157 lines
7.5 KiB
HTML
157 lines
7.5 KiB
HTML
{% load i18n %}
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<!DOCTYPE html>
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<html lang="{{ LANGUAGE_CODE|default:'en' }}" dir="{% if LANGUAGE_CODE == 'ar' %}rtl{% else %}ltr{% endif %}">
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<head>
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<meta charset="UTF-8">
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<meta name="viewport" content="width=device-width, initial-scale=1.0">
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<title>{% trans "Submit Explanation" %} - PX360</title>
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<link href="https://cdn.jsdelivr.net/npm/bootstrap@5.3.0/dist/css/bootstrap.min.css" rel="stylesheet">
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<style>
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body {
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background: linear-gradient(135deg, #667eea 0%, #764ba2 100%);
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min-height: 100vh;
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display: flex;
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align-items: center;
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padding: 20px 0;
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}
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.card {
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border: none;
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border-radius: 15px;
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box-shadow: 0 10px 40px rgba(0,0,0,0.1);
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}
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.card-header {
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background: linear-gradient(135deg, #667eea 0%, #764ba2 100%);
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border-radius: 15px 15px 0 0 !important;
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color: white;
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}
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.btn-primary {
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background: linear-gradient(135deg, #667eea 0%, #764ba2 100%);
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border: none;
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}
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.btn-primary:hover {
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background: linear-gradient(135deg, #764ba2 0%, #667eea 100%);
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}
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.complaint-details {
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background-color: #f8f9fa;
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border-radius: 10px;
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padding: 15px;
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}
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</style>
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</head>
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<body>
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<div class="container">
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<div class="row justify-content-center">
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<div class="col-lg-8">
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<div class="card">
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<div class="card-header py-4">
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<h3 class="mb-0 text-center">
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<i class="bi bi-chat-quote"></i>
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{% trans "Submit Your Explanation" %}
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</h3>
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</div>
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<div class="card-body p-4">
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{% if error %}
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<div class="alert alert-danger" role="alert">
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{{ error }}
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</div>
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{% endif %}
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<div class="complaint-details mb-4">
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<h5 class="mb-3">{% trans "Complaint Details" %}</h5>
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<div class="row">
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<div class="col-md-6 mb-2">
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<strong>{% trans "Reference:" %}</strong> #{{ complaint.id }}
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</div>
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<div class="col-md-6 mb-2">
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<strong>{% trans "Title:" %}</strong> {{ complaint.title }}
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</div>
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<div class="col-md-6 mb-2">
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<strong>{% trans "Severity:" %}</strong>
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<span class="badge bg-{{ complaint.get_severity_badge_class }}">
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{{ complaint.get_severity_display }}
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</span>
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</div>
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<div class="col-md-6 mb-2">
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<strong>{% trans "Priority:" %}</strong>
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<span class="badge bg-{{ complaint.get_priority_badge_class }}">
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{{ complaint.get_priority_display }}
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</span>
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</div>
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{% if complaint.patient %}
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<div class="col-12 mb-2">
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<strong>{% trans "Patient:" %}</strong> {{ complaint.patient.get_full_name }} (MRN: {{ complaint.patient.mrn }})
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</div>
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{% endif %}
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<div class="col-12 mt-3">
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<strong>{% trans "Description:" %}</strong>
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<p class="mt-1 mb-0">{{ complaint.description|linebreaks }}</p>
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</div>
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</div>
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</div>
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<form method="post" enctype="multipart/form-data">
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{% csrf_token %}
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<div class="mb-4">
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<label for="explanation" class="form-label">
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<strong>{% trans "Your Explanation" %} *</strong>
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</label>
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<p class="text-muted small">
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{% trans "Please provide your perspective about the complaint mentioned above. Your explanation will help us understand the situation better." %}
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</p>
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<textarea
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class="form-control"
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id="explanation"
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name="explanation"
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rows="8"
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required
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placeholder="{% trans 'Write your explanation here...' %}"
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></textarea>
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</div>
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<div class="mb-4">
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<label for="attachments" class="form-label">
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<strong>{% trans "Attachments (Optional)" %}</strong>
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</label>
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<p class="text-muted small">
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{% trans "You can attach relevant documents, images, or other files to support your explanation." %}
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</p>
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<input
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class="form-control"
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type="file"
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id="attachments"
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name="attachments"
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multiple
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>
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<div class="form-text">
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{% trans "Accepted file types: PDF, DOC, DOCX, JPG, PNG, etc. Maximum file size: 10MB." %}
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</div>
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</div>
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<div class="alert alert-info">
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<i class="bi bi-info-circle"></i>
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<strong>{% trans "Important Note:" %}</strong>
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{% trans "This link can only be used once. After submitting your explanation, it will expire and cannot be used again." %}
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</div>
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<div class="d-grid">
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<button type="submit" class="btn btn-primary btn-lg">
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<i class="bi bi-send"></i>
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{% trans "Submit Explanation" %}
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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 class="card-footer text-muted text-center py-3">
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<small>{% trans "PX360 Complaint Management System" %}</small>
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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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<script src="https://cdn.jsdelivr.net/npm/bootstrap@5.3.0/dist/js/bootstrap.bundle.min.js"></script>
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<link rel="stylesheet" href="https://cdn.jsdelivr.net/npm/bootstrap-icons@1.10.0/font/bootstrap-icons.css">
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</body>
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</html>
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