[% META
title = 'Haematological Malignancy Research Network » Edit Referral Data'
%]
<!-- BEGIN [% component.name %] -->
[% # PROCESS dumper.tt dump = data %]
[% addcss = [
'validationEngine.jquery.css' # for validationEngine
'smoothness/jquery-ui-1.8.4.custom.css' # for DatePicker
]
%]
[% # PROCESS site/js/jquery.tt # already loaded in html_wrapper %]
<script type="text/javascript" src="/js/jquery-ui-1.8.4.custom.min.js"></script>
<script type="text/javascript">
$(function() {
$('.datepicker').datepicker({
changeMonth: true,
changeYear: true,
dateFormat: 'dd/mm/yy',
});
});
</script>
[% IF not_using_validationEngine_jquery # then use 'basic' jquery val %]
<script type="text/javascript" src="/js/jquery.validate.js"></script>
<script type="text/javascript">
$(document).ready(function() {
$("#referral").validate({
rules: {
[% c.jquery_validation_profile("${profile_name}").join(',') %]
},
});
});
</script>
<script type="text/javascript">
// override default message:
jQuery.extend(jQuery.validator.messages, {
remote: "« invalid entry",
required: "« required field",
});
</script>
[% ELSE; INCLUDE site/js/validationEngine.tt %]
<script type="text/javascript">
$(document).ready(function() {
$("#referral").validationEngine()
})
</script>
[% END %]
<h3>Edit referral data:</h3>
[% IF dfv_errors %]
<p class="error">[% c.cfg('msg').dfv_errors %]</p>
[% END %]
<form method="post" name="referral" id="referral" [% # hmrn_treatment_onsubmit # using jQuery val %]
action="[% app_url %]/hmrn_data/do_edit_referral/[% data.request_id %]/[% data.id %]">
<table class="indent">
<tr>
<td class="label">Referral date:</td>
<td class="content">
<input type="text" name="referral_date" class="validate[ajax[ajaxDate]] datepicker"
id="referral_date" value="[% data.referral_date.strftime('%d.%b.%Y') %]" size="10" />
[% error_referral_date %]
</td>
</tr>
<tr>
<td class="label">Referral type:</td>
<td class="content">
<select name="referral_type_id" id="referral_type_id" class="validate[required]">
<option value=""></option>
[% FOREACH key IN data.maps.referral_types.keys.sort %]
<option value="[% data.maps.referral_types.$key %]"
[% 'selected' IF data.maps.referral_types.$key == data.referral_type_id %]>
[% key %]
</option>
[% END %]
</select>
[% error_referral_type_id %]
</td>
</tr>
<tr>
<td class="label">Referred from:</td>
<td class="content">
<select name="from_source_id" id="from_source_id" class="validate[required]">
<option value=""></option>
[% FOREACH key IN data.maps.referral_sources.keys.sort %]
<option value="[% data.maps.referral_sources.$key %]"
[% 'selected' IF data.maps.referral_sources.$key == data.from_source_id %]>
[% key %]
</option>
[% END %]
</select>
[% error_from_source_id %]
</td>
</tr>
<tr>
<td class="label">Referred to:</td>
<td class="content">
<select name="to_source_id" id="to_source_id" class="validate[required]">
<option value=""></option>
[% FOREACH key IN data.maps.referral_sources.keys.sort %]
<option value="[% data.maps.referral_sources.$key %]"
[% 'selected' IF data.maps.referral_sources.$key == data.to_source_id %]>
[% key %]
</option>
[% END %]
</select>
[% error_to_source_id %]
</td>
</tr>
<tr>
<td class="label">Date first seen:</td>
<td class="content">
<input type="text" name="date_first_seen" class="validate[ajax[ajaxDate]] datepicker"
id="date_first_seen" value="[% data.date_first_seen.strftime('%d.%b.%Y') %]" size="10" />
[% error_date_first_seen %]
</td>
</tr>
<tr class="borderless">
<td>[% site.html.back_button %]</td>
<td align="right">
[% IF c.query.param('delete') %]
<span class="title">confirm deletion (no undo possible):</span>
<input type="checkbox" name="confirm_delete" value="1" />
<input type="hidden" name="delete" value="1" />
[% site.html.submit %]
[% ELSE %]
[% site.html.submit %]
[% site.html.reset %]
<a href="[% app_url %]/hmrn_data/edit_referral/[% c.param('id')
%]/[% c.param('Id') %]?delete=1">
<span class="highlight">delete</span>
</a>
[% END %]
</td>
</tr>
</table>
</form>
<!-- END [% component.name %] -->