58 lines
2.2 KiB
Plaintext
58 lines
2.2 KiB
Plaintext
<!DOCTYPE html>
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<html lang="de">
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<head>
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<meta charset="UTF-8">
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<title>Patient anlegen</title>
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<link rel="stylesheet" href="/css/bootstrap.min.css">
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</head>
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<body class="bg-light">
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<div class="container mt-5">
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<%- include("partials/flash") %>
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<div class="card shadow mx-auto" style="max-width: 600px;">
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<div class="card-body">
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<h3 class="mb-3">Neuer Patient</h3>
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<% if (error) { %>
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<div class="alert alert-danger"><%= error %></div>
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<% } %>
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<form method="POST" action="/patients/create">
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<input class="form-control mb-2" name="firstname" placeholder="Vorname" required>
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<input class="form-control mb-2" name="lastname" placeholder="Nachname" required>
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<input class="form-control mb-2" name="dni" placeholder="N.I.E. / DNI" required>
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<select class="form-select mb-2" name="gender">
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<option value="">Geschlecht</option>
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<option value="m">Männlich</option>
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<option value="w">Weiblich</option>
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<option value="d">Divers</option>
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</select>
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<input class="form-control mb-2" type="date" name="birthdate" required>
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<input class="form-control mb-2" name="email" placeholder="E-Mail">
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<input class="form-control mb-2" name="phone" placeholder="Telefon">
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<input class="form-control mb-2" name="street" placeholder="Straße">
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<input class="form-control mb-2" name="house_number" placeholder="Hausnummer">
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<input class="form-control mb-2" name="postal_code" placeholder="PLZ">
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<input class="form-control mb-2" name="city" placeholder="Ort">
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<input class="form-control mb-2" name="country" placeholder="Land" value="Deutschland">
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<textarea class="form-control mb-3"
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name="notes"
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placeholder="Notizen"></textarea>
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<button class="btn btn-primary w-100">
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Patient speichern
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</button>
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</form>
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</div>
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</div>
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</div>
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</body>
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</html>
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