<commit_before>{% load i18n %}
<style>
    table {
        border-collapse: collapse;
        font-family: "Helvetica Neue", Helvetica, Arial, sans-serif;
        font-size: 13px;
        line-height: 18px
    }
</style>

<div class="hq-generic-report">
    <table style="width: 100%; border: 1px solid;"  cellpadding="0" cellspacing="0">
            <tbody>
                <tr>
                    <td style="border: 1px solid;">{% trans "Mother's name:" %} <strong>{{ case.name }}</strong></td>
                    <td style="border: 1px solid;">{% trans "Husband's name:" %} <strong>{{ case.husband_name }}</strong></td>
                    <td style="border: 1px solid;">{% trans "Villages name:" %} <strong>{{ case.hamlet_name }}</strong></td>
                    <td style="border: 1px solid;">{% trans "Name of sub-centre:"%} <strong>{{ sub_center }}</strong></td>
                    <td style="border: 1px solid;">{% trans "District:" %} </td>
                </tr>
                <tr>
                    <td colspan="3" rowspan="1" style="border: 0">{% trans "Place of delivery-" %}
                        <strong>
                            {% if case.place_birth == "at_home" %}{% trans "Home" %}{% endif %}
                            {% if case.place_birth == "in_hospital" %}{% trans "Hospital" %}{% endif %}
                            {% if case.place_birth != "at_home" and case.place_birth != "in_hospital" %}{% trans "Other" %}{% endif %}
                        </strong>
                    </td>
                    <td colspan="1" rowspan="1" style="border: 0">{% trans "Format Serial Number:" %}</td>
                    <td colspan="1" rowspan="1" style="border: 0"></td>
                </tr>
                <tr>
                    <td colspan="5" rowspan="1" style="border: 0">{% trans "Outcome of delivery" %} -
                        <strong>
                            {% if case.pregnancy_outcome == "live_birth" %}{% trans "Live" %}{% else %}{% trans "Dead" %}{% endif %}
                        </strong> &nbsp;
                        <strong>{{ case.baby_sex|title }} </strong>
                    </td>
                </tr>
            </tbody>
    </table>
    <br>
    <table style="width: 100%" cellpadding="0" cellspacing="0">
        <tbody>
            <tr>
                <td style="border: 1px solid;" colspan="2" rowspan="2">{% trans "Ask/check date of ASHA's visit" %}</td>
                <td style="border: 1px solid;" colspan="7">&nbsp;</td>
                <td style="border: 1px solid;" colspan="2" rowspan="2">{% trans "Works performed by ASHA" %}</td>
                <td style="border: 1px solid;" colspan="2" rowspan="2">{% trans "Inspection by supervisor" %}</td>
            </tr>
            <tr>
                <td style="border: 1px solid;" colspan="1">{% trans "1st" %}</td>
                <td style="border: 1px solid;" colspan="1">{% trans "3rd" %}</td>
                <td style="border: 1px solid;" colspan="1">{% trans "7th" %}</td>
                <td style="border: 1px solid;" colspan="1">{% trans "14th" %}</td>
                <td style="border: 1px solid;" colspan="1">{% trans "21th" %}</td>
                <td style="border: 1px solid;" colspan="1">{% trans "28th" %}</td>
                <td style="border: 1px solid;" colspan="1">{% trans "42nd" %}</td>
            </tr>
            {% for question in questions %}
                <tr>
                    <td style="border: 1px solid;" colspan="2" rowspan="1">{{question.label}}</td>
                    {% for answer in question.answers %}
                        <td style="border: 1px solid;" colspan="1">{{ answer }}</td>
                    {% endfor %}
                    <td style="border: 1px solid;" colspan="2" rowspan="1">&nbsp;</td>
                    <td style="border: 1px solid;" colspan="2" rowspan="1">&nbsp;</td>
                </tr>
            {% endfor %}
        </tbody>
    </table>
    <br>
    <table style="width: 100%" cellpadding="0" cellspacing="0">
        <tbody>
            <tr>
                <td style="border: 1px solid;" colspan="11" rowspan="1">{% trans "NOTE:" %}</td>
            </tr>
            <tr>
                <td style="border: 1px solid;" colspan="3" rowspan="1">{% trans "Name of ASHA:" %} <strong>{{ user.full_name }}</strong></td>
                <td style="border: 1px solid;" colspan="3" rowspan="1">{% trans "Name of Village:" %} <strong>{{ user.user_data.village }}</strong></td>
                <td style="border: 1px solid;" colspan="5" rowspan="1">{% trans "Name of CHC/PHC:" %} <strong></strong></td>
            </tr>
            <tr>
                <td style="border: 1px solid;" colspan="3" rowspan="1">{% trans "Name of supervisor/facilitator:" %} <strong>{{ owner_name }}</strong></td>
                <td style="border: 1px solid;" colspan="2" rowspan="1">{% trans "Sign of Supervisor:" %} </td>
                <td style="border: 1px solid;" colspan="2" rowspan="1">{% trans "Date:" %} </td>
                <td style="border: 1px solid;" colspan="2">{% trans "Signature of HEO:" %} </td>
                <td style="border: 1px solid;" colspan="2" rowspan="1">{% trans "Date:" %}</td>
            </tr>
            <tr>
                <td style="border: 1px solid;" colspan="11">{% trans "NOTE:" %}</td>
            </tr>
        </tbody>
    </table>
</div>
<commit_msg>#24: Added missing ASHA signature<commit_after>{% load i18n %}
<style>
    table {
        border-collapse: collapse;
        table-layout: fixed;
        font-family: "Helvetica Neue", Helvetica, Arial, sans-serif;
        font-size: 13px;
        line-height: 18px
    }
</style>

<div class="hq-generic-report">
    <table style="width: 100%; border: 1px solid;"  cellpadding="0" cellspacing="0">
            <tbody>
                <tr>
                    <td style="border: 1px solid;">{% trans "Mother's name:" %} <strong>{{ case.name }}</strong></td>
                    <td style="border: 1px solid;">{% trans "Husband's name:" %} <strong>{{ case.husband_name }}</strong></td>
                    <td style="border: 1px solid;">{% trans "Villages name:" %} <strong>{{ case.hamlet_name }}</strong></td>
                    <td style="border: 1px solid;">{% trans "Name of sub-centre:"%} <strong>{{ sub_center }}</strong></td>
                    <td style="border: 1px solid;">{% trans "District:" %} </td>
                </tr>
                <tr>
                    <td colspan="3" rowspan="1" style="border: 0">{% trans "Place of delivery-" %}
                        <strong>
                            {% if case.place_birth == "at_home" %}{% trans "Home" %}{% endif %}
                            {% if case.place_birth == "in_hospital" %}{% trans "Hospital" %}{% endif %}
                            {% if case.place_birth != "at_home" and case.place_birth != "in_hospital" %}{% trans "Other" %}{% endif %}
                        </strong>
                    </td>
                    <td colspan="1" rowspan="1" style="border: 0">{% trans "Format Serial Number:" %}</td>
                    <td colspan="1" rowspan="1" style="border: 0"></td>
                </tr>
                <tr>
                    <td colspan="5" rowspan="1" style="border: 0">{% trans "Outcome of delivery" %} -
                        <strong>
                            {% if case.pregnancy_outcome == "live_birth" %}{% trans "Live" %}{% else %}{% trans "Dead" %}{% endif %}
                        </strong> &nbsp;
                        <strong>{{ case.baby_sex|title }} </strong>
                    </td>
                </tr>
            </tbody>
    </table>
    <br>
    <table style="width: 100%" cellpadding="0" cellspacing="0">
        <tbody>
            <tr>
                <td style="border: 1px solid;" colspan="2" rowspan="2">{% trans "Ask/check date of ASHA's visit" %}</td>
                <td style="border: 1px solid; width: 40%" colspan="7">&nbsp;</td>
                <td style="border: 1px solid;" colspan="2" rowspan="2">{% trans "Works performed by ASHA" %}</td>
                <td style="border: 1px solid;" colspan="2" rowspan="2">{% trans "Inspection by supervisor" %}</td>
            </tr>
            <tr>
                <td style="border: 1px solid;" colspan="1">{% trans "1st" %}</td>
                <td style="border: 1px solid;" colspan="1">{% trans "3rd" %}</td>
                <td style="border: 1px solid;" colspan="1">{% trans "7th" %}</td>
                <td style="border: 1px solid;" colspan="1">{% trans "14th" %}</td>
                <td style="border: 1px solid;" colspan="1">{% trans "21th" %}</td>
                <td style="border: 1px solid;" colspan="1">{% trans "28th" %}</td>
                <td style="border: 1px solid;" colspan="1">{% trans "42nd" %}</td>
            </tr>
            {% for question in questions %}
                <tr>
                    <td style="border: 1px solid;" colspan="2" rowspan="1">{{question.label}}</td>
                    {% for answer in question.answers %}
                        <td style="border: 1px solid;" colspan="1">{{ answer }}</td>
                    {% endfor %}
                    <td style="border: 1px solid;" colspan="2" rowspan="1">&nbsp;</td>
                    <td style="border: 1px solid;" colspan="2" rowspan="1">&nbsp;</td>
                </tr>
            {% endfor %}
        </tbody>
    </table>
    <br>
    <table style="width: 100%" cellpadding="0" cellspacing="0">
        <tbody>
            <tr>
                <td style="border: 1px solid;" colspan="11" rowspan="1">{% trans "NOTE:" %}</td>
            </tr>
            <tr>
                <td style="border: 1px solid;" colspan="3" rowspan="1">{% trans "Name of ASHA:" %} <strong>{{ user.full_name }}</strong></td>
                <td style="border: 1px solid;" colspan="3" rowspan="1">{% trans "Name of Village:" %} <strong>{{ user.user_data.village }}</strong></td>
                <td style="border: 1px solid;" colspan="5" rowspan="1">{% trans "Name of CHC/PHC:" %} <strong></strong></td>
            </tr>
            <tr>
                <td style="border: 1px solid;" colspan="3" rowspan="1">{% trans "Name of supervisor/facilitator:" %} <strong>{{ owner_name }}</strong></td>
                <td style="border: 1px solid;" colspan="2" rowspan="1">{% trans "Sign of Supervisor:" %} </td>
                <td style="border: 1px solid;" colspan="2" rowspan="1">{% trans "Date:" %} </td>
                <td style="border: 1px solid;" colspan="2">{% trans "Signature of HEO:" %} </td>
                <td style="border: 1px solid;" colspan="2" rowspan="1">{% trans "Date:" %}</td>
            </tr>
            <tr>
                <td style="border: 1px solid;" colspan="11">{% trans "NOTE:" %}</td>
            </tr>
        </tbody>
    </table>
    <br>
    <table style="width: 100%">
        <tbody>
            <tr>
                <td style="width: 70%; ">&nbsp;</td>
                <td style="vertical-align: top; width: 30%; height: 100px; border: 1px solid;" >{% trans "Signature of ASHA" %} <strong></strong></td>

            </tr>
        </tbody>
    </table>



</div>

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