{% extends 'base_labTechnician.html' %}

{% block title %}form_xray{% endblock %}

{% block content %}
		<div class="section section-custom billinfo"> 
			<h2>Please attach below the X-ray for the patient with :</h2>
			<div class="pmd-card pmd-z-depth">
					<div class="pmd-card-body">	
						<form class="row" method="POST" action="{% url 'digiMED:lab_index' %}" role="form" enctype="multipart/form-data">
						{% csrf_token %}
							<div class="form-group pmd-textfield pmd-textfield-floating-label">
							<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>
						
							<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 class="col-sm-10">
								<div class="form-group pmd-textfield pmd-textfield-floating-label">
									<input type="file" id="file" name="file">
								</div>
							</div>
							<div class="col-sm-2">
								<button type="submit" name="data" id="data" value="X-Ray" class="btn btn-primary pmd-ripple-effect">Submit</button>
							</div>
							</div>
						</form>
					</div>
				</div>  
		</div>
{% endblock %}
