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@@ -122,6 +122,76 @@
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</div>
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</div>
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</div>
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</div>
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+ <hr class="m-negator-3 my-3">
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+ <div class="mt-3 mb-2">
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+ <div class="font-weight-bold mb-2">Name</div>
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+ <div class="mb-1">
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+ <div class="mb-1">
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+ Name Prefix: <b>{{$patient->name_prefix}}</b>
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+ </div>
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+ <div class="mb-1">
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+ Name First: <b>{{$patient->name_first}}</b>
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+ </div>
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+ <div class="mb-1">
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+ Name Middle: <b>{{$patient->name_middle}}</b>
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+ </div>
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+ <div class="mb-1">
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+ Name Last: <b>{{$patient->name_last}}</b>
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+ </div>
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+ <div class="mb-1">
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+ Name Suffix: <b>{{$patient->name_suffix}}</b>
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+ </div>
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+ <div class="mb-1">
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+ Name Credential: <b>{{$patient->name_credential}}</b>
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+ </div>
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+ <div class="mb-1">
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+ Name Nickname: <b>{{$patient->name_nickname}}</b>
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+ </div>
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+ <div class="mb-1">
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+ Name Maiden: <b>{{$patient->name_maiden}}</b>
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+ </div>
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+ <div class="mb-1">
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+ Name Previous: <b>{{$patient->name_previous}}</b>
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+ </div>
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+ <div moe wide>
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+ <a start show><i class="fa fa-edit"></i></a>
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+ <form url="/api/client/editName" class="mcp-theme-1">
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+ <input type="hidden" name="uid" value="{{$patient->uid}}">
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+ <div class="mb-2">
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+ <input type="text" class="form-control form-control-sm" name="namePrefix" placeholder="Name Prefix" value="{{$patient->name_prefix}}">
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+ </div>
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+ <div class="mb-2">
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+ <input type="text" class="form-control form-control-sm" name="nameFirst" placeholder="Name First" value="{{$patient->name_first}}">
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+ </div>
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+ <div class="mb-2">
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+ <input type="text" class="form-control form-control-sm" name="nameMiddle" placeholder="Name Middle" value="{{$patient->name_middle}}">
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+ </div>
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+ <div class="mb-2">
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+ <input type="text" class="form-control form-control-sm" name="nameLast" placeholder="Name Last" value="{{$patient->name_last}}">
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+ </div>
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+ <div class="mb-2">
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+ <input type="text" class="form-control form-control-sm" name="nameSuffix" placeholder="Name Suffix" value="{{$patient->name_suffix}}">
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+ </div>
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+ <div class="mb-2">
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+ <input type="text" class="form-control form-control-sm" name="nameCredential" placeholder="Name Credential" value="{{$patient->name_credential}}">
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+ </div>
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+ <div class="mb-2">
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+ <input type="text" class="form-control form-control-sm" name="nameNickname" placeholder="Name Nickname" value="{{$patient->name_nickname}}">
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+ </div>
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+ <div class="mb-2">
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+ <input type="text" class="form-control form-control-sm" name="nameMaiden" placeholder="Name Maiden" value="{{$patient->name_maiden}}">
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+ </div>
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+ <div class="mb-2">
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+ <input type="text" class="form-control form-control-sm" name="namePrevious" placeholder="Name Previous" value="{{$patient->name_previous}}">
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+ </div>
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+ <div>
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+ <button submit class="btn btn-sm btn-primary mr-1">Submit</button>
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+ <button cancel class="btn btn-sm btn-default border">Cancel</button>
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+ </div>
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+ </form>
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+ </div>
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+ </div>
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+
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<hr class="m-negator-3 my-3">
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<hr class="m-negator-3 my-3">
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<div class="mt-3 mb-2">
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<div class="mt-3 mb-2">
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<div class="font-weight-bold mb-2">Basic Info</div>
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<div class="font-weight-bold mb-2">Basic Info</div>
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@@ -488,7 +558,7 @@
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@if($patient->is_enrolled_in_cm == 'YES')
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@if($patient->is_enrolled_in_cm == 'YES')
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<p>Cm Enrollment Consent Method Memo: {{$patient->cm_enrollment_consent_method}}</p>
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<p>Cm Enrollment Consent Method Memo: {{$patient->cm_enrollment_consent_method}}</p>
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<p>Cm Enrollment Consent Method Memo: {{$patient->cm_enrollment_consent_method_memo}}</p>
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<p>Cm Enrollment Consent Method Memo: {{$patient->cm_enrollment_consent_method_memo}}</p>
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- @else
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+ @else
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<p>Why Not Enrolled In Cm Category: {{$patient->why_not_enrolled_in_cm_category}}</p>
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<p>Why Not Enrolled In Cm Category: {{$patient->why_not_enrolled_in_cm_category}}</p>
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<p>Why Not Enrolled In Cm Memo: {{$patient->why_not_enrolled_in_cm_memo}}</p>
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<p>Why Not Enrolled In Cm Memo: {{$patient->why_not_enrolled_in_cm_memo}}</p>
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@endif
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@endif
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@@ -515,7 +585,7 @@
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</div>
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</div>
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</form>
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</form>
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</div>
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</div>
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-
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+
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<div moe class="ml-2">
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<div moe class="ml-2">
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<a start show><i class="fa fa-edit"></i>Update CM Enrollemnt Consent Info</a>
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<a start show><i class="fa fa-edit"></i>Update CM Enrollemnt Consent Info</a>
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<form url="/api/client/updateCmEnrollmentConsentInfo" class="mcp-theme-1">
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<form url="/api/client/updateCmEnrollmentConsentInfo" class="mcp-theme-1">
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@@ -537,7 +607,7 @@
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</div>
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</div>
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</form>
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</form>
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</div>
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</div>
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-
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+
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@else
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@else
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<div moe class="ml-2">
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<div moe class="ml-2">
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<a start show><i class="fa fa-edit"></i>Set is enrolled to CM to YES</a>
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<a start show><i class="fa fa-edit"></i>Set is enrolled to CM to YES</a>
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@@ -650,7 +720,7 @@
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</div>
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</div>
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</form>
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</form>
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</div>
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</div>
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-
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+
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@else
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@else
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<div moe class="ml-2">
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<div moe class="ml-2">
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<a start show><i class="fa fa-edit"></i>Set is enrolled to RM to YES</a>
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<a start show><i class="fa fa-edit"></i>Set is enrolled to RM to YES</a>
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@@ -659,7 +729,7 @@
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<div class="form-group">
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<div class="form-group">
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<label class="control-label">Are you sure?</label>
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<label class="control-label">Are you sure?</label>
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</div>
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</div>
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-
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+
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<div>
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<div>
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<button submit class="btn btn-sm btn-primary mr-1">Submit
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<button submit class="btn btn-sm btn-primary mr-1">Submit
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</button>
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</button>
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@@ -708,14 +778,14 @@
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<div class="form-group">
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<div class="form-group">
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<label class="control-label">Category </label>
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<label class="control-label">Category </label>
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<select name="category" class="form-control">
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<select name="category" class="form-control">
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- <option value="NULL">--</option>
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- <option value="ACTIVE">ACTIVE</option>
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- <option value="INACTIVE">INACTIVE</option>
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- <option value="ENTRY_ERROR">ENTRY_ERROR</option>
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- <option value="DUMMY">DUMMY</option>
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+ <option value="NULL">--</option>
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+ <option value="ACTIVE">ACTIVE</option>
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+ <option value="INACTIVE">INACTIVE</option>
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+ <option value="ENTRY_ERROR">ENTRY_ERROR</option>
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+ <option value="DUMMY">DUMMY</option>
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<option value="DECEASED">DECEASED</option>
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<option value="DECEASED">DECEASED</option>
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- <option value="DUPLICATE">DUPLICATE</option>
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- <option value="NO_LONGER_INTERESTED">NO_LONGER_INTERESTED</option>
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+ <option value="DUPLICATE">DUPLICATE</option>
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+ <option value="NO_LONGER_INTERESTED">NO_LONGER_INTERESTED</option>
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<option value="BAD_RECORD">BAD_RECORD</option>
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<option value="BAD_RECORD">BAD_RECORD</option>
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</select>
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</select>
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</div>
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</div>
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@@ -753,14 +823,14 @@
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<div class="form-group">
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<div class="form-group">
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<label class="control-label">Category </label>
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<label class="control-label">Category </label>
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<select name="category" class="form-control">
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<select name="category" class="form-control">
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- <option value="NULL">--</option>
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- <option value="ACTIVE">ACTIVE</option>
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- <option value="INACTIVE">INACTIVE</option>
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- <option value="ENTRY_ERROR">ENTRY_ERROR</option>
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- <option value="DUMMY">DUMMY</option>
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+ <option value="NULL">--</option>
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+ <option value="ACTIVE">ACTIVE</option>
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+ <option value="INACTIVE">INACTIVE</option>
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+ <option value="ENTRY_ERROR">ENTRY_ERROR</option>
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+ <option value="DUMMY">DUMMY</option>
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<option value="DECEASED">DECEASED</option>
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<option value="DECEASED">DECEASED</option>
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- <option value="DUPLICATE">DUPLICATE</option>
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- <option value="NO_LONGER_INTERESTED">NO_LONGER_INTERESTED</option>
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+ <option value="DUPLICATE">DUPLICATE</option>
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+ <option value="NO_LONGER_INTERESTED">NO_LONGER_INTERESTED</option>
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<option value="BAD_RECORD">BAD_RECORD</option>
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<option value="BAD_RECORD">BAD_RECORD</option>
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</select>
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</select>
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</div>
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</div>
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@@ -797,14 +867,14 @@
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<div class="form-group">
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<div class="form-group">
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<label class="control-label">Category </label>
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<label class="control-label">Category </label>
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<select name="category" class="form-control">
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<select name="category" class="form-control">
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- <option value="NULL">--</option>
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- <option value="ACTIVE">ACTIVE</option>
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- <option value="INACTIVE">INACTIVE</option>
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- <option value="ENTRY_ERROR">ENTRY_ERROR</option>
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- <option value="DUMMY">DUMMY</option>
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+ <option value="NULL">--</option>
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+ <option value="ACTIVE">ACTIVE</option>
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+ <option value="INACTIVE">INACTIVE</option>
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+ <option value="ENTRY_ERROR">ENTRY_ERROR</option>
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+ <option value="DUMMY">DUMMY</option>
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<option value="DECEASED">DECEASED</option>
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<option value="DECEASED">DECEASED</option>
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- <option value="DUPLICATE">DUPLICATE</option>
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- <option value="NO_LONGER_INTERESTED">NO_LONGER_INTERESTED</option>
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+ <option value="DUPLICATE">DUPLICATE</option>
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+ <option value="NO_LONGER_INTERESTED">NO_LONGER_INTERESTED</option>
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<option value="BAD_RECORD">BAD_RECORD</option>
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<option value="BAD_RECORD">BAD_RECORD</option>
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</select>
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</select>
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</div>
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</div>
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