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    <title>Matrícula - Programa Persona Mayor</title>
    
    <style>
        * {
            margin: 0;
            padding: 0;
            box-sizing: border-box;
        }

        body {
            font-family: 'Segoe UI', Tahoma, Geneva, Verdana, sans-serif;
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        .header h1 {
            font-size: 32px;
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        .header p {
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        .img-preview {
            max-width: 200px;
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            }

            .header h1 {
                font-size: 24px;
            }

            .form-content {
                padding: 30px 20px;
            }
        }
    </style>
</head>
<body>
    <div class="container">
        <div class="header">
            <h1><i class='bx bxs-heart'></i> Matrícula al Programa</h1>
            <p>PROGRAMA MUNICIPAL PERSONA MAYOR</p>
            <p>Complete el formulario para registrarse en nuestro programa</p>
        </div>

        <div class="form-content">
            <a href="../login.php" class="btn-back">
                <i class='bx bx-arrow-back'></i> Volver al Login
            </a>

            <form action="" method="POST" enctype="multipart/form-data" id="matriculaForm">
                
                <!-- Información Personal -->
                <div class="form-section">
                    <h2><i class='bx bxs-user'></i> Información Personal</h2>
                    
                    <div class="form-row">
                        <div class="form-group">
                            <label>Tipo de Documento <span class="required">*</span></label>
                            <select required name="tdocumento" id="tdocumento">
                                <option value="">Seleccione</option>
                                <option value="CC">Cédula de Ciudadanía</option>
                                <option value="TI">Tarjeta de Identidad</option>
                                <option value="CE">Cédula de Extranjería</option>
                                <option value="PA">Pasaporte</option>
                            </select>
                        </div>

                        <div class="form-group">
                            <label>Número de Documento <span class="required">*</span></label>
                            <input type="text" placeholder="Número de documento" name="nhi" maxlength="30" required>
                        </div>
                    </div>

                    <div class="form-row">
                        <div class="form-group">
                            <label>Nombres <span class="required">*</span></label>
                            <input type="text" placeholder="Nombres completos" name="namp" maxlength="50" required>
                        </div>

                        <div class="form-group">
                            <label>Apellidos <span class="required">*</span></label>
                            <input type="text" placeholder="Apellidos completos" name="apep" maxlength="50" required>
                        </div>
                    </div>

                    <div class="form-row">
                        <div class="form-group">
                            <label>Fecha de Nacimiento <span class="required">*</span></label>
                            <input type="date" name="cump" required>
                        </div>

                        <div class="form-group">
                            <label>Género <span class="required">*</span></label>
                            <select required name="gep" id="gep">
                                <option value="">Seleccione</option>
                                <option value="MASCULINO">Masculino</option>
                                <option value="FEMENINO">Femenino</option>
                                <option value="OTRO">Otro</option>
                            </select>
                        </div>
                    </div>

                    <div class="form-group">
                        <label>Foto de Perfil</label>
                        <input type="file" name="fotoperfil" id="fotoperfil" accept="image/*">
                        <img id="img-preview" class="img-preview" alt="Vista previa">
                    </div>
                </div>

                <hr>

                <!-- Información de Contacto -->
                <div class="form-section">
                    <h2><i class='bx bxs-phone'></i> Información de Contacto</h2>
                    
                    <div class="form-group">
                        <label>Dirección <span class="required">*</span></label>
                        <input type="text" placeholder="Dirección completa" name="dip" required>
                    </div>

                    <div class="form-row">
                        <div class="form-group">
                            <label>Teléfono <span class="required">*</span></label>
                            <input type="text" maxlength="13" placeholder="+57 300 123 4567" name="telp" required>
                        </div>

                        <div class="form-group">
                            <label>¿Tiene WhatsApp? <span class="required">*</span></label>
                            <select required name="tiene_whatsapp" id="tiene_whatsapp">
                                <option value="">Seleccione</option>
                                <option value="SI">Sí</option>
                                <option value="NO">No</option>
                            </select>
                        </div>
                    </div>

                    <div class="form-group">
                        <label>Correo Electrónico <span class="required">*</span></label>
                        <input type="email" placeholder="correo@ejemplo.com" name="correo" maxlength="70" required>
                    </div>
                </div>

                <hr>

                <!-- Información Adicional -->
                <div class="form-section">
                    <h2><i class='bx bxs-info-circle'></i> Información Adicional</h2>
                    
                    <div class="form-row">
                        <div class="form-group">
                            <label>Grupo Sanguíneo <span class="required">*</span></label>
                            <select required name="grp" id="grp">
                                <option value="">Seleccione</option>
                                <option value="A+">A+</option>
                                <option value="A-">A-</option>
                                <option value="B+">B+</option>
                                <option value="B-">B-</option>
                                <option value="AB+">AB+</option>
                                <option value="AB-">AB-</option>
                                <option value="O+">O+</option>
                                <option value="O-">O-</option>
                            </select>
                        </div>

                        <div class="form-group">
                            <label>Estado Civil <span class="required">*</span></label>
                            <select required name="ecivil" id="ecivil">
                                <option value="">Seleccione</option>
                                <option value="SOLTERO">Soltero(a)</option>
                                <option value="CASADO">Casado(a)</option>
                                <option value="UNION LIBRE">Unión Libre</option>
                                <option value="VIUDO">Viudo(a)</option>
                                <option value="DIVORCIADO">Divorciado(a)</option>
                            </select>
                        </div>
                    </div>

                    <div class="form-group">
                        <label>Observaciones</label>
                        <textarea name="observacionsalida" placeholder="Información adicional que desee compartir"></textarea>
                    </div>
                </div>

                <button type="submit" name="add_patiens_public" class="btn-submit">
                    <i class='bx bx-check-circle'></i> Enviar Matrícula
                </button>
            </form>
        </div>
    </div>

    <script src="../../backend/js/jquery.min.js"></script>
    <?php include_once '../../backend/php/add_patiens_public.php' ?>

    <script>
        // Previsualizar imagen
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            const file = e.target.files[0];
            const preview = document.getElementById('img-preview');
            
            if (file) {
                const reader = new FileReader();
                reader.onload = function(e) {
                    preview.src = e.target.result;
                    preview.style.display = 'block';
                }
                reader.readAsDataURL(file);
            } else {
                preview.style.display = 'none';
            }
        });
    </script>
</body>
</html>
