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@@ -1,7 +1,69 @@
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@extends ('layouts.patient')
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@section('inner-content')
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- <div class="font-weight-bold mb-2">Home Address</div>
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+ <div class="d-flex align-items-center mb-2">
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+ <div class="font-weight-bold">Home Address</div>
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+ <span class="text-secondary mx-2">|</span>
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+ <div moe wide>
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+ <a start show><i class="fa fa-edit"></i> Edit Address</a>
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+ <form url="/api/client/editAddress" class="mcp-theme-1">
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+ <input type="hidden" name="uid" value="{{$patient->uid}}">
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+
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+ <p class="mb-2 font-weight-bold">Home Address</p>
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+ <div class="mb-2">
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+ <input type="text" class="form-control form-control-sm" name="homeAddressLine1" placeholder="Address Line 1" value="{{ $patient->home_address_line1 }}">
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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="homeAddressLine2" placeholder="Address Line 2" value="{{ $patient->home_address_line2 }}">
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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="homeAddressCity" placeholder="City" value="{{ $patient->home_address_city }}">
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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="homeAddressState" placeholder="State" value="{{ $patient->home_address_state }}">
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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="homeAddressZip" placeholder="ZIP" value="{{ $patient->home_address_zip }}">
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+ </div>
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+
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+ <p class="mb-2 mt-3 font-weight-bold">Mailing Address</p>
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+ <label class="d-flex align-items-center">
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+ @php
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+ $isSame = ($patient->home_address_line1 == $patient->mailing_address_line1 &&
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+ $patient->home_address_line2 == $patient->mailing_address_line2 &&
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+ $patient->home_address_city == $patient->mailing_address_city &&
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+ $patient->home_address_state == $patient->mailing_address_state &&
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+ $patient->home_address_zip == $patient->mailing_address_zip);
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+ @endphp
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+ <input type="checkbox" onchange="copyHomeToMailingAndReadOnly(this.checked)" {{ $isSame ? 'checked' : '' }}>
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+ <span class="ml-2">Same as home addess</span>
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+ </label>
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+ <div class="mb-2">
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+ <input type="text" class="form-control form-control-sm" name="mailingAddressLine1" placeholder="Address Line 1" value="{{ $patient->mailing_address_line1 }}">
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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="mailingAddressLine2" placeholder="Address Line 2" value="{{ $patient->mailing_address_line2 }}">
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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="mailingAddressCity" placeholder="City" value="{{ $patient->mailing_address_city }}">
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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="mailingAddressState" placeholder="State" value="{{ $patient->mailing_address_state }}">
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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="mailingAddressZip" placeholder="ZIP" value="{{ $patient->mailing_address_zip }}">
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+ </div>
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+ <div class="mb-2">
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+ <textarea type="text" class="form-control form-control-sm" name="mailingAddressMemo" placeholder="Memo">{{ $patient->mailing_address_memo }}</textarea>
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+ </div>
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+
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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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<div class="pl-3">
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<div class="mb-1">
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Address Line 1: <b>{{ $patient->home_address_line1 }}</b>
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@@ -42,20 +104,11 @@
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</div>
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</div>
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- <div class="font-weight-bold mb-2 mt-3">Contact Info</div>
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- <div class="pl-3">
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- <div class="mb-1">
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- Home Phone: <b>{{ $patient->phone_home }}</b>
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- </div>
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- <div class="mb-1">
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- Cell Phone: <b>{{ $patient->cell_number }}</b>
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- </div>
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- <div class="mb-1">
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- Email: <b>{{ $patient->email_address }}</b>
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- </div>
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- </div>
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+ <hr class="m-negator my-3">
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- <div class="mt-3 d-flex align-items-center">
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+ <div class="d-flex align-items-center mb-2 mt-3">
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+ <div class="font-weight-bold">Contact Info</div>
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+ <span class="text-secondary mx-2">|</span>
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<div moe wide>
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<a start show><i class="fa fa-edit"></i> Edit Contact Info</a>
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<form url="/api/client/putContactInfo" class="mcp-theme-1">
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@@ -75,65 +128,16 @@
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</div>
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</form>
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</div>
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- <span class="mx-2 text-secondary">|</span>
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- <div moe wide>
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- <a start show><i class="fa fa-edit"></i> Edit Address</a>
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- <form url="/api/client/editAddress" class="mcp-theme-1">
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- <input type="hidden" name="uid" value="{{$patient->uid}}">
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-
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- <p class="mb-2 font-weight-bold">Home Address</p>
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- <div class="mb-2">
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- <input type="text" class="form-control form-control-sm" name="homeAddressLine1" placeholder="Address Line 1" value="{{ $patient->home_address_line1 }}">
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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="homeAddressLine2" placeholder="Address Line 2" value="{{ $patient->home_address_line2 }}">
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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="homeAddressCity" placeholder="City" value="{{ $patient->home_address_city }}">
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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="homeAddressState" placeholder="State" value="{{ $patient->home_address_state }}">
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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="homeAddressZip" placeholder="ZIP" value="{{ $patient->home_address_zip }}">
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- </div>
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-
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- <p class="mb-2 mt-3 font-weight-bold">Mailing Address</p>
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- <label class="d-flex align-items-center">
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- @php
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- $isSame = ($patient->home_address_line1 == $patient->mailing_address_line1 &&
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- $patient->home_address_line2 == $patient->mailing_address_line2 &&
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- $patient->home_address_city == $patient->mailing_address_city &&
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- $patient->home_address_state == $patient->mailing_address_state &&
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- $patient->home_address_zip == $patient->mailing_address_zip);
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- @endphp
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- <input type="checkbox" onchange="copyHomeToMailingAndReadOnly(this.checked)" {{ $isSame ? 'checked' : '' }}>
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- <span class="ml-2">Same as home addess</span>
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- </label>
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- <div class="mb-2">
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- <input type="text" class="form-control form-control-sm" name="mailingAddressLine1" placeholder="Address Line 1" value="{{ $patient->mailing_address_line1 }}">
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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="mailingAddressLine2" placeholder="Address Line 2" value="{{ $patient->mailing_address_line2 }}">
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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="mailingAddressCity" placeholder="City" value="{{ $patient->mailing_address_city }}">
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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="mailingAddressState" placeholder="State" value="{{ $patient->mailing_address_state }}">
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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="mailingAddressZip" placeholder="ZIP" value="{{ $patient->mailing_address_zip }}">
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- </div>
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- <div class="mb-2">
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- <textarea type="text" class="form-control form-control-sm" name="mailingAddressMemo" placeholder="Memo">{{ $patient->mailing_address_memo }}</textarea>
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- </div>
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-
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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 class="pl-3">
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+ <div class="mb-1">
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+ Home Phone: <b>{{ $patient->phone_home }}</b>
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+ </div>
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+ <div class="mb-1">
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+ Cell Phone: <b>{{ $patient->cell_number }}</b>
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+ </div>
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+ <div class="mb-1">
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+ Email: <b>{{ $patient->email_address }}</b>
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</div>
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</div>
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