse Action" %}{% else %}{% trans "Report Adverse Action" %}{% endif %} - PX360{% endblock %}

{% block content %}
<div class="p-6 max-w-4xl mx-auto">
    <!-- Header -->
    <div class="mb-6">
        <div class="flex items-center gap-4">
            <a href="{% url 'complaints:complaint_detail' complaint.id %}" class="text-[#64748b] hover:text-[#005696]">
                <i data-lucide="arrow-left" class="w-6 h-6"></i>
            </a>
            <div>
                <h1 class="text-2xl font-bold text-[#005696]">
                    {% if adverse_action %}{% trans "Edit Adverse Action" %}{% else %}{% trans "Report Adverse Action" %}{% endif %}
                </h1>
                <p class="text-[#64748b] mt-1">
                    {% trans "Complaint" %}: {{ complaint.reference_number }}
                </p>
            </div>
        </div>
    </div>

    <!-- Form -->
    <div class="bg-white rounded-xl shadow-sm border border-gray-100 overflow-hidden">
        <form method="post" class="p-6">
            {% csrf_token %}
            
            <!-- Action Type -->
            <div class="mb-6">
                <label class="block text-sm font-bold text-gray-700 mb-2">
                    {% trans "Action Type" %}
                    <span class="text-red-500">*</span>
                </label>
                <select name="action_type" required
                        class="w-full px-4 py-3 border-2 border-gray-200 rounded-xl text-gray-800 focus:ring-2 focus:ring-[#005696] focus:border-transparent transition">
                    {% for value, label in action_type_choices %}
                    <option value="{{ value }}" {% if adverse_action and adverse_action.action_type == value %}selected{% endif %}>
                        {{ label }}
                    </option>
                    {% endfor %}
                </select>
                <p class="mt-1 text-sm text-[#64748b]">
                    {% trans "Select the type of adverse action that occurred." %}
                </p>
            </div>

            <!-- Severity -->
            <div class="mb-6">
                <label class="block text-sm font-bold text-gray-700 mb-2">
                    {% trans "Severity Level" %}
                    <span class="text-red-500">*</span>
                </label>
                <div class="grid grid-cols-2 md:grid-cols-4 gap-3">
                    {% for value, label in severity_choices %}
                    <label class="relative cursor-pointer">
                        <input type="radio" name="severity" value="{{ value }}" 
                               {% if adverse_action and adverse_action.severity == value %}checked{% elif not adverse_action and value == 'medium' %}checked{% endif %}
                               class="peer sr-only" required>
                        <div class="border-2 border-gray-200 rounded-xl p-4 text-center hover:border-[#005696] transition peer-checked:border-[#005696] peer-checked:bg-[#eef6fb]">
                            {% if value == 'low' %}
                                <i data-lucide="arrow-down" class="w-6 h-6 mx-auto mb-2 text-green-500"></i>
                            {% elif value == 'medium' %}
                                <i data-lucide="arrow-right" class="w-6 h-6 mx-auto mb-2 text-yellow-500"></i>
                            {% elif value == 'high' %}
                                <i data-lucide="arrow-up" class="w-6 h-6 mx-auto mb-2 text-orange-500"></i>
                            {% else %}
                                <i data-lucide="alert-triangle" class="w-6 h-6 mx-auto mb-2 text-red-500"></i>
                            {% endif %}
                            <span class="text-sm font-medium">{{ label }}</span>
                        </div>
                    </label>
                    {% endfor %}
                </div>
            </div>

            <!-- Incident Date -->
            <div class="mb-6">
                <label class="block text-sm font-bold text-gray-700 mb-2">
                    {% trans "Incident Date & Time" %}
                    <span class="text-red-500">*</span>
                </label>
                <input type="datetime-local" name="incident_date" required
                       value="{% if adverse_action %}{{ adverse_action.incident_date|date:'Y-m-d\\TH:i' }}{% else %}{% now 'Y-m-d\\TH:i' %}{% endif %}"
                       class="w-full px-4 py-3 border-2 border-gray-200 rounded-xl text-gray-800 focus:ring-2 focus:ring-[#005696] focus:border-transparent transition">
            </div>

            <!-- Location -->
            <div class="mb-6">
                <label class="block text-sm font-bold text-gray-700 mb-2">
                    {% trans "Location" %}
                </label>
                <input type="text" name="location"
                       value="{{ adverse_action.location|default:'' }}"
                       class="w-full px-4 py-3 border-2 border-gray-200 rounded-xl text-gray-800 focus:ring-2 focus:ring-[#005696] focus:border-transparent transition"
                       placeholder="{% trans 'e.g., Emergency Room, Clinic B, Main Reception' %}">
            </div>

            <!-- Description -->
            <div class="mb-6">
                <label class="block text-sm font-bold text-gray-700 mb-2">
                    {% trans "Description" %}
                    <span class="text-red-500">*</span>
                </label>
                <textarea name="description" rows="4" required
                          class="w-full px-4 py-3 border-2 border-gray-200 rounded-xl text-gray-800 focus:ring-2 focus:ring-[#005696] focus:border-transparent transition"
                          placeholder="{% trans 'Describe what happened to the patient...' %}">{{ adverse_action.description|default:'' }}</textarea>
            </div>

            <!-- Patient Impact -->
            <div class="mb-6">
                <label class="block text-sm font-bold text-gray-700 mb-2">
                    {% trans "Impact on Patient" %}
                </label>
                <textarea name="patient_impact" rows="3"
                          class="w-full px-4 py-3 border-2 border-gray-200 rounded-xl text-gray-800 focus:ring-2 focus:ring-[#005696] focus:border-transparent transition"
                          placeholder="{% trans 'Describe the physical, emotional, or financial impact on the patient...' %}">{{ adverse_action.patient_impact|default:'' }}</textarea>
            </div>

            <!-- Involved Staff -->
            <div class="mb-6">
                <label class="block text-sm font-bold text-gray-700 mb-2">
                    {% trans "Involved Staff" %}
                </label>
                <select name="involved_staff" multiple
                        class="w-full px-4 py-3 border-2 border-gray-200 rounded-xl text-gray-800 focus:ring-2 focus:ring-[#005696] focus:border-transparent transition"
                        size="5">
                    {% for staff in staff_list %}
                    <option value="{{ staff.id }}" {% if staff.id in selected_staff %}selected{% endif %}>
                        {{ staff.get_full_name }} - {{ staff.department.name|default:staff.job_title|default:staff.employee_id }}
                    </option>
                    {% endfor %}
                </select>
                <p class="mt-1 text-sm text-[#64748b]">
                    {% trans "Hold Ctrl/Cmd to select multiple staff members." %}
                </p>
            </div>

            <!-- Info Box -->
            <div class="mb-6 bg-amber-50 border border-amber-200 rounded-xl p-4">
                <div class="flex items-start gap-3">
                    <i data-lucide="alert-triangle" class="w-5 h-5 text-amber-500 flex-shrink-0 mt-0.5"></i>
                    <div>
                        <h4 class="font-medium text-amber-800">{% trans "Important Note" %}</h4>
                        <p class="text-sm text-amber-700 mt-1">
                            {% trans "Adverse actions are serious incidents where a patient experiences negative treatment because of a complaint. This information is used to identify patterns and prevent retaliation against patients." %}
                        </p>
                    </div>
                </div>
            </div>

            <!-- Actions -->
            <div class="flex items-center justify-end gap-3 pt-6 border-t border-gray-100">
                <a href="{% url 'complaints:complaint_detail' complaint.id %}" class="px-6 py-3 border border-gray-200 text-gray-700 rounded-xl font-semibold hover:bg-gray-50 transition">
                    {% trans "Cancel" %}
                </a>
                <button type="submit" class="px-8 py-3 bg-[#005696] text-white rounded-xl font-semibold hover:bg-[#007bbd] transition flex items-center gap-2">
                    <i data-lucide="{% if adverse_action %}save{% else %}plus{% endif %}" class="w-5 h-5"></i>
                    {% if adverse_action %}{% trans "Save Changes" %}{% else %}{% trans "Report Adverse Action" %}{% endif %}
                </button>
            </div>
        </form>
    </div>
</div>

<script>
    document.addEventListener('DOMContentLoaded', function() {
        lucide.createIcons();
    });
</script>
{% endblock %}