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| 1 | +{% extends 'layout.html' %} |
| 2 | + |
| 3 | +{% set pageName = "Records" %} |
| 4 | + |
| 5 | +{% set currentSection = "records" %} |
| 6 | + |
| 7 | +{% block content %} |
| 8 | + <div class="nhsuk-grid-row"> |
| 9 | + <div class="nhsuk-grid-column-full"> |
| 10 | + |
| 11 | + <h1 class="nhsuk-heading-l">Records</h1> |
| 12 | + <p class="nhsuk-body-l">Search for a vaccination record you want to view, edit or delete.</p> |
| 13 | + |
| 14 | + <form action="/records/by-batch" method="post" novalidate> |
| 15 | + |
| 16 | + |
| 17 | + |
| 18 | + <div class="nhsuk-form-group"> |
| 19 | + |
| 20 | + <fieldset class="nhsuk-fieldset" aria-describedby="contact-hint"> |
| 21 | + <legend class="nhsuk-fieldset__legend nhsuk-fieldset__legend--m"> |
| 22 | + <h1 class="nhsuk-fieldset__heading"> |
| 23 | + How do you want to search for a record? |
| 24 | + </h1> |
| 25 | + </legend> |
| 26 | + |
| 27 | + |
| 28 | + <p>By patient information</p> |
| 29 | + |
| 30 | + |
| 31 | + <div class="nhsuk-radios nhsuk-radios--conditional"> |
| 32 | + <div class="nhsuk-radios__item"> |
| 33 | + <input class="nhsuk-radios__input" id="contact-1" name="contact" type="radio" value="email" aria-controls="conditional-contact-1" aria-expanded="false"> |
| 34 | + <label class="nhsuk-label nhsuk-radios__label" for="contact-1"> |
| 35 | + NHS number |
| 36 | + </label> |
| 37 | + </div> |
| 38 | + <div class="nhsuk-radios__conditional nhsuk-radios__conditional--hidden" id="conditional-contact-1"> |
| 39 | + |
| 40 | + |
| 41 | + |
| 42 | + <div class="nhsuk-form-group"> |
| 43 | + <label class="nhsuk-label nhsuk-hint nhsuk-radios__hint" for="email"> |
| 44 | + For example, 485 777 3456 |
| 45 | + </div> |
| 46 | + </label> <input class="nhsuk-input nhsuk-u-width-one-third" id="email" name="email" type="text"> |
| 47 | + </div> |
| 48 | + |
| 49 | + |
| 50 | + |
| 51 | + </div> |
| 52 | + |
| 53 | + <div class="nhsuk-radios__item"> |
| 54 | + <input class="nhsuk-radios__input" id="contact-2" name="contact" type="radio" value="phone" aria-controls="conditional-contact-2" aria-expanded="false"> |
| 55 | + <label class="nhsuk-label nhsuk-radios__label" for="contact-2"> |
| 56 | + Patient details |
| 57 | + </label> |
| 58 | + </div> |
| 59 | + |
| 60 | + |
| 61 | + |
| 62 | +<br> |
| 63 | +<p>or by vaccine details </p> |
| 64 | + |
| 65 | + <div class="nhsuk-radios nhsuk-radios--conditional"> |
| 66 | + <div class="nhsuk-radios__item"> |
| 67 | + <input class="nhsuk-radios__input" id="contact-3" name="contact" type="radio" value="email" aria-controls="conditional-contact-3" aria-expanded="false"> |
| 68 | + <label class="nhsuk-label nhsuk-radios__label" for="contact-3"> |
| 69 | + COVID-19 |
| 70 | + |
| 71 | + </label> |
| 72 | + </div> |
| 73 | + <div class="nhsuk-radios__conditional nhsuk-radios__conditional--hidden" id="conditional-contact-3"> |
| 74 | + |
| 75 | + |
| 76 | + |
| 77 | + <div class="nhsuk-radios__item"> |
| 78 | + <input class="nhsuk-radios__input" id="example-3" name="example" type="radio" value="yes"> |
| 79 | + <label class="nhsuk-label nhsuk-radios__label" for="example-3"> |
| 80 | + Corminarty 30 JN.1 |
| 81 | + </label> |
| 82 | + </div> |
| 83 | + |
| 84 | + <div class="nhsuk-radios__item"> |
| 85 | + <input class="nhsuk-radios__input" id="example-3" name="example" type="radio" value="yes"> |
| 86 | + <label class="nhsuk-label nhsuk-radios__label" for="example-3"> |
| 87 | + Spikevax JN.1 |
| 88 | + </label> |
| 89 | + </div> |
| 90 | + |
| 91 | + </div> |
| 92 | + |
| 93 | + |
| 94 | + |
| 95 | + |
| 96 | + |
| 97 | + |
| 98 | + </div> |
| 99 | + |
| 100 | + |
| 101 | + |
| 102 | + <div class="nhsuk-radios nhsuk-radios--conditional"> |
| 103 | + <div class="nhsuk-radios__item"> |
| 104 | + <input class="nhsuk-radios__input" id="contact-4" name="contact" type="radio" value="email" aria-controls="conditional-contact-4" aria-expanded="false"> |
| 105 | + <label class="nhsuk-label nhsuk-radios__label" for="contact-4"> |
| 106 | + Flu </label> |
| 107 | + </div> |
| 108 | + <div class="nhsuk-radios__conditional nhsuk-radios__conditional--hidden" id="conditional-contact-3"> |
| 109 | + |
| 110 | + |
| 111 | + |
| 112 | + <div class="nhsuk-radios__item"> |
| 113 | + <input class="nhsuk-radios__input" id="example-4" name="example" type="radio" value="yes"> |
| 114 | + <label class="nhsuk-label nhsuk-radios__label" for="example-4"> |
| 115 | + COVID-19 |
| 116 | + </label> |
| 117 | + </div> |
| 118 | + |
| 119 | + <div class="nhsuk-radios__item"> |
| 120 | + <input class="nhsuk-radios__input" id="example-divider-4" name="example" type="radio" value="yes"> |
| 121 | + <label class="nhsuk-label nhsuk-radios__label" for="example-4"> |
| 122 | + Flu |
| 123 | + </label> |
| 124 | + </div> |
| 125 | + |
| 126 | + |
| 127 | + </fieldset> |
| 128 | + </div> |
| 129 | + |
| 130 | + |
| 131 | + |
| 132 | + |
| 133 | + |
| 134 | + |
| 135 | + {{ button({ |
| 136 | + text: "Continue" |
| 137 | + })}} |
| 138 | + </form> |
| 139 | + |
| 140 | + |
| 141 | + |
| 142 | + </div> |
| 143 | + </div> |
| 144 | + |
| 145 | + |
| 146 | + |
| 147 | + |
| 148 | + |
| 149 | +{% endblock %} |
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