{% set userData = app.session.get('userData') %}
<form method="POST" id="form-patientReminder">
    <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_widget(form.reminderType) }}
                            {{ form_label(form.reminderType_desc) }}
                        </div>
                        <div class="large-9 columns">
                            {{ form_widget(form.reminderType_desc) }}
                        </div>
                    </div>
                    <div class="row large-text-center">
                        <div class="large-3 large-text-right columns">
                            {{ form_widget(form.assignedToAccountUser) }}
                            {{ form_label(form.assignedToAccountUser_fullName) }}
                        </div>
                        <div class="large-9 columns">
                            {{ form_widget(form.assignedToAccountUser_fullName) }}
                        </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 class="row large-text-center">
                        <div class="large-3 large-text-right columns">
                            {{ form_label(form.status) }}
                        </div>
                        <div class="large-9 columns">
                            {{ form_widget(form.status) }}
                        </div>
                    </div>
                    <div class="row large-text-center">
                        <div class="large-3 large-text-right columns">
                            {{ form_label(form.note) }}
                        </div>
                        <div class="large-9 columns">
                            {{ form_widget(form.note) }}
                        </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-reminder-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 Reminder Delete' in userData.accesses) %}
                    <a href="javascript:void(0)" class="ask-continue button alert href-patient-reminder-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.id) }}
    {{ form_widget(form.account_user) }}
    {{ form_widget(form.patient) }}
    {{ form_widget(form._token) }}
</form>
<script language="javascript">
    //<![CDATA[
        jQ(document).ready(function(){
            let autoCompleteUrl = '{{ path('reminder_type_autocomplete') }}' ;
            let autoCompleteUrl_accountUser = '{{ path('account_user_autocomplete') }}' ;
            global.autocomplete.bind(autoCompleteUrl, '#patientReminder_reminderType_desc', '#patientReminder_reminderType');
            global.autocomplete.bind(autoCompleteUrl_accountUser, '#patientReminder_assignedToAccountUser_fullName', '#patientReminder_assignedToAccountUser');
        });
    //]]>
</script>