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@@ -68,12 +68,12 @@
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<div class="row">
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<div class="form-group col-md-12" v-if="insuranceCardType == 'medicaid' || insuranceCardType == 'commercial'">
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<p class="mb-1">Is Patient The Subscriber?</p>
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- <label class="mr-2">
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- <input type="radio" name="isPatientSubscriber" v-model="isPatientSubscriber" value="1"> Yes
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- </label>
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- <label class="">
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- <input type="radio" name="isPatientSubscriber" v-model="isPatientSubscriber" value="0"> No
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- </label>
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+ <div class="form-check form-check-inline">
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+ <label class="form-check-label"><input class="form-check-input" type="radio" name="isPatientSubscriber" v-model="isPatientSubscriber" value="1">Yes</label>
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+ </div>
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+ <div class="form-check form-check-inline">
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+ <label class="form-check-label"><input class="form-check-input" type="radio" name="isPatientSubscriber" v-model="isPatientSubscriber" value="0">No</label>
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+ </div>
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</div>
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</div>
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@@ -111,7 +111,7 @@
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<input type="date" name="subscriberDob" value="{{$patient->dob}}" class="form-control input-sm">
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</div>
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<div class="form-group col-md-6">
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- <label class="control-label">Patient Relationship To Subscriber</label>
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+ <label class="control-label">What is the patient's relationship to the subscriber?</label>
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<select name="patientRelationshipToSubscriber" class="form-control input-sm">
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<option value="">--</option>
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<option value="SPOUSE">Spouse</option>
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@@ -125,6 +125,9 @@
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</select>
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</div>
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</div>
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+ <div class="mb-1" v-if="insuranceCardType == 'commercial'">
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+ <p>Does the patient also have either a Medicare or Medicaid #? (optional)</p>
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+ </div>
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<div class="row" v-if="insuranceCardType == 'medicaid' || insuranceCardType == 'commercial'">
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<div class="col-md-12 bg-light p-3 mb-2">
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<h5 class="m-0 font-weight-bold">Medicaid Information:</h5>
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