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552 lines
27 KiB
552 lines
27 KiB
<?xml version="1.0"?>
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<odoo>
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<record id="action_report_adult_details" model="ir.actions.report">
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<!-- Report action of adult details-->
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<field name="name">Adult Care Details</field>
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<field name="model">res.partner</field>
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<field name="report_type">qweb-pdf</field>
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<field name="report_name">adult_daycare_center.adult_care_details_report</field>
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<field name="report_file">adult_daycare_center.adult_care_details_report</field>
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<field name="binding_model_id" ref="model_res_partner"/>
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<field name="binding_type">report</field>
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</record>
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<template id="adult_care_details_report">
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<!-- Report template of adult care details-->
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<t t-call="web.html_container">
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<t t-call="web.external_layout">
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<div class="page">
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<t t-foreach="docs" t-as="data">
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<center>
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<span style="font-size:25px;">
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<strong>Member :
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<t t-esc="data['name']"/>
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</strong>
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</span>
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</center>
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<br/>
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<span>
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<strong style="font-size:25px;">Application
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Information
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</strong>
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<table class="table table-borderless">
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<tr>
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<td>
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<strong>Social Security Number</strong>
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</td>
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<td>
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<t t-esc="data['social_security_no']"/>
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</td>
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<td>
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<strong>Referred By</strong>
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</td>
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<td>
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<t t-esc="data['referred_by_id'].name"/>
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</td>
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</tr>
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<tr>
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<td>
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<strong>Medicare Number</strong>
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</td>
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<td>
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<t t-esc="data['medicare_no']"/>
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</td>
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<td>
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<strong>Marital Status</strong>
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</td>
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<td>
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<t t-esc="data['marital_status']"/>
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</td>
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</tr>
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<tr>
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<td>
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<strong>Medicaid Number</strong>
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</td>
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<td>
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<t t-esc="data['medicaid_no']"/>
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</td>
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<td>
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<strong>Place of Birth</strong>
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</td>
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<td>
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<t t-esc="data['place_birth']"/>
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</td>
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</tr>
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<tr>
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<td>
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<strong>Birth Date</strong>
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</td>
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<td>
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<t t-esc="data['birth_date']"/>
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</td>
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<td>
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<strong>Age</strong>
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</td>
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<td>
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<t t-esc="data['age']"/>
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</td>
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</tr>
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<tr>
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<td>
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<strong>Responsible Party/Guardian
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</strong>
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</td>
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<td>
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<t t-esc="data['responsible_id'].name"/>
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</td>
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<td>
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<strong>Primary Care</strong>
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</td>
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<td>
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<t t-esc="data['care_provider_id'].name"/>
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</td>
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</tr>
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<tr>
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<td>
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<strong>Responsible Address</strong>
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</td>
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<td>
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<t t-esc="data['responsible_address']"/>
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</td>
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<td>
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<strong>Primary Care Address</strong>
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</td>
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<td>
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<t t-esc="data['care_provider_address']"/>
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</td>
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</tr>
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<tr>
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<td>
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<strong>Responsible Telephone</strong>
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</td>
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<td>
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<t t-esc="data['responsible_telephone']"/>
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</td>
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<td>
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<strong>Primary Care Telephone</strong>
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</td>
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<td>
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<t t-esc="data['care_provider_telephone']"/>
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</td>
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</tr>
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<tr>
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<td>
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<strong>Present Living Arrangements
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</strong>
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</td>
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<td>
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<t t-esc="data['present_living']"/>
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</td>
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<td>
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<strong>Living with whom</strong>
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</td>
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<td>
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<t t-esc="data['living_with_whom']"/>
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</td>
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</tr>
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<tr>
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<td>
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<strong>Relationship with whom their
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living
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</strong>
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</td>
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<td>
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<t t-esc="data['living_with']"/>
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</td>
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<td>
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<strong>Nearest Responsible Relative
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</strong>
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</td>
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<td>
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<t t-esc="data['nearest_relative']"/>
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</td>
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</tr>
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<tr>
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<td>
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<strong>If Employed, where</strong>
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</td>
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<td>
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<t t-esc="data['employed_at']"/>
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</td>
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<td>
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<strong>Business Phone</strong>
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</td>
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<td>
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<t t-esc="data['business_phone']"/>
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</td>
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</tr>
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<tr>
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<td colspan="2">
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<strong>Why interested in joining the
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program?
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</strong>
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</td>
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<td colspan="2">
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<t t-esc="data['interest_program']"/>
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</td>
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</tr>
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<tr>
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<td colspan="2">
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<strong>Have you had previous experience
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in an Adult Daycare Program?
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</strong>
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</td>
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<td colspan="2">
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<t t-esc="data['previous_experience']"/>
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</td>
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</tr>
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<tr>
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<td colspan="2">
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<strong>If yes, Where and When?</strong>
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</td>
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<td colspan="2">
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<t t-esc="data['where_when']"/>
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</td>
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</tr>
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</table>
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<br/>
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</span>
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<span>
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<strong style="font-size:25px;">Medical Details
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</strong>
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<table class="table table-borderless">
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<tr>
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<td>
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<strong>Physician</strong>
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</td>
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<td>
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<t t-esc="data['physician']"/>
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</td>
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<td>
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<strong>Travel By</strong>
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</td>
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<td>
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<t t-esc="data['travel_by']"/>
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</td>
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</tr>
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<tr>
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<td>
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<strong>Address</strong>
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</td>
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<td>
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<t t-esc="data['physician_address']"/>
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</td>
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<td>
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<strong>Is Need Travel Assistance
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</strong>
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</td>
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<td>
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<t t-esc="data['travel_assistance']"/>
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</td>
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</tr>
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<tr>
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<td>
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<strong>Phone</strong>
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</td>
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<td>
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<t t-esc="data['physician_phone']"/>
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</td>
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<td/>
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<td/>
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</tr>
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<tr>
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<td>
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<strong>Present Diagnoses/Medical
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Problems
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</strong>
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</td>
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<td>
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<t t-esc="data['present_medical']"/>
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</td>
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<td>
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<strong>Other Disability</strong>
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</td>
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<td>
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<t t-esc="data['other_disability']"/>
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</td>
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</tr>
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<tr>
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<td>
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<strong>Weight</strong>
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</td>
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<td>
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<t t-esc="data['weight']"/>
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</td>
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<td>
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<strong>Height</strong>
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</td>
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<td>
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<t t-esc="data['height']"/>
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</td>
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</tr>
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<tr>
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<td>
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<strong>Dentist</strong>
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</td>
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<td>
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<t t-esc="data['dentist']"/>
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</td>
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<td>
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<strong>Address</strong>
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</td>
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<td>
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<t t-esc="data['dentist_address']"/>
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</td>
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</tr>
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<tr>
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<td>
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<strong>Phone Number</strong>
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</td>
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<td>
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<t t-esc="data['dentist_phone']"/>
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</td>
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<td>
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<strong>Date of Last Visit</strong>
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</td>
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<td>
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<t t-esc="data['dentist_last_visit']"/>
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</td>
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</tr>
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</table>
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<br/>
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</span>
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<span t-if="data['daycare_activities_ids']">
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<strong style="font-size:25px;">Activity</strong>
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<table class="table table-borderless">
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<tr>
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<td>
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<strong>Name</strong>
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</td>
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<td>
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<strong>Product</strong>
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</td>
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<td>
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<strong>Notes</strong>
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</td>
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<td>
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<strong>Time In</strong>
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</td>
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<td>
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<strong>Time Out</strong>
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</td>
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<td>
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<strong>Responsible By</strong>
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</td>
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</tr>
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<tr t-foreach="data['daycare_activities_ids']"
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t-as="rec">
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<td>
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<t t-esc="rec['activity_type_id'].name"/>
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</td>
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<td>
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<t t-esc="rec['product_id'].name"/>
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</td>
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<td>
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<t t-esc="rec['notes']"/>
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</td>
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<td>
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<t t-esc="rec['time_in']"/>
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</td>
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<td>
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<t t-esc="rec['time_out']"/>
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</td>
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<td>
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<t t-esc="rec['responsible_id'].name"/>
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</td>
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</tr>
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</table>
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<br/>
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</span>
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<span>
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<strong style="font-size:25px;">Emergency Care
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Information
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</strong>
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<strong style="font-size:20px;">Emergency
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Contact#1
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</strong>
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<br/>
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<table class="table table-borderless">
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<tr>
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<td>
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<strong>Full Name</strong>
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</td>
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<td>
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<t t-esc="data['emergency_name']"/>
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</td>
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<td>
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<strong>Relationship To Applicant
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</strong>
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</td>
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<td>
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<t t-esc="data['applicant_relationship']"/>
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</td>
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</tr>
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<tr>
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<td>
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<strong>Address</strong>
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</td>
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<td>
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<t t-esc="data['emergency_address']"/>
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</td>
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<td>
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<strong>Phone</strong>
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</td>
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<td>
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<t t-esc="data['emergency_phone']"/>
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</td>
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</tr>
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</table>
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<br/>
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<strong style="font-size:20px;">Emergency
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Contact#2
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</strong>
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<table class="table table-borderless">
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<tr>
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<td>
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<strong>Full Name</strong>
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</td>
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<td>
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<t t-esc="data['first_emergency_name']"/>
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</td>
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<td>
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<strong>Relationship To Applicant
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</strong>
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</td>
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<td>
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<t t-esc="data['second_applicant_relationship']"/>
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</td>
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</tr>
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<tr>
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<td>
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<strong>Address</strong>
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</td>
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<td>
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<t t-esc="data['first_emergency_address']"/>
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</td>
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<td>
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<strong>Phone</strong>
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</td>
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<td>
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<t t-esc="data['first_emergency_phone']"/>
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</td>
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</tr>
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</table>
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<br/>
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</span>
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<span>
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<strong style="font-size:25px;">Service</strong>
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<table class="table table-borderless">
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<tr>
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<td>
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<strong>Transportation Provided By
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</strong>
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</td>
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<td>
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<t t-esc="data['transportation']"/>
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</td>
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<td>
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<strong>Arrive Time</strong>
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</td>
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<td>
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<t t-esc="data['arrival_time']"/>
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</td>
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</tr>
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<tr>
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<td>
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<strong>Departure Time</strong>
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</td>
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<td>
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<t t-esc="data['departure_time']"/>
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</td>
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<td>
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<strong>Special Diet?</strong>
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</td>
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<td>
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<t t-esc="data['special_diet']"/>
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</td>
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</tr>
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<tr>
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<td colspan="2">
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<strong>If yes, Give Details</strong>
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</td>
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<td colspan="2">
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<t t-esc="data['diet_detail']"/>
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</td>
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</tr>
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<tr>
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<td colspan="2">
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<strong>List of Allergies</strong>
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</td>
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<td colspan="2">
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<t t-esc="data['allergies']"/>
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</td>
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</tr>
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</table>
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</span>
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<span>
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<strong style="font-size:25px;">Contract and
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Commitment
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</strong>
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<table class="table table-borderless">
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<tr>
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<td colspan="2">
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<strong>I acknowledge that the
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participation in this program will
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be paid by
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</strong>
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</td>
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<td colspan="2">
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<t t-esc="data['paid_by']"/>
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</td>
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</tr>
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<tr>
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<td colspan="2">
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<strong>Name of person/party responsible
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for mentioned above
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</strong>
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</td>
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<td colspan="2">
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<t t-esc="data['paid_by_name']"/>
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</td>
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</tr>
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<tr>
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<td colspan="2">
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<strong>Phone number of person to pay
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bill
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</strong>
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</td>
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<td colspan="2">
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<t t-esc="data['paid_by_phone']"/>
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</td>
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</tr>
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<tr>
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<td colspan="2">
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<strong>Your email</strong>
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</td>
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<td colspan="2">
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<t t-esc="data['your_email']"/>
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</td>
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</tr>
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<tr>
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<td colspan="2">
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<strong>Hospital Choice</strong>
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</td>
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<td colspan="2">
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<t t-esc="data['hospital_name']"/>
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</td>
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</tr>
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<tr>
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<td colspan="2">
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<strong>Digital Signature</strong>
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</td>
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<td colspan="2">
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<t t-esc="data['name']"/>
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</td>
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</tr>
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</table>
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</span>
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</t>
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</div>
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</t>
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</t>
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</template>
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</odoo>
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|