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181 lines
9.9 KiB
181 lines
9.9 KiB
<?xml version="1.0"?>
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<odoo>
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<record id="action_report_crm_lead" model="ir.actions.report">
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<field name="name">Adult Care Details</field>
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<field name="model">crm.lead</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_crm_lead_report</field>
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<field name="report_file">adult_daycare_center.adult_care_crm_lead_report</field>
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<field name="binding_model_id" ref="model_crm_lead"/>
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<field name="binding_type">report</field>
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</record>
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<template id="adult_care_crm_lead_report">
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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><span style="font-size:25px;"><strong><t t-esc="data['name']"/> - <t t-esc="data['partner_id'].name"/></strong></span></center>
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<br/>
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<span><strong style="font-size:25px;">Personal Information</strong>
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<table class="table table-borderless">
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<tr>
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<td><strong>Birthdate</strong></td>
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<td><t t-esc="data['birth_date']"/></td>
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<td><strong>Gender</strong></td>
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<td><t t-esc="data['gender']"/></td>
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</tr>
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<tr>
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<td><strong>Address</strong></td>
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<td><t t-esc="data['street']"/>, <t t-esc="data['city']"/></td>
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<td><strong>Medicaid</strong></td>
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<td><t t-esc="data['medicaid']"/></td>
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</tr>
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<tr>
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<td><strong>Medicare</strong></td>
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<td><t t-esc="data['medicare']"/></td>
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<td><strong>Marital Status</strong></td>
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<td><t t-esc="data['marital_status']"/></td>
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</tr>
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<tr>
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<td><strong>Supplemental Income</strong></td>
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<td><t t-esc="data['supplemental_income']"/></td>
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<td><strong>Interest in Program</strong></td>
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<td><t t-esc="data['interest_program']"/></td>
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</tr>
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<tr>
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<td><strong>Previous Experience</strong></td>
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<td><t t-esc="data['previous_experience']"/></td>
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<td><strong>Where and When</strong></td>
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<td><t t-esc="data['where_when']"/></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><strong style="font-size:25px;">Relative and Emergency Detail</strong>
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<table class="table table-borderless">
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<tr>
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<td><strong>Present Living Arrangement</strong></td>
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<td><t t-esc="data['present_living']"/></td>
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<td><strong>Emergency Name</strong></td>
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<td><t t-esc="data['emergency_name']"/></td>
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</tr>
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<tr>
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<td><strong>Living with whom</strong></td>
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<td><t t-esc="data['living_with_whom']"/>, <t t-esc="data['city']"/></td>
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<td><strong>Applicant Relationship</strong></td>
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<td><t t-esc="data['applicant_relationship']"/></td>
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</tr>
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<tr>
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<td><strong>Living with Relationship</strong></td>
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<td><t t-esc="data['living_with']"/></td>
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<td><strong>Address Emergency</strong></td>
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<td><t t-esc="data['emergency_address']"/></td>
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</tr>
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<tr>
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<td><strong>Responsible Relative</strong></td>
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<td><t t-esc="data['relationship_responsible_relative']"/></td>
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<td><strong>Phone Emergency</strong></td>
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<td><t t-esc="data['emergency_phone']"/></td>
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</tr>
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<tr>
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<td><strong>Nearest Relative</strong></td>
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<td><t t-esc="data['nearest_relative']"/></td>
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<td><strong>Emergency Name</strong></td>
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<td><t t-esc="data['emergency_name_1']"/></td>
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</tr>
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<tr>
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<td><strong>Relationship with Relative</strong></td>
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<td><t t-esc="data['nearest_relative_relation']"/></td>
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<td><strong>Applicant Relationship #1</strong></td>
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<td><t t-esc="data['applicant_relationship_2']"/></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><strong style="font-size:25px;">Medical and Transportation Detail</strong>
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<table class="table table-borderless">
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<tr>
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<td><strong>Physician Name</strong></td>
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<td><t t-esc="data['physician_name']"/></td>
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<td><strong>Transportation</strong></td>
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<td><t t-esc="data['transportation']"/></td>
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</tr>
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<tr>
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<td><strong>Physician Address</strong></td>
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<td><t t-esc="data['physician_address']"/>, <t t-esc="data['city']"/></td>
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<td><strong>Arrival Time</strong></td>
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<td><t t-esc="data['arrival_time']"/></td>
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</tr>
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<tr>
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<td><strong>Phone</strong></td>
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<td><t t-esc="data['physician_phone']"/></td>
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<td><strong>Departure Time</strong></td>
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<td><t t-esc="data['departure_time']"/></td>
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</tr>
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<tr>
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<td><strong>Physician Last Vist</strong></td>
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<td><t t-esc="data['physician_last_visit']"/></td>
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<td><strong>Special Diet</strong></td>
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<td><t t-esc="data['special_diet']"/></td>
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</tr>
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<tr>
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<td><strong>Dentist Name</strong></td>
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<td><t t-esc="data['dentist_name']"/></td>
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<td><strong>Transportation</strong></td>
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<td><t t-esc="data['transportation']"/></td>
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</tr>
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<tr>
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<td><strong>Dentist Address</strong></td>
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<td><t t-esc="data['dentist_address']"/></td>
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<td><strong>Responsible</strong></td>
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<td><t t-esc="data['responsible']"/></td>
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</tr>
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<tr>
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<td><strong>Dentist Phone</strong></td>
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<td><t t-esc="data['dentist_phone']"/></td>
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<td><strong>Phone Pay</strong></td>
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<td><t t-esc="data['paid_by_name']"/></td>
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</tr>
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<tr>
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<td><strong>Date of Dentist</strong></td>
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<td><t t-esc="data['dentist_last_visit']"/></td>
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<td><strong>Your Email</strong></td>
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<td><t t-esc="data['your_email']"/></td>
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</tr>
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<tr>
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<td><strong>Hospital Name</strong></td>
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<td><t t-esc="data['hospital_name']"/></td>
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<td><strong>Today date</strong></td>
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<td><t t-esc="data['today_date']"/></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><strong style="font-size:25px;">Other Information</strong>
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<table class="table table-borderless">
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<tr>
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<td colspan="2"><strong>Diet Detail</strong></td>
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<td colspan="2"><t t-esc="data['diet_detail']"/></td>
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</tr>
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<tr>
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<td colspan="2"><strong>List of Allergies</strong></td>
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<td colspan="2"><t t-esc="data['allergies']"/></td>
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</tr>
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<tr>
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<td colspan="2"><strong>Time Request</strong></td>
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<td colspan="2"><t t-esc="data['time_request']"/></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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