add_pharmacy.html 13.7 KB
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{% load static %}
<!DOCTYPE html>
<html lang="en">

<head>
    <meta charset="utf-8">
    <meta http-equiv="X-UA-Compatible" content="IE=edge">
    <meta name="viewport" content="width=device-width, initial-scale=1">

    <title>Add Pharmacy</title>

    <!-- ================= Favicon ================== -->
    <!-- Standard -->
    <link rel="shortcut icon" href="http://placehold.it/64.png/000/fff">
    <!-- Retina iPad Touch Icon-->
    <link rel="apple-touch-icon" sizes="144x144" href="http://placehold.it/144.png/000/fff">
    <!-- Retina iPhone Touch Icon-->
    <link rel="apple-touch-icon" sizes="114x114" href="http://placehold.it/114.png/000/fff">
    <!-- Standard iPad Touch Icon-->
    <link rel="apple-touch-icon" sizes="72x72" href="http://placehold.it/72.png/000/fff">
    <!-- Standard iPhone Touch Icon-->
    <link rel="apple-touch-icon" sizes="57x57" href="http://placehold.it/57.png/000/fff">

    <!-- Styles -->
    <link href="{% static 'css/lib/calendar2/pignose.calendar.min.css' %}" rel="stylesheet">
    <link href="{% static 'css/lib/chartist/chartist.min.css' %}" rel="stylesheet">
    <link href="{% static 'css/lib/font-awesome.min.css' %}" rel="stylesheet">
    <link href="{% static 'css/lib/themify-icons.css' %}" rel="stylesheet">
    <link href="{% static 'css/lib/owl.carousel.min.css' %}" rel="stylesheet" />
    <link href="{% static 'css/lib/owl.theme.default.min.css' %}" rel="stylesheet" />
    <link href="{% static 'css/lib/weather-icons.css' %}" rel="stylesheet" />
    <link href="{% static 'css/lib/menubar/sidebar.css' %}" rel="stylesheet">
    <link href="{% static 'css/lib/bootstrap.min.css' %}" rel="stylesheet">
    <link href="{% static 'css/lib/helper.css' %}" rel="stylesheet">
    <link href="{% static 'css/style.css' %}" rel="stylesheet">
</head>

<body>

    {% include "sidebar/sidebar.html" %}  
    <!-- /# sidebar -->

    <div class="header">
        <div class="container-fluid">
            <div class="row">
                <div class="col-lg-12">
                    <div class="float-left">
                        <div class="hamburger sidebar-toggle">
                            <span class="line"></span>
                            <span class="line"></span>
                            <span class="line"></span>
                        </div>
                    </div>

                </div>
            </div>
        </div>
    </div>




    <div class="content-wrap">
        <div class="main">
            <div class="container-fluid">
                <div class="row">
                    <div class="col-lg-8 p-r-0 title-margin-right">
                        <div class="page-header">
                            
                        </div>
                    </div>
                    <!-- /# column -->
                    <div class="col-lg-4 p-l-0 title-margin-left">
                        <div class="page-header">
                            <div class="page-title">
                                <ol class="breadcrumb">
                                    <li class="breadcrumb-item"><a href="#">Dashboard</a></li>
                                    <li class="breadcrumb-item active">Add Hospital</li>
                                </ol>
                            </div>
                        </div>
                    </div>
                    <!-- /# column -->
                </div>
                <!-- /# row -->
                <section id="main-content">


                    <!-- /# row -->
                    <div class="row">
                        <div class="col-lg-6">
                            <div class="card">
                                <div class="card-title">
                                    <h4>Add New Pharmacy</h4>
                                    
                                </div>
                                <div class="card-body">
                                    <div class="basic-form">

                                        <form action="add_pharmacy_db" method="POST">
                                            {% csrf_token %}
                                            <div class="row">

                                                <div class="col-6">
                                                    <div class="form-group">
                                                        <label>Pharmacy Name</label>
                                                        <input type="text" name="pharmacy_name" class="form-control" placeholder="Pharmacy Name">
                                                    </div>
                                                </div>

                                                <div class="col-6">
                                                    <div class="form-group">
                                                        <label>Address</label>
                                                        <input type="text" name="address" class="form-control" placeholder="Address">
                                                    </div>
                                                </div>
                                                <div class="col-6">
                                                    <div class="form-group">
                                                        <label>District</label>
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                                                        <select class="form-control" name="district" aria-label="Default select example">
                                                            <option selected value="Colombo">Colombo</option>
                                                            <option value="Ampara">Ampara</option>
                                                            <option value="Anuradhapura">Anuradhapura</option>
                                                            <option value="Badulla">Badulla</option>
                                                            <option value="Batticaloa">Batticaloa</option>
                                                            <option value="Galle">Galle</option>
                                                            <option value="Gampaha">Gampaha</option>
                                                            <option value="Hambantota">Hambantota</option>
                                                            <option value="Jaffna">Jaffna</option>
                                                            <option value="Kalutara">Kalutara</option>
                                                            <option value="Kandy">Kandy</option>
                                                            <option value="Kegalle">Kegalle</option>
                                                            <option value="Kilinochchi">Kilinochchi</option>
                                                            <option value="Mannar">Mannar</option>
                                                            <option value="Matale">Matale</option>
                                                            <option value="Matara">Matara</option>
                                                            <option value="Monaragala">Monaragala</option>
                                                            <option value="Mullativu">Mullativu</option>
                                                            <option value="Nuwaraeliya">Nuwaraeliya</option>
                                                            <option value="Polonnaruwa">Polonnaruwa</option>
                                                            <option value="Puttalam">Puttalam</option>
                                                            <option value="Ratnapura">Ratnapura</option>
                                                            <option value="Trincomalee">Trincomalee</option>
                                                            <option value="Vavuniya">Vavuniya</option>
                                                        </select>
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                                                    </div>
                                                </div>
                                                <div class="col-6">
                                                    <div class="form-group">
                                                        <label>City</label>
                                                        <input type="text" name="city" class="form-control" placeholder="City">
                                                    </div>
                                                </div>
                                                <div class="col-6">
                                                    <div class="form-group">
                                                        <label>Email</label>
                                                        <input type="email" name="email" class="form-control" placeholder="Email">
                                                    </div>
                                                </div>
                                                <div class="col-6">
                                                    <div class="form-group">
                                                        <label>Mobile</label>
                                                        <input type="number" name="mobile" class="form-control" placeholder="Mobile">
                                                    </div>
                                                </div>
                                                <div class="col-12">
                                                    <a style="color: green;" href="https://www.latlong.net/"  target="_blank">Get Latitude & Longitude</a> 
                                                </div>
                                                <br><br>
                                                <div class="col-6">
                                                    <div class="form-group">
                                                        <label>Latitude</label>
                                                        <input type="text" name="lat" class="form-control" placeholder="Latitude">
                                                    </div>
                                                </div>
                                                <div class="col-6">
                                                    <div class="form-group">
                                                        <label>Longitude</label>
                                                        <input type="text" name="long" class="form-control" placeholder="Longitude">
                                                    </div>
                                                </div>

                                            </div>

                                            {% if messages %}
                                                <div>
                                                    {% for message in messages %}
                                                    <p style="color: red;" {% if message.tags %} class="{{ message.tags }}"{% endif %}>
                                                        {% if message.level == DEFAULT_MESSAGE_LEVELS.ERROR %}Important: {% endif %}
                                                        {{ message }}
                                                    </p>
                                                    {% endfor %}
                                                    </div>
                                                {% endif %}
                                            
                                            <button type="submit" class="btn btn-default">Submit</button>
                                        </form>
                                    </div>
                                </div>
                            </div>
                        </div>
 
                    </div>



                    <div class="row">
                        <div class="col-lg-12">
                            <div class="footer">
                                <p>2022 © Admin. - <a href="#">projectX.com</a></p>
                            </div>
                        </div>
                    </div>
                </section>
            </div>
        </div>
    </div>





    
    <!-- jquery vendor -->
    <script src="{% static 'js/lib/jquery.min.js' %}"></script>
    <script src="{% static 'js/lib/jquery.nanoscroller.min.js' %}"></script>
    <!-- nano scroller -->
    <script src="{% static 'js/lib/menubar/sidebar.js' %}"></script>
    <script src="{% static 'js/lib/preloader/pace.min.js' %}"></script>
    <!-- sidebar -->

    <script src="{% static 'js/lib/bootstrap.min.js' %}"></script>
    <script src="{% static 'js/scripts.js' %}"></script>
    <!-- bootstrap -->

    <script src="{% static 'js/lib/calendar-2/moment.latest.min.js' %}"></script>
    <script src="{% static 'js/lib/calendar-2/pignose.calendar.min.js' %}"></script>
    <script src="{% static 'js/lib/calendar-2/pignose.init.js' %}"></script>


    <script src="{% static 'js/lib/weather/jquery.simpleWeather.min.js' %}"></script>
    <script src="{% static 'js/lib/weather/weather-init.js' %}"></script>
    <script src="{% static 'js/lib/circle-progress/circle-progress.min.js' %}"></script>
    <script src="{% static 'js/lib/circle-progress/circle-progress-init.js' %}"></script>
    <script src="{% static 'js/lib/chartist/chartist.min.js' %}"></script>
    <script src="{% static 'js/lib/sparklinechart/jquery.sparkline.min.js' %}"></script>
    <script src="{% static 'js/lib/sparklinechart/sparkline.init.js' %}"></script>
    <script src="{% static 'js/lib/owl-carousel/owl.carousel.min.js' %}"></script>
    <script src="{% static 'js/lib/owl-carousel/owl.carousel-init.js' %}"></script>
    <!-- scripit init-->
    <script src="{% static 'js/dashboard2.js' %}"></script>




</body>

</html>