blood_management/add_request.html at master · ServiceToMankind/blood_management · GitHub

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<!DOCTYPE html>
<html lang="en">
  <head>
    <!-- Required meta tags -->
    <meta charset="utf-8" />
    <meta
      name="viewport"
      content="width=device-width, initial-scale=1, shrink-to-fit=no"
    />
    <title>STM | Blood Management</title>
    <!-- plugins:css -->
    <link
      rel="stylesheet"
      href="assets/vendors/mdi/css/materialdesignicons.min.css"
    />
    <link rel="stylesheet" href="assets/vendors/css/vendor.bundle.base.css" />
    <!-- endinject -->
    <!-- Plugin css for this page -->
    <!-- End plugin css for this page -->
    <!-- inject:css -->
    <!-- endinject -->
    <!-- ovveride css -->
    <link rel="stylesheet" href="assets/css/custom_override.css" />
    <!-- Layout styles -->
    <link rel="stylesheet" href="assets/css/style.css" />

    <!-- End layout styles -->
    <link rel="shortcut icon" href="assets/images/favicon.ico" />
  </head>
  <body>
    <div class="container-scroller">
      <!-- partial:partials/_navbar.html -->
      <nav
        class="navbar default-layout-navbar col-lg-12 col-12 p-0 fixed-top d-flex flex-row"
      >
        <div
          class="text-center navbar-brand-wrapper d-flex align-items-center justify-content-center"
        >
          <a class="navbar-brand brand-logo" href="index.html"
            >Blood Management</a
          >
          <a class="navbar-brand brand-logo-mini" href="index.html"
            ><img
              src="https://stmorg.in/accesories/service_to_man_kind-20200709-0001.jpg"
              width="28px"
              height="28px"
              alt="logo"
          /></a>
        </div>
        <div class="navbar-menu-wrapper d-flex align-items-stretch">
          <button
            class="navbar-toggler navbar-toggler align-self-center"
            type="button"
            data-toggle="minimize"
          >
            <span class="mdi mdi-menu"></span>
          </button>
          <div class="search-field d-none d-md-block">
            <form class="d-flex align-items-center h-100" action="#">
              <div class="input-group">
                <div class="input-group-prepend bg-transparent">
                  <i class="input-group-text border-0 mdi mdi-magnify"></i>
                </div>
                <input
                  type="text"
                  class="form-control bg-transparent border-0"
                  placeholder="Search projects"
                />
              </div>
            </form>
          </div>
          <ul class="navbar-nav navbar-nav-right">
            <li class="nav-item nav-profile dropdown">
              <a
                class="nav-link dropdown-toggle"
                id="profileDropdown"
                href="#"
                data-bs-toggle="dropdown"
                aria-expanded="false"
              >
                <div class="nav-profile-img">
                  <img
                    src="https://stmorg.in/accesories/service_to_man_kind-20200709-0001.jpg"
                    alt="image"
                  />
                  <span class="availability-status online"></span>
                </div>
                <div class="nav-profile-text">
                  <p class="mb-1 text-black">Pranay Kiran</p>
                </div>
              </a>
              <div
                class="dropdown-menu navbar-dropdown"
                aria-labelledby="profileDropdown"
              >
                <a class="dropdown-item" href="#">
                  <i class="mdi mdi-cached me-2 text-success"></i> Activity Log
                </a>
                <div class="dropdown-divider"></div>
                <a class="dropdown-item" href="#">
                  <i class="mdi mdi-logout me-2 text-primary"></i> Signout
                </a>
              </div>
            </li>
            <li class="nav-item d-none d-lg-block full-screen-link">
              <a class="nav-link">
                <i class="mdi mdi-fullscreen" id="fullscreen-button"></i>
              </a>
            </li>
          </ul>
          <button
            class="navbar-toggler navbar-toggler-right d-lg-none align-self-center"
            type="button"
            data-toggle="offcanvas"
          >
            <span class="mdi mdi-menu"></span>
          </button>
        </div>
      </nav>
      <!-- partial -->
      <div class="container-fluid page-body-wrapper">
        <!-- partial:partials/_sidebar.html -->
        <nav class="sidebar sidebar-offcanvas" id="sidebar">
          <ul class="nav">
            <li class="nav-item nav-profile">
              <a href="#" class="nav-link">
                <div class="nav-profile-image">
                  <img
                    src="https://stmorg.in/accesories/service_to_man_kind-20200709-0001.jpg"
                    alt="profile"
                  />
                  <span class="login-status online"></span>
                  <!--change to offline or busy as needed-->
                </div>
                <div class="nav-profile-text d-flex flex-column">
                  <span class="font-weight-bold mb-2">Pranay Kiran</span>
                  <span class="text-secondary text-small">Secretary</span>
                </div>
                <i
                  class="mdi mdi-bookmark-check text-success nav-profile-badge"
                ></i>
              </a>
            </li>
            <li class="nav-item">
              <a class="nav-link" href="index.html">
                <span class="menu-title">Dashboard</span>
                <i class="mdi mdi-home menu-icon"></i>
              </a>
            </li>
            <li class="nav-item">
              <a
                class="nav-link"
                data-bs-toggle="collapse"
                href="#ui-basic"
                aria-expanded="false"
                aria-controls="ui-basic"
              >
                <span class="menu-title">Requests</span>
                <i class="menu-arrow"></i>
                <i class="mdi mdi-comment-plus-outline menu-icon"></i>
              </a>
              <div class="collapse" id="ui-basic">
                <ul class="nav flex-column sub-menu">
                  <li class="nav-item">
                    <a class="nav-link" href="add_request.html">Add Request</a>
                  </li>
                  <li class="nav-item">
                    <a class="nav-link" href="manage_requests.html"
                      >Manage Requests</a
                    >
                  </li>
                </ul>
              </div>
            </li>
          </ul>
        </nav>
        <!-- partial -->
        <div class="main-panel">
          <div class="content-wrapper">
            <div class="page-header">
              <h3 class="page-title">
                <span
                  class="page-title-icon bg-gradient-danger text-white me-2"
                >
                  <i class="mdi mdi-home"></i>
                </span>
                Blood Requests
              </h3>
              <nav aria-label="breadcrumb">
                <ul class="breadcrumb">
                  <li class="breadcrumb-item active" aria-current="page">
                    <span></span>Overview
                    <i
                      class="mdi mdi-alert-circle-outline icon-sm text-primary align-middle"
                    ></i>
                  </li>
                </ul>
              </nav>
            </div>
            <!-- form  -->
            <div class="col-md-6 grid-margin stretch-card">
              <div class="card">
                <div class="card-body">
                  <h4 class="card-title">Add Blood Request</h4>
                  <p class="card-description">Data must be verified.</p>
                  <form class="forms-sample">
                    <div class="form-group">
                      <label for="exampleInputUsername1">Name</label>
                      <input
                        type="text"
                        class="form-control"
                        id="exampleInputUsername1"
                        placeholder="Username"
                      />
                    </div>
                    <div class="form-group">
                      <label for="exampleInputUsername1">Attende</label>
                      <input
                        type="text"
                        class="form-control"
                        id="exampleInputUsername1"
                        placeholder="Username"
                      />
                    </div>
                    <div class="form-group">
                      <label for="exampleInputUsername1">Treatment</label>
                      <input
                        type="text"
                        class="form-control"
                        id="exampleInputUsername1"
                        placeholder="Username"
                      />
                    </div>
                    <div class="form-group">
                      <label for="exampleSelectGender">Requirement</label>
                      <select class="form-control" id="exampleSelectGender">
                        <option value="1">A+</option>
                        <option value="2">A-</option>
                        <option value="3">B+</option>
                        <option value="4">B-</option>
                        <option value="5">AB+</option>
                        <option value="6">AB-</option>
                        <option value="7">O+</option>
                        <option value="8">O-</option>
                      </select>
                    </div>
                    <div class="form-group">
                      <label for="exampleInputUsername1">No. Of Units</label>
                      <input
                        type="text"
                        class="form-control"
                        id="exampleInputUsername1"
                        placeholder="Username"
                      />
                    </div>
                    <div class="form-group">
                      <label for="exampleInputUsername1">required On</label>
                      <input
                        type="datetime"
                        class="form-control"
                        id="exampleInputUsername1"
                        placeholder="dd/mm/yyyy"
                      />
                    </div>
                    <div class="form-group">
                      <label for="exampleInputUsername1">Location</label>
                      <input
                        type="text"
                        class="form-control"
                        id="exampleInputUsername1"
                        placeholder="Username"
                      />
                    </div>
                    <div class="form-group">
                      <label for="exampleInputUsername1">Contact</label>
                      <input
                        type="text"
                        class="form-control"
                        id="exampleInputUsername1"
                        placeholder="Username"
                      />
                    </div>
                    <div class="form-check form-check-flat form-check-primary">
                      <label class="form-check-label">
                        <input type="checkbox" class="form-check-input" />
                        Remember me
                      </label>
                    </div>
                    <button type="submit" class="btn btn-gradient-primary me-2">
                      Submit
                    </button>
                    <button class="btn btn-light">Cancel</button>
                  </form>
                </div>
              </div>
            </div>
          </div>
          <!-- content-wrapper ends -->
          <!-- partial:partials/_footer.html -->
          <footer class="footer">
            <div class="container-fluid d-flex justify-content-between">
              <span
                class="text-muted d-block text-center text-sm-start d-sm-inline-block"
                >Copyright © stmorg.in 2023</span
              >
              <span
                class="text-muted d-block text-center text-sm-start d-sm-inline-block"
                >Copyright © bootstrapdash.com 2021</span
              >
              <span
                class="text-muted d-block text-center text-sm-start d-sm-inline-block"
              >
                <a
                  href="https://www.bootstrapdash.com/bootstrap-admin-template/"
                  target="_blank"
                  >Bootstrap admin template</a
                ></span
              >
            </div>
          </footer>
          <!-- partial -->
        </div>
        <!-- main-panel ends -->
      </div>
      <!-- page-body-wrapper ends -->
    </div>
    <!-- container-scroller -->
    <!-- plugins:js -->
    <script src="assets/vendors/js/vendor.bundle.base.js"></script>
    <!-- endinject -->
    <!-- Plugin js for this page -->
    <script src="assets/vendors/chart.js/Chart.min.js"></script>
    <script src="assets/js/jquery.cookie.js" type="text/javascript"></script>
    <!-- End plugin js for this page -->
    <!-- inject:js -->
    <script src="assets/js/off-canvas.js"></script>
    <script src="assets/js/hoverable-collapse.js"></script>
    <script src="assets/js/misc.js"></script>
    <!-- endinject -->
    <!-- Custom js for this page -->
    <script src="assets/js/dashboard.js"></script>
    <script src="assets/js/todolist.js"></script>
    <!-- End custom js for this page -->
  </body>
</html>