48 lines
2.5 KiB
HTML
48 lines
2.5 KiB
HTML
<!-- templates/edit_record.html -->
|
|
{% extends "base.html" %}
|
|
|
|
{% block title %}Edit Health Record - Health History Tracker{% endblock %}
|
|
|
|
{% block content %}
|
|
<div class="row">
|
|
<div class="col-md-8 mx-auto">
|
|
<div class="main-content">
|
|
<h2 class="content-header"><i class="fas fa-edit"></i> Edit Health Record</h2>
|
|
|
|
<form method="POST" action="{{ url_for('edit_record', record_id=record.id) }}">
|
|
<div class="form-grid">
|
|
<div class="form-group">
|
|
<label for="illness-name">Illness Name</label>
|
|
<input type="text" class="form-control" id="illness-name" name="illness_name" value="{{ record.illness_name }}" required>
|
|
</div>
|
|
<div class="form-group">
|
|
<label for="diagnosis-date">Diagnosis Date</label>
|
|
<input type="date" class="form-control" id="diagnosis-date" name="diagnosis_date" value="{{ record.diagnosis_date.strftime('%Y-%m-%d') }}" required>
|
|
</div>
|
|
<div class="form-group">
|
|
<label for="severity">Severity</label>
|
|
<select class="form-control" id="severity" name="severity" required>
|
|
<option value="mild" {% if record.severity == 'mild' %}selected{% endif %}>Mild</option>
|
|
<option value="moderate" {% if record.severity == 'moderate' %}selected{% endif %}>Moderate</option>
|
|
<option value="severe" {% if record.severity == 'severe' %}selected{% endif %}>Severe</option>
|
|
</select>
|
|
</div>
|
|
<div class="form-group">
|
|
<label for="treatment">Treatment</label>
|
|
<input type="text" class="form-control" id="treatment" name="treatment" value="{{ record.treatment or '' }}">
|
|
</div>
|
|
</div>
|
|
<div class="form-group">
|
|
<label for="description">Description</label>
|
|
<textarea class="form-control" id="description" name="description" rows="4">{{ record.description }}</textarea>
|
|
</div>
|
|
<button type="submit" class="btn btn-primary">
|
|
<i class="fas fa-save"></i> Update Record
|
|
</button>
|
|
<a href="{{ url_for('dashboard') }}" class="btn btn-outline-secondary">Cancel</a>
|
|
</form>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
{% endblock %}
|