{% extends "site.html" %}


{% block head %}
    {{ block.super }}
    <script>
        $(function () {

        });
    </script>
{% endblock %}

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

{% block content %}
    <a href="{% url 'site:settings-manage-medpass' %}">Back To Medpass Management</a>
    <p>&nbsp;</p>
    <form name="medpassLookupForm" id="medpassLookupForm" method="POST">
        {% csrf_token %}
        <table class="table table-bordered table-striped" style="width: 500px;">
            <thead>
            <tr class="dosis-report-header">
                <th>Lookup Value</th>
                <th>Delete</th>
            </tr>
            </thead>
            <tbody>
            {% for look in medpass_lookup_list %}
                <tr>
                    <td style="padding-bottom: 2px;"><input style="width: 15em;" type="text" name="lookupval-{{ forloop.counter }}" id="lookupval-{{ forloop.counter }}" value="{{ look.lookup }}"/></td>
                    <td><input type="checkbox" name="dellookup-{{ forloop.counter }}" id="dellookup={{ forloop.counter }}" value="Y"/>
                    </td>
                </tr>
            {% endfor %}
            </tbody>
        </table>
        <div>
            <input type="text" style="width: 15em;" name="add-medpass-lookup-text" id="add-medpass-lookup-text"/>&nbsp;&nbsp;<button name="btn-add-medpass-lookup" id="btn-add-medpass-lookup"
                          class="btn">Add Lookup</button>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
            <button name="btn-update-medpass-lookup" id="btn-update-medpass-lookup" class="btn">Update Values</button>
        </div>
    </form>
{% endblock %}