{% extends 'base.html.twig' %}

{% block title %}Toxicología{% endblock %}

{% block body %}

    <div class="container-fluid">
        <div class="row mt-5">
            <div class="col-12">
                <h6 class="m-0 font-weight-bold text-primary text-uppercase">Registro de Toxicología</h6>
            </div>
        </div>
        <div class="row mt-2">
            <div class="col-md-12">
                <form method="post" class="form-inline mt-3">
                    <input name="curp" id="curp" value="" placeholder="CURP" class="form-control mb-2 mr-sm-2">&nbsp;<button
                            class="btn btn-primary mb-2" id="curpContinue">Continuar
                    </button>
                </form>
                <div class="alert alert-danger mt-2" id="notFoundMsg" style="display: none" role="alert">¡CURP no
                    registrado en BlackTrust!
                </div>
                <br>
            </div>
        </div>
    </div>


    <!-- Modal -->
    <div class="modal fade" id="evalModal" tabindex="-1" role="dialog" aria-labelledby="evalModalLabel"
         aria-hidden="true">
        <div class="modal-dialog modal-lg" role="document">
            <div class="modal-content">
                <div class="modal-header">
                    <h6 class="text-secondary">Evaluar examen toxicológico</h6>
                    <button type="button" class="close" data-dismiss="modal" aria-label="Close">
                        <span aria-hidden="true">&times;</span>
                    </button>
                </div>
                <div class="modal-body">
                    <form id="toxi-evaluation" action="/toxi" method="post" enctype="multipart/form-data">
                        <div class="row">
                            <div class="col-sm-12">
                                <div style="margin-bottom: 0" class="alert alert-warning" id="newRegisterAlert">National
                                    ID no registrado, se creará un nuevo registro.
                                </div>
                                <br>
                            </div>
                        </div>
                        <div class="row justify-content-center">
                            <div class="col-md-10">
                                <div class="text-center">
                                    <h4 class="modal-userName font-weight-bold text-center mt-2"></h4>
                                </div>
                            </div>
                            <div class="col-md-10 mt-3">
                                <div class="row">
                                    <div class="col-sm-4 no-gutters">
                                        <div class="col-12">
                                            <label class="col-form-label">Sustancias</label>
                                        </div>
                                        <ul class="list-group">
                                            <li class="list-group-item">
                                                <div class="form-check">
                                                    <input class="form-check-input" name="substances" type="checkbox" value="thc" id="tox_thc">
                                                    <label class="form-check-label" for="tox_thc">
                                                        THC
                                                    </label>
                                                </div>
                                            </li>
                                            <li class="list-group-item">
                                                <div class="form-check">
                                                    <input class="form-check-input" name="substances" type="checkbox" value="coc" id="tox_coc">
                                                    <label class="form-check-label" for="tox_coc">
                                                        COC
                                                    </label>
                                                </div>
                                            </li>
                                            <li class="list-group-item">
                                                <div class="form-check">
                                                    <input class="form-check-input" name="substances" type="checkbox" value="amp" id="tox_amp">
                                                    <label class="form-check-label" for="tox_amp">
                                                        AMP
                                                    </label>
                                                </div>
                                            </li>
                                        </ul>
                                    </div>
                                    <div class="col-sm-8">
                                        <div class="col-12">
                                            <label class="col-form-label">Fotografías</label>
                                            <div class="row">
                                                <div class="col-4">
                                                    <div id="test1" data-min-width="300"></div>
                                                </div>
                                                <div class="col-4">
                                                    <div id="test2" data-min-width="300"></div>
                                                </div>
                                                <div class="col-4">
                                                    <div id="test3" data-min-width="300"></div>
                                                </div>

                                                <div class="col-12 mt-3">
                                                    <div class="form-check">
                                                        <input class="form-check-input" name="receta" type="checkbox" value="receta" id="tox_receta">
                                                        <label class="form-check-label" for="tox_receta">
                                                            ¿Cuenta con receta médica?
                                                        </label>
                                                    </div>
                                                </div>
                                                {#<input type="file" id="test1" name="test1" accept="image/png, image/jpeg">#}
                                                {#<input type="file" id="test2" name="test1" accept="image/png, image/jpeg">#}
                                                {#<input type="file" id="test3" name="test1" accept="image/png, image/jpeg">#}
                                            </div>
                                        </div>
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-10">
                                <div class="form-group row">
                                    <div class="col-sm-12">
                                        <label for="message-text" class="col-form-label">Comentarios:</label>
                                        <textarea  name="comments" class="form-control" id="comments"></textarea>
                                    </div>
                                </div>
                                <div class="form-group row">
                                    <input type="hidden" name="candidateId" id="candidateId" value="">
                                    <label for="evalResult" class="col-sm-4 col-form-label">Resultado</label>
                                    <div class="col-sm-8">
                                        <select class="form-control" id="evalResult" name="evalResult">
                                            <option value="">-----</option>
                                            <option value="APPROVED">Aprobado</option>
                                            <option value="NOT_APPROVED">No aprobado</option>
                                        </select>
                                    </div>
                                </div>
                                <div class="form-group row">
                                    <input type="hidden" name="candidateId" id="candidateId" value="">
                                    <label for="evalResult" class="col-sm-4 col-form-label">Ciudad</label>
                                    <div class="col-sm-8">
                                        <select class="form-control" id="city" name="city">
                                            <option value="">-----</option>
                                            {% for cityId, cityName in cities %}
                                                <option value="{{ cityId }}">{{ cityName }}</option>
                                            {% endfor %}
                                        </select>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-sm-12">
                                        <span class="form-alerts text-danger"></span>
                                    </div>
                                </div>
                                <div class="form-group row">
                                    <div class="col-10 text-right mt-3">
                                        <button type="button" data-dismiss="modal" aria-label="Close" class="btn btn-dark">Cancelar</button>
                                    </div>
                                    <div class="col-2 text-right mt-3">

                                        <button type="submit" class="btn btn-primary mb-2">Guardar</button>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </form>
                </div>
{#              <div class="modal-footer">#}
{#                  <button type="button" class="btn btn-secondary" data-dismiss="modal">Close</button>#}
{#                  <button type="button" class="btn btn-primary">Send message</button>#}
{#               </div>#}
            </div>
        </div>
    </div>



{% endblock %}
{% block javascripts %}
    {{ parent() }}
    {{ encore_entry_script_tags('toxi') }}
{% endblock %}