{% extends "layouts/base.html" %} {% load i18n %} {% block title %}{% trans "New Complaint" %} - PX360{% endblock %} {% block extra_css %} {% endblock %} {% block content %}
{% csrf_token %}

{% trans "Feedback Type" %}

{% trans "Complaint" %}

{% trans "Report an issue or concern" %}

{% trans "Appreciation" %}

{% trans "Share positive feedback" %}

{% trans "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 }} {% if form.encounter_id.errors %}

{% for error in form.encounter_id.errors %}{{ error }}{% endfor %}

{% endif %}

{% trans "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 %}

{% trans "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 %}

{% trans "AI Classification" %}

{% trans "AI will automatically analyze and classify your feedback:" %}

  • {% trans "Title" %}: {% trans "AI-generated title" %}
  • {% trans "Category" %}: {% trans "AI-determined category" %}
  • {% trans "Severity" %}: {% trans "AI-calculated severity" %}
  • {% trans "Priority" %}: {% trans "AI-calculated priority" %}

{% trans "SLA Information" %}

{% trans "SLA deadline will be automatically calculated based on severity:" %}

  • C
    {% trans "Critical" %}: {% trans "4 hours" %}
  • H
    {% trans "High" %}: {% trans "24 hours" %}
  • M
    {% trans "Medium" %}: {% trans "72 hours" %}
  • L
    {% trans "Low" %}: {% trans "168 hours (7 days)" %}
{% if source_user %} {% trans "Cancel" %} {% else %} {% trans "Cancel" %} {% endif %}
{% endblock %}