{% block scripts %}
    <script src="{{ asset('bundles/fosjsrouting/js/router.js') }}"></script>
    <script src="{{ path('fos_js_routing_js', { callback: 'fos.Router.setData' }) }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/shedule/js/schedule_Appointment_Patient.js') }}"></script>
    <script type="text/javascript">
        var UrlUpdaData = '{{ path("updateDataPatient") }}';
        var UrlDataMunicipality = '{{ path("municipalityList") }}';
        var UrlDataPatient = '{{ path("patientList") }}';
        var years = '{{ 'labels.date.years'|trans([], 'LocalizationBundle') }}';
        var months = '{{ 'labels.date.month'|trans([], 'LocalizationBundle') }}';
        var year = '{{ 'labels.date.years'|trans([], 'LocalizationBundle') }}';
        var month = '{{ 'labels.date.month'|trans([], 'LocalizationBundle') }}';
        var day = '{{ 'labels.date.days'|trans([], 'LocalizationBundle') }}';
        var days = '{{ 'labels.date.days'|trans([], 'LocalizationBundle') }}';
        var select = '{{ 'button.select'|trans([], 'LocalizationBundle') }}';
        var pleaseWait = '{{ 'messages.pleaseWait'|trans([], 'LocalizationBundle') }}';
        var consulCitas = '{{ 'messages.agenda.consulCitas'|trans([], 'LocalizationBundle') }}';
        var errorAjax = '{{ 'messages.ajax.errorProcess'|trans([], 'LocalizationBundle') }}';
        var noPatient = '{{ 'messages.agenda.noPatient'|trans([], 'LocalizationBundle') }}';
        var selectOk = '{{ 'messages.yes_select_patient'|trans([], 'LocalizationBundle') }}';
        var option = '';
        var modality = '{{ 'modalities.modality'|trans([], 'LocalizationBundle') }}';
        var mandatory_email = '{{ 'messages.campoObliga'|trans([], 'LocalizationBundle') }}: {{ 'labels.patient.email'|trans([], 'LocalizationBundle') }}';
    </script>
    <style>
        .input-group input {
            height: 34px;
            border-radius: 4px;
        }

    </style>
{% endblock %}
{% block content %}


    {#txtdatid#}



    <div id="ocult1" style="visibility: hidden;">
        {# Datos personales #}
        <div class="panel panel-default">
            <div class="panel-body">
                {#Hijo de#}
                <div class="col-md-12">
                    <label for="style" class="col-md-1">{{ 'labels.son_of'|trans([], 'LocalizationBundle') }}:</label>
                    <div class="div_left_check">
                        <input type="checkbox" name="hijo" id="son_of" required="required"/>
                    </div>
                </div>
                <div class="col-md-12"><hr></div>
                {#Fin Hijo de#}
                <div class="clearfix"></div>

                {#Tipo ID#}
                <div class="col-md-6">
                    <div class="form-group">
                        <label for="style" class="col-sm-6 control-label">{{ 'labels.documentType'|trans([], 'LocalizationBundle') }}: (*)</label>

                        <div class="col-sm-6">
                            <select id="documentType" name="documentType" required="required" class="form-control select_receive">
                                <option value="">{{ 'button.select'|trans([], 'LocalizationBundle') }}</option>
                                {% for document in typeDocument %}
                                    <option value="{{ document.docType }}">{{ document.docType }}</option>
                                {% endfor %}
                            </select>
                        </div>
                    </div>
                </div>
                {#Fin Tipo ID#}
                {#Tipo GS/RH#}
                <div class="col-md-6">
                    <div class="form-group">
                        <label for="style" class="col-sm-6 control-label">{{ 'labels.GS_RH'|trans([], 'LocalizationBundle') }}:</label>

                        <div class="col-sm-6">
                            <select id="rh" name="rh" class="form-control select_receive" required="required">
                                {% for blood in bloodList %}
                                    <option value="{{ loop.index0 }}">{{ blood.tipo }}{{ blood.RH }}</option>
                                {% endfor %}
                            </select>
                        </div>
                    </div>
                </div>
                {#Fin Tipo GS/RH#}

                {#Primer Nombre#}
                <div class="col-md-6">
                    <div class="form-group">
                        <label for="style" class="col-sm-6 control-label">{{ 'labels.patient.firstName'|trans([], 'LocalizationBundle') }}: (*)</label>

                        <div class="col-sm-6">
                            <input name="firstName" id="firstName_1" class="form-control field_receive" type="text" required="required" onkeyup="javascript:this.value=this.value.toUpperCase();">
                        </div>
                    </div>
                </div>
                {#Fin Primer Nombre#}
                {#Segundo nombre #}
                <div class="col-md-6">
                    <div class="form-group">
                        <label for="style" class="col-sm-6 control-label">{{ 'labels.patient.secondName'|trans([], 'LocalizationBundle') }}:</label>

                        <div class="col-sm-6">
                            <input name="secondName_1" id="secondName_1" class="form-control field_receive" type="text" id="secondName" onkeyup="javascript:this.value=this.value.toUpperCase();">
                        </div>
                    </div>
                </div>
                {#Fin Segundo nombre #}
                {#Primer apellido #}
                <div class="col-md-6">
                    <div class="form-group">
                        <label for="style" class="col-sm-6 control-label">{{ 'labels.patient.lastName'|trans([], 'LocalizationBundle') }}:  (*)</label>

                        <div class="col-sm-6">
                            <input class="form-control field_receive" id="firstLastName_1" name="firstLastName_1" type="text" required="required" onkeyup="javascript:this.value=this.value.toUpperCase();">
                        </div>
                    </div>
                </div>
                {#Fin Primer apellido #}
                {#Segundo apellido #}
                <div class="col-md-6">
                    <div class="form-group">
                        <label for="style" class="col-sm-6 control-label">{{ 'labels.patient.secondLastName'|trans([], 'LocalizationBundle') }}:</label>

                        <div class="col-sm-6">
                            <input class="form-control field_receive" name="secondLastName_1" id="secondLastName_1" type="text" onkeyup="javascript:this.value=this.value.toUpperCase();">
                        </div>
                    </div>
                </div>
                {#Fin Segundo apellido #}

                {#Fecha de nacimiento #}
                <div class="col-md-6">
                    <div class="form-group">
                        <label for="style" class="col-sm-6 control-label">{{ 'labels.patient.birthDate'|trans([], 'LocalizationBundle') }}( YYYY-mm-dd ) : (*)</label>

                        <div class="col-sm-6">
                            <input name="dateBirth" id="dateBirth" class="form-control field_receive" type="text" required="required" placeholder="YYYY-mm-dd" readonly >
                        </div>
                    </div>
                </div>
                {#Fin Fecha de nacimiento #}
                {#Edad#}
                <div class="col-md-6">
                    <div class="form-group">
                        <label for="style" class="col-sm-6 control-label">{{ 'labels.patient.ageType'|trans([], 'LocalizationBundle') }} : (*)</label>

                        <div class="col-sm-6">
                            <input id="age" name="age" maxlength="3" type="text" class="form-control field_receive" required="required" disabled="disabled">
                        </div>
                    </div>
                </div>
                {#Fin Edad#}
                {#Genero#}
                <div class="col-md-6">
                    <div class="form-group">
                        <label for="style" class="col-sm-6 control-label">{{ 'labels.patient.sex'|trans([], 'LocalizationBundle') }}: (*)</label>

                        <div class="col-sm-6">
                            <div class="radio">
                                <label class="col-sm-6">
                                    <input id="sex-M" type="radio" name="sex" value="M" required="required" checked="checked">

                                    {{ 'labels.patient.male'|trans([], 'LocalizationBundle') }}
                                </label>
                            </div>
                            <div class="radio">
                                <label class="col-sm-6">
                                    <input id="sex-F" type="radio" name="sex" value="F" required="required">
                                    {{ 'labels.patient.female'|trans([], 'LocalizationBundle') }}
                                </label>
                            </div>
                        </div>
                    </div>
                </div>
                {#Fin Genero#}

                {#Tipo edad
                <div class="col-md-6">
                    <div class="form-group">
                        <label for="style" class="col-sm-6 control-label">{{ 'receive.old_type'|trans([], 'LocalizationBundle') }} : (*)</label>
                        <div class="col-sm-6">
                            <select name="type_age" id="type_age" class="form-control 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>
                        </div>
                    </div>
                </div>
                {#Fin Tipo edad#}
                <div class="clearfix"></div>
            </div>
        </div>{# Fin datos personales #}

        {# Datos de ubicacion #}
        <div class="panel panel-default">
            <div class="panel-body">

                {#Departamento#}
                <div class="col-md-6">
                    <div class="form-group">

                        <label for="style" class="col-sm-6 control-label">{{ 'labels.departament'|trans([], 'LocalizationBundle') }}: (*)</label>

                        <div class="col-sm-6">
                            <select class="form-control select_receive" id="departamentName" name="departmentName" required="required">
                                <option value="">{{ 'button.select'|trans([], 'LocalizationBundle') }}</option>
                                {% for departamento in list_dept %}
                                    <option value="{{ departamento.departmentCode }}">{{ departamento.departmentName }}</option>
                                {% endfor %}
                            </select>
                        </div>
                    </div>
                </div>
                {#Fin Departamento#}

                {#Municipio#}
                <div class="col-md-6">
                    <div class="form-group">
                        <label for="style" class="col-sm-6 control-label">{{ 'labels.municipio'|trans([], 'LocalizationBundle') }}: (*)</label>

                        <div class="col-sm-6">
                            <select id="municipalityName" class="form-control select_receive" name="municipalityName" required="required">
                                <option value="">{{ 'button.select'|trans([], 'LocalizationBundle') }}</option>
                            </select>
                        </div>
                    </div>
                </div>
                {#Fin Municipio#}
                {#Zona residencial#}
                <div class="col-md-6">
                    <div class="form-group">
                        <label for="style" class="col-sm-6 control-label">{{ 'labels.residential.zone'|trans([], 'LocalizationBundle') }}: (*)</label>

                        <div class="col-sm-6">
                            <div class="radio">
                                <label class="col-sm-6">
                                    <input type="radio" name="zona" id="zona-1" value="1" checked="checked" required="required">
                                    {{ 'labels.residential.urban'|trans([], 'LocalizationBundle') }}
                                </label>
                            </div>
                            <div class="radio">
                                <label class="col-sm-6">
                                    <input type="radio" name="zona" id="zona-2" value="2" required="required">
                                    {{ 'labels.residential.rural'|trans([], 'LocalizationBundle') }}
                                </label>
                            </div>
                        </div>
                    </div>
                </div>
                {#Fin Zona residencial#}
                {#Direccion#}
                <div class="col-md-6">
                    <div class="form-group">
                        <label for="style" class="col-sm-6 control-label">{{ 'labels.patient.address'|trans([], 'LocalizationBundle') }}:</label>

                        <div class="col-sm-6">
                            <input type="text" class="form-control field_receive" id="address" name="address" required="required">
                        </div>
                    </div>
                </div>
                {#Fin Direccion#}
                {#Telefono#}
                <div class="col-md-6">
                    <div class="form-group">
                        <label for="style" class="col-sm-6 control-label">{{ 'labels.patient.tel'|trans([], 'LocalizationBundle') }}: (*)</label>

                        <div class="col-sm-6">
                            <input id="telephone" class="form-control field_receive" maxlength="10" class="field_receive" name="telephone" type="text" required="required">
                        </div>
                    </div>
                </div>
                {#Fin Telefono#}
                {#Celular#}
                <div class="col-md-6">
                    <div class="form-group">
                        <label for="style" class="col-sm-6 control-label">{{ 'labels.patient.cel'|trans([], 'LocalizationBundle') }}:</label>

                        <div class="col-sm-6">
                            <input id="cellphone" class="form-control field_receive" maxlength="10" class="field_receive" name="cellphone" type="tel">
                        </div>
                    </div>
                </div>
                {#Fin celular#}
                {#Acudiente#}
                <div class="col-md-6">
                    <div class="form-group">
                        <label for="style" class="col-sm-6 control-label">{{ 'labels.patient.guardian'|trans([], 'LocalizationBundle') }}:</label>

                        <div class="col-sm-6">
                            <input id="acud" name="acud" class="form-control field_receive" type="text">
                        </div>
                    </div>
                </div>
                {#Fin Acudiente#}
                {#Correo#}
                <div class="col-md-6">
                    <div class="form-group">
                        <label for="style" class="col-sm-6 control-label">{{ 'labels.patient.email'|trans([], 'LocalizationBundle') }}:</label>

                        <div class="col-sm-6">
                            <input id="email" name="email" class="form-control field_receive" type="email">
                            <span id="reqEmail"></span>
                        </div>
                    </div>
                </div>
                {#Fin Correo#}
            </div>
        </div>{# Fin datos de ubicacion #}

        <div class="clearfix"></div>
        {# Btn Actualizar datos #}
        <div class="col-md-6">
            <div class="form-group">
                <input type="button" id="updateDataPatient" class="btn btn-primary" value="{{ 'labels.patient.update_select_patient'|trans([], 'LocalizationBundle') }}">
            </div>
        </div>
        {# Fin Btn Actualizar datos #}

        <div class="clearfix"></div>

        <div>
            <div id="spinner" style="display: none;">
                <img style="width: 40px; border: none;" src="{{ asset('bundles/utilities/images/spinner.gif') }}" />
            </div>
        </div>
        <!-- </div> table data-->
        <!--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 class="clearfix"></div>
    <div class="col-md-6">
        <div class="form-group">
            <label id="no_Seleccionado" style="display: none" for="style" class="col-sm-6 control-label"><h5>{{ 'messages.no_select_patient'|trans([], 'LocalizationBundle') }}.</h5></label>
            <label id="si_Seleccionado" style="display: none" for="style" class="col-sm-6 control-label"><h5>{{ 'messages.yes_select_patient'|trans([], 'LocalizationBundle') }}.</h5></label>
        </div>
    </div>



{% endblock %}