text: import React, { lazy, useState } from 'react'
  import Navbar from '../../components/Navbar';
  import styles from './CovidUpdate.module.css';
  import Footer from '../../Footer';
  import CardItem from '../CardItem';
  import {
    CButton,
    CCard,
    CCardBody,
    CCardFooter,
    CCardHeader,
    CCol,
    CImg,
    CForm,
    CFormGroup,
    CFormText,
    CModal,
    CModalBody,
    CModalFooter,
    CModalHeader,
    CModalTitle,
  
    CTextarea,
    CInput,
    CInputFile,
    CInputCheckbox,
    CInputRadio,
    CLabel,
    CSelect,
    CRow,
    CSwitch
  } from '@coreui/react'
  import CIcon from '@coreui/icons-react'
  
  const FeedbackEvaluationForm = () => {
      const [large, setLarge] = useState(true)
  
    return (
      <div>
  
  
        <div class="nav" >
          <Navbar />
  
          <div class="cov" className={styles.immu}>
  
            <CRow>
              <CCol  >
                <CCard>
                  <CCardBody>
                  <CModal show={large} 
                onClose={() => setLarge(!large)}
                size="lg"  >
                      <CModalHeader closeButton>
                        <CModalTitle>FEEDBACK EVALUATION FORM</CModalTitle>
                      </CModalHeader>
                      <CModalBody>
                        <CRow>
                          <CImg
                            src="avatars/doh.png"
                            fluid
                            className={styles.doh}
                          />
  
  
                          <CCardHeader className={styles.doh2}>
                            TB IMMUNIZATION
                <small> CARD</small>
                          </CCardHeader>
                          <CImg
                            src="avatars/doh.png"
                            fluid
                            className={styles.doh1}
                          />
                        </CRow>
                        <CCardBody>
                          <CForm action="" method="post" encType="multipart/form-data" className="form-horizontal">
                            <CFormGroup row>
                              <CCol md="3">
                                <CLabel>Static</CLabel>
                              </CCol>
                              <CCol xs="12" md="9">
                                <p className="form-control-static">Username</p>
                              </CCol>
                            </CFormGroup>
                            <CFormGroup row>
                              <CCol md="3">
                                <CLabel htmlFor="text-input">CHILD'S NAME</CLabel>
                              </CCol>
                              <CCol xs="12" md="9">
                                <CInput id="text-input" name="text-input" placeholder="Name of child" />
                                <CFormText>This is a help text</CFormText>
                              </CCol>
                            </CFormGroup>
                            <CFormGroup row>
                              <CCol md="3">
                                <CLabel htmlFor="text-input">HEALTH CENTER</CLabel>
                              </CCol>
                              <CCol xs="12" md="9">
                                <CInput id="text-input" name="text-input" placeholder="Name of child" />
                                <CFormText>This is a help text</CFormText>
                              </CCol>
                            </CFormGroup>
                            <CFormGroup row>
                              <CCol md="3">
                                <CLabel htmlFor="text-input">BARANGAY</CLabel>
                              </CCol>
                              <CCol xs="12" md="9">
                                <CInput id="text-input" name="text-input" placeholder="Name of child" />
                                <CFormText>This is a help text</CFormText>
                              </CCol>
                            </CFormGroup>
                            <CFormGroup row>
                              <CCol md="3">
                                <CLabel htmlFor="text-input">FAMILY NO.</CLabel>
                              </CCol>
                              <CCol xs="12" md="9">
                                <CInput id="text-input" name="text-input" placeholder="Name of child" />
                                <CFormText>This is a help text</CFormText>
                              </CCol>
                            </CFormGroup>
                            <CFormGroup row>
                              <CCol md="3">
                                <CLabel htmlFor="date-input">DATE OF BIRTH</CLabel>
                              </CCol>
                              <CCol xs="12" md="9">
                                <CInput type="date" id="date-input" name="date-input" placeholder="date" />
                              </CCol>
                            </CFormGroup>
                            <CFormGroup row>
                              <CCol md="3">
                                <CLabel htmlFor="text-input">PLACE OF BIRTH</CLabel>
                              </CCol>
                              <CCol xs="12" md="9">
                                <CInput id="text-input" name="text-input" placeholder="Name of child" />
                                <CFormText>This is a help text</CFormText>
                              </CCol>
                            </CFormGroup>
                            <CFormGroup row>
                              <CCol md="3">
                                <CLabel htmlFor="text-input">ADDRESS</CLabel>
                              </CCol>
                              <CCol xs="12" md="9">
                                <CInput id="text-input" name="text-input" placeholder="Name of child" />
                                <CFormText>This is a help text</CFormText>
                              </CCol>
                            </CFormGroup>
                            <CFormGroup row>
                              <CCol md="3">
                                <CLabel htmlFor="text-input">MOTHER'S NAME</CLabel>
                              </CCol>
                              <CCol xs="12" md="9">
                                <CInput id="text-input" name="text-input" placeholder="Name of child" />
                                <CFormText>This is a help text</CFormText>
                              </CCol>
                            </CFormGroup>
                            <CFormGroup row>
                              <CCol md="3">
                                <CLabel htmlFor="text-input">FATHER'S NAME</CLabel>
                              </CCol>
                              <CCol xs="12" md="9">
                                <CInput id="text-input" name="text-input" placeholder="Name of child" />
                                <CFormText>This is a help text</CFormText>
                              </CCol>
                            </CFormGroup>
                            <CFormGroup row>
                              <CCol md="3">
                                <CLabel htmlFor="text-input">BIRTH HEIGHT</CLabel>
                              </CCol>
                              <CCol xs="12" md="9">
                                <CInput id="text-input" name="text-input" placeholder="Name of child" />
                                <CFormText>This is a help text</CFormText>
                              </CCol>
                            </CFormGroup>
                            <CFormGroup row>
                              <CCol md="3">
                                <CLabel htmlFor="text-input">BIRTH WEIGHT</CLabel>
                              </CCol>
                              <CCol xs="12" md="9">
                                <CInput id="text-input" name="text-input" placeholder="Name of child" />
                                <CFormText>This is a help text</CFormText>
                              </CCol>
                            </CFormGroup>
                            <CFormGroup row>
                              <CCol md="3">
                                <CLabel>Sex</CLabel>
                              </CCol>
                              <CCol md="9">
                                <CFormGroup variant="checkbox">
                                  <CInputRadio className="form-check-input" id="radio1" name="radios" value="option1" />
                                  <CLabel variant="checkbox" htmlFor="radio1">Male</CLabel>
                                </CFormGroup>
                                <CFormGroup variant="checkbox">
                                  <CInputRadio className="form-check-input" id="radio2" name="radios" value="option2" />
                                  <CLabel variant="checkbox" htmlFor="radio2">Female</CLabel>
                                </CFormGroup>
  
                              </CCol>
                            </CFormGroup>
  
                            <CFormGroup row>
                              <CCol md="3">
                                <CLabel htmlFor="email-input">Email Input</CLabel>
                              </CCol>
                              <CCol xs="12" md="9">
                                <CInput type="email" id="email-input" name="email-input" placeholder="Enter Email" autoComplete="email" />
                                <CFormText className="help-block">Please enter your email</CFormText>
                              </CCol>
                            </CFormGroup>
                        
                          </CForm>
                        </CCardBody>
                        <CCardFooter>
                          <CButton type="submit" size="sm" color="primary"><CIcon name="cil-scrubber" /> Submit</CButton>
                          <CButton type="reset" size="sm" color="danger"><CIcon name="cil-ban" /> Reset</CButton>
                        </CCardFooter>
                      </CModalBody>
                      <CModalFooter>
                        {/* <CButton to="/ChildImmunization" color="primary" 
                    onClick={() => setModal(false)}
                    >I Understand</CButton>{' '} */}
                        <CButton to="/Immunization">Cancel</CButton>
                      </CModalFooter>
                    </CModal>
  
                  </CCardBody>
                  <CRow>
                    <CardItem
                      src={'avatars/doh.png'}
                      className={styles.img}
                      label='Information & Consent Form'
                      alt="ConsentForm"
                      path='/ChildImmunization1'
                    />
  
                    <CardItem
                      src={'avatars/doh.png'}
                      className={styles.img}
                      label='Screening Form'
                      alt="ScreeningForm"
                      path='/TBImmunization1'
                    />
                    <CardItem
                      src={'avatars/doh.png'}
                      className={styles.img}
                      label='Agreement Form'
                      alt="AgreementForm"
                      path='/GetStarted'
                    />
                    <CardItem
                      src={'avatars/doh.png'}
                      className={styles.img}
                      label='Feedback Evaluation Form'
                      alt="FeedbackEvaluationForm"
                      path='/GetStarted'
                    />
                  </CRow>
                  <CRow className={styles.img1}>
                    <CardItem
                      src={'avatars/doh.png'}
                      className={styles.img}
                      label='NTP Identification Card'
                      alt="NTPIdentificationCard"
                      path='/GetStarted'
                    />
                    <CardItem
                      src={'avatars/doh.png'}
                      className={styles.img}
                      label='Treatment / IPT Card'
                      alt="Treatment/IPTCard"
                      path='/GetStarted'
                    />
                  </CRow>
                 
                </CCard>
  
              </CCol>
            </CRow>
          </div>
        </div>
        <Footer />
      </div>
  
    );
  }
  
  
  export default FeedbackEvaluationForm;