{% block scripts %}

    {% if mode is defined %}
        <script src="{{ asset('bundles/main/js/jquery-1.9.1.js') }}"></script>
    {% endif %}

    <script type="text/javascript">
        $(document).ready(function () {
            {% if mode is defined %}
            var errorAjax = '{{ 'messages.ajax.errorProcess'|trans([], 'LocalizationBundle') }}';
            var url_buscar_encuestaCT2 = '{{ path('DataEncuestaCT2') }}';
            $.ajax({
                url: url_buscar_encuestaCT2,
                type: "POST",
                data: {
                    'appCode': '{{ appCode }}'
                },
                success: function (resp) {
                    var jsonResp = JSON.parse(resp);
                    for (var i = 0; i < jsonResp.length; i++) {
                        $("#encrm1").val(jsonResp[i]['campo1']);
                        $("#encrm2").val(jsonResp[i]['campo2']);
                        $("#encrm3").val(jsonResp[i]['campo3']);
                        $("#encrm4").val(jsonResp[i]['campo4']);
                        $("#encrm5").val(jsonResp[i]['campo5']);
                        $("#encrm6").val(jsonResp[i]['campo6']);
                        $("#encrm7").val(jsonResp[i]['campo7']);
                        $("#encrm8").val(jsonResp[i]['campo8']);
                        $("#encrm9").val(jsonResp[i]['campo9']);
                        if (jsonResp[i]['campo10'] === '1') {
                            $("#encrm10").prop('checked', true);
                        }
                        if (jsonResp[i]['campo11'] === '1') {
                            $("#encrm11").prop('checked', true);
                        }
                        if (jsonResp[i]['campo12'] === '1') {
                            $("#encrm12").prop('checked', true);
                        }
                        $("#encrm13").val(jsonResp[i]['campo13']);
                        $("#encrm14").val(jsonResp[i]['campo14']);
                        $("#encrm15").val(jsonResp[i]['campo15']);

                        if (jsonResp[i]['campo16'] === '1') {
                            $("#encrm16").prop('checked', true);
                            $("#encrm18").prop('disabled', false)
                        } else if (jsonResp[i]['campo16'] === '2') {
                            $("#encrm17").prop('checked', true);
                            $("#encrm18").prop('disabled', true)
                        }

                        $("#encrm18").val(jsonResp[i]['campo18']);
                        if (jsonResp[i]['campo19'] === '1') {
                            $("#encrm19").prop('checked', true);
                            $("#encrm21").val(jsonResp[i]['campo21']);
                            $("#encrm22").val(jsonResp[i]['campo22']);
                            $("#encrm23").val(jsonResp[i]['campo23']);
                            $("#encrm21").prop('disabled', false)
                            $("#encrm22").prop('disabled', false)
                            $("#encrm23").prop('disabled', false)
                        } else if (jsonResp[i]['campo19'] === '2') {
                            $("#encrm20").prop('checked', true);
                            $("#encrm21").prop('disabled', true);
                            $("#encrm22").prop('disabled', true);
                            $("#encrm23").prop('disabled', true);
                        }
                        if (jsonResp[i]['campo24'] === '1') {
                            $("#encrm24").prop('checked', true);
                        } else if (jsonResp[i]['campo24'] === '2') {
                            $("#encrm25").prop('checked', true);
                        } else if (jsonResp[i]['campo24'] === '3') {
                            $("#encrm26").prop('checked', true);
                        }
                        $("#encrm27").val(jsonResp[i]['campo27']);
                        $("#encrm28").val(jsonResp[i]['campo28']);
                        if (jsonResp[i]['campo29'] == '1') {
                            $("#campo29").prop('checked', true);
                            $("#encrm31").prop('disabled', false);
                        } else if (jsonResp[i]['campo29'] == '2') {
                            $("#encrm30").prop('checked', true);
                            $("#encrm31").prop('disabled', true);
                        }
                        $("#encrm31").val(jsonResp[i]['campo31']);
                        $("#encrm32").val(jsonResp[i]['campo32']);
                        $("#encrm33").val(jsonResp[i]['campo33']);
                        $("#encrm34").val(jsonResp[i]['campo34']);
                        $("#encrm36").val(jsonResp[i]['campo36']);
                        if (jsonResp[i]['campo37'] == '1') {
                            $("#encrm37").prop('checked', true);
                            $("#encrm6").prop('disabled', false);
                            $("#encrm35").prop('disabled', false);
                            $("#encrm41").prop('disabled', false);
                            $("#encrm41").val(jsonResp[i]['campo39']);
                            $("#encrm35").val(jsonResp[i]['campo35']);
                            $("#encrm6").val(jsonResp[i]['campo6']);
                        } else if (jsonResp[i]['campo37'] == '2') {
                            $("#encrm37").prop('checked', false);
                            $("#encrm38").prop('checked', true);
                            $("#encrm6").prop('disabled', true);
                            $("#encrm41").prop('disabled', true);
                            $("#encrm35").prop('disabled', true);
                        }
                        if (jsonResp[i]['campo38'] == '1') {
                            $("#encrm39").prop('checked', true);
                            $("#encrm7").prop('disabled', false);
                            $("#encrm36").prop('disabled', false);
                            $("#encrm42").prop('disabled', false);
                            $("#encrm42").val(jsonResp[i]['campo40']);
                            $("#encrm36").val(jsonResp[i]['campo36']);
                            $("#encrm7").val(jsonResp[i]['campo7']);
                        } else if (jsonResp[i]['campo38'] == '2') {
                            $("#encrm39").prop('checked', false);
                            $("#encrm40").prop('checked', true);
                            $("#encrm7").prop('disabled', true);
                            $("#encrm42").prop('disabled', true);
                            $("#encrm36").prop('disabled', true);
                        }
                        $("#encrm43").val(jsonResp[i]['campo43']);
                    }
                },
                error: function (jqXHR, textStatus, errorThrown) {
                    $.blockUI({
                        css: {
                            border: 'none',
                            padding: '15px',
                            '-webkit-border-radius': '10px',
                            '-moz-border-radius': '10px',
                            'border-radius': '10px',
                            color: '#fff'
                        },
                        message: '<div class="alert alert-danger" role="alert" style="font-size:25px; margin:0; padding:0;" >' +
                        ' <span class="glyphicon glyphicon-alert" aria-hidden="true"></span> <span class="sr-only">Error:</span> ' + errorAjax + '</div>'
                    });
                    setTimeout($.unblockUI, 1000);
                }
            })
            {% endif %}
        })
    </script>

{% endblock %}
{% block content %}
    {% block stylesheets %}
        <link rel="stylesheet" href="{{ asset('bundles/main/css/bootstrap.css') }}"/>
        <link rel="stylesheet" href="{{ asset('bundles/shedule/'~ hrk_skin ~'/dataTableCustom.css') }}"/>
        <link rel="stylesheet" href="{{ asset('bundles/reading/css/notificationsLight.css') }}"/>
        <link href="{{ asset('bundles/utilities/css/font-awesome.css') }}" rel="stylesheet">
    {% endblock %}
    {% if disabled is defined %}
        <fieldset disabled>
    {% endif %}
    <div class="row">
        <div class="table-responsive encuesta-mammo">
            <div class="col-md-6">
                <table class="table table-condensed table-bordered table-mammo" style="width:100%;font-size:12px;">
                    {#<thead>
                        <tr>
                            <th style="text-align: center;">{{ 'labels.antecedentes'|trans([],'LocalizationBundle') }}</th>
                            <th style="text-align: center;">{{ 'labels.right'|trans([],'LocalizationBundle') }}</th>
                            <th style="text-align: center;">{{ 'labels.left'|trans([],'LocalizationBundle') }}</th>
                        </tr>
                    </thead>#}
                    <tbody>
                    <tr>
                        <th colspan="4" style="text-align: center;">
                            Encuesta para estudios de tomografia:
                        </th>
                    </tr>
                    <tr>
                        <td>
                            Cr:<input id="encrm1" name="encrm1" type="text" class="form-control">
                        </td>
                        <td>
                            Depuración:<input id="encrm2" name="encrm2" type="text" class="form-control">
                        </td>
                        <td>
                            PA:<input id="encrm3" name="encrm3" type="text" class="form-control">
                        </td>
                    </tr>
                    <tr>
                        <th colspan="3" style="text-align: center;">Antecedentes:</th>
                    </tr>
                    <tr>
                        <td>Patológicos:</td>
                        <td colspan="2" style="text-align: center;"><input id="encrm4" name="encrm4"
                                                                           class="form-control" type="text"></td>
                    </tr>
                    <tr>
                        <td>Cáncer (ubicación):</td>
                        <td colspan="2" style="text-align: center;"><input id="encrm5" name="encrm5"
                                                                           class="form-control" type="text"></td>
                    </tr>
                    <tr>
                        <td>
                            Quimio:
                            {{ 'labels.yes'|trans([],'LocalizationBundle') }}:&nbsp;&nbsp;<input id="encrm37"
                                                                                                 name="encrm_quimio"
                                                                                                 value="1" type="radio">&nbsp;&nbsp;
                            {{ 'labels.no'|trans([],'LocalizationBundle') }}:&nbsp;&nbsp;<input id="encrm38"
                                                                                                name="encrm_quimio"
                                                                                                value="2" type="radio" checked="true">
                        </td>
                        <td>Fecha:<input id="encrm6" name="encrm6" class="form-control" type="text"
                                         placeholder="__/__/____ " disabled="true"></td>
                        <td>N° sesiones:<input id="encrm35" name="encrm35" class="form-control" type="text"
                                               placeholder="#" disabled="true"></td>
                    </tr>
                    <tr>
                        <td>Descripción Quimio:</td>
                        <td colspan="2">
                            <textarea rows="3" id="encrm41" name="encrm41" class="form-control" type="text" disabled="true"></textarea>
                        </td>
                    </tr>
                    <tr>
                        <td>
                            Radio:
                            {{ 'labels.yes'|trans([],'LocalizationBundle') }}:&nbsp;&nbsp;<input id="encrm39"
                                                                                                 name="encrm_radio"
                                                                                                 value="1" type="radio">&nbsp;&nbsp;
                            {{ 'labels.no'|trans([],'LocalizationBundle') }}:&nbsp;&nbsp;<input id="encrm40"
                                                                                                name="encrm_radio"
                                                                                                value="2" type="radio" checked="true">
                        </td>
                        <td>Fecha:<input id="encrm7" name="encrm7" class="form-control" type="text"
                                         placeholder="__/__/____ " disabled="true"></td>
                        <td>N° sesiones:<input id="encrm36" name="encrm36" class="form-control" type="text"
                                               placeholder="#" disabled="true"></td>
                    </tr>
                    <tr>
                        <td>Descripción Radio:</td>
                        <td colspan="2">
                            <textarea rows="3" id="encrm42" name="encrm42" class="form-control" type="text" disabled="true"></textarea>
                        </td>
                    </tr>
                    <tr>
                        <td>Quirúrgico (adicionar fechas):</td>
                        <td colspan="2" style="text-align: center;"><textarea rows="2" id="encrm8" name="encrm8"
                                                                              class="form-control"
                                                                              type="text"></textarea>
                        </td>
                    </tr>
                    <tr>
                        <td>Alérgicos:</td>
                        <td colspan="2" style="text-align: center;"><input id="encrm9" name="encrm9"
                                                                           class="form-control" type="text"></td>
                    </tr>
                    <tr>
                        <td>Insuficiencia renal:
                            <input id="encrm10" class="encrm12_1" value="1" name="encrm_2" type="checkbox"></td>
                        <td>Transplante:
                            <input id="encrm11" class="encrm12_2" value="1" name="encrm_3" type="checkbox"></td>
                        <td>Monorenal:
                            <input id="encrm12" class="encrm12_3" value="1" name="encrm_4" type="checkbox"></td>
                    </tr>
                    <tr>
                        <td>Medicamentos actuales</td>
                        <td colspan="2" style="text-align: center;"><input id="encrm13" name="encrm13"
                                                                           class="form-control" type="text"></td>
                    </tr>
                    <tr>
                        <td>Estudios previos</td>
                        <td colspan="2" style="text-align: center;">
                           <textarea rows="3" id="encrm14" name="encrm14" class="form-control" type="text"></textarea>
                        </td>
                        </td>
                    </tr>
                    </tbody>
                </table>
            </div>
            <div class="col-md-6">
                <table class="table table-condensed table-bordered table-mammo" style="width:100%;font-size:12px;">
                    {#<thead>
                        <tr>
                            <td colspan="2" style="text-align: center;"></td>
                            <td style="text-align: center;">{{ 'labels.yes'|trans([],'LocalizationBundle') }}</td>
                            <td style="text-align: center;">{{ 'labels.no'|trans([],'LocalizationBundle') }}</td>
                        </tr>
                    </thead>#}
                    <tbody>
                    <tr>
                        <th colspan="4" style="text-align: center;">Evaluación de riesgos y/o contraindicaciones para
                            estudios de tomografia:
                        </th>
                    </tr>
                    <tr>
                        <td colspan="2">¿Fecha de última menstruación?
                            <input id="encrm15" name="encrm15" class="form-control" type="text"
                                   placeholder="__/__/____">
                        </td>
                        <td>Ayuno:
                            {{ 'labels.yes'|trans([],'LocalizationBundle') }}:&nbsp;&nbsp;<input id="encrm16"
                                                                                                 name="encrm_ayu"
                                                                                                 value="1" type="radio">&nbsp;&nbsp;
                            {{ 'labels.no'|trans([],'LocalizationBundle') }}:&nbsp;&nbsp;<input id="encrm17"
                                                                                                name="encrm_ayu"
                                                                                                value="2" type="radio" checked="true">
                        </td>
                        <td>
                            ¿Cuántas horas?
                            <input id="encrm18" name="encrm18" class="form-control" type="text" disabled="true">
                        </td>
                    </tr>
                    <tr>
                        <th colspan="4" style="text-align: center;">Inyección previa de medios de contraste:</th>
                    </tr>
                    <tr>
                        <td>
                            {{ 'labels.yes'|trans([],'LocalizationBundle') }}:<input id="encrm19" name="encrm_iny"
                                                                                     value="1" type="radio">
                            {{ 'labels.no'|trans([],'LocalizationBundle') }}:<input id="encrm20" name="encrm_iny"
                                                                                    value="2" type="radio" checked="true">
                            Cual:<input id="encrm21" name="encrm21" class="form-control" type="text" disabled="true">
                        </td>
                        <td colspan="2">Fecha:<input id="encrm22" name="encrm22" class="form-control" type="text"
                                                     placeholder="__/__/____" disabled="true"></td>
                        <td>Hora:<input id="encrm23" name="encrm23" class="form-control" type="text"
                                        placeholder="__:__:__" disabled="true"></td>
                    </tr>
                    <tr>
                        <th colspan="4" style="text-align: center;">Requerimientos durante todo el procedimiento:</th>
                    </tr>
                    <tr>
                        <td colspan="4" style="text-align: center;">
                            Sedación&nbsp;&nbsp;<input id="encrm24" name="encrm_rm1" value="1" type="radio">&nbsp;&nbsp;&nbsp;&nbsp;
                            BAG&nbsp;&nbsp;<input id="encrm25" name="encrm_rm1" value="2" type="radio">&nbsp;&nbsp;&nbsp;&nbsp;
                            Ninguno&nbsp;&nbsp;<input id="encrm26" name="encrm_rm1" value="3" type="radio" checked="true">
                        </td>
                    </tr>
                    <tr>
                        <td colspan="2">
                            Contraste vía intravenosa:<input id="encrm27" name="encrm27" class="form-control"
                                                             type="text">
                        </td>
                        <td colspan="2">
                            Contraste vía oral:<input id="encrm28" name="encrm28" class="form-control" type="text">
                        </td>
                    </tr>
                    <tr>
                        <td colspan="2">Reacciones adversas</td>
                        <td>
                            {{ 'labels.yes'|trans([],'LocalizationBundle') }}:&nbsp;&nbsp;<input id="encrm29"
                                                                                                 name="encrm_reac"
                                                                                                 value="1" type="radio">&nbsp;&nbsp;
                            {{ 'labels.no'|trans([],'LocalizationBundle') }}:&nbsp;&nbsp;<input id="encrm30"
                                                                                                name="encrm_reac"
                                                                                                value="2" type="radio" checked="true">
                        </td>
                        <td>
                            Conducta médica<input id="encrm31" name="encrm31" class="form-control" type="text" disabled="true">
                        </td>
                    </tr>
                    <tr>
                        <td colspan="2">Registro enfermería</td>
                        <td colspan="2">
                            <textarea rows="4" id="encrm32" name="encrm32" class="form-control" type="text"></textarea>
                        </td>
                    </tr>
                    <tr>
                        <td colspan="2">Nombre de quien brinda la información:</td>
                        <td colspan="2">
                            <input id="encrm33" name="encrm33" class="form-control" type="text">
                        </td>
                    </tr>
                    <tr>
                        <td colspan="2">Parentesco:</td>
                        <td colspan="2">
                            <input id="encrm34" name="encrm34" class="form-control" type="text">
                        </td>
                    </tr>
                    </tbody>
                </table>
                <table class="table table-condensed table-bordered table-mammo" style="width:100%;font-size:12px;">
                    <tbody>
                    <tr>
                        <td colspan="3"><b> Realizado por:</b></td>
                        <td colspan="1">
                            <input id="encrm43" name="encrm43" class="form-control" type="text">
                        </td>
                    </tr>
                    </tbody>
                </table>
            </div>
        </div>
    </div>
    </fieldset>
    <div class="clearfix"></div>

{% endblock %}