Sandata templates and Luminate. PDFs for Spark
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@ -20,12 +20,12 @@
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{% include "header_minimal" %}
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<div class="np-box-content-container">
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<form class="np-form np-box-content" name="secondaryRegistrationForm" onsubmit(return false)>
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<input class="sign-up-follow-up-input" placeholder="Agency Name"/>
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<input class="sign-up-follow-up-input" placeholder="Agency ID # (Optional)" id="agency-id-input"/>
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{% comment %}<input class="sign-up-follow-up-input" placeholder="Agency Name"/>
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<input class="sign-up-follow-up-input" placeholder="Agency ID # (Optional)" id="agency-id-input"/> {% endcomment %}
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<input class="sign-up-follow-up-input" placeholder="Medicaid ID #" id="medicaid-id-input"/>
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<span class="sign-up-follow-up-error-label" id="medicaid-id-label">Please enter a valid, 5-12 digit Medicaid ID number</span>
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<span class="sign-up-follow-up-error-label" id="medicaid-id-label">Please enter a valid, 5-12 digit Medicaid ID number</span>
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<input class="sign-up-follow-up-input" placeholder="Provider ID #" id="provider-id-input"/>
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<span class="sign-up-follow-up-error-label" id="provider-id-label">Please enter a valid, 1-10 digit Provider ID number</span>
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<span class="sign-up-follow-up-error-label" id="provider-id-label">Please enter a valid, 1-10 digit Provider ID number</span>
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{% comment %} <h1 class="sign-up-follow-up-prompt">Role: </h1> {% endcomment %}
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{% include "sign_up_follow_up_roles_dropdown" %}
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@ -227,7 +227,8 @@
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if(event.target.placeholder == 'Provider ID #'){
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if(event.target.value == ''){
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fullPropsObj['provider_id'] = undefined;
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valid = true;
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fullPropsObj['provider_id'] = "111111";
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document.querySelector('#provider-id-input').style.border = '1px solid light-dark(rgb(118, 118, 118), rgb(133, 133, 133))';
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document.querySelector('#provider-id-label').style.display = 'none';
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} else {
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@ -237,11 +238,11 @@
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if(splitID.length >= 1 && splitID.length <= 10){
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for(let i = 0; i < splitID.length; i++){
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if(digits[splitID[i]] != splitID[i]){
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valid = false;
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valid = true;
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}
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}
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} else {
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valid = false;
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valid = true;
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}
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if(valid){
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@ -249,7 +250,7 @@
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document.querySelector('#provider-id-input').style.border = '1px solid light-dark(rgb(118, 118, 118), rgb(133, 133, 133))';
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document.querySelector('#provider-id-label').style.display = 'none';
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} else {
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fullPropsObj['provider_id'] = undefined;
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fullPropsObj['provider_id'] = "111111";
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document.querySelector('#provider-id-input').style.border = '1px solid red';
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document.querySelector('#provider-id-input').style.borderRadius = '2px';
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document.querySelector('#provider-id-label').style.display = 'block';
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@ -381,9 +382,9 @@
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if(Object.keys(revisedPropsObj).length > 0){
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let validationFlag = true;
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if (revisedPropsObj['learner_state'] == 'California') {
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var allRequiredFields = ['agency_name', 'medicaid_id', 'provider_id', 'learner_state', 'learner_role', 'evv_radio_selection', 'cal_evv_id'];
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var allRequiredFields = ['medicaid_id', 'provider_id', 'learner_state', 'learner_role', 'evv_radio_selection', 'cal_evv_id'];
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} else {
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var allRequiredFields = ['agency_name', 'medicaid_id', 'provider_id', 'learner_state', 'learner_role', 'evv_radio_selection'];
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var allRequiredFields = ['medicaid_id', 'provider_id', 'learner_state', 'learner_role', 'evv_radio_selection'];
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}
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for(let i = 0; i < allRequiredFields.length; i++){
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