coverage fixes

resources/views/app/patient/client-primary-coverages.blade.php

@@ -81,7 +81,7 @@
                     </div>
                     <div class="form-group">
                         <label for="" class="control-label">Manual Determination Category Memo</label>
-                        <input type="text" name="baseManualDeterminationValue.manualDeterminationCategoryMemo" class="form-control input-sm"/>
+                        <input type="text" name="manualDeterminationCategoryMemo" class="form-control input-sm"/>
                     </div>
                     <div class="form-group">
                         <label for="" class="control-label">Manual Detail Json</label>
@@ -537,7 +537,7 @@
                             </div>
                             <div class="form-group">
                                 <label for="" class="control-label">Manual Determination Category Memo</label>
-                                <input type="text" name="baseManualDeterminationValue.manualDeterminationCategoryMemo" class="form-control input-sm"/>
+                                <input type="text" name="manualDeterminationCategoryMemo" class="form-control input-sm"/>
                             </div>
                             <div class="form-group">
                                 <label for="" class="control-label">Manual Detail Json</label>
@@ -689,7 +689,7 @@
                             </div>
                             <div class="form-group">
                                 <label for="" class="control-label">Manual Determination Category Memo</label>
-                                <input type="text" name="baseManualDeterminationValue.manualDeterminationCategoryMemo" class="form-control input-sm"/>
+                                <input type="text" name="manualDeterminationCategoryMemo" class="form-control input-sm"/>
                             </div>
                             <div class="form-group">
                                 <label for="" class="control-label">Manual Detail Json</label>
@@ -744,7 +744,7 @@
                             </div>
                             <div class="form-group">
                                 <label for="" class="control-label">Manual Determination Category Memo</label>
-                                <input type="text" name="baseManualDeterminationValue.manualDeterminationCategoryMemo" class="form-control input-sm"/>
+                                <input type="text" name="manualDeterminationCategoryMemo" class="form-control input-sm"/>
                             </div>
                             <div class="form-group">
                                 <label for="" class="control-label">Manual Detail Json</label>