Sindbad~EG File Manager

{% extends 'mc_details/mc_layout.html' %}
 {% block content %}


 <div class="container">

 	{% for mesg in get_flashed_messages(category_filter=["successMsg"]) %} 
  <div class="row"> 
      <div class="col-lg-4 col-sm-4 col-sm-12"></div>
        <div class="col-lg-4 col-sm-4 col-sm-12">
    <div class=" text-center" id="successMsg" >
      <h6 class="alert alert-success  alert-dismissible">
        <a href="#" class="close" data-dismiss="alert" aria-label="close">&times;</a>{{ mesg | safe}}</h6>
    </div>
     <div class="col-lg-4 col-sm-4 col-sm-12"></div>
      </div>
    </div>
  {% endfor %} 
  {% for mesg in get_flashed_messages(category_filter=["errorMsg"]) %} 
     <div class="row"> 
      <div class="col-lg-4 col-sm-4 col-sm-12"></div>
        <div class="col-lg-4 col-sm-4 col-sm-12">
          <div class="text-center" id="successMsg" >
          <h6 class="alert alert-danger  alert-dismissible">
           <a href="#" class="close" data-dismiss="alert" aria-label="close">&times;</a>{{ mesg | safe }}</h6>
          </div>
          <div class="col-lg-4 col-sm-4 col-sm-12"></div>
      </div>
    </div>
  {% endfor %}
 	<br/>
 	<form id="mc_form" method="POST" action="{{url_for('mc_details.PostDelegateInfo')}}"> 

 		<div class="card">
 			<div class="card-bod p-4">

 		<div class="row mt-2">
 			<div class="col-md-2"></div>
 			<div class="col-md-6">
 				<h4>Dear {{data.prefix or  '' }} {{data.full_name or '' }}, </h4>
 			</div>

 		</div>
		<div class="row mt-2">
			<div class="col-md-2"></div>
			<div class="col-md-4">Delegate Number</div>
			<div class="col-md-4">{{data.delegate_no or ''}}</div>
			<div class="col-md-2"></div>
		</div>
		<div class="row mt-2">
			<div class="col-md-2"></div>
			<div class="col-md-4">Email</div>
			<div class="col-md-4">
			  <input type="text" class="form-control" id="email" name="email" value="{{data.email or '' }}" required>
			  </div>
			<div class="col-md-2"></div>
		</div>
		<div class="row mt-2">
			<div class="col-md-2"></div>
			<div class="col-md-4">Mobile</div>
			<div class="col-md-4">
			    <input type="text" class="form-control" id="mobile" name="mobile" value="{{data.mobile or '' }}" required>
			</div>
			<div class="col-md-2"></div>
		</div>
		<div class="row mt-2">
			<div class="col-md-2"></div>
			<div class="col-md-4">Medical Council Number</div>
			<div class="col-md-4">
			 <input type="text" class="form-control" id="mc_number" name="mc_number" value="{{data.mc_number or  '' }}"required >	
			</div>
			<div class="col-md-2"></div>
		</div>

		<div class="row mt-2">
			<div class="col-md-2"></div>
			<div class="col-md-4">Medical Council State</div>
			<div class="col-md-4">
                <select class = "form-control" id = "mc_state_id" name = "mc_state_id"   >
                  <option value = "" id = "select"  selected>--select--</option>
                    {% if states : %}
                        {% for  s in states : %}
                          {% if mc_state_id and mc_state_id == s.state_id%}
                           <option value = "{{s.state_id}}" selected > {{s.state_name or '' }} </option>
                          {% else :  %}
                           <option value = "{{s.state_id}}" > {{s.state_name or '' }} </option>
                          {% endif %}
                       {% endfor %}  
                    {% endif %}      
                </select>
                
              </div>
              <div class="col-md-2"></div>
			 
			</div>

		<div class="row mt-5 mb-3">
			<div class="col-md-3"></div>
			<div class="col-md-6 text-center">
			
				<input type="hidden" name="conf_id" id="conf_id"     value="{{conf.conf_id}}">
				<input type="hidden" name="conf_key" id="conf_key"   value="{{conf.conf_key}}">
				<input type="hidden" name="user_uuid" id="user_uuid" value="{{data.user_uuid or ''}}">
				<input type="hidden" name="prefix" id="prefix" value="{{data.prefix or '' }}">
				<input type="hidden" name="full_name" id="full_name" value="{{data.full_name or '' }}">
				<input type="hidden" name="enc_delegate_no" id="enc_delegate_no" value="{{enc_delegate_no or '' }}">
				<input type="hidden" name="delegate_no" id="delegate_no" value="{{data.delegate_no or '' }}">
				

				<button class="btn btn-success"> Submit</button>
			
			</div>
			<div class="col-md-3"></div>
		</div>	

		<div class="row mt-2">
			<div class="col-md-2"></div>
			<div class="col-md-8">
				<label><b> Note:</b></label> If you want to change your name, please write a mail to <a href="mailto:{{conf.e_support_email}}">{{conf.e_support_email}}</a> .
			</div>
			
			<div class="col-md-2"></div>
		</div>

		</div>
 		</div>
        </form>
	</div>
 {% endblock %}