ruby:
  back_path = patient_transplants_recipient_dashboard_path(patient)

.row.top
  .medium-6.columns
    = f.submit "Save", class: "button"
    span= " or "
    = link_to "cancel", back_path

.form-content
  = f.simple_fields_for :document, f.object.document do |fd|

    = render layout: "renalware/shared/fieldset",
        locals: { legend: "Transplant Failure", name: "transplant_failure" } do
      = f.input :stent_removed_on, as: :date_picker, wrapper: :horizontal_datepicker
      = f.input :transplant_failed, as: :inline_radio_buttons, wrapper: :horizontal_small
      = f.input :transplant_failed_on, as: :date_picker, wrapper: :horizontal_datepicker
      = f.input :transplant_failure_cause_description_id,
                as: :grouped_select,
                collection: Renalware::Transplants::FailureCauseDescriptionGroup.all,
                group_method: :ordered_descriptions,
                group_label_method: :name,
                value_method: :id,
                wrapper: :horizontal_medium
      = f.input :transplant_failure_cause_other, wrapper: :horizontal_medium
      = f.input :transplant_failure_notes,
                input_html: { rows: 5 },
                wrapper: :horizontal_large

    = render layout: "renalware/shared/fieldset",
             locals: { legend: "Cardiovascular Complication",
                       name: "cardiovascular_complication" } do
      = fd.simple_fields_for :cardiovascular_complication,
                             fd.object.cardiovascular_complication do |fcm|
        table.with-trailing-datepicker
          = render_input fcm, :myocardial_infact
          = render_input fcm, :peripheral_vascular_disease
          = render_input fcm, :stroke
          = render_input fcm, :transient_ischaemic_attack

    = render layout: "renalware/shared/fieldset",
        locals: { legend: "Observations", name: "observation" } do
      table.with-trailing-datepicker
        = render_input fd, :malignancy_within_first_3_months
        = render_input fd, :malignancy_within_first_12_months
        = render_input fd, :recipient_pregnancy
        = render_input fd, :acute_rejection_biopsy_proven
        = render_input fd, :primary_or_recurrent_renal_disease

  = render layout: "renalware/shared/fieldset",
      locals: { legend: "Admin", name: "admin" } do
    = f.input :notes,
              as: :text,
              input_html: { rows: 5 }


.row
  .large-12.columns
    = f.submit "Save", class: "button"

    span= " or "
    = link_to "cancel", back_path