Nexa Admin
431052920e
- fusion_claims: separated field service logic, updated controllers/views - fusion_tasks: updated task views and map integration - fusion_authorizer_portal: added page 11 signing, schedule booking, migrations - fusion_shipping: new standalone shipping module (Canada Post, FedEx, DHL, Purolator) - fusion_ltc_management: new standalone LTC management module
323 lines
18 KiB
XML
323 lines
18 KiB
XML
<?xml version="1.0" encoding="utf-8"?>
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<odoo>
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<template id="portal_ltc_repair_form"
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name="LTC Repair Form">
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<t t-call="website.layout">
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<div id="wrap" class="oe_structure">
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<section class="container py-5">
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<div class="row justify-content-center">
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<div class="col-lg-8">
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<div class="text-center mb-4">
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<h1>LTC Repairs Request</h1>
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<p class="lead text-muted">
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Submit a repair request for medical equipment at your facility.
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</p>
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</div>
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<t t-if="request.params.get('error') == 'facility'">
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<div class="alert alert-danger">Please select a facility.</div>
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</t>
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<t t-if="request.params.get('error') == 'name'">
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<div class="alert alert-danger">Patient name is required.</div>
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</t>
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<t t-if="request.params.get('error') == 'description'">
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<div class="alert alert-danger">Issue description is required.</div>
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</t>
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<t t-if="request.params.get('error') == 'photos'">
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<div class="alert alert-danger">At least one before photo is required.</div>
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</t>
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<t t-if="request.params.get('error') == 'server'">
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<div class="alert alert-danger">
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An error occurred. Please try again or contact us.
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</div>
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</t>
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<form action="/repair-form/submit" method="POST"
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enctype="multipart/form-data"
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class="card shadow-sm">
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<input type="hidden" name="csrf_token"
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t-att-value="request.csrf_token()"/>
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<div class="card-body p-4">
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<div class="mb-4">
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<div class="form-check">
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<input type="checkbox" class="form-check-input"
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id="is_emergency" name="is_emergency"/>
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<label class="form-check-label fw-bold text-danger"
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for="is_emergency">
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Is this an Emergency Repair Request?
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</label>
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</div>
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<small class="text-muted">
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Emergency visits may be chargeable at an extra rate.
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</small>
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</div>
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<hr/>
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<div class="mb-3">
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<label for="facility_id" class="form-label fw-bold">
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Facility Location *
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</label>
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<select name="facility_id" id="facility_id"
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class="form-select" required="required">
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<option value="">-- Select Facility --</option>
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<t t-foreach="facilities" t-as="fac">
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<option t-att-value="fac.id">
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<t t-esc="fac.name"/>
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</option>
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</t>
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</select>
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</div>
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<div class="mb-3">
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<label for="client_name" class="form-label fw-bold">
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Patient Name *
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</label>
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<input type="text" name="client_name" id="client_name"
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class="form-control" required="required"
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placeholder="Enter patient name"/>
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</div>
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<div class="mb-3">
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<label for="room_number" class="form-label fw-bold">
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Room Number *
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</label>
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<input type="text" name="room_number" id="room_number"
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class="form-control" required="required"
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placeholder="e.g. 305"/>
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</div>
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<div class="mb-3">
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<label for="issue_description" class="form-label fw-bold">
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Describe the Issue *
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</label>
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<textarea name="issue_description" id="issue_description"
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class="form-control" rows="4"
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required="required"
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placeholder="Please provide as much detail as possible about the issue."/>
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</div>
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<div class="mb-3">
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<label for="issue_reported_date" class="form-label fw-bold">
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Issue Reported Date *
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</label>
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<input type="date" name="issue_reported_date"
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id="issue_reported_date"
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class="form-control" required="required"
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t-att-value="today"/>
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</div>
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<div class="mb-3">
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<label for="product_serial" class="form-label fw-bold">
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Product Serial # *
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</label>
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<input type="text" name="product_serial"
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id="product_serial"
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class="form-control" required="required"
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placeholder="Serial number is required for repairs"/>
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</div>
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<div class="mb-3">
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<label for="before_photos" class="form-label fw-bold">
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Before Photos (Reported Condition) *
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</label>
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<input type="file" name="before_photos" id="before_photos"
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class="form-control" multiple="multiple"
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accept="image/*" required="required"/>
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<small class="text-muted">
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At least 1 photo required. Up to 4 photos (max 10MB each).
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</small>
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</div>
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<hr/>
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<h5>Family / POA Contact</h5>
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<div class="row">
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<div class="col-md-6 mb-3">
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<label for="poa_name" class="form-label">
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Relative/POA Name
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</label>
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<input type="text" name="poa_name" id="poa_name"
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class="form-control"
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placeholder="Contact name"/>
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</div>
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<div class="col-md-6 mb-3">
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<label for="poa_phone" class="form-label">
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Relative/POA Phone
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</label>
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<input type="tel" name="poa_phone" id="poa_phone"
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class="form-control"
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placeholder="Phone number"/>
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</div>
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</div>
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<t t-if="is_technician">
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<hr/>
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<div class="bg-light p-3 rounded mb-3">
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<p class="fw-bold text-muted mb-2">
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FOR TECHNICIAN USE ONLY
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</p>
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<div class="mb-3">
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<label class="form-label">
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Has the issue been resolved?
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</label>
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<div class="form-check form-check-inline">
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<input type="radio" name="resolved" value="yes"
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class="form-check-input" id="resolved_yes"/>
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<label class="form-check-label"
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for="resolved_yes">Yes</label>
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</div>
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<div class="form-check form-check-inline">
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<input type="radio" name="resolved" value="no"
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class="form-check-input" id="resolved_no"
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checked="checked"/>
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<label class="form-check-label"
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for="resolved_no">No</label>
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</div>
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</div>
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<div id="resolution_section"
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style="display: none;">
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<div class="mb-3">
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<label for="resolution_description"
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class="form-label">
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Describe the Solution
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</label>
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<textarea name="resolution_description"
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id="resolution_description"
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class="form-control" rows="3"
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placeholder="How was the issue resolved?"/>
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</div>
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<div class="mb-3">
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<label for="after_photos" class="form-label fw-bold">
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After Photos (Completed Repair)
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</label>
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<input type="file" name="after_photos" id="after_photos"
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class="form-control" multiple="multiple"
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accept="image/*"/>
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<small class="text-muted">
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Attach after repair is completed. Up to 4 photos (max 10MB each).
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</small>
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</div>
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</div>
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</div>
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</t>
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<div class="text-center mt-4">
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<button type="submit" class="btn btn-primary btn-lg px-5">
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Submit Repair Request
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</button>
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</div>
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</div>
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</form>
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</div>
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</div>
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</section>
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</div>
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<script>
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document.addEventListener('DOMContentLoaded', function() {
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var section = document.getElementById('resolution_section');
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if (!section) return;
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var radios = document.querySelectorAll('input[name="resolved"]');
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radios.forEach(function(r) {
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r.addEventListener('change', function() {
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section.style.display = this.value === 'yes' ? 'block' : 'none';
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});
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});
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});
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</script>
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</t>
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</template>
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<template id="portal_ltc_repair_thank_you"
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name="Repair Request Submitted">
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<t t-call="website.layout">
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<div id="wrap" class="oe_structure">
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<section class="container py-5">
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<div class="row justify-content-center">
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<div class="col-lg-6 text-center">
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<div class="mb-4">
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<i class="fa fa-check-circle text-success"
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style="font-size: 4rem;"/>
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</div>
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<h2>Thank You!</h2>
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<p class="lead text-muted">
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Your repair request has been submitted successfully.
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</p>
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<div class="card mt-4">
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<div class="card-body">
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<p><strong>Reference:</strong>
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<t t-esc="repair.name"/></p>
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<p><strong>Facility:</strong>
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<t t-esc="repair.facility_id.name"/></p>
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<p><strong>Patient:</strong>
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<t t-esc="repair.display_client_name"/></p>
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<p><strong>Room:</strong>
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<t t-esc="repair.room_number"/></p>
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</div>
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</div>
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<a href="/repair-form" class="btn btn-outline-primary mt-4">
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Submit Another Request
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</a>
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</div>
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</div>
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</section>
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</div>
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</t>
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</template>
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<template id="portal_ltc_repair_password"
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name="LTC Repair Form - Password">
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<t t-call="website.layout">
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<div id="wrap" class="oe_structure">
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<section class="container py-5">
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<div class="row justify-content-center">
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<div class="col-lg-5">
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<div class="card shadow-sm">
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<div class="card-body p-4 text-center">
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<div class="mb-3">
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<i class="fa fa-lock text-primary"
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style="font-size: 3rem;"/>
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</div>
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<h3>LTC Repairs Request</h3>
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<p class="text-muted">
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Please enter the access password to continue.
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</p>
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<t t-if="error">
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<div class="alert alert-danger">
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Incorrect password. Please try again.
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</div>
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</t>
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<form action="/repair-form/auth" method="POST"
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class="mt-3">
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<input type="hidden" name="csrf_token"
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t-att-value="request.csrf_token()"/>
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<div class="mb-3">
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<input type="password" name="password"
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class="form-control form-control-lg text-center"
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placeholder="Enter password"
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minlength="4" required="required"
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autofocus="autofocus"/>
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</div>
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<button type="submit"
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class="btn btn-primary btn-lg w-100">
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Access Form
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</button>
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</form>
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</div>
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</div>
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</div>
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</div>
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</section>
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</div>
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</t>
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</template>
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</odoo>
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