255 lines
9.8 KiB
HTML
255 lines
9.8 KiB
HTML
{% extends "layouts/base.html" %}
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{% load i18n %}
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{% block title %}{% if adverse_action %}{% trans "Edit Adverse Action" %}{% else %}{% trans "Report Adverse Action" %}{% endif %} - PX360{% endblock %}
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{% block extra_css %}
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<style>
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.page-header-gradient {
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background: linear-gradient(135deg, #005696 0%, #0069a8 50%, #007bbd 100%);
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color: white;
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padding: 1.5rem 2rem;
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border-radius: 1rem;
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margin-bottom: 1.5rem;
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box-shadow: 0 10px 15px -3px rgba(0, 86, 150, 0.2);
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}
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.form-section {
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background: #fff;
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border: 2px solid #e2e8f0;
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border-radius: 1rem;
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padding: 1.5rem;
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margin-bottom: 1.5rem;
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transition: all 0.3s ease;
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}
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.form-section:hover {
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border-color: #005696;
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box-shadow: 0 4px 12px rgba(0, 86, 150, 0.1);
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}
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.form-label {
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display: block;
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font-size: 0.875rem;
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font-weight: 600;
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color: #1e293b;
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margin-bottom: 0.5rem;
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}
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.form-control, .form-select {
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width: 100%;
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padding: 0.75rem 1rem;
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border: 2px solid #e2e8f0;
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border-radius: 0.75rem;
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font-size: 0.875rem;
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transition: all 0.2s ease;
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}
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.form-control:focus, .form-select:focus {
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outline: none;
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border-color: #005696;
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box-shadow: 0 0 0 3px rgba(0, 86, 150, 0.1);
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}
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.btn-primary {
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display: inline-flex;
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align-items: center;
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gap: 0.5rem;
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padding: 0.75rem 1.5rem;
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background: #005696;
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color: white;
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border-radius: 0.75rem;
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font-weight: 600;
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transition: all 0.2s ease;
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border: none;
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cursor: pointer;
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}
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.btn-primary:hover {
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background: #007bbd;
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}
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.btn-secondary {
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display: inline-flex;
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align-items: center;
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gap: 0.5rem;
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padding: 0.75rem 1.5rem;
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background: white;
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color: #64748b;
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border: 2px solid #e2e8f0;
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border-radius: 0.75rem;
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font-weight: 600;
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transition: all 0.2s ease;
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}
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.btn-secondary:hover {
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background: #f1f5f9;
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border-color: #005696;
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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="p-6 max-w-4xl mx-auto">
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<!-- Gradient Header -->
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<div class="page-header-gradient">
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<div class="flex items-center gap-4">
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<a href="{% url 'complaints:complaint_detail' complaint.id %}" class="text-white/80 hover:text-white transition">
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<i data-lucide="arrow-left" class="w-6 h-6"></i>
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</a>
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<div>
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<h1 class="text-2xl font-bold">
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{% if adverse_action %}{% trans "Edit Adverse Action" %}{% else %}{% trans "Report Adverse Action" %}{% endif %}
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</h1>
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<p class="text-white/80 mt-1">
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{% trans "Complaint" %}: {{ complaint.reference_number }}
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</p>
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</div>
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</div>
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</div>
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<!-- Form -->
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<div class="form-section">
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<form method="post">
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{% csrf_token %}
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<!-- Action Type -->
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<div class="mb-6">
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<label class="form-label">
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{% trans "Action Type" %}
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<span class="text-red-500">*</span>
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</label>
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<select name="action_type" required class="form-select">
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{% for value, label in action_type_choices %}
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<option value="{{ value }}" {% if adverse_action and adverse_action.action_type == value %}selected{% endif %}>
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{{ label }}
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</option>
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{% endfor %}
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</select>
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<p class="mt-2 text-sm text-[#64748b]">
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{% trans "Select the type of adverse action that occurred." %}
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</p>
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</div>
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<!-- Severity -->
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<div class="mb-6">
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<label class="form-label">
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{% trans "Severity Level" %}
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<span class="text-red-500">*</span>
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</label>
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<div class="grid grid-cols-2 md:grid-cols-4 gap-3">
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{% for value, label in severity_choices %}
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<label class="relative cursor-pointer">
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<input type="radio" name="severity" value="{{ value }}"
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{% if adverse_action and adverse_action.severity == value %}checked{% elif not adverse_action and value == 'medium' %}checked{% endif %}
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class="peer sr-only" required>
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<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]">
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{% if value == 'low' %}
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<i data-lucide="arrow-down" class="w-6 h-6 mx-auto mb-2 text-green-500"></i>
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{% elif value == 'medium' %}
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<i data-lucide="arrow-right" class="w-6 h-6 mx-auto mb-2 text-yellow-500"></i>
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{% elif value == 'high' %}
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<i data-lucide="arrow-up" class="w-6 h-6 mx-auto mb-2 text-orange-500"></i>
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{% else %}
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<i data-lucide="alert-triangle" class="w-6 h-6 mx-auto mb-2 text-red-500"></i>
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{% endif %}
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<span class="text-sm font-medium">{{ label }}</span>
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</div>
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</label>
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{% endfor %}
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</div>
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</div>
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<!-- Incident Date -->
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<div class="mb-6">
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<label class="form-label">
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{% trans "Incident Date & Time" %}
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<span class="text-red-500">*</span>
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</label>
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<input type="datetime-local" name="incident_date" required
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value="{% if adverse_action %}{{ adverse_action.incident_date|date:'Y-m-d\\TH:i' }}{% else %}{% now 'Y-m-d\\TH:i' %}{% endif %}"
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class="form-control">
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</div>
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<!-- Location -->
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<div class="mb-6">
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<label class="form-label">
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{% trans "Location" %}
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</label>
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<input type="text" name="location"
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value="{{ adverse_action.location|default:'' }}"
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class="form-control"
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placeholder="{% trans 'e.g., Emergency Room, Clinic B, Main Reception' %}">
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</div>
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<!-- Description -->
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<div class="mb-6">
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<label class="form-label">
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{% trans "Description" %}
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<span class="text-red-500">*</span>
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</label>
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<textarea name="description" rows="4" required
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class="form-control resize-none"
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placeholder="{% trans 'Describe what happened to the patient...' %}">{{ adverse_action.description|default:'' }}</textarea>
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</div>
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<!-- Patient Impact -->
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<div class="mb-6">
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<label class="form-label">
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{% trans "Impact on Patient" %}
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</label>
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<textarea name="patient_impact" rows="3"
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class="form-control resize-none"
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placeholder="{% trans 'Describe the physical, emotional, or financial impact on the patient...' %}">{{ adverse_action.patient_impact|default:'' }}</textarea>
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</div>
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<!-- Involved Staff -->
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<div class="mb-6">
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<label class="form-label">
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{% trans "Involved Staff" %}
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</label>
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<select name="involved_staff" multiple
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class="form-control"
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size="5">
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{% for staff in staff_list %}
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<option value="{{ staff.id }}" {% if staff.id in selected_staff %}selected{% endif %}>
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{{ staff.get_full_name }} - {{ staff.department.name|default:staff.job_title|default:staff.employee_id }}
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</option>
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{% endfor %}
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</select>
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<p class="mt-2 text-sm text-[#64748b]">
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{% trans "Hold Ctrl/Cmd to select multiple staff members." %}
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</p>
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</div>
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<!-- Info Box -->
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<div class="mb-6 bg-amber-50 border border-amber-200 rounded-xl p-4">
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<div class="flex items-start gap-3">
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<i data-lucide="alert-triangle" class="w-5 h-5 text-amber-500 flex-shrink-0 mt-0.5"></i>
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<div>
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<h4 class="font-medium text-amber-800">{% trans "Important Note" %}</h4>
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<p class="text-sm text-amber-700 mt-1">
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{% 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." %}
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</p>
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</div>
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</div>
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</div>
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<!-- Actions -->
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<div class="flex items-center justify-end gap-3 pt-6 border-t border-gray-100">
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<a href="{% url 'complaints:complaint_detail' complaint.id %}" class="btn-secondary">
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<i data-lucide="x" class="w-4 h-4"></i>
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{% trans "Cancel" %}
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</a>
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<button type="submit" class="btn-primary">
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<i data-lucide="{% if adverse_action %}save{% else %}plus{% endif %}" class="w-4 h-4"></i>
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{% if adverse_action %}{% trans "Save Changes" %}{% else %}{% trans "Report Adverse Action" %}{% 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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<script>
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document.addEventListener('DOMContentLoaded', function() {
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lucide.createIcons();
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});
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</script>
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{% endblock %}
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