{% 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</h4> <p class="mb-0">{{ case.caseName }}</p> </div> <div class="card-body"> <div class="container"> {{ form_errors(form) }} {{ form_start(form) }} <div class='input-group input-group-outline mb-3'> <label for='referral_form_referralId' class='form-label'>Referral ID</label> <input type='text' name='{{ field_name(form.referralId) }}' id='referral_form_referralId' class='form-control'/> </div> <div class='input-group input-group-outline mb-3'> <select name='{{ field_name(form.serviceCode) }}' id='referral_form_serviceCode' class='form-control'> <option value=''>-- Select Service Code --</option> {% for sc in enum('App\\Enums\\ReferralServiceType').cases() %} <option value='{{ sc.value }}'>{{ sc.name }}</option> {% endfor %} </select> </div> <div class='input-group input-group-outline mb-3'> <label for='referral_form_hours' class='form-label'>Hours</label> <input type='number' name='{{ field_name(form.hours) }}' id='referral_form_hours' class='form-control'/> </div> <div class='input-group input-group-outline mb-3'> <label for='referral_form_endDate' class='form-label'></label> <input type='date' name='{{ field_name(form.endDate) }}' id='referral_form_endDate' class='form-control'/> </div> <div class='input-group input-group-outline mb-3'> <select name='{{ field_name(form.dischargeReason) }}' id='referral_form_dischargeReason' class='form-control'> <option value=''>-- Select Discharge Reason --</option> {% for dr in enum('App\\Enums\\DischargeReason').cases() %} <option value='{{ dr.value }}'>{{ dr.name }}</option> {% endfor %} </select> </div> <div class='input-group input-group-outline mb-3'> <label for='referral_form_dischargeDate' class='form-label'></label> <input type='date' name='{{ field_name(form.dischargeDate) }}' id='referral_form_dischargeDate' class='form-control'/> </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 Referral</button> </div> </div> {{ form_end(form) }} </div> </div> </div> </section> </main> {% endblock %}