## -*- coding: utf-8 -*-
<%inherit file="../main.mako" />

<%def name="buildNavipath()">
  ${parent.buildNavipath()}
  <li><a href="${h.url(controller='case', action='index')}">${_('Case Management')}</a></li>
  <li><a href="${h.url(controller='case', action='new2')}">${_('Create new case')}</a></li>
</%def>

<div class="waska_form">
  <form id="waska_form" action="${h.url(controller='case', action='newAction')}" accept-charset="UTF-8"
        name="waska_form" method="POST">
    <h1>${_('Create new case document')}</h1>
    <fieldset>
      <legend>${_('Basic data')}</legend>
      <table>
        <tr>
          <td class="label">
            <label for="name">${_('Lastname')}:</label>
          </td>
          <td>
            <input class="field" type="text" size="50" maxlength="60"
                   name="name_1" id="name" value="${c.case.last_name or ""}">
          </td>
        </tr>
        <tr>
          <td class="label">
            <label for="vorname">${_('Firstname')}:</label>
          </td>
          <td>
            <input class="field" type="text" size="50" maxlength="60"
                   name="vorname_1" id="vorname"
                   value="${c.case.first_name or ""}">
          </td>
        </tr>
        <tr>
          <td class="label">
            <label for="adresse_strasse">${_('Street')}:</label>
          </td>
          <td>
            <input class="field" type="text" size="50" maxlength="60" 
                   name="strasse" id="adresse_strasse" 
                   value="${c.case.street or ""}">
          </td>
        </tr>
        <tr>
          <td class="label">
            <label for="adresse_plz">${_('PLZ')}:</label>
          </td>
          <td>
            <input class="field" type="text" size="50" maxlength="60"
                   name="plz" id="adresse_plz" 
                   value="${c.case.plz or ""}">
          </td>
        </tr>
        <tr>
          <td class="label">
            <label for="adresse_ort">${_('Place')}:</label>
          </td>
          <td>
            <input class="field" type="text" size="50" maxlength="60" 
                   name="wohnort" id="adresse_ort" 
                   value="${c.case.city or ""}">
          </td>
        </tr>
      </table>
    </fieldset>
    <%include file="new_statement_block.mako" />
    <div class="input_space">
      <input type="hidden" name="page" value="page_1">
      <input type="submit" value="${_('Print statement')}" name="print">
      <input type="submit" value="${_('Create new case document')}" name="save">
    </div>
  </form>
</div>