{% extends edc_base_template %}
{% load static %}

{% block main %}
    {{ block.super }}
    <div class="container">
        <div class="col-sm-12">

            <div style="padding:10px;">
                <a href="{% url "edc_pharmacy:home_url" %}">Edc Pharmacy</a> &rsaquo;
                <a href="{% url "edc_pharmacy:stock_request_home_url" %}">Stock requests</a> &rsaquo;
                {% if instance %}{{ instance.request_identifier }}{% else %}New request{% endif %}
            </div>

            <div class="panel panel-default">
                <div class="panel-heading">
                    <b>{% if instance %}Edit stock request {{ instance.request_identifier }}{% else %}New stock request{% endif %}</b>
                </div>
                <div class="panel-body">
                    <div class="alert alert-info" style="font-size:13px;">
                        <i class="fa fa-info-circle"></i>
                        Select the site location, formulation, and container type for this request.
                        The system will identify subjects with upcoming appointments
                        who need stock allocated.
                    </div>
                    <form method="post">
                        {% csrf_token %}
                        {% for field in form %}
                        <div class="form-group {% if field.errors %}has-error{% endif %}">
                            <label class="control-label col-sm-3" for="{{ field.id_for_label }}">
                                {{ field.label }}{% if field.field.required %} <span class="text-danger">*</span>{% endif %}
                            </label>
                            <div class="col-sm-7">
                                {{ field }}
                                {% if field.help_text %}
                                    <p class="help-block">{{ field.help_text }}</p>
                                {% endif %}
                                {% for error in field.errors %}
                                    <p class="help-block text-danger">{{ error }}</p>
                                {% endfor %}
                            </div>
                        </div>
                        {% endfor %}
                        {% if form.non_field_errors %}
                        <div class="form-group has-error">
                            <div class="col-sm-offset-3 col-sm-7">
                                {% for error in form.non_field_errors %}
                                    <p class="help-block text-danger">{{ error }}</p>
                                {% endfor %}
                            </div>
                        </div>
                        {% endif %}
                        <div class="form-group">
                            <div class="col-sm-offset-3 col-sm-7">
                                <button type="submit" class="btn btn-primary">Save</button>
                                {% if instance %}
                                <a href="{% url "edc_pharmacy:stock_request_url" stock_request=instance.pk %}"
                                   class="btn btn-default">Cancel</a>
                                {% else %}
                                <a href="{% url "edc_pharmacy:stock_request_home_url" %}"
                                   class="btn btn-default">Cancel</a>
                                {% endif %}
                            </div>
                        </div>
                    </form>
                </div>
            </div>

        </div>
    </div>
{% endblock main %}