{% extends 'basic.html' %}
{% load humanize i18n static %}
{% block title %}
Pendaftaran
{% endblock %}
{% block head %}
{% endblock %}

{% block content %}
{% language 'id' %}
<style>
    label{
        text-align: left !important
    }
</style>

<div class="tab-pane fade show active" id="pills-home" role="tabpanel" aria-labelledby="pills-home-tab" tabindex="0">

    <form method="post" action="/pemeriksaan/post_bulk_pasien">
        {% csrf_token %}
        <div class="card-body mb-12">
                <div style="display: flex;justify-content: center;text-align: center;" class="mb-3">
                    <h3><b>FORM INPUT PASIEN</b></h3>
                </div>
                <div class="col-sm-12 mb-3">
                    <label style="display: flex;"><b>Pasien</b></label>
                    <select style="border-radius: 5px !important;" class="form-select" aria-label="Default select example" id="ruang_rawat_pasien" name="ruang_rawat_pasien" required>
                        <option value="">Pilih pasien..</option>
                        {% for item in pasien %}
                            <option value="{{item.id}}">{{item.pasien.first_name}}</option>
                        {% endfor %}
                    </select>
                </div>
                <div class="col-sm-12 mb-3">
                    <label style="display: flex;"><b>Keluhan Utama</b></label>
                    <input placeholder="" style="border-radius: 5px !important;" type="text" class="form-control" name="" value="">
                </div>
                <div style="display: flex;">
                    <div class="col-sm-6 mb-3" style="margin-right: 10px">
                        <label style="display: flex;"><b>Tensi</b></label>
                        <input placeholder="" style="border-radius: 5px !important;" type="text" class="form-control" name="" value="">
                    </div>
                    <div class="col-sm-6 mb-3" style="margin-left: 10px">
                        <label style="display: flex;"><b>NADI</b></label>
                        <input placeholder="" style="border-radius: 5px !important;" type="text" class="form-control" name="" value="">
                    </div>
                </div>
                <div style="display: flex;">
                    <div class="col-sm-6 mb-3" style="margin-right: 10px">
                        <label style="display: flex;"><b>RR</b></label>
                        <input placeholder="" style="border-radius: 5px !important;" type="text" class="form-control" name="" value="">
                    </div>
                    
                    
                    <div class="col-sm-6 mb-3" style="margin-left: 10px">
                        <label style="display: flex;"><b>Suhu</b></label>
                        <input placeholder="" style="border-radius: 5px !important;" type="text" class="form-control" name="" value="">
                    </div>
                </div>
                <div style="display: flex;">
                    <div class="col-sm-6 mb-3" style="margin-right: 10px">
                        <label style="display: flex;"><b>TB</b></label>
                        <input placeholder="" style="border-radius: 5px !important;" type="text" class="form-control" name="" value="">
                    </div>
                    
                    <div class="col-sm-6 mb-3" style="margin-left: 10px">
                        <label style="display: flex;"><b>BB</b></label>
                        <input placeholder="" style="border-radius: 5px !important;" type="text" class="form-control" name="" value="">
                    </div>
                </div>
                <div class="col-sm-12 mb-3">
                    <label style="display: flex;"><b>Hasil kajian</b></label>
                    <select style="border-radius: 5px !important;" class="form-select" aria-label="Default select example" id="ruang_rawat_pasien" name="ruang_rawat_pasien" required>
                        <option value="">Pilih ..</option>
                        <option value="1">Tidak Beresiko</option>
                        <option value="2">Resiko Rendah</option>
                        <option value="3">Resiko Tinggi</option>
                    </select>
                </div>
                <div class="col-sm-12 mb-3">
                    <label style="display: flex;"><b>Analisa</b></label>
                    <select style="border-radius: 5px !important;" class="form-select" aria-label="Default select example" id="ruang_rawat_pasien" name="ruang_rawat_pasien" required>
                        <option value="">Pilih ..</option>
                        <option value="1">Tidak Beresiko</option>
                        <option value="2">Resiko Rendah</option>
                        <option value="3">Resiko Tinggi</option>
                    </select>
                </div>
                <div style="display: flex;">
                    <div class="col-sm-6 mb-3" style="margin-right: 10px">
                        <label style="display: flex;"><b>Nama Perawat</b></label>
                        <input placeholder="" style="border-radius: 5px !important;" type="text" class="form-control" name="" value="">
                    </div>
                    <div class="col-sm-6 mb-3" style="margin-left: 10px">
                        <label style="display: flex;"><b>Nama Dokter</b></label>
                        <input placeholder="" style="border-radius: 5px !important;" type="text" class="form-control" name="" value="">
                    </div>
                </div>
            </div>
        </div>
    </form>
</div>
<script src="https://cdn.jsdelivr.net/npm/sweetalert2@10"></script>
<script>
    function confirmSubmit() {
        // Use SweetAlert for confirmation
        Swal.fire({
            title: 'Hi, Admin!',
            text: 'Apakah kamu yakin untuk mendaftarkan pasien?',
            icon: 'warning',
            showCancelButton: true,
            confirmButtonColor: '#3085d6',
            cancelButtonColor: '#d33',
            confirmButtonText: 'Yes'
        }).then((result) => {
            if (result.isConfirmed) {
                // If user clicks "Yes," submit the form
                document.getElementById('form_pendaftaran').submit();
            }
        });

        // Prevent the default form submission
        return false;
    }
</script>


<script>

</script>
{% endlanguage %}
{% endblock content %}