{% extends '@RxConnexion/Admin/content.html.twig' %}
{% block content %}
    <form method="POST" action="{{ path('email_template_form', {action: action, id: id}) }}" enctype="multipart/form-data">
        <div class="row max-width-initial">
            <div class="large-6 columns">
                <h5>Basic information</h5>
                <p class="form-hint-text">Enter basic information below</p>
                <div class="row">
                    <div class="large-3 large-text-right columns">
                        {{ form_label(form.company_description) }}
                    </div>
                    <div class="large-9 columns">
                        {{ form_widget(form.company_description) }}
                        {{ form_widget(form.company) }}
                    </div>
                </div>
                <div class="row" style="margin-bottom: 10px;">
                    <div class="large-3 large-text-right columns">
                        {{ form_label(form.description) }}
                    </div>
                    <div class="large-9 columns">
                        {{ form_widget(form.description) }}
                    </div>
                </div>
                <div class="row">
                    <div class="large-3 large-text-right columns">
                        {{ form_label(form.body) }}
                    </div>
                    <div class="large-9 columns">
                        {{ form_widget(form.body) }}
                    </div>
                </div>
            </div>
            <div class="large-12 columns">
                <hr>
                <div class="row">
                    <div class="large-6 columns" style="font-size: 12px; margin-top: 20px;">
                        <strong>Email Notes:</strong>
                        <div>{{ '{{PATIENT-REFERRING-PHYSICIAN}}' }} - Referring Physician</div>
                        <div>{{ '{{PATIENT-REFERRING-AFFILIATE}}' }} - Referring Affiliate</div>
                        <div>{{ '{{PATIENT-REFERRAL-DATE}}' }} - Referral Date</div>
                        <div>{{ '{{PATIENT-RECEIVED-DATE}}' }} - Received Date</div>
                        <div>{{ '{{PATIENT-FIRSTNAME}}' }} - Patient First Name</div>
                        <div>{{ '{{PATIENT-FULLNAME}}' }} - Patient Full Name</div>
                        <div>{{ '{{PATIENT-GENDER}}' }} - Patient Gender (he / she)</div>
                        <div>{{ '{{PATIENT-GENDER2}}' }} - Patient Gender (him / her)</div>
                        <div>{{ '{{PATIENT-GENDER3}}' }} - Patient Gender (his / her)</div>
                        <div>{{ '{{PATIENT-GENDER4}}' }} - Patient Gender (He / She)</div>
                        <div>{{ '{{PATIENT-PHN}}' }} - Patient Personal Health No.</div>
                        <div>{{ '{{PATIENT-DOB}}' }} - Patient Date of Birth</div>
                        <div>{{ '{{DATE-TODAY}}' }} - Date Today</div>
                        <div>{{ '{{DATE-CREATED}}' }} - Date Created</div>
                    </div>
                    <div class="large-6 columns" style="font-size: 12px; margin-top: 20px;">
                    </div>
                </div>
            </div>
            <div class="small-12 columns">
                <hr class="max-width-initial">
                <div class="button-container">
                    <button type="submit" class="button just-continue" name="action" value="{{ action }}"
                            data-message="Are you sure you want to save this information?"
                    >Save</button>
                    {% if action == 'u' and (userData.type == 'Super Admin' or 'Admin Email Template Delete' in userData.accesses) %}
                        <button type="submit" class="ask-continue button alert" name="action" value="d"
                                data-message="Are you sure you want to delete this record?"
                        >Delete</button>
                    {% endif %}
                    <a href="{{ path('email_template') }}" class="button secondary">Back</a>
                </div>
            </div>
        </div>
        {{ form_widget(form.action) }}
        {{ form_widget(form.id) }}
        {{ form_widget(form._token) }}
    </form>
    {% include '@RxConnexion/Admin/js.html.twig' %}
    <script>
        //<![CDATA[
        jQ(document).ready(function(){
            emailTemplate_form.settings.company_autocomplete_url = '{{ path('company_autocomplete') }}';
            emailTemplate_form.init();
        });
        //]]>
    </script>
{% endblock %}