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@@ -18,7 +18,7 @@ $medicaidStates = Config::get('constants.medicaid_states');
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</strong>
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</div>
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<div class="card-body">
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- <form show url="/api/client/create" class="px-2 pb-1 primary-form" redir="patients/view/[data]">
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+ <form id="createNewPatientForm" show url="/api/client/create" class="px-2 pb-1 primary-form" redir="patients/view/[data]">
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@if (session('message'))
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<div class="alert alert-danger">{{ session('message') }}</div>
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@endif
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@@ -159,7 +159,7 @@ $medicaidStates = Config::get('constants.medicaid_states');
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<div class='form-group mb-3'>
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<label class='control-label'>How did you hear about us?</label>
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- <input class='form-control' type='text' required="" name='initiative' />
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+ <input class='form-control' type='text' name='initiative' />
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</div>
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<div class='form-group mb-3 checkbox'>
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@@ -286,7 +286,7 @@ $medicaidStates = Config::get('constants.medicaid_states');
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<div class="form-group col-md-6">
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<label class="control-label">Medicaid Number</label>
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- <input type="text" name="mcdNumber" class="form-control input-sm">
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+ <input type="text" name="mcdNumber" class="form-control input-sm" oninput="this.value = this.value.toUpperCase()">
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</div>
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</div>
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</div>
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@@ -302,7 +302,7 @@ $medicaidStates = Config::get('constants.medicaid_states');
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<div class="px-2">
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<div class="form-group col-md-6">
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<label class="control-label">Medicare Number</label>
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- <input type="text" name="mcrNumber" class="form-control input-sm">
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+ <input type="text" name="mcrNumber" class="form-control input-sm" oninput="this.value = this.value.toUpperCase()">
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</div>
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</div>
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</div>
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@@ -376,7 +376,16 @@ $medicaidStates = Config::get('constants.medicaid_states');
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hiddenInput.val(_data.uid);
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});
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},
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+ initOnInputChange: function(){
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+ var form = $('#createNewPatientForm');
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+ form.find('input[type=text],textarea').change(function(){
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+ var value = this.value.replace(/\s\s+/g, ' ');
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+ value = value.trim();
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+ $(this).val(value);
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+ });
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+ },
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init: function() {
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+ this.initOnInputChange();
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this.onCommercialPayerChange();
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}
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},
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