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@@ -104,26 +104,25 @@
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<div class='form-group mb-3'>
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<div class='form-group mb-3'>
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<label class='control-label d-flex align-items-center'>
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<label class='control-label d-flex align-items-center'>
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<span>Home Phone Number</span>
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<span>Home Phone Number</span>
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- <a href="#"
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- class="ml-2 px-1 on-hover-opaque hpn-to-cpn">
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+ <a v-if="form.homeNumber" @click="hpnToCpn"
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+ class="ml-2 px-1 on-hover-opaque hpn-to-cpn pointer">
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<i class="fa fa-arrow-down"></i>
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<i class="fa fa-arrow-down"></i>
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</a>
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</a>
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- <a href="#"
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- class="ml-2 px-1 on-hover-opaque swap-pns">
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+ <a v-if="form.cellNumber && form.homeNumber" @click="swapHpnCpn"
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+ class="ml-2 px-1 on-hover-opaque swap-pns pointer">
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<i class="fa fa-retweet"></i>
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<i class="fa fa-retweet"></i>
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</a>
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</a>
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</label>
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</label>
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- <input class='form-control' stag-input-phone type='tel' name='homeNumber'>
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+ <input class='form-control' stag-input-phone type='tel' name='homeNumber' v-model="form.homeNumber">
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</div>
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</div>
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<div class='form-group mb-3'>
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<div class='form-group mb-3'>
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<label class='control-label d-flex align-items-center'>
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<label class='control-label d-flex align-items-center'>
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<span>Cell Phone Number</span>
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<span>Cell Phone Number</span>
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- <a href="#"
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- class="ml-2 px-1 on-hover-opaque cpn-to-hpn">
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+ <a v-if="form.cellNumber" @click="cpnToHpn" class="ml-2 px-1 on-hover-opaque cpn-to-hpn pointer">
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<i class="fa fa-arrow-up"></i>
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<i class="fa fa-arrow-up"></i>
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</a>
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</a>
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</label>
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</label>
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- <input class='form-control' stag-input-phone type='tel' name='cellNumber'>
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+ <input class='form-control' stag-input-phone type='tel' name='cellNumber' v-model="form.cellNumber">
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</div>
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</div>
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<div class='form-group mb-3'>
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<div class='form-group mb-3'>
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<label class='control-label'>Email Address </label>
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<label class='control-label'>Email Address </label>
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@@ -228,62 +227,9 @@
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<input class="form-control input-sm" list="mcdPayer" name="mcdPayerName" id="mcdPayerName">
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<input class="form-control input-sm" list="mcdPayer" name="mcdPayerName" id="mcdPayerName">
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<datalist id="mcdPayer">
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<datalist id="mcdPayer">
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<option value="">--</option>
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<option value="">--</option>
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- <option>MEDICAID ALABAMA</option>
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- <option>MEDICAID ALASKA</option>
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- <option>MEDICAID ARIZONA</option>
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- <option>MEDICAID ARKANSAS</option>
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- <option>MEDICAID CALIFORNIA MEDI-CAL</option>
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- <option>MEDICAID COLORADO</option>
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- <option>MEDICAID CONNECTICUT</option>
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- <option>MEDICAID DELAWARE</option>
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- <option>MEDICAID DISTRICT OF COLUMBIA</option>
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- <option>MEDICAID FLORIDA</option>
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- <option>MEDICAID GEORGIA</option>
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- <option>MEDICAID HAWAII</option>
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- <option>MEDICAID IDAHO</option>
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- <option>MEDICAID ILLINOIS</option>
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- <option>MEDICAID INDIANA</option>
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- <option>MEDICAID IOWA</option>
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- <option>MEDICAID KANSAS</option>
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- <option>MEDICAID KENTUCKY</option>
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- <option>MEDICAID LOUISIANA</option>
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- <option>MEDICAID MAINE</option>
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- <option>MEDICAID MARYLAND</option>
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- <option>MEDICAID MARYLAND DHMH</option>
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- <option>MEDICAID MASSACHUSETTS</option>
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- <option>MEDICAID MICHIGAN</option>
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- <option>MEDICAID MINNESOTA</option>
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- <option>MEDICAID MISSISSIPPI</option>
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- <option>MEDICAID MISSISSIPPI</option>
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- <option>MEDICAID MISSOURI</option>
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- <option>MEDICAID MONTANA</option>
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- <option>MEDICAID NEBRASKA</option>
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- <option>MEDICAID NEVADA</option>
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- <option>MEDICAID NEW HAMPSHIRE</option>
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- <option>MEDICAID NEW JERSEY</option>
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- <option>MEDICAID NEW MEXICO</option>
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- <option>MEDICAID NEW YORK</option>
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- <option>MEDICAID NEW YORK</option>
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- <option>MEDICAID NORTH CAROLINA</option>
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- <option>MEDICAID NORTH DAKOTA</option>
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- <option>MEDICAID OHIO</option>
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- <option>MEDICAID OKLAHOMA</option>
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- <option>MEDICAID OREGON</option>
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- <option>MEDICAID OREGON (DHS OMAP)</option>
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- <option>MEDICAID PENNSYLVANIA</option>
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- <option>MEDICAID RHODE ISLAND</option>
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- <option>MEDICAID SOUTH CAROLINA</option>
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- <option>MEDICAID SOUTH DAKOTA</option>
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- <option>MEDICAID TENNESSEE</option>
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- <option>MEDICAID TEXAS</option>
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- <option>MEDICAID TEXAS AND TEXAS HEALTH STEPS</option>
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- <option>MEDICAID UTAH</option>
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- <option>MEDICAID VERMONT</option>
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- <option>MEDICAID VIRGINIA</option>
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- <option>MEDICAID WASHINGTON (PROVIDER ONE)</option>
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- <option>MEDICAID WEST VIRGINIA</option>
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- <option>MEDICAID WISCONSIN</option>
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- <option>MEDICAID WYOMING</option>
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+ @foreach($medicaidStates as $state)
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+ <option>{{ $state }}</option>
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+ @endforeach
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</datalist>
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</datalist>
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</div>
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</div>
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@@ -324,29 +270,7 @@
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<script>
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<script>
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(function() {
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(function() {
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function init() {
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function init() {
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- let im = new Inputmask("(999) 999-9999").mask('[stag-input-phone]');
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- $(document)
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- .off('click.hpn-to-cpn', '.hpn-to-cpn')
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- .on('click.hpn-to-cpn', '.hpn-to-cpn', function() {
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- $('[name="cellNumber"]').val($('[name="homeNumber"]').val());
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- $('[name="homeNumber"]').val('');
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- return false;
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- });
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- $(document)
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- .off('click.cpn-to-hpn', '.cpn-to-hpn')
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- .on('click.cpn-to-hpn', '.cpn-to-hpn', function() {
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- $('[name="homeNumber"]').val($('[name="cellNumber"]').val());
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- $('[name="cellNumber"]').val('');
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- return false;
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- });
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- $(document)
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- .off('click.swap-pns', '.swap-pns')
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- .on('click.swap-pns', '.swap-pns', function() {
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- let hpn = $('[name="homeNumber"]').val();
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- $('[name="homeNumber"]').val($('[name="cellNumber"]').val());
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- $('[name="cellNumber"]').val(hpn);
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- return false;
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- });
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+ let im = new Inputmask("(999) 999-9999").mask('[stag-input-phone]');
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$(document)
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$(document)
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.off('change.insurance', '.insurance')
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.off('change.insurance', '.insurance')
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.on('change.insurance', '.insurance', function() {
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.on('change.insurance', '.insurance', function() {
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@@ -367,10 +291,24 @@
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var newPatientContainer = new Vue({
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var newPatientContainer = new Vue({
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el: '#newPatientContainer',
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el: '#newPatientContainer',
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data: {
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data: {
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+ form:{},
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planType: 'MEDICARE',
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planType: 'MEDICARE',
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isPatientSubscriber: true
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isPatientSubscriber: true
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},
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},
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methods: {
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methods: {
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+ hpnToCpn: function(){
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+ this.form.cellNumber = this.form.homeNumber;
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+ this.form.homeNumber = null;
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+ },
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+ cpnToHpn: function(){
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+ this.form.homeNumber = this.form.cellNumber;
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+ this.form.cellNumber = null;
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+ },
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+ swapHpnCpn: function(){
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+ var data = $.extend({}, this.form);
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+ this.form.homeNumber = data.cellNumber;
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+ this.form.cellNumber = data.homeNumber;
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+ },
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onCommercialPayerChange: function() {
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onCommercialPayerChange: function() {
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var input = $('input[name=commercialPayerUidSuggest]');
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var input = $('input[name=commercialPayerUidSuggest]');
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var hiddenInput = $('input[name=commercialPayerUid]');
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var hiddenInput = $('input[name=commercialPayerUid]');
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