373 lines
13 KiB
HTML
373 lines
13 KiB
HTML
{% extends "layouts/base.html" %}
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{% load i18n %}
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{% block title %}{% trans "Create New Inquiry" %} - PX360{% endblock %}
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{% block extra_css %}
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<style>
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:root {
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--hh-navy: #005696;
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--hh-blue: #007bbd;
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--hh-light: #eef6fb;
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--hh-slate: #64748b;
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}
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.form-card {
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background: white;
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border-radius: 1rem;
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border: 1px solid #e2e8f0;
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box-shadow: 0 4px 6px -1px rgba(0, 0, 0, 0.05);
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}
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.card-header {
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background: linear-gradient(135deg, var(--hh-light), #e0f2fe);
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padding: 1.25rem 1.75rem;
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border-bottom: 1px solid #bae6fd;
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border-radius: 1rem 1rem 0 0;
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}
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.form-section {
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padding: 1.5rem;
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border-bottom: 1px solid #f1f5f9;
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}
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.form-section:last-child {
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border-bottom: none;
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}
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.section-title {
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display: flex;
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align-items: center;
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gap: 0.5rem;
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font-size: 1.1rem;
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font-weight: 700;
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color: var(--hh-navy);
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margin-bottom: 1.5rem;
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}
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.form-group {
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margin-bottom: 1.25rem;
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}
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.form-label {
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display: block;
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margin-bottom: 0.5rem;
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font-weight: 600;
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color: var(--hh-navy);
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font-size: 0.9rem;
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}
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.form-input {
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width: 100%;
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padding: 0.75rem 1rem;
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border: 2px solid #cbd5e1;
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border-radius: 0.75rem;
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font-size: 0.95rem;
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transition: all 0.2s;
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background: white;
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color: #1e293b;
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font-family: 'Inter', sans-serif;
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}
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.form-input:focus {
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outline: none;
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border-color: var(--hh-blue);
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box-shadow: 0 0 0 4px rgba(0, 123, 189, 0.1);
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transform: translateY(-1px);
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}
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.form-input.error {
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border-color: #ef4444;
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}
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.form-input.error:focus {
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box-shadow: 0 0 0 4px rgba(239, 68, 68, 0.1);
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}
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textarea.form-input {
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resize: vertical;
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min-height: 120px;
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}
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.form-help {
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color: var(--hh-slate);
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font-size: 0.825rem;
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margin-top: 0.375rem;
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}
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.form-error {
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color: #ef4444;
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font-size: 0.825rem;
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margin-top: 0.375rem;
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display: flex;
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align-items: center;
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gap: 0.25rem;
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}
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.btn-primary {
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background: linear-gradient(135deg, var(--hh-navy) 0%, var(--hh-blue) 100%);
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color: white;
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padding: 0.75rem 1.5rem;
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border-radius: 0.75rem;
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font-weight: 600;
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border: none;
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cursor: pointer;
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transition: all 0.3s cubic-bezier(0.4, 0, 0.2, 1);
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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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}
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.btn-primary:hover {
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transform: translateY(-2px);
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box-shadow: 0 8px 16px rgba(0, 86, 150, 0.3);
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}
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.btn-secondary {
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background: white;
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color: #475569;
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padding: 0.75rem 1.5rem;
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border-radius: 0.75rem;
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font-weight: 600;
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border: 2px solid #e2e8f0;
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cursor: pointer;
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transition: all 0.3s ease;
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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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text-decoration: none;
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}
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.btn-secondary:hover {
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background: #f1f5f9;
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border-color: #cbd5e1;
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transform: translateY(-1px);
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}
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@keyframes fadeIn {
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from { opacity: 0; transform: translateY(20px); }
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to { opacity: 1; transform: translateY(0); }
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}
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.animate-in {
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animation: fadeIn 0.5s ease-out forwards;
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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="px-4 py-6">
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<!-- Breadcrumb -->
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<nav class="mb-4 animate-in">
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<ol class="flex items-center gap-2 text-sm text-slate">
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<li><a href="{% url 'complaints:inquiry_list' %}" class="text-blue hover:text-navy font-medium">{% trans "Inquiries" %}</a></li>
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<li><i data-lucide="chevron-right" class="w-4 h-4 text-slate"></i></li>
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<li class="text-navy font-semibold">{% trans "Create New Inquiry" %}</li>
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</ol>
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</nav>
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<!-- Page Header -->
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<div class="mb-6 animate-in">
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<h1 class="text-2xl font-bold text-navy flex items-center gap-3">
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<div class="w-10 h-10 bg-blue/10 rounded-xl flex items-center justify-center">
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<i data-lucide="plus-circle" class="w-5 h-5 text-blue"></i>
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</div>
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{% trans "Create New Inquiry" %}
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</h1>
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<p class="text-slate mt-1">{% trans "Create a new patient inquiry or request" %}</p>
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</div>
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<!-- Form Card -->
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<form method="post" action="{% url 'complaints:inquiry_create' %}" id="inquiryForm" class="form-card max-w-5xl animate-in">
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{% csrf_token %}
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<div class="card-header">
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<h2 class="text-lg font-bold text-navy flex items-center gap-2 m-0">
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<i data-lucide="file-text" class="w-5 h-5"></i>
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{% trans "Inquiry Information" %}
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</h2>
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</div>
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<div class="p-0">
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<!-- Organization Section -->
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<div class="form-section">
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<h3 class="section-title">
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<i data-lucide="building" class="w-5 h-5"></i>
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{% trans "Organization" %}
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</h3>
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<div class="grid grid-cols-1 md:grid-cols-2 gap-5">
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<div class="form-group">
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<label for="{{ form.hospital.id_for_label }}" class="form-label">
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{{ form.hospital.label }} <span class="text-red-500">*</span>
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</label>
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{{ form.hospital }}
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{% if form.hospital.help_text %}
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<p class="form-help">{{ form.hospital.help_text }}</p>
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{% endif %}
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{% for error in form.hospital.errors %}
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<p class="form-error">
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<i data-lucide="alert-circle" class="w-4 h-4"></i>
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{{ error }}
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</p>
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{% endfor %}
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</div>
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<div class="form-group">
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<label for="{{ form.department.id_for_label }}" class="form-label">
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{{ form.department.label }}
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</label>
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{{ form.department }}
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{% for error in form.department.errors %}
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<p class="form-error">
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<i data-lucide="alert-circle" class="w-4 h-4"></i>
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{{ error }}
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</p>
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{% endfor %}
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</div>
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</div>
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</div>
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<!-- Contact Information Section -->
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<div class="form-section">
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<h3 class="section-title">
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<i data-lucide="user" class="w-5 h-5"></i>
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{% trans "Contact Information" %}
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</h3>
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<div class="grid grid-cols-1 md:grid-cols-2 gap-5">
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<div class="form-group">
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<label for="{{ form.contact_name.id_for_label }}" class="form-label">
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{{ form.contact_name.label }} <span class="text-red-500">*</span>
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</label>
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{{ form.contact_name }}
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{% for error in form.contact_name.errors %}
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<p class="form-error">
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<i data-lucide="alert-circle" class="w-4 h-4"></i>
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{{ error }}
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</p>
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{% endfor %}
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</div>
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<div class="form-group">
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<label for="{{ form.contact_phone.id_for_label }}" class="form-label">
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{{ form.contact_phone.label }} <span class="text-red-500">*</span>
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</label>
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{{ form.contact_phone }}
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{% for error in form.contact_phone.errors %}
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<p class="form-error">
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<i data-lucide="alert-circle" class="w-4 h-4"></i>
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{{ error }}
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</p>
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{% endfor %}
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</div>
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<div class="form-group md:col-span-2">
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<label for="{{ form.contact_email.id_for_label }}" class="form-label">
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{{ form.contact_email.label }}
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</label>
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{{ form.contact_email }}
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{% for error in form.contact_email.errors %}
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<p class="form-error">
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<i data-lucide="alert-circle" class="w-4 h-4"></i>
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{{ error }}
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</p>
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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 Section -->
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<div class="form-section">
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<h3 class="section-title">
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<i data-lucide="help-circle" class="w-5 h-5"></i>
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{% trans "Inquiry Details" %}
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</h3>
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<div class="grid grid-cols-1 md:grid-cols-2 gap-5">
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<div class="form-group">
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<label for="{{ form.category.id_for_label }}" class="form-label">
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{{ form.category.label }} <span class="text-red-500">*</span>
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</label>
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{{ form.category }}
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{% for error in form.category.errors %}
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<p class="form-error">
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<i data-lucide="alert-circle" class="w-4 h-4"></i>
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{{ error }}
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</p>
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{% endfor %}
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</div>
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<div class="form-group">
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<label for="{{ form.priority.id_for_label }}" class="form-label">
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{{ form.priority.label }}
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</label>
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{{ form.priority }}
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{% if form.priority.help_text %}
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<p class="form-help">{{ form.priority.help_text }}</p>
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{% endif %}
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{% for error in form.priority.errors %}
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<p class="form-error">
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<i data-lucide="alert-circle" class="w-4 h-4"></i>
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{{ error }}
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</p>
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{% endfor %}
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</div>
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</div>
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<div class="form-group">
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<label for="{{ form.subject.id_for_label }}" class="form-label">
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{{ form.subject.label }} <span class="text-red-500">*</span>
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</label>
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{{ form.subject }}
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{% for error in form.subject.errors %}
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<p class="form-error">
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<i data-lucide="alert-circle" class="w-4 h-4"></i>
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{{ error }}
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</p>
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{% endfor %}
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</div>
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<div class="form-group">
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<label for="{{ form.message.id_for_label }}" class="form-label">
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{{ form.message.label }} <span class="text-red-500">*</span>
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</label>
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{{ form.message }}
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{% for error in form.message.errors %}
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<p class="form-error">
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<i data-lucide="alert-circle" class="w-4 h-4"></i>
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{{ error }}
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</p>
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{% endfor %}
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</div>
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</div>
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</div>
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<!-- Form Actions -->
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<div class="p-6 bg-slate-50 border-t border-slate-200 rounded-b-1rem flex gap-3">
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<button type="submit" class="btn-primary">
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<i data-lucide="check-circle" class="w-5 h-5"></i>
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{% trans "Create Inquiry" %}
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</button>
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<a href="{% url 'complaints:inquiry_list' %}" class="btn-secondary">
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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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</div>
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<script>
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document.addEventListener('DOMContentLoaded', function() {
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lucide.createIcons();
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// Add error class to inputs with errors
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document.querySelectorAll('.form-error').forEach(function(errorEl) {
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const input = errorEl.parentElement.querySelector('.form-input');
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if (input) {
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input.classList.add('error');
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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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