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@@ -323,79 +323,101 @@ $medications = $points;
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<input type="hidden" data-name="routedDosageFormMedId">
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<input type="hidden" data-name="gcnSeqno">
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- <input type="hidden" name="additionReasonCategory">
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- <input type="hidden" name="isRemoved">
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- <input type="hidden" name="removalReasonCategory">
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- <input type="hidden" name="isRemovedDueToEntryError">
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-
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<p class="mb-2"><b>Add Medication</b></p>
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<div class="row">
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<div class="col-7">
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+ <div class="mb-2">
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+ <label class="text-sm text-secondary mb-0">Name</label>
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+ <input type="text"
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+ data-name="name"
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+ class="form-control form-control-sm"
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+ stag-suggest
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+ stag-suggest-bottom-left
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+ stag-suggest-ep="/fdb-med-suggest-v2/json"
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+ required>
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+ </div>
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<div class="row mb-2">
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- <div class="col-8 pr-0">
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- <label class="text-sm text-secondary mb-0">Name</label>
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- <input type="text"
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- data-name="name"
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- class="form-control form-control-sm"
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- stag-suggest
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- stag-suggest-bottom-left
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- stag-suggest-ep="/fdb-med-suggest-v2/json"
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- required>
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- </div>
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- <div class="col-4">
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- <label class="text-sm text-secondary mb-0">Frequency</label>
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- <input type="text" class="form-control form-control-sm" data-name="frequency"
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- data-option-list="frequency-options" autocomplete="off">
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+ <div class="col-4 pr-0">
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+ <label class="text-sm mb-1">Frequency</label>
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+ <input type="text" class="form-control form-control-sm min-width-unset"
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+ data-option-list="frequency-options" data-field="frequency"
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+ data-name="frequency">
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<div id="frequency-options" class="data-option-list">
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<div>Once a day</div>
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<div>Twice a day</div>
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</div>
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</div>
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+ <div class="col-4 pr-0">
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+ <label class="text-sm mb-0">Start Date</label>
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+ <input type="date"
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+ data-name="start_date"
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+ class="form-control form-control-sm min-width-unset">
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+ </div>
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+ <div class="col-4">
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+ <label class="text-sm mb-0">Prescribed By</label>
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+ <input type="text"
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+ data-name="prescriber"
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+ class="form-control form-control-sm min-width-unset">
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+ </div>
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</div>
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+ <div class="mb-2">
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+ <label class="text-sm mb-1">Description</label>
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+ <textarea rows="1" data-name="description" class="form-control form-control-sm"></textarea>
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+ </div>
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+
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+ <hr class="my-3">
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+
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<div class="row mb-2">
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- <div class="col-12">
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- <label class="text-sm text-secondary mb-0">Historic / Preexisting / New</label>
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- <select class="form-control form-control-sm additionReasonCategory_ui" name="additionReasonCategory_ui" required>
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+ <div class="col-4 pr-0">
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+ <label class="text-sm mb-0">When Added</label>
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+ <select class="form-control form-control-sm min-width-unset" name="additionReasonCategory" required>
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<option value="">-- select --</option>
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- <option value="HISTORIC">Historic</option>
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- <option value="PRE_EXISTING">Preexisting</option>
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- <option value="NEW">New (Prescribed during this visit)</option>
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+ <option value="ON_INTAKE">On Intake</option>
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+ <option value="DURING_VISIT">During Visit</option>
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</select>
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</div>
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+ <div class="col-8">
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+ <label class="text-sm mb-0 min-width-unset">Addition Memo</label>
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+ <input type="text"
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+ name="additionReasonMemo"
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+ class="form-control form-control-sm min-width-unset">
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+ </div>
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</div>
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- <div class="d-flex align-items-start mb-2">
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- <div class="w-25">
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- <div class="start_date_ui" style="display: none">
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- <label class="text-sm text-secondary mb-0">Start Date</label>
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- <input type="date"
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- data-name="start_date"
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- class="form-control form-control-sm min-width-unset">
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- </div>
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+
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+ <hr class="my-3">
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+
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+ <div class="row mb-2">
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+ <div class="col-6 pr-0">
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+ <label class="text-sm mb-0 min-width-unset">Is medication active?</label>
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+ <select class="form-control form-control-sm min-width-unset" name="isRemoved" required>
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+ <option value="0" selected>Yes</option>
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+ <option value="1">No</option>
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+ </select>
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</div>
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- <div class="w-25 pl-2">
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- <div class="prescriber_ui" style="display: none">
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- <label class="text-sm text-secondary mb-0">Prescribed By</label>
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- <input type="text"
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- data-name="prescriber"
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- class="form-control form-control-sm min-width-unset">
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- </div>
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+ <input type="hidden" name="isRemovedDueToEntryError" value="0">
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+ </div>
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+
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+ <div class="row mb-2 is_removed_ui_2" style="display: none">
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+ <div class="col-4 pr-0">
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+ <label class="text-sm mb-0 min-width-unset">When Removed</label>
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+ <select class="form-control form-control-sm min-width-unset" name="removalReasonCategory">
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+ <option value="">-- select --</option>
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+ <option value="ON_INTAKE">On Intake</option>
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+ <option value="DURING_VISIT">During Visit</option>
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+ </select>
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</div>
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- <div class="w-25 pl-2">
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- <div class="removalEffectiveDate_ui" style="display: none">
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- <label class="text-sm text-secondary mb-0">End Date</label>
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- <input type="date"
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- name="removalEffectiveDate"
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- class="form-control form-control-sm min-width-unset">
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- </div>
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+ <div class="col-4 pr-0">
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+ <label class="text-sm mb-0 min-width-unset">End Date</label>
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+ <input type="date"
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+ name="removalEffectiveDate"
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+ class="form-control form-control-sm min-width-unset">
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</div>
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- <div class="w-25 pl-2">
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- <div class="removalReasonMemo_ui" style="display: none">
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- <label class="text-sm text-secondary mb-0">Removal By/Memo</label>
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- <input type="text"
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- name="removalReasonMemo"
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- class="form-control form-control-sm min-width-unset">
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- </div>
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+ <div class="col-4">
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+ <label class="text-sm mb-0 min-width-unset">Removal By/Memo</label>
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+ <input type="text"
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+ name="removalReasonMemo"
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+ class="form-control form-control-sm min-width-unset">
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</div>
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</div>
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</div>
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