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@@ -4,7 +4,7 @@
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<div class="d-flex align-items-center pb-2">
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<h4 class="font-weight-bold m-0">Supply Orders</h4>
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<span class="mx-2 text-secondary">|</span>
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- <div moe>
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+ <div moe large>
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<a start show href="#">Add</a>
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<form url="/api/supplyOrder/create" redir="/patients/view/{{ $patient->uid }}/supply-orders/[data]">
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<input type="hidden" name="clientUid" value="{{ $patient->uid }}">
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@@ -19,6 +19,26 @@
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@endforeach
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</select>
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</div>
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+ <div class="mb-2">
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+ <label class="text-secondary text-sm">Address Line1</label>
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+ <input type="text" class="form-control form-control-sm" name="mailingAddressLine1" value="{{$patient->mailing_address_line1}}">
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+ </div>
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+ <div class="mb-2">
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+ <label class="text-secondary text-sm">Address Line2</label>
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+ <input type="text" class="form-control form-control-sm" name="mailingAddressLine2" value="{{$patient->mailing_address_line2}}">
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+ </div>
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+ <div class="mb-2">
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+ <label class="text-secondary text-sm">Address City</label>
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+ <input type="text" class="form-control form-control-sm" name="mailingAddressCity" value="{{$patient->mailing_address_city}}">
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+ </div>
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+ <div class="mb-2">
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+ <label class="text-secondary text-sm">Address State</label>
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+ <input type="text" class="form-control form-control-sm" name="mailingAddressState" value="{{$patient->mailing_address_state}}">
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+ </div>
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+ <div class="mb-2">
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+ <label class="text-secondary text-sm">Address Zip</label>
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+ <input type="text" class="form-control form-control-sm" name="mailingAddressZip" value="{{$patient->mailing_address_zip}}">
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+ </div>
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<div class="mb-2">
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<label class="text-secondary text-sm">Reason</label>
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<input type="text" class="form-control form-control-sm" name="reason">
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@@ -114,6 +134,41 @@
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</form>
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</div>
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</div>
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+ <div class="mb-3">
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+ <label class="text-secondary text-sm mb-1">Address</label>
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+ <div moe class="d-block">
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+ <a start show>
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+ {{$supplyOrder->mailing_address_full ? implode(" ", [$supplyOrder->mailing_address_line1, $supplyOrder->mailing_address_line2, $supplyOrder->mailing_address_city, $supplyOrder->mailing_address_state, $supplyOrder->mailing_address_zip]) : '(not set)'}}
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+ </a>
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+ <form url="/api/supplyOrder/updateMailingAddress">
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+ <input type="hidden" name="uid" value="{{ $supplyOrder->uid }}">
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+ <div class="mb-2">
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+ <label class="text-secondary text-sm">Address Line1</label>
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+ <input type="text" class="form-control form-control-sm" name="mailingAddressLine1" value="{{$supplyOrder->mailing_address_line1}}">
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+ </div>
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+ <div class="mb-2">
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+ <label class="text-secondary text-sm">Address Line2</label>
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+ <input type="text" class="form-control form-control-sm" name="mailingAddressLine2" value="{{$supplyOrder->mailing_address_line2}}">
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+ </div>
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+ <div class="mb-2">
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+ <label class="text-secondary text-sm">Address City</label>
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+ <input type="text" class="form-control form-control-sm" name="mailingAddressCity" value="{{$supplyOrder->mailing_address_city}}">
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+ </div>
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+ <div class="mb-2">
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+ <label class="text-secondary text-sm">Address State</label>
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+ <input type="text" class="form-control form-control-sm" name="mailingAddressState" value="{{$supplyOrder->mailing_address_state}}">
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+ </div>
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+ <div class="mb-2">
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+ <label class="text-secondary text-sm">Address Zip</label>
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+ <input type="text" class="form-control form-control-sm" name="mailingAddressZip" value="{{$supplyOrder->mailing_address_zip}}">
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+ </div>
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+ <div class="d-flex align-items-center">
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+ <button class="btn btn-sm btn-primary mr-2" submit>Save</button>
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+ <button class="btn btn-sm btn-default mr-2 border" cancel>Cancel</button>
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+ </div>
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+ </form>
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+ </div>
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+ </div>
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<div class="mb-3 d-none">
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<label class="text-secondary text-sm mb-1">Requested Ship Date</label>
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<div moe class="d-block">
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