MakersNetwork/agenda-saude

<%= form_for [:admin, @patient] do |f| %>
  <%= error_messages_for(f.object) %>

  <h3>Dados pessoais</h3>

  <div class="form-row">
    <div class="form-group col-md-6">
      <%= f.label :cpf %>
      <%= f.text_field :cpf,
                       required: true,
                       class: "form-control" %>
    </div>
  </div>

  <div class="form-row">
    <div class="form-group col-md-4">
      <%= f.label :name %>
      <%= f.text_field :name,
                       autocomplete: "name", required: true,
                       class: "form-control" %>
    </div>

    <div class="form-group col-md-4">
      <%= f.label :birthday %>
      <div class="form-row date">
        <%= f.date_select :birthday,
                          {
                            start_year: (Date.current.year.to_i) - 17, # min age
                            end_year: Date.current.year.to_i - 120, # max age
                            with_css_classes: true
                          },
                          required: true,
                          class: "form-control" %>
      </div>
    </div>

    <div class="form-group col-md-4">
      <%= f.label :mother_name %>
      <%= f.text_field :mother_name,
                       autocomplete: "mother_name", required: true,
                       class: "form-control" %>
    </div>
  </div>

  <h3>Grupos prioritários que pertence</h3>

  <div class="form-row">
    <div class="form-group col-md-12">
      <%= render partial: '/shared/group_boxes', locals: { for_group: :priority, f: f } %>
    </div>
  </div>

  <h3>Comorbidades que possui</h3>

  <div class="form-row">
    <div class="form-group col-md-12">
      <%= render partial: '/shared/group_boxes', locals: { for_group: :comorbidity, f: f } %>
    </div>
  </div>

  <h3>Endereço residencial</h3>

  <div class="form-row">
    <div class="form-group col-md-8">
      <%= f.label :public_place %>
      <%= f.text_field :public_place,
                       autocomplete: "place", required: true,
                       class: "form-control" %>
    </div>

    <div class="form-group col-md-4">
      <%= f.label :place_number %>
      <%= f.text_field :place_number,
                       required: true,
                       class: "form-control" %>
    </div>
  </div>

  <div class="form-row">
    <div class="form-group col-md-8">
      <%= f.label :street_2 %>
      <%= f.text_field :street_2,
                       autocomplete: "place",
                       class: "form-control" %>
    </div>

    <div class="form-group col-md-4">
      <%= f.label :neighborhood_id %>
      <%= f.collection_select :neighborhood_id, Neighborhood.order(:name), :id, :name, { prompt: '- Escolha o bairro -' },
                              class: "form-control" %>
    </div>
  </div>

  <div class="form-row">
    <div class="form-group col-md-6">
      <%= f.label :phone %>
      <%= f.text_field :phone,
                       autocomplete: "phone", required: true,
                       class: "form-control sp-celphones" %>
    </div>

    <div class="form-group col-md-6">
      <%= f.label :other_phone %>
      <%= optional_field_tag %>
      <%= f.text_field :other_phone,
                       autocomplete: "other_phone", required: false,
                       class: "form-control sp-celphones" %>
    </div>
  </div>

  <h3>Dados complementares</h3>

  <div class="form-row">
    <div class="form-group col-md-8">
      <%= f.label :email %>
      <%= optional_field_tag %>
      <%= f.email_field :email,
                        autocomplete: "email", required: false,
                        class: "form-control" %>
    </div>

    <div class="form-group col-md-4">
      <%= f.label :sus %>
      <%= optional_field_tag %>
      <%= f.number_field :sus,
                         autocomplete: "sus", required: false,
                         class: "form-control" %>
    </div>
  </div>

  <div class="form-row">
    <div class="form-group col-md-12">
      <%= f.submit class: 'form-control btn-primary' %>
    </div>
  </div>
<% end %>