Merge branch 'dev' of rav.triplestart.com:jmudaka/stagfe2 into dev

resources/views/app/new-patient.blade.php

@@ -34,19 +34,19 @@ $medicaidStates = Config::get('constants.medicaid_states');
 									<h5 class="m-0 font-weight-bold">Patient Name / Demographics:</h5>
 								</div>
 								<div class="col-md-12 form-group mt-2">
-									<div class="d-flex align-items-center">
-										<label class="m-0 w-25">Name:</label>
-										<input autocomplete="_blank" type="text" name="patientNamePrefix" placeholder="Prefix" class="ml-2 form-control input-sm w-50">
-										<input autocomplete="_blank" type="text" required name="patientNameFirst" placeholder="First" class="ml-2 form-control input-sm">
-										<input autocomplete="_blank" type="text" name="patientNameMiddle" placeholder="Middle" class="ml-2 form-control input-sm">
-										<input autocomplete="_blank" type="text" name="patientNameLast" placeholder="Last" class="ml-2 form-control input-sm">
-										<input autocomplete="_blank" type="text" name="patientNameSuffix" placeholder="Suffix" class="ml-2 form-control input-sm w-50">
+									<div class="d-md-flex align-items-center">
+										<label class="font-weight-bold m-0 w-25">Name:</label>
+										<input autocomplete="_blank" type="text" name="patientNamePrefix" placeholder="Prefix" class="ml-2 mb-md-0 mb-2 form-control input-sm w-md-50">
+										<input autocomplete="_blank" type="text" required name="patientNameFirst" placeholder="First*" required class="ml-2 mb-md-0 mb-2 form-control input-sm">
+										<input autocomplete="_blank" type="text" name="patientNameMiddle" placeholder="Middle" class="ml-2 mb-md-0 mb-2 form-control input-sm">
+										<input autocomplete="_blank" type="text" name="patientNameLast" placeholder="Last*" required class="ml-2 mb-md-0 mb-2 form-control input-sm">
+										<input autocomplete="_blank" type="text" name="patientNameSuffix" placeholder="Suffix" class="ml-2 mb-md-0 mb-2 form-control input-sm w-md-50">
 									</div>
 								</div>
 								<div class="col-md-12 p-0">
 									<div class="col-md-6 form-group">
 										<div class="d-flex align-items-center">
-											<label class="m-0">Email:</label>
+											<label class="font-weight-bold m-0">Email:</label>
 											<input class='form-control ml-2' type='email' placeholder="Email Address" name='emailAddress'>
 										</div>
 									</div>
@@ -54,7 +54,7 @@ $medicaidStates = Config::get('constants.medicaid_states');
 								<div class="col-md-12 p-0">
 									<div class="col-md-4 form-group">
 										<div class="d-flex align-items-center">
-											<label class="m-0 w-25">Gender:</label>
+											<label class="font-weight-bold m-0 w-25">Gender:</label>
 											<select class="form-control input-sm ml-2" name="patientSex" select2>
 												<option value="">--</option>
 												<option value="M">Male</option>
@@ -68,13 +68,13 @@ $medicaidStates = Config::get('constants.medicaid_states');
 							<div class="row">
 								<div class="col-md-5 form-group">
 									<div class="d-flex align-items-center">
-										<label class="m-0 w-25">DOB: <span class="text-danger">*</span></label>
+										<label class="font-weight-bold m-0 w-25">DOB: <span class="text-danger">*</span></label>
 										<input type="date" required name="patientDob" value="" class="form-control input-sm">
 									</div>
 								</div>
 								<div class="col-md-5 form-group">
 									<div class="d-flex align-items-center">
-										<label class="m-0 w-25">Service:</label>
+										<label class="font-weight-bold m-0 w-25">Service:</label>
 										<input type="date" name="dateOfService" value="{{date('Y-m-d')}}" class="form-control input-sm">
 									</div>
 								</div>
@@ -83,7 +83,7 @@ $medicaidStates = Config::get('constants.medicaid_states');
 							<div class="row">
 								<div class="col-md-5 form-group">
 									<div class="d-flex align-items-center">
-										<label class="m-0 w-25">HCP Pro:</label>
+										<label class="font-weight-bold m-0 w-25">HCP Pro:</label>
 										<select name="hcpProUid" class="form-control input-sm" provider-search provider-type="hcp">
 											<option value="">--select--</option>
 										</select>
@@ -91,7 +91,7 @@ $medicaidStates = Config::get('constants.medicaid_states');
 								</div>
 								<div class="col-md-7 form-group">
 									<div class="d-flex align-items-center">
-										<label class='m-0 w-25'>Coordinator:</label>
+										<label class='font-weight-bold m-0 w-25'>Coordinator:</label>
 										<select name="assistantProUid" class="form-control input-sm ml-2" provider-search provider-type="default-na">
 											<option value="">--select--</option>
 										</select>
@@ -103,7 +103,7 @@ $medicaidStates = Config::get('constants.medicaid_states');
 								<div class="col-md-12">
 									<div class='form-group'>
 										<div class="d-flex align-items-center">
-											<label class="m-0 w-25">HCP Pro:</label>
+											<label class="font-weight-bold m-0 w-25">HCP Pro:</label>
 											<input type="text" class="form-control" readonly value="{{$pro->displayName()}}">
 											<input type="hidden" name="hcpProUid" value="{{$pro->uid}}">
 										</div>
@@ -114,7 +114,7 @@ $medicaidStates = Config::get('constants.medicaid_states');
 							<div class="row">
 								<div class="col-md-5 form-group">
 									<div class="d-flex align-items-center">
-										<label class="m-0 w-25">HCP Pro:</label>
+										<label class="font-weight-bold m-0 w-25">HCP Pro:</label>
 										<?php $teams = $pro->teamsWhereAssistant; ?>
 										<select name="hcpProUid" class="form-control">
 											@if(count($teams) > 1)
@@ -128,7 +128,7 @@ $medicaidStates = Config::get('constants.medicaid_states');
 								</div>
 								<div class="col-md-7 form-group">
 									<div class="d-flex align-items-center">
-										<label class='m-0 w-25'>Coordinator:</label>
+										<label class='font-weight-bold m-0 w-25'>Coordinator:</label>
 										<input type="text" class="form-control" readonly value="{{$pro->displayName()}}">
 										<input type="hidden" name="assistantProUid" value="{{$pro->uid}}">
 									</div>
@@ -139,7 +139,7 @@ $medicaidStates = Config::get('constants.medicaid_states');
 								<div class="col-md-6 form-group">
 									<div class="d-flex align-items-center">
 										<label class='control-label m-0 d-flex align-items-center'>
-											<span>Phone:</span>
+											<span class="font-weight-bold">Home Phone:</span>
 											<a v-if="form.homeNumber" @click="hpnToCpn" class="ml-1 px-1 on-hover-opaque hpn-to-cpn c-pointer">
 												<i class="fa fa-arrow-right"></i>
 											</a>
@@ -154,7 +154,7 @@ $medicaidStates = Config::get('constants.medicaid_states');
 								<div class="col-md-6 form-group">
 									<div class="d-flex align-items-center">
 										<label class='control-label m-0 d-flex align-items-center'>
-											<span>Phone:</span>
+											<span class="font-weight-bold">Cell Phone:</span>
 											<a v-if="form.cellNumber" @click="cpnToHpn" class="ml-1 px-1 on-hover-opaque cpn-to-hpn c-pointer">
 												<i class="fa fa-arrow-left"></i>
 											</a>
@@ -167,7 +167,7 @@ $medicaidStates = Config::get('constants.medicaid_states');
 
 
 							<div class='form-group mb-3'>
-								<label class='control-label'>How did you hear about us?</label>
+								<label class='control-label font-weight-bold'>How did you hear about us?</label>
 								<input class='form-control' type='text' name='initiative' />
 							</div>
 
@@ -283,7 +283,7 @@ $medicaidStates = Config::get('constants.medicaid_states');
 											<div class="col-12">
 												<div class="row">
 
-												
+
 												<div class="form-group col-md-6">
 													<label for="" class="control-label">Medicaid State</label>
 													<input class="form-control input-sm" list="mcdPayerOptions" name="mcdPayerName" id="mcdPayerName">
@@ -311,8 +311,8 @@ $medicaidStates = Config::get('constants.medicaid_states');
 											</div>
 											<div class="col-12">
 												<div class="form-group col-md-6">
-													<label class="control-label">Medicare Number</label>
-													<input type="text" name="mcrNumber" class="form-control input-sm" oninput="this.value = this.value.toUpperCase()">
+													<label class="control-label">Medicare Number <span class="text-danger">*</span> </label>
+													<input type="text" name="mcrNumber" class="form-control input-sm" required oninput="this.value = this.value.toUpperCase()">
 												</div>
 											</div>