{% extends 'base_labTechnician.html' %}

{% block title %}form_mri{% endblock %}

{% block content %}
		<div class="section section-custom billinfo"> 
			<h2>Please attach below the MRI scan for the patient with :</h2><!--  section-title end -->
			<div class="pmd-card pmd-z-depth">
				<div class="pmd-card-body">	
					<form class="row" role="form" method="POST" action="{% url 'digiMED:lab_index' %}" enctype="multipart/form-data">
					{% csrf_token %}
						<div class="form-group pmd-textfield">
							<label for="inputEmail3" class="col-sm-2 control-label">Patient ID</label>
							<div class="col-sm-10">
								<input class="form-control input-sm" name="patient_id" id="patient_id" value="{{ patient_id }}" placeholder="{{ patient_id }}" type="text" readonly >
							</div>
						</div>
						<div class="form-group pmd-textfield">
							<label for="inputEmail3" class="col-sm-2 control-label">Date</label>
							<div class="col-sm-10">
								<input class="form-control input-sm" name="date" value="{{ date }}" id="date" placeholder="{{ date }}" type="text" readonly >
							</div>
						</div>
						<div class="form-group">
						<div class="col-sm-10">
								<div class="form-group pmd-textfield pmd-textfield-floating-label">
									<input type="file" id="file" name="file" >
								</div>
						</div>
						</div>
						<div class="form-group">
							<div class="col-sm-2">
								<button type="submit"  name="data" id="data" value="MRI"  class="btn btn-primary pmd-checkbox-ripple-effect">Submit</button>
							</div>
						</div>
					</form>
				</div>
			</div>
		</div>
		
{% endblock %}
