242 lines
9.5 KiB
HTML
242 lines
9.5 KiB
HTML
{% extends base_layout %}
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{% load i18n %}
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{% load static %}
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{% block title %}{{ _("New Inquiry")}} - PX360{% endblock %}
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{% block extra_css %}
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<style>
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.form-section {
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background: #fff;
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border: 1px solid #dee2e6;
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border-radius: 8px;
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padding: 25px;
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margin-bottom: 20px;
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}
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.form-section-title {
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font-size: 1.1rem;
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font-weight: 600;
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color: #495057;
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margin-bottom: 20px;
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padding-bottom: 10px;
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border-bottom: 2px solid #17a2b8;
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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="mb-4">
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{% if source_user %}
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<a href="{% url 'px_sources:source_user_inquiry_list' %}" class="btn btn-outline-secondary btn-sm mb-3">
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<i class="bi bi-arrow-left me-1"></i> {{ _("Back to My Inquiries")}}
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</a>
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{% else %}
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<a href="{% url 'complaints:inquiry_list' %}" class="btn btn-outline-secondary btn-sm mb-3">
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<i class="bi bi-arrow-left me-1"></i> {{ _("Back to Inquiries")}}
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</a>
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{% endif %}
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<h2 class="mb-1">
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<i class="bi bi-plus-circle text-info me-2"></i>
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{{ _("Create New Inquiry")}}
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</h2>
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<p class="text-muted mb-0">{{ _("Create a new patient inquiry or request")}}</p>
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</div>
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<form method="post" action="{% url 'complaints:inquiry_create' %}" id="inquiryForm">
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{% csrf_token %}
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{% if form.non_field_errors %}
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<div class="alert alert-danger">
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{{ form.non_field_errors }}
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</div>
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{% endif %}
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<div class="row">
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<div class="col-lg-8">
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<!-- Organization Information -->
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<div class="form-section">
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<h5 class="form-section-title">
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<i class="bi bi-hospital me-2"></i>{{ _("Organization") }}
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</h5>
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<div class="mb-3">
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{{ form.hospital.label_tag }}
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{{ form.hospital }}
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{% if form.hospital.help_text %}
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<small class="form-text text-muted">{{ form.hospital.help_text }}</small>
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{% endif %}
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{% for error in form.hospital.errors %}
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<div class="invalid-feedback d-block">{{ error }}</div>
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{% endfor %}
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</div>
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<div class="mb-3">
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{{ form.department.label_tag }}
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{{ form.department }}
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{% for error in form.department.errors %}
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<div class="invalid-feedback d-block">{{ error }}</div>
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{% endfor %}
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</div>
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</div>
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<!-- Contact/Patient Information -->
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<div class="form-section">
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<h5 class="form-section-title">
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<i class="bi bi-person-fill me-2"></i>{{ _("Contact Information")}}
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</h5>
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<!-- Patient Field -->
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<div class="mb-3">
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{{ form.patient.label_tag }}
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{{ form.patient }}
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{% for error in form.patient.errors %}
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<div class="invalid-feedback d-block">{{ error }}</div>
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{% endfor %}
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</div>
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<div class="mb-3">
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{{ form.contact_name.label_tag }}
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{{ form.contact_name }}
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{% for error in form.contact_name.errors %}
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<div class="invalid-feedback d-block">{{ error }}</div>
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{% endfor %}
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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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{{ form.contact_phone.label_tag }}
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{{ form.contact_phone }}
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{% for error in form.contact_phone.errors %}
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<div class="invalid-feedback d-block">{{ error }}</div>
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{% endfor %}
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</div>
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<div class="col-md-6 mb-3">
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{{ form.contact_email.label_tag }}
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{{ form.contact_email }}
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{% for error in form.contact_email.errors %}
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<div class="invalid-feedback d-block">{{ error }}</div>
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{% endfor %}
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</div>
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</div>
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</div>
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<!-- Inquiry Details -->
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<div class="form-section">
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<h5 class="form-section-title">
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<i class="bi bi-file-text me-2"></i>{{ _("Inquiry Details")}}
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</h5>
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<div class="mb-3">
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{{ form.category.label_tag }}
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{{ form.category }}
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{% for error in form.category.errors %}
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<div class="invalid-feedback d-block">{{ error }}</div>
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{% endfor %}
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</div>
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<div class="mb-3">
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{{ form.subject.label_tag }}
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{{ form.subject }}
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{% for error in form.subject.errors %}
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<div class="invalid-feedback d-block">{{ error }}</div>
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{% endfor %}
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</div>
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<div class="mb-3">
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{{ form.message.label_tag }}
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{{ form.message }}
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{% for error in form.message.errors %}
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<div class="invalid-feedback d-block">{{ error }}</div>
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{% endfor %}
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</div>
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</div>
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</div>
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<!-- Sidebar -->
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<div class="col-lg-4">
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<!-- Due Date -->
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<div class="mb-3">
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<label class="form-label">{% trans "Due Date" %}</label>
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<input type="datetime-local" name="due_date" class="form-control"
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placeholder="{% trans 'Optional due date' %}">
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<small class="form-text text-muted">
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{{ _("Leave empty for default")}}
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</small>
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</div>
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<!-- Help Information -->
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<div class="alert alert-info">
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<h6 class="alert-heading">
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<i class="bi bi-info-circle me-2"></i>{{ _("Help")}}
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</h6>
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<p class="mb-0 small">
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{{ _("Use this form to create a new inquiry from a patient or visitor.")}}
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</p>
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<hr class="my-2">
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<p class="mb-0 small">
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{{ _("Fill in the inquiry details. Fields marked with * are required.")}}
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</p>
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</div>
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<!-- Action Buttons -->
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<div class="d-grid gap-2">
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<button type="submit" class="btn btn-primary btn-lg">
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<i class="bi bi-check-circle me-2"></i>{{ _("Create Inquiry")}}
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</button>
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{% if source_user %}
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<a href="{% url 'px_sources:source_user_inquiry_list' %}" class="btn btn-outline-secondary">
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<i class="bi bi-x-circle me-2"></i>{{ _("Cancel") }}
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</a>
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{% else %}
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<a href="{% url 'complaints:inquiry_list' %}" class="btn btn-outline-secondary">
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<i class="bi bi-x-circle me-2"></i>{{ _("Cancel") }}
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</a>
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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>
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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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// Department loading
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document.getElementById('{{ form.hospital.id_for_label }}')?.addEventListener('change', function() {
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const hospitalId = this.value;
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const departmentSelect = document.getElementById('{{ form.department.id_for_label }}');
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if (!hospitalId) {
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departmentSelect.innerHTML = '<option value="">{{ _("Select department")}}</option>';
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return;
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}
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fetch(`/complaints/ajax/departments/?hospital_id=${hospitalId}`)
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.then(response => response.json())
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.then(data => {
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departmentSelect.innerHTML = '<option value="">{{ _("Select department")}}</option>';
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data.departments.forEach(dept => {
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const option = document.createElement('option');
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option.value = dept.id;
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option.textContent = dept.name_en || dept.name;
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departmentSelect.appendChild(option);
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});
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})
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.catch(error => console.error('Error loading departments:', error));
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});
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// Patient search (optional - for better UX)
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const patientSelect = document.getElementById('{{ form.patient.id_for_label }}');
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if (patientSelect) {
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patientSelect.addEventListener('change', function() {
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const selectedOption = this.options[this.selectedIndex];
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if (!selectedOption || selectedOption.value === '') {
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document.getElementById('patient-results').style.display = 'none';
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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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