{% extends 'base.html.twig' %} {% block body %} {{ block('nav', 'internal/libs/nav.html.twig') }} <main class="main-content position-relative max-height-vh-100 h-100 border-radius-lg "> {{ block('topnav', 'internal/libs/top-nav.html.twig') }} <section> <div class="card card-plain"> <div class="card-header"> <h4 class="font-weight-bolder">Add Referral Note</h4> <p class="mb-0">{{ referral.memberCase.caseName }}</p> </div> <div class="card-body"> {{ form_start(form) }} {{ form_errors(form) }} <div class='container'> <div class='row'> {% set endDateWarning = '' %} {% if date("+28 days") >= referral.endDate %} {% set endDateWarning = 'bg-gradient-warning' %} {% elseif date("+14 days") >= referral.endDate %} {% set endDateWarning = 'bg-gradient-danger text-white' %} {% endif %} <span class='col{% if referral.hours < 40 %} bg-gradient-danger text-white{% endif %}'> Hours: {{ referral.hours }} / Remaining: {{ referral.getHoursRemaining() }} </span> <span class='col {{ endDateWarning }}'> Expiration Date: {{ referral.endDate|date('M j, Y') }} </span> </div> <div class='row' style='margin-top:10px;'> <div class='col'> <div class='input-group input-group-outline mb-3'> <label for='note_form_date'></label> <input type='date' name='{{ field_name(form.date) }}' id='note_form_date' class='form-control' title='Visit Date'/> </div> <div class='input-group input-group-outline mb-3'> <label for='note_form_startTime'></label> <input type='time' name='{{ field_name(form.startTime) }}' id='note_form_startTime' onchange='calcTime()' class='form-control' title='Start Time'/> <label for='note_form_endTime'></label> <input type='time' name='{{ field_name(form.endTime) }}' id='note_form_endTime' onchange='calcTime()' class='form-control' title='End Time'/> </div> <div class='input-group input-group-outline mb-3'> <input type='text' id='case-mins' style='width:49%;margin-right:5px;' disabled='disabled' title='Case Minutes'/> <input type='text' id='case-hours' style='width:49%;margin-left:5px;' disabled='disabled' title='Case Hours'/> </div> <div class='input-group input-group-outline mb-3'> <select name='{{ field_name(form.status) }}' id='note_form_status' class='form-control'> <option value=''>-- Status --</option> {% for s in enum('App\\Enums\\NoteStatus').cases() %} <option value='{{ s.value }}'>{{ s.value|capitalize }}</option> {% endfor %} </select> </div> <div class='input-group input-group-outline mb-3'> <select name='{{ field_name(form.location) }}' id='note_form_location' class='form-control'> <option value=''>-- Location --</option> {% for l in enum('App\\Enums\\NoteLocation').cases() %} <option value='{{ l.value }}' {% if l == default_location %} selected='selected' {% endif %}>{{ l.value }}</option> {% endfor %} </select> </div> <div class='input-group input-group-outline mb-3'> <select name='{{ field_name(form.method) }}' id='note_form_method' class='form-control'> <option value=''>-- Method --</option> {% for m in enum('App\\Enums\\NoteMethod').cases() %} <option value='{{ m.value }}' {% if m == default_method %} selected='selected' {% endif %}>{{ m.name|replace({'_': ' '})|lower|capitalize }}</option> {% endfor %} </select> </div> <div class='input-group input-group-outline mb-3'> <label for='note_form_parentalRole'>Parental Role</label> </div> <div class='input-group input-group-outline mb-3'> <select name='{{ field_name(form.parentalRole) }}' id='note_form_parentalRole' class='form-control'> <option value=''>-- Select --</option> {% for q in enum('App\\Enums\\VisitQualityLevel').cases() %} <option value='{{ q.value }}'>{{ q.name|lower|capitalize }}</option> {% endfor %} </select> </div> <div class='input-group input-group-outline mb-3'> <label for='note_form_childDevelopment'>Child Development</label> </div> <div class='input-group input-group-outline mb-3'> <select name='{{ field_name(form.childDevelopment) }}' id='note_form_childDevelopment' class='form-control'> <option value=''>-- Select --</option> {% for q in enum('App\\Enums\\VisitQualityLevel').cases() %} <option value='{{ q.value }}'>{{ q.name|lower|capitalize }}</option> {% endfor %} </select> </div> <div class='input-group input-group-outline mb-3'> <label for='note_form_appropriateResponse'>Appropriate Response</label> </div> <div class='input-group input-group-outline mb-3'> <select name='{{ field_name(form.appropriateResponse) }}' id='note_form_appropriateResponse' class='form-control'> <option value=''>-- Select --</option> {% for q in enum('App\\Enums\\VisitQualityLevel').cases() %} <option value='{{ q.value }}'>{{ q.name|lower|capitalize }}</option> {% endfor %} </select> </div> <div class='input-group input-group-outline mb-3'> <label for='note_form_childAheadOfSelf'>Child Ahead Of Self</label> </div> <div class='input-group input-group-outline mb-3'> <select name='{{ field_name(form.childAheadOfSelf) }}' id='note_form_childAheadOfSelf' class='form-control'> <option value=''>-- Select --</option> {% for q in enum('App\\Enums\\VisitQualityLevel').cases() %} <option value='{{ q.value }}'>{{ q.name|lower|capitalize }}</option> {% endfor %} </select> </div> <div class='input-group input-group-outline mb-3'> <label for='note_form_showsEmpathy'>Shows Empathy</label> </div> <div class='input-group input-group-outline mb-3'> <select name='{{ field_name(form.showsEmpathy) }}' id='note_form_showsEmpathy' class='form-control'> <option value=''>-- Select --</option> {% for q in enum('App\\Enums\\VisitQualityLevel').cases() %} <option value='{{ q.value }}'>{{ q.name|lower|capitalize }}</option> {% endfor %} </select> </div> <div class='input-group input-group-outline mb-3'> <label for='note_form_childFocused'>Child Focused</label> </div> <div class='input-group input-group-outline mb-3'> <select name='{{ field_name(form.childFocused) }}' id='note_form_childFocused' class='form-control'> <option value=''>-- Select --</option> {% for q in enum('App\\Enums\\VisitQualityLevel').cases() %} <option value='{{ q.value }}'>{{ q.name|lower|capitalize }}</option> {% endfor %} </select> </div> </div> <div class='col'> <div class='input-group input-group-outline mb-3'> {{ form_row(form.members, { 'label': 'Members Present', 'label_attr': {'class': ''}, 'attr': {'class': 'form-control'} }) }} </div> <div class='input-group input-group-outline mb-3'> <label for='note_form_narrative'>Observed Narrative</label> <textarea name='{{ field_name(form.narrative) }}' id='note_form_narrative' class='form-control' style='width:100%;height:200px;'></textarea> </div> <div class='input-group input-group-outline mb-3'> <label for='note_form_strengths'>Observed Strengths</label> <textarea name='{{ field_name(form.strengths) }}' id='note_form_strengths' class='form-control' style='width:100%;height:200px;'></textarea> </div> <div class='input-group input-group-outline mb-3'> <label for='note_form_issues'>Observed Issues</label> <textarea name='{{ field_name(form.issues) }}' id='note_form_issues' class='form-control' style='width:100%;height:100px;'></textarea> </div> <div class='input-group input-group-outline mb-3'> <label for='note_form_recommendation'>Recommendation</label> <textarea name='{{ field_name(form.recommendation) }}' id='note_form_recommendation' class='form-control' style='width:100%;height:100px;'></textarea> </div> </div> </div> <div class='row'> <div class="text-center"> <button type="submit" class="btn btn-lg bg-gradient-dark btn-lg w-100 mt-4 mb-0">Save Note</button> </div> </div> </div> {{ form_end(form) }} </div> </div> </section> </main> {% endblock %}