= within_patient_layout(title: t("new_record.page_title"),
    breadcrumbs: breadcrumb_for("Modality History", patient_modalities_path(patient))) do

  = render "renalware/shared/errors", model: modality

  .modality-form.row
    = simple_form_for modality,
                      as: :modality,
                      url: patient_modalities_path(patient),
                      html: { autocomplete: "off" },
                      wrapper: "horizontal_form" do |m|

        .large-9.columns
          = field_set_tag "", class: "borderless" do

              = m.input :description_id,
                        collection: Renalware::Modalities::Description.where(hidden: false),
                        input_html: { id: "modality-description-select" },
                        label_method: :name, value_method: :id,
                        wrapper: :horizontal_medium,
                        autofocus: true

              .hide-death
                = m.input :modal_change_type,
                    label: "Type of Change",
                    input_html: { class: "modal-change-type" },
                    collection: Renalware::Modalities::ChangeType.to_a,
                    wrapper: :horizontal_medium

              .hide-death
                = m.input :reason_id,
                    label: "Reason for Change",
                    input_html: { class: "modality-reason-select" },
                    collection: Renalware::Modalities::Reason.where(type: m.object.modal_change_type),
                    label_method: :description, value_method: :id,
                    wrapper: :horizontal_medium

              .hide-death.reference.columns.small-12.medium-8.medium-offset-4.large-9.large-offset-3
                = link_to "Renal Registry Reason for Change Codes", "#", id: "modal-reason-code"

              = m.input :started_on,
                        as: :date_picker,
                        wrapper: :horizontal_datepicker

              .hide-death
                = m.input :notes,
                          as: :text,
                          input_html: { rows: 5 },
                          wrapper: :horizontal_large

              = m.submit "Save", class: "button"
              '  or
              = link_to "cancel", patient_modalities_path(patient)