Init dump
This commit is contained in:
Jason Jordan
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<div class="bg-deepcove min-h-screen w-full flex flex-col">
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<h1 class="font-bold text-4xl text-platinum">New Employer Setup</h1>
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<h3 class="font-bold text-2xl text-bluemana">General Information</h3>
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<%= form_with model: @form, url: employer_setup_index_path, local: true do |f| %>
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<div class="flex flex-col my-8 space-y-6">
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<div class="flex space-x-10">
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<div class="w-1/5">
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<%= f.text_field :name, label: { text: "Employer Name" }, class: "w-full" %>
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</div>
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<div class="w-1/5">
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<%= f.text_field :group_number, label: { text: "Group/Medical Number" }, class: "w-full" %>
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</div>
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<div>
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<%= f.check_box :dental %>
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</div>
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</div>
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<div class="flex space-x-10">
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<div class="w-1/5">
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<%= f.text_field :pl_plan_key, label: { text: "Pl Plan Key" }, class: "w-full" %>
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</div>
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<div class="w-1/5">
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<%= f.text_field :effect_date, label: { text: "Effective Date" }, class: "w-full" %>
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</div>
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</div>
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<div class="flex space-x-10">
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<div class="w-1/5">
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<%= f.select :number_of_plans, options_for_select((1..6).to_a), label: { text: "Number of Plans" }, class: "w-1/3" %>
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</div>
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<div class="w-1/5">
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<%= f.select :network, options_for_select([["Cigna", "cig"], ["Cigna+Regional", "cig+"], ["Medcost", "med"]]), label: { text: "Provider Network" }, data: { controller: "form-toggle", action: "change->form-toggle#toggleDivs" }, class: "w-full" %>
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</div>
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<div id="div-a" class="w-1/5" data-form-toggle-target="divA">
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<%= f.select :number_of_additional_network_logos, options_for_select((0..6).to_a), label: { text: "Number of Additional Network Logos" }, class: "w-1/3" %>
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</div>
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</div>
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<div class="flex space-x-5 items-center mt-4">
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<label for="file_upload_input" class="cursor-pointer bg-atmosphere hover:bg-bluetang text-platinum font-bold py-2 px-4 rounded border border-platinum">
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Choose Employer Logo File
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</label>
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<span id="file_name_display" class="ml-2 text-bluemana font-semibold">No file chosen</span>
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<%= f.file_field :employer_logo, class: "hidden", id: "file_upload_input" %>
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</div>
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<div class="pt-8">
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<%= f.submit "Continue to Plans" %>
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</div>
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</div>
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<% end %>
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</div>
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<script>
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document.getElementById('file_upload_input').addEventListener('change', function(e) {
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var fileName = e.target.files[0] ? e.target.files[0].name : 'No file chosen';
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document.getElementById('file_name_display').textContent = fileName;
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});
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</script>
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@@ -0,0 +1,41 @@
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<div class="bg-deepcove min-h-screen w-full flex flex-col">
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<h1 class="font-bold text-4xl text-platinum">New Employer Setup</h1>
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<h3 class="font-bold text-2xl text-bluemana">Provider Network</h3>
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<%= form_with model: @form, url: employer_setup_index_path, local: true do |f| %>
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<% @form.number_of_additional_network_logos.to_i.times do |i| %>
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<%= f.fields_for :network_exceptions do |network_fields| %>
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<div class="w-full flex flex-col my-8 space-y-6">
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<div class="flex space-x-5 items-center mt-4">
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<label for="file_upload_input" class="cursor-pointer bg-atmosphere hover:bg-bluetang text-platinum font-bold py-2 px-4 rounded border border-platinum">
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Choose Network Logo File
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</label>
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<span id="file_name_display" class="ml-2 text-bluemana font-semibold">No file chosen</span>
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<%= network_fields.file_field :network_logo, class: "hidden", id: "file_upload_input" %>
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</div>
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<% 2.to_i.times do |j| %>
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<%= network_fields.fields_for :exceptions do |exception_fields| %>
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<div class="flex space-x-10">
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<div class="w-1/5">
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<%= exception_fields.select :type, options_for_select(["Zipcode","State"]), label: { text: "Exception Type" }, prompt: "Select Type", class: "w-full" %>
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</div>
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<div class="w-1/5">
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<%= exception_fields.text_field :value, label: { text: "Exception Value" }, class: "w-full" %>
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</div>
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</div>
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<% end %>
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<% end %>
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</div>
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<% end %>
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<% end %>
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<div class="py-10">
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<%= f.submit "Continue to Summary" %>
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</div>
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<% end %>
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</div>
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<script>
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document.getElementById('file_upload_input').addEventListener('change', function(e) {
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var fileName = e.target.files[0] ? e.target.files[0].name : 'No file chosen';
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document.getElementById('file_name_display').textContent = fileName;
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});
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</script>
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@@ -0,0 +1,38 @@
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<div class="bg-deepcove min-h-screen w-full flex flex-col">
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<h1 class="font-bold text-4xl text-platinum">New Employer Setup</h1>
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<%= form_with url: 'create_plans', method: :post do |form| %>
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<div class="w-full flex">
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<div class="flex flex-col mr-4">
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<% @id_card_template_benefits.each do |bene| %>
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<div>
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<%= form.text_field "plans[benefit_descs][#{bene.sequence}]", label: { text: "Benefit Description" }, value: "#{bene.benefit_desc}" %>
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</div>
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<% end %>
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</div>
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<% @employer_data['employer']['number_of_plans'].to_i.times do |i| %>
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<div class="flex flex-col">
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<div>
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<%= form.text_field "plans[plan_#{i}][plan_id]", label: { text: "Plan Id" } %>
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</div>
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<div class="bg-gray-200 rounded py-2 px-4 text-bluetang font-semibold leading-tight">
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<select data-action="benefits-template-picker#fetchData" data-benefits-template-picker-url-value="/id_card_benefits_templates/get_templates_benefits/:id">
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<option value="">Select Existing Template (optional)</option>
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<% @id_card_templates.each do |temp| %>
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<option value="<%= temp.id %>"><%= temp.name %></option>
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<% end %>
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</select>
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</div>
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<% @id_card_template_benefits.each do |bene| %>
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<div>
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<div>
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<%= form.text_field "plans[plan_#{i}][#{bene.sequence}]", label: { text: "Benefit Value" }, data: { benefits_template_picker_target: "benefit_#{bene.sequence}" } %>
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</div>
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</div>
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<% end %>
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</div>
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<% end %>
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</div>
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<%= form.submit "Summary" %>
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</div>
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<% end %>
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</div>
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@@ -0,0 +1,47 @@
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<div class="bg-deepcove min-h-screen w-full flex flex-col">
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<h1 class="font-bold text-4xl text-platinum">New Employer Setup</h1>
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<h3 class="font-bold text-2xl text-bluemana">Medical Plans</h3>
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<div class="flex flex-col pl-6">
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<%= form_with model: @form, url: employer_setup_index_path, local: true do |f| %>
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<div class="w-full flex my-8">
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<div class="flex flex-col justify-end pr-6">
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<% @id_card_template_benefits.each do |bene| %>
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<%= f.fields_for :benefit_descs do |bd_fields| %>
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<div>
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<%= bd_fields.text_field "#{bene.sequence}", label: { text: "Benefit Description #{bene.sequence}" }, value: "#{bene.benefit_desc}" %>
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</div>
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<% end %>
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<% end %>
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</div>
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<% @form.number_of_plans.to_i.times do |i| %>
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<% border_colors = ['border-atmosphere', 'border-copper', 'border-bluemana'] %>
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<% text_colors = ['text-atmosphere', 'text-copper', 'text-bluemana'] %>
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<div class="inline-flex flex-col justify-end pr-6 pl-1 relative">
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<div class="absolute left-0 top-[2%] h-[98%] border-l-4 <%= border_colors[i] %> rounded-bl-lg"></div>
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<div class="font-bold text-2xl <%= text_colors[i] %> -ml-[6px] z-2 w-full">
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<%= "Plan #{i + 1}" %>
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</div>
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<%= f.fields_for :plans do |plan_fields| %>
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<div class="pl-1 w-full">
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<%= plan_fields.text_field :plan_id, label: { text: "Plan Id" }, class: "w-full" %>
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</div>
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<div class="pl-1" data-controller="benefits_template_picker_controller">
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<%= f.select :template_id, options_from_collection_for_select(@id_card_templates, :id, :name), { prompt: "Select Existing Template (optional)", data: { action: "benefits-template-picker#fetchData" }} %>
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</div>
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<% @id_card_template_benefits.each do |bene| %>
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<div>
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<div class="pl-1 w-full">
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<%= plan_fields.text_field "#{bene.sequence}", label: { text: "Benefit Value #{bene.sequence}" }, data: { benefits_template_picker_target: "benefit_#{bene.sequence}" }, class: "w-full" %>
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</div>
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</div>
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<% end %>
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<% end %>
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</div>
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<% end %>
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</div>
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<div class="py-10">
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<%= f.submit "Continue to Provider Network" %>
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</div>
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<% end %>
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</div>
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</div>
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@@ -0,0 +1,9 @@
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<div class="bg-deepcove min-h-screen w-full flex flex-col">
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<h1 class="font-bold text-4xl text-platinum">New Employer Setup</h1>
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<h3 class="font-bold text-2xl text-bluemana">Summary</h3>
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<%= form_with model: @form, url: employer_setup_index_path, local: true do |f| %>
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<div class="py-10">
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<%= f.submit "Submit" %>
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</div>
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<% end %>
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</div>
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