242 lines
8.7 KiB
HTML
242 lines
8.7 KiB
HTML
{% extends 'layouts/base.html' %}
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{% load i18n %}
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{% load static %}
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{% block title %}{{ title }} - 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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.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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<!-- Gradient Header -->
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<div class="page-header-gradient">
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<div class="flex items-center gap-2 mb-3">
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<a href="{% url 'organizations:patient_list' %}"
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class="inline-flex items-center gap-2 px-4 py-2 bg-white/20 backdrop-blur-sm rounded-xl text-white hover:bg-white/30 transition text-sm font-semibold">
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<i data-lucide="arrow-left" class="w-4 h-4"></i> {% trans "Back" %}
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</a>
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</div>
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<h1 class="text-2xl font-bold">
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{{ title }}
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</h1>
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<p class="text-white/80 mt-1">
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{% trans "Manage patient information and records" %}
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</p>
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</div>
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<form method="post">
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{% csrf_token %}
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<div class="grid grid-cols-1 lg:grid-cols-2 gap-6">
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<!-- Basic Information -->
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<div class="form-section">
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<h2 class="text-lg font-semibold text-navy mb-4 flex items-center gap-2">
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<i data-lucide="user" class="w-5 h-5"></i>
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{% trans "Basic Information" %}
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</h2>
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<div class="space-y-4">
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<div>
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<label for="{{ form.mrn.id_for_label }}" class="block text-sm font-medium text-navy mb-1">
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{{ form.mrn.label }}
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</label>
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{{ form.mrn }}
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{% if form.mrn.help_text %}
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<p class="text-xs text-slate mt-1">{{ form.mrn.help_text }}</p>
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{% endif %}
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{% if form.mrn.errors %}
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<p class="text-xs text-red-600 mt-1">{{ form.mrn.errors.0 }}</p>
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{% endif %}
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</div>
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<div class="grid grid-cols-2 gap-4">
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<div>
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<label for="{{ form.first_name.id_for_label }}" class="block text-sm font-medium text-navy mb-1">
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{{ form.first_name.label }} *
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</label>
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{{ form.first_name }}
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{% if form.first_name.errors %}
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<p class="text-xs text-red-600 mt-1">{{ form.first_name.errors.0 }}</p>
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{% endif %}
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</div>
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<div>
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<label for="{{ form.last_name.id_for_label }}" class="block text-sm font-medium text-navy mb-1">
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{{ form.last_name.label }} *
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</label>
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{{ form.last_name }}
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{% if form.last_name.errors %}
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<p class="text-xs text-red-600 mt-1">{{ form.last_name.errors.0 }}</p>
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{% endif %}
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</div>
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</div>
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<div class="grid grid-cols-2 gap-4">
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<div>
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<label for="{{ form.first_name_ar.id_for_label }}" class="block text-sm font-medium text-navy mb-1">
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{{ form.first_name_ar.label }}
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</label>
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{{ form.first_name_ar }}
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</div>
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<div>
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<label for="{{ form.last_name_ar.id_for_label }}" class="block text-sm font-medium text-navy mb-1">
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{{ form.last_name_ar.label }}
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</label>
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{{ form.last_name_ar }}
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</div>
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</div>
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<div class="grid grid-cols-2 gap-4">
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<div>
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<label for="{{ form.national_id.id_for_label }}" class="block text-sm font-medium text-navy mb-1">
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{{ form.national_id.label }}
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</label>
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{{ form.national_id }}
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</div>
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<div>
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<label for="{{ form.date_of_birth.id_for_label }}" class="block text-sm font-medium text-navy mb-1">
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{{ form.date_of_birth.label }}
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</label>
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{{ form.date_of_birth }}
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</div>
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</div>
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<div class="grid grid-cols-2 gap-4">
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<div>
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<label for="{{ form.gender.id_for_label }}" class="block text-sm font-medium text-navy mb-1">
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{{ form.gender.label }}
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</label>
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{{ form.gender }}
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</div>
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<div>
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<label for="{{ form.status.id_for_label }}" class="block text-sm font-medium text-navy mb-1">
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{{ form.status.label }}
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</label>
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{{ form.status }}
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</div>
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</div>
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</div>
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</div>
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<!-- Contact Information -->
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<div class="form-section">
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<h2 class="text-lg font-semibold text-navy mb-4 flex items-center gap-2">
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<i data-lucide="phone" class="w-5 h-5"></i>
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{% trans "Contact Information" %}
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</h2>
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<div class="space-y-4">
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<div>
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<label for="{{ form.phone.id_for_label }}" class="block text-sm font-medium text-navy mb-1">
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{{ form.phone.label }}
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</label>
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{{ form.phone }}
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</div>
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<div>
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<label for="{{ form.email.id_for_label }}" class="block text-sm font-medium text-navy mb-1">
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{{ form.email.label }}
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</label>
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{{ form.email }}
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</div>
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<div>
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<label for="{{ form.address.id_for_label }}" class="block text-sm font-medium text-navy mb-1">
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{{ form.address.label }}
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</label>
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{{ form.address }}
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</div>
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<div>
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<label for="{{ form.city.id_for_label }}" class="block text-sm font-medium text-navy mb-1">
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{{ form.city.label }}
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</label>
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{{ form.city }}
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</div>
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<div>
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<label for="{{ form.primary_hospital.id_for_label }}" class="block text-sm font-medium text-navy mb-1">
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{{ form.primary_hospital.label }} *
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</label>
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{{ form.primary_hospital }}
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</div>
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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 gap-3 mt-6">
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<button type="submit" class="btn-primary">
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<i data-lucide="save" class="w-5 h-5"></i>
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{% trans "Save Patient" %}
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</button>
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<a href="{% url 'organizations:patient_list' %}" class="btn-secondary">
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<i data-lucide="x" class="w-5 h-5"></i>
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{% trans "Cancel" %}
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</a>
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</div>
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</form>
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{% endblock %}
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{% block extra_js %}
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<script>
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lucide.createIcons();
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</script>
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{% endblock %}
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