{% extends "hostis-main.html" %}


{% block head %}
    {{ block.super }}
    <script>

        function change_field(field, field_name) {
            var fieldVal = field.val();
            if (field.is(':checkbox')) {
                if (field.is(':checked')) {
                    fieldVal = "TRUE";
                } else {
                    fieldVal = "FALSE";
                }
            }
            $.post("{% url 'hostis:update-hostis-setting-info-value' %}",
                {
                    'csrfmiddlewaretoken': '{{csrf_token}}',
                    field_name: field_name,
                    field_val: fieldVal
                }
            );
        }

        $(function () {
            $(document).tooltip();

            $("[id$='pharmacy_name']").change(function () {
                change_field($(this), 'pharmacy_name');
            });

            $("[id$='pharmacy_address']").change(function () {
                change_field($(this), 'pharmacy_address');
            });

            $("[id$='pharmacy_address_2']").change(function () {
                change_field($(this), 'pharmacy_address_2');
            });

            $("[id$='pharmacy_city']").change(function () {
                change_field($(this), 'pharmacy_city');
            });

            $("[id$='pharmacy_state']").change(function () {
                change_field($(this), 'pharmacy_state');
            });

            $("[id$='pharmacy_zip']").change(function () {
                change_field($(this), 'pharmacy_zip');
            });

            $("[id$='pharmacy_phone']").change(function () {
                change_field($(this), 'pharmacy_phone');
            });

            $("[id$='pharmacy_fax']").change(function () {
                change_field($(this), 'pharmacy_fax');
            });
        });
    </script>
{% endblock %}

{% block pagehead %}
    {% include 'hostis-pagehead.html' %}
{% endblock %}

{% block content %}
    <form name="pharmacyInfoForm" id="pharmacyInfoForm" class="form-horizontal" method="POST">
    {% csrf_token %}
        <div class="well well-small">
            <div class="control-group" style="margin-bottom: 5px;">
                <label class="control-label" for="id_pharmacy_name">Pharmacy Name: </label>
                <div class="controls">
                    {{ pharmacy_info_form.pharmacy_name }}
                </div>
            </div>
            <div class="control-group" style="margin-bottom: 5px;">
                <label class="control-label" for="id_pharmacy_address">Address Line 1: </label>
                <div class="controls">
                    {{ pharmacy_info_form.pharmacy_address }}
                </div>
            </div>
            <div class="control-group" style="margin-bottom: 5px;">
                <label class="control-label" for="id_pharmacy_address_2">Address Line 2: </label>
                <div class="controls">
                    {{ pharmacy_info_form.pharmacy_address_2 }}
                </div>
            </div>
            <div class="control-group" style="margin-bottom: 5px;">
                <label class="control-label" for="id_pharmacy_city">City: </label>
                <div class="controls">
                    {{ pharmacy_info_form.pharmacy_city }}
                </div>
            </div>
            <div class="control-group" style="margin-bottom: 5px;">
                <label class="control-label" for="id_pharmacy_state">State: </label>
                <div class="controls">
                    {{ pharmacy_info_form.pharmacy_state }}
                </div>
            </div>
            <div class="control-group" style="margin-bottom: 5px;">
                <label class="control-label" for="id_pharmacy_zip">Zip Code: </label>
                <div class="controls">
                    {{ pharmacy_info_form.pharmacy_zip }}
                </div>
            </div>
            <div class="control-group" style="margin-bottom: 5px;">
                <label class="control-label" for="id_pharmacy_phone">Phone: </label>
                <div class="controls">
                    {{ pharmacy_info_form.pharmacy_phone }}
                </div>
            </div>
            <div class="control-group" style="margin-bottom: 5px;">
                <label class="control-label" for="id_pharmacy_fax">Fax: </label>
                <div class="controls">
                    {{ pharmacy_info_form.pharmacy_fax }}
                </div>
            </div>
        </div>
    </form>
{% endblock %}