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@@ -0,0 +1,87 @@
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+<div moe large id="cm-entry-form{{@$entry ? '-' . $entry->uid : ''}}">
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+ <a start show class="py-0 mb-3">{{@$entry ? 'Edit' : (@$label ?: 'Add')}}</a>
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+ <form url="/api/careMonthEntry/{{@$entry ? 'updateSimpleForCm' : 'createForCm'}}" {{@$right ? 'right' : ''}} {{@$hook ? 'hook=' . $hook : ''}}>
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+ @if(@$entry)
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+ <input type="hidden" name="uid" value="{{ $entry->uid }}">
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+ @else
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+ <input type="hidden" name="careMonthUid" value="{{ $careMonth->uid }}">
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+ @endif
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+ <div class="mb-2">
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+ <div class="row">
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+ <div class="col-4 pr-0">
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+ <label class="mb-1 text-sm text-secondary text-left">Pro</label>
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+ <select class="form-control form-control-sm w-100" name="proUid" provider-search data-pro-uid="{{ @$entry ? $entry->pro->uid : ($pro ? $pro->uid : '') }}"
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+ required>
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+ <option value="">-- Select Pro --</option>
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+ </select>
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+ </div>
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+ <div class="col-4 pr-0">
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+ <?php
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+ $sD = strtotime($careMonth->start_date);
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+ $y = date('Y', $sD);
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+ $m = date('m', $sD);
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+ $d = date('t', $sD);
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+ $yCurrent = date('Y');
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+ $mCurrent = date('m');
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+ $isToday = false;
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+ if($y === $yCurrent && $m === $mCurrent) {
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+ $d = date('d');
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+ $isToday = true;
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+ }
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+ ?>
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+ <label class="mb-1 text-sm text-secondary text-left">Date</label>
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+ <input autofocus type="date" min="{{ date($y . '-' . $m . '-01') }}" max="{{ date($y . '-' . $m . '-' . $d) }}"
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+ value="{{@$entry ? $entry->effective_date : (@$defaultDate ?: $careMonth->end_date)}}"
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+ class="form-control form-control-sm w-100" name="effectiveDate"
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+ placeholder="Effective Date" required>
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+ </div>
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+ <div class="col-4">
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+ <label class="mb-1 text-sm text-secondary text-left">Minutes</label>
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+ <input type="hidden" name="timeInSeconds" value="{{@$entry ? $entry->time_in_seconds : (@$defaultSeconds ?: '')}}">
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+ <input type="number" min="1" max="20" name="timeInMinutes" class="form-control form-control-sm w-100 cm-time-value"
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+ value="{{@$entry ? round($entry->time_in_seconds / 60, 0) : (@$defaultSeconds ? $defaultSeconds/60 : '')}}"
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+ required>
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+ </div>
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+ </div>
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+ </div>
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+{{-- <div class="mb-2 border border-info p-2 mt-2 bg-light text-left">--}}
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+{{-- <span><i class="fa fa-phone rotateh text-dark mr-1"></i>This time entry involved interactive communication (audio, video, or in-person) with the patient and/or caretaker.</span>--}}
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+{{-- <div class="d-flex border-top mt-2">--}}
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+{{-- <label class="mt-2 mb-0 d-inline-flex align-items-center mr-3">--}}
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+{{-- <input type="radio" class="mr-2" name="didProInteractWithClientAboutRm" value="true" {{((@$entry && $entry->did_pro_interact_with_client_about_rm) || @$defaultInteracted) ? 'checked' : ''}} required>--}}
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+{{-- <span>Yes</span>--}}
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+{{-- </label>--}}
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+{{-- <label class="mt-2 mb-0 d-inline-flex align-items-center">--}}
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+{{-- <input type="radio" class="mr-2" name="didProInteractWithClientAboutRm" value="false" {{((@$entry && $entry->did_pro_interact_with_client_about_rm) || @$defaultInteracted) ? '' : 'checked' }} required>--}}
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+{{-- <span>No</span>--}}
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+{{-- </label>--}}
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+{{-- </div>--}}
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+{{-- </div>--}}
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+ <div class="mb-2">
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+ <div class="row">
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+ <div class="col-12">
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+ <div cm-rte data-name="contentText">{!! @$entry ? $entry->content_text : (@$defaultComment ?: 'Reviewed patient feedback regarding ' . $type . ' instructions.') !!}</div>
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+ </div>
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+ </div>
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+ </div>
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+ <div class="d-flex align-items-center">
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+ <button class="btn btn-sm btn-primary mr-2" submit>Save</button>
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+ <button class="btn btn-sm btn-default mr-2 border" cancel>Cancel</button>
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+ </div>
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+ </form>
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+</div>
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+<script>
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+ (function() {
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+ function init() {
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+ $(document)
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+ .off('input change paste keyup', '[name="timeInMinutes"]')
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+ .on('input change paste keyup', '[name="timeInMinutes"]', function() {
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+ let form = $(this).closest('form'), val = '' + $(this).val();
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+ if(!isNaN(val)) {
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+ form.find('[name="timeInSeconds"]').val(+val * 60);
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+ }
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+ });
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+ }
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+ addMCInitializer('cm-entry-form{{@$entry ? '-' . $entry->uid : ''}}', init, '#cm-entry-form{{@$entry ? '-' . $entry->uid : ''}}');
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+ }).call(window);
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+</script>
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