48 lines
2.4 KiB
HTML
48 lines
2.4 KiB
HTML
<!-- templates/add_record.html -->
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{% extends "base.html" %}
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{% block title %}Add Health Record - Health History Tracker{% endblock %}
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{% block content %}
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<div class="row">
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<div class="col-md-8 mx-auto">
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<div class="main-content">
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<h2 class="content-header"><i class="fas fa-file-medical"></i> Add New Health Record</h2>
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<form method="POST" action="{{ url_for('add_record') }}">
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<div class="form-grid">
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<div class="form-group">
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<label for="illness-name">Illness Name</label>
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<input type="text" class="form-control" id="illness-name" name="illness_name" placeholder="e.g., Influenza, Migraine..." required>
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</div>
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<div class="form-group">
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<label for="diagnosis-date">Diagnosis Date</label>
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<input type="date" class="form-control" id="diagnosis-date" name="diagnosis_date" required>
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</div>
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<div class="form-group">
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<label for="severity">Severity</label>
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<select class="form-control" id="severity" name="severity" required>
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<option value="mild">Mild</option>
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<option value="moderate">Moderate</option>
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<option value="severe">Severe</option>
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</select>
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</div>
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<div class="form-group">
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<label for="treatment">Treatment</label>
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<input type="text" class="form-control" id="treatment" name="treatment" placeholder="Medication, therapy, etc.">
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</div>
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</div>
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<div class="form-group">
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<label for="description">Description</label>
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<textarea class="form-control" id="description" name="description" rows="4" placeholder="Describe symptoms, treatment, and recovery process..."></textarea>
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</div>
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<button type="submit" class="btn btn-primary">
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<i class="fas fa-save"></i> Save Record
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</button>
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<a href="{{ url_for('dashboard') }}" class="btn btn-outline-secondary">Cancel</a>
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</form>
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</div>
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</div>
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</div>
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{% endblock %}
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