{{ form_start(form, {
    attr: { id: 'ambito_salud_form' },
    action: action
}) }}

<div class="row g-3 mb-4">
    <div class="col-md-6">
        {{ form_row(form.fecha, { attr: { class: 'form-control' } }) }}
    </div>
    <div class="col-md-6">
        {{ form_row(form.tipoIntervencion, { attr: { class: 'form-select' } }) }}
    </div>
</div>

<hr>

{# ITS #}
<h6 class="fw-bold text-primary mb-3"><i class="fa-solid fa-virus me-2"></i>ITS (Información de Salud)</h6>
<div class="row g-3 mb-4">
    <div class="col-md-3 border-end">
        {{ form_row(form.vih) }}
        {{ form_row(form.vihEspecificar, { attr: { class: 'form-control', placeholder: 'Especificar...', rows: 2 } }) }}
        {{ form_row(form.vihFecha, { attr: { class: 'form-control form-control-sm' } }) }}
    </div>
    <div class="col-md-3 border-end">
        {{ form_row(form.vhc) }}
        {{ form_row(form.vhcEspecificar, { attr: { class: 'form-control', placeholder: 'Especificar...', rows: 2 } }) }}
        {{ form_row(form.vhcFecha, { attr: { class: 'form-control form-control-sm' } }) }}
    </div>
    <div class="col-md-3 border-end">
        {{ form_row(form.vhb) }}
        {{ form_row(form.vhbEspecificar, { attr: { class: 'form-control', placeholder: 'Especificar...', rows: 2 } }) }}
        {{ form_row(form.vhbFecha, { attr: { class: 'form-control form-control-sm' } }) }}
    </div>
    <div class="col-md-3">
        {{ form_row(form.sifilis) }}
        {{ form_row(form.sifilisEspecificar, { attr: { class: 'form-control', placeholder: 'Especificar...', rows: 2 } }) }}
        {{ form_row(form.sifilisFecha, { attr: { class: 'form-control form-control-sm' } }) }}
    </div>
</div>

<hr>

{# ESTADO DE SALUD #}
<h6 class="fw-bold text-primary mb-3"><i class="fa-solid fa-heart-pulse me-2"></i>Estado de Salud y Tratamiento</h6>
<div class="row g-3 mb-4">
    <div class="col-md-6 border-end">
        {{ form_row(form.comorbilidades) }}
        {{ form_row(form.comorbilidadesEspecificar, { attr: { rows: 2 } }) }}
        {{ form_row(form.alergias) }}
        {{ form_row(form.alergiasEspecificar, { attr: { rows: 2 } }) }}
        <div class="row mt-2">
            <div class="col-md-6">{{ form_row(form.enfermedadMentalDiagnostico) }}</div>
            <div class="col-md-6">{{ form_row(form.enfermedadMentalSospecha) }}</div>
        </div>
    </div>
    <div class="col-md-6">
         {{ form_row(form.adherencia) }}
         {{ form_row(form.adherenciaOtrosEspecificar, { attr: { rows: 2, placeholder: 'Especificar otros...' } }) }}
    </div>
</div>

<hr>

{# ADICCIONES #}
<h6 class="fw-bold text-primary mb-3"><i class="fa-solid fa-capsules me-2"></i>Adicciones</h6>
<div class="mb-3">
    {{ form_row(form.consumoNo) }}
</div>
<div class="row g-3 mb-4 text-muted">
    <div class="col-md-3 border-end">
        <div class="form-check small">{{ form_widget(form.consumoHeroinaInyectada) }} {{ form_label(form.consumoHeroinaInyectada) }}</div>
        <div class="form-check small">{{ form_widget(form.consumoHeroinaInhalada) }} {{ form_label(form.consumoHeroinaInhalada) }}</div>
        <div class="form-check small">{{ form_widget(form.consumoHeroinaEsnifada) }} {{ form_label(form.consumoHeroinaEsnifada) }}</div>
    </div>
    <div class="col-md-3 border-end">
        <div class="form-check small">{{ form_widget(form.consumoCocainaInyectada) }} {{ form_label(form.consumoCocainaInyectada) }}</div>
        <div class="form-check small">{{ form_widget(form.consumoCocainaFumada) }} {{ form_label(form.consumoCocainaFumada) }}</div>
        <div class="form-check small">{{ form_widget(form.consumoCocainaEsnifada) }} {{ form_label(form.consumoCocainaEsnifada) }}</div>
    </div>
    <div class="col-md-3 border-end">
        <div class="form-check small">{{ form_widget(form.consumoPastillas) }} {{ form_label(form.consumoPastillas) }}</div>
        <div class="form-check small">{{ form_widget(form.consumoAlcohol) }} {{ form_label(form.consumoAlcohol) }}</div>
        <div class="form-check small">{{ form_widget(form.consumoTabaco) }} {{ form_label(form.consumoTabaco) }}</div>
    </div>
    <div class="col-md-3">
        <div class="form-check small">{{ form_widget(form.consumoMetadona) }} {{ form_label(form.consumoMetadona) }}</div>
        <div class="form-check small">{{ form_widget(form.consumoLudopatia) }} {{ form_label(form.consumoLudopatia) }}</div>
        <div class="form-check small">{{ form_widget(form.consumoOtros) }} {{ form_label(form.consumoOtros) }}</div>
        {{ form_widget(form.consumoOtrosEspecificar, { attr: { class: 'form-control form-control-sm mt-1', placeholder: 'Especificar otros...' } }) }}
    </div>
</div>

<hr>

{# AUTOCUIDADO #}
<h6 class="fw-bold text-primary mb-3"><i class="fa-solid fa-person-dots-from-line me-2"></i>Estado de Autocuidado</h6>
<div class="row g-3 mb-4">
    <div class="col-md-4">
        {{ form_row(form.autocuidadoHigiene, { attr: { class: 'form-select' } }) }}
        {{ form_row(form.autocuidadoArreglo, { attr: { class: 'form-select' } }) }}
    </div>
    <div class="col-md-4">
        {{ form_row(form.autocuidadoRopaLimpieza, { attr: { class: 'form-select' } }) }}
        {{ form_row(form.autocuidadoRopaAdecuada, { attr: { class: 'form-select' } }) }}
    </div>
    <div class="col-md-4">
        {{ form_row(form.autocuidadoAlimentacion, { attr: { class: 'form-select' } }) }}
        {{ form_row(form.autocuidadoAyuda, { attr: { class: 'form-select' } }) }}
    </div>
</div>
<div class="row g-3 mb-4">
    <div class="col-md-12">
        {{ form_row(form.autocuidadoOtros, { attr: { class: 'form-select' } }) }}
        {{ form_row(form.autocuidadoOtrosEspecificar, { attr: { rows: 2 } }) }}
    </div>
</div>

<hr>

{# HABILIDADES #}
<h6 class="fw-bold text-primary mb-3"><i class="fa-solid fa-brain me-2"></i>Otras Habilidades</h6>
<div class="row g-3 mb-4">
    <div class="col-md-6">
        <div class="p-3 bg-light rounded border mb-3">
            {{ form_row(form.habilidadAutoObservacion) }}
            {{ form_row(form.habilidadAutoObservacionDesc, { attr: { rows: 2, placeholder: 'Describir...' } }) }}
        </div>
        <div class="p-3 bg-light rounded border mb-3">
            {{ form_row(form.habilidadDeterminacionPropia) }}
            {{ form_row(form.habilidadDeterminacionPropiaDesc, { attr: { rows: 2, placeholder: 'Describir...' } }) }}
        </div>
        <div class="p-3 bg-light rounded border">
            {{ form_row(form.habilidadDeterminacionTerceros) }}
            {{ form_row(form.habilidadDeterminacionTercerosDesc, { attr: { rows: 2, placeholder: 'Describir...' } }) }}
        </div>
    </div>
    <div class="col-md-6">
        <div class="p-3 bg-light rounded border mb-3">
            {{ form_row(form.habilidadTomaDecisiones) }}
            {{ form_row(form.habilidadTomaDecisionesDesc, { attr: { rows: 2, placeholder: 'Describir...' } }) }}
        </div>
        <div class="p-3 bg-light rounded border mb-3">
            {{ form_row(form.habilidadAnalisisRealista) }}
            {{ form_row(form.habilidadAnalisisRealistaDesc, { attr: { rows: 2, placeholder: 'Describir...' } }) }}
        </div>
        <div class="p-3 bg-light rounded border">
            {{ form_row(form.habilidadMotivacionCambio) }}
            {{ form_row(form.habilidadMotivacionCambioDesc, { attr: { rows: 2, placeholder: 'Describir...' } }) }}
        </div>
    </div>
</div>
<div class="row g-3 mb-4">
    <div class="col-md-12">
        <div class="p-3 bg-light rounded border">
            {{ form_row(form.habilidadOtros) }}
            {{ form_row(form.habilidadOtrosDesc, { attr: { rows: 2, placeholder: 'Especificar...' } }) }}
        </div>
    </div>
</div>

<div class="text-end mt-4">
    <button type="submit" class="btn btn-orange fw-bold px-4">
        <i class="fa-solid fa-floppy-disk me-2"></i> Guardar Ámbito Salud
    </button>
</div>

{{ form_end(form) }}