Update templates/re.html

templates/re.html

@@ -206,105 +206,7 @@
     <li>Emergency services (call emergency).</li>
   </ul>
 
-        <h1>Patient Information Form</h1>
-        <fieldset>
-            <legend>Personal Info</legend>
-            <div class="form-group">
-                <label>First Name:</label>
-                <input type="text" name="first_name" required>
-                <label>____Surname:</label>
-                <input type="text" name="surname" required>
-            </div>
-            <div class="form-group">
-                <label>Father's Name:</label>
-                <input type="text" name="father_name" required>
-                <label>____Mother's Name:</label>
-                <input type="text" name="mother_name" required>
-            </div>
-            <div class="form-group">
-                <label>Age:</label>
-                <input type="number" name="age" min="0" required>
-                <label>____Weight (kg):</label>
-                <input type="number" name="weight" min="0" required>
-            </div>
-            <div class="form-group">
-                <label>Height (cm):</label>
-                <input type="number" name="height" min="0" required>
-                <label>_____Gender:</label>
-                <select name="gender" required>
-                    <option value="male">Male</option>
-                    <option value="female">Female</option>
-                    <option value="other">Other</option>
-                </select>
-            </div>
-            <div class="form-group">
-                <label>Passport Photo:</label>
-                <input type="file" name="photo" accept="image/*" required>
-            </div>
-        </fieldset>
-
-        <fieldset>
-            <legend>Contact Details</legend>
-            <div class="form-group">
-                <label>Phone:</label>
-                <input type="tel" name="phone" required>
-                <label>_________Email:</label>
-                <input type="email" name="email" required>
-            </div>
-            <div class="form-group">
-                <label>Address:_______________________________________</label>
-                <textarea name="address" required></textarea>
-            </div>
-            <div class="form-group">
-                <label>Marital Status:</label>
-                <select name="marital_status" required>
-                    <option value="single">Single</option>
-                    <option value="married">Married</option>
-                    <option value="divorced">Divorced</option>
-                    <option value="widowed">Widowed</option>
-                </select>
-            </div>
-        </fieldset>
-
-        <fieldset>
-            <legend>Medical Info</legend>
-            <div class="form-group">
-                <label>Cause of Injury:</label>
-                <textarea name="injury_cause" required></textarea>
-            </div>
-            <div class="form-group">
-                <label>Do you have Insurance?</label>
-                <select name="insurance" required>
-                    <option value="yes">Yes</option>
-                    <option value="no">No</option>
-                </select>
-            </div>
-            <div class="form-group">
-                <label>Allergies?</label>
-                <select name="allergies" required>
-                    <option value="yes">Yes</option>
-                    <option value="no">No</option>
-                </select>
-            </div>
-        </fieldset>
-
-        <fieldset>
-            <legend>X-ray Upload</legend>
-            <div class="form-group">
-                <label>Side View:</label>
-                <input type="file" name="xray_side" accept="image/*" required>
-            </div>
-            <div class="form-group">
-                <label>Top View:</label>
-                <input type="file" name="xray_top" accept="image/*" required>
-            </div>
-        </fieldset>
-
-        <div class="button-group">
-    <button type="button" class="cancel-btn" onclick="document.querySelector('form').reset();" style="font-size: 26px; padding: 10px 20px;">Cancel</button>
-    <button type="submit" class="submit-btn" style="font-size: 26px; padding: 10px 20px;">Submit</button>
-    <button type="button" class="download-btn" onclick="window.location.href='report.pdf';" style="font-size: 26px; padding: 10px 20px;">Download Report (PDF)</button>
-</div>
+        
 
     </form>