Sleep study - sleep study address

resources/views/app/patient/sleep-study.blade.php

@@ -52,7 +52,7 @@
                 </div>
 
                 <div data-key="sleep-study-address">
-                    <h4 class="p-2 bg-light font-weight-bold d-block py-1 border-bottom text-nowrap">Sleep Study Address</h4>
+                    @include('app.patient.sleep-study.sleep-study-address')
                 </div>
 
                 <div data-key="manager">

resources/views/app/patient/sleep-study/sleep-study-address.blade.php

@@ -0,0 +1,75 @@
+<div class="d-flex px-3 py-2 bg-light align-items-baseline border-bottom">
+    <h4 class="font-weight-bold text-nowrap m-0">Sleep Study Address</h4>
+    <div moe class="ml-3">
+        <a start show href="#"><i class="fa fa-edit"></i> Edit</a>
+        <form url="/api/client/updateHomeAddressForWatchPatStudy">
+            <input type="hidden" name="uid" value="{{$patient->uid}}">
+            <div class="font-weight-bold font-size-14 text-secondary border-bottom px-2 pb-2 mb-2 text-nowrap">Sleep Study Address</div>
+
+            <div class="mb-2">
+                <div class="mb-1">Address Line 1:</div>
+                <input type="text" value="{{$patient->home_address_for_watch_pat_line1}}" name="homeAddressForWatchPatLine1" class="form-control form-control-sm d-inline-block flex-grow-1">
+            </div>
+            <div class="mb-2">
+                <div class="mb-1">Address Line 2:</div>
+                <input type="text" value="{{$patient->home_address_for_watch_pat_line2}}" name="homeAddressForWatchPatLine2" class="form-control form-control-sm d-inline-block flex-grow-1">
+            </div>
+            <div class="mb-2">
+                <div class="mb-1">Address City:</div>
+                <input type="text" value="{{$patient->home_address_for_watch_pat_city}}" name="homeAddressForWatchPatCity" class="form-control form-control-sm d-inline-block flex-grow-1">
+            </div>
+            <div class="mb-2">
+                <div class="mb-1">Address State:</div>
+                <input type="text" value="{{$patient->home_address_for_watch_pat_state}}" name="homeAddressForWatchPatState" class="form-control form-control-sm d-inline-block flex-grow-1">
+            </div>
+            <div class="mb-2">
+                <div class="mb-1">Address ZIP:</div>
+                <input type="text" value="{{$patient->home_address_for_watch_pat_zip}}" name="homeAddressForWatchPatZip" class="form-control form-control-sm d-inline-block flex-grow-1">
+            </div>
+            <div class="mb-2">
+                <div class="mb-1">Address Country:</div>
+                <input type="text" value="{{$patient->home_address_for_watch_pat_country}}" name="homeAddressForWatchPatCountry" class="form-control form-control-sm d-inline-block flex-grow-1">
+            </div>
+
+            <div class="mb-2">
+                <div class="mb-1">Effective As Of:</div>
+                <input type="date" value="{{$patient->home_address_for_watch_pat_effective_as_of}}" name="homeAddressForWatchPatEffectiveAsOf" class="form-control form-control-sm d-inline-block flex-grow-1">
+            </div>
+
+            <div class="mt-2 border-top pt-2 text-center">
+                <button class="btn btn-primary btn-sm" submit>Submit</button>
+                <button class="btn btn-default border btn-sm" cancel>Cancel</button>
+            </div>
+        </form>
+    </div>
+</div>
+
+<div class="px-3 pt-2 pb-1">
+    Address Line 1: <b>{{$patient->home_address_for_watch_pat_line1 ?: '-'}}</b>
+</div>
+<div class="px-3 py-1">
+    Address Line 2: <b>{{$patient->home_address_for_watch_pat_line2 ?: '-'}}</b>
+</div>
+<div class="px-3 py-1">
+    Address City: <b>{{$patient->home_address_for_watch_pat_city ?: '-'}}</b>
+</div>
+<div class="px-3 py-1">
+    Address State: <b>{{$patient->home_address_for_watch_pat_state ?: '-'}}</b>
+</div>
+<div class="px-3 py-1">
+    Address ZIP: <b>{{$patient->home_address_for_watch_pat_zip ?: '-'}}</b>
+</div>
+<div class="px-3 py-1">
+    Address Country: <b>{{$patient->home_address_for_watch_pat_country ?: '-'}}</b>
+</div>
+<div class="px-3 py-1">
+    Effective As Of: <b>{{$patient->home_address_for_watch_pat_effective_as_of ?: '-'}}</b>
+</div>
+
+
+
+
+
+
+
+