<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 800 700"><!-- Background --><rect width="800" height="700" fill="#f8f9fa" /><!-- Header --><rect x="0" y="0" width="800" height="80" fill="#0066cc" /><text x="30" y="50" font-family="Arial" font-size="24" fill="white" font-weight="bold">MediCare Hospital - Lab Test Scheduler</text><!-- Form Container --><rect x="50" y="100" width="700" height="580" rx="10" fill="white" stroke="#ddd" stroke-width="1" /><!-- Section 1: Patient Details --><rect x="70" y="120" width="660" height="80" rx="5" fill="#e6f7ff" stroke="#ddd" stroke-width="1" /><text x="80" y="145" font-family="Arial" font-size="18" fill="#333" font-weight="bold">1. Patient Details</text><text x="90" y="175" font-family="Arial" font-size="14" fill="#555">Registration ID*</text><rect x="200" y="160" width="160" height="30" rx="4" fill="white" stroke="#ccc" /><text x="380" y="175" font-family="Arial" font-size="14" fill="#555">Patient Name*</text><rect x="480" y="160" width="230" height="30" rx="4" fill="white" stroke="#ccc" /><!-- Section 2: Test Category --><rect x="70" y="210" width="660" height="80" rx="5" fill="#e6ffe6" stroke="#ddd" stroke-width="1" /><text x="80" y="235" font-family="Arial" font-size="18" fill="#333" font-weight="bold">2. Test Category</text><rect x="90" y="250" width="20" height="20" rx="10" fill="white" stroke="#555" /><text x="120" y="265" font-family="Arial" font-size="14" fill="#555">Pathology</text><rect x="220" y="250" width="20" height="20" rx="10" fill="white" stroke="#555" /><text x="250" y="265" font-family="Arial" font-size="14" fill="#555">Radiology</text><rect x="350" y="250" width="20" height="20" rx="10" fill="white" stroke="#555" /><text x="380" y="265" font-family="Arial" font-size="14" fill="#555">Cardiology</text><rect x="480" y="250" width="20" height="20" rx="10" fill="white" stroke="#555" /><text x="510" y="265" font-family="Arial" font-size="14" fill="#555">Neurology</text><rect x="610" y="250" width="20" height="20" rx="10" fill="white" stroke="#555" /><text x="640" y="265" font-family="Arial" font-size="14" fill="#555">Other</text><!-- Section 3: Test Selection --><rect x="70" y="300" width="660" height="80" rx="5" fill="#fff5e6" stroke="#ddd" stroke-width="1" /><text x="80" y="325" font-family="Arial" font-size="18" fill="#333" font-weight="bold">3. Test Selection</text><rect x="90" y="340" width="630" height="30" rx="4" fill="white" stroke="#ccc" /><polygon points="700,355 680,345 680,365" fill="#555" /><!-- Section 4: Emergency Status --><rect x="70" y="390" width="660" height="60" rx="5" fill="#ffe6e6" stroke="#ddd" stroke-width="1" /><text x="80" y="415" font-family="Arial" font-size="18" fill="#333" font-weight="bold">4. Emergency Status</text><rect x="90" y="425" width="20" height="20" rx="4" fill="white" stroke="#555" /><text x="120" y="440" font-family="Arial" font-size="14" fill="#555">This is an emergency case (requires doctor's note)</text><!-- Section 5: Preferred Date --><rect x="70" y="460" width="660" height="60" rx="5" fill="#e6e6ff" stroke="#ddd" stroke-width="1" /><text x="80" y="485" font-family="Arial" font-size="18" fill="#333" font-weight="bold">5. Preferred Date</text><rect x="90" y="490" width="180" height="30" rx="4" fill="white" stroke="#ccc" /><text x="310" y="510" font-family="Arial" font-size="14" fill="#555">Next available: March 22, 2025</text><!-- Section 6: Price Calculation --><rect x="70" y="530" width="660" height="90" rx="5" fill="#e6fff2" stroke="#ddd" stroke-width="1" /><text x="80" y="555" font-family="Arial" font-size="18" fill="#333" font-weight="bold">6. Price Calculation</text><text x="90" y="585" font-family="Arial" font-size="14" fill="#555">Base Test Price:</text><text x="210" y="585" font-family="Arial" font-size="14" fill="#555">₹2,500.00</text><text x="350" y="585" font-family="Arial" font-size="14" fill="#555">Emergency Fee:</text><text x="470" y="585" font-family="Arial" font-size="14" fill="#555">₹0.00</text><line x1="90" y1="595" x2="600" y2="595" stroke="#ccc" /><text x="90" y="615" font-family="Arial" font-size="16" fill="#333" font-weight="bold">Total Price:</text><text x="210" y="615" font-family="Arial" font-size="16" fill="#0066cc" font-weight="bold">₹2,500.00</text><!-- Section 7: Confirmation --><rect x="70" y="630" width="660" height="40" rx="5" fill="#f0e6ff" stroke="#ddd" stroke-width="1" /><text x="80" y="655" font-family="Arial" font-size="18" fill="#333" font-weight="bold">7. Confirmation</text><rect x="400" y="635" width="150" height="30" rx="15" fill="#0066cc" /><text x="475" y="655" font-family="Arial" font-size="14" fill="white" text-anchor="middle">Schedule Test</text><rect x="570" y="635" width="150" height="30" rx="15" fill="#f0f0f0" stroke="#ccc" /><text x="645" y="655" font-family="Arial" font-size="14" fill="#555" text-anchor="middle">Cancel</text></svg>
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