You can not select more than 25 topics
Topics must start with a letter or number, can include dashes ('-') and can be up to 35 characters long.
113 lines
5.7 KiB
113 lines
5.7 KiB
<?xml version="1.0" encoding="utf-8" ?>
|
|
<odoo>
|
|
<!-- Patient card template-->
|
|
<template id="patient_card_form">
|
|
<t t-call="website.layout">
|
|
<div id="patient_form">
|
|
<section
|
|
class="s_title parallax s_parallax_is_fixed bg-black-50 pt24 pb24"
|
|
data-vcss="001" data-snippet="s_title"
|
|
data-scroll-background-ratio="1">
|
|
<span class="s_parallax_bg oe_img_bg"
|
|
style="background-image: url('/web/image/website.s_banner_default_image'); background-position: 50% 0;"/>
|
|
<div class="o_we_bg_filter bg-black-50"/>
|
|
<div class="container-fluid">
|
|
<h1 class="container">Patient Card</h1>
|
|
</div>
|
|
</section>
|
|
<section class="p-3">
|
|
<div class="container">
|
|
<form action="/patient_card/success"
|
|
method="post" enctype="multipart/form-data">
|
|
<div class="row">
|
|
<div class="mb-3 col-8">
|
|
<label for="pname"
|
|
class="form-label">Patient Name
|
|
</label>
|
|
<input class="form-control" type="text"
|
|
id="pname" name="pname"
|
|
required="True"/>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="mb-3 col-3">
|
|
<label for="dob"
|
|
class="form-label">Date of Birth
|
|
</label>
|
|
<input class="form-control" type="date"
|
|
id="dob" name="dob"
|
|
required="True"/>
|
|
</div>
|
|
<div class="mb-3 col-5">
|
|
<label for="gender"
|
|
class="form-label">Gender
|
|
</label>
|
|
<select class="form-control"
|
|
id="gender" name="gender"
|
|
required="True">
|
|
<option/>
|
|
<option value="male">Male</option>
|
|
<option value="female">Female
|
|
</option>
|
|
<option value="others">Other
|
|
</option>
|
|
</select>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="mb-3 col-8">
|
|
<label for="mail"
|
|
class="form-label">Email
|
|
</label>
|
|
<input class="form-control" type="email"
|
|
id="mail" name="mail"
|
|
required="True"/>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="mb-3 col-8">
|
|
<label for="phone"
|
|
class="form-label">Phone
|
|
</label>
|
|
<input class="form-control" type="text"
|
|
id="phone" name="phone"
|
|
required="True"/>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="mb-3 col-8">
|
|
<label for="place"
|
|
class="form-label">Place
|
|
</label>
|
|
<input class="form-control" type="text"
|
|
id="place" name="place"
|
|
required="True"/>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="mb-3 col-8">
|
|
<label for="file"
|
|
class="form-label">Upload your
|
|
photo here
|
|
</label>
|
|
<br/>
|
|
<input type="file"
|
|
id="file" name="file"
|
|
required="True"/>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="mb-3 col-8">
|
|
<button type="submit"
|
|
class="btn btn-primary">
|
|
Submit
|
|
</button>
|
|
</div>
|
|
</div>
|
|
</form>
|
|
</div>
|
|
</section>
|
|
</div>
|
|
</t>
|
|
</template>
|
|
</odoo>
|
|
|