381 lines
17 KiB
HTML
381 lines
17 KiB
HTML
{% extends "layouts/base.html" %}
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{% load i18n %}
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{% load static %}
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{% block title %}{% if is_create %}Create{% else %}Edit{% endif %} Feedback - PX360{% endblock %}
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{% block extra_css %}
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<style>
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.form-card {
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border: 1px solid #dee2e6;
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border-radius: 8px;
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margin-bottom: 20px;
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}
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.form-card-header {
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background: #f8f9fa;
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border-bottom: 1px solid #dee2e6;
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padding: 15px 20px;
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font-weight: 600;
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}
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.form-card-body {
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padding: 20px;
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}
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.required-field::after {
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content: " *";
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color: #dc3545;
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}
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.form-help-text {
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font-size: 0.875rem;
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color: #6c757d;
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margin-top: 0.25rem;
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}
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.rating-input {
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display: flex;
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gap: 10px;
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align-items: center;
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}
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.rating-input input[type="radio"] {
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display: none;
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}
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.rating-input label {
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font-size: 2rem;
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color: #ddd;
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cursor: pointer;
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transition: color 0.2s;
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}
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.rating-input input[type="radio"]:checked ~ label,
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.rating-input label:hover,
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.rating-input label:hover ~ label {
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color: #ffc107;
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}
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.rating-input {
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flex-direction: row-reverse;
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justify-content: flex-end;
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}
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</style>
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{% endblock %}
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{% block content %}
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<div class="container-fluid">
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<!-- Page Header -->
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<div class="d-flex justify-content-between align-items-center mb-4">
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<div>
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<nav aria-label="breadcrumb">
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<ol class="breadcrumb mb-2">
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<li class="breadcrumb-item"><a href="{% url 'feedback:feedback_list' %}">{% trans "Feedback" %}</a></li>
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<li class="breadcrumb-item active">{% if is_create %}Create{% else %}Edit{% endif %}</li>
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</ol>
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</nav>
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<h2 class="mb-0">
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<i class="bi bi-chat-heart-fill text-primary me-2"></i>
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{% if is_create %}Create New Feedback{% else %}Edit Feedback{% endif %}
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</h2>
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</div>
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<div>
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<a href="{% url 'feedback:feedback_list' %}" class="btn btn-outline-secondary">
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<i class="bi bi-x-circle me-1"></i> Cancel
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</a>
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</div>
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</div>
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<div class="row">
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<div class="col-lg-8 mx-auto">
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<form method="post" id="feedbackForm">
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{% csrf_token %}
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<!-- Display form errors -->
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{% if form.non_field_errors %}
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<div class="alert alert-danger alert-dismissible fade show" role="alert">
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{{ form.non_field_errors }}
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<button type="button" class="btn-close" data-bs-dismiss="alert"></button>
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</div>
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{% endif %}
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<!-- Patient/Contact Information -->
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<div class="form-card">
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<div class="form-card-header">
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<i class="bi bi-person me-2"></i>Patient/Contact Information
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</div>
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<div class="form-card-body">
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<!-- Anonymous Checkbox -->
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<div class="mb-3">
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<div class="form-check">
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{{ form.is_anonymous }}
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<label class="form-check-label" for="{{ form.is_anonymous.id_for_label }}">
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Submit as Anonymous Feedback
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</label>
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</div>
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{% if form.is_anonymous.errors %}
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<div class="text-danger small">{{ form.is_anonymous.errors }}</div>
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{% endif %}
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</div>
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<!-- Patient Selection (shown when not anonymous) -->
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<div class="mb-3" id="patientField">
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<label for="{{ form.patient.id_for_label }}" class="form-label">{% trans "Patient" %}</label>
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{{ form.patient }}
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{% if form.patient.help_text %}
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<div class="form-help-text">{{ form.patient.help_text }}</div>
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{% endif %}
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{% if form.patient.errors %}
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<div class="text-danger small">{{ form.patient.errors }}</div>
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{% endif %}
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</div>
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<!-- Anonymous Contact Fields (shown when anonymous) -->
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<div id="anonymousFields" style="display: none;">
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<div class="mb-3">
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<label for="{{ form.contact_name.id_for_label }}" class="form-label required-field">{% trans "Contact Name" %}</label>
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{{ form.contact_name }}
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{% if form.contact_name.errors %}
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<div class="text-danger small">{{ form.contact_name.errors }}</div>
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{% endif %}
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</div>
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<div class="row">
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<div class="col-md-6 mb-3">
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<label for="{{ form.contact_email.id_for_label }}" class="form-label">{% trans "Email" %}</label>
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{{ form.contact_email }}
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{% if form.contact_email.errors %}
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<div class="text-danger small">{{ form.contact_email.errors }}</div>
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{% endif %}
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</div>
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<div class="col-md-6 mb-3">
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<label for="{{ form.contact_phone.id_for_label }}" class="form-label">{% trans "Phone" %}</label>
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{{ form.contact_phone }}
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{% if form.contact_phone.errors %}
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<div class="text-danger small">{{ form.contact_phone.errors }}</div>
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{% endif %}
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</div>
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</div>
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</div>
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</div>
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</div>
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<!-- Feedback Details -->
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<div class="form-card">
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<div class="form-card-header">
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<i class="bi bi-chat-text me-2"></i>Feedback Details
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</div>
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<div class="form-card-body">
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<!-- Feedback Type -->
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<div class="mb-3">
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<label for="{{ form.feedback_type.id_for_label }}" class="form-label required-field">{% trans "Feedback Type" %}</label>
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{{ form.feedback_type }}
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{% if form.feedback_type.errors %}
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<div class="text-danger small">{{ form.feedback_type.errors }}</div>
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{% endif %}
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</div>
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<!-- Title -->
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<div class="mb-3">
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<label for="{{ form.title.id_for_label }}" class="form-label required-field">{% trans "Title" %}</label>
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{{ form.title }}
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{% if form.title.errors %}
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<div class="text-danger small">{{ form.title.errors }}</div>
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{% endif %}
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</div>
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<!-- Message -->
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<div class="mb-3">
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<label for="{{ form.message.id_for_label }}" class="form-label required-field">{% trans "Message" %}</label>
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{{ form.message }}
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<div class="form-help-text">Please provide detailed feedback</div>
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{% if form.message.errors %}
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<div class="text-danger small">{{ form.message.errors }}</div>
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{% endif %}
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</div>
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<!-- Category and Subcategory -->
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<div class="row">
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<div class="col-md-6 mb-3">
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<label for="{{ form.category.id_for_label }}" class="form-label required-field">{% trans "Category" %}</label>
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{{ form.category }}
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{% if form.category.errors %}
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<div class="text-danger small">{{ form.category.errors }}</div>
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{% endif %}
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</div>
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<div class="col-md-6 mb-3">
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<label for="{{ form.subcategory.id_for_label }}" class="form-label">{% trans "Subcategory" %}</label>
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{{ form.subcategory }}
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{% if form.subcategory.errors %}
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<div class="text-danger small">{{ form.subcategory.errors }}</div>
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{% endif %}
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</div>
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</div>
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<!-- Rating -->
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<div class="mb-3">
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<label class="form-label">{% trans "Rating (Optional)" %}</label>
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<div class="rating-input">
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<input type="radio" name="rating" value="5" id="rating5" {% if form.rating.value == 5 %}checked{% endif %}>
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<label for="rating5"><i class="bi bi-star-fill"></i></label>
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<input type="radio" name="rating" value="4" id="rating4" {% if form.rating.value == 4 %}checked{% endif %}>
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<label for="rating4"><i class="bi bi-star-fill"></i></label>
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<input type="radio" name="rating" value="3" id="rating3" {% if form.rating.value == 3 %}checked{% endif %}>
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<label for="rating3"><i class="bi bi-star-fill"></i></label>
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<input type="radio" name="rating" value="2" id="rating2" {% if form.rating.value == 2 %}checked{% endif %}>
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<label for="rating2"><i class="bi bi-star-fill"></i></label>
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<input type="radio" name="rating" value="1" id="rating1" {% if form.rating.value == 1 %}checked{% endif %}>
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<label for="rating1"><i class="bi bi-star-fill"></i></label>
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</div>
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<div class="form-help-text">Rate your experience from 1 to 5 stars</div>
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{% if form.rating.errors %}
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<div class="text-danger small">{{ form.rating.errors }}</div>
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{% endif %}
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</div>
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<!-- Priority -->
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<div class="mb-3">
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<label for="{{ form.priority.id_for_label }}" class="form-label">{% trans "Priority" %}</label>
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{{ form.priority }}
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{% if form.priority.errors %}
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<div class="text-danger small">{{ form.priority.errors }}</div>
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{% endif %}
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</div>
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</div>
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</div>
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<!-- Organization Information -->
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<div class="form-card">
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<div class="form-card-header">
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<i class="bi bi-building me-2"></i>Organization Information
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</div>
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<div class="form-card-body">
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<!-- Hospital -->
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<div class="mb-3">
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<label for="{{ form.hospital.id_for_label }}" class="form-label required-field">{% trans "Hospital" %}</label>
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{{ form.hospital }}
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{% if form.hospital.errors %}
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<div class="text-danger small">{{ form.hospital.errors }}</div>
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{% endif %}
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</div>
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<!-- Department -->
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<div class="mb-3">
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<label for="{{ form.department.id_for_label }}" class="form-label">{% trans "Department" %}</label>
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{{ form.department }}
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<div class="form-help-text">Select the department related to this feedback (optional)</div>
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{% if form.department.errors %}
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<div class="text-danger small">{{ form.department.errors }}</div>
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{% endif %}
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</div>
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<!-- Physician -->
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<div class="mb-3">
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<label for="{{ form.physician.id_for_label }}" class="form-label">{% trans "Physician" %}</label>
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{{ form.physician }}
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<div class="form-help-text">Select the physician mentioned in this feedback (optional)</div>
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{% if form.physician.errors %}
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<div class="text-danger small">{{ form.physician.errors }}</div>
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{% endif %}
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</div>
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<!-- Encounter ID -->
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<div class="mb-3">
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<label for="{{ form.encounter_id.id_for_label }}" class="form-label">{% trans "Encounter ID" %}</label>
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{{ form.encounter_id }}
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<div class="form-help-text">Related encounter ID if applicable (optional)</div>
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{% if form.encounter_id.errors %}
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<div class="text-danger small">{{ form.encounter_id.errors }}</div>
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{% endif %}
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</div>
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</div>
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</div>
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<!-- Form Actions -->
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<div class="d-flex justify-content-between align-items-center mb-4">
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<a href="{% url 'feedback:feedback_list' %}" class="btn btn-outline-secondary">
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<i class="bi bi-x-circle me-1"></i> Cancel
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</a>
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<button type="submit" class="btn btn-primary">
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<i class="bi bi-check-circle me-1"></i>
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{% if is_create %}Create Feedback{% else %}Update Feedback{% endif %}
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</button>
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</div>
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</form>
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</div>
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</div>
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</div>
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{% endblock %}
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{% block extra_js %}
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<script>
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document.addEventListener('DOMContentLoaded', function() {
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const anonymousCheckbox = document.getElementById('{{ form.is_anonymous.id_for_label }}');
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const patientField = document.getElementById('patientField');
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const anonymousFields = document.getElementById('anonymousFields');
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function toggleAnonymousFields() {
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if (anonymousCheckbox.checked) {
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patientField.style.display = 'none';
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anonymousFields.style.display = 'block';
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} else {
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patientField.style.display = 'block';
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anonymousFields.style.display = 'none';
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}
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}
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// Initial state
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toggleAnonymousFields();
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// Listen for changes
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anonymousCheckbox.addEventListener('change', toggleAnonymousFields);
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// Rating stars interaction
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const ratingLabels = document.querySelectorAll('.rating-input label');
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ratingLabels.forEach(label => {
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label.addEventListener('mouseenter', function() {
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const rating = this.previousElementSibling.value;
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highlightStars(rating);
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});
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});
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document.querySelector('.rating-input').addEventListener('mouseleave', function() {
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const checkedInput = document.querySelector('.rating-input input:checked');
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if (checkedInput) {
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highlightStars(checkedInput.value);
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} else {
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resetStars();
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}
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});
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function highlightStars(rating) {
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ratingLabels.forEach((label, index) => {
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if (5 - index <= rating) {
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label.style.color = '#ffc107';
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} else {
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label.style.color = '#ddd';
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}
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});
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}
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function resetStars() {
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ratingLabels.forEach(label => {
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label.style.color = '#ddd';
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});
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}
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// Form validation
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const form = document.getElementById('feedbackForm');
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form.addEventListener('submit', function(e) {
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const isAnonymous = anonymousCheckbox.checked;
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const patient = document.getElementById('{{ form.patient.id_for_label }}').value;
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const contactName = document.getElementById('{{ form.contact_name.id_for_label }}').value;
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if (!isAnonymous && !patient) {
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e.preventDefault();
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alert('Please select a patient or mark as anonymous.');
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return false;
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}
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if (isAnonymous && !contactName) {
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e.preventDefault();
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alert('Please enter a contact name for anonymous feedback.');
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return false;
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}
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});
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});
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</script>
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{% endblock %}
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