{% extends 'MainBundle:Master:template.html.twig' %}
{% block scripts %}
    {# CSS #}
    {#Bootstrap#}

    {# Importados 
    <link rel="stylesheet" href="{{ asset('bundles/utilities/bootstrap-3.3.7/css/bootstrap.min.css') }}"/>
    <link rel="stylesheet" href="{{ asset('bundles/indicator/css/bootstrap-select.css') }}"/>
    #}

    <link rel="stylesheet" href="{{ asset('bundles/main/css/bootstrap.css') }}"/>
    <link rel="stylesheet" href="{{ asset('bundles/indicator/css/bootstrap-select.css') }}"/>
    <link rel="stylesheet" href="{{ asset('bundles/shedule/datatable/css/dataTables.bootstrap.css') }}" >
    <link rel="stylesheet" href="{{ asset('bundles/shedule/datatable/css/dataTables.responsive.css') }}" >
    <link rel="stylesheet" href="{{ asset('bundles/shedule/datatable/css/dataTables.tableTools.css') }}" >
    <link rel="stylesheet" href="{{ asset('bundles/shedule/'~ hrk_skin ~'/dataTableCustom.css') }}"/>

    
    
    {# Checkbox #}
    <link rel="stylesheet" href="{{ asset('bundles/utilities/css/font-awesome.css') }}">
    <link rel="stylesheet" href="{{ asset('bundles/shedule/css/build.css') }}"/>
    
    {# Custom #}
    <link rel="stylesheet" href="{{ asset('bundles/hirukofacturacion/css/customfacturacion.css') }}" />
    
    {# JS #}
    <script type="text/javascript" src="{{ asset('bundles/shedule/bootstrap/js/bootstrap.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/indicator/js/bootstrap-select.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/shedule/datatable/js/jquery.dataTables.min.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/shedule/datatable/js/dataTables.tableTools.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/shedule/datatable/js/dataTables.responsive.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/shedule/datatable/js/dataTables.bootstrap.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/shedule/js/blockUI.js') }}"></script>

    {# Nuevo #}
    <script src="{{ asset('bundles/hirukoadmin/js/ajax/listReferring.js') }}"></script>
    <script>
        var SrcSwf = '{{ asset('bundles/indicator/datatable/swf/copy_csv_xls_pdf.swf') }}';
        var UrlConsultarModalidadesConvenio = '{{ path('hiruko_consultar_modalidades_convenios') }}';
        var UrlConsultarTarifasConvenio = '{{ path('hiruko_consultar_tarifas_modalidades') }}';
        var UrlBuscarEstudios = "{{ path('hiruko_consultar_estudios') }}";
        var UrlRelacionarEstudiosContrato = "{{ path('hiruko_relacionar_estudios_contratos') }}";
        var UrlEditarRelacion = "{{ path('hiruko_editar_relacion_estudios_contratos') }}";
        var UrlEliminarRelacion = "{{ path('hiruko_eliminar_relacion_estudios_contratos') }}";
        var gif_carga = "{{ asset('bundles/utilities/images/anim_gif.gif') }}";


        {# Nuevo #}
        var referringData = '{{ path('referringData') }}';
        var save_data_referring = '{{ path('save_data_referring') }}';
        var deleteReferring = '{{ path('deleteReferring') }}';
        var listReferring = '{{ path('list_referring') }}';
        var enable = "{{ 'schedule.enable'|trans([], 'LocalizationBundle') }}";
        var disable = "{{ 'schedule.disable'|trans([], 'LocalizationBundle') }}";
    </script>
    <style>
        .input-group input{
            height:34px;
            border-radius: 4px;
        }
        .checkbox{
            display:inline;
        }
    </style>
  
{% endblock %}
{% block content %}
    {# Container fluid #}
    <div class="container-fluid">
        {# panel primary #}
        <div class="panel panel-primary">
            <div class="panel-heading">
                <h3 class="panel-title">Medico Remitente</h3>
            </div>
            {# panel-body #}
            <div class="panel-body">
                <div class="row">
                    <div class="col-md-6">
                        <h5>{{ 'labels.role.doctor_referring'|trans([],'LocalizationBundle') }}</h5>
                    </div>
                    <div class="col-md-6">
                        <button class="btn btn-primary-outline pull-right" id="openReferringModal" >
                                <span class="glyphicon glyphicon-plus mr-1"></span>
                                {{ 'labels.registerDoctorReferring'|trans([],'LocalizationBundle') }}
                        </button>
                    </div>
                </div>
                <hr>
                <div class="row" id="tablaCrear">
                    <div class="col-md-12">
                    </br>
                    </br>
                        <div id="panel-body">
                            <div class="table-responsive">
                                <table class="table table-bordered table-striped table-hover dt-responsive" width="100%" id="docReferringLst" cellspacing="0">
                                    <thead>
                                        <tr>
                                            <th>Acciones</th>
                                            <th>Estado</th>
                                            <th>Identificación</th>
                                            <th>Empresa</th>
                                            <th>Título</th>
                                            <th>Médico Remitente</th>
                                            {% if ris_internacional %}
                                            <th>Preferencia de entrega</th>
                                            {% endif %}
                                        </tr>
                                    </thead>
                                    <tbody>

                                    </tbody>
                                </table>
                            </div>
                        </div>
                    </div>
                </div>{# fin primera tabla #}
            </div>{# Fin panel-body #}
        </div> {# Fin panel primary #}
    </div>{# Fin Container fluid #}
    {# Modal share Images#}
    <div class="modal fade " tabindex="-1" id="doctorReferringModal" role="dialog">
        <div class="modal-dialog" role="document">
            <div class="modal-content">
                <div class="modal-header">
                    <h4 class="modal-title">{{ 'labels.registerDoctorReferring' | trans([],'LocalizationBundle') }}</h4>
                </div>
                <div class="modal-body">
                    <form id="docRefForm" name="docRefForm" method="post" autocomplete="off" class="form-horizontal">
                        <input type="hidden" name="idReferring" id="idReferring" value=""/>
                        <div class="row">
                                <div class="col-md-6">
                                    <div class="form-group __title__dr__">
                                        <label for="style"
                                               class="col-sm-4 control-label">{{ 'labels.role.title'|trans([], 'LocalizationBundle') }}
                                            :</label>
                                        <div class="col-sm-8">
                                            <input maxlength="10" name="title" id="titleReferring" class="form-control required" type="text" value="">
                                        </div>
                                    </div>
                                </div>
                        </div>

                        <div class="row">
                            <div class="col-md-6">
                                <div class="form-group __provider__number__dr__">
                                    <label for="style"
                                           class="col-sm-4 control-label">{{ 'labels.role.providerNum'|trans([], 'LocalizationBundle') }}
                                        :</label>
                                    <div class="col-sm-8">
                                        <input name="providerNo" id="providerNumber" class="form-control required" type="text" value="">
                                    </div>
                                </div>
                            </div>
                            {% if ris_internacional == false %}
                                <div class="col-md-6">
                                    <div class="form-group">
                                        <label for="style"
                                               class="col-sm-4 control-label">{{ 'Query.typeDocument.label'|trans([], 'LocalizationBundle') }}
                                            :</label>
                                        <div class="col-sm-8">
                                            <select name="documentType" id="documentType" class="form-control">
                                                {% for document in docType %}
                                                    <option value="{{ document }}">{{ document }}</option>
                                                {% endfor %}
                                            </select>
                                        </div>
                                    </div>
                                </div>
                            {% endif %}
                        </div>
                        <div class="row">
                            <div class="col-md-6">
                                <div class="form-group __first__name__dr__">
                                    <label for="style"
                                           class="col-sm-4 control-label">{{ 'assistive.name.label'|trans([], 'LocalizationBundle') }}
                                        :</label>
                                    <div class="col-sm-8">
                                        <input name="name_full" id="firstNameReferring" class="form-control required" type="text" value="">
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="form-group __last__name__dr__">
                                    <label for="style"
                                           class="col-sm-4 control-label">{{ 'schedule.lastNamePatient'|trans([], 'LocalizationBundle') }}
                                        :</label>
                                    <div class="col-sm-8">
                                        <input name="last_name_full" id="lastNameReferring" class="form-control required" type="text" value="">
                                    </div>
                                </div>
                            </div>
                        </div>
                        <div class="row">
                            <div class="col-md-6">
                                <div class="form-group">
                                    <label for="style"
                                            class="col-sm-4 control-label">{{ 'labels.role.practiceName'|trans([], 'LocalizationBundle') }}
                                        :</label>
                                    <div class="col-sm-8">
                                        <input maxlength="80" name="practice_name" id="practiceName" class="form-control required" type="text" value="">
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="form-group">
                                    <label for="style"
                                           class="col-sm-4 control-label">{{ 'labels.specialty'|trans([], 'LocalizationBundle') }}
                                        :</label>
                                    <div class="col-sm-8">
                                        <input maxlength="30" name="specialised_field" id="specialisedField" class="form-control" type="text" value="">
                                    </div>
                                </div>
                            </div>
                        </div>
                        {% if ris_internacional %}
                            <div class="row">
                                <div class="col-md-6">
                                    <div class="form-group __delivery_Report__dr__">
                                        <label for="style" class="col-sm-4 control-label">{{ 'labels.deliveryPreference'|trans([], 'LocalizationBundle') }} :</label>
                                        <div class="col-sm-8">
                                            <select name="delivery_report" id="deliveryReport" class="form-control selectpicker">
                                                <option value="2">HL7</option>
                                                <option value="1">Fax</option>
                                                <option value="0">Courier</option>
                                            </select>
                                        </div>
                                    </div>
                                </div>
                            </div>
                        {% endif %}                            
                        <div class="row">
                            <div class="col-md-12">
                                <hr>
                            </div>
                        </div>
                        <div class="row">
                            <div class="col-md-6">
                                <div class="form-group __address__dr__">
                                    <label for="style"  class="col-sm-4 control-label">{{ 'labels.patient.address'|trans([], 'LocalizationBundle') }} 1:</label>
                                    <div class="col-sm-8">
                                        <input name="address_1" id="addressReferring" class="form-control" type="text" value="">
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="form-group">
                                    <label for="style" class="col-sm-4 control-label">{{ 'labels.patient.address'|trans([], 'LocalizationBundle') }} 2:</label>
                                    <div class="col-sm-8">
                                        <input name="address_2" id="address2" class="form-control" type="text" value="">
                                    </div>
                                </div>
                            </div>
                        </div>
                        <div class="row">
                            <div class="col-md-6">
                                <div class="form-group">
                                    <label for="style" class="col-sm-4 control-label">{{ 'mail.email'|trans([], 'LocalizationBundle') }}:</label>
                                    <div class="col-sm-8">
                                        <input name="email" id="emailReferring" class="form-control" type="text" value="">
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="form-group __code__postal__dr__">
                                    <label for="style" class="col-sm-4 control-label">{{ 'labels.postCode'|trans([], 'LocalizationBundle') }}:</label>
                                    <div class="col-sm-8">
                                        <input maxlength="5" name="post_code" id="postalReferring" class="form-control" type="text" value="">
                                    </div>
                                </div>
                            </div>
                        </div>
                        {% if ris_internacional %}
                            <div class="row">
                                <div class="col-md-6">
                                    <div class="form-group __state__dr__">
                                        <label for="style" class="col-sm-4 control-label">State:</label>
                                        <div class="col-sm-8">
                                            <input maxlength="5" name="state" id="stateReferring" class="form-control" type="text" value="">
                                        </div>
                                    </div>
                                </div>
                                <div class="col-md-6">
                                    <div class="form-group __suburb__dr__">
                                        <label for="style" class="col-sm-4 control-label">{{ 'labels.suburb'|trans([], 'LocalizationBundle') }}:</label>
                                        <div class="col-sm-8">
                                            <input maxlength="29" name="suburb" id="suburbReferring" class="form-control" type="text" value="">
                                        </div>
                                    </div>
                                </div>
                            </div>
                        {% endif %}
                        <div class="row">
                            <div class="col-md-6">
                                <div class="form-group">
                                    <label for="style"
                                           class="col-sm-4 control-label">{{ 'patient.telephone.label'|trans([], 'LocalizationBundle') }}
                                        - {{ 'utilities.business'|trans([], 'LocalizationBundle') }}:</label>
                                    <div class="col-sm-8">
                                        <input maxlength="255" name="telephone_business" id="telBusiness" class="form-control" type="text" value="">
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="form-group">
                                    <label for="style"
                                           class="col-sm-4 control-label">{{ 'patient.telephone.label'|trans([], 'LocalizationBundle') }}
                                        - {{ 'utilities.home'|trans([], 'LocalizationBundle') }}:</label>
                                    <div class="col-sm-8">
                                        <input maxlength="80" name="telephone_home" id="telHome" class="form-control" type="text" value="">
                                    </div>
                                </div>
                            </div>
                        </div>
                        <div class="row">
                            {% if ris_internacional %}
                                <div class="col-md-6">
                                    <div class="form-group">
                                        <label for="style"
                                            class="col-sm-4 control-label">{{ 'labels.patient.fax'|trans([], 'LocalizationBundle') }}
                                            - {{ 'utilities.business'|trans([], 'LocalizationBundle') }}:</label>
                                        <div class="col-sm-8">
                                            <input type="tel" id="fax" name="fax_business"
                                                placeholder="61-2-12345678"
                                                pattern="[0-9]{2}-[0-9]{1}-[0-9]{8,9}"
                                                required class="validity col-md-11" />
                                            <span class="validity col-md-1"></span>
                                            {#<input maxlength="16" name="fax_business" id="fax" class="form-control" type="text" value="">#}
                                        </div>
                                    </div>
                                </div>
                            {% endif %}
                            <div class="col-md-6">
                                <div class="form-group">
                                    <label for="style"
                                           class="col-sm-4 control-label">{{ 'labels.patient.cel'|trans([], 'LocalizationBundle') }}
                                        :</label>
                                    <div class="col-sm-8">
                                        <input name="mobile" id="mobile" class="form-control" type="text" value="">
                                    </div>
                                </div>
                            </div>
                        </div>
                </div>
                <div class="modal-footer">
                    <div class="col-md-12">
                        <h5><span id="sureSave"
                                  class="hide msg sureSave">{{ 'messages.seguro' |trans([], 'LocalizationBundle') }}</span></h5>
                        <h4 id="success"
                            class="hide msg">{{ 'messages.processOk' | trans([], 'LocalizationBundle') }}</h4>
                        <h4 id="error"
                            class="hide msg">{{ 'messages.ajax.error' | trans([], 'LocalizationBundle') }}</h4>
                    </div>
                    <div class="msgSending msg hide">
                        <div class="mt-2 mb-2">
                            <div class="spinner">
                                <div class="double-bounce1"></div>
                                <div class="double-bounce2"></div>
                            </div>
                            {{ 'labels.sending' | trans([], 'LocalizationBundle') }}, {{ 'messages.pleaseWait' | trans([], 'LocalizationBundle') }}
                        </div>
                    </div>
                    <div id="btnActionsSave">
                        <div class="pull-right">
                            <a href="#" class="btn btn-default" id="cancelAction" data-dismiss="modal">{{ 'button.cancel'|trans([], 'LocalizationBundle') }}</a>
                            <a href="#" class="btn btn-primary" id="saveAction">{{ 'button.save'|trans([], 'LocalizationBundle') }}</a>
                            <a href="#" class="btn btn-primary hide msg" id="sendDocRef">{{ 'button.acept'|trans([], 'LocalizationBundle') }}</a>
                        </div>
                    </div>
                    </form>
                </div>
            </div>
        </div>
    </div>
    {# Modal sureDelete#}
    <div class="modal fade bs-example-modal-sm" tabindex="-1" id="deleteModal" role="dialog" aria-labelledby="mySmallModalLabel">
        <div class="modal-dialog modal-sm" role="document">
            <div class="modal-content">
                <div class="modal-body">
                    <h4><span id="labelRefDelete"></span></h4>
                    <h4>{{ 'messages.seguro' | trans([], 'LocalizationBundle') }}</h4>
                </div>
                <div class="modal-footer">
                    <div class="col-md-12">
                        <h4 id="successWait"
                            class="hide msg">{{ 'messages.processOk' | trans([], 'LocalizationBundle') }}</h4>
                        <h4 id="errorWait"
                            class="hide msg">{{ 'messages.ajax.error' | trans([], 'LocalizationBundle') }}</h4>
                    </div>
                    <div class="msgWait msg hide">
                        <div class="mt-2 mb-2">
                            <div class="spinner">
                                <div class="double-bounce1"></div>
                                <div class="double-bounce2"></div>
                            </div>
                            {{ 'messages.pleaseWait' | trans([], 'LocalizationBundle') }}
                        </div>
                    </div>
                    <div id="btnActionsDelete">
                        <div class="pull-right">
                            <a href="#" class="btn btn-default" id="cancelDelete" data-dismiss="modal">{{ 'button.cancel'|trans([], 'LocalizationBundle') }}</a>
                            <a href="#" class="btn btn-primary" id="btnDelete">{{ 'button.acept'|trans([], 'LocalizationBundle') }}</a>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
{% endblock %}