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@@ -60,12 +60,31 @@
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<div class="d-flex align-items-center">
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<div class="d-flex align-items-center">
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<span class="mr-1 text-secondary">Enrollment:</span>
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<span class="mr-1 text-secondary">Enrollment:</span>
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<span>{{ ucwords($patient->is_enrolled_in_rm ? $patient->is_enrolled_in_rm : '-') }}</span>
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<span>{{ ucwords($patient->is_enrolled_in_rm ? $patient->is_enrolled_in_rm : '-') }}</span>
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+ @if($patient->is_enrolled_in_rm === 'NO' && $patient->why_not_enrolled_in_rm_category)
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+ <span class="text-sm ml-2">({{$patient->why_not_enrolled_in_rm_category}})</span>
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+ @endif
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@if($patient->is_enrolled_in_rm === 'YES')
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@if($patient->is_enrolled_in_rm === 'YES')
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<div moe wide class="ml-2">
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<div moe wide class="ml-2">
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<a start show><i class="fa fa-edit on-hover-opaque"></i></a>
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<a start show><i class="fa fa-edit on-hover-opaque"></i></a>
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<form url="/api/client/setIsEnrolledInRmToFalse" class="mcp-theme-1">
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<form url="/api/client/setIsEnrolledInRmToFalse" class="mcp-theme-1">
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<input type="hidden" name="uid" value="{{$patient->uid}}">
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<input type="hidden" name="uid" value="{{$patient->uid}}">
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<h2 class="alert alert-warning"><i class="fa fa-warning"></i> RPM Enrollment Cancellation</h2>
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<h2 class="alert alert-warning"><i class="fa fa-warning"></i> RPM Enrollment Cancellation</h2>
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+ <div class="mb-2">
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+ <label class="text-secondary text-sm mb-1">Reason</label>
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+ <select name="whyNotEnrolledInRmCategory" class="form-control" required>
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+ <option value="">-- select --</option>
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+ <option value="Withdrawn">Withdrawn</option>
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+ <option value="Inactive">Inactive</option>
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+ <option value="Entry Error">Entry Error</option>
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+ <option value="Test Chart">Test Chart</option>
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+ <option value="Deceased">Deceased</option>
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+ <option value="No Longer Eligible">No Longer Eligible</option>
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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 mb-1">Memo</label>
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+ <textarea type="text" name="whyNotEnrolledInRmMemo" class="form-control"></textarea>
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+ </div>
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<div>
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<div>
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<button submit class="btn btn-sm btn-primary mr-1">Submit</button>
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<button submit class="btn btn-sm btn-primary mr-1">Submit</button>
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<button cancel class="btn btn-sm btn-default border">Cancel</button>
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<button cancel class="btn btn-sm btn-default border">Cancel</button>
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