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<?xml version="1.0"?>
<odoo>
<record id="action_report_crm_lead" model="ir.actions.report">
<!-- Report action of report crm lead-->
<field name="name">Adult Care Details</field>
<field name="model">crm.lead</field>
<field name="report_type">qweb-pdf</field>
<field name="report_name">adult_daycare_center.adult_care_crm_lead_report</field>
<field name="report_file">adult_daycare_center.adult_care_crm_lead_report</field>
<field name="binding_model_id" ref="model_crm_lead"/>
<field name="binding_type">report</field>
</record>
<template id="adult_care_crm_lead_report">
<!-- Report template of adult care crm lead-->
<t t-call="web.html_container">
<t t-call="web.external_layout">
<div class="page">
<t t-foreach="docs" t-as="data">
<center>
<span style="font-size:25px;">
<strong>
<t t-esc="data['name']"/>
-
<t t-esc="data['partner_id'].name"/>
</strong>
</span>
</center>
<br/>
<span>
<strong style="font-size:25px;">Personal
Information
</strong>
<table class="table table-borderless">
<tr>
<td>
<strong>Birthdate</strong>
</td>
<td>
<t t-esc="data['birth_date']"/>
</td>
<td>
<strong>Gender</strong>
</td>
<td>
<t t-esc="data['gender']"/>
</td>
</tr>
<tr>
<td>
<strong>Address</strong>
</td>
<td><t t-esc="data['street']"/>,
<t t-esc="data['city']"/>
</td>
<td>
<strong>Medicaid</strong>
</td>
<td>
<t t-esc="data['medicaid']"/>
</td>
</tr>
<tr>
<td>
<strong>Medicare</strong>
</td>
<td>
<t t-esc="data['medicare']"/>
</td>
<td>
<strong>Marital Status</strong>
</td>
<td>
<t t-esc="data['marital_status']"/>
</td>
</tr>
<tr>
<td>
<strong>Supplemental Income</strong>
</td>
<td>
<t t-esc="data['supplemental_income']"/>
</td>
<td>
<strong>Interest in Program</strong>
</td>
<td>
<t t-esc="data['interest_program']"/>
</td>
</tr>
<tr>
<td>
<strong>Previous Experience</strong>
</td>
<td>
<t t-esc="data['previous_experience']"/>
</td>
<td>
<strong>Where and When</strong>
</td>
<td>
<t t-esc="data['where_when']"/>
</td>
</tr>
</table>
<br/>
</span>
<span>
<strong style="font-size:25px;">Relative and
Emergency Detail
</strong>
<table class="table table-borderless">
<tr>
<td>
<strong>Present Living Arrangement
</strong>
</td>
<td>
<t t-esc="data['present_living']"/>
</td>
<td>
<strong>Emergency Name</strong>
</td>
<td>
<t t-esc="data['emergency_name']"/>
</td>
</tr>
<tr>
<td>
<strong>Living with whom</strong>
</td>
<td><t t-esc="data['living_with_whom']"/>,
<t t-esc="data['city']"/>
</td>
<td>
<strong>Applicant Relationship</strong>
</td>
<td>
<t t-esc="data['applicant_relationship']"/>
</td>
</tr>
<tr>
<td>
<strong>Living with Relationship
</strong>
</td>
<td>
<t t-esc="data['living_with']"/>
</td>
<td>
<strong>Address Emergency</strong>
</td>
<td>
<t t-esc="data['emergency_address']"/>
</td>
</tr>
<tr>
<td>
<strong>Responsible Relative</strong>
</td>
<td>
<t t-esc="data['relationship_responsible_relative']"/>
</td>
<td>
<strong>Phone Emergency</strong>
</td>
<td>
<t t-esc="data['emergency_phone']"/>
</td>
</tr>
<tr>
<td>
<strong>Nearest Relative</strong>
</td>
<td>
<t t-esc="data['nearest_relative']"/>
</td>
<td>
<strong>Emergency Name</strong>
</td>
<td>
<t t-esc="data['first_emergency_name']"/>
</td>
</tr>
<tr>
<td>
<strong>Relationship with Relative
</strong>
</td>
<td>
<t t-esc="data['nearest_relative_relation']"/>
</td>
<td>
<strong>Applicant Relationship #1
</strong>
</td>
<td>
<t t-esc="data['second_applicant_relationship']"/>
</td>
</tr>
</table>
<br/>
</span>
<span>
<strong style="font-size:25px;">Medical and
Transportation Detail
</strong>
<table class="table table-borderless">
<tr>
<td>
<strong>Physician Name</strong>
</td>
<td>
<t t-esc="data['physician_name']"/>
</td>
<td>
<strong>Transportation</strong>
</td>
<td>
<t t-esc="data['transportation']"/>
</td>
</tr>
<tr>
<td>
<strong>Physician Address</strong>
</td>
<td><t t-esc="data['physician_address']"/>,
<t t-esc="data['city']"/>
</td>
<td>
<strong>Arrival Time</strong>
</td>
<td>
<t t-esc="data['arrival_time']"/>
</td>
</tr>
<tr>
<td>
<strong>Phone</strong>
</td>
<td>
<t t-esc="data['physician_phone']"/>
</td>
<td>
<strong>Departure Time</strong>
</td>
<td>
<t t-esc="data['departure_time']"/>
</td>
</tr>
<tr>
<td>
<strong>Physician Last Vist</strong>
</td>
<td>
<t t-esc="data['physician_last_visit']"/>
</td>
<td>
<strong>Special Diet</strong>
</td>
<td>
<t t-esc="data['special_diet']"/>
</td>
</tr>
<tr>
<td>
<strong>Dentist Name</strong>
</td>
<td>
<t t-esc="data['dentist_name']"/>
</td>
<td>
<strong>Transportation</strong>
</td>
<td>
<t t-esc="data['transportation']"/>
</td>
</tr>
<tr>
<td>
<strong>Dentist Address</strong>
</td>
<td>
<t t-esc="data['dentist_address']"/>
</td>
<td>
<strong>Responsible</strong>
</td>
<td>
<t t-esc="data['responsible']"/>
</td>
</tr>
<tr>
<td>
<strong>Dentist Phone</strong>
</td>
<td>
<t t-esc="data['dentist_phone']"/>
</td>
<td>
<strong>Phone Pay</strong>
</td>
<td>
<t t-esc="data['paid_by_name']"/>
</td>
</tr>
<tr>
<td>
<strong>Date of Dentist</strong>
</td>
<td>
<t t-esc="data['dentist_last_visit']"/>
</td>
<td>
<strong>Your Email</strong>
</td>
<td>
<t t-esc="data['your_email']"/>
</td>
</tr>
<tr>
<td>
<strong>Hospital Name</strong>
</td>
<td>
<t t-esc="data['hospital_name']"/>
</td>
<td>
<strong>Today date</strong>
</td>
<td>
<t t-esc="data['today_date']"/>
</td>
</tr>
</table>
<br/>
</span>
<span>
<strong style="font-size:25px;">Other Information
</strong>
<table class="table table-borderless">
<tr>
<td colspan="2">
<strong>Diet Detail</strong>
</td>
<td colspan="2">
<t t-esc="data['diet_detail']"/>
</td>
</tr>
<tr>
<td colspan="2">
<strong>List of Allergies</strong>
</td>
<td colspan="2">
<t t-esc="data['allergies']"/>
</td>
</tr>
<tr>
<td colspan="2">
<strong>Time Request</strong>
</td>
<td colspan="2">
<t t-esc="data['time_request']"/>
</td>
</tr>
</table>
</span>
</t>
</div>
</t>
</t>
</template>
</odoo>