[% user = session.user; # INCLUDE dumper.tt dump = session %]

<table class="table table-striped table-condensed">
  <!--
    <tr>
        <td>NHS number</td>
		<td>[% user.nhs_number %]</td>
	</tr>
  -->
    <tr>
        <td>Date of Birth</td>
		<td>[% user.dob.strftime('%d.%b.%Y') %]</td>
	</tr>
    <tr>
        <td>Address</td>
		<td>[% user.address %], [% user.post_code %]</td>
	</tr>
    <tr>
        <td>Contact number</td>
		<td>[% user.contact_number %]</td>
	</tr>
    <tr>
        <td>Email</td>
		<td>[% user.email %]</td>
	</tr>
    <tr>
        <td>Your GP</td>
		<td>[% user.gp %], [% user.practice %]</td>
	</tr>
</table>

<div class="panel-group" id="accordion" role="tablist" aria-multiselectable="true">
  <div class="panel panel-warning">
    <div class="panel-heading" role="tab" id="panel-heading">
      <div class="panel-title">
        <a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion"
		   href="#patientdetails" aria-expanded="false" aria-controls="patientdetails">
			If any of the above details are incorrect, please click here
        </a>
      </div>
    </div>
    <div id="patientdetails" class="panel-collapse collapse" role="tabpanel"
		 aria-labelledby="panel-heading">
      <div class="panel-body">
		[% # INCLUDE dumper.tt dump = session.user %]
		<form action="javascript:;" method="post" id="patient-details">
			<div class="form-group" id="fist_name-group">
			  <label for="first_name">First name</label>
			  <input type="text" class="form-control" id="first_name"
					name="first_name" value="[% user.first_name.ucfirst %]">
			</div>
			<div class="form-group" id="last_name-group">
			  <label for="last_name">Last name</label>
			  <input type="text" class="form-control" id="last_name"
					name="last_name" value="[% user.last_name.upper %]">
			</div>
			<div class="form-group" id="dob-group">
			  <label for="dob">Date of birth</label>
			  <input type="text" class="form-control" id="dob"
					name="dob" value="[% user.dob.strftime('%d %b %Y') %]">
			</div>
			<div class="form-group" id="contact_number-group">
			  <label for="contact_number">Contact number</label>
			  <input type="text" class="form-control" id="contact_number"
					name="contact_number" value="[% user.contact_number %]">
			</div>
			<div class="form-group" id="email-group">
			  <label for="email">Email address</label>
			  <input type="email" class="form-control" id="email"
					name="email" value="[% user.email %]">
			</div>
			<div class="form-group" id="address-group">
			  <label for="address">Postal address</label>
			  <input type="text" class="form-control" id="address"
					name="address" value="[% user.address %], [% user.post_code %]">
			</div>

			<div class="form-group" id="practice-group">
			  <label for="practice">GP details</label>
			  <input type="text" class="form-control" id="practice"
					name="practice" value="[% user.gp %], [% user.practice %]">
			</div>

			<div class="form-group" id="password-group">
			  <label for="password">Your password</label>
			  <input type="password" class="form-control" id="password"
					required name="password" placeholder="password">
			</div>
			<button type="submit" class="btn btn-success">Submit
				<span class="fa fa-arrow-right"></span>
			</button>
			<div id="result"></div>
		</form>
      </div>
    </div>
  </div>
</div>