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@@ -2,11 +2,82 @@
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<h4 class="font-weight-bold text-nowrap m-0">Watchpat Medical Necessity</h4>
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<div moe class="ml-3">
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<a start show href="#"><i class="fa fa-edit"></i> Edit</a>
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- <form url="/api/client/updateWatchPatSignsAndSymptoms">
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+ <form url="/api/client/updateWatchPatMedicalNecessity">
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<input type="hidden" name="uid" value="{{$patient->uid}}">
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- <div class="font-weight-bold font-size-14 text-secondary border-bottom px-2 pb-2 mb-2 text-nowrap">Watchpat Medical Necessity</div>
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+ <div class="font-weight-bold font-size-14 text-secondary border-bottom pb-2 mb-2 text-nowrap">Watchpat Medical Necessity</div>
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+
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+ <div class="mb-2">
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+ <div class="mb-1">Is WatchPat Medically Needed:</div>
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+ <select name="isWatchPatMedicallyNeeded" class="form-control form-control-sm">
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+ <option value="">-- select --</option>
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+ <option value="YES" {{$patient->is_watch_pat_medically_needed === 'YES' ? 'selected' : ''}}>Yes</option>
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+ <option value="NO" {{$patient->is_watch_pat_medically_needed === 'NO' ? 'selected' : ''}}>No</option>
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+ <option value="UNKNOWN" {{$patient->is_watch_pat_medically_needed === 'UNKNOWN' ? 'selected' : ''}}>Unknown</option>
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+ </select>
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+ </div>
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+
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+ <div class="mb-2">
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+ <div class="mb-1">Memo:</div>
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+ <input type="text" value="{{$patient->watch_pat_medically_needed_for_memo}}" name="watchPatMedicallyNeededForMemo" class="form-control form-control-sm d-inline-block flex-grow-1">
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+ </div>
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+
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+ <div class="mb-2">
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+ <table class="table table-sm table-bordered m-0">
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+ <thead class="bg-light">
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+ <tr>
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+ <th class="text-sm text-secondary font-weight-normal border-bottom-0">ICD</th>
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+ <th class="text-sm text-secondary font-weight-normal border-bottom-0">Description</th>
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+ </tr>
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+ </thead>
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+ <tbody>
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+ <tr>
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+ <td>
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+ <input type="text" class="icd-input search_field" icd-autocomplete-code="" name="watchPatMedicallyNeededForIcd1" value="{{$patient->watch_pat_medically_needed_for_icd1}}" placeholder="ICD 1" autocomplete="off" role="combobox" aria-expanded="false">
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+ </td>
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+ <td>
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+ <input type="text" class="form-control form-control-sm" icd-autocomplete-description="" name="watchPatMedicallyNeededForIcd1Description" value="{{$patient->watch_pat_medically_needed_for_icd1description}}">
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+ </td>
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+ </tr>
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+ <tr>
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+ <td>
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+ <input type="text" class="icd-input search_field" icd-autocomplete-code="" name="watchPatMedicallyNeededForIcd2" value="{{$patient->watch_pat_medically_needed_for_icd2}}" placeholder="ICD 2" autocomplete="off" role="combobox" aria-expanded="false">
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+ </td>
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+ <td>
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+ <input type="text" class="form-control form-control-sm" icd-autocomplete-description="" name="watchPatMedicallyNeededForIcd2Description" value="{{$patient->watch_pat_medically_needed_for_icd2description}}">
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+ </td>
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+ </tr>
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+ <tr>
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+ <td>
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+ <input type="text" class="icd-input search_field" icd-autocomplete-code="" name="watchPatMedicallyNeededForIcd3" value="{{$patient->watch_pat_medically_needed_for_icd3}}" placeholder="ICD 3" autocomplete="off" role="combobox" aria-expanded="false">
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+ </td>
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+ <td>
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+ <input type="text" class="form-control form-control-sm" icd-autocomplete-description="" name="watchPatMedicallyNeededForIcd3Description" value="{{$patient->watch_pat_medically_needed_for_icd3description}}">
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+ </td>
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+ </tr>
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+ <tr>
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+ <td>
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+ <input type="text" class="icd-input search_field" icd-autocomplete-code="" name="watchPatMedicallyNeededForIcd4" value="{{$patient->watch_pat_medically_needed_for_icd4}}" placeholder="ICD 4" autocomplete="off" role="combobox" aria-expanded="false">
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+ </td>
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+ <td>
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+ <input type="text" class="form-control form-control-sm" icd-autocomplete-description="" name="watchPatMedicallyNeededForIcd4Description" value="{{$patient->watch_pat_medically_needed_for_icd4description}}">
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+ </td>
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+ </tr>
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+ </tbody>
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+ </table>
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+ </div>
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+
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+ <div class="mb-2">
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+ <div class="mb-1">Note:</div>
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+ <select name="watchPatMedicalNecessityNoteUid" class="form-control form-control-sm">
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+ <option value="">-- select --</option>
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+ @foreach($patient->notes as $note)
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+ <option value="{{$note->uid}}">
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+ {{$note->hcpPro ? $note->hcpPro->displayName() : 'Note'}} ({{friendly_date_time($note->effective_dateest, false)}})
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+ </option>
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+ @endforeach
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+ </select>
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+ </div>
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- TODO
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<div class="mt-2 border-top pt-2 text-center">
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<button class="btn btn-primary btn-sm" submit>Submit</button>
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<button class="btn btn-default border btn-sm" cancel>Cancel</button>
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