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@@ -1,61 +1,119 @@
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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">Contact Info</div>
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- <div class="mb-2">
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+ <div class="font-weight-bold mb-2">Home Address</div>
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+ <div class="pl-3">
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<div class="mb-1">
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- Phone: <b>{{ $patient->cell_number }}</b>
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+ Address Line 1: <b>{{ $patient->home_address_line1 }}</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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+ Address Line 2: <b>{{ $patient->home_address_line2 }}</b>
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</div>
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<div class="mb-1">
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- Home City: <b>{{ $patient->home_address_city }}</b>
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+ City: <b>{{ $patient->home_address_city }}</b>
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</div>
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<div class="mb-1">
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- Home State: <b>{{ $patient->home_address_state }}</b>
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+ State: <b>{{ $patient->home_address_state }}</b>
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</div>
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- <div class="mt-3">
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- <div moe>
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- <a start show><i class="fa fa-edit"></i> Edit Info</a>
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- <form url="/api/client/putContactInfo" class="mcp-theme-1">
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- <input type="hidden" name="uid" value="{{$patient->uid}}">
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- <div class="mb-2">
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- <input type="tel"
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- class="form-control form-control-sm"
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- name="cellNumber"
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- placeholder="Phone Number"
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- value="{{ $patient->cell_number }}">
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- </div>
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- <div class="mb-2">
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- <input type="text"
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- class="form-control form-control-sm"
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- name="email"
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- placeholder="Email"
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- value="{{ $patient->email_address }}">
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- </div>
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- <div class="mb-2">
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- <input type="text"
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- class="form-control form-control-sm"
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- name="city"
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- placeholder="City"
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- 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"
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- class="form-control form-control-sm"
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- name="state"
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- placeholder="State"
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- value="{{ $patient->home_address_state }}">
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- </div>
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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="mb-1">
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+ ZIP: <b>{{ $patient->home_address_zip }}</b>
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+ </div>
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+ </div>
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+
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+ <div class="font-weight-bold mb-2 mt-3">Mailing Address</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->mailing_address_line1 }}</b>
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+ </div>
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+ <div class="mb-1">
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+ Address Line 2: <b>{{ $patient->mailing_address_line2 }}</b>
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+ </div>
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+ <div class="mb-1">
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+ City: <b>{{ $patient->mailing_address_city }}</b>
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+ </div>
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+ <div class="mb-1">
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+ State: <b>{{ $patient->mailing_address_state }}</b>
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+ </div>
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+ <div class="mb-1">
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+ ZIP: <b>{{ $patient->mailing_address_zip }}</b>
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</div>
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</div>
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+
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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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+ 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>{{ $patient->email_address }}</b>
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+ </div>
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+ </div>
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+
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+ <div class="mt-3 d-flex align-items-center">
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+ <div moe wide>
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+ <a start show><i class="fa fa-edit"></i> Edit Contact Info</a>
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+ <form url="/api/client/putContactInfo" class="mcp-theme-1">
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+ <input type="hidden" name="uid" value="{{$patient->uid}}">
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+ <div class="mb-2">
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+ <input type="tel" class="form-control form-control-sm" name="cellNumber" placeholder="Phone Number" value="{{ $patient->cell_number }}">
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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="email" placeholder="Email" value="{{ $patient->email_address }}">
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+ </div>
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+ <div>
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+ <button submit class="btn btn-sm btn-primary mr-1">Submit</button>
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+ <button cancel class="btn btn-sm btn-default border">Cancel</button>
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+ </div>
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+ </form>
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+ </div>
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+ <span class="mx-2 text-secondary">|</span>
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+ <div moe wide>
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+ <a start show><i class="fa fa-edit"></i> Edit Address</a>
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+ <form url="/api/client/editAddress" class="mcp-theme-1">
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+ <input type="hidden" name="uid" value="{{$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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+ <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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+
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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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+
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<hr class="m-negator my-3">
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<span>MCP Onboarding Visit: <b>{{ $patient->has_mcp_done_onboarding_visit }}</b></span>
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<span moe class="ml-2">
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