{% extends 'modal_base.html' %}
{% load forms %}
{% block icon %}<i class="fa fa-stethoscope"></i>{% endblock %}
{% block modal_body %}
  <form class="form-horizontal">
    {% input "autofocus" label="Condition" model="editing.condition" lookuplist="condition_list" %}
    {% checkbox label="Provisional?" model="editing.provisional" %}
    {% input label="Details" model="editing.details" %}
    {% datepicker label="Date of diagnosis" model="editing.date_of_diagnosis" %}
  </form>
{% endblock %}
