{% extends 'backend/components/layouts/auth.html' %}
{% load static %}

{% block content %}
<div class="panel h-full w-full">

    <!-- infobox -->
<div class="border border-gray-500/20 rounded-md shadow-[rgb(31_45_61_/_10%)_0px_2px_10px_1px] dark:shadow-[0_2px_11px_0_rgb(6_8_24_/_39%)] p-6 pt-12 mt-8 relative">
    <div class="bg-primary absolute text-white-light left-6 -top-8 w-16 h-16 rounded-md flex items-center justify-center mb-5 mx-auto">
        <svg width="24" height="24" viewBox="0 0 24 24" fill="none" xmlns="http://www.w3.org/2000/svg">
            <path d="M22 22L2 22" stroke="currentColor" stroke-width="1.5" stroke-linecap="round" />
            <path d="M2 11L10.1259 4.49931C11.2216 3.62279 12.7784 3.62279 13.8741 4.49931L22 11" stroke="currentColor" stroke-width="1.5" stroke-linecap="round" />
            <path opacity="0.5" d="M15.5 5.5V3.5C15.5 3.22386 15.7239 3 16 3H18.5C18.7761 3 19 3.22386 19 3.5V8.5" stroke="currentColor" stroke-width="1.5" stroke-linecap="round" />
            <path d="M4 22V9.5" stroke="currentColor" stroke-width="1.5" stroke-linecap="round" />
            <path d="M20 22V9.5" stroke="currentColor" stroke-width="1.5" stroke-linecap="round" />
            <path opacity="0.5" d="M15 22V17C15 15.5858 15 14.8787 14.5607 14.4393C14.1213 14 13.4142 14 12 14C10.5858 14 9.87868 14 9.43934 14.4393C9 14.8787 9 15.5858 9 17V22" stroke="currentColor" stroke-width="1.5" />
            <path opacity="0.5" d="M14 9.5C14 10.6046 13.1046 11.5 12 11.5C10.8954 11.5 10 10.6046 10 9.5C10 8.39543 10.8954 7.5 12 7.5C13.1046 7.5 14 8.39543 14 9.5Z" stroke="currentColor" stroke-width="1.5" />
        </svg>
    </div>


<h5 class="text-dark text-lg font-semibold mb-3.5 dark:text-white-light">Participant Medical prescription.</h5>

    
</div>

<br/>
    <div class="panel h-full w-full">
        <div class="flex items-center justify-between mb-5">
            <h5 class="font-semibold text-lg dark:text-white-light">Participant Medical prescription form</h5>
        </div>
        <form method="post" class="border border-[#ebedf2] dark:border-[#191e3a] rounded-md p-4 mb-5 bg-white dark:bg-[#0e1726]">
            {% csrf_token %}
            <h6 class="text-lg font-bold mb-5">Participant's Prescription</h6>
            <div class="flex flex-col sm:flex-row">
                
                <div class="flex-1 grid grid-cols-1 sm:grid-cols-2 gap-5">
                    <div class="col-span-2">
                        <label for="participant">Participant</label>
                        <input type="text" class="form-input" value="{{ health_service.participant.name }} - ({{ health_service.participant.phone }} - {{ health_service.participant.email }})" disabled>
                    
                        <input type="hidden" name="participant" value="{{ health_service.participant.id }}">
                    </div>
        
                    <div class="col-span-2">
                        <label for="services">Service</label>
                        <input type="text" class="form-input" value="{{ health_service.service.service_title }}" disabled>
                        <input type="hidden" name="services" value="{{ health_service.service.id }}">
                    </div>
                    
        
                    <div class="col-span-2">
                        <label for="participant_results">Participant Test Results from Nurse 
                        <span style="color: #a9a9a9; font-style: italic;">e.g., Blood Pressure, Temperature, Random Blood Sugar Level, etc.</span>
                        </label>
                        <textarea id="participant_results" name="participant_results" rows="7" class="form-input" disabled placeholder="(**Participant Results from your service/s e.g., Blood Pressure, Temperature, Random Blood Sugar Level, etc.**)" x-tooltip="Describe the results and outcomes of the tests of your service/s.">{{ health_service.participant_results }}</textarea>
                    </div>
                    
                    <div class="col-span-2">
                        <label for="service_officer_officer_feedback">Nurse Notes, <span style="color: #a9a9a9; font-style: italic;">e.g., Nurse Feedback, Comments, Suggestions etc.</span></label>
                        <textarea id="service_officer_officer_feedback" name="service_officer_officer_feedback" rows="7" class="form-input" disabled placeholder="(**Nurse Notes, Feedback, Comments, Suggestions etc.**)" x-tooltip="Provide feedback from the service officer regarding the results and outcomes from the tests.">{{ health_service.service_officer_officer_feedback }}</textarea>
                    </div>
                    <br/>
                    <h6 class="font-semibold text-lg dark:text-white-light">For Doctor Use only!</h6>
                    <div class="col-span-2">
                        <label for="doctors_feedback">Your Notes:<span style="color: #a9a9a9; font-style: italic;">e.g., Diagnosis, Feedback, Comments, Suggestions etc.</span></label>
                        <span style="color: #a9a9a9; font-style: italic;">Required<span style="color: Red;">*</span></span>
                        </label>
                        <textarea id="doctors_feedback" name="doctors_feedback" rows="7" class="form-input" placeholder="(**Your Diagnosis, Feedback, Comments, Suggestions etc.**)" x-tooltip="Your Diagnosis, Feedback, Comments, Suggestions etc."></textarea>
                    </div>
                    <div class="col-span-2">
                        <label for="doctors_prescription">Your Prescription to {{ health_service.participant.name }}
                        <span style="color: #a9a9a9; font-style: italic;">Required <span style="color: Red;">*</span></span>
                        </label>
                        <textarea id="doctors_prescription" name="doctors_prescription" rows="7" class="form-input"  placeholder="(**Your Prescription to {{ health_service.participant.name }}**)" x-tooltip="Your Prescription to {{ health_service.participant.name }}."></textarea>
                    </div>
                    
                </div>
            </div>
            
            <div class="sm:col-span-2 mt-3">
                <button type="submit" class="btn btn-primary">Diagnosis and Prescription to  {{ health_service.participant.name }}</button>
            </div>
        </form>
        
    </div>
<script>
    
    document.addEventListener("alpine:init", () => {
        Alpine.directive("tooltip", (el, {
            expression
        }) => {
            tippy(el, {
                content: expression,
                placement: el.getAttribute("data-placement") || undefined,
                allowHTML: true,
                delay: el.getAttribute("data-delay") || 0,
                animation: el.getAttribute("data-animation") || "fade",
                theme: el.getAttribute("data-theme") || "",
            });
        });
    });
    
    

</script>

{% endblock %}