{% extends '@RxConnexion/Admin/content.html.twig' %}
{% block content %}
    <style>
        #pdf {
            display: none;
        }
        #excel {
            display: none;
        }
    </style>
    <div class="row max-width-initial">
        <div class="small-12 columns">
            <div class="content-container">
                <div class="content-container-content">
                    <div class="row max-width-initial">
                        <div class="large-12 columns">
                            {#<span>Referral Date</span>#}
                            <div class="row max-width-initial">
                                <div class="large-6 medium-6 small-12 columns">
                                    <label>Date From</label>
                                    <input type="text" class="date" id="date_from" value="" />
                                </div>
                                <div class="large-6 medium-6 small-12 columns">
                                    <label>Date To</label>
                                    <input type="text" class="date" id="date_to" value="" />
                                </div>
                            </div>
                            <div class="row max-width-initial">
                                <div class="large-6 medium-6 small-12 columns">
                                    <label>Type</label>
                                    <select name="" id="type" required>
                                        <option value="an">Appointment Notice</option>
                                        <option value="pl">Patient Letter</option>
                                        <option value="fo">Fax Option</option>
                                    </select>
                                </div>
                                <div class="large-6 medium-6 small-12 columns">
                                </div>
                            </div>
                        </div>
                    </div>
                    {%
                        include '@RxConnexion/Report/buttons.html.twig'
                        with {
                        'preview_url': 'main/report/fax_outbound/preview',
                        'export_to_pdf_url': '',
                        'export_to_excel_url': '',
                        'paramsIds': 'date_from|date_to|type'
                    }
                    %}
                </div>
            </div>
        </div>
    </div>
    {% include '@RxConnexion/Admin/js.html.twig' %}
    <script language="javascript">
        //<![CDATA[
        jQ(document).ready(function(){
            report.init('{{ app.environment }}');
            // file.init();
        });
        //]]>
    </script>
{% endblock %}