Fixes

resources/views/layouts/patient-intake-data-form.blade.php

@@ -0,0 +1,85 @@
+<div id="patient-intake-data-form" visit-moe moe relative wide class="ml-2 hide-inside-popup">
+	<a start show><i class="fa fa-edit"></i></a>
+	<form id="patientIntakeDataForm" url="/api/client/updateCanvasData" class="mcp-theme-1" right>
+		<input type="hidden" name="uid" value="{{$patient->uid}}">
+		<input type="hidden" name="key" name="INTAKE_DATA">
+		<input type="hidden" name="data">
+		<div class="mb-2">
+			<label class="text-secondary text-sm">Height</label>
+			<input name="height" class="form-control" />
+		</div>
+		<div class="mb-2">
+			<label class="text-secondary text-sm">Weight</label>
+			<input name="weight" class="form-control" />
+		</div>
+		<div class="mb-2">
+			<label class="text-secondary text-sm">Weight</label>
+			<input name="weight" class="form-control" />
+		</div>
+		<div class="mb-2">
+			<label class="text-secondary text-sm">Weight</label>
+			<input name="weight" class="form-control" />
+		</div>
+		<div class="mb-2">
+			<label class="text-secondary text-sm">Weight</label>
+			<input name="weight" class="form-control" />
+		</div>
+		<div class="mb-2">
+			<label class="text-secondary text-sm">Weight</label>
+			<input name="weight" class="form-control" />
+		</div>
+		<div class="mb-2">
+			<label class="text-secondary text-sm">Weight</label>
+			<input name="weight" class="form-control" />
+		</div>
+
+
+	Last Vitamin D
+	Ethnicity
+	Previous Dx:
+	Hypertension
+	Diabetes
+	COPD
+	Arthritis
+
+		<div>
+			<button submit class="btn btn-sm btn-primary mr-1">Submit</button>
+			<button cancel class="btn btn-sm btn-default border">
+				Cancel
+			</button>
+		</div>
+	</form>
+</div>
+
+<script>
+	(function() {
+		function init() {
+			(function($){
+				var patientDataIntake = {
+					form: null,
+					data:{},
+					initOnInputChange: function(){
+						var self = this;
+						self.form.find('input').change(function(evt){
+							var input = evt.target;
+							var name = input.name;
+							var value = input.value;
+							self.data[name] = value;
+							self.updateJsonStringValue();
+						});
+					},
+					updateJsonStringValue: function(){
+						var self = this;
+						self.form.find('input[name=data]').val(JSON.stringify(self.data));
+					},
+					init: function(){
+						this.form = $('#patientIntakeDataForm');
+						this.initOnInputChange();
+					}
+				};
+				patientDataIntake.init();
+			})(jQuery);
+		}
+		addMCInitializer('patient-intake-data-form', init, '#patient-intake-data-form');
+	})();
+</script>

resources/views/layouts/patient.blade.php

@@ -673,28 +673,7 @@ $isOldClient = (date_diff(date_create(config('app.point_impl_date')), date_creat
 									</section>
 									<section class="mr-4 align-self-start mt-2 ml-auto">
 										<label>Intake Data:</label> <span class="text-secondary"></span>
-											<div visit-moe moe relative wide class="ml-2 hide-inside-popup">
-												<a start show><i class="fa fa-edit"></i></a>
-												<form url="/api/client/updateCanvasData" class="mcp-theme-1" right>
-													<input type="hidden" name="uid" value="{{$patient->uid}}">
-													<input type="hidden" name="key" name="INTAKE_DATA">
-													<input type="hidden" name="data">
-													<div class="mb-2">
-														<label class="text-secondary text-sm">Weight</label>
-														<input name="data" data-field-name="weight" class="form-control"/>
-													</div>
-													<div class="mb-2">
-														<label class="text-secondary text-sm">Height</label>
-														<input name="data" data-field-name="height" class="form-control"/>
-													</div>
-													<div>
-														<button submit class="btn btn-sm btn-primary mr-1">Submit</button>
-														<button cancel class="btn btn-sm btn-default border">
-															Cancel
-														</button>
-													</div>
-												</form>												
-											</div>
+											@include('layouts.patient-intake-data-form')
 									</section>
 									<ul class="vbox mt-2 align-self-start patient-header-address ">
 										<li class="d-flex align-items-start">