ID Card Setup:

(<%= @employer.name %>)

<%= form_with model: @configuration, url: update_general_employer_id_card_configuration_index_path(@employer.slug), local: true, multipart: true do |f| %>
<%= f.text_field :print_name, label: { text: "Print Name" }, class: "w-full" %>
<%= f.text_field :rx_group_number, label: { text: "Rx Group Number" }, class: "w-full" %>
<%= f.select :network_provider, options_for_select(["Cigna", "Medcost", "Other"], @configuration.network_provider), { label: { text: "Provider Network" }, include_blank: "Select", class: "w-full" }, data: { provider_update_target: "providerNetworkField", action: "change->provider-update#syncDefaults" } %>
<%= f.select :card_template, options_for_select([["FairosRx", "FairosRxIDCard"], ["Tandemloc", "TandemlocIDCard"], ["smART", "SmartIDCard"], ["QRCode (Healthbus)", "QRCodeIDCard"]], @configuration.card_template || "FairosRxIDCard" ), { label: { text: "Card Template" }, include_blank: "Select", class: "w-full" } %>
>
<%= f.text_field :employer_logo_filename, label: { text: "Employer Logo" }, default: "No logo added", data: { logo_upload_target: "logoNameField" }, class: "w-full rounded-r-none", readonly: true %>
<%= f.hidden_field :employer_logo_id, label: { text: "Employer Logo" }, data: { logo_upload_target: "logoIdField" } %> <%= f.file_field :employer_logo_file, class: "hidden", id: "employer_logo_file", data: { logo_upload_target: "previewContainer", action: "change->logo-upload#uploadLogo" }, direct_upload: true %>
<%= f.select :network_logo_id, options_for_select(IdCard::NetworkLogo.pluck(:filename, :id), @configuration.network_logo_id), { include_blank: "Select/Add Network Logo", class: "rounded-r-none flex flex-col" }, data: { provider_update_target: "networkLogoField", logo_upload_target: "logoIdField", action: "change->logo-upload#setSelectPreview" } %>
<%= f.file_field :network_logo_file, class: "hidden", id: "network_logo_file", data: { logo_upload_target: "previewContainer", action: "change->logo-upload#uploadLogo" }, direct_upload: true %>
<%= f.select :rx_section_id, options_from_collection_for_select(@rx_options, :id, :title, @configuration.rx_section_id || @fairos_rx_id), { include_blank: "Select Rx", class: "flex-col w-full" } %>
<%= f.select :provider_section_id, options_for_select(@provider_options, @configuration.provider_section_id), { label: { text: "Claims Submission Section" }, include_blank: "Select/Add Claims Submission", class: "flex flex-col w-full" }, data: { provider_update_target: "providerSectionField", general_form_target: "selectField", action: "change->general-form#toggleNewFieldSection" } %>
<%= f.submit "Create ID Card Setup" %>
<% end %>