Updates

resources/views/app/new-patient.blade.php

@@ -17,9 +17,6 @@ $medicaidStates = Config::get('constants.medicaid_states');
 	#newPatientContainer label {
 		font-size: 11px;
 	}
-	#newPatientContainer .w-30 {
-		width: 30% !important;
-	}
 </style>
 
 <div class="p-3 mcp-theme-1" id="newPatientContainer" v-cloak>
@@ -38,7 +35,7 @@ $medicaidStates = Config::get('constants.medicaid_states');
 					<div class="alert alert-danger">{{ session('message') }}</div>
 					@endif
 					<div class="row">
-						<div class="border-lighter col-12 col-lg-7 col-xl-6 px-0">
+						<div class="border-lighter col-md-6 px-0">
 							<div class="px-3">
 								@include('app.patient.create-patient.demographics-form')
 							</div>
@@ -49,7 +46,7 @@ $medicaidStates = Config::get('constants.medicaid_states');
 							@endif
 
 						</div>
-						<div class="col-12 col-lg-5 col-xl-6">
+						<div class="col-md-6">
 							<div class="border-lighter">
 							@if($pro->pro_type === 'ADMIN')
 								@include('app.patient.create-patient.create-patient-script-templates')

resources/views/app/patient/create-patient/demographics-form.blade.php

@@ -12,67 +12,79 @@
 			<input autocomplete="_blank" type="text" name="patientNameSuffix" placeholder="Suffix" class="ml-2 mb-md-0 mb-2 form-control input-sm w-md-50">
 		</div>
 	</div>
-	<div class="col-md-12 p-0">
-		<div class="col-md-6 form-group">
-			<div class="d-flex align-items-center">
-				<label class="font-weight-bold m-0">Email:</label>
-				<input class='form-control ml-2' type='email' placeholder="Email Address" name='emailAddress'>
+	<div class="col-md-12">
+		<div class="row form-group align-items-center">			
+				<label class="col col-label font-weight-bold m-0">Email:</label>
+			<div class="col-md-10">	
+				<input class='form-control' type='email' placeholder="Email Address" name='emailAddress'>
 			</div>
 		</div>
 	</div>
-	<div class="col-md-12 p-0">
-		<div class="col-md-4 form-group">
-			<div class="d-flex align-items-center">
-				<label class="font-weight-bold m-0 w-30">Gender:</label>
-				<select class="form-control input-sm ml-2" name="patientSex" select2>
-					<option value="">--</option>
-					<option value="M">Male</option>
-					<option value="F">Female</option>
-					<option value="UNKNOWN">Unknown</option>
-				</select>
-			</div>
+	<div class="col-md-12">
+		<div class="row form-group align-items-center">			
+				<label class="col-md-2 pr-0 font-weight-bold m-0">Gender:</label>
+				<div class="col-md-10">
+					<select class="form-control input-sm" name="patientSex" select2>
+						<option value="">--</option>
+						<option value="M">Male</option>
+						<option value="F">Female</option>
+						<option value="UNKNOWN">Unknown</option>
+					</select>
+				</div>
 		</div>
 	</div>
 </div>
 <div class="row">
-	<div class="col-md-5 form-group">
-		<div class="d-flex align-items-center">
-			<label class="font-weight-bold m-0 w-25">DOB: <span class="text-danger">*</span></label>
-			<input type="date" required name="patientDob" value="" class="form-control input-sm">
+	<div class="col-12">
+		<div class="row align-items-center form-group">
+			<label class="col-md-2 pr-0 font-weight-bold m-0">DOB: <span class="text-danger">*</span></label>
+			<div class="col-md-10">	
+				<input type="date" required name="patientDob" value="" class="form-control input-sm">
+			</div>
 		</div>
 	</div>
-	<div class="col-md-5 form-group">
-		<div class="d-flex align-items-center">
-			<label class="font-weight-bold m-0 w-25">Service:</label>
-			<input type="date" name="dateOfService" value="{{date('Y-m-d')}}" class="form-control input-sm">
+
+	<div class="col-12">
+		<div class="row align-items-center form-group">			
+			<label class="col-md-2 pr-0 font-weight-bold m-0">Service:</label>
+			<div class="col-md-10">	
+				<input type="date" name="dateOfService" value="{{date('Y-m-d')}}" class="form-control input-sm">
+			</div>
 		</div>
 	</div>
+
+	
+	
 </div>
 @if($pro->pro_type === 'ADMIN')
 <div class="row">
-	<div class="col-md-5 form-group">
-		<div class="d-flex align-items-center">
-			<label class="font-weight-bold m-0 w-25">HCP Pro:</label>
-			<select name="hcpProUid" class="form-control input-sm" provider-search provider-type="hcp">
-				<option value="">--select--</option>
-			</select>
+	<div class="col-12">
+		<div class="row align-items-center form-group">			
+			<label class="col-md-2 pr-0 font-weight-bold m-0">HCP Pro:</label>
+			<div class="col-md-10">	
+				<select name="hcpProUid" class="form-control input-sm" provider-search provider-type="hcp">
+					<option value="">--select--</option>
+				</select>
+			</div>
 		</div>
 	</div>
-	<div class="col-md-7 form-group">
-		<div class="d-flex align-items-center">
-			<label class='font-weight-bold m-0 w-25'>Coordinator:</label>
-			<select name="assistantProUid" class="form-control input-sm ml-2" provider-search provider-type="default-na">
-				<option value="">--select--</option>
-			</select>
+	<div class="col-12">
+		<div class="row align-items-center form-group">		
+			<label class='col-md-2 pr-0 font-weight-bold m-0' style="font-size:10px !important;">Coordinator:</label>
+			<div class="col-md-10">
+				<select name="assistantProUid" class="form-control input-sm" provider-search provider-type="default-na">
+					<option value="">--select--</option>
+				</select>
+			</div>
 		</div>
-	</div>
+	</div>	
 </div>
 @elseif($pro->is_hcp === true)
 <div class="row">
 	<div class="col-md-12">
-		<div class='form-group'>
-			<div class="d-flex align-items-center">
-				<label class="font-weight-bold m-0 w-25">HCP Pro:</label>
+		<div class='row form-group'>			
+				<label class="col-md-2 pr-0 font-weight-bold m-0">HCP Pro:</label>
+			<div class="col-md-10">	
 				<input type="text" class="form-control" readonly value="{{$pro->displayName()}}">
 				<input type="hidden" name="hcpProUid" value="{{$pro->uid}}">
 			</div>
@@ -81,27 +93,34 @@
 </div>
 @elseif($pro->isDefaultNA())
 <div class="row">
-	<div class="col-md-5 form-group">
-		<div class="d-flex align-items-center">
-			<label class="font-weight-bold m-0 w-25">HCP Pro:</label>
-			<?php $teams = $pro->teamsWhereAssistant; ?>
-			<select name="hcpProUid" class="form-control">
-				@if(count($teams) > 1)
-				<option value="">--select--</option>
-				@endif
-				@foreach($teams as $team)
-				<option value="{{$team->mcp->uid}}">{{$team->mcp->displayName()}}</option>
-				@endforeach
-			</select>
+	<div class="col-12">
+		<div class="row align-items-center form-group">			
+				<label class="col-md-2 pr-0 font-weight-bold m-0">HCP Pro:</label>
+				<div class="col-md-10">
+				<?php $teams = $pro->teamsWhereAssistant; ?>
+				<select name="hcpProUid" class="form-control">
+					@if(count($teams) > 1)
+					<option value="">--select--</option>
+					@endif
+					@foreach($teams as $team)
+					<option value="{{$team->mcp->uid}}">{{$team->mcp->displayName()}}</option>
+					@endforeach
+				</select>
+			</div>
 		</div>
 	</div>
-	<div class="col-md-7 form-group">
-		<div class="d-flex align-items-center">
-			<label class='font-weight-bold m-0 w-25'>Coordinator:</label>
-			<input type="text" class="form-control" readonly value="{{$pro->displayName()}}">
-			<input type="hidden" name="assistantProUid" value="{{$pro->uid}}">
+
+	<div class="col-12">
+		<div class="row align-items-center form-group">			
+			<label class='col-md-2 pr-0 font-weight-bold m-0'>Coordinator:</label>
+			<div class="col-md-10">	
+				<input type="text" class="form-control" readonly value="{{$pro->displayName()}}">
+				<input type="hidden" name="assistantProUid" value="{{$pro->uid}}">
+			</div>
 		</div>
 	</div>
+	
+	
 </div>
 @endif
 <div class="row">
@@ -145,4 +164,4 @@
 		<input type='checkbox' name='isTestRecord' />
 		This is a test record
 	</label>
-</div>
+</div>