{% extends 'manager/base.html' %}
{% load static %}
{% load i18n %}

{% block content %}
    <div class="content">
        <div class="row">
            <div class="col-sm-8">
                <h4 class="page-title">{% trans "Create Hospital" %}</h4>
            </div>
            <div class="col-sm-4 text-right m-b-30">
                <a href="{% url 'panel-manager-hospitals' %}" class="btn btn-primary btn-rounded"><i class="fa fa-arrow-left"></i> {% trans "Back to Hospitals" %}</a>
            </div>
        </div>
        
        <div class="row">
            <div class="col-md-12">
                <div class="card">
                    <div class="card-body">
                        <form method="post" action="{% url 'panel-manager-create-hospital' %}">
                            {% csrf_token %}
                            
                            <h4 class="card-title">{% trans "Hospital Information" %}</h4>
                            
                            <div class="row">
                                <div class="col-md-6">
                                    <div class="form-group">
                                        <label>{% trans "Hospital Name" %} *</label>
                                        <input type="text" class="form-control" name="name" required>
                                    </div>
                                </div>
                                <div class="col-md-6">
                                    <div class="form-group">
                                        <label>{% trans "Hospital Code" %} *</label>
                                        <input type="text" class="form-control" name="hospital_code" required>
                                        <small class="form-text text-muted">{% trans "Unique code for this hospital" %}</small>
                                    </div>
                                </div>
                            </div>
                            
                            <h4 class="card-title mt-4">{% trans "Contact Information" %}</h4>
                            
                            <div class="row">
                                <div class="col-md-6">
                                    <div class="form-group">
                                        <label>{% trans "Contact Email" %} *</label>
                                        <input type="email" class="form-control" name="contact_email" required>
                                    </div>
                                </div>
                                <div class="col-md-6">
                                    <div class="form-group">
                                        <label>{% trans "Contact Phone" %} *</label>
                                        <input type="text" class="form-control" name="contact_phone" required>
                                    </div>
                                </div>
                            </div>
                            
                            <div class="row">
                                <div class="col-md-12">
                                    <div class="form-group">
                                        <label>{% trans "Contact Person" %}</label>
                                        <input type="text" class="form-control" name="contact_person">
                                    </div>
                                </div>
                            </div>
                            
                            <div class="row">
                                <div class="col-md-12">
                                    <div class="form-group">
                                        <label>{% trans "Address" %}</label>
                                        <textarea class="form-control" name="address" rows="3"></textarea>
                                    </div>
                                </div>
                            </div>
                            
                            <div class="row">
                                <div class="col-md-12">
                                    <div class="form-group">
                                        <label>{% trans "Description" %}</label>
                                        <textarea class="form-control" name="description" rows="3"></textarea>
                                    </div>
                                </div>
                            </div>
                            
                            <h4 class="card-title mt-4">{% trans "Login Credentials" %}</h4>
                            
                            <div class="row">
                                <div class="col-md-6">
                                    <div class="form-group">
                                        <label>{% trans "Username" %} *</label>
                                        <input type="text" class="form-control" name="username" required>
                                        <small class="form-text text-muted">{% trans "Username for hospital login" %}</small>
                                    </div>
                                </div>
                                <div class="col-md-6">
                                    <div class="form-group">
                                        <label>{% trans "Password" %} *</label>
                                        <input type="password" class="form-control" name="password" required>
                                        <small class="form-text text-muted">{% trans "Password for hospital login" %}</small>
                                    </div>
                                </div>
                            </div>
                            
                            <div class="alert alert-info mt-3">
                                <i class="fa fa-info-circle"></i> {% trans "API credentials will be generated automatically upon creation" %}
                            </div>
                            
                            <div class="text-right mt-4">
                                <button type="submit" class="btn btn-primary">{% trans "Create Hospital" %}</button>
                            </div>
                        </form>
                    </div>
                </div>
            </div>
        </div>
    </div>
{% endblock %}