{% extends 'MainBundle:Master:template.html.twig' %}

{% block scripts %}

    <link rel="stylesheet" href="{{ asset('bundles/utilities/sweetalert/sweetalert.css') }}" >
    <script type="text/javascript" src="{{ asset('bundles/utilities/sweetalert/sweetalert.min.js') }}"></script>

    <script type="text/javascript" src="{{ asset('bundles/receive/js/receive.js') }}"></script>
    <link rel="stylesheet" href="{{ asset('bundles/receive/css/receive.css') }}"/>

    <script type="text/javascript">
        var UrlUpdaData = '{{ path("updateDataPatient") }}';
        var urlSendFile = '{{ path("SendFile") }}';
        var UrlSaveDataWorklist = '{{ path("SaveDataWorklist") }}';
        var UrlNewData = '{{ path('receive_homepage') }}';
        var UrlDataMunicipality = '{{ path("municipalityList") }}';
        var UrlDataPatient = '{{ path("patientList") }}';
        var UrlDataStudies = '{{ path("studyList") }}';
        var UrlDataRoom = '{{ path("roomList") }}';
        var years = '{{ 'receive.years'|trans([], 'LocalizationBundle') }}';
        var months = '{{ 'receive.months'|trans([], 'LocalizationBundle') }}';
        var year = '{{ 'receive.year'|trans([], 'LocalizationBundle') }}';
        var month = '{{ 'receive.month'|trans([], 'LocalizationBundle') }}';
        var day = '{{ 'receive.day'|trans([], 'LocalizationBundle') }}';
        var days = '{{ 'receive.days'|trans([], 'LocalizationBundle') }}';
        var select = '{{ 'receive.select'|trans([], 'LocalizationBundle') }}';
        var study = '{{ 'receive.study'|trans([], 'LocalizationBundle') }}';
        var room = '{{ 'receive.room'|trans([], 'LocalizationBundle') }}';
        var option = '';
        {% for mod in modList %}
        option += '<option value="{{ mod.varMod }}">{{ mod.varMod }}</option>';
        {% endfor %}
        var modality = '{{ 'receive.modality'|trans([], 'LocalizationBundle') }}';
        var mandatory_email = '{{ 'receive.mandatory_email'|trans([], 'LocalizationBundle') }}';
        var ok = '{{ 'receive.ok'|trans([], 'LocalizationBundle') }}';
        var cancel = '{{ 'receive.cancel'|trans([], 'LocalizationBundle') }}';
    </script>
{% endblock %}
{% block content %}
    <section>
    <article>
    <div id="accordion1">
    <h3>{{ 'receive.receive_title'|trans([], 'LocalizationBundle') }}:</h3>

    <div>
    <input id="firstLastName" name="firstLastName" type="text" value="" tabindex="1001" class="txtdatid" onblur="javascript:this.value=this.value.toUpperCase();">
    <input id="secondLastName" name="secondLastName" type="text" value="" tabindex="1002" class="txtdatid" onblur="javascript:this.value=this.value.toUpperCase();">
    <input id="firstName" name="firstName" type="text" value="" tabindex="1003" class="txtdatid" onblur="javascript:this.value=this.value.toUpperCase();">
    <input id="secondName" name="secondName" type="text" value="" tabindex="1004" class="txtdatid" onblur="javascript:this.value=this.value.toUpperCase();">
    <input id="gender" name="gender" type="text" value="" tabindex="1005" class="txtdatid">
    <input id="birthDate" name="birthDate" type="text" value="" tabindex="1006" class="txtdatid">
    <input id="gs_rh" name="gs_rh" type="text" value="" tabindex="1007" class="txtdatid">
    <input id="first_number" type="text" tabindex="1008" class="txtdatid">
    <input id="second_number" type="text" tabindex="1009" class="txtdatid">

    <div  class="table_data">

    <div>
        <fieldset>
            <table>
                <tr>
                    <th><label id="" for="style">{{ 'receive.document'|trans([], 'LocalizationBundle') }}: (*)</label></th>
                    <td>
                        <input id="doc" name="doc" maxlength="20" class="field_receive" type="text" required="required"
                               tabindex="1000">
                        <input type="button" id="button" tabindex="1010" value="Buscar"/>
                    </td>
                </tr>
            </table>
        </fieldset>
    </div>
    <div id="ocult1" style="visibility: hidden;">
    <div>
    <fieldset>
        <table >
            <tr>
                <td>
                    <label for="style">{{ 'receive.son_of'|trans([], 'LocalizationBundle') }}:</label>
                </td>
                <td>
                    <div class="div_left_check">
                        <input type="checkbox" name="hijo" id="son_of" required="required"/>
                    </div>
                </td>
                <td class="space_table"></td>
                <td>
                    &nbsp;
                </td>
                <td>
                    &nbsp;
                </td>
            </tr>
        </table>
    </fieldset>
    <fieldset>
        <table>
            <tr>
                <th><label for="style">{{ 'receive.id_type'|trans([], 'LocalizationBundle') }}: (*)</label>
                </th>
                <td><select id="documentType" name="documentType" required="required" class="select_receive">
                        <option value="">Seleccione</option>
                        <!--<option value="1">CC</option>
                        <option value="2">CE</option>
                        <option value="3">PA</option>
                        <option value="4">RC</option>
                        <option value="5">TI</option>
                        <option value="8">{# 'receive.not_available'|trans([], 'LocalizationBundle') #}</option>-->
                        {% for document in typeDocument %}
                            <option value="{{ document.docType }}">{{ document.docType }}</option>
                        {% endfor %}
                    </select>
                </td>
                <td class="space_table"></td>
                <th>
                    <label for="style">{{ 'receive.GS_RH'|trans([], 'LocalizationBundle') }}: (*)</label>
                </th>
                <td>
                    <select id="rh" name="rh" class="select_receive" required="required">
                        {% for blood in bloodList %}
                            <option value="{{ loop.index0 }}">{{ blood.tipo }}{{ blood.RH }}</option>
                        {% endfor %}
                    </select>
                </td>
            </tr>
            <tr>
                <th><label for="style">{{ 'receive.first_name'|trans([], 'LocalizationBundle') }}: (*)</label>
                </th>
                <td>
                    <input name="firstName" id="firstName_1" class="field_receive" type="text" required="required" onkeyup="javascript:this.value=this.value.toUpperCase();">
                </td>
                <td class="space_table"></td>
                <th>
                    <label for="style">{{ 'receive.second_name'|trans([], 'LocalizationBundle') }}:</label>
                </th>
                <td>
                    <input name="secondName_1" id="secondName_1" class="field_receive" type="text" id="secondName" onkeyup="javascript:this.value=this.value.toUpperCase();">
                </td>
            </tr>
            <tr>
                <th>
                    <label for="style">{{ 'receive.first_last_name'|trans([], 'LocalizationBundle') }}:  (*)</label>
                </th>
                <td>
                    <input class="field_receive" id="firstLastName_1" name="firstLastName_1" type="text" required="required" onkeyup="javascript:this.value=this.value.toUpperCase();">
                </td>
                <td class="space_table"></td>
                <th>
                    <label for="style">{{ 'receive.second_last_name'|trans([], 'LocalizationBundle') }}:</label>
                </th>
                <td>
                    <input class="field_receive" name="secondLastName_1" id="secondLastName_1" type="text" onkeyup="javascript:this.value=this.value.toUpperCase();">
                </td>
            </tr>


            <tr>
                <th>
                    <label for="style">{{ 'receive.birthday'|trans([], 'LocalizationBundle') }}</label><br>
                    <label>( YYYY-mm-dd ) : (*)</label>
                </th>
                <td>
                    <input name="dateBirth" id="dateBirth" class="field_receive" type="text" required="required">
                </td>
                <td class="space_table"></td>
                <th>
                    <label for="style">{{ 'receive.age_typing'|trans([], 'LocalizationBundle') }} : (*)</label>
                </th>
                <td>
                    <input id="age" name="age" maxlength="3" type="text" class="field_receive" required="required" disabled="disabled">
                </td>
            </tr>
            <tr>
                <th><label for="style">{{ 'receive.gender'|trans([], 'LocalizationBundle') }}: (*)</label></th>
                <td>
                    <div class="div_left">
                        {{ 'receive.men'|trans([], 'LocalizationBundle') }}
                        <input id="sex-M" type="radio" name="sex" value="M" required="required" checked="checked">
                    </div>
                    <div class="div_right">
                        {{ 'receive.women'|trans([], 'LocalizationBundle') }}
                        <input id="sex-F" type="radio" name="sex" value="F" required="required">
                    </div>
                </td>
                <td class="space_table"></td>
                <th>
                    <label for="style">{{ 'receive.old_type'|trans([], 'LocalizationBundle') }} : (*)</label>
                </th>
                <td>
                    <select name="type_age" id="type_age" class="select_receive" required="required">
                        <option value="">{{ 'receive.select'|trans([], 'LocalizationBundle') }}</option>
                        <option value="1">{{ 'receive.years'|trans([], 'LocalizationBundle') }}</option>
                        <option value="2">{{ 'receive.months'|trans([], 'LocalizationBundle') }}</option>
                        <option value="3">{{ 'receive.days'|trans([], 'LocalizationBundle') }}</option>
                    </select>
                </td>
            </tr>
        </table>
    </fieldset>
    <fieldset>
        <table class="table_ar">
            <tr>
                <th>
                    <label for="style">{{ 'receive.departament_name'|trans([], 'LocalizationBundle') }}: (*)</label>
                </th>
                <td>
                    <select class="select_receive" id="departamentName" name="departmentName" required="required">
                        <option value="">{{ 'receive.select'|trans([], 'LocalizationBundle') }}</option>
                        {% for departamento in list_dept %}
                            <option value="{{ departamento.departmentCode }}">{{ departamento.departmentName }}</option>
                        {% endfor %}
                    </select>
                </td>
                <td class="space_table"></td>
                <th><label for="style">{{ 'receive.municipality'|trans([], 'LocalizationBundle') }}: (*)</label></th>
                <td>
                    <select id="municipalityName" class="select_receive" name="municipalityName"
                            required="required">
                        <option value="">{{ 'receive.select'|trans([], 'LocalizationBundle') }}</option>
                    </select>
                </td>
            </tr>
            <tr>
                <th>
                    <label for="style">{{ 'receive.residential_zone'|trans([], 'LocalizationBundle') }}: (*)</label>
                </th>
                <td>
                    <div class="div_left">
                        {{ 'receive.urban'|trans([], 'LocalizationBundle') }}
                        <input type="radio" name="zona" id="zona-1" value="1" checked="checked" required="required">
                    </div>
                    <div class="div_right">
                        {{ 'receive.rural'|trans([], 'LocalizationBundle') }}
                        <input type="radio" name="zona" id="zona-2" value="2" required="required">
                    </div>
                </td>
                <td class="space_table"></td>
                <th>
                    <label for="style">{{ 'receive.address'|trans([], 'LocalizationBundle') }}: (*)</label>
                </th>
                <td>
                    <input type="text" class="field_receive" id="address" name="address" required="required">
                </td>
            </tr>
            <tr>
                <th>
                    <label for="style">{{ 'receive.phone'|trans([], 'LocalizationBundle') }}: (*)</label>
                </th>
                <td>
                    <input id="telephone" maxlength="10" class="field_receive" name="telephone" type="text"
                           required="required">
                </td>
                <td class="space_table"></td>
                <th>
                    <label for="style">{{ 'receive.cellphone'|trans([], 'LocalizationBundle') }}:</label>
                </th>
                <td>
                    <input id="cellphone" maxlength="10" class="field_receive" name="cellphone" type="tel">
                </td>

            </tr>
            <tr>
                <th><label for="style">{{ 'receive.guardian'|trans([], 'LocalizationBundle') }}:</label></th>
                <td><input id="acud" name="acud" class="field_receive" type="text">
                </td>
                <td class="space_table"></td>
                <th><label for="style">{{ 'receive.email'|trans([], 'LocalizationBundle') }}:</label></th>
                <td><input id="email" name="email" class="field_receive" type="email"></td>
                <td><span id="reqEmail"></span></td>
            </tr>
            <tr>
                <td>
                <br>
                <input type="button" id="updateDataPatient" class="ui-button ui-widget ui-state-default ui-corner-all" value="Actualizar Datos Paciente">
                </td>
            </tr>
        </table>
    </fieldset>
    </div>
    <fieldset>
        <table id="modality_st_one">
            <tr>
                <th><label for="style">{{ 'receive.doctor_referring'|trans([], 'LocalizationBundle') }}: (*)</label></th>
                <td><input id="doctor_referring" name="doctor_referring" class="field_receive" type="text" required="required" onkeyup="javascript:this.value=this.value.toUpperCase();">
                </td>
                <td class="space_table"></td>
                <th><label for="style">{{ 'receive.clinicalData'|trans([], 'LocalizationBundle') }}: (*)</label></th>
                <td>
                    <div class="div_left">
                        {{ 'receive.yes'|trans([], 'LocalizationBundle') }}
                        <input type="radio" name="clinicalData" value="1" checked="checked" required="required">
                    </div>
                    <div class="div_right">
                        {{ 'receive.no'|trans([], 'LocalizationBundle') }}
                        <input type="radio" name="clinicalData" value="2" required="required">
                    </div>
                </td>
            </tr>
            <tr>
                <th><label for="style">{{ 'patient.prio.label'|trans([], 'LocalizationBundle') }}: (*)</label></th>
                <td><select id="select_priority" name="select_priority" class="select_receive">
                        {% for priority in priList %}
                            <option value="{{ priority.priId }}">{{ priority.priName }}</option>
                        {% endfor %}
                    </select>
                </td>
                <td class="space_table"></td>
                <th><label for="style">{{ 'patient.prec.label'|trans([], 'LocalizationBundle') }}: (*)</label></th>
                <td>
                    <select id="select_procedence" name="select_procedence" class="select_receive">
                        {% for provenance in proList %}
                            <option value="{{ provenance.id }}">{{ provenance.name }}</option>
                        {% endfor %}
                    </select>
                </td>
                <td class="space_table"></td>
                <th><label for="style">{{ 'receive.agreement'|trans([], 'LocalizationBundle') }}: (*)</label></th>
                <td>
                    <select id="select_convenio" name="select_convenio" class="select_receive">
                        {% for eps in epsList %}
                            <option value="{{ eps.idEps }}">{{ eps.name }}</option>
                        {% endfor %}
                    </select>
                </td>
            </tr>
        </table>
    </fieldset>
    <fieldset>
    <table id="modality_st">
            <tr>
                <th><label for="style">{{ 'receive.modality'|trans([], 'LocalizationBundle') }}: (*)</label></th>
                <td><select id="select_modality" title="select_studies" alt="select_room" name="select_modality"
                            class="select_receive modality_worklist">
                        <option value="">{{ 'receive.select'|trans([], 'LocalizationBundle') }}</option>
                        
                            {% for mod in modList %}
                            <option value="{{ mod.varMod }}">{{ mod.varMod }}</option>
                        {% endfor %}
                    </select>
                </td>
                <td class="space_table"></td>
                <th><label for="style">{{ 'receive.study'|trans([], 'LocalizationBundle') }}: (*)</label></th>
                <td>
                    <select id="select_studies" name="select_studies" class="select_receive">
                        <option value="">{{ 'receive.select'|trans([], 'LocalizationBundle') }}</option>
                    </select>
                </td>
                <td class="space_table"></td>
                <th><label for="style">{{ 'receive.room'|trans([], 'LocalizationBundle') }}: (*)</label></th>
                <td><select id="select_room" name="select_room" class="select_receive">
                        <option value="">{{ 'receive.select'|trans([], 'LocalizationBundle') }}</option>
                    </select>
                </td>
                <td>
                    <ul id="icons" class="ui-widget ui-helper-clearfix">
                        <li class="ui-state-default ui-corner-all" title=".ui-icon-plusthick">
                            <a id="plus_modality">
                                <span class="ui-icon ui-icon-plusthick"></span>
                            </a>
                        </li>
                    </ul>
                </td>
            </tr>
        </table>
    </fieldset>
    <form id="registerReceipt" name="registerReceipt" enctype="multipart/form-data" method="post">
       <div>
           <fieldset>
               <label>{{ 'patient.order.label'|trans([], 'LocalizationBundle') }}:&nbsp;</label>
               <input id="file_Clinical_Order" name="file_Clinical_Order" type="file">&nbsp;*
               <br><br>
           </fieldset>
       </div>
    </form>
    <div>
        <div id="spinner" style="display: none;">
            <img style="width: 40px;" src="{{ asset('bundles/utilities/images/spinner.gif') }}" style="border: none;"/>
        </div>
        <p id="container_btn_save">
            <input type="button" id="NewData" class="ui-button ui-widget ui-state-default ui-corner-all"
                   value="{{ 'receive.new'|trans([], 'LocalizationBundle') }}">
            <input class="ui-button ui-widget ui-state-default ui-corner-all" id="save"
                   type="button" value="{{ 'receive.save'|trans([], 'LocalizationBundle') }}">
        </p>
    </div>
    </div>
    </div>
    <!--Muestra un mensaje cuando se debe mostrar al usuario algún mensaje que no sea de error-->
    <div>
        <div id="confirm" class="ui-widget">
            <div class="ui-state-highlight ui-corner-all" style="margin-top: 20px; padding: 0 .7em;">
                <p>
                    <span class="ui-icon ui-icon-info" style="float: left; margin-right: .3em;"></span>
                <div id="mensajeConfirm"></div>
                </p>
            </div>
        </div>
        <!--Muestra un mensaje cuando se presenta algún error-->
        <div id="error" class="ui-widget" style="margin-top: 10px;">
            <div class="ui-state-error ui-corner-all" style="padding: 0 .7em;">
                <p>
                    <span class="ui-icon ui-icon-alert" style="float: left; margin-right: .3em;"></span>

                <div id="mensajeError"></div>
                </p>
            </div>
        </div>
    </div>
    </div>

    </div>

    </article>
    </section>


{% endblock %}