|
@@ -69,7 +69,7 @@
|
|
|
<main role="main" class="col-md-9 ml-sm-auto col-lg-10 px-md-4">
|
|
<main role="main" class="col-md-9 ml-sm-auto col-lg-10 px-md-4">
|
|
|
<div class="card mt-3">
|
|
<div class="card mt-3">
|
|
|
<div class=card-header>
|
|
<div class=card-header>
|
|
|
- <?
|
|
|
|
|
|
|
+ <?php
|
|
|
$thumbnail = $patient->profile_picture_base64;
|
|
$thumbnail = $patient->profile_picture_base64;
|
|
|
$initials = !$thumbnail ? substr($patient->name_first, 0, 1).substr($patient->name_last, 0, 1) : '';
|
|
$initials = !$thumbnail ? substr($patient->name_first, 0, 1).substr($patient->name_last, 0, 1) : '';
|
|
|
$online = $patient->is_online ? 'online' : '';
|
|
$online = $patient->is_online ? 'online' : '';
|
|
@@ -125,7 +125,7 @@
|
|
|
@else
|
|
@else
|
|
|
None provided.
|
|
None provided.
|
|
|
@endif
|
|
@endif
|
|
|
- </a>
|
|
|
|
|
|
|
+ </a>
|
|
|
<form url="/api/client/putMcn">
|
|
<form url="/api/client/putMcn">
|
|
|
<input type="hidden" name="uid" value="{{$patient->uid}}">
|
|
<input type="hidden" name="uid" value="{{$patient->uid}}">
|
|
|
<input type="text" name="name_first" value="{{$patient->name_first}}">
|
|
<input type="text" name="name_first" value="{{$patient->name_first}}">
|
|
@@ -145,7 +145,7 @@
|
|
|
<li><i class="fa fa-phone-alt" aria-hidden="true"></i> {{$confirmedCell}}</li>
|
|
<li><i class="fa fa-phone-alt" aria-hidden="true"></i> {{$confirmedCell}}</li>
|
|
|
<li><i class="fa fa-envelope" aria-hidden="true"></i> {{$confirmedEmail}}</li>
|
|
<li><i class="fa fa-envelope" aria-hidden="true"></i> {{$confirmedEmail}}</li>
|
|
|
<li><i class="fa fa-map-marker-alt" aria-hidden="true"></i> {{$location}}</li>
|
|
<li><i class="fa fa-map-marker-alt" aria-hidden="true"></i> {{$location}}</li>
|
|
|
- </ul>
|
|
|
|
|
|
|
+ </ul>
|
|
|
<div class=separators>
|
|
<div class=separators>
|
|
|
<div>Joined <?=$memberSince?></div>
|
|
<div>Joined <?=$memberSince?></div>
|
|
|
<div><label>PCP:</label> {{$mcpName}}</div>
|
|
<div><label>PCP:</label> {{$mcpName}}</div>
|
|
@@ -399,7 +399,7 @@
|
|
|
<label for="" class="control-label text-left">Effective date</label>
|
|
<label for="" class="control-label text-left">Effective date</label>
|
|
|
<input type="date" name="effectiveDateEST" class="form-control">
|
|
<input type="date" name="effectiveDateEST" class="form-control">
|
|
|
</div>
|
|
</div>
|
|
|
-
|
|
|
|
|
|
|
+
|
|
|
<div class="form-group">
|
|
<div class="form-group">
|
|
|
<label for="" class="control-label text-left">Effective time</label>
|
|
<label for="" class="control-label text-left">Effective time</label>
|
|
|
<input type="time" name="effectiveTime" class="form-control">
|
|
<input type="time" name="effectiveTime" class="form-control">
|
|
@@ -407,32 +407,32 @@
|
|
|
</div>
|
|
</div>
|
|
|
<div class="col-md-6">
|
|
<div class="col-md-6">
|
|
|
<div class="form-group">
|
|
<div class="form-group">
|
|
|
- <label for="" class="control-label">reason1</label>
|
|
|
|
|
|
|
+ <label for="" class="control-label">reason1</label>
|
|
|
<input type="text" name="reason1" class="form-control">
|
|
<input type="text" name="reason1" class="form-control">
|
|
|
</div>
|
|
</div>
|
|
|
-
|
|
|
|
|
|
|
+
|
|
|
<div class="form-group">
|
|
<div class="form-group">
|
|
|
- <label for="" class="control-label">reason2</label>
|
|
|
|
|
|
|
+ <label for="" class="control-label">reason2</label>
|
|
|
<input type="text" name="reason2" class="form-control">
|
|
<input type="text" name="reason2" class="form-control">
|
|
|
</div>
|
|
</div>
|
|
|
-
|
|
|
|
|
|
|
+
|
|
|
<div class="form-group">
|
|
<div class="form-group">
|
|
|
- <label for="" class="control-label">reason3</label>
|
|
|
|
|
|
|
+ <label for="" class="control-label">reason3</label>
|
|
|
<input type="text" name="reason3" class="form-control">
|
|
<input type="text" name="reason3" class="form-control">
|
|
|
</div>
|
|
</div>
|
|
|
-
|
|
|
|
|
|
|
+
|
|
|
<div class="form-group">
|
|
<div class="form-group">
|
|
|
- <label for="" class="control-label">reason3Plus</label>
|
|
|
|
|
|
|
+ <label for="" class="control-label">reason3Plus</label>
|
|
|
<input type="text" name="reason3Plus" class="form-control">
|
|
<input type="text" name="reason3Plus" class="form-control">
|
|
|
</div>
|
|
</div>
|
|
|
-
|
|
|
|
|
|
|
+
|
|
|
<div class="form-group">
|
|
<div class="form-group">
|
|
|
- <label for="" class="control-label">serviceLocation</label>
|
|
|
|
|
|
|
+ <label for="" class="control-label">serviceLocation</label>
|
|
|
<input type="text" name="serviceLocation" class="form-control">
|
|
<input type="text" name="serviceLocation" class="form-control">
|
|
|
</div>
|
|
</div>
|
|
|
-
|
|
|
|
|
|
|
+
|
|
|
<div class="form-group">
|
|
<div class="form-group">
|
|
|
- <label for="" class="control-label">category</label>
|
|
|
|
|
|
|
+ <label for="" class="control-label">category</label>
|
|
|
<input type="text" name="category" class="form-control">
|
|
<input type="text" name="category" class="form-control">
|
|
|
</div>
|
|
</div>
|
|
|
</div>
|
|
</div>
|
