added coverage forms

resources/views/app/patient/primary-coverage-manual-determination.blade.php

@@ -0,0 +1,120 @@
+<?php
+	$mdc = 'UNKNOWN';
+?>
+<div moe relative large>
+	<a href="" start show class="">Manual Determination {{$planType}}</a>
+	<form url="/api/clientPrimaryCoverage/manualDeterminationForMedicare" class="mcp-theme-1">
+		<input type="hidden" name="clientPrimaryCoverageUid" value="{{$cpc->uid}}" class="form-control input-sm" />
+		<div class="form-group">
+			<label for="" class="control-label">Manual Determination Strategy</label>
+			<select name="manualDeterminationStrategy" class="form-control input-sm">
+				<option value="">--select--</option>
+				<option value="REVIEWED_ELECTRONIC">Reviewed electronic</option>
+				<option value="CALLED_PAYER">Called payer</option>
+			</select>
+		</div>
+		<div class="form-group">
+			<label for="" class="control-label">Manual Determination Category</label>
+			<select name="manualDeterminationCategory" class="form-control input-sm">
+				<option value="">--select--</option>
+				<option value="ALLOW">Allow</option>
+				<option value="COVERED">Covered</option>
+				<option value="NOT_COVERED">Not Covered</option>
+				<option value="INVALID">Invalid</option>
+				<option value="UNKNOWN">Unknown</option>
+			</select>
+		</div>
+		<div class="form-group">
+			<label for="" class="control-label">Manual Determination Category Memo</label>
+			<input type="text" name="manualDeterminationCategoryMemo" class="form-control input-sm" />
+		</div>
+		
+		@if($planType == 'COMMERCIAL' && $cpc->mcr_number)
+		<div class="form-group">
+			<label for="" class="control-label">Manual Medicare Is Matched</label>
+			<select name="manualMedicareIsMatched" class="form-control input-sm">
+				<option value="">--select--</option>
+				<option value="YES">Yes</option>
+				<option value="NO">No</option>
+				<option value="UNKNOWN">Unknown</option>
+			</select>
+		</div>
+		@endif
+		@if($planType == 'MEDICARE' || ($planType == 'COMMERCIAL' && $cpc->mcr_number ) ) <!-- and manualMedicareIsMatched  -->
+		<div class="form-group">
+			<label for="" class="control-label">Manual Medicare Is Part B Active</label>
+			<select name="manualMedicareIsPartBActive" class="form-control input-sm">
+				<option value="">--select--</option>
+				<option value="YES">Yes</option>
+				<option value="NO">No</option>
+				<option value="UNKNOWN">Unknown</option>
+			</select>
+		</div>
+		<div class="form-group">
+			<label for="" class="control-label">Manual Medicare Is Part B Primary</label>
+			<select name="manualMedicareIsPartBPrimary" class="form-control input-sm">
+				<option value="">--select--</option>
+				<option value="YES">Yes</option>
+				<option value="NO">No</option>
+				<option value="UNKNOWN">Unknown</option>
+			</select>
+		</div>
+		<div class="form-group">
+			<label for="" class="control-label">Manual Medicare Is Part C Active</label>
+			<select name="manualMedicareIsPartCActive" class="form-control input-sm">
+				<option value="">--select--</option>
+				<option value="YES">Yes</option>
+				<option value="NO">No</option>
+				<option value="UNKNOWN">Unknown</option>
+			</select>
+		</div>
+		<div class="form-group">
+			<label for="" class="control-label">Manual Medicare Is Inpatient</label>
+			<select name="manualMedicareIsInpatient" class="form-control input-sm">
+				<option value="">--select--</option>
+				<option value="YES">Yes</option>
+				<option value="NO">No</option>
+				<option value="UNKNOWN">Unknown</option>
+			</select>
+		</div>
+		<div class="form-group">
+			<label for="" class="control-label">Manual Medicare Is Hospice Or Home Health</label>
+			<select name="manualMedicareIsHospiceOrHomeHealth" class="form-control input-sm">
+				<option value="">--select--</option>
+				<option value="YES">Yes</option>
+				<option value="NO">No</option>
+				<option value="UNKNOWN">Unknown</option>
+			</select>
+		</div>
+		<div class="form-group">
+			<label for="" class="control-label">Manual Medicare Is Msp</label>
+			<select name="manualMedicareIsMsp" class="form-control input-sm">
+				<option value="">--select--</option>
+				<option value="YES">Yes</option>
+				<option value="NO">No</option>
+				<option value="UNKNOWN">Unknown</option>
+			</select>
+		</div>
+		<div class="form-group">
+			<label for="" class="control-label">Manual Medicare Msp Memo</label>
+			<textarea name="manualMedicareMspMemo" class="form-control"></textarea>
+		</div>
+		@endif
+		@if($planType == 'COMMERCIAL' && $cpc->mcd_number)
+		<div class="form-group">
+			<label for="" class="control-label">Manual Medicaid Is Matched</label>
+			<select name="manualMedicaidIsMatched" class="form-control input-sm">
+				<option value="">--select--</option>
+				<option value="YES">Yes</option>
+				<option value="NO">No</option>
+				<option value="UNKNOWN">Unknown</option>
+			</select>
+		</div>
+		@endif
+		
+		<div class="form-group text-nowrap mb-0">
+			<button class="btn btn-sm btn-primary" submit>Submt</button>
+			<button class="btn btn-sm btn-default border" cancel>Close</button>
+		</div>
+	</form>
+</div>

resources/views/app/patient/primary-coverage-new.blade.php

@@ -0,0 +1,130 @@
+<div moe relative large>
+	<a href="" start show>
+		@if($planType == 'MEDICARE')
+		+ Medicare Part B (Primary)
+		@elseif($planType == 'MEDICAID')
+		+ Medicaid
+		@elseif($planType == 'COMMERCIAL')
+		+ Commercial
+		@endif
+	</a>
+	<form url="/api/clientPrimaryCoverage/createNewCoverageForMedicare" right class="mcp-theme-1">
+		<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
+
+		<div class="form-group">
+			<label class="control-label">Patient Name First</label>
+			<input type="text" name="patientNameFirst" value="{{$patient->name_first}}" class="form-control input-sm">
+		</div>
+		<div class="form-group">
+			<label class="control-label">Patient Name Middle</label>
+			<input type="text" name="patientNameMiddle" value="{{$patient->name_middle}}" class="form-control input-sm">
+		</div>
+		<div class="form-group">
+			<label class="control-label">Patient Name Last</label>
+			<input type="text" name="patientNameLast" value="{{$patient->name_last}}" class="form-control input-sm">
+		</div>
+		<div class="form-group">
+			<label class="control-label">Patient Name Suffix</label>
+			<input type="text" name="patientNameSuffix" value="{{$patient->name_suffix}}" class="form-control input-sm">
+		</div>
+		<div class="form-group">
+			<label class="control-label">Patient Sex</label>
+			<input type="text" name="patientSex" value="{{$patient->sex}}" class="form-control input-sm">
+		</div>
+		<div class="form-group">
+			<label class="control-label">Patient Dob</label>
+			<input type="text" name="patientDob" value="{{$patient->dob}}" class="form-control input-sm">
+		</div>
+		<div class="form-group">
+			<label class="control-label">
+				<input type="checkbox" name="isPatientSubscriber">
+				Is Patient Subscriber
+			</label>
+		</div>
+		<div class="form-group">
+			<label class="control-label">Patient Relationship To Subscriber</label>
+			<select name="patientRelationshipToSubscriber" class="form-control input-sm">
+				<option value="">--</option>
+				<option value="SELF">Self</option>
+				<option value="SPOUSE">Spouse</option>
+				<option value="CHILD">Child</option>
+				<option value="EMPLOYEE">Employee</option>
+				<option value="ORGAN_DONOR">Organ Donor</option>
+				<option value="CADAVER_DONOR">Cadaver Donor</option>
+				<option value="LIFE_PARTNER">Life Partner</option>
+				<option value="OTHER_RELATIONSHIP">Other Relationship</option>
+				<option value="UNKNOWN">Unknown</option>
+			</select>
+		</div>
+		<div class="form-group">
+			<label class="control-label">Subscriber Name First</label>
+			<input type="text" name="subscriberNameFirst" value="{{$patient->name_first}}" class="form-control input-sm">
+		</div>
+		<div class="form-group">
+			<label class="control-label">Subscriber Name Middle</label>
+			<input type="text" name="subscriberNameMiddle" value="{{$patient->name_middle}}" class="form-control input-sm">
+		</div>
+		<div class="form-group">
+			<label class="control-label">Subscriber Name Last</label>
+			<input type="text" name="subscriberNameLast" value="{{$patient->name_last}}" class="form-control input-sm">
+		</div>
+		<div class="form-group">
+			<label class="control-label">Subscriber Name Suffix</label>
+			<input type="text" name="subscriberNameSuffix" value="{{$patient->name_suffix}}" class="form-control input-sm">
+		</div>
+		<div class="form-group">
+			<label class="control-label">Subscriber Sex</label>
+			<input type="text" name="subscriberSex" value="{{$patient->sex}}" class="form-control input-sm">
+		</div>
+		<div class="form-group">
+			<label class="control-label">Subscriber Dob</label>
+			<input type="date" name="subscriberDob" value="{{$patient->dob}}" class="form-control input-sm">
+		</div>
+		<div class="form-group">
+			<label class="control-label">Date Of Service</label>
+			<input type="date" name="dateOfService" value="{{date('Y-m-d')}}" class="form-control input-sm">
+		</div>
+
+		@if($planType == 'MEDICARE' || $planType == 'COMMERCIAL')
+		<div class="form-group">
+			<label class="control-label">Medicare Number</label>
+			<input type="text" name="mcrNumber" class="form-control input-sm">
+		</div>
+		@endif
+
+		@if($planType == 'MEDICAID' || $planType == 'COMMERCIAL')
+		<div class="form-group">
+			<label class="control-label">Medicaid Number</label>
+			<input type="text" name="mcdNumber"  class="form-control input-sm">
+		</div>
+		<div class="form-group">
+			<label for="" class="control-label">Medicaid Payer</label>
+			<select name="mcdPayerUid" id="" class="form-control input-sm">
+				<option value="">--</option>
+			</select>
+		</div>
+		@endif
+
+		@if($planType == 'COMMERCIAL')
+		<div class="form-group">
+			<label for="" class="control-label">Commercial Payer</label>
+			<select name="commercialPayerUid" id="" class="form-control input-sm">
+				<option value="">--</option>
+			</select>
+		</div>
+		<div class="form-group">
+			<label class="control-label">Commercial Member Identifier</label>
+			<input type="text" name="commercialMemberIdentifier"  class="form-control input-sm">
+		</div>
+		<div class="form-group">
+			<label class="control-label">Commercial Group Number</label>
+			<input type="text" name="commercialGroupNumber"  class="form-control input-sm">
+		</div>
+		@endif
+
+		<div class="form-group text-nowrap mb-0">
+			<button class="btn btn-sm btn-primary" submit>Submt</button>
+			<button class="btn btn-sm btn-default border" cancel>Close</button>
+		</div>
+	</form>
+</div>

resources/views/app/patient/primary-coverage-refresh.blade.php

@@ -0,0 +1,14 @@
+<div moe relative>
+	<a href="" start show class="">Refresh</a>
+
+	<form url="/api/clientPrimaryCoverage/{{$endpoint}}" class="mcp-theme-1">
+		<input type="hidden" name="uid" value="{{$cpc->uid}}" class="form-control input-sm" />
+		<div class="form-group">
+			<p>Refresh?</p>
+		</div>
+		<div class="form-group text-nowrap mb-0">
+			<button class="btn btn-sm btn-primary" submit>Submt</button>
+			<button class="btn btn-sm btn-default border" cancel>Close</button>
+		</div>
+	</form>
+</div>

resources/views/app/patient/primary-coverage.blade.php

@@ -1,837 +1,57 @@
 @extends ('layouts.patient')
 
 @section('inner-content')
-
-        <div class="d-flex align-items-baseline">
-            <h4 class="font-weight-bold m-0 font-size-16 text-nowrap">Client Latest Coverage</h4>
-            <div class="ml-4 d-inline-flex justify-content-center">
-                <div moe relative large>
-                    <a href="" start show>+ Medicare Part B (Primary)</a>
-                    <form url="/api/clientPrimaryCoverage/createNewCoverageForMedicareWithoutManualDetermination" right class="mcp-theme-1">
-                        <input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
-                        <div class="form-group">
-                            <label class="control-label">Subscriber Name First</label>
-                            <input type="text" name="subscriberNameFirst" class="form-control input-sm" value="{{$patient->name_first}}" />
-                        </div>
-                        <div class="form-group">
-                            <label class="control-label">Subscriber Name Last</label>
-                            <input type="text" name="subscriberNameLast" class="form-control input-sm" value="{{$patient->name_last}}" />
-                        </div>
-                        <div class="form-group">
-                            <label class="control-label">Subscriber Dob</label>
-                            <input type="date" name="subscriberDob" class="form-control input-sm" value="{{$patient->dob}}" />
-                        </div>
-                        <div class="form-group">
-                            <label class="control-label">Medicare Number</label>
-                            <input type="text" name="payerMemberIdentifier" class="form-control input-sm" />
-                        </div>
-                        <div class="form-group">
-                            <label class="control-label">Date Of Service</label>
-                            <input type="date" name="dateOfService" class="form-control input-sm" value="{{date('Y-m-d')}}" />
-                        </div>
-                        <div class="form-group text-nowrap mb-0">
-                            <button class="btn btn-sm btn-primary" submit>Submt</button>
-                            <button class="btn btn-sm btn-default border" cancel>Close</button>
-                        </div>
-                    </form>
-                </div>
+<div class="d-flex align-items-baseline">
+    <h4 class="font-weight-bold m-0 font-size-16 text-nowrap">Client Latest Coverage</h4>
+    <div class="ml-4 d-inline-flex justify-content-center">
+        @include('app.patient.primary-coverage-new', ['planType' => 'MEDICARE'])
+        <span class="mx-2 text-secondary text-sm">|</span>
+        @include('app.patient.primary-coverage-new', ['planType' => 'MEDICAID'])
+        <span class="mx-2 text-secondary text-sm">|</span>
+        @include('app.patient.primary-coverage-new', ['planType' => 'COMMERCIAL'])
+    </div>
+</div>
+
+<div class="mt-2 pt-2">
+    @php
+        $cpc = $patient->latestClientPrimaryCoverage;
+    @endphp
+</div>
+    @if(!$cpc)
+        <div class="alert alert-info">No coverage for this client</div>
+    @else
+        @php
+            $cpc->auto_detail_json = json_decode($cpc->auto_detail_json);
+        @endphp
+        <div class="d-flex mb-2">
+            @if($cpc->plan_type == 'MEDICARE')
+                @include('app.patient.primary-coverage-refresh', ['endpoint'=>'refreshCoverageForMedicare'])
                 <span class="mx-2 text-secondary text-sm">|</span>
-                <div moe relative large>
-                    <a href="" start show >+ Medicaid</a>
-                    <form url="/api/clientPrimaryCoverage/createNewCoverageForMedicaidWithoutManualDetermination" right class="mcp-theme-1">
-                        <input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
-                        <div class="form-group">
-                            <label for="" class="control-label">Subscriber Name First</label>
-                            <input type="text" name="subscriberNameFirst" class="form-control input-sm" value="{{$patient->name_first}}">
-                        </div>
-                        <div class="form-group">
-                            <label for="" class="control-label">Subscriber Name Last</label>
-                            <input type="text" name="subscriberNameLast" class="form-control input-sm" value="{{$patient->name_last}}">
-                        </div>
-                        <div class="form-group">
-                            <label for="" class="control-label">Subscriber Dob</label>
-                            <input type="date" name="subscriberDob" class="form-control input-sm" value="{{$patient->dob}}">
-                        </div>
-                        <div class="form-group">
-                            <label for="" class="control-label">Subscriber Sex</label>
-                            <select  name="subscriberSex" class="form-control input-sm">
-                                <option value="">--select--</option>
-                                <option value="M" {{$patient->sex === 'M' ? 'selected' : ''}}>M</option>
-                                <option value="F" {{$patient->sex === 'F' ? 'selected' : ''}}>F</option>
-                            </select>
-                        </div>
-                        <div class="form-group">
-                            <label for="" class="control-label">Payer Name</label>
-                            <select name="payerName" class="form-control input-sm">
-                                <option value="">--</option>
-                                <option>MEDICAID ALABAMA</option>
-                                <option>MEDICAID ALASKA</option>
-                                <option>MEDICAID ARIZONA</option>
-                                <option>MEDICAID ARIZONA (AHCCCS)</option>
-                                <option>MEDICAID ARKANSAS</option>
-                                <option>MEDICAID CALIFORNIA MEDI-CAL</option>
-                                <option>MEDICAID CALIFORNIA MEDI-CAL (VISION)</option>
-                                <option>MEDICAID COLORADO</option>
-                                <option>MEDICAID CONNECTICUT</option>
-                                <option>MEDICAID DELAWARE</option>
-                                <option>MEDICAID DISTRICT OF COLUMBIA</option>
-                                <option>MEDICAID FLORIDA</option>
-                                <option>MEDICAID GEORGIA</option>
-                                <option>MEDICAID HAWAII</option>
-                                <option>MEDICAID IA</option>
-                                <option>MEDICAID IDAHO</option>
-                                <option>MEDICAID ILLINOIS</option>
-                                <option>MEDICAID ILLINOIS IDPA</option>
-                                <option>MEDICAID INDIANA</option>
-                                <option>MEDICAID IOWA</option>
-                                <option>MEDICAID KANSAS</option>
-                                <option>MEDICAID KENTUCKY</option>
-                                <option>MEDICAID LOUISIANA</option>
-                                <option>MEDICAID LOUISIANA AMBULANCE CLAIMS</option>
-                                <option>MEDICAID LOUISIANA DME CLAIMS</option>
-                                <option>MEDICAID LOUISIANA HOME HEALTH</option>
-                                <option>MEDICAID LOUISIANA KIDMED CLAIMS</option>
-                                <option>MEDICAID MAINE</option>
-                                <option>MEDICAID MARYLAND</option>
-                                <option>MEDICAID MARYLAND DHMH</option>
-                                <option>MEDICAID MASSACHUSETTS</option>
-                                <option>MEDICAID MICHIGAN</option>
-                                <option>MEDICAID MICHIGAN (BCCCP)</option>
-                                <option>MEDICAID MICHIGAN ENCOUNTERS</option>
-                                <option>MEDICAID MINNESOTA</option>
-                                <option>MEDICAID MISSISSIPPI</option>
-                                <option>MEDICAID MISSOURI</option>
-                                <option>MEDICAID MONTANA</option>
-                                <option>MEDICAID NEBRASKA</option>
-                                <option>MEDICAID NEVADA</option>
-                                <option>MEDICAID NEW HAMPSHIRE</option>
-                                <option>MEDICAID NEW JERSEY</option>
-                                <option>MEDICAID NEW MEXICO</option>
-                                <option>MEDICAID NEW MEXICO PRESBYTERIAN SALUD</option>
-                                <option>MEDICAID NEW YORK</option>
-                                <option>MEDICAID NEW YORK (EMEDNY TEST SYSTEM)</option>
-                                <option>MEDICAID NORTH CAROLINA</option>
-                                <option>MEDICAID NORTH DAKOTA</option>
-                                <option>MEDICAID OHIO</option>
-                                <option>MEDICAID OKLAHOMA</option>
-                                <option>MEDICAID OREGON</option>
-                                <option>MEDICAID OREGON (DHS OMAP)</option>
-                                <option>MEDICAID PENNSYLVANIA</option>
-                                <option>MEDICAID RHODE ISLAND</option>
-                                <option>MEDICAID SOUTH CAROLINA</option>
-                                <option>MEDICAID SOUTH DAKOTA</option>
-                                <option>MEDICAID TENNESSEE</option>
-                                <option>MEDICAID TENNESSEE BLUECARE TENNCARE SELECT</option>
-                                <option>MEDICAID TEXAS</option>
-                                <option>MEDICAID TEXAS AND TEXAS HEALTH STEPS</option>
-                                <option>MEDICAID TEXAS HEALTH STEPS</option>
-                                <option>MEDICAID TEXAS LTC</option>
-                                <option>MEDICAID TEXAS PREMIER PLAN</option>
-                                <option>MEDICAID UNITED STATES VIRGIN ISLANDS</option>
-                                <option>MEDICAID UTAH</option>
-                                <option>MEDICAID VERMONT</option>
-                                <option>MEDICAID VIRGINIA</option>
-                                <option>MEDICAID WASHINGTON (PROVIDER ONE)</option>
-                                <option>MEDICAID WEST VIRGINIA</option>
-                                <option>MEDICAID WISCONSIN</option>
-                                <option>MEDICAID WYOMING</option>
-                            </select>
-                        </div>
-                        <div class="form-group">
-                            <label for="" class="control-label">Medicaid Number</label>
-                            <input type="String" name="payerMemberIdentifier" class="form-control input-sm">
-                        </div>
-                        <div class="form-group">
-                            <label for="" class="control-label">Date Of Service</label>
-                            <input type="date" name="dateOfService" class="form-control input-sm" value="{{date('Y-m-d')}}">
-                        </div>
-
-                        <div class="form-group text-nowrap mb-0">
-                            <button class="btn btn-sm btn-primary" submit>Submt</button>
-                            <button class="btn btn-sm btn-default border" cancel>Close</button>
-                        </div>
-                    </form>
-                </div>
+                @include('app.patient.primary-coverage-manual-determination', ['planType' => 'MEDICARE'])
+            @endif
+            @if($cpc->plan_type == 'MEDICAID')
+                @include('app.patient.primary-coverage-refresh', ['endpoint'=>'refreshCoverageForMedicaid'])
                 <span class="mx-2 text-secondary text-sm">|</span>
-                <div moe relative large>
-                    <a href="" start show >+ Commercial</a>
-                    <form url="/api/clientPrimaryCoverage/createNewCoverageForCommercialWithoutManualDetermination" right class="mcp-theme-1">
-                        <input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
-                        <div class="form-group">
-                            <label class="control-label">Subscriber Name First</label>
-                            <input type="text" name="subscriberNameFirst" class="form-control input-sm" value="{{$patient->name_first}}">
-                        </div>
-                        <div class="form-group">
-                            <label class="control-label">Subscriber Name Last</label>
-                            <input type="text" name="subscriberNameLast" class="form-control input-sm" value="{{$patient->name_last}}">
-                        </div>
-                        <div class="form-group">
-                            <label class="control-label">Subscriber Dob</label>
-                            <input type="date" name="subscriberDob" class="form-control input-sm" value="{{$patient->dob}}">
-                        </div>
-                        <div class="form-group">
-                            <label for="" class="control-label">Subscriber Sex</label>
-                            <select  name="subscriberSex" class="form-control input-sm">
-                                <option value="">--select--</option>
-                                <option value="M" {{$patient->sex === 'M' ? 'selected' : ''}}>M</option>
-                                <option value="F" {{$patient->sex === 'F' ? 'selected' : ''}}>F</option>
-                            </select>
-                        </div>
-                        <div class="form-group">
-                            <label class="control-label">Payer Name</label>
-                            <input type="text" name="payerName" class="form-control input-sm">
-                        </div>
-                        <div class="form-group">
-                            <label class="control-label">Payer Member Identifier</label>
-                            <input type="text" name="payerMemberIdentifier" class="form-control input-sm">
-                        </div>
-                        <div class="form-group">
-                            <label class="control-label">Date Of Service</label>
-                            <input type="date" name="dateOfService" class="form-control input-sm" value="{{date('Y-m-d')}}">
-                        </div>
-
-                        <div class="form-group text-nowrap mb-0">
-                            <button class="btn btn-sm btn-primary" submit>Submt</button>
-                            <button class="btn btn-sm btn-default border" cancel>Close</button>
-                        </div>
-                    </form>
-                </div>
+                @include('app.patient.primary-coverage-manual-determination', ['planType' => 'MEDICAID'])
+            @endif
+            @if($cpc->plan_type == 'COMMERCIAL')
+                @include('app.patient.primary-coverage-refresh', ['endpoint'=>'refreshCoverageForCommercial'])
                 <span class="mx-2 text-secondary text-sm">|</span>
-                <div moe relative large>
-                    <a href="" start show >+ Medicare Advantage (Part C Primary)</a>
-                    <form url="/api/clientPrimaryCoverage/createNewCoverageForMcrAdvWithoutManualDetermination" right class="mcp-theme-1">
-                        <input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
-                        <div class="form-group">
-                            <label class="control-label">Subscriber Name First</label>
-                            <input type="text" name="subscriberNameFirst" class="form-control input-sm" value="{{$patient->name_first}}">
-                        </div>
-                        <div class="form-group">
-                            <label class="control-label">Subscriber Name Last</label>
-                            <input type="text" name="subscriberNameLast" class="form-control input-sm" value="{{$patient->name_last}}">
-                        </div>
-                        <div class="form-group">
-                            <label class="control-label">Subscriber Dob</label>
-                            <input type="date" name="subscriberDob" class="form-control input-sm" value="{{$patient->dob}}">
-                        </div>
-                        <div class="form-group">
-                            <label for="" class="control-label">Subscriber Sex</label>
-                            <select  name="subscriberSex" class="form-control input-sm">
-                                <option value="">--select--</option>
-                                <option value="M" {{$patient->sex === 'M' ? 'selected' : ''}}>M</option>
-                                <option value="F" {{$patient->sex === 'F' ? 'selected' : ''}}>F</option>
-                            </select>
-                        </div>
-                        <div class="form-group">
-                            <label class="control-label">Payer Member Identifier</label>
-                            <input type="text" name="payerMemberIdentifier" class="form-control input-sm">
-                        </div>
-                        <div class="form-group">
-                            <label class="control-label">Medicare Number</label>
-                            <input type="text" name="mcrNumber" class="form-control input-sm">
-                        </div>
-                        <div class="form-group">
-                            <label class="control-label">Date Of Service</label>
-                            <input type="date" name="dateOfService" class="form-control input-sm" value="{{date('Y-m-d')}}">
-                        </div>
-
-                        <div class="form-group text-nowrap mb-0">
-                            <button class="btn btn-sm btn-primary" submit>Submt</button>
-                            <button class="btn btn-sm btn-default border" cancel>Close</button>
-                        </div>
-                    </form>
-                </div>
-                <span class="mx-2 text-secondary text-sm">|</span>
-                <div moe relative large>
-                    <a href="" start show >+ Medicaid MCO</a>
-                    <form url="/api/clientPrimaryCoverage/createNewCoverageForMcdMcoWithoutManualDetermination" right class="mcp-theme-1">
-                        <input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
-                        <div class="form-group">
-                            <label class="control-label">Subscriber Name First</label>
-                            <input type="text" name="subscriberNameFirst" class="form-control input-sm" value="{{$patient->name_first}}">
-                        </div>
-                        <div class="form-group">
-                            <label class="control-label">Subscriber Name Last</label>
-                            <input type="text" name="subscriberNameLast" class="form-control input-sm" value="{{$patient->name_last}}">
-                        </div>
-                        <div class="form-group">
-                            <label class="control-label">Subscriber Dob</label>
-                            <input type="date" name="subscriberDob" class="form-control input-sm" value="{{$patient->dob}}">
-                        </div>
-                        <div class="form-group">
-                            <label for="" class="control-label">Subscriber Sex</label>
-                            <select  name="subscriberSex" class="form-control input-sm">
-                                <option value="">--select--</option>
-                                <option value="M" {{$patient->sex === 'M' ? 'selected' : ''}}>M</option>
-                                <option value="F" {{$patient->sex === 'F' ? 'selected' : ''}}>F</option>
-                            </select>
-                        </div>
-
-                        <div class="form-group">
-                            <label class="control-label">Payer Member Identifier</label>
-                            <input type="text" name="payerMemberIdentifier" class="form-control input-sm">
-                        </div>
-                        <div class="form-group">
-                            <label class="control-label">Medicaid Number</label>
-                            <input type="text" name="mcdNumber" class="form-control input-sm">
-                        </div>
-                        <div class="form-group">
-                            <label class="control-label">Medicaid State</label>
-                            <select name="mcdState" class="form-control input-sm">
-                                <option value="">--</option>
-                                <option>MEDICAID ALABAMA</option>
-                                <option>MEDICAID ALASKA</option>
-                                <option>MEDICAID ARIZONA</option>
-                                <option>MEDICAID ARIZONA (AHCCCS)</option>
-                                <option>MEDICAID ARKANSAS</option>
-                                <option>MEDICAID CALIFORNIA MEDI-CAL</option>
-                                <option>MEDICAID CALIFORNIA MEDI-CAL (VISION)</option>
-                                <option>MEDICAID COLORADO</option>
-                                <option>MEDICAID CONNECTICUT</option>
-                                <option>MEDICAID DELAWARE</option>
-                                <option>MEDICAID DISTRICT OF COLUMBIA</option>
-                                <option>MEDICAID FLORIDA</option>
-                                <option>MEDICAID GEORGIA</option>
-                                <option>MEDICAID HAWAII</option>
-                                <option>MEDICAID IA</option>
-                                <option>MEDICAID IDAHO</option>
-                                <option>MEDICAID ILLINOIS</option>
-                                <option>MEDICAID ILLINOIS IDPA</option>
-                                <option>MEDICAID INDIANA</option>
-                                <option>MEDICAID IOWA</option>
-                                <option>MEDICAID KANSAS</option>
-                                <option>MEDICAID KENTUCKY</option>
-                                <option>MEDICAID LOUISIANA</option>
-                                <option>MEDICAID LOUISIANA AMBULANCE CLAIMS</option>
-                                <option>MEDICAID LOUISIANA DME CLAIMS</option>
-                                <option>MEDICAID LOUISIANA HOME HEALTH</option>
-                                <option>MEDICAID LOUISIANA KIDMED CLAIMS</option>
-                                <option>MEDICAID MAINE</option>
-                                <option>MEDICAID MARYLAND</option>
-                                <option>MEDICAID MARYLAND DHMH</option>
-                                <option>MEDICAID MASSACHUSETTS</option>
-                                <option>MEDICAID MICHIGAN</option>
-                                <option>MEDICAID MICHIGAN (BCCCP)</option>
-                                <option>MEDICAID MICHIGAN ENCOUNTERS</option>
-                                <option>MEDICAID MINNESOTA</option>
-                                <option>MEDICAID MISSISSIPPI</option>
-                                <option>MEDICAID MISSOURI</option>
-                                <option>MEDICAID MONTANA</option>
-                                <option>MEDICAID NEBRASKA</option>
-                                <option>MEDICAID NEVADA</option>
-                                <option>MEDICAID NEW HAMPSHIRE</option>
-                                <option>MEDICAID NEW JERSEY</option>
-                                <option>MEDICAID NEW MEXICO</option>
-                                <option>MEDICAID NEW MEXICO PRESBYTERIAN SALUD</option>
-                                <option>MEDICAID NEW YORK</option>
-                                <option>MEDICAID NEW YORK (EMEDNY TEST SYSTEM)</option>
-                                <option>MEDICAID NORTH CAROLINA</option>
-                                <option>MEDICAID NORTH DAKOTA</option>
-                                <option>MEDICAID OHIO</option>
-                                <option>MEDICAID OKLAHOMA</option>
-                                <option>MEDICAID OREGON</option>
-                                <option>MEDICAID OREGON (DHS OMAP)</option>
-                                <option>MEDICAID PENNSYLVANIA</option>
-                                <option>MEDICAID RHODE ISLAND</option>
-                                <option>MEDICAID SOUTH CAROLINA</option>
-                                <option>MEDICAID SOUTH DAKOTA</option>
-                                <option>MEDICAID TENNESSEE</option>
-                                <option>MEDICAID TENNESSEE BLUECARE TENNCARE SELECT</option>
-                                <option>MEDICAID TEXAS</option>
-                                <option>MEDICAID TEXAS AND TEXAS HEALTH STEPS</option>
-                                <option>MEDICAID TEXAS HEALTH STEPS</option>
-                                <option>MEDICAID TEXAS LTC</option>
-                                <option>MEDICAID TEXAS PREMIER PLAN</option>
-                                <option>MEDICAID UNITED STATES VIRGIN ISLANDS</option>
-                                <option>MEDICAID UTAH</option>
-                                <option>MEDICAID VERMONT</option>
-                                <option>MEDICAID VIRGINIA</option>
-                                <option>MEDICAID WASHINGTON (PROVIDER ONE)</option>
-                                <option>MEDICAID WEST VIRGINIA</option>
-                                <option>MEDICAID WISCONSIN</option>
-                                <option>MEDICAID WYOMING</option>
-                            </select>
-                        </div>
-                        <div class="form-group">
-                            <label class="control-label">Date Of Service</label>
-                            <input type="date" name="dateOfService" class="form-control input-sm" value="{{date('Y-m-d')}}">
-                        </div>
-
-                        <div class="form-group text-nowrap mb-0">
-                            <button class="btn btn-sm btn-primary" submit>Submt</button>
-                            <button class="btn btn-sm btn-default border" cancel>Close</button>
-                        </div>
-                    </form>
-                </div>
-            </div>
-
+                @include('app.patient.primary-coverage-manual-determination', ['planType' => 'COMMERCIAL'])
+            @endif
         </div>
 
-        <div class="mt-2 pt-2">
-            @php
-                $cpc = $patient->latestClientPrimaryCoverage;
-            @endphp
-        </div>
-        @if(!$cpc)
-        <div class="alert alert-info">No coverage for this client</div>
-        @else
-            @php
-                $cpc->auto_detail_json = json_decode($cpc->auto_detail_json);
-            @endphp
-        <div class="d-flex mb-2">
-                @if($cpc->plan_type == 'MEDICARE')
-                    <div moe relative>
-                        <a href="" start show class="">Refresh</a>
-
-                        <form url="/api/clientPrimaryCoverage/refreshCoverageForMedicare" class="mcp-theme-1">
-                            <input type="hidden" name="uid" value="{{$cpc->uid}}" class="form-control input-sm" />
-                            <div class="form-group">
-                                <p>Refresh?</p>
-                            </div>
-                            <div class="form-group text-nowrap mb-0">
-                                <button class="btn btn-sm btn-primary" submit>Submt</button>
-                                <button class="btn btn-sm btn-default border" cancel>Close</button>
-                            </div>
-                        </form>
-                    </div>
-                <span class="mx-2 text-secondary text-sm">|</span>
-                <div moe relative large>
-                        <a href="" start show class="">Manual Determination</a>
-
-                        <form url="/api/clientPrimaryCoverage/manualDeterminationForMedicare" class="mcp-theme-1">
-                            <input type="hidden" name="uid" value="{{$cpc->uid}}" class="form-control input-sm" />
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Determination Strategy</label>
-                                <select  name="manualDeterminationStrategy" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="REVIEWED_ELECTRONIC">Reviewed electronic</option>
-                                    <option value="CALLED_PAYER">Called payer</option>
-                                </select>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Determination Category</label>
-                                <select  name="manualDeterminationCategory" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="COVERED">Covered</option>
-                                    <option value="NOT_COVERED">Not Covered</option>
-                                    <option value="INVALID">Invalid</option>
-                                    <option value="UNKNOWN">Unknown</option>
-                                </select>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Determination Category Memo</label>
-                                <input type="text" name="manualDeterminationCategoryMemo" class="form-control input-sm"/>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Detail Json</label>
-                                <input type="text" name="manualDetailJson" class="form-control input-sm"/>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Medicare Is Part B Primary</label>
-                                <select  name="manualMedicareIsPartBPrimary" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="YES">Yes</option>
-                                    <option value="NO">No</option>
-                                    <option value="UNKNOWN">Unknown</option>
-                                </select>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Medicare Is Part B Active</label>
-                                <select  name="manualMedicareIsPartBActive" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="YES">Yes</option>
-                                    <option value="NO">No</option>
-                                    <option value="UNKNOWN">Unknown</option>
-                                </select>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Medicare Is Part C Active</label>
-                                <select  name="manualMedicareIsPartCActive" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="YES">Yes</option>
-                                    <option value="NO">No</option>
-                                    <option value="UNKNOWN">Unknown</option>
-                                </select>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Medicare Is Inpatient</label>
-                                <select  name="manualMedicareIsInpatient" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="YES">Yes</option>
-                                    <option value="NO">No</option>
-                                    <option value="UNKNOWN">Unknown</option>
-                                </select>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Medicare Is Hospice Or Home Health</label>
-                                <select  name="manualMedicareIsHospiceOrHomeHealth" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="YES">Yes</option>
-                                    <option value="NO">No</option>
-                                    <option value="UNKNOWN">Unknown</option>
-                                </select>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Medicare Is Msp</label>
-                                <select  name="manualMedicareIsMsp" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="YES">Yes</option>
-                                    <option value="NO">No</option>
-                                    <option value="UNKNOWN">Unknown</option>
-                                </select>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Medicare Msp Memo</label>
-                                <select  name="manualMedicareMspMemo" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="YES">Yes</option>
-                                    <option value="NO">No</option>
-                                    <option value="UNKNOWN">Unknown</option>
-                                </select>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Medicare Mpb Start Date</label>
-                                <input type="date" name="manualMedicareMpbStartDate" class="form-control input-sm"/>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Medicare Mpb End Date</label>
-                                <input type="date" name="manualMedicareMpbEndDate" class="form-control input-sm"/>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Medicare Mpb Deductible</label>
-                                <input type="number" name="manualMedicareMpbDeductible" class="form-control input-sm"/>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Medicare Mpb Remaining</label>
-                                <input type="number" name="manualMedicareMpbRemaining" class="form-control input-sm"/>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Medicare Mpb Insurance Type</label>
-                                <input type="text" name="manualMedicareMpbInsuranceType" class="form-control input-sm"/>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Medicare Mpb Insurance Type Label</label>
-                                <input type="text" name="manualMedicareMpbInsuranceTypeLabel" class="form-control input-sm"/>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Medicare Mpb Coinsurance Percent</label>
-                                <input type="number" name="manualMedicareMpbCoinsurancePercent" class="form-control input-sm"/>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Medicare Mpb Info Valid Until</label>
-                                <input type="date" name="manualMedicareMpbInfoValidUntil" class="form-control input-sm"/>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Medicare Mpb Info Valid Till</label>
-                                <input type="date" name="manualMedicareMpbInfoValidTill" class="form-control input-sm"/>
-                            </div>
-                            <div class="form-group text-nowrap mb-0">
-                                <button class="btn btn-sm btn-primary" submit>Submt</button>
-                                <button class="btn btn-sm btn-default border" cancel>Close</button>
-                            </div>
-                        </form>
-                    </div>
-                @endif
-                @if($cpc->plan_type == 'MEDICAID')
-                    <div moe relative>
-                        <a href="" start show class="">Refresh</a>
-
-                        <form url="/api/clientPrimaryCoverage/refreshCoverageForMedicaid" class="mcp-theme-1">
-                            <input type="hidden" name="uid" value="{{$cpc->uid}}" class="form-control input-sm" />
-                            <div class="form-group">
-                                <p>Refresh?</p>
-                            </div>
-                            <div class="form-group text-nowrap mb-0">
-                                <button class="btn btn-sm btn-primary" submit>Submt</button>
-                                <button class="btn btn-sm btn-default border" cancel>Close</button>
-                            </div>
-                        </form>
-                    </div>
-                        <span class="mx-2 text-secondary text-sm">|</span>
-                    <div moe relative large>
-                        <a href="" start show class="">Manual Determination</a>
-
-                        <form url="/api/clientPrimaryCoverage/manualDeterminationForMedicaid" class="mcp-theme-1">
-                            <input type="hidden" name="uid" value="{{$cpc->uid}}" class="form-control input-sm" />
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Determination Strategy</label>
-                                <select  name="manualDeterminationStrategy" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="REVIEWED_ELECTRONIC">Reviewed electronic</option>
-                                    <option value="CALLED_PAYER">Called payer</option>
-                                </select>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Determination Category</label>
-                                <select  name="manualDeterminationCategory" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="COVERED">Covered</option>
-                                    <option value="NOT_COVERED">Not Covered</option>
-                                    <option value="INVALID">Invalid</option>
-                                    <option value="UNKNOWN">Unknown</option>
-                                </select>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Determination Category Memo</label>
-                                <input type="text" name="manualDeterminationCategoryMemo" class="form-control input-sm"/>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Detail Json</label>
-                                <input type="text" name="manualDetailJson" class="form-control input-sm"/>
-                            </div>
-
-
-                            <div class="form-group text-nowrap mb-0">
-                                <button class="btn btn-sm btn-primary" submit>Submt</button>
-                                <button class="btn btn-sm btn-default border" cancel>Close</button>
-                            </div>
-                        </form>
-                    </div>
-                @endif
-                @if($cpc->plan_type == 'COMMERCIAL')
-                    <div moe relative>
-                        <a href="" start show class="">Refresh</a>
-
-                        <form url="/api/clientPrimaryCoverage/refreshCoverageForCommercial" class="mcp-theme-1">
-                            <input type="hidden" name="uid" value="{{$cpc->uid}}" class="form-control input-sm" />
-                            <div class="form-group">
-                                <p>Refresh?</p>
-                            </div>
-                            <div class="form-group text-nowrap mb-0">
-                                <button class="btn btn-sm btn-primary" submit>Submt</button>
-                                <button class="btn btn-sm btn-default border" cancel>Close</button>
-                            </div>
-                        </form>
-                    </div>
-                        <span class="mx-2 text-secondary text-sm">|</span>
-                    <div moe relative large>
-                        <a href="" start show class="">Manual Determination</a>
-
-                        <form url="/api/clientPrimaryCoverage/manualDeterminationForCommercial" class="mcp-theme-1">
-                            <input type="hidden" name="uid" value="{{$cpc->uid}}" class="form-control input-sm" />
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Determination Strategy</label>
-                                <select  name="manualDeterminationStrategy" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="REVIEWED_ELECTRONIC">Reviewed electronic</option>
-                                    <option value="CALLED_PAYER">Called payer</option>
-                                </select>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Determination Category</label>
-                                <select  name="manualDeterminationCategory" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="COVERED">Covered</option>
-                                    <option value="NOT_COVERED">Not Covered</option>
-                                    <option value="INVALID">Invalid</option>
-                                    <option value="UNKNOWN">Unknown</option>
-                                </select>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Is Payer Member Identifier Valid</label>
-                                <select  name="manualIsPayerMemberIdentifierValid" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="YES">Yes</option>
-                                    <option value="NO">No</option>
-                                    <option value="UNKNOWN">Unknown</option>
-                                </select>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Determination Category Memo</label>
-                                <input type="text" name="manualDeterminationCategoryMemo" class="form-control input-sm"/>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Detail Json</label>
-                                <input type="text" name="manualDetailJson" class="form-control input-sm"/>
-                            </div>
-
-
-                            <div class="form-group text-nowrap mb-0">
-                                <button class="btn btn-sm btn-primary" submit>Submt</button>
-                                <button class="btn btn-sm btn-default border" cancel>Close</button>
-                            </div>
-                        </form>
-                    </div>
-                @endif
-                @if($cpc->plan_type == 'MCR_ADV')
-                    <div moe relative>
-                        <a href="" start show class="">Refresh</a>
-
-                        <form url="/api/clientPrimaryCoverage/refreshCoverageForMcrAdv" class="mcp-theme-1">
-                            <input type="hidden" name="uid" value="{{$cpc->uid}}" class="form-control input-sm" />
-                            <div class="form-group">
-                                <p>Refresh?</p>
-                            </div>
-                            <div class="form-group text-nowrap mb-0">
-                                <button class="btn btn-sm btn-primary" submit>Submt</button>
-                                <button class="btn btn-sm btn-default border" cancel>Close</button>
-                            </div>
-                        </form>
-                    </div>
-                        <span class="mx-2 text-secondary text-sm">|</span>
-                    <div moe relative large>
-                        <a href="" start show class="">Manual Determination</a>
-                        <form url="/api/clientPrimaryCoverage/manualDeterminationForMcrAdv" class="mcp-theme-1">
-                            <input type="hidden" name="uid" value="{{$cpc->uid}}" class="form-control input-sm" />
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Determination Strategy</label>
-                                <select  name="manualDeterminationStrategy" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="REVIEWED_ELECTRONIC">Reviewed electronic</option>
-                                    <option value="CALLED_PAYER">Called payer</option>
-                                </select>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Determination Category</label>
-                                <select  name="manualDeterminationCategory" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="COVERED">Covered</option>
-                                    <option value="NOT_COVERED">Not Covered</option>
-                                    <option value="INVALID">Invalid</option>
-                                    <option value="UNKNOWN">Unknown</option>
-                                </select>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Determination Category Memo</label>
-                                <input type="text" name="manualDeterminationCategoryMemo" class="form-control input-sm"/>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Detail Json</label>
-                                <input type="text" name="manualDetailJson" class="form-control input-sm"/>
-                            </div>
-
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Is Payer Member Identifier Valid</label>
-                                <select  name="manualIsPayerMemberIdentifierValid" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="YES">Yes</option>
-                                    <option value="NO">No</option>
-                                    <option value="UNKNOWN">Unknown</option>
-                                </select>
-                            </div>
-
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Is Mcr Number Valid</label>
-                                <select  name="manualIsMcrNumberValid" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="YES">Yes</option>
-                                    <option value="NO">No</option>
-                                    <option value="UNKNOWN">Unknown</option>
-                                </select>
-                            </div>
-
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Is Mcr Part Bprimary</label>
-                                <select  name="manualIsMcrPartBPrimary" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="YES">Yes</option>
-                                    <option value="NO">No</option>
-                                    <option value="UNKNOWN">Unknown</option>
-                                </select>
-                            </div>
-
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Is Mcr Part C Active</label>
-                                <select  name="manualIsMcrPartCActive" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="YES">Yes</option>
-                                    <option value="NO">No</option>
-                                    <option value="UNKNOWN">Unknown</option>
-                                </select>
-                            </div>
-
-                            <div class="form-group text-nowrap mb-0">
-                                <button class="btn btn-sm btn-primary" submit>Submt</button>
-                                <button class="btn btn-sm btn-default border" cancel>Close</button>
-                            </div>
-                        </form>
-                    </div>
-                @endif
-                @if($cpc->plan_type == 'MCD_MCO')
-                    <div moe relative>
-                        <a href="" start show class="">Refresh</a>
-
-                        <form url="/api/clientPrimaryCoverage/refreshCoverageForMcdMco" class="mcp-theme-1">
-                            <input type="hidden" name="uid" value="{{$cpc->uid}}" class="form-control input-sm" />
-                            <div class="form-group">
-                                <p>Refresh?</p>
-                            </div>
-                            <div class="form-group text-nowrap mb-0">
-                                <button class="btn btn-sm btn-primary" submit>Submt</button>
-                                <button class="btn btn-sm btn-default border" cancel>Close</button>
-                            </div>
-                        </form>
-                    </div>
-                        <span class="mx-2 text-secondary text-sm">|</span>
-                    <div moe relative large>
-                        <a href="" start show class="">Manual Determination</a>
-                        <form url="/api/clientPrimaryCoverage/manualDeterminationForMcdMco" class="mcp-theme-1">
-                            <input type="hidden" name="uid" value="{{$cpc->uid}}" class="form-control input-sm" />
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Determination Strategy</label>
-                                <select  name="manualDeterminationStrategy" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="REVIEWED_ELECTRONIC">Reviewed electronic</option>
-                                    <option value="CALLED_PAYER">Called payer</option>
-                                </select>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Determination Category</label>
-                                <select  name="manualDeterminationCategory" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="COVERED">Covered</option>
-                                    <option value="NOT_COVERED">Not Covered</option>
-                                    <option value="INVALID">Invalid</option>
-                                    <option value="UNKNOWN">Unknown</option>
-                                </select>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Determination Category Memo</label>
-                                <input type="text" name="manualDeterminationCategoryMemo" class="form-control input-sm"/>
-                            </div>
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Detail Json</label>
-                                <input type="text" name="manualDetailJson" class="form-control input-sm"/>
-                            </div>
-
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Is Mcd Number Valid</label>
-                                <select  name="manualIsMcdNumberValid" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="YES">Yes</option>
-                                    <option value="NO">No</option>
-                                    <option value="UNKNOWN">Unknown</option>
-                                </select>
-                            </div>
-
-                            <div class="form-group">
-                                <label for="" class="control-label">Manual Is Mcd Response Mco Active</label>
-                                <select  name="manualIsMcdResponseMcoActive" class="form-control input-sm">
-                                    <option value="">--select--</option>
-                                    <option value="YES">Yes</option>
-                                    <option value="NO">No</option>
-                                    <option value="UNKNOWN">Unknown</option>
-                                </select>
-                            </div>
-
-                            <div class="form-group text-nowrap mb-0">
-                                <button class="btn btn-sm btn-primary" submit>Submt</button>
-                                <button class="btn btn-sm btn-default border" cancel>Close</button>
-                            </div>
-                        </form>
-                    </div>
-                @endif
-            </div>
-
         <div>
             @php
-              dump(json_decode($cpc->toJson(JSON_PRETTY_PRINT | JSON_UNESCAPED_UNICODE | JSON_UNESCAPED_SLASHES)));
+                dump(json_decode($cpc->toJson(JSON_PRETTY_PRINT | JSON_UNESCAPED_UNICODE | JSON_UNESCAPED_SLASHES)));
             @endphp
         </div>
+
         <div>
             @php
                 dump($cpc->auto_detail_json);
             @endphp
         </div>
-        @endif
-    </div>
-@endsection
+    @endif
+</div>
+@endsection