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calebasse / calebasse / dossiers / templates / dossiers / patientaddress_new.html @ 78bae9a3

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{% load widget_tweaks %}
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<form action="{{ request.get_full_path }}" method="post">
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  {% csrf_token %}
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  <table>
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    <tbody>
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      <tr>
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        <p>
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        </p>
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        <td>
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          {{ form.recipient.label_tag }} :<br>
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          {{ form.recipient }}
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          {{ form.recipient.errors }}
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        </td>
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      </tr>
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      <tr>
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        <p>
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        </p>
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        <td>
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          {{ form.number.label_tag }} :<br>
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          {{ form.number }}
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          {{ form.number.errors }}
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        </td>
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        <td>
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          {{ form.street.label_tag }} :<br>
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          {{ form.street }}
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          {{ form.street.errors }}
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        </td>
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      </tr>
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      <tr>
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        <td></td>
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        <td>
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          {{ form.address_complement.label_tag }} :<br>
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          {{ form.address_complement }}
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          {{ form.address_complement.errors }}
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        </td>
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      </tr>
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      <tr>
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        <td>
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          {{ form.zip_code.label_tag }} :<br>
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          {{ form.zip_code }}
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          {{ form.zip_code.errors }}
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        </td>
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        <td>
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          {{ form.city.label_tag }} :<br>
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          {{ form.city }}
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          {{ form.city.errors }}
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        </td>
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      </tr>
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      <tr>
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        <td>
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          {{ form.phone.label_tag }} :<br>
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          {{ form.phone }}
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          {{ form.phone.errors }}
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        </td>
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        <td>
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          {{ form.fax.label_tag }} :<br>
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          {{ form.fax }}
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          {{ form.fax.errors }}
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        </td>
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      </tr>
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    </tbody>
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  </table>
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  <br>
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  <p>
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  {{ form.place_of_life.label_tag }}
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  {{ form.place_of_life }}
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  {{ form.place_of_life.errors }}
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  </p>
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  <p>
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  {{ form.comment.label_tag }} {{ form.comment }}
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  {{ form.comment.errors }}
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  </p>
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</form>
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