{% set absUrl = app.request.getSchemeAndHttpHost() ~ app.request.baseUrl|replace({'/app_dev.php': ''}) %}
{% set userData = app.session.get('userData') %}
<!DOCTYPE html>
<html class="no-js" lang="en" dir="ltr">
<head>
	<meta charset="utf-8">
	<meta http-equiv="x-ua-compatible" content="ie=edge">
	<meta name="viewport" content="width=device-width, initial-scale=1.0">
	<title>Somnus Letter</title>
</head>
<body style="font-family:'Arial'; font-size:18px;">
{% if patientLetter.patientReferringProvider %}
	{% set rp = patientLetter.patientReferringProvider.referringProvider %}
	{% set patient = patientLetter.patient %}
	{% set receiverFullName = patientLetter.patientReferringProvider.referringProvider.getReferringProviderFullName|title %}
	{% if patientLetter.patientReferringProvider.referringProvider.phoneNo is null or patientLetter.patientReferringProvider.referringProvider.phoneNo == '' %}
		{% set receiverPhone = '' %}
		{% for prhf in patient.patientReferringHealthFacilities %}
			{% for rhfp in rp.referringHealthFacilityProviders %}
				{% if prhf.referringHealthFacility.id == rhfp.referringHealthFacility.id %}
					{% set receiverPhone = prhf.referringHealthFacility.phoneNo %}
				{% endif %}
			{% endfor %}
		{% endfor %}
	{% else %}
		{% set receiverPhone = patientLetter.patientReferringProvider.referringProvider.phoneNo %}
	{% endif %}
	{% if patientLetter.patientReferringProvider.referringProvider.faxNo is null or patientLetter.patientReferringProvider.referringProvider.faxNo == '' %}
		{% set receiverFax = '' %}
		{% for prhf in patient.patientReferringHealthFacilities %}
			{% for rhfp in rp.referringHealthFacilityProviders %}
				{% if prhf.referringHealthFacility.id == rhfp.referringHealthFacility.id %}
					{% set receiverFax = prhf.referringHealthFacility.faxNo %}
				{% endif %}
			{% endfor %}
		{% endfor %}
	{% else %}
		{% set receiverFax = patientLetter.patientReferringProvider.referringProvider.faxNo %}
	{% endif %}
{% endif %}
{% if patientLetter.patientReferringHealthFacility %}
	{% set receiverFullName = patientLetter.patientReferringHealthFacility.referringHealthFacility.description %}
	{% set receiverPhone = patientLetter.patientReferringHealthFacility.referringHealthFacility.phoneNo is null ? patientLetter.patientReferringHealthFacility.referringHealthFacility.phoneNoTwo : patientLetter.patientReferringHealthFacility.referringHealthFacility.phoneNo %}
	{% set receiverFax = patientLetter.patientReferringHealthFacility.referringHealthFacility.faxNo is null ? patientLetter.patientReferringHealthFacility.referringHealthFacility.faxNoTwo : patientLetter.patientReferringHealthFacility.referringHealthFacility.faxNo %}
{% endif %}
{% if patientLetter.patientInsurance %}
	{% set receiverFullName = patientLetter.patientInsurance.insurance.description %}
	{% set receiverPhone = patientLetter.patientInsurance.insurance.phoneNo is null ? patientLetter.patientInsurance.insurance.phoneNoTwo : patientLetter.patientInsurance.insurance.phoneNo %}
	{% set receiverFax = patientLetter.patientInsurance.insurance.faxNo is null ? patientLetter.patientInsurance.insurance.faxNoTwo : patientLetter.patientInsurance.insurance.faxNo %}
{% endif %}
{% if patientLetter.specialist %}
	{% set receiverFullName = patientLetter.specialist.fullName|title %}
	{% set receiverPhone = patientLetter.specialist.phoneNo is null ? patientLetter.specialist.phoneNoTwo : patientLetter.specialist.phoneNo %}
	{% set receiverFax = patientLetter.specialist.faxNo is null ? patientLetter.specialist.faxNoTwo : patientLetter.specialist.faxNo %}
{% endif %}
{% set patientFullName = patientLetter.patient.fullName %}
{% set patientFirstName = patientLetter.patient.firstName %}
{% set patientLastName = patientLetter.patient.lastName %}
{% set patient = patientLetter.patient %}
{% set dateOfBirth = patientLetter.patient.birthDate|date('F j, Y') %}

{% set customBody = patientLetter.customBody|replace({
	'{{RECEVIER-FULLNAME}}' :  receiverFullName,
	'{{PATIENT-FULLNAME}}' : patientFullName,
	'{{PATIENT-FIRSTNAME}}' :  patientLetter.patient.firstName,
	'{{PATIENT-LASTNAME}}' :  patientLetter.patient.lastName,
	'{{USERDATA-FULLNAME}}' : userData.fullName,
	'{{DATE-TODAY}}' : 'now'|date('m/d/Y'),
	'{{DATE-CREATED}}' : patientLetter.createdAt|date('m/d/Y'),
	'{{PATIENT-PHN}}' : patientLetter.patient.personalHealthNo|default(''),
	'{{PATIENT-DOB}}' : patientLetter.patient.birthDate|date('m/d/Y'),
	'{{PATIENT-GENDER}}' : patientLetter.patient.gender == 'Male' ? 'he' : 'she',
	'{{PATIENT-GENDER2}}' : patientLetter.patient.gender == 'Male' ? 'him' : 'her',
	'{{PATIENT-GENDER3}}' : patientLetter.patient.gender == 'Male' ? 'his' : 'her',
	'{{PATIENT-GENDER4}}' : patientLetter.patient.gender == 'Male' ? 'He' : 'She'
})
%}


<!------ 1ST PAGE ------>
{% include '@RxConnexion/Patient/FaxTemplate/SomnusTemplate/fax_cover.wkpdf.twig' with {patientLetter: patientLetter} %}
<div style="page-break-before: always"></div>
<div style="width:768px; position: relative; padding:0px; margin: 0 auto; box-shadow:3px 1px 10px 1px;">
	<div style="border: none;">
		<div style="color: #ED226D; font-size: 22px;"><strong>ADHERENCE REPORT</strong></div>
		<div style="margin-bottom: 25px; margin-top: 10px; float: left;">
			Thank you, {{ receiverFullName }}, for referring you patient {{ patientFullName }} to CPAP Pros
		</div>
		<div style="width:100%; float: left; margin-bottom: 10px;">
			<div style="width:50%; float: left;">
				<table>
					<tr>
						<td>Today's Date:</td>
						<td>{{ 'now'|date('m/d/Y') }}</td>
					</tr>
					<tr>
						<td>Date of Birth:</td>
						<td>{{ patientLetter.patient.birthDate|date('m/d/Y') }}</td>
					</tr>
					<tr>
						<td>Set Up Date:</td>
						<td>{{ 'now'|date('m/d/Y') }}</td>
					</tr>
				</table>
			</div>
			<div style="width:50%; float: right; margin-bottom: 10px;">
				<table>
					<tr>
						<td>ULI/PHN:</td>
						<td>{{ patientLetter.patient.personalHealthNo|default('') }}</td>
					</tr>
					<tr>
						<td>Sleep Clinician:</td>
						<td>{{ adherence.clinician|default('') }}</td>
					</tr>
				</table>
			</div>
		</div>
		<div style="width:100%; float: left; margin-bottom: 10px;">
			<div style="width:50%; float: left;">
				<table>
					<tr>
						<td>AHI Untreated:</td>
						<td>{{ adherence.ahiUntreated|default('') }}</td>
					</tr>
					<tr>
						<td>AHI Treated:</td>
						<td>{{ adherence.ahiTreated|default('') }}</td>
					</tr>
					<tr>
						<td>Epworth Score: Pre</td>
						<td>{{ adherence.epworthScorePre|default('') }}</td>
					</tr>
				</table>
			</div>
			<div style="width:50%; float: right; margin-bottom: 10px;">
				<table>
					<table>
						<tr>
							<td>Average Hours Usage per Night:</td>
							<td>{{ adherence.averageHoursUsagePerNight|default('') }}</td>
						</tr>
						<tr>
							<td>Length of Time on Therapy:</td>
							<td>{{ adherence.lengthOfTimeOnTherapy|default('') }}</td>
						</tr>
						<tr>
							<td>Post:</td>
							<td>{{ adherence.epworthScorePost|default('') }}</td>
						</tr>
					</table>
				</table>
			</div>
		</div>
		<div style="float: left; width: 100%; border: 1px solid #ED226D; padding: 5px; margin-bottom: 20px; height: 300px;">
			<div style="width: 100%; height: 150px">
				<div><strong>Notes</strong></div>
				{{ adherence.notes|raw }}
			</div>
			<div style="width: 100%; height: 150px;">
				<div><strong>Plan</strong></div>
				{{ adherence.plan|raw }}
			</div>
		</div>
		<div style="width:100%; float: left; margin-bottom: 20px;">
			<div>Next Follow-up Date: ______________</div>
			<div>Does the patient continue to have any of the following signs and symptoms?</div>
			<div style="margin-left: 5px; margin-bottom: 10px;">
				<table>
					<tr>
						<td>Snoring,gasping,choking?</td>
						<td>
							<span>Yes <input type="checkbox" {{ adherence.isSnoringGaspingChoking|default('') == true ? 'checked' : '' }}></span>
							<span>No <input type="checkbox" {{ adherence.isSnoringGaspingChoking|default('') != true ? 'checked' : '' }}></span>
						</td>
					</tr>
					<tr>
						<td>Fatigue or daytime sleepiness?</td>
						<td>
							<span>Yes <input type="checkbox" {{ adherence.isFatigueDaytimeSleepiness|default('') == true ? 'checked' : '' }}></span>
							<span>No <input type="checkbox" {{ adherence.isFatigueDaytimeSleepiness|default('') != true ? 'checked' : '' }}></span>
						</td>
					</tr>
					<tr>
						<td>Morning headache?</td>
						<td>
							<span>Yes <input type="checkbox" {{ adherence.isMorningHeadache|default('') == true ? 'checked' : '' }}></span>
							<span>No <input type="checkbox" {{ adherence.isMorningHeadache|default('') != true ? 'checked' : '' }}></span>
						</td>
					</tr>
					<tr>
						<td>Increase frequency of urination at night?</td>
						<td>
							<span>Yes <input type="checkbox" {{ adherence.isIncreaseFrequencyOfUrinationAtNight|default('') == true ? 'checked' : '' }}></span>
							<span>No <input type="checkbox" {{ adherence.isIncreaseFrequencyOfUrinationAtNight|default('') != true ? 'checked' : '' }}></span>
						</td>
					</tr>
					<tr>
						<td>Poor memory or concentration?</td>
						<td>
							<span>Yes <input type="checkbox" {{ adherence.isPoorMemoryOrConcentration|default('') == true ? 'checked' : '' }}></span>
							<span>No <input type="checkbox" {{ adherence.isPoorMemoryOrConcentration|default('') != true ? 'checked' : '' }}></span>
						</td>
					</tr>
					<tr>
						<td>High blood pressure?</td>
						<td>
							<span>Yes <input type="checkbox" {{ adherence.isHighBloodPressure|default('') == true ? 'checked' : '' }}></span>
							<span>No <input type="checkbox" {{ adherence.isHighBloodPressure|default('') != true ? 'checked' : '' }}></span>
						</td>
					</tr>
				</table>
			</div>
		</div>
		<div style="width:100%; float: left; margin-bottom: 10px;">
			Should you have any questions or if we can be of any further assistance, please don't hesitate to let us know.
		</div>
		<div style="width:100%; float: left;">
			Clinician: {{ adherence.clinician|default('') }}
		</div>
	</div>
</div>
</body>
</html>