overrides

resources/views/app/patient/primary-coverage-manual-determination-form.blade.php

@@ -30,8 +30,7 @@
 						<td>Record Found?</td>
 						<td>{{$cpc->auto_medicare_is_match_found ? 'YES' : 'NO'}}</td>
 						<td>
-							<div class="form-group">
-								<p class="mb-1">Is Matched?</p>
+							<div class="form-group mb-0">
 								<div class="form-check form-check-inline">
 									<label class="form-check-label"><input class="form-check-input" type="radio" :checked="cpc.auto_medicare_is_partbactive == 'YES'" name="manualMedicareIsMatched" value="YES">Yes</label>
 								</div>
@@ -46,7 +45,6 @@
 						<td>{{$cpc->auto_medicaid_is_match_found ? 'YES' : 'NO'}}</td>
 						<td>
 							<div class="form-group">
-								<p class="mb-1">Is Matched?</p>
 								<div class="form-check form-check-inline">
 									<label class="form-check-label"><input class="form-check-input" type="radio" :checked="cpc.auto_medicaid_is_match_found == 'YES'" name="manualMedicaidIsMatched" value="YES">Yes</label>
 								</div>
@@ -104,7 +102,6 @@
 						<td>{{$cpc->auto_medicare_is_partbactive}}</td>
 						<td>
 							<div class="form-group mb-0">
-								<p class="mb-1">Is Part B Active?</p>
 								<div class="form-check form-check-inline">
 									<label class="form-check-label"><input class="form-check-input" type="radio" :checked="cpc.auto_medicare_is_partbprimary == 'YES'" name="manualMedicareIsPartBActive" value="YES">Yes</label>
 								</div>
@@ -115,21 +112,15 @@
 						</td>
 					</tr>
 					<tr v-if="(cpc.plan_type == 'MEDICARE') || (cpc.plan_type == 'COMMERCIAL' && cpc.mcr_number)">
-						<td>Part B Primary?</td>
+						<td>Is Part B Primary?</td>
 						<td>{{$cpc->auto_medicare_is_partbprimary}}</td>
 						<td>
-							<div class="form-group">
-								<label for="" class="control-label">Manual Determination Category</label>
-								<select name="manualDeterminationCategory" class="form-control input-sm">
-									<option value="">--select--</option>
-									<option value="COVERED" :selected="cpc.auto_medicare_is_partbprimary == 'YES'">Covered</option>
-									<option value="NOT_COVERED">Not Covered</option>
-									<option value="INVALID">Invalid</option>
-									<option value="UNKNOWN">Unknown</option>
-								</select>
-							</div>
+							<input v-if="cpc.plan_type == 'MEDICARE'" type="hidden" name="manualDeterminationCategory" :value="
+							!cpc.auto_medicare_is_match_found ? 'INVALID' :
+							cpc.auto_medicare_is_partbprimary == 'YES' ? 'COVERED' :
+							cpc.auto_medicare_is_partbprimary == 'NO' ? 'NOT_COVERED' : 'UNKNOWN'
+							">
 							<div class="form-group mb-0">
-								<p class="mb-1">Is Part B Primary?</p>
 								<div class="form-check form-check-inline">
 									<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartBPrimary" v-model="uiState.manualMedicareIsPartBPrimary" value="YES">Yes</label>
 								</div>
@@ -140,16 +131,13 @@
 						</td>
 					</tr>
 					<tr v-if="(cpc.plan_type == 'MEDICARE') || (cpc.plan_type == 'COMMERCIAL' && cpc.mcr_number)">
-						<td>Part C Active?</td>
+						<td>Is Part C Active?</td>
 						<td>{{$cpc->auto_medicare_is_partcactive}}</td>
 						<td>
-							<div class="form-group">
-								<div class="alert alert-danger" v-if="(cpc.auto_medicare_is_partcactive == 'YES' && cpc.auto_medicare_is_partbprimary == 'YES') || (uiState.manualMedicareIsPartBPrimary == 'YES' && uiState.manualMedicareIsPartCActive == 'YES')">
-									Oops! Patient Medicare Part B Primary is set to <b>Yes</b>.
-								</div>
+							<div class="alert alert-danger" v-if="(cpc.auto_medicare_is_partcactive == 'YES' && cpc.auto_medicare_is_partbprimary == 'YES') || (uiState.manualMedicareIsPartBPrimary == 'YES' && uiState.manualMedicareIsPartCActive == 'YES')">
+								Oops! Patient Medicare Part B Primary is set to <b>Yes</b>.
 							</div>
 							<div class="form-group mb-0">
-								<p class="mb-1">Is Part C Active?</p>
 								<div class="form-check form-check-inline">
 									<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartCActive" v-model="uiState.manualMedicareIsPartCActive" value="YES">Yes</label>
 								</div>
@@ -164,7 +152,6 @@
 						<td>{{$cpc->auto_medicare_is_inpatient}}</td>
 						<td>
 							<div class="form-group mb-0">
-								<p class="mb-1">Inpatient?</p>
 								<div class="form-check form-check-inline">
 									<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsInpatient" value="YES">Yes</label>
 								</div>
@@ -182,7 +169,6 @@
 						<td>UNKNOWN</td>
 						<td>
 							<div class="form-group mb-0">
-								<p class="mb-1">Hospice?</p>
 								<div class="form-check form-check-inline">
 									<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHospice" value="YES">Yes</label>
 								</div>
@@ -200,7 +186,6 @@
 						<td>UNKNOWN</td>
 						<td>
 							<div class="form-group mb-0">
-								<p class="mb-1">Home Health?</p>
 								<div class="form-check form-check-inline">
 									<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHomeHealth" value="YES">Yes</label>
 								</div>
@@ -218,7 +203,6 @@
 						<td>{{$cpc->auto_medicare_is_msp}}</td>
 						<td>
 							<div class="form-group mb-0">
-								<p class="mb-1">MSP?</p>
 								<div class="form-check form-check-inline">
 									<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsMsp" value="YES">Yes</label>
 								</div>