ID Card Network:

(<%= @employer.name %>)

<%= form_with model: @configuration, url: update_network_employer_id_card_configuration_index_path(@employer.slug), local: true, multipart: true do |f| %>

<%= f.select :network_logo_id, options_for_select(IdCard::NetworkLogo.pluck(:filename)), { include_blank: "Select/Add Network Logo", class: "rounded-r-none flex flex-col" }, data: { logo_upload_target: "logoField" } %>

<%= icon "image-plus", library: "lucide" %>

<%= f.file_field :logo_file, class: "hidden", id: "employer_logo_file", data: { logo_upload_target: "previewContainer", parent_value: "network_logo", action: "change->logo-upload#uploadLogo" }, direct_upload: true %>

<%= f.select :provider_section_id, options_from_collection_for_select(@provider_sections, :id, :title), { include_blank: "Select/Add Network Provider Info", class: "rounded-r-none flex flex-col" }, data: { logo_upload_target: "logoField" } %>

<%= f.select :rx_section_id, options_from_collection_for_select(@rx_sections, :id, :title), { include_blank: "Select Rx Info", class: "rounded-r-none flex flex-col" } %>

Claims Submission Section

<%= render 'provider_fields', f: f %>

<%= render 'claim_fields', f: f %>

<%= f.submit "Submit Network" %>