Produits Entr'ouvert » Calebasse

{% extends "dossiers/base.html" %}

{% load url from future %}

{% block extrascripts %}

<link rel="stylesheet" type="text/css" media="all" href="{{ STATIC_URL }}filter-widget/css/filter-widget.css"/>

<script src="{{ STATIC_URL }}js/jquery.parse-url.js"></script>

<script src="{{ STATIC_URL }}js/calebasse.dossiers.js"></script>

<script src="{{ STATIC_URL }}filter-widget/js/i18n.js"></script>

<script src="{{ STATIC_URL }}filter-widget/js/core.js"></script>

<script src="{{ STATIC_URL }}filter-widget/js/SelectBox.js"></script>

<script src="{{ STATIC_URL }}filter-widget/js/SelectFilter2.js"></script>

{% endblock %}

{% block title %}{{ object.last_name }} {{ object.first_name }} - Dossier {{ object.paper_id|default_if_none:"" }}{% endblock %}

{% block appbar %}

<h2><span class="lastname">{{ object.last_name }}</span> {{ object.first_name }} - Dossier {{ object.paper_id|default_if_none:"" }}</h2>

<span id="ajax-redirect" data-url="{{ object.id }}/view"/>

<a href="..">Retourner aux dossiers</a>

{% if 'validator' in role %}{% if object.can_be_deleted %}<button type="button" id="patientrecord-delete">Supprimer</button>{% endif %}{% endif %}

{% endblock %}

{% block content %}

{% if messages %}

<ul class="messages">

    {% for message in messages %}

    <li{% if message.tags %} class="{{ message.tags }}"{% endif %}>{{ message }}</li>

    {% endfor %}

</ul>

<script type="text/javascript">

$('.messages').delay(1000*(1+{{ messages|length }})).fadeOut('slow');

</script>

{% endif %}

<ul class="messages" style="display: none;"></ul>

<div id="tabs">

  <ul>

    <li><a data-id="0" class="atabs" href="#tabs-1">Général</a></li>

    <li><a data-id="1" class="atabs" href="#tabs-2">Fiche administrative</a></li>

    <li><a data-id="2" class="atabs" href="#tabs-3">Adresses / contacts</a></li>

    {% if object.service.name == "CMPP" %}

    <li><a data-id="3"  class="atabs" href="#tabs-4">Prise en charge</a></li>

    {% elif object.service.name == "SESSAD TED" or object.service.name == "SESSAD DYS" %}

    <li><a data-id="3" class="atabs" href="#tabs-4">Notifications</a></li>

    {% else %}

    <li style="display: none;"><a data-id="3" class="atabs" href="#tabs-4">Notifications</a></li>

    {% endif %}

    <li><a data-id="4" class="atabs" href="#tabs-5">Actes passés</a>

    <li><a data-id="5" class="atabs" href="#tabs-6">Prochains rendez-vous</a>

    <li><a data-id="6" class="atabs" href="#tabs-7">Socialisation</a>

    <li><a data-id="7" class="atabs" href="#tabs-8">Données à caractère médical</a>

  </ul>

  <div id="tabs-1"> <!-- Général -->

      {% include "dossiers/patientrecord_tab1.html" %}

  </div>

  <div id="tabs-2"> <!-- Fiche administrative -->

      {% include "dossiers/patientrecord_tab2.html" %}

  </div>

    <div id="tabs-3"> <!-- Adresses / Contacts -->

    <form method="post" id="policyholder-form" class="patientrecordform">{% csrf_token %}

            <div class="contact patient">

                <h4>{{ object.first_name }} <span class="lastname">{{ object.last_name }}</span> (Patient)</h4>

                <div class="right">Assuré

                    <input type="radio"

                    {% if object.policyholder.id == object.id %} checked="checked" {% endif %}

                    id="id_policyholder-policyholder_{{ object.id }}"

                    value="{{ object.id }}"

                    class="policyholder-radio"

                    name="policyholder-policyholder">

                    <button type="button" data-id="{{ object.id }}" class="update-contact-btn icon-edit" title="Modifier"></button>

                </div>

                <div>

                    <ul>

                        {% if object.parente %}

                            <li><label>Lien avec le patient :</label>

                            {{ object.parente }}</li>

                        {% endif %}

                        {% if object.mobile %}

                            <li>

                            <span class="icon-user-space">{{ object.mobile }} (perso)</span>

                            </li>

                        {% endif %}

                        {% if object.phone %}

                            <li>

                            <span class="icon-user-space">{{ object.phone }} (pro)</span>

                            </li>

                        {% endif %}

                        {% if object.email %}

                            <li>

                            <label>Courriel :</label>

                            {{ object.email }}

                            </li>

                        {% endif %}

                        {% if object.job %}

                            <li>

                            <label>Profession :</label>

                            {{ object.job }}

                            </li>

                        {% endif %}

                        {% if object.contact_comment %}

                            <li>

                            <label>Commentaire :</label>

                            {{ object.contact_comment }}

                            </li>

                        {% endif %}

                        <li><label>Données d'assuré social</label>

<!--                            <button class="blind">détails</button>-->

                            <ul>

                            {% if object.social_security_id %}

                                <li><label>Numéro d'assuré social :</label>

                                {{ object.social_security_id }} {{ object.get_control_key }}</li>

                            {% endif %}

                            {% if object.birthdate %}

                                <li><label>Date de naissance :</label>

                                {{ object.birthdate }}</li>

                            {% endif %}

                            {% if object.birthplace %}

                                <li><label>Lieu de naissance :</label>

                                {{ object.birthplace }}</li>

                            {% endif %}

                            {% if object.begin_rights %}

                                <li><label>Début de droits :</label>

                                {{ object.begin_rights }}</li>

                            {% endif %}

                            {% if object.end_rights %}

                                <li><label>Fin de droits :</label>

                                {{ object.end_rights }}</li>

                            {% endif %}

                            {% if object.health_center %}

                                <li><label>Caisse :</label>

                                {{ object.health_center }}</li>

                            {% endif %}

                            {% if object.other_health_center %}

                                <li><label>Centre spécifique :</label>

                                {{ object.other_health_center }}</li>

                            {% endif %}

                            {% if object.management_code %}

                                <li><label>Code de gestion :</label>

                                {{ object.management_code }}</li>

                            {% endif %}

                            <li><label>Tiers-payant :</label>

                                {% if object.thirdparty_payer %}

                                    Oui

                                {% else %}

                                    Non

                                {% endif %}

                            </li>

                            {% if object.twinning_rank %}

                                <li><label>Rang (gémellité) :</label>

                                {{ object.twinning_rank }}</li>

                            {% endif %}

                            </ul>

                        </li>

                    </ul>

                </div>

            </div>

        <button type="button" id="new-address-btn">Nouvelle adresse</button>

        <button type="button" id="new-contact-btn">Nouveau contact</button>

        {% for address in object.addresses.all %}

        <div class="frame">

            <h3>{% if not address.display_name %}Non renseigné{% else %}{{ address.display_name }}{% endif %}</h3>

            <div class="buttons">

                <button type="button" data-id="{{ address.id }}" class="del-address icon-minus" title="Supprimer"></button>

                <button type="button" data-id="{{ address.id }}" class="update-address-btn icon-edit" title="Modifier"></button>

            </div>

            <div class="right">

                <ul class="ajax_messages" style="display: none;"></ul>

                <input type="checkbox" data-id="{{ address.id }}" class="place_of_life" {% if address.place_of_life %}checked{% endif %}>Lieu de vie</input>

            </div>

            {% if address.phone %}<p><span class="icon-home-space">{{ address.phone }}</span></p>{% endif %}

            {% if address.comment %}<p><label>Commentaire :</label>{{ address.comment }}</p>{% endif %}

            {% if not address.phone and not address.comment %}<p>&nbsp;<!-- intentionaly empty --></p>{% endif %}

            {% for contact in address.patientcontact_set.all  %}

            {% if contact.id != object.id %}

            <div class="contact{% if contact.id == object.id %} patient{% endif %}">

                <h4>{% if contact.gender == 1 %}M.{% elif contact.gender == 2 %}Mme{% endif %}

                    {{ contact.first_name }} <span class="lastname">{{ contact.last_name }}</span> {% if contact.id == object.id %} (PATIENT){% endif %}</h4>

                <div class="right">Assuré

                    <input type="radio"

                    {% if object.policyholder.id == contact.id %} checked="checked" {% endif %}

                    id="id_policyholder-policyholder_{{ contact.id }}"

                    value="{{ contact.id }}"

                    class="policyholder-radio"

                    name="policyholder-policyholder">

                    <button type="button" data-id="{{ contact.id }}" data-address-id="{{ address.id }}" class="del-contact icon-minus" title="Supprimer"></button>

                    <button type="button" data-id="{{ contact.id }}" class="update-contact-btn icon-edit" title="Modifier"></button>

                </div>

                <div>

                    <ul>

                        {% if contact.parente %}

                            <li><label>Lien avec le patient :</label>

                            {{ contact.parente }}</li>

                        {% endif %}

                        {% if contact.mobile %}

                            <li>

                            <span class="icon-user-space">{{ contact.mobile }} (perso)</span>

                            </li>

                        {% endif %}

                        {% if contact.phone %}

                            <li>

                            <span class="icon-user-space">{{ contact.phone }} (pro)</span>

                            </li>

                        {% endif %}

                        {% if contact.email %}

                            <li>

                            <label>Courriel :</label>

                            {{ contact.email }}

                            </li>

                        {% endif %}

                        {% if contact.job %}

                            <li>

                            <label>Profession :</label>

                            {{ contact.job }}

                            </li>

                        {% endif %}

                        {% if contact.contact_comment %}

                            <li>

                            <label>Commentaire :</label>

                            {{ contact.contact_comment }}

                            </li>

                        {% endif %}

                        <li><label>Données d'assuré social</label>

<!--                            <button class="blind">détails</button>-->

                            <ul>

                            {% if contact.social_security_id %}

                                <li><label>Numéro d'assuré social :</label>

                                {{ contact.social_security_id }} {{ contact.get_control_key }}</li>

                            {% endif %}

                            {% if contact.birthdate %}

                                <li><label>Date de naissance :</label>

                                {{ contact.birthdate }}</li>

                            {% endif %}

                            {% if contact.birthplace %}

                                <li><label>Lieu de naissance :</label>

                                {{ contact.birthplace }}</li>

                            {% endif %}

                            {% if contact.begin_rights %}

                                <li><label>Début de droits :</label>

                                {{ contact.begin_rights }}</li>

                            {% endif %}

                            {% if contact.end_rights %}

                                <li><label>Fin de droits :</label>

                                {{ contact.end_rights }}</li>

                            {% endif %}

                            {% if contact.health_center %}

                                <li><label>Centre de santé :</label>

                                {{ contact.health_center }}</li>

                            {% endif %}

                            {% if contact.management_code %}

                                <li><label>Code de gestion :</label>

                                {{ contact.management_code }}</li>

                            {% endif %}

                            <li><label>Tiers-payant :</label>

                                {% if contact.thirdparty_payer %}

                                    Oui

                                {% else %}

                                    Non

                                {% endif %}

                            </li>

                            {% if contact.twinning_rank %}

                                <li><label>Rang (gémellité) :</label>

                                {{ contact.twinning_rank }}</li>

                            {% endif %}

                            </ul>

                        </li>

                    </ul>

                </div>

            </div>

            {% endif %}

            {% endfor %}

        </div>

        {% endfor %}

    </form>

    </div>

    <div id="tabs-4"> <!-- Prise en charge et notifications -->

    {% if object.service.name == "CMPP" %}

        <div class="notifs">

        <h4>Information sur la prise en charge</h4>

        <ul>

        <li><span{% if hc_status.1 %} id="highlight"{% endif %}>{{ hc_status.0 }}</span></li>

        {% if object.pause %}<li><span id="highlight">Le dossier est en pause facturation.</span></li>{% endif %}

        {% if missing_policy %}<li><span id="highlight">Informations d'assuré sociale manquantes.</span></li>{% endif %}

        </div>

        <p>

        <button id="new-hcdiag-btn">Nouvelle PC diagnostic</button>

        <button id="new-hctrait-btn">Nouvelle PC traitement</button>

        </p>

        {% if acts_losts %}

            <p><strong>{{ acts_losts|length }}</strong> actes facturables qui ne peuvent pas être facturés :

            <ul>

            {% for act in acts_losts %}

            <li>{{ act }}</li>

            {% endfor %}

            </ul></p>

        {% endif %}

        {% if acts_pause %}

            <p><strong>{{ acts_pause|length }}</strong> actes qui sont en pause :

            <ul>

            {% for act in acts_pause %}

            <li>{{ act }}</li>

            {% endfor %}

            </ul></p>

        {% endif %}

        {% if hcs %}

            {% for hc, acts in hcs %}

                {% if hc.cmpphealthcarediagnostic %}

                  <div id="patient-diag">

                    <div class="frame">

                    <div class="buttons">

                        <button type="button" data-id="{{ hc.id }}" class="del-hcdiag icon-minus" title="Supprimer"></button>

                        <button type="button" data-id="{{ hc.id }}" class="update-hcdiag-btn icon-edit" title="Modifier"></button>

                    </div>

                      <h3>Prise en charge de diagnostic, débutée le {{ hc.start_date|date:"d/m/Y" }}</h3>

                      <ul>

                        {% if hc.request_date %}<li><label>Date de demande</label> : {{ hc.request_date|date:"d/m/Y" }}</li>{% endif %}

                        {% if hc.agree_date %}<li><label>Date d'accord</label> : {{ hc.agree_date|date:"d/m/Y" }}</li>{% endif %}

                        {% if hc.insist_date %}<li><label>Date de relance</label> : {{ hc.insist_date|date:"d/m/Y" }}</li>{% endif %}

                        {% if hc.comment %}<li><label>Commentaire</label> : {{ hc.comment }}</li>{% endif %}

                        <li><label>Nombres d'actes de la prise en charge</label> : <strong>{{ hc.cmpphealthcarediagnostic.get_act_number }}</strong></li>

                        {% if acts %}<li><strong>{{ acts|length }}</strong> actes pouvant être pris en charge lors de la prochaine facturation :</li>

                        <ul>

                          {% for act in acts %}

                          <li>{{ act }}</li>

                          {% endfor %}

                        </ul>

                        {% endif %}

                        {% if hc.get_nb_acts_cared %}

                        <li><strong>{{ hc.get_nb_acts_cared }}</strong> actes déja facturés :</li>

                        <ul>

                          {% for act in hc.act_set.all %}

                          <li>{{ act }}</li>

                          {% endfor %}

                        </ul>

                        {% else %}<li>Aucun acte facturé.</li>

                        {% endif %}

                      </ul>

                    </div>

                  </div>

                {% else %}

                  <div id="patient-traitement">

                    <div class="frame">

                    <div class="buttons">

                        <button type="button" data-id="{{ hc.id }}" class="del-hctrait icon-minus" title="Supprimer"></button>

                        <button type="button" data-id="{{ hc.id }}" class="update-hctrait-btn icon-edit" title="Modifier"></button>

                    </div>

                      <h3>Prise en charge de traitement, débutée le {{ hc.start_date|date:"d/m/Y" }}{% if hc.end_date %}, se terminant le {{ hc.end_date|date:"d/m/Y" }}{% endif %}</h3>

                      <ul>

                        {% if hc.cmpphealthcaretreatment.end_date %}<li><label>Date de fin</label> : {{ hc.cmpphealthcaretreatment.end_date|date:"d/m/Y" }}</li>{% endif %}

                        {% if hc.request_date %}<li><label>Date de demande</label> : {{ hc.request_date|date:"d/m/Y" }}</li>{% endif %}

                        {% if hc.agree_date %}<li><label>Date d'accord</label> : {{ hc.agree_date|date:"d/m/Y" }}</li>{% endif %}

                        {% if hc.insist_date %}<li><label>Date de relance</label> : {{ hc.insist_date|date:"d/m/Y" }}</li>{% endif %}

                        {% if hc.comment %}<li><label>Commentaire</label> : {{ hc.comment }}</li>{% endif %}

                        <li><label>Nombres d'actes de la prise en charge</label> : <strong>{{ hc.cmpphealthcaretreatment.get_act_number }}</strong></li>

                        {% if acts %}<li><strong>{{ acts|length }}</strong> actes pouvant être pris en charge lors de la prochaine facturation :</li>

                        <ul>

                          {% for act in acts %}

                          <li>{{ act }}</li>

                          {% endfor %}

                        </ul>

                        {% endif %}

                        {% if hc.get_nb_acts_cared %}

                        <li><strong>{{ hc.get_nb_acts_cared }}</strong> actes déja facturés :</li>

                        <ul>

                          {% for act in hc.act_set.all %}

                          <li>{{ act }}</li>

                          {% endfor %}

                        </ul>

                        {% else %}<li>Aucun acte facturé.</li>

                        {% endif %}

                      </ul>

                    </div>

                  </div>

                {% endif %}

            {% endfor %}

        {% endif %}

    {% endif %}

    {% if object.service.name == "SESSAD TED" or object.service.name == "SESSAD DYS" %}

        <p>

        <button id="new-notification-btn">Nouvelle notification</button>

        </p>

        {% if hcs %}

            {% for hc in hcs %}

              <div id="patient-diag">

                <div class="frame">

                <div class="buttons">

                    <button type="button" data-id="{{ hc.id }}" class="del-notification icon-minus" title="Supprimer"></button>

                    <button type="button" data-id="{{ hc.id }}" class="update-notification-btn icon-edit" title="Modifier"></button>

                </div>

                  <h3>Notification</h3>

                  <ul>

                    {% if hc.start_date %}<li><label>Date de début</label> : {{ hc.start_date|date:"d/m/Y" }}</li>{% endif %}

                    {% if hc.sessadhealthcarenotification.end_date %}<li><label>Date de fin</label> : {{ hc.sessadhealthcarenotification.end_date|date:"d/m/Y" }}</li>{% endif %}

                    {% if hc.request_date %}<li><label>Date de demande</label> : {{ hc.request_date|date:"d/m/Y" }}</li>{% endif %}

                    {% if hc.agree_date %}<li><label>Date d'accord</label> : {{ hc.agree_date|date:"d/m/Y" }}</li>{% endif %}

                    {% if hc.insist_date %}<li><label>Date de relance</label> : {{ hc.insist_date|date:"d/m/Y" }}</li>{% endif %}

                    {% if hc.comment %}<li><label>Commentaire</label> : {{ hc.comment }}</li>{% endif %}

                  </ul>

                </div>

              </div>

            {% endfor %}

        {% endif %}

    {% endif %}

    </div>

    <div id="tabs-5"> <!-- Actes passés -->

    <table class="main">

      <thead>

          <tr> <th>Date</th> <th>Pointage</th> <th>Type d'acte</th> <th>Intervenants</th> <th>Commentaire</th></tr>

      </thead>

      <tbody>

        {% for act, state in last_rdvs %}

        <tr>

          <td>{{ act.date|date:"l d/m/y"|title }} {{ act.time|date:"H:i" }}</td>

          <td>{% if state %}<strong>{{ state }}</strong>{% else %}Non pointé.{% endif %}</td>

          <td>{{ act.act_type }}</td>

          <td>{% for doctor in act.doctors.all %}

            {{ doctor.first_name }} <span class="lastname">{{ doctor.last_name }}</span>

            {% endfor %}</td>

          <td>{% if act.comment %}{{ act.comment }}{% endif %}</td>

        </tr>

        {% endfor %}

      </tbody>

    </table>

    </div>

    <div id="tabs-6"> <!-- Prochains rendez-vous -->

    <table class="main">

      <thead>

          <tr> <th>Date</th> <th>Pointage</th> <th>Type d'acte</th> <th>Intervenants</th> <th>Commentaire</th> </tr>

      </thead>

      <tbody>

        {% for event, state in next_rdvs %}

        <tr>

          <td>{% firstof event.start_datetime|date:"l d/m/y H:i"|title %}</td>

          <td>{% if state %}<strong>{{ state }}</strong>{% else %}Non pointé.{% endif %}</td>

          <td>{{ event.act_type }}</td>

          <td>{% for doctor in event.participants.all %}

                {{ doctor.first_name }} <span class="lastname">{{ doctor.last_name }}</span>

                {% endfor %}</td>

          <td>{{ event.description }}</td>

        </tr>

        {% endfor %}

      </tbody>

    </table>

    </div>

    <div id="tabs-7">

        <div class="frame">

            <h3>Périodes de socialisation</h3>

            <p><button id="new-socialisation-duration-btn">Nouvelle période de socialisation</button></p>

            {% for duration in object.socialisation_durations.all %}

                <div class="subframe">

                Arrivée le <strong>{{ duration.start_date }}</strong> dans {% if duration.school %}l'établissement <strong>{{ duration.school }}</strong>{% else %}un établissement non renseigné{% endif %}{% if duration.level %} (en {{ duration.level }}){% endif %}

                <div class="buttons">

                    <button type="button" data-id="{{ duration.id }}" class="del-duration icon-minus" title="Supprimer"></button>

                    <button type="button" data-id="{{ duration.id }}" class="update-duration-btn icon-edit" title="Modifier"></button>

                </div>

                <div>

                    <ul>

                        {% if duration.end_date %}<li><label>Date de départ</label> : {{ duration.end_date }}</li>{% endif %}

                        {% if duration.comment %}<li><label>Commentaire</label> : {{ duration.comment }}</li>{% endif %}

                    </ul>

                </div>

                </div>

            {% endfor %}

        </div>

        <div class="frame">

            <h3>Demandes MDPH</h3>

            <p><button id="new-mdph-request-btn">Nouvelle demande MDPH</button></p>

            {% for request in object.mdph_requests.all %}

                <div class="subframe">

                Demande le <strong>{{ request.start_date }}</strong> à la MDPH <strong>{{ request.mdph }}</strong>

                <div class="buttons">

                    <button type="button" data-id="{{ request.id }}" class="del-mdph-request icon-minus" title="Supprimer"></button>

                    <button type="button" data-id="{{ request.id }}" class="update-mdph-request-btn icon-edit" title="Modifier"></button>

                </div>

                <div>

                    <ul>

                        {% if request.comment %}<li><label>Commentaire</label> : {{ request.comment }}</li>{% endif %}

                    </ul>

                </div>

                </div>

            {% endfor %}

        </div>

        <div class="frame">

            <h3>Réponses MDPH</h3>

            <p><button id="new-mdph-response-btn">Nouvelle réponse MDPH</button></p>

            {% for response in object.mdph_responses.all %}

                <div class="subframe">

                Du <strong>{{ response.start_date }}</strong> au <strong>{{ response.end_date }}</strong> à la MDPH <strong>{{ response.mdph }}</strong>

                <div class="buttons">

                    <button type="button" data-id="{{ response.id }}" class="del-mdph-response icon-minus" title="Supprimer"></button>

                    <button type="button" data-id="{{ response.id }}" class="update-mdph-response-btn icon-edit" title="Modifier"></button>

                </div>

                <div>

                    <ul>

                        {% if response.comment %}<li><label>Commentaire</label> : {{ response.comment }}</li>{% endif %}

                        {% if response.type_aide %}<li><label>Type d'aide</label> : {{ response.type_aide }}</li>{% endif %}

                        {% if response.name %}<li><label>Nom</label> : {{ response.name }}</li>{% endif %}

                        {% if response.rate %}<li><label>Taux</label> : {{ response.rate }}</li>{% endif %}

                    </ul>

                </div>

                </div>

            {% endfor %}

        </div>

    </div>

    <div id="tabs-8">

        <form method="post" id="physiology-form" class="patientrecordform">

          {% csrf_token %}

            <button class="save enable-on-change">Enregistrer</button>

            {% for field in forms.physiology %}

            <p>

                {{ field.errors }}

            </p>

            <p>

                {{ field.label_tag  }}

                {{ field }}

            </p>

            {% endfor %}

            </p>

            <input type="hidden"  name="tab"  value="7">

            <button class="save enable-on-change">Enregistrer</button>

        </form>

    </div>

  </div>

</div>

{% endblock %}

{% block dialogs %}

<div id="ajax-dlg" style="display: none;"></div>

<div id="change-record" style="display: none;" data-id="{{ object.id }}" data-service-id="{{ service_id }}">

 </div>

  <div id="dossier-histo-dlg" style="display: none;">

   <dl>

    {% for state in states %}

    <dt><b>{{ state.date_selected|date:"d/m/Y" }}</b> <!--<small>(date info: {{ state.created|date:"d/m/Y" }})</small>-->

      <button data-id="{{ state.id }}" class="update-patient-state-btn icon-edit" title="Modifier"></button>

      {% if states|length > 1 %}<button data-id="{{ state.id }}" class="del-patient-state-btn icon-remove"></button>{% endif %}

    </dt>

    <dd>

    <p><b>{{ state.status.name }}</b>{% if state.comment %}; <label>commentaire:</label> {{ state.comment }}{% endif %}</p>

    </dd>

    <dd class="edit-histo-item" style="display: none;">

<form action="{{ request.get_full_path }}/../update-state" method="post">

  <input type="hidden" name="state_id" value="{{ state.id }}"/>

  {% csrf_token %}

   <p>

   <label for="id_date">Date :</label>

   {{ form.date.errors }}

   <input id="id_date" class="date" name="date" value="{{ state.created|date:"d/m/Y" }}"/>

   </p>

   <p>

    <label for="id_comment">Commentaire :</label>

    <textarea id="id_comment" style="width: 90%;" name="comment">{% if state.comment %}{{ state.comment }}{% endif %}</textarea>

   </p>

   <button>Modifier</button>

 </form>

    </dd>

    {% endfor%}

   </dl>

  </div>

  <div id="add-prise-en-charge-dlg" style="display: none;">

   <div>

    <label for="id_partir">À partir du :</label>

    <input id="id_partir" class="partir" name="partir" size="10" value="11/06/2012"/>

   </div>

   <div>

    <label for="id_pour">Pour :</label>

    <input id="id_pour" class="pour" name="pour" size="4" value="30"/> séances

   </div>

  </div>

  <div id="add-prolongation-dlg" style="display: none;">

   <div>

    <label for="id_pour">Pour :</label>

    <input id="id_pour" class="pour" name="pour" size="4" value="10"/> actes

   </div>

  </div>

<div id="finaccueil-patientrecord-dialog" title="Patient en fin d'accueil">

  <div id="finaccueil-patientrecord-dialog-content">

  </div>

  <form method="post" action="finaccueil-patientrecord/">

    {% csrf_token %}

    <input type="hidden" name="Close" value="1">

  </form>

</div>

{% endblock %}