{% 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 New Hospital</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 class="page-title">
<!-- <h1>Hello,<span>Welcome Here</span></h1> -->
</div>
</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 Hospital</h4>
</div>
<div class="card-body">
<div class="basic-form">
<form action="add_hospital_db" method="POST">
{% csrf_token %}
<div class="row">
<div class="col-6">
<div class="form-group">
<label>Hospital Name</label>
<input type="text" name="hospital_name" class="form-control" placeholder="Hospital 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>
<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>
</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>Hospital Type</label>
<select class="form-control" name="hospital_type" aria-label="Default select example">
<option selected value="Colombo">One</option>
<option value="Ampara">Two</option>
<option value="Anuradhapura">Three</option>
</select>
</div>
</div>
<div class="col-6">
<div class="form-group">
<label>Email</label>
<input type="text" name="email" class="form-control" placeholder="Email">
</div>
</div>
<div class="col-6">
<div class="form-group">
<label>Phone</label>
<input type="number" name="mobile" class="form-control" placeholder="Phone">
</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>
</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>