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@@ -37,9 +37,9 @@
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<h4 class="font-weight-bold m-0 font-size-16 text-nowrap">Client Primary Coverages</h4>
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<h4 class="font-weight-bold m-0 font-size-16 text-nowrap">Client Primary Coverages</h4>
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<div class="ml-auto d-inline-flex justify-content-center">
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<div class="ml-auto d-inline-flex justify-content-center">
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<span class="mr-2">Auto:</span>
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<span class="mr-2">Auto:</span>
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- <div moe relative>
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+ <div moe relative large>
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<a href="" start show>+ MC</a>
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<a href="" start show>+ MC</a>
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- <form url="/api/clientPrimaryCoverage/createNewCoverageForMedicareWithoutManualDetermination" class="mcp-theme-1">
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+ <form url="/api/clientPrimaryCoverage/createNewCoverageForMedicareWithoutManualDetermination" right class="mcp-theme-1">
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<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
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<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
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<div class="form-group">
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<div class="form-group">
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<label class="control-label">Subscriber Name First</label>
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<label class="control-label">Subscriber Name First</label>
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@@ -62,15 +62,15 @@
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<input type="date" name="dateOfService" class="form-control input-sm" />
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<input type="date" name="dateOfService" class="form-control input-sm" />
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</div>
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</div>
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<div class="form-group">
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<div class="form-group">
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- <button class="btn btn-sm" submit>Submt</button>
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- <button class="btn btn-sm" close>Close</button>
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+ <button class="btn btn-sm btn-primary" submit>Submt</button>
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+ <button class="btn btn-sm btn-default border" close>Close</button>
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</div>
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</div>
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</form>
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</form>
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</div>
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</div>
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<span class="mx-2 text-secondary text-sm">|</span>
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<span class="mx-2 text-secondary text-sm">|</span>
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- <div moe relative>
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+ <div moe relative large>
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<a href="" start show >+ Medicaid</a>
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<a href="" start show >+ Medicaid</a>
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- <form url="/api/clientPrimaryCoverage/createNewCoverageForMedicaidWithoutManualDetermination" class="mcp-theme-1">
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+ <form url="/api/clientPrimaryCoverage/createNewCoverageForMedicaidWithoutManualDetermination" right class="mcp-theme-1">
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<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
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<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
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<div class="form-group">
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<div class="form-group">
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<label for="" class="control-label">Subscriber Name First</label>
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<label for="" class="control-label">Subscriber Name First</label>
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@@ -109,15 +109,15 @@
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<input type="text" name="planIdentifier" class="form-control input-sm">
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<input type="text" name="planIdentifier" class="form-control input-sm">
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</div>
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</div>
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<div class="form-group">
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<div class="form-group">
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- <button class="btn btn-sm" submit>Submt</button>
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- <button class="btn btn-sm" close>Close</button>
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+ <button class="btn btn-sm btn-primary" submit>Submt</button>
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+ <button class="btn btn-sm btn-default border" close>Close</button>
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</div>
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</div>
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</form>
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</form>
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</div>
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</div>
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<span class="mx-2 text-secondary text-sm">|</span>
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<span class="mx-2 text-secondary text-sm">|</span>
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- <div moe relative>
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+ <div moe relative large>
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<a href="" start show >+ Comm.</a>
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<a href="" start show >+ Comm.</a>
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- <form url="/api/clientPrimaryCoverage/createNewCoverageForCommercialWithoutManualDetermination" class="mcp-theme-1">
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+ <form url="/api/clientPrimaryCoverage/createNewCoverageForCommercialWithoutManualDetermination" right class="mcp-theme-1">
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<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
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<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
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<div class="form-group">
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<div class="form-group">
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<label class="control-label">Subscriber Name First</label>
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<label class="control-label">Subscriber Name First</label>
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@@ -156,17 +156,17 @@
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<input type="text" name="planIdentifier" class="form-control input-sm">
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<input type="text" name="planIdentifier" class="form-control input-sm">
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</div>
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</div>
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<div class="form-group">
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<div class="form-group">
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- <button class="btn btn-sm" submit>Submt</button>
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- <button class="btn btn-sm" close>Close</button>
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+ <button class="btn btn-sm btn-primary" submit>Submt</button>
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+ <button class="btn btn-sm btn-default border" close>Close</button>
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</div>
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</div>
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</form>
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</form>
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</div>
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</div>
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</div>
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</div>
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<div class="ml-4 d-inline-flex justify-content-center">
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<div class="ml-4 d-inline-flex justify-content-center">
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<span class="mr-2">Manual:</span>
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<span class="mr-2">Manual:</span>
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- <div moe relative>
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+ <div moe relative large>
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<a href="" start show >+ MC</a>
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<a href="" start show >+ MC</a>
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- <form url="/api/clientPrimaryCoverage/createNewCoverageForMedicareWithManualDetermination" class="mcp-theme-1">
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+ <form url="/api/clientPrimaryCoverage/createNewCoverageForMedicareWithManualDetermination" right class="mcp-theme-1">
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<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
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<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
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<div class="form-group">
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<div class="form-group">
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<label for="" class="control-label">Subscriber Name First</label>
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<label for="" class="control-label">Subscriber Name First</label>
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@@ -314,15 +314,15 @@
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<input type="date" name="manualMedicareMpbInfoValidTill" class="form-control input-sm"/>
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<input type="date" name="manualMedicareMpbInfoValidTill" class="form-control input-sm"/>
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</div>
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</div>
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<div class="form-group">
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<div class="form-group">
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- <button class="btn btn-sm" submit>Submt</button>
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- <button class="btn btn-sm" close>Close</button>
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+ <button class="btn btn-sm btn-primary" submit>Submt</button>
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+ <button class="btn btn-sm btn-default border" close>Close</button>
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</div>
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</div>
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</form>
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</form>
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</div>
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</div>
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<span class="mx-2 text-secondary text-sm">|</span>
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<span class="mx-2 text-secondary text-sm">|</span>
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- <div moe relative>
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+ <div moe relative large>
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<a href="" start show >+ Medicaid</a>
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<a href="" start show >+ Medicaid</a>
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- <form url="/api/clientPrimaryCoverage/createNewCoverageForMedicaidWithManualDetermination" class="mcp-theme-1">
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+ <form url="/api/clientPrimaryCoverage/createNewCoverageForMedicaidWithManualDetermination" right class="mcp-theme-1">
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<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
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<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
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<div class="form-group">
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<div class="form-group">
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<label for="" class="control-label">Manual Determination Strategy</label>
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<label for="" class="control-label">Manual Determination Strategy</label>
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@@ -351,15 +351,15 @@
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<input type="text" name="manualDetailJson" class="form-control input-sm">
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<input type="text" name="manualDetailJson" class="form-control input-sm">
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</div>
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</div>
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<div class="form-group">
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<div class="form-group">
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- <button class="btn btn-sm" submit>Submt</button>
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- <button class="btn btn-sm" close>Close</button>
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+ <button class="btn btn-sm btn-primary" submit>Submt</button>
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+ <button class="btn btn-sm btn-default border" close>Close</button>
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</div>
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</div>
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</form>
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</form>
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</div>
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</div>
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<span class="mx-2 text-secondary text-sm">|</span>
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<span class="mx-2 text-secondary text-sm">|</span>
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- <div moe relative>
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+ <div moe relative large>
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<a href="" start show >+ Comm.</a>
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<a href="" start show >+ Comm.</a>
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- <form url="/api/clientPrimaryCoverage/createNewCoverageForCommercialWithManualDetermination" class="mcp-theme-1">
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+ <form url="/api/clientPrimaryCoverage/createNewCoverageForCommercialWithManualDetermination" right class="mcp-theme-1">
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<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
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<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
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<div class="form-group">
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<div class="form-group">
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<label class="control-label">Subscriber Name First</label>
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<label class="control-label">Subscriber Name First</label>
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@@ -424,8 +424,8 @@
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<textarea name="manualDetailJson" class="form-control input-sm"></textarea>
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<textarea name="manualDetailJson" class="form-control input-sm"></textarea>
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</div>
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</div>
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<div class="form-group">
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<div class="form-group">
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- <button class="btn btn-sm" submit>Submt</button>
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- <button class="btn btn-sm" close>Close</button>
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+ <button class="btn btn-sm btn-primary" submit>Submt</button>
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+ <button class="btn btn-sm btn-default border" close>Close</button>
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</div>
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</div>
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</form>
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</form>
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</div>
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</div>
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@@ -538,8 +538,8 @@
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<p>Refresh?</p>
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<p>Refresh?</p>
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</div>
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</div>
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<div class="form-group">
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<div class="form-group">
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- <button class="btn btn-sm" submit>Submt</button>
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- <button class="btn btn-sm" close>Close</button>
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+ <button class="btn btn-sm btn-primary" submit>Submt</button>
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+ <button class="btn btn-sm btn-default border" close>Close</button>
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</div>
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</div>
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</form>
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</form>
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</div>
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</div>
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@@ -675,8 +675,8 @@
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<input type="date" name="manualMedicareMpbInfoValidTill" class="form-control input-sm"/>
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<input type="date" name="manualMedicareMpbInfoValidTill" class="form-control input-sm"/>
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</div>
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</div>
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<div class="form-group">
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<div class="form-group">
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- <button class="btn btn-sm" submit>Submt</button>
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- <button class="btn btn-sm" close>Close</button>
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+ <button class="btn btn-sm btn-primary" submit>Submt</button>
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+ <button class="btn btn-sm btn-default border" close>Close</button>
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</div>
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</div>
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</form>
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</form>
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</div>
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</div>
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@@ -691,8 +691,8 @@
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<p>Refresh?</p>
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<p>Refresh?</p>
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</div>
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</div>
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<div class="form-group">
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<div class="form-group">
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- <button class="btn btn-sm" submit>Submt</button>
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- <button class="btn btn-sm" close>Close</button>
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+ <button class="btn btn-sm btn-primary" submit>Submt</button>
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+ <button class="btn btn-sm btn-default border" close>Close</button>
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</div>
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</div>
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</form>
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</form>
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</div>
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</div>
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@@ -730,8 +730,8 @@
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<div class="form-group">
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<div class="form-group">
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- <button class="btn btn-sm" submit>Submt</button>
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- <button class="btn btn-sm" close>Close</button>
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+ <button class="btn btn-sm btn-primary" submit>Submt</button>
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+ <button class="btn btn-sm btn-default border" close>Close</button>
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</div>
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</div>
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</form>
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</form>
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</div>
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</div>
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@@ -746,8 +746,8 @@
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<p>Refresh?</p>
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<p>Refresh?</p>
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</div>
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</div>
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<div class="form-group">
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<div class="form-group">
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- <button class="btn btn-sm" submit>Submt</button>
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- <button class="btn btn-sm" close>Close</button>
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+ <button class="btn btn-sm btn-primary" submit>Submt</button>
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+ <button class="btn btn-sm btn-default border" close>Close</button>
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</div>
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</div>
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</form>
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</form>
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</div>
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</div>
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@@ -785,8 +785,8 @@
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<div class="form-group">
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<div class="form-group">
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- <button class="btn btn-sm" submit>Submt</button>
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- <button class="btn btn-sm" close>Close</button>
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+ <button class="btn btn-sm btn-primary" submit>Submt</button>
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+ <button class="btn btn-sm btn-default border" close>Close</button>
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</div>
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</div>
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</form>
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</form>
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</div>
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</div>
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