|
@@ -1,5 +1,6 @@
|
|
<?php
|
|
<?php
|
|
$medicaidStates = Config::get('constants.medicaid_states');
|
|
$medicaidStates = Config::get('constants.medicaid_states');
|
|
|
|
+ $cpc = $patient->latestClientPrimaryCoverage;
|
|
?>
|
|
?>
|
|
<div id="new-coverage-form-{{$patient->uid}}">
|
|
<div id="new-coverage-form-{{$patient->uid}}">
|
|
<div class="p-3">
|
|
<div class="p-3">
|
|
@@ -155,7 +156,7 @@
|
|
|
|
|
|
<div class="form-group col-md-6">
|
|
<div class="form-group col-md-6">
|
|
<label class="control-label">Medicaid Number</label>
|
|
<label class="control-label">Medicaid Number</label>
|
|
- <input type="text" name="mcdNumber" class="form-control input-sm" oninput="this.value = this.value.toUpperCase()">
|
|
|
|
|
|
+ <input type="text" name="mcdNumber" class="form-control input-sm" value="{{ $cpc->mcd_number ?? '' }}" oninput="this.value = this.value.toUpperCase()">
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
|
|
@@ -165,7 +166,7 @@
|
|
</div>
|
|
</div>
|
|
<div class="form-group col-md-6">
|
|
<div class="form-group col-md-6">
|
|
<label class="control-label">Medicare Number</label>
|
|
<label class="control-label">Medicare Number</label>
|
|
- <input type="text" name="mcrNumber" class="form-control input-sm" oninput="this.value = this.value.toUpperCase()">
|
|
|
|
|
|
+ <input type="text" name="mcrNumber" class="form-control input-sm" value="{{ $cpc->mcr_number ?? '' }}" oninput="this.value = this.value.toUpperCase()">
|
|
</div>
|
|
</div>
|
|
|
|
|
|
</div>
|
|
</div>
|