HH/templates/callcenter/inquiry_form.html
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{% extends "layouts/base.html" %}
{% load i18n %}
{% load static %}
{% block title %}{% trans "Create Inquiry" %} - {% trans "Call Center" %} - PX360{% endblock %}
{% block extra_css %}
<style>
.page-header-gradient {
background: linear-gradient(135deg, #005696 0%, #0069a8 50%, #007bbd 100%);
color: white;
padding: 1.5rem 2rem;
border-radius: 1rem;
margin-bottom: 1.5rem;
box-shadow: 0 10px 15px -3px rgba(0, 86, 150, 0.2);
}
.section-card {
background: white;
border-radius: 1rem;
border: 2px solid #e2e8f0;
box-shadow: 0 4px 6px -1px rgba(0, 0, 0, 0.1);
overflow: hidden;
transition: all 0.3s ease;
}
.section-card:hover {
border-color: #005696;
box-shadow: 0 10px 25px -5px rgba(0, 86, 150, 0.15);
}
.section-header {
padding: 1rem 1.5rem;
border-bottom: 2px solid #e2e8f0;
background: linear-gradient(to right, #f8fafc, #f1f5f9);
display: flex;
align-items: center;
gap: 0.75rem;
}
.section-icon {
width: 40px;
height: 40px;
border-radius: 0.75rem;
display: flex;
align-items: center;
justify-content: center;
}
.patient-search-result {
padding: 10px;
border: 1px solid #e2e8f0;
border-radius: 8px;
margin-bottom: 10px;
cursor: pointer;
transition: all 0.2s;
}
.patient-search-result:hover {
background: #f8fafc;
border-color: #005696;
}
.patient-search-result.selected {
background: #e0f2fe;
border-color: #005696;
}
</style>
{% endblock %}
{% block content %}
<div class="page-header-gradient">
<div class="flex justify-between items-center">
<div>
<div class="flex items-center gap-2 text-blue-100 text-sm mb-2">
<a href="{% url 'callcenter:inquiry_list' %}" class="hover:text-white transition">{% trans "Call Center" %}</a>
<i data-lucide="chevron-right" class="w-3 h-3"></i>
<span class="text-white">{% trans "Create Inquiry" %}</span>
</div>
<h1 class="text-2xl font-bold">{% trans "Create Inquiry" %}</h1>
<p class="text-blue-100 text-sm">{% trans "Create an inquiry on behalf of a patient or caller" %}</p>
</div>
<a href="{% url 'callcenter:inquiry_list' %}" class="inline-flex items-center px-4 py-2.5 bg-white text-navy font-medium rounded-xl hover:bg-blue-50 transition">
<i data-lucide="arrow-left" class="w-4 h-4 me-2"></i>{% trans "Back to List" %}
</a>
</div>
</div>
<form method="post" action="{% url 'callcenter:create_inquiry' %}" id="inquiryForm">
{% csrf_token %}
<input type="hidden" name="patient_id" id="patientId">
<div class="grid grid-cols-1 lg:grid-cols-3 gap-6">
<div class="lg:col-span-2 space-y-6">
<div class="section-card">
<div class="section-header">
<div class="section-icon bg-blue-500/10">
<i data-lucide="user" class="w-5 h-5 text-blue-600"></i>
</div>
<h5 class="text-lg font-semibold text-gray-800">{% trans "Caller Information" %}</h5>
</div>
<div class="p-6">
<div class="bg-blue-50 border border-blue-200 rounded-lg p-3 mb-5 text-sm text-blue-700">
<i data-lucide="info" class="w-4 h-4 inline-block me-1"></i>
{% trans "Search for an existing patient or enter contact details manually" %}
</div>
<div class="mb-5">
<label class="block text-sm font-semibold text-slate-700 mb-1.5">{% trans "Search Patient" %}</label>
<div class="flex gap-2">
<input type="text" class="flex-1 px-4 py-2.5 border border-slate-200 rounded-xl text-sm focus:outline-none focus:ring-2 focus:ring-navy" id="patientSearch"
placeholder="{% trans 'Search by MRN, name, phone, or national ID...' %}">
<button type="button" id="searchBtn" class="px-4 py-2.5 bg-navy text-white rounded-xl text-sm font-semibold hover:bg-navy/90 transition">
<i data-lucide="search" class="w-4 h-4 inline-block"></i> {% trans "Search" %}
</button>
</div>
<div id="patientResults" class="mt-2"></div>
</div>
<div class="grid grid-cols-1 md:grid-cols-3 gap-5">
<div>
<label class="block text-sm font-semibold text-slate-700 mb-1.5">{% trans "Contact Name" %} <span class="text-red-500">*</span></label>
<input type="text" name="contact_name" id="contactName" class="w-full px-4 py-2.5 border border-slate-200 rounded-xl text-sm focus:outline-none focus:ring-2 focus:ring-navy"
placeholder="{% trans 'Full name' %}" required>
</div>
<div>
<label class="block text-sm font-semibold text-slate-700 mb-1.5">{% trans "Contact Phone" %} <span class="text-red-500">*</span></label>
<input type="tel" name="contact_phone" id="contactPhone" class="w-full px-4 py-2.5 border border-slate-200 rounded-xl text-sm focus:outline-none focus:ring-2 focus:ring-navy"
placeholder="{% trans 'Phone number' %}" required>
</div>
<div>
<label class="block text-sm font-semibold text-slate-700 mb-1.5">{% trans "Contact Email" %}</label>
<input type="email" name="contact_email" id="contactEmail" class="w-full px-4 py-2.5 border border-slate-200 rounded-xl text-sm focus:outline-none focus:ring-2 focus:ring-navy"
placeholder="{% trans 'Email address' %}">
</div>
</div>
<div class="mt-4">
<label class="block text-sm font-semibold text-slate-700 mb-1.5">{% trans "Relationship" %} <span class="text-red-500">*</span></label>
<select name="caller_relationship" class="px-4 py-2.5 border border-slate-200 rounded-xl text-sm focus:outline-none focus:ring-2 focus:ring-navy bg-white" required>
<option value="patient">{% trans "Patient" %}</option>
<option value="family">{% trans "Family Member" %}</option>
<option value="other">{% trans "Other" %}</option>
</select>
</div>
</div>
</div>
<div class="section-card">
<div class="section-header">
<div class="section-icon bg-cyan-500/10">
<i data-lucide="building-2" class="w-5 h-5 text-cyan-600"></i>
</div>
<h5 class="text-lg font-semibold text-gray-800">{% trans "Organization" %}</h5>
</div>
<div class="p-6">
<div class="grid grid-cols-1 md:grid-cols-2 gap-5">
<div>
<label class="block text-sm font-semibold text-slate-700 mb-1.5">{% trans "Hospital" %}</label>
<input type="text" class="w-full px-4 py-2.5 border border-slate-200 rounded-xl text-sm bg-slate-50" value="{{ current_hospital.name }}" readonly>
<input type="hidden" name="hospital_id" value="{{ current_hospital.id }}">
</div>
<div>
<label class="block text-sm font-semibold text-slate-700 mb-1.5">{% trans "Department" %}</label>
<select name="department_id" class="w-full px-4 py-2.5 border border-slate-200 rounded-xl text-sm focus:outline-none focus:ring-2 focus:ring-navy bg-white" id="departmentSelect">
<option value="">{% trans "Select department..." %}</option>
</select>
</div>
</div>
</div>
</div>
<div class="section-card">
<div class="section-header">
<div class="section-icon bg-orange-500/10">
<i data-lucide="help-circle" class="w-5 h-5 text-orange-600"></i>
</div>
<h5 class="text-lg font-semibold text-gray-800">{% trans "Inquiry Details" %}</h5>
</div>
<div class="p-6 space-y-5">
<div>
<label class="block text-sm font-semibold text-slate-700 mb-1.5">{% trans "Category" %} <span class="text-red-500">*</span></label>
<select name="category" class="w-full px-4 py-2.5 border border-slate-200 rounded-xl text-sm focus:outline-none focus:ring-2 focus:ring-navy bg-white" required>
<option value="">{% trans "Select category..." %}</option>
<option value="appointment">{% trans "Appointment" %}</option>
<option value="billing">{% trans "Billing" %}</option>
<option value="medical_records">{% trans "Medical Records" %}</option>
<option value="general">{% trans "General Information" %}</option>
<option value="other">{% trans "Other" %}</option>
</select>
</div>
<div>
<label class="block text-sm font-semibold text-slate-700 mb-1.5">{% trans "Subject" %} <span class="text-red-500">*</span></label>
<input type="text" name="subject" class="w-full px-4 py-2.5 border border-slate-200 rounded-xl text-sm focus:outline-none focus:ring-2 focus:ring-navy"
placeholder="{% trans 'Brief summary of the inquiry' %}" required maxlength="500">
</div>
<div>
<label class="block text-sm font-semibold text-slate-700 mb-1.5">{% trans "Message" %} <span class="text-red-500">*</span></label>
<textarea name="message" class="w-full px-4 py-3 border border-slate-200 rounded-xl text-sm focus:outline-none focus:ring-2 focus:ring-navy resize-none" rows="6"
placeholder="{% trans 'Detailed description of the inquiry. Include all relevant information provided by the caller...' %}" required></textarea>
</div>
</div>
</div>
</div>
<div class="space-y-6">
<div class="section-card">
<div class="section-header">
<div class="section-icon bg-blue-500/10">
<i data-lucide="info" class="w-5 h-5 text-blue-600"></i>
</div>
<h5 class="text-lg font-semibold text-gray-800">{% trans "Categories" %}</h5>
</div>
<div class="p-6 text-sm text-slate-600 space-y-2">
<p><strong>{% trans "Appointment:" %}</strong> {% trans "Scheduling, rescheduling, or cancellation" %}</p>
<p><strong>{% trans "Billing:" %}</strong> {% trans "Payment questions or invoice requests" %}</p>
<p><strong>{% trans "Medical Records:" %}</strong> {% trans "Record requests or updates" %}</p>
<p><strong>{% trans "General:" %}</strong> {% trans "Hospital information or services" %}</p>
</div>
</div>
<div class="section-card">
<div class="section-header">
<div class="section-icon bg-purple-500/10">
<i data-lucide="headphones" class="w-5 h-5 text-purple-600"></i>
</div>
<h5 class="text-lg font-semibold text-gray-800">{% trans "Call Center Note" %}</h5>
</div>
<div class="p-6 text-sm text-slate-600">
{% trans "This inquiry will be logged as received via Call Center. A call center interaction record will be automatically created for tracking purposes." %}
</div>
</div>
<div class="section-card">
<div class="section-header">
<div class="section-icon bg-green-500/10">
<i data-lucide="lightbulb" class="w-5 h-5 text-green-600"></i>
</div>
<h5 class="text-lg font-semibold text-gray-800">{% trans "Tips" %}</h5>
</div>
<div class="p-6 text-sm text-slate-600 space-y-1">
<p>{% trans "Be clear and concise in the subject line" %}</p>
<p>{% trans "Include all relevant details in the message" %}</p>
<p>{% trans "Verify contact information for follow-up" %}</p>
<p>{% trans "Select the most appropriate category" %}</p>
</div>
</div>
<div class="flex flex-col gap-3">
<button type="submit" class="w-full px-6 py-3 bg-navy text-white rounded-xl font-bold hover:bg-navy/90 transition text-sm inline-flex items-center justify-center gap-2">
<i data-lucide="check-circle" class="w-4 h-4"></i>{% trans "Create Inquiry" %}
</button>
<a href="{% url 'callcenter:inquiry_list' %}" class="w-full px-6 py-3 border-2 border-slate-200 rounded-xl font-semibold text-slate-600 hover:bg-slate-50 transition text-sm text-center">
{% trans "Cancel" %}
</a>
</div>
</div>
</div>
</form>
{% endblock %}
{% block extra_js %}
<script>
document.addEventListener('DOMContentLoaded', function() {
const departmentSelect = document.getElementById('departmentSelect');
const patientSearch = document.getElementById('patientSearch');
const searchBtn = document.getElementById('searchBtn');
const patientResults = document.getElementById('patientResults');
const patientIdInput = document.getElementById('patientId');
const contactNameInput = document.getElementById('contactName');
const contactPhoneInput = document.getElementById('contactPhone');
const contactEmailInput = document.getElementById('contactEmail');
const currentHospitalId = '{{ current_hospital.id|default:"" }}';
if (currentHospitalId) {
fetch(`/callcenter/ajax/departments/?hospital_id=${currentHospitalId}`)
.then(response => response.json())
.then(data => {
departmentSelect.innerHTML = '<option value="">{% trans "Select department..." %}</option>';
data.departments.forEach(dept => {
const option = document.createElement('option');
option.value = dept.id;
option.textContent = dept.name_ar || dept.name;
departmentSelect.appendChild(option);
});
})
.catch(error => console.error('Error loading departments:', error));
}
function searchPatients() {
const query = patientSearch.value.trim();
const hospitalId = currentHospitalId;
if (query.length < 2) {
patientResults.innerHTML = '<div class="bg-amber-50 border border-amber-200 rounded-lg p-2 text-xs text-amber-700">{% trans "Please enter at least 2 characters to search" %}</div>';
return;
}
patientResults.innerHTML = '<div class="text-center text-sm text-slate-500 py-2">{% trans "Searching..." %}</div>';
let url = `/callcenter/ajax/patients/?q=${encodeURIComponent(query)}`;
if (hospitalId) {
url += `&hospital_id=${hospitalId}`;
}
fetch(url)
.then(response => response.json())
.then(data => {
if (data.patients.length === 0) {
patientResults.innerHTML = '<div class="bg-blue-50 border border-blue-200 rounded-lg p-2 text-xs text-blue-700">{% trans "No patients found. Please enter contact details manually." %}</div>';
return;
}
let html = '<div class="mb-2 text-sm font-semibold text-slate-700">{% trans "Select Patient:" %}</div>';
data.patients.forEach(patient => {
html += `
<div class="patient-search-result" data-patient-id="${patient.id}"
data-patient-name="${patient.name}" data-patient-phone="${patient.phone}"
data-patient-email="${patient.email || ''}">
<div class="flex justify-between items-center">
<div>
<strong class="text-slate-800">${patient.name}</strong><br>
<small class="text-slate-500">
MRN: ${patient.mrn} |
Phone: ${patient.phone || 'N/A'} |
ID: ${patient.national_id_masked || 'N/A'}
</small>
</div>
<i data-lucide="check-circle" class="w-5 h-5 text-green-500 hidden"></i>
</div>
</div>
`;
});
patientResults.innerHTML = html;
lucide.createIcons();
document.querySelectorAll('.patient-search-result').forEach(result => {
result.addEventListener('click', function() {
document.querySelectorAll('.patient-search-result').forEach(r => {
r.classList.remove('selected');
const icon = r.querySelector('[data-lucide="check-circle"]');
if (icon) icon.classList.add('hidden');
});
this.classList.add('selected');
const icon = this.querySelector('[data-lucide="check-circle"]');
if (icon) icon.classList.remove('hidden');
patientIdInput.value = this.dataset.patientId;
contactNameInput.value = this.dataset.patientName;
contactPhoneInput.value = this.dataset.patientPhone;
contactEmailInput.value = this.dataset.patientEmail;
});
});
})
.catch(error => {
console.error('Error searching patients:', error);
patientResults.innerHTML = '<div class="bg-red-50 border border-red-200 rounded-lg p-2 text-xs text-red-700">{% trans "Error searching patients. Please try again." %}</div>';
});
}
searchBtn.addEventListener('click', searchPatients);
patientSearch.addEventListener('keypress', function(e) {
if (e.key === 'Enter') {
e.preventDefault();
searchPatients();
}
});
const form = document.getElementById('inquiryForm');
form.addEventListener('submit', function(e) {
if (!form.checkValidity()) {
e.preventDefault();
e.stopPropagation();
}
form.classList.add('was-validated');
});
});
</script>
{% endblock %}