<div class="modal displayBlock" id="patientOrientationConfig">
    <div class="modal-dialog">
        <div class="modal-content">
            <div class="modal-header">
                {{#ifEquals mode "edit"}}
                <h4 class="modal-title">{{i18n 'adminsetting.editPatientOrientationQuestionHeader'}}</h4>
                {{else}}
                <h4 class="modal-title">{{i18n 'adminsetting.addPatientOrientationQuestionHeader'}}</h4>
                {{/ifEquals}}
            </div>
            <div class="container modal-body">
                <div class="col-xs-7 col-lg-6">
                    <div class="required margin-right-10">{{i18n 'FirstAccess.required'}}</div>
                </div>
                <br/>
                <form class="form-horizontal group-settings paddingtop-10" action="">
                    <div class="clear-both"></div>
                    <div class="form-group paddingtop-10">
                        <label for="languageSelect" class="col-xs-2 control-label">
                            <span class="asterix">*</span> {{i18n 'FirstAccess.LanguageLabel'}}
                        </label>
                        <div class="col-xs-5 col-lg-4">
                            <select id="languageSelect" name="languageSelect" class="form-control">
                                {{#each Languages}}
                                <option value="{{langCd}}" {{#if selected}} selected="selected" {{/if}}>
                                    {{i18n name}}
                                </option>
                                {{/each}}
                            </select>
                        </div>
                        <div class="clear-both"></div>
                        <div class="col-xs-7 col-lg-6">
                            <span class="help-block float-right hidden control-label"></span>
                        </div>
                    </div>
                    <div class="clear-both"></div>
                    <div class="form-group paddingtop-10">
                        <label for="questionType" class="col-xs-2 control-label">
                            <span class="asterix">*</span> {{i18n 'adminsetting.questionType'}}
                        </label>
                        <div class="col-xs-5 col-lg-4">
                            <select id="questionTypeSelect" name="questionTypeSelect" class="form-control">
                                {{#each questionTypes}}
                                <option value="{{type}}" {{#if selected}} selected="selected" {{/if}}>
                                    {{text}}
                                </option>
                                {{/each}}
                            </select>
                        </div>
                        <div class="clear-both"></div>
                        <div class="col-xs-7 col-lg-6">
                            <span class="help-block float-right hidden control-label"></span>
                        </div>
                    </div>
                    <div class="clear-both"></div>
                    <div class="form-group paddingtop-10">
                        <label for="" class="col-xs-2 control-label">
                            <span class="asterix">*</span> {{i18n 'adminsetting.questionText'}}
                        </label>
                        <div class="col-xs-5 col-lg-4">
                            <textarea id="questionText" name="questionText" class="form-control typeahead" style="height: auto;" placeholder="" rows="5" maxlength="1000">{{QuestionText}}</textarea>
                        </div>
                        <div class="clear-both"></div>
                        <div class="col-xs-7 col-lg-6">
                            <span class="help-block float-right hidden control-label"></span>
                        </div>
                    </div>
                    <div class="clear-both"></div>
                    <div class="form-group paddingtop-10">
                        <label for="" class="col-xs-2 control-label">
                            <span class="asterix">*</span> {{i18n 'adminsetting.messageText'}}
                        </label>
                        <div class="col-xs-5 col-lg-4">
                            <textarea id="messageText" name="messageText" class="form-control typeahead" style="height: auto;" placeholder="" rows="5" maxlength="1000">{{MessageText}}</textarea>
                        </div>
                        <div class="clear-both"></div>
                        <div class="col-xs-7 col-lg-6">
                            <span class="help-block float-right hidden control-label"></span>
                        </div>
                    </div>
                    <div class="clear-both"></div>
                    <div class="form-group  paddingtop-10">
                        <label class="col-xs-2 control-label">
                            {{i18n 'adminsetting.crystalreport'}}
                        </label>
                        <div class="col-xs-5 col-lg-4">
                            <div class="input-group">
                                <input id="textFileArea" type="text" class="form-control" value="{{CrystalReport}}" readonly="">
                                <span class="input-group-btn">
                                    <span class="btn btn-default-gray btn-file">
                                        {{i18n 'adminglobal.choosefile'}}<input type="file" id="selectCrystalReport" name="selectCrystalReport" accept=".rpt" title="{{i18n 'adminsetting.chooseFile'}}">
                                    </span>
                                </span>
                            </div>
                        </div>
                        <div class="clear-both"></div>
                        <div class="col-xs-offset-2 discardReport">
                            <span><button id="discardLink" type="button" class="btn-link" disabled data-bypass>Discard Report</button></span>
                        </div>
                        <div class="clear-both"></div>
                        <div class="col-xs-7 col-lg-6">
                            <span class="help-block float-right control-label"></span>    <!-- Error message -->
                        </div>
                    </div>
                </form>
            </div>
            <div class="modal-footer">
                <button type="button"  name="cancel" class="btn btn-default" data-dismiss="modal">{{i18n 'FirstAccess.cancel'}}</button>
                <button type="button" name="save" class="btn btn-primary" data-dismiss="modal">{{i18n 'FirstAccess.done'}}</button>
            </div>
        </div>
    </div>
</div>

