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@@ -162,6 +162,13 @@ $medicaidStates = Config::get('constants.medicaid_states');
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<input class='form-control' type='text' required="" name='initiative' />
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<input class='form-control' type='text' required="" name='initiative' />
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</div>
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</div>
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+ <div class='form-group mb-3 checkbox'>
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+ <label>
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+ <input type='checkbox' name='isTestRecord' />
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+ This is a test record
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+ </label>
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+ </div>
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+
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</div>
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</div>
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<div class="col-md-7">
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<div class="col-md-7">
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<div class="border-lighter">
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<div class="border-lighter">
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