{% set userData = app.session.get('userData') %}
<form method="POST" id="form-patientServices">
    <h5>{{ page_title }}</h5>
    <div id="flash-messages-content-modal"></div>
    <div class="row max-width-initial">
        <div class="large-12 columns">
            <div class="row max-width-initial">
                <div class="large-12 columns">
                    <div class="row large-text-center">
                        <div class="large-3 large-text-right columns">
                            {{ form_label(form.service_desc) }}
                        </div>
                        <div class="large-9 columns">
                            {{ form_widget(form.service_desc) }}
                            {{ form_widget(form.service) }}
                        </div>
                    </div>
                    <div class="row large-text-center">
                        <div class="large-3 large-text-right columns">
                            {{ form_label(form.health_facility_desc) }}
                        </div>
                        <div class="large-9 columns">
                            {{ form_widget(form.health_facility_desc) }}
                            {{ form_widget(form.health_facility) }}
                        </div>
                    </div>
                    <div class="row large-text-center">
                        <div class="large-3 large-text-right columns">
                            {{ form_label(form.specialist_full_name) }}
                        </div>
                        <div class="large-9 columns">
                            {{ form_widget(form.specialist_full_name) }}
                            {{ form_widget(form.specialist) }}
                        </div>
                    </div>
                    <div class="row large-text-center">
                        <div class="large-3 large-text-right columns">
                            {{ form_label(form.start_date) }}
                        </div>
                        <div class="large-9 columns">
                            {{ form_widget(form.start_date) }}
                        </div>
                    </div>
                    <div class="row large-text-center">
                        <div class="large-3 large-text-right columns">
                            {{ form_label(form.end_date) }}
                        </div>
                        <div class="large-9 columns">
                            {{ form_widget(form.end_date) }}
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
    <hr>
    <div class="row-max-width-initial">
        <div class="small-12 columns no-padding-right">
            <div class="button-container clearfix text-right">
                <a href="javascript:void(0)" class="button just-continue href-patient-services-action float-right" data-axn="{{ action }}"
                   data-message="Are you sure you want to save this information?"
                   style="margin-left: 10px; margin-right: 0;"
                >Save</a>
                {% if action == 'u' and (userData.type == 'Super Admin' or 'Admin Patient Services Delete' in userData.accesses) %}
                    <a href="javascript:void(0)" class="ask-continue button alert href-patient-services-action float-right" data-axn="d"
                       data-message="Are you sure you want to delete this record?"
                       style="margin-left: 10px; margin-right: 0;"
                    >Delete</a>
                {% endif %}
                <a href="javascript:void(0)" class="button secondary" data-close style="margin-left: 10px; margin-right: 0;">Close</a>
            </div>
        </div>
    </div>
    {{ form_widget(form.action) }}
    {{ form_widget(form.patient_service_type) }}
    {{ form_widget(form.id) }}
    {{ form_widget(form.patient) }}
    {{ form_widget(form._token) }}
</form>
<script language="javascript">
    //<![CDATA[
        jQ(document).ready(function(){
            let autoCompleteUrl = '{{ path('service_autocomplete') }}' ;
            let branchAutoCompleteUrl = '{{ path('health_facility_autocomplete') }}' ;
            let specialistAutoCompleteUrl = '{{ path('specialist_autocomplete') }}' ;
            global.autocomplete.bind(autoCompleteUrl, '#patientServiceForm_service_desc', '#patientServiceForm_service');
            global.autocomplete.bind(branchAutoCompleteUrl, '#patientServiceForm_health_facility_desc', '#patientServiceForm_health_facility');
            global.autocomplete.bind(specialistAutoCompleteUrl, '#patientServiceForm_specialist_full_name', '#patientServiceForm_specialist');
        });
    //]]>
</script>