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= __webpack_public_path__ + \"static/media/calendar.38913150.png\";","module.exports = __webpack_public_path__ + \"static/media/verisma_logo.2eb1a5a4.png\";","module.exports = __webpack_public_path__ + \"static/media/error-icon.c214a35f.png\";","module.exports = __webpack_public_path__ + \"static/media/pbv.6e9f9f35.png\";","module.exports = __webpack_public_path__ + \"static/media/copy-icon.92c7f6d7.png\";","\r\n// REFACTOR; separate configs into separate files and import/export using index.js\r\n\r\n// TODO; consider trying to load only the required locale per client configuration\r\nimport {registerLocale} from 'react-datepicker';\r\nimport enUS from \"date-fns/locale/en-us\";\r\nimport es from \"date-fns/locale/es\";\r\nimport zhCN from \"date-fns/locale/zh-cn\";\r\nimport fr from \"date-fns/locale/fr\";\r\n\r\nexport const registerLocales = _ => {\r\n  registerLocale(\"en-us\", enUS);\r\n  registerLocale(\"es\", es);\r\n  registerLocale(\"zh-cn\", zhCN);\r\n  registerLocale(\"fr\", fr);\r\n}\r\n\r\n\r\n\r\n// DESIGN; these attributes control the structure - not really client specific - where do we put this? \r\nexport const modalCustomStyles = {\r\n  content: {\r\n    width: \"50rem\",\r\n    maxWidth: \"calc(100vw - 2rem)\",\r\n    maxHeight: \"calc(100vh - 2rem)\",\r\n    boxShadow: \"0 0 30px 0 rgba(0, 0, 0, 0.25)\",\r\n    overflowY: \"auto\",\r\n    position: \"relative\",\r\n    padding: \"1px\",\r\n    top: \"50%\",\r\n    left: \"50%\",\r\n    right: \"auto\",\r\n    bottom: \"auto\",\r\n    border: \"none\",\r\n    overflow: \"auto\",\r\n    marginRight: \"-50%\",\r\n    transform: \"translate(-50%, -50%)\"\r\n\r\n  }\r\n};\r\n\r\n// NOTE; options are left, right, top, bottom\r\nexport const popoverLocation = \"right\"; ","import React, { useState } from \"react\";\r\n\r\nconst FormikProps = ({ values, touched, errors }) => {\r\n  const [showProps, setShowProps] = useState(false);\r\n  return (\r\n    <div>\r\n      <div className=\"text-center\">\r\n        <button className=\"btn btn-light\" type=\"button\" onClick={() => setShowProps(!showProps)}>\r\n          Develoment Only: Toggle Form Internals\r\n        </button>\r\n      </div>\r\n      {showProps && (\r\n        <div style={{ border: \"dashed 1px #ccc\", padding: 10, marginTop: 20 }}>\r\n          <h5>Formik Internals</h5>\r\n          <div>Values</div>\r\n          <pre>{JSON.stringify(values, null, 2)}</pre>\r\n          <hr />\r\n          <div>Touched</div>\r\n          <pre>{JSON.stringify(touched, null, 2)}</pre>\r\n          <hr />\r\n          <div>Errors</div>\r\n          <pre>{JSON.stringify(errors, null, 2)}</pre>\r\n        </div>\r\n      )}\r\n    </div>\r\n  );\r\n};\r\n\r\nexport default FormikProps;\r\n","import React from \"react\";\r\n\r\nconst Required = ({ value }) => value ? <span className=\"required-displayer\">*</span> : null;\r\n\r\nexport default Required;\r\n","import React, { useState } from \"react\";\r\nimport DatePicker from \"react-datepicker\";\r\nimport { ErrorMessage } from \"formik\";\r\nimport Required from \"../../../components/Required\";\r\nimport MaskedInput from 'react-text-mask';\r\nimport calendar from '../styles/assets/calendar.png'\r\n\r\n\r\nconst PatientInfomation = ({ formik, inputClasses, props, template, config }) => {\r\n  const [showAlert, setShowAlert] = useState(true);\r\n\r\n  const isUser18 = (DOB) => {\r\n    var today = new Date();\r\n    var birthDate = new Date(DOB);\r\n    var age = today.getFullYear() - birthDate.getFullYear();\r\n    var m = today.getMonth() - birthDate.getMonth();\r\n    if (m < 0 || (m === 0 && today.getDate() < birthDate.getDate())) {\r\n      age--;\r\n    }\r\n    return age;\r\n  }\r\n\r\n  const setDateLimit = () => {\r\n    let currentDate = new Date();\r\n    currentDate.setFullYear(new Date().getFullYear() - 200);\r\n    return currentDate;\r\n  }\r\n\r\n\r\n\r\n  return (\r\n    config.page.form.sections.patientInformationSection.active ?\r\n      <div id='patientInfoSection' className='form-section'>\r\n\r\n        <h2\r\n          style={template.styles.section}\r\n          className=\"section-heading\">\r\n          {template.title}\r\n        </h2>\r\n\r\n        <div className=\"form-fields\">\r\n\r\n\r\n          {template.fields.patientInfoFirstName.active &&\r\n            <div className=\"form-field firstName-field\">\r\n              <label htmlFor=\"patientInfofirstName\">\r\n                <span style={template.styles.label}>\r\n                  {template.fields.patientInfoFirstName.label}\r\n                </span>{\" \"}\r\n                <Required\r\n                  value={\r\n                    template.fields.patientInfoFirstName.validations.required\r\n                      .value\r\n                  }\r\n                />\r\n              </label>\r\n              <input\r\n                {...formik.getFieldProps(\"patientInfoFirstName\")}\r\n                maxLength={\r\n                  template.fields.patientInfoFirstName.validations.maxLength.value\r\n                }\r\n                type=\"text\"\r\n                name=\"patientInfoFirstName\"\r\n                id=\"patientInfoFirstName\"\r\n                style={config.page.form.styles.hint}\r\n                className={inputClasses(\r\n                  formik.touched.patientInfoFirstName &&\r\n                  formik.errors.patientInfoFirstName\r\n                )}\r\n                placeholder={template.fields.patientInfoFirstName.hint}\r\n              />\r\n              <ErrorMessage name=\"patientInfoFirstName\">\r\n                {msg => <div className=\"input-error-text\">{msg}</div>}\r\n              </ErrorMessage>\r\n\r\n            </div>\r\n          }\r\n\r\n          {template.fields.patientInfoMiddleInitial.active && (\r\n            <div className=\"form-field MI-field\">\r\n              <label htmlFor=\"patientInfoMiddleInitial\">\r\n                <span style={template.styles.label}>\r\n                  {template.fields.patientInfoMiddleInitial.label}\r\n                </span>{\" \"}\r\n                <Required\r\n                  value={\r\n                    template.fields.patientInfoMiddleInitial.validations\r\n                      .required.value\r\n                  }\r\n                />\r\n              </label>\r\n              <input\r\n                {...formik.getFieldProps(\"patientInfoMiddleInitial\")}\r\n                // style={{ width: 65 }}\r\n                type=\"text\"\r\n                style={config.page.form.styles.hint}\r\n                maxLength={\r\n                  template.fields.patientInfoMiddleInitial.validations\r\n                    .maxLength.value\r\n                }\r\n                name=\"patientInfoMiddleInitial\"\r\n                id=\"patientInfoMiddleInitial\"\r\n                className=\"form-control\"\r\n                placeholder={template.fields.patientInfoMiddleInitial.hint}\r\n              />\r\n            </div>\r\n          )}\r\n\r\n\r\n          {template.fields.patientInfoLastName.active &&\r\n            <div className=\"form-field lastName-field\">\r\n              <label htmlFor=\"patientInfoLastName\">\r\n                <span style={template.styles.label}>\r\n                  {template.fields.patientInfoLastName.label}\r\n                </span>{\" \"}\r\n                <Required\r\n                  value={\r\n                    template.fields.patientInfoLastName.validations.required.value\r\n                  }\r\n                />\r\n              </label>\r\n              <input\r\n                {...formik.getFieldProps(\"patientInfoLastName\")}\r\n                type=\"text\"\r\n                style={config.page.form.styles.hint}\r\n                maxLength={\r\n                  template.fields.patientInfoLastName.validations.maxLength.value\r\n                }\r\n                name=\"patientInfoLastName\"\r\n                id=\"patientInfoLastName\"\r\n                className={inputClasses(\r\n                  formik.touched.patientInfoLastName &&\r\n                  formik.errors.patientInfoLastName\r\n                )}\r\n                placeholder={template.fields.patientInfoLastName.hint}\r\n              />\r\n              <ErrorMessage name=\"patientInfoLastName\">\r\n                {msg => <div className=\"input-error-text\">{msg}</div>}\r\n              </ErrorMessage>\r\n            </div>\r\n          }\r\n\r\n          {template.fields.patientInfoOtherName.active &&\r\n            <div className=\"form-field otherName-field\">\r\n              <label htmlFor=\"patientInfoOtherName\">\r\n                <span style={template.styles.label}>\r\n                  {template.fields.patientInfoOtherName.label}\r\n                </span>{\" \"}\r\n                <Required value={template.fields.patientInfoOtherName.required} />\r\n              </label>\r\n              <input\r\n                {...formik.getFieldProps(\"patientInfoOtherName\")}\r\n                type=\"text\"\r\n                maxLength=\"16\"\r\n                name=\"patientInfoOtherName\"\r\n                id=\"patientInfoOtherName\"\r\n                style={config.page.form.styles.hint}\r\n                className={inputClasses(\r\n                  formik.touched.patientInfoOtherName &&\r\n                  formik.errors.patientInfoOtherName\r\n                )}\r\n                placeholder={template.fields.patientInfoOtherName.hint}\r\n              />\r\n              <ErrorMessage name=\"patientInfoOtherName\">\r\n                {msg => <div className=\"input-error-text\">{msg}</div>}\r\n              </ErrorMessage>\r\n            </div>\r\n          }\r\n\r\n          {template.fields.patientInfoDob.active &&\r\n            <div className=\"form-field dob-field\">\r\n\r\n              <label htmlFor=\"patientInfoDob\">\r\n                <span style={template.styles.label}>\r\n                  {template.fields.patientInfoDob.label}\r\n                </span>\r\n                {\" \"}\r\n                <Required\r\n                  value={template.fields.patientInfoDob.validations.required.value}\r\n                />\r\n              </label>\r\n\r\n              <div className='date-input'>\r\n                <DatePicker\r\n                  locale={template.locale}\r\n                  autoComplete=\"off\"\r\n                  style={template.styles.hint}\r\n                  {...formik.getFieldProps(\"patientInfoDob\")}\r\n                  dateFormat=\"MM/dd/yyyy\"\r\n                  customInput={<MaskedInput\r\n                    mask={[/\\d/, /\\d/, '/', /\\d/, /\\d/, '/', /\\d/, /\\d/, /\\d/, /\\d/]}\r\n                  />}\r\n                  disabledKeyboardNavigation\r\n                  selected={formik.values.patientInfoDob}\r\n                  className={`${inputClasses(\r\n                    formik.touched.patientInfoDob &&\r\n                    formik.errors.patientInfoDob\r\n                  )} date-field`}\r\n                  name=\"patientInfoDob\"\r\n                  id=\"patientInfoDob\"\r\n\r\n                  onCalendarClose={\r\n                    () => {\r\n                      formik.setFieldTouched(\"patientInfoDob\", true, false)\r\n                      if (isUser18(formik.getFieldProps(\"patientInfoDob\").value) < 18 && showAlert && (new Date(formik.getFieldProps(\"patientInfoDob\").value) <= new Date())) {\r\n                        setShowAlert(false)\r\n                        alert(template.fields.patientInfoDob.validations.minimumYearsOld.message)\r\n                      }\r\n                    }\r\n                  }\r\n                  onBlur={date => {\r\n                    formik.setFieldTouched(\"patientInfoDob\", true, true)\r\n                    //formik.setFieldValue(\"patientInfoDob\", date)\r\n                    // if(isUser18(date.target.value) < 18 && showAlert && (new Date(date.target.value) <= new Date())){\r\n                    //   setShowAlert(false)\r\n                    //   alert(template.fields.patientInfoDob.validations.minimumYearsOld.message)\r\n                    //}\r\n                  }}\r\n\r\n                  onChange={date => {\r\n                    formik.setFieldTouched(\"patientInfoDob\", true, true)\r\n                    formik.setFieldValue(\"patientInfoDob\", date)\r\n                  }}\r\n                  onSelect={date => {\r\n\r\n                    formik.setFieldTouched(\"patientInfoDob\", true, true)\r\n                    formik.setFieldValue(\"patientInfoDob\", date)\r\n                  }}\r\n                  placeholderText={template.fields.patientInfoDob.hint}\r\n                />\r\n                <img className='calendar-icon' src={calendar} onClick={(e)=>{document.getElementById('patientInfoDob').focus()}}></img>\r\n              </div>{\" \"}\r\n\r\n              <ErrorMessage name=\"patientInfoDob\">\r\n                {msg => <div className=\"input-error-text\">{msg}</div>}\r\n              </ErrorMessage>\r\n            </div>\r\n          }\r\n\r\n          {/* ______________Form Fields below this line have not been formatted______________________ */}\r\n\r\n          <div className=\"row\">\r\n\r\n            {template.fields.patientInfoMrn.active &&\r\n              <div className=\"col\">\r\n                <div className=\"form-group\">\r\n                  <label htmlFor=\"patientInfoMrn\">\r\n                    <span style={template.styles.label}>\r\n                      {template.fields.patientInfoMrn.label}\r\n                    </span>{\" \"}\r\n                    <Required\r\n                      value={\r\n                        template.fields.patientInfoMrn.validations.required.value\r\n                      }\r\n                    />\r\n                  </label>\r\n                  <input\r\n                    {...formik.getFieldProps(\"patientInfoMrn\")}\r\n                    type=\"text\"\r\n                    maxLength={\r\n                      template.fields.patientInfoMrn.validations.maxLength.value\r\n                    }\r\n                    name=\"patientInfoMrn\"\r\n                    id=\"patientInfoMrn\"\r\n                    className={inputClasses(\r\n                      formik.touched.patientInfoMrn && formik.errors.patientInfoMrn\r\n                    )}\r\n                    placeholder={template.fields.patientInfoMrn.hint}\r\n                  />\r\n                  <ErrorMessage name=\"patientInfoMrn\">\r\n                    {msg => <div className=\"input-error-text\">{msg}</div>}\r\n                  </ErrorMessage>\r\n                </div>\r\n              </div>\r\n            }\r\n          </div>\r\n\r\n\r\n          <div className=\"row\">\r\n            {template.fields.patientInfoEmail.active &&\r\n              <div className=\"col\">\r\n                <div className=\"form-group\">\r\n                  <label htmlFor=\"patientInfoEmail\">\r\n                    <span style={template.styles.label}>\r\n                      {template.fields.patientInfoEmail.label}\r\n                    </span>{\" \"}\r\n                    <Required\r\n                      value={\r\n                        template.fields.patientInfoEmail.validations.required.value\r\n                      }\r\n                    />\r\n                  </label>\r\n                  <input\r\n                    {...formik.getFieldProps(\"patientInfoEmail\")}\r\n                    type=\"text\"\r\n                    maxLength={\r\n                      template.fields.patientInfoEmail.validations.maxLength.value\r\n                    }\r\n                    name=\"patientInfoEmail\"\r\n                    id=\"patientInfoEmail\"\r\n                    className={inputClasses(\r\n                      formik.touched.patientInfoEmail &&\r\n                      formik.errors.patientInfoEmail\r\n                    )}\r\n                    placeholder={template.fields.patientInfoEmail.hint}\r\n                  />\r\n                  {formik.touched.patientInfoEmail &&\r\n                    formik.errors.patientInfoEmail && (\r\n                      <span className=\"input-error-text\">\r\n                        {formik.errors.patientInfoEmail}\r\n                      </span>\r\n                    )}\r\n                </div>\r\n              </div>\r\n            }\r\n            {template.fields.patientInfoEmailConfirmation.active &&\r\n              <div className=\"col\">\r\n                <div className=\"form-group\">\r\n                  <label htmlFor=\"patientInfoEmailConfirmation\">\r\n                    <span style={template.styles.label}>\r\n                      {template.fields.patientInfoEmailConfirmation.label}\r\n                    </span>{\" \"}\r\n                    <Required\r\n                      value={\r\n                        template.fields.patientInfoEmailConfirmation.validations\r\n                          .required.value\r\n                      }\r\n                    />\r\n                  </label>\r\n                  <input\r\n                    {...formik.getFieldProps(\"patientInfoEmailConfirmation\")}\r\n                    type=\"text\"\r\n                    maxLength={\r\n                      template.fields.patientInfoEmailConfirmation.validations\r\n                        .maxLength.value\r\n                    }\r\n                    name=\"patientInfoEmailConfirmation\"\r\n                    id=\"patientInfoEmailConfirmation\"\r\n                    className={inputClasses(\r\n                      formik.touched.patientInfoEmailConfirmation &&\r\n                      formik.errors.patientInfoEmailConfirmation\r\n                    )}\r\n                    placeholder={template.fields.patientInfoEmailConfirmation.hint}\r\n                  />\r\n                  {formik.touched.patientInfoEmailConfirmation &&\r\n                    formik.errors.patientInfoEmailConfirmation && (\r\n                      <span className=\"input-error-text\">\r\n                        {formik.errors.patientInfoEmailConfirmation}\r\n                      </span>\r\n                    )}\r\n                </div>\r\n              </div>\r\n            }\r\n          </div>\r\n\r\n\r\n          <div className=\"row\">\r\n            {template.fields.patientInfoPhone.active &&\r\n              <div className=\"col\">\r\n                <div className=\"form-group\">\r\n                  <label htmlFor=\"patientInfoPhone\">\r\n                    <span style={template.styles.label}>\r\n                      {template.fields.patientInfoPhone.label}\r\n                    </span>{\" \"}\r\n                    <Required\r\n                      value={\r\n                        template.fields.patientInfoPhone.validations.required.value\r\n                      }\r\n                    />\r\n                  </label>\r\n                  <input\r\n                    {...formik.getFieldProps(\"patientInfoPhone\")}\r\n                    type=\"text\"\r\n                    name=\"patientInfoPhone\"\r\n                    id=\"patientInfoPhone\"\r\n                    className={inputClasses(\r\n                      formik.touched.patientInfoPhone &&\r\n                      formik.errors.patientInfoPhone\r\n                    )}\r\n                    placeholder={template.fields.patientInfoPhone.hint}\r\n                  />\r\n                  {formik.touched.patientInfoPhone &&\r\n                    formik.errors.patientInfoPhone && (\r\n                      <span className=\"input-error-text\">\r\n                        {formik.errors.patientInfoPhone}\r\n                      </span>\r\n                    )}\r\n                </div>\r\n              </div>\r\n            }\r\n            <div className=\"col\">\r\n              {template.fields.patientInfoPhoneConfirmation.active &&\r\n                <div className=\"form-group\">\r\n                  <label htmlFor=\"patientInfoPhoneConfirmation\">\r\n                    <span style={template.styles.label}>\r\n                      {template.fields.patientInfoPhoneConfirmation.label}\r\n                    </span>{\" \"}\r\n                    <Required\r\n                      value={\r\n                        template.fields.patientInfoPhoneConfirmation.validations\r\n                          .required.value\r\n                      }\r\n                    />\r\n                  </label>\r\n                  <input\r\n                    {...formik.getFieldProps(\"patientInfoPhoneConfirmation\")}\r\n                    type=\"text\"\r\n                    name=\"patientInfoPhoneConfirmation\"\r\n                    id=\"patientInfoPhoneConfirmation\"\r\n                    className={inputClasses(\r\n                      formik.touched.patientInfoPhoneConfirmation &&\r\n                      formik.errors.patientInfoPhoneConfirmation\r\n                    )}\r\n                    placeholder={template.fields.patientInfoPhoneConfirmation.hint}\r\n                  />\r\n                  {formik.touched.patientInfoPhoneConfirmation &&\r\n                    formik.errors.patientInfoPhoneConfirmation && (\r\n                      <span className=\"input-error-text\">\r\n                        {formik.errors.patientInfoPhoneConfirmation}\r\n                      </span>\r\n                    )}\r\n                </div>\r\n              }\r\n            </div>\r\n          </div>\r\n\r\n\r\n          <div className=\"row\">\r\n            {template.fields.patientInfoAddressLine1.active &&\r\n              <div className=\"col\">\r\n                <div className=\"form-group\">\r\n                  <label htmlFor=\"patientInfoAddressLine1\">\r\n                    <span style={template.styles.label}>\r\n                      {\" \"}\r\n                      {template.fields.patientInfoAddressLine1.label}\r\n                    </span>{\" \"}\r\n                    <Required\r\n                      value={\r\n                        template.fields.patientInfoAddressLine1.validations.required\r\n                          .value\r\n                      }\r\n                    />\r\n                  </label>\r\n                  <input\r\n                    {...formik.getFieldProps(\"patientInfoAddressLine1\")}\r\n                    type=\"text\"\r\n                    maxLength={\r\n                      template.fields.patientInfoAddressLine1.validations.maxLength\r\n                        .value\r\n                    }\r\n                    name=\"patientInfoAddressLine1\"\r\n                    id=\"patientInfoAddressLine1\"\r\n                    className={inputClasses(\r\n                      formik.touched.patientInfoAddressLine1 &&\r\n                      formik.errors.patientInfoAddressLine1\r\n                    )}\r\n                    placeholder={template.fields.patientInfoAddressLine1.hint}\r\n                  />\r\n                  {formik.touched.patientInfoAddressLine1 &&\r\n                    formik.errors.patientInfoAddressLine1 && (\r\n                      <span className=\"input-error-text\">\r\n                        {formik.errors.patientInfoAddressLine1}\r\n                      </span>\r\n                    )}\r\n                </div>\r\n              </div>\r\n            }\r\n          </div>\r\n\r\n\r\n          <div className=\"row\">\r\n            {template.fields.patientInfoAddressLine2.active &&\r\n              <div className=\"col\">\r\n                <div className=\"form-group\">\r\n                  {template.fields.patientInfoAddressLine2.label && (\r\n                    <label htmlFor=\"patientInfoAddressLine2\">\r\n                      <span style={template.styles.label}>\r\n                        {template.fields.patientInfoAddressLine2.label}\r\n                      </span>{\" \"}\r\n                      <Required\r\n                        value={\r\n                          template.fields.patientInfoAddressLine2.validations.required\r\n                            .value\r\n                        }\r\n                      />\r\n                    </label>\r\n                  )}\r\n                  <input\r\n                    {...formik.getFieldProps(\"patientInfoAddressLine2\")}\r\n                    type=\"text\"\r\n                    maxLength={\r\n                      template.fields.patientInfoAddressLine2.validations.maxLength\r\n                        .value\r\n                    }\r\n                    name=\"patientInfoAddressLine2\"\r\n                    id=\"patientInfoAddressLine2\"\r\n                    className={inputClasses(\r\n                      formik.touched.patientInfoAddressLine2 &&\r\n                      formik.errors.patientInfoAddressLine2\r\n                    )}\r\n                    placeholder={template.fields.patientInfoAddressLine2.hint}\r\n                  />\r\n                  {formik.touched.patientInfoAddressLine2 &&\r\n                    formik.errors.patientInfoAddressLine2 && (\r\n                      <span className=\"input-error-text\">\r\n                        {formik.errors.patientInfoAddressLine2}\r\n                      </span>\r\n                    )}\r\n                </div>\r\n              </div>\r\n            }\r\n          </div>\r\n\r\n\r\n          <div className=\"row\">\r\n            {template.fields.patientInfoCity.active &&\r\n              <div className=\"col\">\r\n                <div className=\"form-group\">\r\n                  {template.fields.patientInfoCity.label && (\r\n                    <label htmlFor=\"patientInfoCity\">\r\n                      <span style={template.styles.label}>\r\n                        {template.fields.patientInfoCity.label}\r\n                      </span>{\" \"}\r\n                      <Required\r\n                        value={\r\n                          template.fields.patientInfoCity.validations.required.value\r\n                        }\r\n                      />\r\n                    </label>\r\n                  )}\r\n                  <input\r\n                    {...formik.getFieldProps(\"patientInfoCity\")}\r\n                    type=\"text\"\r\n                    maxLength={\r\n                      template.fields.patientInfoCity.validations.maxLength.value\r\n                    }\r\n                    name=\"patientInfoCity\"\r\n                    id=\"patientInfoCity\"\r\n                    className={inputClasses(\r\n                      formik.touched.patientInfoCity && formik.errors.patientInfoCity\r\n                    )}\r\n                    placeholder={template.fields.patientInfoCity.hint}\r\n                  />\r\n                  {formik.touched.patientInfoCity &&\r\n                    formik.errors.patientInfoCity && (\r\n                      <span className=\"input-error-text\">\r\n                        {formik.errors.patientInfoCity}\r\n                      </span>\r\n                    )}\r\n                </div>\r\n              </div>\r\n            }\r\n            {template.fields.patientInfoState.active &&\r\n              <div className=\"col-sm-3\">\r\n                <div className=\"form-group\">\r\n                  {template.fields.patientInfoState.label && (\r\n                    <label htmlFor=\"patientInfoState\">\r\n                      <span style={template.styles.label}>\r\n                        {template.fields.patientInfoState.label}\r\n                      </span>{\" \"}\r\n                      <Required\r\n                        value={\r\n                          template.fields.patientInfoState.validations.required.value\r\n                        }\r\n                      />\r\n                    </label>\r\n                  )}\r\n                  <input\r\n                    {...formik.getFieldProps(\"patientInfoState\")}\r\n                    type=\"text\"\r\n                    maxLength={\r\n                      template.fields.patientInfoState.validations.maxLength.value\r\n                    }\r\n                    name=\"patientInfoState\"\r\n                    id=\"patientInfoState\"\r\n                    className={inputClasses(\r\n                      formik.touched.patientInfoState &&\r\n                      formik.errors.patientInfoState\r\n                    )}\r\n                    placeholder={template.fields.patientInfoState.hint}\r\n                  />\r\n                  {formik.touched.patientInfoState &&\r\n                    formik.errors.patientInfoState && (\r\n                      <span className=\"input-error-text\">\r\n                        {formik.errors.patientInfoState}\r\n                      </span>\r\n                    )}\r\n                </div>\r\n              </div>\r\n            }\r\n            {template.fields.patientInfoZip.active &&\r\n              <div className=\"col-sm-2\">\r\n                <div className=\"form-group\">\r\n                  {template.fields.patientInfoZip.label && (\r\n                    <label htmlFor=\"patientInfoZip\">\r\n                      <span style={template.styles.label}>\r\n                        {template.fields.patientInfoZip.label}\r\n                      </span>{\" \"}\r\n                      <Required\r\n                        value={\r\n                          template.fields.patientInfoZip.validations.required.value\r\n                        }\r\n                      />\r\n                    </label>\r\n                  )}\r\n                  <input\r\n                    {...formik.getFieldProps(\"patientInfoZip\")}\r\n                    type=\"text\"\r\n                    name=\"patientInfoZip\"\r\n                    id=\"patientInfoZip\"\r\n                    className={inputClasses(\r\n                      formik.touched.patientInfoZip && formik.errors.patientInfoZip\r\n                    )}\r\n                    placeholder={template.fields.patientInfoZip.hint}\r\n                  />\r\n                  {formik.touched.patientInfoZip && formik.errors.patientInfoZip && (\r\n                    <span className=\"input-error-text\">\r\n                      {formik.errors.patientInfoZip}\r\n                    </span>\r\n                  )}\r\n                </div>\r\n              </div>\r\n            }\r\n          </div></div>\r\n      </div>\r\n      :\r\n      <></>\r\n  );\r\n};\r\n\r\nexport default PatientInfomation;\r\n","import React from \"react\";\r\nimport { Field } from \"formik\";\r\n\r\nconst Checkbox = props => {\r\n  return (\r\n    <Field name={props.name}>\r\n      {({ field, form }) => (\r\n        <div style={{display:'flex', flexDirection:'row'}}>\r\n          <input\r\n            type=\"checkbox\"\r\n            {...props}          \r\n            checked={field.value.includes(props.value)}\r\n            onChange={() => {\r\n              if (field.value.includes(props.value)) {\r\n                \r\n                const nextValue = field.value.filter(\r\n                  value => value !== props.value\r\n                );\r\n                form.setFieldValue(props.name, nextValue);\r\n              } else {\r\n                if(props.name === \"sensitiveInfo\" && props.value > 90 ){\r\n                    \r\n                  const nextValue = [props.value];\r\n                  form.setFieldValue(props.name, nextValue);\r\n                    \r\n                }else if(props.name === \"sensitiveInfo\" && props.value < 90){\r\n                    const cleanArray = field.value.filter(\r\n                      value => value < 90\r\n                    );\r\n                    const nextValue = cleanArray.concat(props.value);\r\n                  form.setFieldValue(props.name, nextValue);\r\n                }\r\n                else{\r\n                  const nextValue = field.value.concat(props.value);\r\n                  const finalValue = nextValue.filter((value)=>{return value !== 'allLocations'})\r\n                  form.setFieldValue(props.name, finalValue);\r\n                }\r\n                \r\n              }\r\n            }}\r\n          />\r\n          <label htmlFor={props.value} className='paragraph' style={props.style}>{props.label}</label>\r\n        </div>\r\n      )}\r\n    </Field>\r\n  );\r\n};\r\n\r\nexport default Checkbox;\r\n","import React from 'react';\r\nimport classNames from 'classnames';\r\n\r\n// Radio group\r\nconst RadioButtonGroup = ({\r\n  value,\r\n  error,\r\n  touched,\r\n  id,\r\n  label,\r\n  className,\r\n  children\r\n}) => {\r\n  const classes = classNames(\r\n    \"input-field\",\r\n    {\r\n      \"is-success\": value || (!error && touched), // handle prefilled or user-filled\r\n      \"is-error\": !!error && touched\r\n    },\r\n    className\r\n  );\r\n\r\n  return (\r\n    <div  className={classes + \" custom-form-check\"}>\r\n      {/* <fieldset>\r\n        <legend>{label}</legend> */}\r\n        {children}\r\n      {/* </fieldset> */}\r\n    </div>\r\n  );\r\n};\r\n\r\nexport default RadioButtonGroup;","import React from 'react';\r\nimport './styles/components.scss';\r\n\r\nconst RadioButton = ({\r\n  field: { name, value, onChange, onBlur, onClick },\r\n  id,\r\n  label,\r\n  className,\r\n  checked,\r\n  config,\r\n  ...props\r\n}) => {\r\n  \r\n  return (\r\n    <span className='radio-option'>\r\n      <input\r\n        name={name}\r\n        id={id}\r\n        type=\"radio\"\r\n        value={value} \r\n        checked={value === id}\r\n        onChange={onChange}\r\n        onBlur={onBlur}\r\n        onClick={onClick}\r\n        className=\"radio-button\" \r\n        // className=''\r\n        {...props}\r\n      />\r\n      <label style={config.page.form.styles.list}  htmlFor={id}>{label}</label>\r\n    </span>\r\n  );\r\n};\r\n\r\nexport default RadioButton;","import React, {useState} from \"react\";\r\nimport Required from \"../../../../components/Required\";\r\n// import Checkbox from \"../../../components/Checkbox\";\r\nimport { Field } from \"formik\";\r\nimport RadioButtonGroup from \"../../../../components/RadioButtonGroup\";\r\nimport RadioButton from \"../../../../components/RadioButton\";\r\n\r\nconst Facilities_7224 = ({ formik, template, config, orgId }) => {\r\n\r\n    // const [otherFac, setOtherFac] = useState(null)\r\n\r\n  // console.log(formik.getFieldProps(\"facilitiesGroup\"))\r\n  // console.log(formik.values)\r\n\r\n  return (\r\n    <div id='medicalFacilitiesRequested' className='form-section'>\r\n      <h2 style={template.styles.section} className=\"section-heading\"> {template.title} </h2>\r\n      <label className='non-textbox-label'> <span style={template.styles.label}> {template.fields.facilitiesGroup.label} </span> {\" \"} <Required value={template.fields.facilitiesGroup.validations.required.value} /> </label>\r\n      \r\n      <div id='7224'>\r\n        {/* ^^ special behavior for Temple */}\r\n          <RadioButtonGroup id=\"rep-radio-options\" value={formik.values.facilitiesGroup} error={formik.errors.facilitiesGroup} touched={formik.touched.facilitiesGroup} onBlur={formik.setFieldTouched} >\r\n            <span id=\"rep-radio-options\">\r\n              {template.fields.facilitiesGroup.entries.map(option => {\r\n                return (\r\n                    <Field \r\n                    config={config} \r\n                    key={option.value} \r\n                    component={RadioButton} \r\n                    name=\"facilitiesGroup\" \r\n                    id={option.key} \r\n                    checked={formik.values.facilitiesGroup === [option.key] ? true : console.log(formik.values.facilitiesGroup)} \r\n                    value={option.key} \r\n                    label={(option.key !== 'otherFac') ? option.value \r\n                    : \r\n                    <div className=\"form-group\" style={{ marginBottom: 0, alignSelf: 'flex-start', width: 430 }}>\r\n                    <input\r\n                      {...formik.getFieldProps(\"otherFac\")}\r\n                      style={{width:'40%'}}\r\n                      type=\"text\"\r\n                      maxLength={\r\n                        template.fields.otherFac.validations.maxLength.value\r\n                      }\r\n                      name=\"otherFac\"\r\n                      id=\"otherFac\"\r\n                      className=\"form-control\"\r\n                      style={config.page.form.styles.hint}\r\n                      placeholder={template.fields.otherFac.hint}\r\n                    />\r\n                    {formik.touched.otherFac &&\r\n                      formik.errors.otherFac ? (\r\n                        <span className=\"input-error-text\">\r\n                          {formik.errors.otherFac}\r\n                        </span>\r\n                      ) : null}\r\n                </div>} />\r\n                  )  \r\n              } )}\r\n            </span>\r\n          </RadioButtonGroup>\r\n        </div>\r\n              \r\n    </div>\r\n  );\r\n};\r\n\r\nexport default Facilities_7224;\r\n","import React from \"react\";\r\nimport './styles/facilities.css'\r\nimport Required from '../../../../components/Required'\r\nimport {FacilityItem} from '../../sections/AuthorizationToReleaseSection'\r\n\r\nconst NYPOutpatientFacilities = ({ formik, template, config, orgId }) => {\r\n\r\n    let facGroup = formik.values.facilitiesGroup;\r\n    let formSpecOutpatientGroup = template.fields.outPatientFacilitiesGroup\r\n\r\n    const addValueToFormObj = (index, event) => {\r\n        facGroup[0][index.opKey] = event.target.value;\r\n    }\r\n\r\n    facGroup.length === 0 && facGroup.push({ CUIMC: '', WCM: '', NMGB: '', NMGHV: '', NMGQ: '', NMGW: '' });\r\n\r\n    return (\r\n        \r\n        <div id='medicalFacilitiesRequested' className='form-section'>\r\n        <h2 style={template.styles.section} className=\"section-heading\"> {template.title} </h2>\r\n        <label className='non-textbox-label'> <span style={template.styles.label}> {template.fields.facilitiesGroup.label} </span> {\" \"} <Required value={template.fields.facilitiesGroup.validations.required.value} /> </label>\r\n\r\n        <label className='non-textbox-label' style={{display: 'block'}}>NYP Hospitals</label>\r\n        <div id='ordinary-facilities' className='form-fields' style={{flexFlow: 'column wrap', maxHeight:250, marginBottom: 10}}>\r\n          {template.fields.facilitiesGroup.entries.map((item, index) => {\r\n            return (\r\n              (item.type === 'hospital') && (item.key !== 'otherFac') &&\r\n              // Check to see if the above line is needed for Temple to work\r\n              <FacilityItem item={item} template={template} formik={formik} config={config} disabled={item.disabled} key={index}/>\r\n            )\r\n          })\r\n          }\r\n          \r\n        </div>\r\n        \r\n        <label className='non-textbox-label' style={{display: 'block'}}>NYP Medical Groups</label>\r\n        <div id='ordinary-facilities' className='form-fields' style={{flexFlow: 'column wrap', maxHeight:250, marginBottom: 10}}>\r\n          {template.fields.facilitiesGroup.entries.map((item, index) => {\r\n            return (\r\n              (item.type === 'medGroup') && (item.key !== 'otherFac') &&\r\n              // Check to see if the above line is needed for Temple to work\r\n              <FacilityItem item={item} template={template} formik={formik} config={config} disabled={item.disabled} key={index}/>\r\n            )\r\n          })\r\n          }\r\n          \r\n        </div>\r\n        <FacilityItem item={{key: 'otherFac', value: 'Specific facility or provider at CBC Trial Works'}} template={template} formik={formik} config={config} disabled={false} key={54321}/>\r\n        \r\n        <div id='1007042'>\r\n            <p id='tp-op-label'>{formSpecOutpatientGroup.label}</p>\r\n            <div id='tp-op-facilities' className='form-fields form-fields-column'>\r\n\r\n                {formSpecOutpatientGroup.entries.map(item => {\r\n                    return (\r\n                        <div className='tp-op-field' key={item.key} style={{ opacity: item.disabled && .5 }}>\r\n                            <p className='tp-op-field-label'>{item.value}</p>\r\n                            {item.disabled && <input onBlur={(e) => { addValueToFormObj(item, e) }} type=\"text\" disabled maxLength={100} name=\"otherFac\" id=\"otherFac\" className=\"form-control tripartite-outpatient-input\" style={config.page.form.styles.hint} placeholder={item.placeholder} />}\r\n                            {!item.disabled && <input onBlur={(e) => { addValueToFormObj(item, e) }} type=\"text\" maxLength={100} name=\"otherFac\" id=\"otherFac\" className=\"form-control tripartite-outpatient-input\" style={config.page.form.styles.hint} placeholder={item.placeholder} />}\r\n                            {formik.touched.otherFac &&\r\n                                formik.errors.otherFac ? (<span className=\"input-error-text\"> {formik.errors.otherFac} </span>) : null}\r\n                        </div>\r\n                    )\r\n                })}\r\n            </div>\r\n        </div>\r\n    </div>\r\n\r\n    );\r\n};\r\n\r\nexport default NYPOutpatientFacilities;\r\n","import React, { useState } from 'react';\r\nimport './styles/facilities.css'\r\n\r\n\r\nexport const DisabledCheckbox = ({ template, item }) => {\r\n\r\n    const [disabledMessageOpacity, setDisabledMessageOpacity] = useState(0);\r\n\r\n    return (\r\n        <div className='disabled-checkbox' onMouseOver={() => { setDisabledMessageOpacity(1) }} onMouseOut={() => { setDisabledMessageOpacity(0) }}>\r\n            <input type=\"checkbox\" className='checkbox' checked={false} style={{opacity:.5}} />\r\n            <p style={{ ...template.styles.list, opacity: .25 }}>{(item.key === 'otherFac') ? \"\" : item.value}</p>\r\n            <DisabledMessage disabledMessageOpacity={disabledMessageOpacity} />\r\n        </div>\r\n    )\r\n}\r\n\r\nexport const DisabledMessage = ({ disabledMessageOpacity }) => {\r\n\r\n    return (\r\n        <div className='disabled-message' style={{opacity: disabledMessageOpacity}}>\r\n            <p className='facility-hover-text' >{'Verisma does not process for this facility at this time. Please send your request directly to this location.'}</p>\r\n        </div>\r\n    )\r\n}\r\n\r\nexport const TriLogoAndBanner = ({config, getwayApi, formId, imgPlacement}) => {\r\n    return (\r\n        <div id='logo-and-title-container'>\r\n          <img className={imgPlacement[config.page.form.logo.position]} id='form-logo' src={`${getwayApi}/api/client/logo/${formId}`} alt={config.page.form.logo.alt} style={{ ...config.page.form.styles.logos.form, alignSelf: 'flex-start' }} />\r\n          <div id='NYP-banner' style={{ background: config.page.form.styles.heading.color }}><h1 style={{ ...config.page.form.styles.heading, color: 'white' }} id={\"tri-form-title\"} > {config.page.form.heading.text} </h1></div>\r\n        </div>\r\n    )\r\n}\r\n\r\n\r\n\r\n","import { createContext } from 'react';\r\n\r\nexport const { Provider, Consumer } = createContext();\r\n","import React, { cloneElement } from 'react';\r\nimport PropTypes from 'prop-types';\r\n\r\nimport { Consumer } from './context';\r\n\r\nconst Target = ({ children: element }) => (\r\n  <Consumer>\r\n    {({ setTargetNode, togglePopover, onMouseEnterOnTarget, onMouseLeaveFromTarget }) =>\r\n      cloneElement(element, {\r\n        ref: setTargetNode,\r\n        onMouseEnter: onMouseEnterOnTarget,\r\n        onMouseLeave: onMouseLeaveFromTarget,\r\n      })\r\n    }\r\n  </Consumer>\r\n);\r\n\r\nTarget.propTypes = {\r\n  children: PropTypes.element,\r\n};\r\n\r\nexport default Target;\r\n","import React, { Component } from 'react';\r\nimport PropTypes from 'prop-types';\r\nimport PopperJS from 'popper.js';\r\n\r\nclass Popper extends Component {\r\n  static propTypes = {\r\n    placement: PropTypes.oneOf(['top', 'left', 'bottom', 'right']),\r\n    children: PropTypes.node.isRequired,\r\n  };\r\n\r\n  static defaultProps = {\r\n    placement: 'bottom',\r\n  };\r\n\r\n  content = null;\r\n  arrow = null;\r\n  popper = null;\r\n\r\n  componentDidMount() {\r\n    this.initPopper();\r\n  }\r\n\r\n  componentDidUpdate() {\r\n    this.updatePopper();\r\n  }\r\n\r\n  componentWillUnmount() {\r\n    this.destroyPopper();\r\n  }\r\n\r\n  initPopper = () => {\r\n    this.popper = new PopperJS(\r\n      this.props.target,\r\n      this.content,\r\n      {\r\n        placement: this.props.placement,\r\n        modifiers: {\r\n          arrow: {\r\n            element: this.arrow,\r\n          },\r\n        },\r\n      }\r\n    );\r\n  };\r\n\r\n  updatePopper = () => {\r\n    this.popper && this.popper.update();\r\n  };\r\n\r\n  destroyPopper = () => {\r\n    this.popper && this.popper.destroy();\r\n  };\r\n\r\n  setContentNode = (node) => { this.content = node; };\r\n\r\n  setArrowNode = (node) => { this.arrow = node; };\r\n\r\n  render() {\r\n    const { placement, children } = this.props;\r\n\r\n    return (\r\n      <div\r\n        ref={this.setContentNode}\r\n        className={`popover bs-popover-${placement}`}\r\n        role=\"tooltip\"\r\n      >\r\n        <div ref={this.setArrowNode} className=\"arrow\" />\r\n        <div className=\"popover-body\">{children}</div>\r\n      </div>\r\n    );\r\n  }\r\n}\r\n\r\nexport default Popper;\r\n","import React from 'react';\r\nimport PropTypes from 'prop-types';\r\nimport { Consumer } from './context';\r\nimport Popper from './Popper';\r\n\r\nconst Content = ({ children }) => (\r\n  <Consumer>\r\n    {({ placement, targetNode, showPopover }) => showPopover ? (\r\n      <Popper placement={placement} target={targetNode}>\r\n        {children}\r\n      </Popper>\r\n    ) : null}\r\n  </Consumer>\r\n);\r\n\r\nContent.propTypes = {\r\n  children: PropTypes.node,\r\n};\r\n\r\nexport default Content;","import React, { PureComponent } from 'react';\r\nimport PropTypes from 'prop-types';\r\nimport Target from './Target';\r\nimport Content from './Content';\r\nimport { Provider } from './context';\r\n\r\nclass Popover extends PureComponent {\r\n  static propTypes = {\r\n    placement: PropTypes.oneOf(['top', 'left', 'bottom', 'right']),\r\n  };\r\n\r\n  static defaultProps = {\r\n    placement: 'bottom',\r\n  };\r\n\r\n  static Target = Target;\r\n  static Content = Content;\r\n\r\n  state = {\r\n    placement: this.props.placement,\r\n    showPopover: false,\r\n    targetNode: null,\r\n  };\r\n\r\n  static getDerivedStateFromProps(nextProps, prevState) {\r\n    if (nextProps.placement !== prevState.placement) {\r\n      return { placement: nextProps.placement };\r\n    }\r\n\r\n    return null;\r\n  }\r\n\r\n  setTargetNode = node => this.setState({ targetNode: node });\r\n\r\n  showPopover = () => this.setState({ showPopover: true });\r\n\r\n  hidePopover = () => this.setState({ showPopover: false });\r\n\r\n  render() {\r\n    const context = {\r\n      showPopover: this.state.showPopover,\r\n      placement: this.state.placement,\r\n      targetNode: this.state.targetNode,\r\n      setTargetNode: this.setTargetNode,\r\n      onMouseEnterOnTarget: this.showPopover,\r\n      onMouseLeaveFromTarget: this.hidePopover,\r\n    };\r\n    return <Provider value={context}>{this.props.children}</Provider>\r\n  }\r\n}\r\n\r\nexport default Popover;\r\n","import React, {useState} from 'react';\r\nimport Required from \"../../../../components/Required\";\r\nimport Checkbox from \"../../../../components/Checkbox\";\r\nimport { Field } from \"formik\";\r\n// import RadioButtonGroup from \"../../RadioButtonGroup\";\r\n// import RadioButton from \"../../RadioButton\";\r\nimport './styles/facilities.css'\r\nimport infoCircle from '../../styles/assets/info-circle.png'\r\nimport Popover from '../../../../../formik/refactorOut/components/Popper/Popover.js'\r\nimport { popoverLocation } from \"../../../../../config/Configuration\";\r\n\r\nconst Facilities_7227 = ({ formik, template, config, orgId }) => {\r\n    const [outPatient, setOutPatient] = useState(false)\r\n    const [longTerm, setLongTerm] = useState(false)\r\n\r\n    return (\r\n        <>\r\n            <div id='medicalFacilitiesRequested' className='form-section'>\r\n                <h2 style={template.styles.section} className=\"section-heading\"> {template.title} </h2>\r\n                <label className='non-textbox-label'> <span style={template.styles.label}> {template.fields.facilitiesGroup.label} </span> {\" \"} <Required value={template.fields.facilitiesGroup.validations.required.value} /> </label>\r\n                \r\n                <div className='facility-options'>\r\n                    \r\n                    <div className='default-facility'>\r\n                        <DecorativeCheckbox checked={true} onChange={null} labelStyle={template.styles.list} label={template.defaultFacility}/>\r\n                    </div>\r\n                    \r\n                    <div className='additional-facilities'>\r\n                        <p style={{marginBottom:10, fontWeight:600, textDecoration:'underline'}}>Additional Locations:</p>\r\n                        <p>Please select any additional clinic locations by selecting the checkboxes below.</p>\r\n                        \r\n                        <div className='facility-list additional-facility-list'>\r\n                            {template.fields.facilitiesGroup.entries.map((facility)=>{\r\n                                return <span style={{ margin: 10, display: 'flex', alignItems: 'center' }}><Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={facility.value} name=\"facilitiesGroup\" label={(facility.key === 'otherFac') ? \"\" : facility.value} value={facility.key} />\r\n                                    <Popover placement={popoverLocation}>\r\n                                        <Popover.Target>\r\n                                            {/* <i className=\"fa fa-info-circle fa_custom\"></i> */}\r\n                                            <img className='info-circle' src={infoCircle}></img>\r\n                                        </Popover.Target>\r\n                                        <Popover.Content>\r\n                                            {facility.tooltip}\r\n                                        </Popover.Content>\r\n                                    </Popover>\r\n                                </span>\r\n                            })}\r\n                        </div>\r\n                        \r\n                        <DecorativeCheckbox checked={outPatient && true} onChange={()=>{!outPatient ? setOutPatient(true) : setOutPatient(false)}} labelStyle={template.styles.list} label={template.fields.outPatientGroup.label}/>\r\n                        <div className='facility-list'>\r\n                            {outPatient && template.fields.outPatientGroup.entries.map((facility)=>{\r\n                                return <span style={{ margin: 10, display: 'flex', alignItems: 'center' }}><Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={facility.value} name=\"facilitiesGroup\" label={(facility.key === 'otherFac') ? \"\" : facility.value} value={facility.key} />\r\n                                    <Popover placement={popoverLocation}>\r\n                                        <Popover.Target>\r\n                                            {/* <i className=\"fa fa-info-circle fa_custom\"></i> */}\r\n                                            <img className='info-circle' src={infoCircle}></img>\r\n                                        </Popover.Target>\r\n                                        <Popover.Content>\r\n                                            {facility.tooltip}\r\n                                        </Popover.Content>\r\n                                    </Popover></span>\r\n                            })}\r\n                        </div>\r\n                        \r\n                        <div className='facility-list'>\r\n                            <DecorativeCheckbox checked={longTerm && true} onChange={()=>{!longTerm ? setLongTerm(true) : setLongTerm(false)}} labelStyle={template.styles.list} label={template.fields.longTermGroup.label}/>\r\n                            {longTerm && template.fields.longTermGroup.entries.map((facility)=>{\r\n                                return <span style={{ margin: 10, display: 'flex', alignItems: 'center' }}><Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={facility.value} name=\"facilitiesGroup\" label={(facility.key === 'otherFac') ? \"\" : facility.value} value={facility.key} />\r\n                                    <Popover placement={popoverLocation}>\r\n                                        <Popover.Target>\r\n                                            {/* <i className=\"fa fa-info-circle fa_custom\"></i> */}\r\n                                            <img className='info-circle' src={infoCircle}></img>\r\n                                        </Popover.Target>\r\n                                        <Popover.Content>\r\n                                            {facility.tooltip}\r\n                                        </Popover.Content>\r\n                                    </Popover>\r\n                                </span>\r\n                            })}\r\n                        </div>\r\n                    </div>\r\n                </div>\r\n            </div>\r\n        </>\r\n    )\r\n}\r\n\r\nexport default Facilities_7227;\r\n\r\n// const DropdownCheckSection = () => {\r\n//     return(\r\n//         <DecorativeCheckbox checked={longTerm && true} onChange={()=>{!longTerm ? setLongTerm(true) : setLongTerm(false)}} labelStyle={template.styles.list} label={template.fields.longTermGroup.label}/>\r\n//     )\r\n// }\r\n\r\nconst DecorativeCheckbox = (props) => {\r\n    \r\n    return (\r\n        <div className='decorative-checkbox'>\r\n            <input type=\"checkbox\" className='7227-checkbox checkbox' checked={props.checked} onChange={props.onChange} /> \r\n            <label className='decorative-checkbox-label' style={{...props.labelStyle, fontWeight:600}}>{props.label}</label>\r\n        </div>\r\n    )\r\n}","import React from 'react';\r\nimport Checkbox from '../../../../components/Checkbox'\r\nimport { Field } from \"formik\";\r\nimport {FacilityItem} from '../../sections/AuthorizationToReleaseSection'\r\n\r\nconst BothwellFacilities = ({template, formik, config}) => {\r\n    return(\r\n        <div className=\"bothwell-facilities\">\r\n            <div id='medicalFacilitiesRequested' className='form-section'>\r\n                <h2 style={template.styles.section} className=\"section-heading\"> {template.title} </h2>\r\n                <label className='non-textbox-label'> <span style={template.styles.label}> {template.fields.facilitiesGroup.label} </span> {\" \"} </label>\r\n                <div className=\"facility_list\" style={{display: 'flex', flexFlow: 'row wrap', alignItems: 'flex-start'}}>\r\n                    {template.fields.facilitiesGroup.entries.map((facility, index)=>{\r\n                        return (\r\n                            facility.key !== 'otherFac' && \r\n                            <div className='check-option'><Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={facility.value} name=\"facilitiesGroup\" label={(facility.key === 'otherFac') ? \"\" : facility.value} value={facility.key} bothwell={true}/></div>\r\n                        )\r\n                    })}\r\n                </div>\r\n                \r\n                <Field name={'facilitiesGroup'}>\r\n                    {({ field, form }) => (\r\n                        <div className='other-field' style={{display: 'flex', marginTop: 25, marginBottom: 25}}>\r\n                            <input type=\"checkbox\" className='checkbox' checked={field.value.includes('allLocations')} onChange={()=>{\r\n                                field.value.includes('allLocations') ?\r\n                                form.setFieldValue('facilitiesGroup', [])\r\n                                :\r\n                                form.setFieldValue('facilitiesGroup', ['allLocations'])\r\n                            }}/>\r\n                            <label className='paragraph' htmlFor=\"\" style={{fontFamily: 'Arial', color: 'black', fontSize: '1em', fontWeight: 600}}>Request records from all locations</label>\r\n                        </div>\r\n                    )}\r\n                </Field>\r\n                <FacilityItem item={{key: 'otherFac', value: 'Specific facility or provider at CBC Trial Works'}} template={template} formik={formik} config={config} disabled={false} key={54321}/>\r\n            </div>\r\n        </div>\r\n    )\r\n}\r\n\r\nexport default BothwellFacilities;","import React, {useEffect, useState, useCallback} from \"react\";\r\nimport Required from \"../../../../components/Required\";\r\nimport Checkbox from \"../../../../components/Checkbox\";\r\nimport { DisabledCheckbox } from '../../orgs/7042/components'\r\nimport { Field } from \"formik\";\r\nimport RadioButtonGroup from \"../../../../components/RadioButtonGroup\";\r\nimport RadioButton from \"../../../../components/RadioButton\";\r\n\r\nconst BaptistFacilitySection = ({ formik, inputClasses, props, template, config }) => {\r\n\r\n  const [BHMGPPSelected, setBHMGPPSelected] = useState(false)\r\n  \r\n  const clearOtherField = () =>{\r\n    setBHMGPPSelected(false); \r\n    formik.setFieldValue(\"otherFac\", \"\");\r\n    console.log(formik.values) \r\n  }\r\n  \r\n  const setOtherField = () =>{\r\n    setBHMGPPSelected(true);\r\n    // document.getElementsByClassName('custom-form-check')[30].blur()\r\n    !formik.values.otherFac.length && document.getElementById('otherFac').focus()\r\n    document.getElementById('otherFac').disabled = false\r\n    console.log(formik.values) \r\n  }\r\n  \r\n  useEffect(()=>{\r\n    console.log(\"facility:\", formik.values.facilitiesGroup)\r\n    if (!formik.values.facilitiesGroup.includes('CBDNetwork10')) {\r\n      formik.setFieldValue(\"otherFac\", \"\")\r\n      document.getElementById('otherFac').disabled = true\r\n    }\r\n    console.log(\"values\", formik.values)\r\n  }, [formik.values.facilitiesGroup])\r\n  \r\n  useEffect(()=>{\r\n    formik.values.facilitiesGroup.includes('CBDNetwork10') ? \r\n    setOtherField()\r\n    : \r\n    console.log()\r\n  }, [formik.values.facilitiesGroup])\r\n\r\n  \r\n  return (\r\n    config.page.form.sections.authorizationToReleaseSection.active ?\r\n      <div id='medicalFacilitiesRequested' className='form-section'>\r\n        <h2 style={template.styles.section} className=\"section-heading\"> {template.title} </h2>\r\n        <label className='non-textbox-label'> <span style={template.styles.label}> {template.fields.facilitiesGroup.label} </span> {\" \"} <Required value={template.fields.facilitiesGroup.validations.required.value} /> </label>\r\n\r\n        <RadioButtonGroup id=\"rep-radio-options\" value={formik.values.facilitiesGroup} error={formik.errors.facilitiesGroup} touched={formik.touched.facilitiesGroup} onBlur={formik.setFieldTouched} >\r\n            <span className=\"rep-radio-options\">\r\n              {template.fields.facilitiesGroup.entries.map(option => {\r\n                if (option.key !== 'otherFac' && option.key !== 'CBDNetwork10'){\r\n                  return (\r\n                      <Field \r\n                      config={config} \r\n                      key={option.value} \r\n                      component={RadioButton} \r\n                      name=\"facilitiesGroup\" \r\n                      id={option.key} \r\n                      checked={formik.values.facilitiesGroup === [option.key] ? true : console.log(formik.values.facilitiesGroup)} \r\n                      value={option.key} \r\n                      label={option.value}\r\n                      />\r\n                  )  \r\n                }\r\n              } )}\r\n            </span>\r\n          </RadioButtonGroup>\r\n        \r\n        {/* <FacilityItem item={{key: 'CBDNetwork10', value: 'Baptist Health Medical Group Physician Practice'}} template={template} formik={formik} config={config} disabled={false} /> */}\r\n        <Field config={config} key={\"Baptist Health Medical Group Physician Practice\"} component={RadioButton} name=\"facilitiesGroup\" id={\"CBDNetwork10\"} checked={formik.values.facilitiesGroup === [\"CBDNetwork10\"] ? true : console.log(formik.values.facilitiesGroup)} value={\"CBDNetwork10\"} label={\"Baptist Health Medical Group Physician Practice\"} />\r\n        <FacilityItem item={{key: 'otherFac', value: 'Indicate provider name or facility if requesting BHMG records'}} template={template} formik={formik} config={config} disabled={!BHMGPPSelected} key={54321}/>\r\n      </div>\r\n      :\r\n      <></>\r\n  );\r\n};\r\n\r\nexport const FacilityItem = ({ item, template, formik, config, disabled }) => {\r\n\r\n  return (\r\n    <div key={item.key} className={`check-option tp-facility-item ${item.key === 'otherFac' && 'other-tp-facility-item'}`}>\r\n      {!disabled && <Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={item.value} name=\"facilitiesGroup\" label={(item.key === 'otherFac') ? \"\" : item.value} value={item.key} />}\r\n      {disabled && <div style={{marginLeft:26}}></div>}\r\n      {\" \"}\r\n      {item.key === \"otherFac\" &&\r\n        <div className=\"form-group\" style={{ marginBottom: 0, alignSelf: 'flex-start', width: '100vw', position: 'relative', left: -27 }}>\r\n          <input\r\n            {...formik.getFieldProps(\"otherFac\")}\r\n            style={{ width: '40%' }}\r\n            type=\"text\"\r\n            maxLength={template.fields.otherFac.validations.maxLength.value}\r\n            name=\"otherFac\"\r\n            id=\"otherFac\"\r\n            className=\"form-control\"\r\n            style={config.page.form.styles.hint}\r\n            placeholder={template.fields.otherFac.hint}\r\n            disabled={disabled}\r\n          />\r\n          {formik.touched.otherFac &&\r\n            formik.errors.otherFac ? (\r\n            <span className=\"input-error-text\">\r\n              {formik.errors.otherFac}\r\n            </span>\r\n          ) : null}\r\n        </div>\r\n      }\r\n    </div>\r\n  )\r\n}\r\n\r\n\r\n\r\nexport default BaptistFacilitySection;","import React, {useEffect, useState, useCallback} from \"react\";\r\nimport Required from \"../../../../components/Required\";\r\nimport Checkbox from \"../../../../components/Checkbox\";\r\nimport { DisabledCheckbox } from '../../orgs/7042/components';\r\nimport Popover from \"../../../../../formik/refactorOut/components/Popper/Popover\";\r\nimport { popoverLocation } from \"../../../../../config/Configuration\";\r\n\r\nconst AlleghenyFacilitySection = ({ formik, inputClasses, props, template, config }) => {\r\n\r\n    return (\r\n        config.page.form.sections.authorizationToReleaseSection.active ?\r\n          <div id='medicalFacilitiesRequested' className='form-section'>\r\n            <h2 style={template.styles.section} className=\"section-heading\"> {template.title} </h2>\r\n            <label className='non-textbox-label'> <span style={template.styles.label}> {template.fields.facilitiesGroup.label} </span> {\" \"} <Required value={template.fields.facilitiesGroup.validations.required.value} /> </label>\r\n    \r\n            <div id='ordinary-facilities' className='form-fields' style={{flexFlow: 'column wrap', maxHeight:250, marginBottom: 10}}>\r\n              {template.fields.facilitiesGroup.entries.map((item, index) => {\r\n                return (\r\n                  (!item.type) && (item.key !== 'otherFac') &&\r\n                    <div key={index} style={{marginBottom: 10}}>\r\n                        <input className='radio-button' type=\"radio\" name='facility' id={`facility${item.key}`} onChange={()=>{formik.setFieldValue('facilitiesGroup', [item.key])}}/> \r\n                            <label htmlFor={`facility${item.key}`} style={{ fontWeight: 400 }}> &nbsp;{item.value}&nbsp;\r\n                                <Popover placement={popoverLocation}>\r\n                                    <Popover.Target>\r\n                                        <i className=\"fa fa-info-circle fa_custom\"></i>\r\n                                    </Popover.Target>\r\n                                    <Popover.Content>{item.address}</Popover.Content>\r\n                                </Popover>\r\n                            </label>\r\n                    </div>\r\n                )\r\n              })}\r\n            </div>\r\n            <input type=\"text\" className='form-control' style={{width: '50%'}} placeholder='List any facilities, providers, or physicians in the Allegheny Health Network' maxLength='20' onChange={(e)=>{formik.setFieldValue('otherFac', e.target.value)}}/>\r\n          </div>\r\n          :\r\n          <></>\r\n      );\r\n};\r\n\r\nexport default AlleghenyFacilitySection;","import React, {useEffect, useState, useCallback} from \"react\";\r\nimport Required from \"../../../../components/Required\";\r\nimport Checkbox from \"../../../../components/Checkbox\";\r\nimport { DisabledCheckbox } from '../../orgs/7042/components'\r\nimport {FacilityItem} from '../../sections/AuthorizationToReleaseSection'\r\nimport './FacilitiesSection.scss'\r\n\r\nconst NorthwellFacilitySection = ({ formik, inputClasses, props, template, config, preCheckedFacility }) => {\r\n\r\n    \r\n    // const [facilitiesGroup, setFacilitiesGroup] = useState({customFacName1:\"\", customFacAddress1: \"\", customFacName2:\"\", customFacAddress2: \"\", customFacName3:\"\", customFacAddress3: \"\", customFacName4:\"\", customFacAddress4: \"\", })\r\n    const [facilitiesGroup, setFacilitiesGroup] = useState()\r\n\r\n    \r\n    \r\n    \r\n    useEffect(()=>{\r\n      // When local facilitiesGroup changes, update formik facilitiesGroup\r\n\r\n      console.log(formik.values.facilitiesGroup)\r\n      const emptyFacilitiesGroup = facilitiesGroup && Object.values(facilitiesGroup).every((value)=>{ return !value })\r\n      \r\n      if (emptyFacilitiesGroup) {\r\n        formik.setFieldValue('facilitiesGroup', [])\r\n      }\r\n      else {\r\n        formik.setFieldValue('facilitiesGroup', [facilitiesGroup])\r\n        console.log(facilitiesGroup)\r\n      }\r\n      console.log(formik.values.facilitiesGroup)\r\n      \r\n    }, [facilitiesGroup])\r\n\r\n    useEffect(()=>{\r\n      console.log(formik.values.facilitySelected)\r\n      if (formik.values.facilitiesGroup[0]) {\r\n          (!formik.values.facilitiesGroup[0].customFacName1 || !formik.values.facilitiesGroup[0].customFacAddress1) ? formik.setFieldValue('facilitySelected', \"\") : formik.setFieldValue('facilitySelected', true)\r\n      }\r\n    }, [formik.values.facilitiesGroup])\r\n\r\n    \r\n    const updateFacilities = (e, firstIndex, secondIndex) => {\r\n        setFacilitiesGroup(facilitiesGroup.map((innerArray, index)=>{\r\n            console.log(index)\r\n            \r\n            if (index === firstIndex) {\r\n                innerArray.map((info, index)=>{\r\n                    if (index === secondIndex) {\r\n                        return innerArray\r\n                    }\r\n                })\r\n                \r\n                return [e.target.value, innerArray[1]]\r\n            }\r\n            \r\n            else {\r\n                return innerArray\r\n            }\r\n      })); \r\n        console.log(facilitiesGroup)}\r\n    \r\n    return (\r\n        config.page.form.sections.authorizationToReleaseSection.active ?\r\n          <div id='medicalFacilitiesRequested' className='form-section'>\r\n            <h2 style={template.styles.section} className=\"section-heading\"> {template.title} </h2>\r\n            {preCheckedFacility &&\r\n              <label className='non-textbox-label'> \r\n                <span style={template.styles.label}> {'Specify the facilities you authorize to release medical information'} </span> {\" \"} \r\n                {/* <Required value={template.fields.facilitiesGroup.validations.required.value} />  */}\r\n              </label>\r\n            }\r\n    \r\n              {preCheckedFacility &&\r\n                <div style={{display: 'flex', alignItems: 'center'}}>\r\n                  <input type=\"checkbox\" checked={true} className='checkbox' id='defaultCheck'/> <label htmlFor=\"defaultCheck\" style={{fontWeight: 400}}>{template.fields.facilitiesGroup.entries[0].value}</label>\r\n                </div>\r\n              }\r\n            <div id='ordinary-facilities' className='form-fields' style={{flexFlow: 'column wrap', maxHeight:250, marginBottom: 10, marginTop: 20}}>\r\n\r\n              <label htmlFor=\"\" style={{marginBottom: 10}}>List clinics and providers below (You must enter information into the first name and address boxes, respectively) <Required value={template.fields.facilitiesGroup.validations.required.value} /> </label>\r\n              <div className='name-address-facility-input-container-holder'>\r\n                  <FacilitySet setIndex={1} facilitiesGroup={facilitiesGroup} setFacilitiesGroup={setFacilitiesGroup} formik={formik}/>\r\n                  <FacilitySet setIndex={2} facilitiesGroup={facilitiesGroup} setFacilitiesGroup={setFacilitiesGroup} formik={formik}/>\r\n                  <FacilitySet setIndex={3} facilitiesGroup={facilitiesGroup} setFacilitiesGroup={setFacilitiesGroup} formik={formik}/>\r\n                  <FacilitySet setIndex={4} facilitiesGroup={facilitiesGroup} setFacilitiesGroup={setFacilitiesGroup} formik={formik}/>\r\n              </div>\r\n            </div>\r\n          </div>\r\n          :\r\n          <></>\r\n      );\r\n};\r\n\r\nexport default NorthwellFacilitySection;\r\n\r\nconst FacilitySet = ({setIndex, facilitiesGroup, setFacilitiesGroup, formik}) => {\r\n  \r\n  // const updateFacilitiesGroup = (event) => {\r\n  //   setFacilitiesGroup(facilitiesGroup.map((facilityArray, mapIndex)=>{\r\n  //     if (mapIndex === setIndex) {\r\n  //       return [event.target.value, innerArray[1]]\r\n  //     }\r\n  //     else {\r\n  //       return innerArray\r\n  //     }\r\n  //   }))\r\n  // }\r\n  \r\n  return (\r\n        <div style={{display:'flex'}} className='name-address-facility-input-container'>\r\n            <input type=\"text\" className='form-control name-address-facility-input' placeholder={\"Provider's first and last name\"} onChange={(e)=>{\r\n                setFacilitiesGroup(\r\n                  // {...facilitiesGroup, [setIndex]: [e.target.value, facilitiesGroup[setIndex][1]]}\r\n                    {...facilitiesGroup, [`customFacName${setIndex}`]: e.target.value}\r\n                );\r\n                \r\n              }}\r\n            />\r\n            <input type=\"text\" className='form-control name-address-facility-input' placeholder={\"Provider's address, including city & state\"} onChange={(e)=>{\r\n              setFacilitiesGroup(\r\n                \r\n                {...facilitiesGroup, [`customFacAddress${setIndex}`]: e.target.value}\r\n                \r\n                ); \r\n              }}\r\n            /> \r\n          </div>\r\n    )\r\n}","import React, {useEffect, useState, useCallback} from \"react\";\r\nimport Required from \"../../../../components/Required\";\r\nimport Checkbox from \"../../../../components/Checkbox\";\r\nimport { DisabledCheckbox } from '../../orgs/7042/components'\r\nimport {FacilityItem} from '../../sections/AuthorizationToReleaseSection'\r\nimport './FacilitiesSection.scss'\r\n\r\nconst SBCPMPFacilitySection = ({ formik, inputClasses, props, template, config }) => {\r\n\r\n    const [internistFacilitiesDisplay, setInternistFacilitiesDisplay] = useState('none')\r\n    \r\n    useEffect(()=>{\r\n      const facilitiesGroup = formik.values.facilitiesGroup\r\n      facilitiesGroup.includes('Facility15') ? setInternistFacilitiesDisplay('flex') : setInternistFacilitiesDisplay('none')\r\n    }, [formik.values.facilitiesGroup])\r\n    \r\n    return (\r\n        config.page.form.sections.authorizationToReleaseSection.active ?\r\n          <div id='medicalFacilitiesRequested' className='form-section'>\r\n            <h2 style={template.styles.section} className=\"section-heading\"> {template.title} </h2>\r\n            <label className='non-textbox-label'> <span style={template.styles.label}> {'I authorize'} </span> {\" \"} <Required value={template.fields.facilitiesGroup.validations.required.value} /> </label>\r\n    \r\n            <ul style={{paddingInlineStart: 0, display: 'flex', flexFlow: 'row wrap', justifyContent: 'space-between'}}>\r\n              <RadioOption_CPMP facilityNum={'1'} facilityValue={'Stony Brook Anaesthesiology (Pain Management), UFPC'} formik={formik}/>\r\n              <RadioOption_CPMP facilityNum={'2'} facilityValue={'Stony Brook Dermatology, UFPC'} formik={formik}/>\r\n              <RadioOption_CPMP facilityNum={'3'} facilityValue={'Stony Brook Family and Preventive Medicine, UFPC'} formik={formik}/>\r\n              <RadioOption_CPMP facilityNum={'4'} facilityValue={'Neurology Associates of Stony Brook, UFPC'} formik={formik}/>\r\n              <RadioOption_CPMP facilityNum={'5'} facilityValue={'New York Spine & Brain Surgery, UFPC'} formik={formik}/>\r\n              <RadioOption_CPMP facilityNum={'6'} facilityValue={'University Associates in Obstetrics & Gynecology, UFPC'} formik={formik}/>\r\n              <RadioOption_CPMP facilityNum={'7'} facilityValue={'Stony Brook Opthalmology, UFPC'} formik={formik}/>\r\n              <RadioOption_CPMP facilityNum={'8'} facilityValue={'Stony Brook Orthopedics Associates, UFPC'} formik={formik}/>\r\n              <RadioOption_CPMP facilityNum={'9'} facilityValue={'Stony Brook Children\\'s Service, UFPC'} formik={formik}/>\r\n              <RadioOption_CPMP facilityNum={'10'} facilityValue={'Stony Brook Psychiatric Associates, UFPC'} formik={formik}/>\r\n              <RadioOption_CPMP facilityNum={'12'} facilityValue={'Stony Brook Radiation Oncology, UFPC'} formik={formik}/>\r\n              <RadioOption_CPMP facilityNum={'13'} facilityValue={'Stony Brook Surgical Associates, UFPC'} formik={formik}/>\r\n              <RadioOption_CPMP facilityNum={'14'} facilityValue={'Stony Brook Urology, UFPC'} formik={formik}/>\r\n              <RadioOption_CPMP facilityNum={'11'} facilityValue={'Stony Brook Radiology, UFPC *For Radiology Images please call (631) 638-0618'} formik={formik}/>\r\n              <div className='' style={{width: '48%', marginRight: 19}}>\r\n                <input type=\"radio\" className='radio-button' id='facility15' name='facility-select' onChange={() => { formik.setFieldValue('facilitiesGroup', ['Facility15']) }}/>\r\n                <label htmlFor=\"facility15\" style={{fontWeight: 400}}>Stony Brook Internists, UFPC</label>\r\n                <div className='internist-facilities' style={{display: internistFacilitiesDisplay, marginTop: 10, flexWrap: 'wrap', }}>\r\n                  <div className='check-option'><Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={'Cardiology'} name=\"facilitiesGroup\" label={'Cardiology'} value={'Facility16'} /></div>\r\n                  <div className='check-option'><Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={'Endocrinology'} name=\"facilitiesGroup\" label={'Endocrinology'} value={'Facility17'} /></div>\r\n                  <div className='check-option'><Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={'Gastroenterology'} name=\"facilitiesGroup\" label={'Gastroenterology'} value={'Facility18'} /></div>\r\n                  <div className='check-option'><Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={'Infectious Disease'} name=\"facilitiesGroup\" label={'Infectious Disease'} value={'Facility19'} /></div>\r\n                  <div className='check-option'><Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={'Pulmonology'} name=\"facilitiesGroup\" label={'Pulmonology'} value={'Facility20'} /></div>\r\n                  <div className='check-option'><Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={'Rheumatology'} name=\"facilitiesGroup\" label={'Rheumatology'} value={'Facility21'} /></div>\r\n                  <div className='check-option'><Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={'Sleep Center'} name=\"facilitiesGroup\" label={'Sleep Center'} value={'Facility22'} /></div>\r\n                  <div className='check-option'><Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={'Medical Oncology'} name=\"facilitiesGroup\" label={'Medical Oncology'} value={'Facility23'} /></div>\r\n                </div>\r\n              </div>\r\n            </ul>\r\n          </div>\r\n          :\r\n          <></>\r\n      );\r\n};\r\n\r\nexport default SBCPMPFacilitySection;\r\n\r\nconst RadioOption_CPMP = ({facilityNum, facilityValue, formik}) => {\r\n    return (\r\n      <div className='radio-option' style={{marginBottom: 10, width: '48%', alignItems: 'flex-start'}} onChange={() => { formik.setFieldValue('facilitiesGroup', [`Facility${facilityNum}`])}}>\r\n        <input type=\"radio\" className='radio-button' id={`facility${facilityNum}`} name='facility-select' />\r\n        <label htmlFor={`facility${facilityNum}`}>{facilityValue}</label>\r\n      </div>\r\n    )\r\n}\r\n\r\n","import React, {useEffect, useState, useCallback} from \"react\";\r\nimport Required from \"../../../../components/Required\";\r\nimport Checkbox from \"../../../../components/Checkbox\";\r\nimport { DisabledCheckbox } from '../7042/components'\r\nimport {FacilityItem} from '../../sections/AuthorizationToReleaseSection'\r\nimport './FacilitiesSection.scss'\r\n\r\nconst THRFacilitySection = ({ formik, inputClasses, props, template, config }) => {\r\n    \r\n    // useEffect(()=>{\r\n    //   !formik.values.facilitiesGroup.includes('Facility1') && formik.setFieldValue('facilitiesGroup', ['Facility1'])\r\n    //   console.log(formik.values)\r\n    // }, [formik.values.facilitiesGroup])\r\n    \r\n    return (\r\n        config.page.form.sections.authorizationToReleaseSection.active ?\r\n          <div id='medicalFacilitiesRequested' className='form-section thr-form-section'>\r\n            <h2 style={template.styles.section} className=\"section-heading\"> {template.title} </h2>\r\n            <label className='non-textbox-label'> <span style={template.styles.label}> {'I authorize'} </span> {\" \"} <Required value={template.fields.facilitiesGroup.validations.required.value} /> </label>\r\n            <Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={'Facility1'} name=\"facilitiesGroup\" label={'Texas Health'} value={'Facility1'} />\r\n            <Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={'Facility2'} name=\"facilitiesGroup\" label={'THPG Clinics'} value={'Facility2'} />\r\n            <Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={'Facility3'} name=\"facilitiesGroup\" label={'Texas Health Urgent Care'} value={'Facility3'} />\r\n            <br />\r\n            <FacilityItem item={{key: 'otherFac', value: 'Specific facility or provider at CBC Trial Works'}} template={template} formik={formik} config={config} disabled={false} key={54321}/>\r\n          </div>\r\n          :\r\n          <></>\r\n      );\r\n};\r\n\r\nexport default THRFacilitySection;\r\n\r\n","import React, {useEffect, useState, useCallback} from \"react\";\r\nimport Required from \"../../../../components/Required\";\r\nimport Checkbox from \"../../../../components/Checkbox\";\r\nimport { DisabledCheckbox } from '../7042/components'\r\nimport {FacilityItem} from '../../sections/AuthorizationToReleaseSection'\r\nimport './FacilitiesSection.scss'\r\n\r\nconst GuthrieFacilitySection = ({ formik, inputClasses, props, template, config }) => {\r\n    \r\n  const [guthrieMedicalGroupInput, setGuthrieMedicalGroupInput] = useState(null)\r\n  const [guthrieMedicalGroupCheck, setGuthrieMedicalGroupCheck] = useState(false)\r\n  const [guthrieMedicalGroupValue, setGuthrieMedicalGroupValue] = useState(null)\r\n  \r\n    useEffect(()=>{\r\n      const newFacilities = formik.values.facilitiesGroup.filter(fac => !fac.includes('Guthrie Medical Group'))\r\n      console.log(newFacilities);\r\n      if(guthrieMedicalGroupInput && guthrieMedicalGroupCheck){\r\n        formik.setFieldValue('facilitiesGroup', [...newFacilities, `Guthrie Medical Group: ${guthrieMedicalGroupInput}`])\r\n      } else{\r\n        formik.setFieldValue('facilitiesGroup', formik.values.facilitiesGroup.filter(fac => !fac.includes('Guthrie Medical Group')))\r\n      }\r\n    }, [guthrieMedicalGroupInput, guthrieMedicalGroupCheck])\r\n    \r\n    useEffect(()=>{\r\n      !guthrieMedicalGroupValue && formik.setFieldValue('otherFac', '')\r\n    }, [formik.values.otherFac])\r\n    \r\n    useEffect(()=>{\r\n      !guthrieMedicalGroupCheck && formik.setFieldValue('otherFac', '') && setGuthrieMedicalGroupValue('')\r\n      if (!guthrieMedicalGroupCheck) {\r\n        document.getElementById('GMGCField').value = ''\r\n      }\r\n    }, [guthrieMedicalGroupCheck])\r\n    \r\n    \r\n    return (\r\n        config.page.form.sections.authorizationToReleaseSection.active ?\r\n          <div id='medicalFacilitiesRequested' className='form-section thr-form-section'>\r\n            <h2 style={template.styles.section} className=\"section-heading\"> {template.title} </h2>\r\n            <label className='non-textbox-label'> <span style={template.styles.label}> {'I authorize'} </span> {\" \"} <Required value={template.fields.facilitiesGroup.validations.required.value} /> </label>\r\n            <div className=\"hospitalFacilities\">\r\n              <strong>Hospital:</strong>\r\n              <Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={'Facility1'} name=\"facilitiesGroup\" label={'Corning'} value={'Facility1'} />\r\n              <Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={'Facility2'} name=\"facilitiesGroup\" label={'Cortland'} value={'Facility2'} />\r\n              <Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={'Facility3'} name=\"facilitiesGroup\" label={'Robert Packer'} value={'Facility3'} />\r\n              <Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={'Facility4'} name=\"facilitiesGroup\" label={'Robert Packer Hospital Towanda Campus'} value={'Facility4'} />\r\n              <Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={'Facility5'} name=\"facilitiesGroup\" label={'Troy'} value={'Facility5'} />\r\n              <Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={'Facility6'} name=\"facilitiesGroup\" label={'Lourdes Hospital'} value={'Facility6'} />\r\n            </div>\r\n            <div className=\"gmg\">\r\n              <strong>Clinic Location:</strong>\r\n              {/* <Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={'Facility1'} name=\"facilitiesGroup\" label={`Guthrie Medical Group:`}  /> */}\r\n              <input type=\"checkbox\" style={{width:18, height: 18, marginRight: 10}} onChange={(e)=>{setGuthrieMedicalGroupCheck(e.target.checked)}}/>\r\n              Guthrie Medical Group:\r\n              <input type=\"text\" id='GMGCField' disabled={!guthrieMedicalGroupCheck} placeholder='City, State (indicate all locations)' className='form-control'  onChange={(e)=>{formik.setFieldValue('otherFac', e.target.value); setGuthrieMedicalGroupValue(e.target.value)}}/>\r\n              {/* <FacilityItem item={{key: 'otherFac', value: 'City, State (indicate all locations)'}} template={template} formik={formik} config={config} disabled={false} key={54321}/> */}\r\n            </div>\r\n            <br />\r\n            {/* <FacilityItem item={{key: 'otherFac', value: 'Specific facility or provider at CBC Trial Works'}} template={template} formik={formik} config={config} disabled={false} key={54321}/> */}\r\n          </div>\r\n          :\r\n          <></>\r\n      );\r\n};\r\n\r\nexport default GuthrieFacilitySection;\r\n\r\n","import React, {useEffect, useState, useCallback} from \"react\";\r\nimport Required from \"../../../../components/Required\";\r\nimport Checkbox from \"../../../../components/Checkbox\";\r\nimport { DisabledCheckbox } from '../../orgs/7042/components'\r\nimport {FacilityItem} from '../../sections/AuthorizationToReleaseSection'\r\nimport './FacilitiesSection.scss'\r\n\r\nconst CarbonFacilitySection = ({ formik, inputClasses, props, template, config, preCheckedFacility }) => {\r\n\r\n    \r\n    const [facilitiesGroup, setFacilitiesGroup] = useState()\r\n    const [facilitiesArray, setFacilitiesArray] = useState()\r\n\r\n    \r\n    \r\n    \r\n    useEffect(()=>{\r\n      // When local facilitiesGroup changes, update formik facilitiesGroup\r\n\r\n      console.log(formik.values.facilitiesGroup)\r\n      const emptyFacilitiesGroup = facilitiesGroup && Object.values(facilitiesGroup).every((value)=>{ return !value })\r\n      \r\n      if (emptyFacilitiesGroup) {\r\n        formik.setFieldValue('facilitiesGroup', [])\r\n      }\r\n      else {\r\n        formik.setFieldValue('facilitiesGroup', [facilitiesGroup])\r\n        console.log(facilitiesGroup)\r\n      }\r\n      console.log(formik.values.facilitiesGroup)\r\n      \r\n    }, [facilitiesGroup])\r\n\r\n    useEffect(()=>{\r\n      console.log(formik.values.facilitiesGroup)\r\n    }, [formik.values.facilitiesGroup])\r\n\r\n    \r\n    \r\n    useEffect(()=>{\r\n      console.log(formik.values.facilitySelected)\r\n      if (formik.values.facilitiesGroup[0]) {\r\n          (!formik.values.facilitiesGroup[0].customFacName1 || !formik.values.facilitiesGroup[0].customFacAddress1) ? formik.setFieldValue('facilitySelected', \"\") : formik.setFieldValue('facilitySelected', true)\r\n      }\r\n    }, [formik.values.facilitiesGroup])\r\n\r\n    \r\n    \r\n    \r\n    const updateFacilities = (e, firstIndex, secondIndex) => {\r\n        setFacilitiesGroup(facilitiesGroup.map((innerArray, index)=>{\r\n            console.log(index)\r\n            \r\n            if (index === firstIndex) {\r\n                innerArray.map((info, index)=>{\r\n                    if (index === secondIndex) {\r\n                        return innerArray\r\n                    }\r\n                })\r\n                \r\n                return [e.target.value, innerArray[1]]\r\n            }\r\n            \r\n            else {\r\n                return innerArray\r\n            }\r\n      })); \r\n        console.log(facilitiesGroup)}\r\n    \r\n    return (\r\n        config.page.form.sections.authorizationToReleaseSection.active ?\r\n          <div id='medicalFacilitiesRequested' className='form-section carbon-health-facilities'>\r\n            <h2 style={template.styles.section} className=\"section-heading\"> {template.title} </h2>\r\n            {preCheckedFacility &&\r\n              <label className='non-textbox-label'> \r\n                <span style={template.styles.label}> {'Specify the facilities you authorize to release medical information'} </span> {\" \"} \r\n                {/* <Required value={template.fields.facilitiesGroup.validations.required.value} />  */}\r\n              </label>\r\n            }\r\n    \r\n              {preCheckedFacility &&\r\n                <div style={{display: 'flex', alignItems: 'center'}}>\r\n                  <input type=\"checkbox\" checked={true} className='checkbox' id='defaultCheck'/> <label htmlFor=\"defaultCheck\" style={{fontWeight: 400}}>{template.fields.facilitiesGroup.entries[0].value}</label>\r\n                </div>\r\n              }\r\n            <div id='ordinary-facilities' className='form-fields' style={{flexFlow: 'column', maxHeight:250, marginBottom: 10, marginTop: 20}}>\r\n\r\n              <label htmlFor=\"\" style={{marginBottom: 10}}>List clinics and providers below (You must enter information into the first name and address boxes, respectively) <Required value={template.fields.facilitiesGroup.validations.required.value} /> </label>\r\n              <div className='name-address-facility-input-container-holder'>\r\n                  <FacilitySet setIndex={1} facilitiesGroup={facilitiesGroup} setFacilitiesGroup={setFacilitiesGroup} formik={formik}/>\r\n                  <FacilitySet setIndex={2} facilitiesGroup={facilitiesGroup} setFacilitiesGroup={setFacilitiesGroup} formik={formik}/>\r\n                  <FacilitySet setIndex={3} facilitiesGroup={facilitiesGroup} setFacilitiesGroup={setFacilitiesGroup} formik={formik}/>\r\n                  <FacilitySet setIndex={4} facilitiesGroup={facilitiesGroup} setFacilitiesGroup={setFacilitiesGroup} formik={formik}/>\r\n              </div>\r\n            </div>\r\n          </div>\r\n          :\r\n          <></>\r\n      );\r\n};\r\n\r\nexport default CarbonFacilitySection;\r\n\r\nconst FacilitySet = ({setIndex, facilitiesGroup, setFacilitiesGroup, formik}) => {\r\n  \r\n  \r\n  return (\r\n        <div style={{display:'flex'}} className='name-address-facility-input-container'>\r\n            <input type=\"text\" className='form-control name-address-facility-input name-input' placeholder={\"Facility Name\"} onChange={(e)=>{\r\n                setFacilitiesGroup(\r\n                  // {...facilitiesGroup, [setIndex]: [e.target.value, facilitiesGroup[setIndex][1]]}\r\n                    {...facilitiesGroup, [`customFacName${setIndex}`]: e.target.value}\r\n                );\r\n                \r\n              }}\r\n            />\r\n            <input type=\"text\" className='form-control name-address-facility-input address-input' placeholder={\"Facility Address\"} onChange={(e)=>{\r\n              setFacilitiesGroup(\r\n                \r\n                {...facilitiesGroup, [`customFacAddress${setIndex}`]: e.target.value}\r\n                \r\n                ); \r\n              }}\r\n            /> \r\n            <input type=\"text\" className='form-control name-address-facility-input doctor-input' placeholder={\"Name of Doctor (Optional)\"} onChange={(e)=>{\r\n              setFacilitiesGroup(\r\n                \r\n                {...facilitiesGroup, [`customFacDoctor${setIndex}`]: e.target.value}\r\n                \r\n                ); \r\n              }}\r\n            /> \r\n          </div>\r\n    )\r\n}","import React, { useEffect, useState, useCallback } from \"react\";\r\nimport Required from \"../../../components/Required\";\r\nimport Popover from \"../../../../formik/refactorOut/components/Popper/Popover\";\r\nimport { popoverLocation } from \"../../../../config/Configuration\";\r\n\r\nconst FacilityRadioList = ({ formik, inputClasses, props, template, config }) => {\r\n\r\n    let otherTip = config.page.form.sections.authorizationToReleaseSection.fields.otherFac.hint || \"List any specific facilities or providers.\";\r\n    return (\r\n        config.page.form.sections.authorizationToReleaseSection.active ?\r\n            <div id='medicalFacilitiesRequested' className='form-section'>\r\n                <h2 style={template.styles.section} className=\"section-heading\"> {template.title} </h2>\r\n                <label className='non-textbox-label'> <span style={template.styles.label}> {template.fields.facilitiesGroup.label} </span> {\" \"} <Required value={template.fields.facilitiesGroup.validations.required.value} /> </label>\r\n\r\n                <div id='ordinary-facilities' className='form-fields' style={{ flexFlow: 'column wrap', maxHeight: 250, marginBottom: 10 }}>\r\n                    {template.fields.facilitiesGroup.entries.map((item, index) => {\r\n                        return (\r\n                            (!item.type) && (item.key !== 'otherFac') &&\r\n                            <div key={index} style={{ marginBottom: 10 }}>\r\n                                <input className='radio-button' type=\"radio\" name='facility' id={`facility${item.key}`} onChange={() => { formik.setFieldValue('facilitiesGroup', [item.key]) }} />\r\n                                    <label htmlFor={`facility${item.key}`} style={{ fontWeight: 400 }}> &nbsp;{item.value}&nbsp;\r\n                                        {(item.address) ?\r\n                                    <Popover placement={popoverLocation}>\r\n                                        <Popover.Target>\r\n                                            <i className=\"fa fa-info-circle fa_custom\"></i>\r\n                                        </Popover.Target>\r\n                                        <Popover.Content>{item.address}</Popover.Content>\r\n                                    </Popover> : <></>}\r\n                                </label>\r\n                            </div>\r\n                        )\r\n                    })}\r\n                </div>\r\n                <input type=\"text\" className='form-control' style={{ width: '50%' }} placeholder={otherTip} maxLength='20' onChange={(e) => { formik.setFieldValue('otherFac', e.target.value) }} />\r\n            </div>\r\n            :\r\n            <></>\r\n    );\r\n};\r\n\r\nexport default FacilityRadioList;","import React from \"react\";\r\nimport Required from \"../../../components/Required\";\r\nimport Checkbox from \"../../../components/Checkbox\";\r\nimport { Field } from \"formik\";\r\nimport RadioButtonGroup from \"../../../components/RadioButtonGroup\";\r\nimport RadioButton from \"../../../components/RadioButton\";\r\nimport Facilities_7224 from '../orgs/7224/facilities';\r\nimport NYPOutpatientFacilities from '../orgs/7042/facilities';\r\nimport '../styles/css/authToRelease.css';\r\nimport { DisabledCheckbox } from '../orgs/7042/components';\r\nimport Facilities_7227 from '../orgs/7227/facilities';\r\nimport BothwellFacilities from '../orgs/7302/facilities';\r\nimport BaptistFacilitySection from '../orgs/7291/facilitySection';\r\nimport AlleghenyFacilitySection from '../orgs/7150/FacilitiesSection';\r\nimport NorthwellFacilitySection from '../orgs/7229/FacilitiesSection';\r\nimport SBCMFacilitySection from '../orgs/7342/FacilitiesSection';\r\nimport SBCPMPFacilitySection from '../orgs/7343/FacilitiesSection';\r\nimport THRFacilitySection from '../orgs/7451/FacilitiesSection';\r\nimport GuthrieFacilitySection from '../orgs/7163/FacilitiesSection';\r\nimport CarbonFacilitySection from '../orgs/7307/FacilitiesSection';\r\nimport Popover from \"../../../../formik/refactorOut/components/Popper/Popover\";\r\nimport infoCircle from '../styles/assets/info-circle.png';\r\nimport  FacilityRadioList from './RenderFacilityRadioList';\r\n\r\nconst AuthorizationToRelease = ({ formik, inputClasses, props, template, config }) => {\r\n\r\n    const orgId = config.context.organization;\r\n    const renderFacilityRadiogroup = (config.page.form.sections.authorizationToReleaseSection.facilitiesRadiogroup||false);\r\n\r\n    const tripartiteOrg = orgId === '1007042' || orgId === '1007239' || orgId === '1007101' || orgId === '1006987';\r\n\r\n\r\n  if (renderFacilityRadiogroup) { return <FacilityRadioList formik={formik} inputClasses={inputClasses} props={props} template={template} config={config} /> }\r\n\r\n    if (orgId === '1007291') { return <BaptistFacilitySection formik={formik} inputClasses={inputClasses} props={props} template={template} config={config} /> }\r\n    if (orgId === '1007150') { return <AlleghenyFacilitySection formik={formik} inputClasses={inputClasses} props={props} template={template} config={config} /> }\r\n    // if (orgId === '1007342') { return <SBCMFacilitySection formik={formik} inputClasses={inputClasses} props={props} template={template} config={config}/> }\r\n    if (orgId === '1007229') { return <NorthwellFacilitySection formik={formik} inputClasses={inputClasses} props={props} template={template} config={config} preCheckedFacility={true} /> }\r\n    if (orgId === '1007342') { return <NorthwellFacilitySection formik={formik} inputClasses={inputClasses} props={props} template={template} config={config} preCheckedFacility={true} /> }\r\n    if (orgId === '1007343') { return <SBCPMPFacilitySection formik={formik} inputClasses={inputClasses} props={props} template={template} config={config} preCheckedFacility={false} /> }\r\n    if (orgId === '1007451') { return <THRFacilitySection formik={formik} inputClasses={inputClasses} props={props} template={template} config={config} preCheckedFacility={false} /> }\r\n    if (orgId === '1007163') { return <GuthrieFacilitySection formik={formik} inputClasses={inputClasses} props={props} template={template} config={config} preCheckedFacility={false} /> }\r\n    if (orgId === '1007307') {\r\n        return <CarbonFacilitySection formik={formik} inputClasses={inputClasses} props={props} template={template} config={config} />\r\n    }\r\n\r\n    if (orgId === '1007224') {\r\n        return (\r\n            <Facilities_7224 orgId={orgId} formik={formik} template={template} config={config} />\r\n        )\r\n    }\r\n\r\n    if (orgId === '1007227') {\r\n        return (\r\n            <Facilities_7227 orgId={orgId} formik={formik} template={template} config={config} />\r\n        )\r\n    }\r\n\r\n    if (orgId === '1007302') {\r\n        return <BothwellFacilities template={template} formik={formik} config={config} />\r\n    }\r\n\r\n    if (tripartiteOrg) {\r\n        return <NYPOutpatientFacilities orgId={orgId} formik={formik} template={template} config={config} />\r\n    }\r\n\r\n    return (\r\n        config.page.form.sections.authorizationToReleaseSection.active ?\r\n            <div id='medicalFacilitiesRequested' className='form-section'>\r\n                <h2 style={template.styles.section} className=\"section-heading\"> {template.title} </h2>\r\n                <label className='non-textbox-label'> <span style={template.styles.label}> {template.fields.facilitiesGroup.label} </span> {\" \"} <Required value={template.fields.facilitiesGroup.validations.required.value} /> </label>\r\n\r\n                <div id='ordinary-facilities' className='form-fields' style={{ flexFlow: 'column wrap', maxHeight: 250, marginBottom: 10 }}>\r\n                    {template.fields.facilitiesGroup.entries.map((item, index) => {\r\n                        return (\r\n                            (!item.type) && (item.key !== 'otherFac') &&\r\n                            // Check to see if the above line is needed for Temple to work\r\n                            <FacilityItem item={item} template={template} formik={formik} config={config} disabled={item.disabled} key={index} />\r\n                        )\r\n                    })\r\n                    }\r\n\r\n                </div>\r\n                {orgId !== '1007278' && <FacilityItem item={{ key: 'otherFac', value: 'Specific facility or provider at CBC Trial Works' }} template={template} formik={formik} config={config} disabled={false} key={54321} />}\r\n\r\n                {(tripartiteOrg) && <NYPOutpatientFacilities orgId={orgId} formik={formik} template={template} config={config} />}\r\n\r\n            </div>\r\n            :\r\n            <></>\r\n    );\r\n};\r\n\r\nexport const FacilityItem = ({ item, template, formik, config, disabled }) => {\r\n\r\n    return (\r\n        <div key={item.key} className={`check-option tp-facility-item ${item.key === 'otherFac' && 'other-tp-facility-item'}`}>\r\n            {!disabled && <Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={item.value} name=\"facilitiesGroup\" label={(item.key === 'otherFac') ? \"\" : item.value} value={item.key} />}\r\n            {disabled && <DisabledCheckbox template={template} item={item} />}\r\n            {\" \"}\r\n            {item.key === \"otherFac\" &&\r\n                <div className=\"form-group\" style={{ marginBottom: 0, alignSelf: 'flex-start', width: '100vw', position: 'relative', left: -27 }}>\r\n                    <input\r\n                        {...formik.getFieldProps(\"otherFac\")}\r\n                        style={{ width: '40%' }}\r\n                        type=\"text\"\r\n                        maxLength={template.fields.otherFac.validations.maxLength.value}\r\n                        name=\"otherFac\"\r\n                        id=\"otherFac\"\r\n                        className=\"form-control\"\r\n                        style={config.page.form.styles.hint}\r\n                        placeholder={template.fields.otherFac.hint}\r\n                    />\r\n                    {formik.touched.otherFac &&\r\n                        formik.errors.otherFac ? (\r\n                        <span className=\"input-error-text\">\r\n                            {formik.errors.otherFac}\r\n                        </span>\r\n                    ) : null}\r\n                </div>\r\n            }\r\n\r\n            {item.value === 'NYP Westchester' &&\r\n                <Popover placement={'right'}>\r\n                    <Popover.Target>\r\n                        <img className='info-circle' src={infoCircle}></img>\r\n                    </Popover.Target>\r\n                    <Popover.Content>{'Formerly known as Lawrence'}</Popover.Content>\r\n                </Popover>}\r\n        </div>\r\n    )\r\n}\r\n\r\n\r\n\r\nexport default AuthorizationToRelease;\r\n","import React from 'react';\r\nimport './styles.scss';\r\n\r\nconst BaptistFacilityInfo = () => {\r\n    return (\r\n        <div className=\"baptist-facility-info\">\r\n            <hr />\r\n            <p>Please do not submit requests for <strong>billing</strong> or <strong>imaging/films</strong> with this form. Contact the respective departments to submit a request for billing records and/or films/images.</p>\r\n            <div className='films-billing-container'>\r\n                <div className='billing-section section'>\r\n                    <p style={{ fontWeight: 700 }}>Billing Records:</p>\r\n                    <p>If you are requesting a copy of billing records, you must contact <strong>Patient Financial Services</strong> at 786-596-6507.</p>\r\n                    <p><strong>Itemized Billing</strong> requests must be sent to:</p>\r\n                    <p style={{ fontWeight: 700 }}>\r\n                        Baptist Health South Florida<br />\r\n                        ATTN: Patient Financial Services<br />\r\n                        PO Box 830880<br />\r\n                        Miami, FL 33283\r\n                    </p>\r\n                </div>\r\n                <div className='separator'></div>\r\n                <div className='films-and-images-section section'>\r\n                    <p style={{ fontWeight: 700 }}>Films/Images:</p>\r\n                    <table className='billing-facility-table'>\r\n                        <tr>\r\n                            <th>Facility</th>\r\n                            {/* <th>Department</th> */}\r\n                            <th>Fax</th>\r\n                            <th>Email or Phone</th>\r\n                        </tr>\r\n                        <tr>\r\n                            <td>Baptist Hospital of Miami - BH Imaging Legal</td>\r\n                            {/* <td>Film Library</td> */}\r\n                            <td className='film-fax'>786-533-9579</td>\r\n                            <td><a href=\"mailto:BHImagingLegal@baptisthealth.net\">BHImagingLegal@baptisthealth.net</a></td>\r\n                        </tr>\r\n                        <tr>\r\n                            <td>South Miami Hospital</td>\r\n                            {/* <td>Film Library</td> */}\r\n                            <td className='film-fax'>786-533-9531</td>\r\n                            <td><a href=\"mailto:SMHImagesRequests@baptisthealth.net\">SMHImagesRequests@baptisthealth.net</a></td>\r\n                        </tr>\r\n                        <tr>\r\n                            <td>Doctors Hospital</td>\r\n                            {/* <td>Film Library</td> */}\r\n                            <td className='film-fax'>786-533-9712</td>\r\n                            <td><a href=\"mailto:DHImagesRequests@baptisthealth.net\">DHImagesRequests@baptisthealth.net</a></td>\r\n                        </tr>\r\n                        <tr>\r\n                            <td>Homestead Hospital - HHImagingLegal</td>\r\n                            {/* <td>Film Library</td> */}\r\n                            <td className='film-fax'>786-243-8562</td>\r\n                            <td><a href=\"mailto:HHImagingLegal@baptisthealth.net\">HHImagingLegal@baptisthealth.net</a></td>\r\n                        </tr>\r\n                        <tr>\r\n                            <td>West Kendall Baptist Hospital</td>\r\n                            {/* <td>Film Library</td> */}\r\n                            <td className='film-fax'>786-533-9633</td>\r\n                            <td><a href=\"mailto:DG-WKBHFilmRoom@baptisthealth.net\">DG-WKBHFilmRoom@baptisthealth.net</a></td>\r\n                        </tr>\r\n                        <tr>\r\n                            <td>Mariners Hospital</td>\r\n                            {/* <td>Film Library</td> */}\r\n                            <td className='film-fax'>786-260-0517</td>\r\n                            <td className='film-fax'>305-434-1588</td>\r\n                        </tr>\r\n                        <tr>\r\n                            <td>Fishermen’s Community Hospital</td>\r\n                            {/* <td>Film Library</td> */}\r\n                            <td className='film-fax'>786-260-0533</td>\r\n                            <td className='film-fax'>305-434-1589</td>\r\n                        </tr>\r\n                        <tr>\r\n                            <td>Baptist Outpatient Services</td>\r\n                            {/* <td>Film Library</td> */}\r\n                            <td className='film-fax'>786-596-3613</td>\r\n                            <td><a href=\"mailto:BHImagingLegal@baptisthealth.net\">BHImagingLegal@baptisthealth.net</a></td>\r\n                        </tr>\r\n                    </table>\r\n                    <p style={{ fontWeight: 700, marginTop: 20 }}>Pathology Slides:</p>\r\n                    <table className='billing-facility-table'>\r\n                        <tr>\r\n                            <th>Facility</th>\r\n                            <th>Phone Number</th>\r\n                            <th>Fax Number</th>\r\n                            <th>Email or Phone</th>\r\n                        </tr>\r\n                        <tr>\r\n                            <td>Baptist Hospital of Miami</td>\r\n                            <td className='film-fax'>786-596-4166</td>\r\n                            <td className='film-fax'></td>\r\n                            <td>Refer to phone/fax number</td>\r\n                        </tr>\r\n                        <tr>\r\n                            <td>Doctors Hospital</td>\r\n                            <td className='film-fax'>786-308-3120</td>\r\n                            <td className='film-fax'>786-533-9567</td>\r\n                            <td><a href=\"mailto:DG-DHPathologyGroup@baptisthealth.net\">DG-DHPathologyGroup@baptisthealth.net</a></td>\r\n                        </tr>\r\n                        <tr>\r\n                            <td>Homestead Hospital</td>\r\n                            <td className='film-fax'>786-243-8519</td>\r\n                            <td className='film-fax'>786-533-9891</td>\r\n                            <td><a href=\"mailto:DG-BHSFPathologyOvation@baptisthealth.net\">DG-BHSFPathologyOvation@baptisthealth.net</a></td>\r\n                        </tr>\r\n                        <tr>\r\n                            <td>South Miami Hospital</td>\r\n                            <td className='film-fax'>786-662-8168</td>\r\n                            <td className='film-fax'>786-533-9434</td>\r\n                            <td>Refer to phone/fax number</td>\r\n                        </tr>\r\n                        <tr>\r\n                            <td>Bapitst Health Hospital Doral</td>\r\n                            <td className='film-fax'>786-662-8168</td>\r\n                            <td className='film-fax'>786-533-9434</td>\r\n                            <td>Refer to phone/fax number</td>\r\n                        </tr>\r\n\r\n                    </table>\r\n                </div>\r\n            </div>\r\n        </div>\r\n    )\r\n}\r\n\r\nexport default BaptistFacilityInfo;","import React from 'react';\r\nimport Checkbox from '../../../../components/Checkbox'\r\n\r\nconst HSSDocField = ({template, formik}) => {\r\n    return (\r\n        <div id='physician-field' style={{ display: 'flex', width: '48.42%' }}>\r\n            <Checkbox style={{ ...template.styles.list, display: 'flex' }} className=\"custom-form-check checkbox\" key={'HSS Physician Office Record(s)'} name=\"infoToReleaseGroup\" label={'HSS Physician Office Record(s)'} value={'22314'} />\r\n            <input\r\n                type=\"text\"\r\n                className='form-control'\r\n                placeholder={\"Physician's Name\"}\r\n                onChange={(e) => {\r\n                    formik.setFieldValue('otherFac', e.target.value)\r\n                    console.log(formik.values)\r\n                }}\r\n            />\r\n        </div>\r\n    )\r\n}\r\n\r\nexport default HSSDocField;","import React from \"react\";\r\nimport DatePicker from \"react-datepicker\";\r\nimport Required from \"../../../components/Required\";\r\nimport Checkbox from \"../../../components/Checkbox\";\r\nimport Popover from \"../../../../formik/refactorOut/components/Popper/Popover\";\r\nimport { popoverLocation } from \"../../../../config/Configuration\";\r\nimport MaskedInput from 'react-text-mask';\r\nimport calendar from '../styles/assets/calendar.png'\r\nimport infoCircle from '../styles/assets/info-circle.png'\r\nimport BaptistFacilityInfo from '../orgs/7291/facilityInfo'\r\nimport HSSDocField from '../orgs/7278/HSSDocField'\r\n\r\n\r\nconst InformationToRelease = ({ formik, inputClasses, template, config }) => {\r\n\r\n  const orgId = config.context.organization;\r\n  const baptistId = '1007291';\r\n\r\n  return (\r\n    config.page.form.sections.informationToReleaseSection.active ?\r\n      <div id='infoToReleaseSection' className='form-section'>\r\n\r\n        <h2\r\n          style={template.styles.section}\r\n          className=\"section-heading\">\r\n          {template.title}\r\n        </h2>\r\n\r\n        <div className='form-fields'>\r\n          <label className='section-instruction'\r\n            style={template.styles.label}\r\n          >\r\n            {template.fields.infoToReleaseGroup.label}{\" \"}\r\n            <Required value={true} />\r\n          </label>\r\n\r\n          {orgId == '1007393' && <i style={{width: '100%', marginTop: 10, marginBottom: 20}}>If you are requesting scanned hospital records please notate in the “Other” section below</i>}          \r\n          <div style={{ padding: \"0 0 10px 0\" }} className=\"check-option-container\">\r\n\r\n            {template.fields.infoToReleaseGroup.entries.slice(0, template.fields.infoToReleaseGroup.entries.length).map(item => (\r\n              <div key={item.value} className='check-option'>\r\n                {/* {console.log(item)} */}\r\n                <Checkbox style={{...template.styles.list, display: (item.key === 'otherItem') ? 'none' : 'flex'}} className=\"custom-form-check checkbox\" key={item.value} name=\"infoToReleaseGroup\" label={item.value} value={item.key}/>\r\n                {\" \"}\r\n\r\n                {\r\n                  item.key == \"otherItem\" &&\r\n                  <>\r\n                    {/* <div>\r\n                      <div style={{}}>                     */}\r\n                    {/* <div style={{ marginTop: 20}}></div> */}\r\n                    <input\r\n                      {...formik.getFieldProps(\"infoToReleaseGroupOther\")}\r\n                      type=\"text\"\r\n                      maxLength={\r\n                        template.fields.infoToReleaseGroupOther.validations.maxLength.value\r\n                      }\r\n                      name=\"infoToReleaseGroupOther\"\r\n                      id=\"infoToReleaseGroupOther\"\r\n                      className=\"form-control\"\r\n                      placeholder={template.fields.infoToReleaseGroupOther.hint}\r\n                    />\r\n                    {formik.touched.infoToReleaseGroupOther &&\r\n                      formik.errors.infoToReleaseGroupOther ? (\r\n                      <span className=\"input-error-text\">\r\n                        {formik.errors.infoToReleaseGroupOther}\r\n                      </span>\r\n                    ) : null}\r\n                    {/* </div>\r\n                  </div> */}\r\n\r\n                  </>\r\n                }\r\n                <Popover placement={popoverLocation}>\r\n                  <Popover.Target>\r\n                    {/* <i className=\"fal fa-info-circle fa_custom info-tip\"></i> */}\r\n                    <img className='info-circle' src={infoCircle}></img>\r\n                  </Popover.Target>\r\n                  <Popover.Content>{item.tooltip}</Popover.Content>\r\n                </Popover>\r\n              </div>\r\n            ))}\r\n            {orgId === '1007278' && <HSSDocField template={template} formik={formik}/>}\r\n          </div>\r\n\r\n\r\n          {/* <div style={{ padding: \"0 0 10px 0\", marginRight: \"10%\", \"marginLeft\": \"23%\" }} className=\"col-auto\">\r\n            {template.fields.infoToReleaseGroup.entries.slice(template.fields.infoToReleaseGroup.entries.length/2, template.fields.infoToReleaseGroup.entries.length).map(item => (\r\n              <div key={item.value}>\r\n                <Checkbox\r\n                  style={template.styles.list}\r\n                  className=\"custom-form-check\"\r\n                  key={item.value}\r\n                  name=\"infoToReleaseGroup\"\r\n                  label={item.value}\r\n                  value={item.key}\r\n                />{\" \"}\r\n                <Popover placement={popoverLocation}>\r\n                  <Popover.Target>\r\n                  <i className=\"fa fa-info-circle fa_custom\"></i>\r\n                  </Popover.Target>\r\n                  <Popover.Content>{item.tooltip}</Popover.Content>\r\n                </Popover>\r\n                {\r\n                  item.key == \"otherItem\" &&\r\n                  <div className=\"form-group col-auto\">\r\n                    <div style={{ marginTop: 20 }}></div>\r\n                    <input\r\n                      {...formik.getFieldProps(\"infoToReleaseGroupOther\")}\r\n                      type=\"text\"\r\n                      maxLength={\r\n                        template.fields.infoToReleaseGroupOther.validations.maxLength.value\r\n                      }\r\n                      name=\"infoToReleaseGroupOther\"\r\n                      id=\"infoToReleaseGroupOther\"\r\n                      className=\"form-control\"\r\n                      placeholder={template.fields.infoToReleaseGroupOther.hint}\r\n                    />\r\n                    {formik.touched.infoToReleaseGroupOther &&\r\n                    formik.errors.infoToReleaseGroupOther ? (\r\n                      <span className=\"input-error-text\">\r\n                        {formik.errors.infoToReleaseGroupOther}\r\n                      </span>\r\n                    ) : null}\r\n                </div>\r\n                }\r\n              </div>\r\n            ))}\r\n            </div> */}\r\n\r\n\r\n\r\n\r\n          <div className=\"date-container\">\r\n\r\n            <div className=\"form-field release-date-field fromDate-field\">\r\n              <label htmlFor=\"releaseFromDate\">\r\n                <span style={template.styles.label}>\r\n                  {template.fields.releaseFromDate.label}\r\n                  <Required value={true} />\r\n                </span>\r\n                <Popover placement={popoverLocation}>\r\n                  <Popover.Target>\r\n                    {/* <i className=\"fa fa-info-circle fa_custom\"></i> */}\r\n                    <img className='info-circle' src={infoCircle}></img>\r\n                  </Popover.Target>\r\n                  <Popover.Content>\r\n                    {template.fields.releaseFromDate.tooltip}\r\n                  </Popover.Content>\r\n                </Popover>\r\n\r\n              </label>\r\n              <div>\r\n                <div className='date-input'>\r\n                  <DatePicker\r\n                    locale={template.locale}\r\n                    autoComplete=\"off\"\r\n                    {...formik.getFieldProps(\"releaseFromDate\")}\r\n                    dateFormat=\"MM/dd/yyyy\"\r\n                    id='from-date-field'\r\n                    customInput={<MaskedInput\r\n                      mask={[/\\d/, /\\d/, '/', /\\d/, /\\d/, '/', /\\d/, /\\d/, /\\d/, /\\d/]}\r\n                    />}\r\n                    selected={formik.values.releaseFromDate}\r\n                    className={`${inputClasses(\r\n                      formik.touched.releaseFromDate &&\r\n                      formik.errors.releaseFromDate\r\n                    )} date-field`}\r\n                    name=\"releaseFromDate\"\r\n                    onChange={date => {\r\n                      formik.setFieldTouched(\"releaseFromDate\", true, true)\r\n                      formik.setFieldValue(\"releaseFromDate\", date)\r\n                    }}\r\n                    onSelect={date => {\r\n                      formik.setFieldTouched(\"releaseFromDate\", true, true)\r\n                      formik.setFieldValue(\"releaseFromDate\", date)\r\n                    }}\r\n                    placeholderText={template.fields.releaseFromDate.hint}\r\n                  />\r\n                  <img className='calendar-icon from-calendar-icon' src={calendar} onClick={(e)=>{document.getElementById('from-date-field').focus()}}></img>\r\n                </div>\r\n                {formik.touched.releaseFromDate &&\r\n                  formik.errors.releaseFromDate && (\r\n                    <span className=\"input-error-text\">\r\n                      {formik.errors.releaseFromDate}\r\n                    </span>\r\n                  )}\r\n              </div>\r\n            </div>\r\n\r\n            <div className=\"form-field release-date-field toDate-field\">\r\n              <label htmlFor=\"releaseToDate\">\r\n                <span style={template.styles.label}>\r\n                  {template.fields.releaseToDate.label}\r\n                  <Required value={true} />\r\n                </span>\r\n                <Popover placement={popoverLocation}>\r\n                  <Popover.Target>\r\n                    {/* <i className=\"fa fa-info-circle fa_custom\"></i> */}\r\n                    <img className='info-circle' src={infoCircle}></img>\r\n                  </Popover.Target>\r\n                  <Popover.Content>\r\n                    {template.fields.releaseToDate.tooltip}\r\n                  </Popover.Content>\r\n                </Popover>\r\n\r\n              </label>\r\n              <div>\r\n                <div className='date-input'>\r\n                  <DatePicker\r\n                    locale={template.locale}\r\n                    autoComplete=\"off\"\r\n                    id='to-date-field'\r\n                    {...formik.getFieldProps(\"releaseToDate\")}\r\n                    dateFormat=\"MM/dd/yyyy\"\r\n                    customInput={<MaskedInput\r\n                      mask={[/\\d/, /\\d/, '/', /\\d/, /\\d/, '/', /\\d/, /\\d/, /\\d/, /\\d/]}\r\n                    />}\r\n                    selected={formik.values.releaseToDate}\r\n                    className={`${inputClasses(\r\n                      formik.touched.releaseToDate && formik.errors.releaseToDate\r\n                    )} date-field`}\r\n                    name=\"releaseToDate\"\r\n                    onChange={date => { formik.setFieldTouched(\"releaseToDate\", true, true); formik.setFieldValue(\"releaseToDate\", date) }}\r\n                    onSelect={date => { formik.setFieldTouched(\"releaseToDate\", true, true); formik.setFieldValue(\"releaseToDate\", date) }}\r\n                    placeholderText={template.fields.releaseToDate.hint}\r\n                  />\r\n                  <img className='calendar-icon to-calendar-icon' src={calendar} onClick={(e)=>{document.getElementById('to-date-field').focus()}}></img>\r\n                </div>\r\n                {formik.touched.releaseToDate && formik.errors.releaseToDate && (\r\n                  <span className=\"input-error-text\">\r\n                    {formik.errors.releaseToDate}\r\n                  </span>\r\n                )}\r\n              </div>\r\n            </div>\r\n          </div>\r\n\r\n\r\n          {(template.fields.infoToReleaseAbstracts)\r\n            ?\r\n            <div id='abstract-query'>\r\n              <p style={template.styles.label}>For the following type of records, I am requesting only a Medical Record Abstract</p>\r\n              <div id='abstract-query-checkOptions'>\r\n                {template.fields.infoToReleaseAbstracts.entries.map((field) => {\r\n                  return <Checkbox style={template.styles.list} className=\"custom-form-check checkbox\" key={field.value} name=\"infoToReleaseGroup\" label={field.value} value={field.key} />\r\n                })}\r\n              </div>\r\n            </div>\r\n            :\r\n            <></>\r\n          }\r\n\r\n\r\n\r\n          <p style={{ ...template.styles.label, marginBottom: 30 }}>{template.fields.certBox.disclaimerText}</p>\r\n          {\r\n            template.fields.certBox.active &&\r\n            template.fields.certBox.entries.map(\r\n              x => {\r\n                return <div id='certification-check-option' className='check-option' key={x.value} style={{display: orgId == '1007343' ? 'none' : 'block'}}>\r\n\r\n                  <input\r\n                    type=\"checkbox\"\r\n                    className='checkbox'\r\n                    checked={formik.getFieldProps('certBox').value}\r\n                    onChange={() => {\r\n                      formik.setFieldTouched(\"certBox\", true, true);\r\n                      if (formik.getFieldProps('certBox').value === true) {\r\n                        formik.setFieldValue('certBox', false)\r\n                      } else {\r\n                        formik.setFieldValue('certBox', true)\r\n                      }\r\n\r\n                    }} />\r\n                  <label htmlFor=\"certBox\" style={template.styles.paragraph}>{x.value}</label>\r\n\r\n                  {x.tooltip != \"\" && <Popover placement={popoverLocation}>\r\n                    <Popover.Target>\r\n                      <i className=\"fa fa-info-circle fa_custom\"></i>\r\n                    </Popover.Target>\r\n                    <Popover.Content>\r\n                      {template.fields.certBox.tooltip}\r\n                    </Popover.Content>\r\n                  </Popover>\r\n                  }\r\n                  {orgId === '1007201' && <p style={{position: 'absolute'}}>* A certification fee may apply</p>}\r\n\r\n                </div>\r\n              }\r\n            )\r\n          }\r\n\r\n          <p style={{ ...template.styles.paragraph, marginTop: 20 }}>{template.fields.certBox.noteText}</p>\r\n          \r\n          {orgId === baptistId && <BaptistFacilityInfo/>}\r\n\r\n\r\n\r\n\r\n\r\n        </div>\r\n      </div>\r\n      :\r\n      <></>\r\n  );\r\n};\r\n\r\nexport default InformationToRelease;\r\n","import React from \"react\";\r\nimport Markdown from 'markdown-to-jsx';\r\nimport Checkbox from \"../../../components/Checkbox\";\r\nimport Popover from \"../../../../formik/refactorOut/components/Popper/Popover\";\r\nimport { popoverLocation } from \"../../../../config/Configuration\";\r\n\r\nconst DisclosureOfSensitiveInformation = ({\r\n  formik,\r\n  inputClasses,\r\n  template,\r\n  config\r\n}) => {\r\n  const seperateOptions = item => item.value === 91 ? { marginTop: \"20px\" } : { marginTop: \"0px\" }\r\n\r\n  return (\r\n    config.page.form.sections.disclosureOfSensitiveInformation.active ?\r\n      <div>\r\n        <div className=\"row\">\r\n          <div className=\"col\">\r\n            <h2 style={template.styles.section} className=\"section-heading\">\r\n              {template.title}\r\n            </h2>\r\n          </div>\r\n        </div>\r\n        <div className=\"container\">\r\n          <div className=\"row\">\r\n            <div style={template.styles.disclaimer} className=\"col\">\r\n              <Markdown>{template.disclaimer}</Markdown>\r\n            </div>\r\n          </div>\r\n          <div className=\"row\">\r\n            <div className=\"col\">\r\n              <div style={{ marginBottom: 10 }}></div>\r\n              <div style={{ padding: \"0 0 10px 0\", marginLeft: \"2%\" }}>\r\n                {template.fields.sensitiveInfo.entries.map(item => (\r\n                  <div style={seperateOptions(item)} key={item.value} >\r\n                    <Checkbox\r\n                      style={template.styles.list}\r\n                      className=\"custom-form-check\"\r\n                      key={item.value}\r\n                      name=\"sensitiveInfo\"\r\n                      label={item.label}\r\n                      value={item.value}\r\n                    />{\" \"}\r\n                    <Popover placement={popoverLocation}>\r\n                      <Popover.Target>\r\n                        <i className=\"fa fa-info-circle fa_custom\"></i>\r\n                      </Popover.Target>\r\n                      <Popover.Content>{item.tooltip}</Popover.Content>\r\n                    </Popover>\r\n                  </div>\r\n                ))}\r\n              </div>\r\n            </div>\r\n          </div>\r\n        </div>\r\n      </div>\r\n      :\r\n      <></>\r\n  );\r\n};\r\n\r\nexport default DisclosureOfSensitiveInformation;\r\n","import React from \"react\";\r\nimport { Field } from \"formik\";\r\nimport RadioButtonGroup from \"../../../components/RadioButtonGroup\";\r\nimport RadioButton from \"../../../components/RadioButton\";\r\nimport Required from \"../../../components/Required\";\r\nimport Popover from \"../../../../formik/refactorOut/components/Popper/Popover\";\r\nimport { popoverLocation } from \"../../../../config/Configuration\";\r\n\r\nconst PurposeOfDisclosure = ({ formik, inputClasses, template, config }) => {\r\n  return (\r\n    config.page.form.sections.purposeOfDisclosureSection.active ?\r\n      <div>\r\n        <div className=\"row\">\r\n          <div className=\"col\">\r\n            <h2 style={template.styles.section} className=\"section-heading\">\r\n              {template.title}\r\n            </h2>\r\n          </div>\r\n        </div>\r\n        <div className=\"container\">\r\n          <div className=\"row\">\r\n            <div className=\"col\">\r\n              <label>\r\n                <span style={template.styles.label}>\r\n                  {template.fields.disclosurePurposeGroup.label}\r\n                </span>{\" \"}\r\n                <Required\r\n                  value={\r\n                    template.fields.disclosurePurposeGroup.validations.required.value\r\n                  }\r\n                />\r\n              </label>\r\n            </div>\r\n          </div>\r\n          <div className=\"row\">\r\n            <div className=\"col\">\r\n              <div className=\"form-group\">\r\n                <RadioButtonGroup\r\n                  id=\"disclosurePurposeGroup\"\r\n                  value={formik.values.disclosurePurposeGroup}\r\n                  error={formik.errors.disclosurePurposeGroup}\r\n                  touched={formik.touched.disclosurePurposeGroup}\r\n                  onChange={formik.setFieldValue}\r\n                  onBlur={formik.setFieldTouched}\r\n                >\r\n                  {template.fields.disclosurePurposeGroup.entries.map(option => (\r\n                    <span\r\n                      style={template.styles.list}\r\n                      key={option.key}\r\n                      className=\"form-check\"\r\n                    >\r\n                      <Field\r\n                        key={option.key}\r\n                        component={RadioButton}\r\n                        name=\"disclosurePurposeGroup\"\r\n                        id={option.key}\r\n                        checked={option.checked}\r\n                        value={option.key}\r\n                        label={option.value}\r\n                      />\r\n                      <Popover placement={popoverLocation}>\r\n                        <Popover.Target>\r\n                          <i className=\"fa fa-info-circle fa_custom\"></i>\r\n                        </Popover.Target>\r\n                        <Popover.Content>{option.tooltip}</Popover.Content>\r\n                      </Popover>\r\n                    </span>\r\n                  ))}\r\n                </RadioButtonGroup>\r\n              </div>\r\n              <div style={{ marginLeft: \"2%\" }} className=\"form-group col-4\">\r\n                <input\r\n                  {...formik.getFieldProps(\"disclosurePurposeGroupOther\")}\r\n                  type=\"text\"\r\n                  maxLength={template.fields.disclosurePurposeGroupOther.validations.maxLength.value}\r\n                  name=\"disclosurePurposeGroupOther\"\r\n                  id=\"disclosurePurposeGroupOther\"\r\n                  className=\"form-control\"\r\n                  placeholder={template.fields.disclosurePurposeGroupOther.hint}\r\n                />\r\n                {formik.touched.disclosurePurposeGroup &&\r\n                  formik.errors.disclosurePurposeGroup ? (\r\n                  <span className=\"input-error-text\">\r\n                    {formik.errors.disclosurePurposeGroup}\r\n                  </span>\r\n                ) : null}\r\n                {formik.touched.disclosurePurposeGroupOther &&\r\n                  formik.errors.disclosurePurposeGroupOther ? (\r\n                  <span className=\"input-error-text\">\r\n                    {formik.errors.disclosurePurposeGroupOther}\r\n                  </span>\r\n                ) : null}\r\n              </div>\r\n              <div style={{ marginTop: 20 }}></div>\r\n            </div>\r\n          </div>\r\n        </div>\r\n      </div>\r\n      :\r\n      <></>\r\n  );\r\n};\r\n\r\nexport default PurposeOfDisclosure;\r\n","import React, { useEffect } from \"react\";\r\nimport { Field } from \"formik\";\r\nimport Required from \"../../../components/Required\";\r\nimport RadioButtonGroup from \"../../../components/RadioButtonGroup\";\r\nimport RadioButton from \"../../../components/RadioButton\";\r\nimport Popover from \"../../../../formik/refactorOut/components/Popper/Popover\";\r\nimport { popoverLocation } from '../../../../config/Configuration'\r\n\r\nconst DeliveryMethod = ({ formik, inputClasses, template, config }) => {\r\n  useEffect(() => {\r\n    console.log(formik.values)\r\n  }, [formik.values])\r\n  \r\n  return (\r\n    config.page.form.sections.deliveryMethodSection.active ?\r\n      <div id='deliveryMethodSection' className='form-section'>\r\n\r\n        <h2\r\n          style={template.styles.section}\r\n          className=\"section-heading\">\r\n          {template.title}\r\n        </h2>\r\n\r\n\r\n\r\n        <div className='form-fields' id='delivery-method-form-field'>\r\n\r\n          <label style={{marginBottom: 22}}>\r\n            <span style={template.styles.label}>{template.fields.deliveryMethodGroup.label}</span>{\" \"}\r\n            <Required value={true} />\r\n          </label>\r\n\r\n\r\n\r\n          {template.fields.deliveryMethodGroup.active && <div className=\"form-group\">\r\n            <RadioButtonGroup\r\n              id=\"deliveryMethodGroup\"\r\n              value={formik.values.deliveryMethodGroup}\r\n              error={formik.errors.deliveryMethodGroup}\r\n              touched={formik.touched.deliveryMethodGroup}\r\n              onChange={formik.setFieldValue}\r\n              onBlur={formik.setFieldTouched}\r\n            >\r\n              {template.fields.deliveryMethodGroup.entries.map(option => (\r\n                <span style={template.styles.list} key={option.key} className=\"form-check\">\r\n                  <Field\r\n                    key={option.key}\r\n                    component={RadioButton}\r\n                    // name=\"deliveryMethodGroup\"\r\n                    name=\"deliveryMethodGroup\"\r\n                    id={option.key}\r\n                    checked={option.checked}\r\n                    value={option.key}\r\n                    label={option.value}\r\n                    config={config}\r\n                  />\r\n                  {/* <Popover placement={popoverLocation}>\r\n                    <Popover.Target>\r\n                      <i className=\"fa fa-info-circle fa_custom\"></i>\r\n                    </Popover.Target>\r\n                    <Popover.Content>{option.tooltip}</Popover.Content>\r\n                  </Popover> */}\r\n                </span>\r\n              ))}\r\n            </RadioButtonGroup>\r\n            {/* not sure how to render errors dependent on other fields - declaritively here fixes logic - can it be done imperatively with yup? */}\r\n            {formik.touched.deliveryMethodGroup &&\r\n              formik.errors.deliveryMethodGroup ? (\r\n              <span className=\"input-error-text\">\r\n                {formik.errors.deliveryMethodGroup}\r\n              </span>\r\n            ) : null}\r\n          </div>}\r\n\r\n        </div>\r\n      </div>\r\n      :\r\n      <></>\r\n  );\r\n};\r\n\r\nexport default DeliveryMethod;\r\n\r\n\r\n{/* <div style={{display:'inline'}}>Delivery Method</div>\r\n                  <div>\r\n                    <input type=\"radio\" name='test' id='Email' value='Email' onChange={()=>{formik.setFieldValue('deliveryMethodGroup', '2'); console.log(formik.values)}}/>\r\n                    <label htmlFor=\"Email\">Email</label>\r\n                  </div>\r\n                  <div>\r\n                    <input type=\"radio\" name='test' id='CD/DVD' value='CD/DVD' onChange={()=>{formik.setFieldValue('deliveryMethodGroup', '7'); console.log(formik.values)}}/>\r\n                    <label htmlFor=\"CD/DVD\">CD/DVD</label>\r\n                  </div>\r\n                  <div>\r\n                    <input type=\"radio\" name='test' id='Mail' value='Mail' onChange={()=>{formik.setFieldValue('deliveryMethodGroup', '5'); console.log(formik.values)}}/>\r\n                    <label htmlFor=\"Mail\">Mail</label>\r\n                  </div> */}","import React from \"react\";\r\nimport Required from \"../../../components/Required\";\r\nimport Markdown from \"markdown-to-jsx\";\r\nimport { Field } from \"formik\";\r\nimport RadioButtonGroup from \"../../../components/RadioButtonGroup\";\r\nimport RadioButton from \"../../../components/RadioButton\";\r\n\r\nconst DiscloseTo = ({ formik, inputClasses, template, config }) => {\r\n  const areFieldsDisabled = formik.values.discloseToEntityGroup === \"namedPersonEntity\" ? true : false;\r\n  return (\r\n    config.page.form.sections.discloseToSection.active ?\r\n      <div>\r\n        <div className=\"row\">\r\n          <div className=\"col\">\r\n            <h2 style={template.styles.section} className=\"section-heading\">\r\n              {template.title}\r\n            </h2>\r\n          </div>\r\n        </div>\r\n        <div className=\"container\">\r\n          <div className=\"row\">\r\n            <div className=\"col\">\r\n              <label>\r\n                <span style={template.styles.label}>\r\n                  {template.fields.discloseToEntityGroup.label}\r\n                </span>{\" \"}\r\n                <Required\r\n                  value={\r\n                    template.fields.discloseToEntityGroup.validations.required.value\r\n                  }\r\n                />\r\n              </label>\r\n            </div>\r\n          </div>\r\n\r\n          <div className=\"row\">\r\n            <div className=\"col\">\r\n              {/* TODO; might need to be separate single radios so text can be inserted between */}\r\n              <RadioButtonGroup\r\n                id=\"discloseToEntityGroup\"\r\n                value={formik.values.discloseToEntityGroup}\r\n                error={formik.errors.discloseToEntityGroup}\r\n                touched={formik.touched.discloseToEntityGroup}\r\n                onChange={formik.setFieldValue}\r\n                onBlur={formik.setFieldTouched}\r\n              >\r\n                {template.fields.discloseToEntityGroup.entries.map(option => (\r\n                  <span\r\n                    style={template.styles.list}\r\n                    key={option.key}\r\n                    className=\"form-check\"\r\n                  >\r\n                    <Field\r\n                      key={option.key}\r\n                      component={RadioButton}\r\n                      name=\"discloseToEntityGroup\"\r\n                      id={option.key}\r\n                      checked={option.checked}\r\n                      value={option.key}\r\n                      label={option.value}\r\n                    />\r\n                  </span>\r\n                ))}\r\n              </RadioButtonGroup>\r\n            </div>\r\n          </div>\r\n          <div className=\"row\">\r\n            <div className=\"col\">\r\n              {formik.touched.discloseToEntityGroup &&\r\n                formik.errors.discloseToEntityGroup ? (\r\n                <span className=\"input-error-text\">\r\n                  {formik.errors.discloseToEntityGroup}\r\n                </span>\r\n              ) : null}\r\n            </div>\r\n          </div>\r\n          <div className=\"row\">\r\n            <div className=\"col\">\r\n              <div style={template.styles.disclaimer}>\r\n                <Markdown>{template.disclaimer}</Markdown>\r\n              </div>\r\n            </div>\r\n          </div>\r\n\r\n          {(areFieldsDisabled) && (\r\n            <div>\r\n              <div className=\"row\">\r\n                <div className=\"col\">\r\n                  <div className=\"form-group\">\r\n                    <label htmlFor=\"discloseToName\">\r\n                      {\" \"}\r\n                      <span style={template.styles.label}>\r\n                        {template.fields.discloseToName.label}\r\n                      </span>{\" \"}\r\n                      <Required\r\n                        value={\r\n                          template.fields.discloseToName.validations.required.value\r\n                        }\r\n                      />\r\n                    </label>\r\n                    <input\r\n                      {...formik.getFieldProps(\"discloseToName\")}\r\n                      type=\"text\"\r\n                      name=\"discloseToName\"\r\n                      className={inputClasses(\r\n                        formik.touched.discloseToName &&\r\n                        formik.errors.discloseToName\r\n                      )}\r\n                      placeholder={template.fields.discloseToName.hint}\r\n                    />\r\n                    {formik.touched.discloseToName &&\r\n                      formik.errors.discloseToName && (\r\n                        <span className=\"input-error-text\">\r\n                          {formik.errors.discloseToName}\r\n                        </span>\r\n                      )}\r\n                  </div>\r\n                </div>\r\n              </div>\r\n              <div className=\"row\">\r\n                <div className=\"col\">\r\n                  <div className=\"form-group\">\r\n                    <label htmlFor=\"discloseToPhone\">\r\n                      {\" \"}\r\n                      <span style={template.styles.label}>\r\n                        {template.fields.discloseToPhone.label}{\" \"}\r\n                      </span>\r\n                      <Required\r\n                        value={template.fields.discloseToPhone.validations.required}\r\n                      />\r\n                    </label>\r\n                    <input\r\n                      {...formik.getFieldProps(\"discloseToPhone\")}\r\n                      type=\"text\"\r\n                      name=\"discloseToPhone\"\r\n                      className={inputClasses(\r\n                        formik.touched.discloseToPhone &&\r\n                        formik.errors.discloseToPhone\r\n                      )}\r\n                      placeholder={template.fields.discloseToPhone.hint}\r\n                    />\r\n                    {formik.touched.discloseToPhone &&\r\n                      formik.errors.discloseToPhone && (\r\n                        <span className=\"input-error-text\">\r\n                          {formik.errors.discloseToPhone}\r\n                        </span>\r\n                      )}\r\n                  </div>\r\n                </div>\r\n                <div className=\"col\">\r\n                  <div className=\"form-group\">\r\n                    <label htmlFor=\"discloseToFax\">\r\n                      <span style={template.styles.label}>\r\n                        {template.fields.discloseToFax.label}\r\n                      </span>{\" \"}\r\n                    </label>\r\n                    <input\r\n                      {...formik.getFieldProps(\"discloseToFax\")}\r\n                      type=\"text\"\r\n                      name=\"discloseToFax\"\r\n                      className={inputClasses(\r\n                        formik.touched.discloseToFax && formik.errors.discloseToFax\r\n                      )}\r\n                      placeholder={template.fields.discloseToFax.hint}\r\n                    />\r\n                    {formik.touched.discloseToFax &&\r\n                      formik.errors.discloseToFax && (\r\n                        <span className=\"input-error-text\">\r\n                          {formik.errors.discloseToFax}\r\n                        </span>\r\n                      )}\r\n                  </div>\r\n                </div>\r\n              </div>\r\n              <div className=\"row\">\r\n                <div className=\"col\">\r\n                  <div className=\"form-group\">\r\n                    <label htmlFor=\"discloseToAddressLine1\">\r\n                      <span style={template.styles.label}>\r\n                        {template.fields.discloseToAddressLine1.label}\r\n                      </span>{\" \"}\r\n                      <Required\r\n                        value={\r\n                          template.fields.discloseToAddressLine1.validations\r\n                            .required\r\n                        }\r\n                      />\r\n                    </label>\r\n                    <input\r\n                      {...formik.getFieldProps(\"discloseToAddressLine1\")}\r\n                      type=\"text\"\r\n                      maxLength={\r\n                        template.fields.discloseToAddressLine1.validations.maxLength\r\n                          .value\r\n                      }\r\n                      name=\"discloseToAddressLine1\"\r\n                      id=\"discloseToAddressLine1\"\r\n                      className={inputClasses(\r\n                        formik.touched.discloseToAddressLine1 &&\r\n                        formik.errors.discloseToAddressLine1\r\n                      )}\r\n                      placeholder={template.fields.discloseToAddressLine1.hint}\r\n                    />\r\n                    {formik.touched.discloseToAddressLine1 &&\r\n                      formik.errors.discloseToAddressLine1 && (\r\n                        <span className=\"input-error-text\">\r\n                          {formik.errors.discloseToAddressLine1}\r\n                        </span>\r\n                      )}\r\n                  </div>\r\n                </div>\r\n              </div>\r\n              <div className=\"row\">\r\n                <div className=\"col\">\r\n                  <div className=\"form-group\">\r\n                    {template.fields.discloseToAddressLine2.label && (\r\n                      <label htmlFor=\"discloseToAddressLine2\">\r\n                        <span style={template.styles.label}>\r\n                          {template.fields.discloseToAddressLine2.label}\r\n                        </span>{\" \"}\r\n                        <Required\r\n                          value={\r\n                            template.fields.discloseToAddressLine2.validations\r\n                              .required.value\r\n                          }\r\n                        />\r\n                      </label>\r\n                    )}\r\n                    <input\r\n                      {...formik.getFieldProps(\"discloseToAddressLine2\")}\r\n                      type=\"text\"\r\n                      maxLength={\r\n                        template.fields.discloseToAddressLine2.validations.maxLength\r\n                          .value\r\n                      }\r\n                      name=\"discloseToAddressLine2\"\r\n                      id=\"discloseToAddressLine2\"\r\n                      className={inputClasses(\r\n                        formik.touched.discloseToAddressLine2 &&\r\n                        formik.errors.discloseToAddressLine2\r\n                      )}\r\n                      placeholder={template.fields.discloseToAddressLine2.hint}\r\n                    />\r\n                    {formik.touched.discloseToAddressLine2 &&\r\n                      formik.errors.discloseToAddressLine2 && (\r\n                        <span className=\"input-error-text\">\r\n                          {formik.errors.discloseToAddressLine2}\r\n                        </span>\r\n                      )}\r\n                  </div>\r\n                </div>\r\n              </div>\r\n              <div className=\"row\">\r\n                <div className=\"col\">\r\n                  <div className=\"form-group\">\r\n                    {template.fields.discloseToCity.label && (\r\n                      <label htmlFor=\"discloseToCity\">\r\n                        <span style={template.styles.label}>\r\n                          {template.fields.discloseToCity.label}\r\n                        </span>{\" \"}\r\n                        <Required\r\n                          value={\r\n                            template.fields.discloseToCity.validations.required\r\n                              .value\r\n                          }\r\n                        />\r\n                      </label>\r\n                    )}\r\n                    <input\r\n                      {...formik.getFieldProps(\"discloseToCity\")}\r\n                      type=\"text\"\r\n                      name=\"discloseToCity\"\r\n                      className={inputClasses(\r\n                        formik.touched.discloseToPhone && formik.errors.discloseCity\r\n                      )}\r\n                      maxLength={\r\n                        template.fields.discloseToCity.validations.maxLength.value\r\n                      }\r\n                      placeholder={template.fields.discloseToCity.hint}\r\n                    />\r\n                    {formik.touched.discloseToCity &&\r\n                      formik.errors.discloseToCity && (\r\n                        <span className=\"input-error-text\">\r\n                          {formik.errors.discloseToCity}\r\n                        </span>\r\n                      )}\r\n                  </div>\r\n                </div>\r\n                <div className=\"col-sm-3\">\r\n                  <div className=\"form-group\">\r\n                    {template.fields.discloseToState.label && (\r\n                      <label htmlFor=\"discloseToState\">\r\n                        <span style={template.styles.label}>\r\n                          {template.fields.discloseToState.label}\r\n                        </span>{\" \"}\r\n                        <Required\r\n                          value={\r\n                            template.fields.discloseToState.validations.required\r\n                              .value\r\n                          }\r\n                        />\r\n                      </label>\r\n                    )}\r\n                    <input\r\n                      {...formik.getFieldProps(\"discloseToState\")}\r\n                      type=\"text\"\r\n                      name=\"discloseToState\"\r\n                      className={inputClasses(\r\n                        formik.touched.discloseToPhone &&\r\n                        formik.errors.discloseState\r\n                      )}\r\n                      maxLength={\r\n                        template.fields.discloseToState.validations.maxLength.value\r\n                      }\r\n                      placeholder={template.fields.discloseToState.hint}\r\n                    />\r\n                    {formik.touched.discloseToState &&\r\n                      formik.errors.discloseToState && (\r\n                        <span className=\"input-error-text\">\r\n                          {formik.errors.discloseToState}\r\n                        </span>\r\n                      )}\r\n                  </div>\r\n                </div>\r\n                <div className=\"col-sm-2\">\r\n                  <div className=\"form-group\">\r\n                    {template.fields.discloseToZip.label && (\r\n                      <label htmlFor=\"discloseToZip\">\r\n                        <span style={template.styles.label}>\r\n                          {template.fields.discloseToZip.label}\r\n                        </span>{\" \"}\r\n                        <Required\r\n                          value={\r\n                            template.fields.discloseToZip.validations.required.value\r\n                          }\r\n                        />\r\n                      </label>\r\n                    )}\r\n                    <input\r\n                      {...formik.getFieldProps(\"discloseToZip\")}\r\n                      type=\"text\"\r\n                      name=\"discloseToZip\"\r\n                      className={inputClasses(\r\n                        formik.touched.discloseToZip && formik.errors.discloseToZip\r\n                      )}\r\n                      placeholder={template.fields.discloseToZip.hint}\r\n                    />\r\n                    {formik.touched.discloseToZip &&\r\n                      formik.errors.discloseToZip && (\r\n                        <span className=\"input-error-text\">\r\n                          {formik.errors.discloseToZip}\r\n                        </span>\r\n                      )}\r\n                  </div>\r\n                </div>\r\n              </div>\r\n            </div>\r\n          )}\r\n        </div>\r\n      </div>\r\n      :\r\n      <></>\r\n  );\r\n};\r\n\r\nexport default DiscloseTo;\r\n","import React from \"react\";\r\nimport Popover from \"../../../../formik/refactorOut/components/Popper/Popover\";\r\nimport { popoverLocation } from '../../../../config/Configuration'\r\nimport Required from \"../../../components/Required\";\r\nimport Markdown from \"markdown-to-jsx\";\r\nimport PBV_icon from '../../../assets/pbv.png'\r\n\r\nconst ReleaseDatesSection = ({ formik, inputClasses, template, config, supportingDocsSection, dirty}) => {\r\n\r\n  return (\r\n    config.page.form.sections.releaseDatesSection.active ?\r\n      <div id='releaseDatesSection'>\r\n        <div id='disclaimer-and-submitButton'>\r\n          <div id='release-disclaimer-container'>\r\n            {/* <label style={template.styles.label}>\r\n              {supportingDocsSection.fields.disclaimers.header} <Required value={true} />\r\n            </label> */}\r\n            <Markdown className=\"disclaimer-text\" style={template.styles.label}>\r\n              {supportingDocsSection.fields.disclaimers.emailNotice}\r\n            </Markdown>\r\n            <br/> <br/>\r\n            <Markdown className=\"disclaimer-text\">\r\n              {supportingDocsSection.fields.disclaimers.requestNotice}\r\n            </Markdown>\r\n          </div>\r\n\r\n\r\n\r\n        <div id='date-and-submit-container'>\r\n          <div className=\"form-field release-date-field\">\r\n            <label htmlFor=\"releaseFromDate\">\r\n              <span style={template.styles.label}>{template.fields.todaysDate.label}</span>{\" \"}\r\n            </label>\r\n            <div>\r\n              <div>\r\n                <input\r\n                  disabled\r\n                  {...formik.getFieldProps(\"todaysDate\")}\r\n                  name=\"todaysDate\"\r\n                  placeholder={template.fields.todaysDate.hint}\r\n                  className=\"form-control\"\r\n                />\r\n              </div>\r\n            </div>\r\n          </div>\r\n          <div id='submit-button-section' className='form-section'>\r\n            <button disabled={!dirty} style={{...config.page.form.styles.buttons.act, opacity: !dirty === true && .5}} id='submit-button' type=\"submit\" > {config.page.form.components.submitButton.text} </button>\r\n          </div>\r\n        </div>\r\n        </div>\r\n        <img src={PBV_icon} alt=\"Powered by Verisma\" className='pbv-icon'/>\r\n      </div>\r\n      :\r\n      <></>\r\n  );\r\n};\r\n\r\nexport default ReleaseDatesSection;\r\n","import React from 'react';\r\nimport { ErrorMessage } from \"formik\";\r\nimport Required from \"../../../components/Required\";\r\n\r\n\r\nexport const CaseNumberSection = ({formik, section, styles, inputClasses}) => {\r\n\r\n    \r\n    return(\r\n        <div id='caseNumberSection' className=\"form-section\">    \r\n                <div style={{display: \"flex\"}} id='caseNumber-form-field' className=\"form-field\">\r\n                    <label style={{\"whiteSpace\": \"nowrap\", marginRight:\"10px\"}} htmlFor=\"caseNumber\" id='caseNumber-label'>\r\n                        <span style={styles.label}>\r\n                            {section.fields.caseNumber.label}\r\n                            {\" \"}\r\n                            <Required\r\n                                value={\r\n                                    section.fields.caseNumber.validations\r\n                                    .required.value\r\n                                }\r\n                            />\r\n                        </span>{\" \"}\r\n                    \r\n                    </label>\r\n                        {/* <div className=\"col-8\" id='caseNumber-textbox'> */}\r\n                    <input\r\n                        {...formik.getFieldProps(\"caseNumber\")}\r\n                        maxLength={\r\n                            section.fields.caseNumber.validations.maxLength.value\r\n                        }\r\n                        type=\"text\"\r\n                        name=\"caseNumber\"\r\n                        id='caseNumber-textbox'\r\n                        style={styles.hint}\r\n                        className={inputClasses(\r\n                            formik.touched.caseNumber &&\r\n                            formik.errors.caseNumber\r\n                        )}\r\n                        placeholder={section.fields.caseNumber.hint}\r\n                    />\r\n                            \r\n                        {/* </div> */}\r\n                </div>\r\n                    \r\n                    <div style={{\"marginLeft\": \"40%\"}} className=\"row\">\r\n                        <ErrorMessage name=\"caseNumber\">\r\n                            {msg => <div className=\"input-error-text text-center\">{msg}</div>}\r\n                        </ErrorMessage>\r\n                    </div>\r\n          \r\n    </div>)\r\n}","import React, { useState } from \"react\";\r\nimport { ErrorMessage } from \"formik\";\r\nimport Markdown from \"markdown-to-jsx\";\r\nimport { Field } from \"formik\";\r\nimport Required from \"../../../components/Required\";\r\n\r\nexport const SupportingDocsSection = ({ formik, template, fileSubmissionAction, fileDeletionAction, config }) => {\r\n  const [error, giveError] = useState(false);\r\n\r\n  return (\r\n    config.page.form.sections.supportingDocsSection.active ?\r\n      <div id=\"supportingDocSection\" className=\"form-section\">\r\n        <h2 style={template.styles.section} className=\"section-heading\">\r\n          {\"Supporting Documents\"}\r\n        </h2>\r\n\r\n        <div className=\"form-fields\">\r\n          {/* <label style={template.styles.label}>\r\n            {template.section.fields.disclaimers.header} <Required value={true} />\r\n          </label> */}\r\n\r\n          <div style={template.styles.disclaimer}>\r\n            {/* <Markdown>{template.section.disclaimer.body}</Markdown> */}\r\n            {/* <p className=\"disclaimer-text\">\r\n              {template.section.fields.disclaimers.requestNotice}\r\n            </p>\r\n            <p className=\"disclaimer-text\">\r\n              {template.section.fields.disclaimers.emailNotice}\r\n            </p> */}\r\n            <p\r\n              className=\"disclaimer-text\"\r\n              style={{ fontWeight: 700, marginBottom: 3.2 }}\r\n            >\r\n              {template.section.fields.disclaimers.authHeader}\r\n            </p>\r\n            <Markdown>{template.section.fields.disclaimers.authNotice}</Markdown>\r\n          </div>\r\n\r\n          <label>\r\n            <span style={template.styles.label}>\r\n              {template.section.fields.supportingDoc.label}\r\n            </span>{\" \"}\r\n            <Required value={true} />\r\n          </label>\r\n          <br />\r\n\r\n          <div style={{ cursor: \"pointer\", zIndex: 0 }} className=\"input-group mb-3\">\r\n            <div className=\"custom-file\">\r\n              <input\r\n                id=\"supportingDoc\"\r\n                name=\"supportingDoc\"\r\n                type=\"file\"\r\n                onChange={(event) => {\r\n                  if (\r\n                    event.currentTarget.files[0] &&\r\n                    event.currentTarget.files[0].size < 15000000\r\n                  ) {\r\n                    giveError(false);\r\n                    if (!formik.getFieldProps(\"supportingDoc\").value) {\r\n                      formik.setFieldTouched(\"supportingDoc\", true, true);\r\n                      formik.setFieldValue(\"supportingDoc\", [\r\n                        event.currentTarget.files[0],\r\n                      ]);\r\n                      fileSubmissionAction(event.currentTarget.files[0]);\r\n                    } else {\r\n                      formik.setFieldTouched(\"supportingDoc\", true, true);\r\n                      formik.setFieldValue(\r\n                        \"supportingDoc\",\r\n                        formik\r\n                          .getFieldProps(\"supportingDoc\")\r\n                          .value.concat(event.currentTarget.files[0])\r\n                      );\r\n                      fileSubmissionAction(event.currentTarget.files[0]);\r\n                    }\r\n                  } else {\r\n                    // console.log(formik);\r\n                    giveError(template.section.fields.supportingDoc.validations.fileSize.message);\r\n                  }\r\n                }}\r\n              />\r\n              <label\r\n                className=\"custom-file-label\"\r\n                style={template.styles.hint}\r\n                htmlFor=\"supportingDoc\"\r\n              >\r\n                {template.section.fields.supportingDoc.hint}\r\n              </label>\r\n            </div>\r\n          </div>\r\n\r\n          <div id=\"supportingDoc-error-message\" style={{ fontSize: 14, color: \"red\" }} >\r\n            {error}\r\n          </div>\r\n\r\n          <ErrorMessage name=\"supportingDoc\">\r\n            {(msg) => (\r\n              <div style={template.styles.error} className=\"input-error-text\">\r\n                {msg}\r\n              </div>\r\n            )}\r\n          </ErrorMessage>\r\n\r\n          <div\r\n            style={{ marginLeft: \"2%\", marginTop: \"1%\", msrginRight: \"2%\" }}\r\n            className=\"container\"\r\n          >\r\n            <ul className=\"list-group\">\r\n              {formik.getFieldProps(\"supportingDoc\").value &&\r\n                formik.getFieldProps(\"supportingDoc\").value.map((item) => {\r\n                  return (\r\n                    <li class=\"list-group-item\">\r\n                      {item.name}\r\n                      <button\r\n                        type=\"button\"\r\n                        className=\"float-right close\"\r\n                        aria-label=\"Close\"\r\n                        onClick={() => {\r\n                          formik.validateForm();\r\n                          formik.setFieldValue(\r\n                            \"supportingDoc\",\r\n                            formik\r\n                              .getFieldProps(\"supportingDoc\")\r\n                              .value.filter((x) => x != item)\r\n                          );\r\n                          fileDeletionAction(item.name);\r\n                        }}\r\n                      >\r\n                        <span aria-hidden=\"true\">&times;</span>\r\n                      </button>\r\n                    </li>\r\n                  );\r\n                })}\r\n            </ul>\r\n          </div>\r\n        </div>\r\n      </div>\r\n      :\r\n      <></>\r\n  );\r\n};\r\n","import React from \"react\";\r\nimport './ValidationErrorPopupBody.css';\r\n\r\nconst ValidationErrorPopupBody = ({messages, styles, errors}) => (\r\n  \r\n  <div id='error-popup' style={{ padding: \"10px 20px 0px 20px\" }}> \r\n    <div style={styles.topMessage}>{messages.topMessageText}</div>\r\n    {errors &&\r\n      errors.map(s => (\r\n        <div key={s.name}>\r\n          {/* TODO; control */}\r\n          <div style={styles.sectionName}>{s.name}</div>\r\n          {/* TODO; control */}\r\n          {s.messages.map((m, idx) => (\r\n            <div key={idx} style={styles.message}>{messages.messageTextPrefix} {m}</div>\r\n          ))}\r\n          \r\n        </div>\r\n      ))}\r\n      <div style={styles.bottomMessage}>{messages.bottomMessageText}</div>\r\n  </div>\r\n);\r\n\r\nexport default ValidationErrorPopupBody;\r\n","export const mapErrorsToSection = (config, errors) => {\r\n  // TODO; works, clean it up\r\n  let display = [];\r\n\r\n  const errorFields = Object.keys(errors);\r\n\r\n  Object.values(config.page.form.sections)\r\n    .filter(s => s.active)\r\n    .forEach(s => {\r\n      const output = { name: s.title, messages: [] };\r\n      const fields = Object.keys(s.fields);\r\n\r\n      fields.forEach(field => {\r\n        if (errorFields.includes(field)) {\r\n          output.messages.push(errors[field]);\r\n        }\r\n      });\r\n\r\n      if (output.messages.length > 0)\r\n        display.push(output);\r\n    });\r\n\r\n  return display;\r\n};\r\n","\r\n  export const inputClasses = (errors) =>\r\n  errors ? \"form-control is-invalid\" : \"form-control\";\r\n","export const spaEndpointHost =  process.env.PUBLIC_URL;\r\nexport const apiHost = process.env.PUBLIC_URL;\r\nexport const getwayApi = process.env.PUBLIC_URL;\r\n// export const apiHost = 'https://vra-test.azurewebsites.net/';\r\n// export const getwayApi = 'https://vra-test.azurewebsites.net/';\r\nexport const vraUX =  process.env.PUBLIC_URL;\r\nexport const instkey = 'InstrumentationKey=4f254ea7-2eec-4f68-b038-744c9f7c9e5c';\r\nexport const captchaUrl = \"https://captcha-dev.azurewebsites.net\";\r\n","import React, {useState} from 'react';\r\n\r\nimport Modal from \"react-modal\";\r\nimport axios from \"axios\";\r\nimport {apiHost} from \"../../../../config/Constants\";\r\n\r\n//called when user fills out Phone & Email. It sends the org, phone input, and email input to the DB, which returns array of objects matching\r\nexport const getMatchingRequestor = (org, email, phone, setRequestors, showModal, setRequestor, formik) => {\r\n  return async () => {\r\n    \r\n    await axios\r\n      .post(`${apiHost}/api/requestorMatch`, \r\n        {\r\n          org: org,\r\n          email: email,\r\n          phone: phone\r\n        }\r\n     , {headers: {'content-type': 'application/json'}})\r\n      .then(res => {\r\n        // console.log(res.data.Result, 'Matching Requestors')\r\n        \r\n        // if(Array.isArray(res.data.Result)){\r\n        // console.log(res.data.Result)\r\n        \r\n        const matchingRequestors = res.data.Result;\r\n\r\n        // const matchingRequestors = res.data.Result.filter((set)=>{\r\n        //   return set.Phone === formik.values.discloseToPhone\r\n        // })\r\n        // }\r\n        \r\n        if(Array.isArray(res.data.Result)){\r\n          console.log(`${res.data.Result.length} requestors found`, res.data.Result)\r\n          // if(res.data.Result.length == 1){\r\n          //   //set rep contact info the values from result\r\n          //   console.log(res.data.Result)\r\n          //   return setRequestor(res.data.Result[0].FirstName, res.data.Result[0].LastName, \r\n          //     res.data.Result[0].Email, res.data.Result[0].Phone, res.data.Result[0].Address1, res.data.Result[0].City, res.data.Result[0].ZipCode, res.data.Result[0].State, res.data.Result[0].RequestorName, res.data.Result[0].Address2);\r\n            \r\n          // }\r\n          if(matchingRequestors.length >= 1){\r\n            // launch modal\r\n            // console.log(\"should launch modal\")\r\n            // console.log(matchingRequestors)\r\n            // console.log(formik);\r\n            setRequestors(matchingRequestors)\r\n            showModal(true)\r\n          }else{\r\n            //do nothing user continues filling out app as normal\r\n            return\r\n          }\r\n\r\n        }else{\r\n          return;\r\n        }\r\n        \r\n      })\r\n      .catch(err => {\r\n        if(err.response !== undefined)\r\n          console.log(err.response)            \r\n      });\r\n  }\r\n}\r\n\r\nexport const RequestorMatchModal = (closeModal, setShowRequestorModal, template, requestors, setRequestor, selectUser, setSelectUser, selectedItem, setSelectedItem, selectorMatch, config) => {\r\n  \r\n    // console.log(config, 'config');\r\n    return(\r\n      <Modal ariaHideApp={false} isOpen={closeModal} onRequestClose={() => {setShowRequestorModal(false);}} className='selector-modal' >\r\n        <p id='popup-title' style={selectorMatch.header.styles}>{selectorMatch.title}</p>\r\n        <div id='popup-field-set'>\r\n              {requestors.map( x => {\r\n                  // console.log(requestors.indexOf(x), 'requestor index')\r\n                  console.log(x, 'requestor set')\r\n                  return( \r\n                    <RequestorSet x={x} setSelectUser={setSelectUser} keyy={requestors.indexOf(x)} setSelectedItem={setSelectedItem} selectedItem={selectedItem} selectorMatch={selectorMatch} config={config}/>\r\n                  )                            \r\n                }) \r\n              } \r\n        \r\n        </div>\r\n          <div id='popup-footer'>\r\n            <button id='popup-close-button' className=\"popup-button\" style={config.page.form.styles.buttons.cancel} onClick={() =>{ setShowRequestorModal(false); }}> {selectorMatch.cancelButton.text} </button>  \r\n            \r\n            <button\r\n              id='popup-select-button'\r\n              className=\"popup-button\"\r\n              // style={selectorMatch.submitButton.styles}\r\n              style={config.page.form.styles.buttons.act}\r\n              onClick={() =>{\r\n                if(selectUser !== undefined)\r\n                  setRequestor(selectUser.firstName, selectUser.lastName, selectUser.email, selectUser.phone, selectUser.address, selectUser.city, selectUser.zipCode, selectUser.state, selectUser.orgName, selectUser.address2, selectUser.fax, selectUser.requestorNameId, selectUser.requestorContactId);\r\n                setShowRequestorModal(false);\r\n              }}\r\n              >\r\n             {selectorMatch.submitButton.text}\r\n          </button>\r\n  \r\n        </div>\r\n        {/* </div> */}\r\n      </Modal>\r\n    );\r\n  \r\n}\r\n  \r\nexport const RequestorSet = ({x, setSelectUser, setSelectedItem, selectedItem, keyy, selectorMatch, config}) =>{\r\n  // const [selected, setSelected] = useState(false)\r\n  const selectorConfig = config.page.form.components.selectorMatch\r\n  \r\n  return(\r\n      <div className='popup-requestor-set' \r\n        style={(selectedItem === keyy) ? {background: selectorConfig.fields.canvas.active.backgroundColor, color: 'white'}:{color: selectorConfig.fields.canvas.active.backgroundColor}}\r\n        key={x.RequestorContactID} \r\n          onClick={() =>{\r\n            setSelectUser({ firstName: x.FirstName, lastName: x.LastName, email: x.Email, phone: x.Phone, address: x.Address1, city: x.City, state: x.State, zipCode: x.ZipCode, orgName: x.RequestorName, address2: x.Address2, fax: x.Fax, requestorNameId: x.RequestorNameID, requestorContactId: x.RequestorContactID});\r\n            setSelectedItem(keyy);\r\n          }}\r\n      >\r\n                    \r\n          <p className='field-datum requestor-name' style={{padding: 0}}>{`${x.FirstName} ${x.LastName}`}</p>\r\n          <p className='field-datum org-name' style={{padding: 0}}>{x.RequestorName}</p>\r\n        \r\n        <div className='popup-minor-info-container'>\r\n          <p className='field-datum popup-minor-info' style={{padding: 0}}>{x.Email}</p>\r\n          <p className='field-datum popup-minor-info' style={{padding: 0}}>{x.Phone}</p>\r\n          <p className='field-datum last-datum popup-minor-info' style={{padding: 0}}>{x.Fax}</p>\r\n        </div>\r\n        \r\n        <div className='popup-minor-info-container'>\r\n          <p className='field-datum popup-minor-info' style={{padding: 0}}>{x.Address1}</p>\r\n          {(x.Address2) ? <p className='field-datum popup-minor-info' style={{padding: 0}}>{x.Address2}</p>:<></>}\r\n          <p className='field-datum popup-minor-info' style={{padding: 0}}>{x.City}</p>\r\n          <p className='field-datum popup-minor-info' style={{padding: 0}}>{x.State}</p>\r\n          <p className='field-datum last-datum popup-minor-info' style={{padding: 0}}>{x.ZipCode}</p>\r\n        </div>\r\n                \r\n      </div>\r\n  )\r\n}\r\n  \r\n  ","import React from 'react'\r\n\r\nexport const FillFormButton = ({ formik }) => {\r\n    return (\r\n        <button onClick={() => {\r\n            formik.values.discloseToPhone = '123-456-7890';\r\n            formik.values.discloseToEmail = 'test@test.com';\r\n            formik.values.discloseToFax = '1234567890';\r\n            formik.values.discloseToFName = 'test';\r\n            formik.values.discloseToMName = 't';\r\n            formik.values.discloseToLName = 'test';\r\n            formik.values.discloseToOrgName = 'test';\r\n            formik.values.discloseToAddressLine1 = 'test';\r\n            formik.values.discloseToAddressLine2 = 'test';\r\n            formik.values.discloseToCity = 'test';\r\n            formik.values.discloseToState = 'TE';\r\n            formik.values.discloseToZip = '00000';\r\n            formik.values.repRole = '2';\r\n            formik.values.patientInfoFirstName = 'test';\r\n            formik.values.patientInfoMiddleInitial = 't';\r\n            formik.values.patientInfoLastName = 'test';\r\n            // formik.values.patientInfoOtherName = 'test';\r\n            formik.values.patientInfoDob = new Date(2000, 11, 24, 10, 33, 30, 0);\r\n            formik.values.infoToReleaseGroup = ['test'];\r\n            formik.values.releaseFromDate = new Date(2020, 11, 24, 10, 33, 30, 0);\r\n            formik.values.releaseToDate = new Date(2020, 11, 25, 10, 33, 30, 0);\r\n            formik.values.supportingDoc = [{ lastModified: 1626787691104, lastModifiedDate: new Date(2021, 11, 24, 10, 33, 30, 0), name: \"Rectangle 423.pdf\", size: 858, type: \"application/pdf\", webkitRelativePath: \"\" }];\r\n            formik.values.facilitiesGroup = ['test1', 'test2'];\r\n            formik.values.certBox = false;\r\n            // formik.values.repDesc = 'test';\r\n            // formik.values.supportingDoc = 'test';\r\n            // console.log(formik.values)\r\n        }}>Fill form </button>\r\n    )\r\n}\r\n","import React, { useEffect, useState } from 'react';\r\nimport { Field } from \"formik\";\r\nimport { RequestorMatchModal, RequestorSet, getMatchingRequestor } from '../selectorMatch/selectorMatch';\r\nimport Required from \"../../../components/Required\";\r\nimport RadioButtonGroup from \"../../../components/RadioButtonGroup\";\r\nimport RadioButton from \"../../../components/RadioButton\";\r\nimport Modal from \"react-modal\";\r\nimport axios from \"axios\";\r\nimport '../styles/css/repContactInfo.css'\r\nimport '../styles/css/popup.css'\r\nimport { ErrorMessage } from \"formik\";\r\nimport { FillFormButton } from '../../../../config/devComponents';\r\n\r\n// import { apiHost } from \"../../../config/Constants\";\r\n\r\n\r\nexport const RepContactInfoSection = ({ formik, inputClasses, template, orgId, selectorMatch, config }) => {\r\n  const [showRequestorModal, setShowRequestorModal] = useState(false);\r\n  const [requestors, setRequestors] = useState([])\r\n  const [selectUser, setSelectUser] = useState(undefined);\r\n  const [selectedItem, setSelectedItem] = useState(false);\r\n\r\n  const setRepContactInfo = (firstName, LastName, email, phone, address, city, zipCode, state, orgName, address2, fax, requestorNameId, requestorContactId) => {\r\n    // console.log(`${firstName} firstname`)\r\n    if (typeof email == \"string\" && email.length > 0) formik.setFieldValue(\"discloseToEmail\", email);\r\n    if (typeof phone == \"string\" && phone.length > 0) formik.setFieldValue(\"discloseToPhone\", phone);\r\n    if (typeof firstName == \"string\" && firstName.length > 0) formik.setFieldValue(\"discloseToFName\", firstName);\r\n    if (typeof LastName == \"string\" && LastName.length > 0) formik.setFieldValue(\"discloseToLName\", LastName);\r\n    if (typeof orgName == \"string\" && orgName.length > 0) formik.setFieldValue(\"discloseToOrgName\", orgName);\r\n    if (typeof address == \"string\" && address.length > 0) formik.setFieldValue(\"discloseToAddressLine1\", address);\r\n    if (typeof address2 == \"string\" && address2.length > 0) formik.setFieldValue(\"discloseToAddressLine2\", address2);\r\n    if (typeof city == \"string\" && city.length > 0) formik.setFieldValue(\"discloseToCity\", city);\r\n    if (typeof state == \"string\" && state.length > 0) formik.setFieldValue(\"discloseToState\", state);\r\n    if (typeof zipCode == \"string\" && zipCode.length > 0) formik.setFieldValue(\"discloseToZip\", zipCode);\r\n    if (typeof fax == \"string\" && fax.length > 0) formik.setFieldValue(\"discloseToFax\", fax);\r\n    if (typeof requestorNameId == \"number\" && requestorNameId > 0) formik.setFieldValue(\"requestorNameId\", requestorNameId);\r\n    if (typeof requestorContactId == \"number\" && requestorContactId > 0) formik.setFieldValue(\"requestorContactId\", requestorContactId);\r\n  }\r\n\r\n\r\n  const phoneFaxFormat = (e) => {\r\n    (e.which > 57 || e.which < 48) && e.preventDefault()\r\n    if (e.target.value.length === 3 || e.target.value.length === 7) {\r\n      e.target.value = e.target.value.concat('-')\r\n    }\r\n    if (e.target.value.length === 12) {\r\n      e.target.value = e.target.value.concat('x')\r\n    }\r\n  }\r\n  const faxFormat = (e) => {\r\n    (e.which > 57 || e.which < 48) && e.preventDefault()\r\n    if (e.target.value.length === 3 || e.target.value.length === 7) {\r\n      e.target.value = e.target.value.concat('-')\r\n    }\r\n    // if (e.target.value.length === 12) {\r\n    //   e.target.value = e.target.value.concat(' x')\r\n    // }\r\n  }\r\n\r\n  useEffect(()=>{\r\n    const phoneFields = ['discloseToPhone', 'discloseToFax']\r\n    phoneFields.forEach((field) => {\r\n      formik.errors[field] && formik.errors[field].includes('number is not valid') && formik.setFieldValue(field, formik.values[field].replace(/^(\\d{3})(\\d{3})(\\d{4}).*/, \"$1-$2-$3\"))\r\n    })\r\n  }, [formik.errors.discloseToPhone, formik.errors.Patient_Phone_Conform, formik.errors.RepPhone, formik.errors.Rep_Phone_Conform])\r\n\r\n\r\n\r\n  useEffect(() => {\r\n    if ((formik.touched.discloseToPhone && !formik.errors.discloseToPhone) && (formik.touched.discloseToEmail && !formik.errors.discloseToEmail)) {\r\n      // If both Phone & Email have been focused, and the inputs result in no errors, call for requestors.\r\n      getMatchingRequestor(orgId, formik.getFieldProps(\"discloseToEmail\").value, formik.getFieldProps(\"discloseToPhone\").value, setRequestors, setShowRequestorModal, setRepContactInfo, formik)()\r\n      //this function internally calls showRequestorModal() which pulls up Modal.\r\n    }\r\n\r\n  }, [formik.touched.discloseToPhone, formik.errors.discloseToPhone, formik.touched.discloseToEmail, formik.errors.discloseToEmail]\r\n  )\r\n\r\n  return (\r\n    config.page.form.sections.repContactInfoSection.active ?\r\n      <div id='repContactInfoSection' className='form-section'>\r\n        {showRequestorModal && RequestorMatchModal(showRequestorModal, setShowRequestorModal, template, requestors, setRepContactInfo, selectUser, setSelectUser, selectedItem, setSelectedItem, selectorMatch, config)}\r\n\r\n        <h2\r\n          style={config.page.form.styles.section}\r\n          className=\"section-heading\">\r\n          {template.title}\r\n        </h2>\r\n\r\n        <div className=\"form-fields\">\r\n\r\n          <div className=\"form-field phone-field\">\r\n            <label htmlFor=\"discloseToPhone\">\r\n              {\" \"}\r\n              <span style={template.styles.label}>\r\n                {template.fields.discloseToPhone.label}{\" \"}\r\n              </span>\r\n              <Required\r\n                value={template.fields.discloseToPhone.validations.required}\r\n              />\r\n            </label>\r\n            <input\r\n              {...formik.getFieldProps(\"discloseToPhone\")}\r\n              type=\"tel\"\r\n              style={config.page.form.styles.hint}\r\n              size={30}\r\n              name=\"discloseToPhone\"\r\n              onFocus={() => { formik.touched.discloseToPhone = false; setTimeout(() => console.log(formik), 3000) }}\r\n              onKeyPress={(e) => { phoneFaxFormat(e) }}\r\n              maxLength={template.fields.discloseToPhone.validations.maxLength.value}\r\n              className={inputClasses(\r\n                formik.touched.discloseToPhone &&\r\n                formik.errors.discloseToPhone\r\n              )}\r\n              placeholder={template.fields.discloseToPhone.hint}\r\n            />\r\n\r\n            {formik.touched.discloseToPhone &&\r\n              formik.errors.discloseToPhone && (\r\n                <span className=\"input-error-text\">\r\n                  {formik.errors.discloseToPhone}\r\n                </span>\r\n              )}\r\n          </div>\r\n\r\n          <div className=\"form-field email-field\">\r\n            <label htmlFor=\"discloseToEmail\">\r\n              <span style={template.styles.label}>\r\n                {template.fields.discloseToEmail.label}\r\n                {\" \"}\r\n                <Required value={template.fields.discloseToEmail.validations.required.value} />\r\n              </span>{\" \"}\r\n            </label>\r\n            <input\r\n              {...formik.getFieldProps(\"discloseToEmail\")}\r\n              type=\"text\"\r\n              name=\"discloseToEmail\"\r\n              onFocus={() => { formik.touched.discloseToEmail = false; setTimeout(() => console.log(formik), 3000) }}\r\n              style={config.page.form.styles.hint}\r\n              className={inputClasses(formik.touched.discloseToEmail && formik.errors.discloseToEmail)}\r\n              maxLength={template.fields.discloseToEmail.validations.maxLength.value}\r\n              placeholder={template.fields.discloseToEmail.hint}\r\n            />\r\n            {formik.touched.discloseToEmail &&\r\n              formik.errors.discloseToEmail && (\r\n                <span className=\"input-error-text\">\r\n                  {formik.errors.discloseToEmail}\r\n                </span>\r\n              )}\r\n          </div>\r\n\r\n          <div className=\"form-field fax-field\">\r\n            <label htmlFor=\"discloseToFax\">\r\n              {\" \"}\r\n              <span style={template.styles.label}>\r\n                {template.fields.discloseToFax.label}{\" \"}\r\n              </span>\r\n              {/* <Required\r\n                value={template.fields.discloseToFax.validations.required}\r\n              /> */}\r\n            </label>\r\n            <input\r\n              {...formik.getFieldProps(\"discloseToFax\")}\r\n              type=\"tel\"\r\n              style={config.page.form.styles.hint}\r\n              size={30}\r\n              name=\"discloseToFax\"\r\n              onKeyPress={(e) => { faxFormat(e) }}\r\n              // maxLength={template.fields.discloseToFax.validations.maxLength.value}\r\n              maxLength={12}\r\n              className={inputClasses(\r\n                formik.touched.discloseToFax &&\r\n                formik.errors.discloseToFax\r\n              )}\r\n              placeholder={template.fields.discloseToFax.hint}\r\n            />\r\n\r\n            {formik.touched.discloseToFax &&\r\n              formik.errors.discloseToFax && (\r\n                <span className=\"input-error-text\">\r\n                  {formik.errors.discloseToFax}\r\n                </span>\r\n              )}\r\n          </div>\r\n\r\n          <div className=\"form-field firstName-field\">\r\n            <label htmlFor=\"discloseToFName\">\r\n              {\" \"}\r\n              <span style={template.styles.label}>\r\n                {template.fields.discloseToFName.label}\r\n              </span>{\" \"}\r\n              <Required\r\n                value={\r\n                  template.fields.discloseToFName.validations.required.value\r\n                }\r\n              />\r\n            </label>\r\n            <input\r\n              {...formik.getFieldProps(\"discloseToFName\")}\r\n              type=\"text\"\r\n              name=\"discloseToFName\"\r\n              style={config.page.form.styles.hint}\r\n              maxLength={template.fields.discloseToFName.validations.maxLength.value}\r\n              className={inputClasses(\r\n                formik.touched.discloseToFName &&\r\n                formik.errors.discloseToFName\r\n              )}\r\n              placeholder={template.fields.discloseToFName.hint}\r\n            />\r\n            {formik.touched.discloseToFName &&\r\n              formik.errors.discloseToFName && (\r\n                <span className=\"input-error-text\">\r\n                  {formik.errors.discloseToFName}\r\n                </span>\r\n              )}\r\n          </div>\r\n\r\n          <div className=\"form-field MI-field\">\r\n            {/* <div className=\"form-group\"> */}\r\n            <label htmlFor=\"discloseToMName\">\r\n              {\" \"}\r\n              <span style={template.styles.label}>\r\n                {template.fields.discloseToMName.label}\r\n              </span>{\" \"}\r\n\r\n            </label>\r\n            <input\r\n              {...formik.getFieldProps(\"discloseToMName\")}\r\n              type=\"text\"\r\n              name=\"discloseToMName\"\r\n              style={config.page.form.styles.hint}\r\n              className={inputClasses(\r\n                formik.touched.discloseToMName &&\r\n                formik.errors.discloseToMName\r\n              )}\r\n              maxLength={template.fields.discloseToMName.validations.maxLength.value}\r\n              placeholder={template.fields.discloseToMName.hint}\r\n            />\r\n            {formik.touched.discloseToMName &&\r\n              formik.errors.discloseToMName && (\r\n                <span className=\"input-error-text\">\r\n                  {formik.errors.discloseToMName}\r\n                </span>\r\n              )}\r\n            {/* </div> */}\r\n          </div>\r\n\r\n          <div className=\"form-field lastName-field\">\r\n            <label htmlFor=\"discloseToLName\">\r\n              {\" \"}\r\n              <span style={template.styles.label}>\r\n                {template.fields.discloseToLName.label}\r\n              </span>{\" \"}\r\n              <Required\r\n                value={\r\n                  template.fields.discloseToLName.validations.required.value\r\n                }\r\n              />\r\n            </label>\r\n            <input\r\n              {...formik.getFieldProps(\"discloseToLName\")}\r\n              type=\"text\"\r\n              name=\"discloseToLName\"\r\n              maxLength={template.fields.discloseToLName.validations.maxLength.value}\r\n              style={config.page.form.styles.hint}\r\n              className={inputClasses(\r\n                formik.touched.discloseToLName &&\r\n                formik.errors.discloseToLName\r\n              )}\r\n              placeholder={template.fields.discloseToLName.hint}\r\n            />\r\n            {formik.touched.discloseToLName &&\r\n              formik.errors.discloseToLName && (\r\n                <span className=\"input-error-text\">\r\n                  {formik.errors.discloseToLName}\r\n                </span>\r\n              )}\r\n          </div>\r\n\r\n          <div className=\"form-field org-name-field\">\r\n            <label htmlFor=\"discloseToOrgName\">\r\n              {\" \"}\r\n              <span style={template.styles.label}>\r\n                {template.fields.discloseToOrgName.label}\r\n              </span>{\" \"}\r\n              <Required\r\n                value={template.fields.discloseToOrgName.validations.required}\r\n              />\r\n            </label>\r\n            <input\r\n              {...formik.getFieldProps(\"discloseToOrgName\")}\r\n              type=\"text\"\r\n              name=\"discloseToOrgName\"\r\n              style={config.page.form.styles.hint}\r\n              maxLength={template.fields.discloseToOrgName.validations.maxLength.value}\r\n              className={inputClasses(\r\n                formik.touched.discloseToOrgName &&\r\n                formik.errors.discloseToOrgName\r\n              )}\r\n              placeholder={template.fields.discloseToOrgName.hint}\r\n            />\r\n            {formik.touched.discloseToOrgName &&\r\n              formik.errors.discloseToOrgName && (\r\n                <span className=\"input-error-text\">\r\n                  {formik.errors.discloseToOrgName}\r\n                </span>\r\n              )}\r\n          </div>\r\n\r\n          <div className='address-container'>\r\n            <div className=\"form-field org-address1-field\">\r\n              <label htmlFor=\"discloseToAddressLine1\">\r\n                <span style={template.styles.label}>\r\n                  {template.fields.discloseToAddressLine1.label}\r\n                </span>{\" \"}\r\n                <Required\r\n                  value={\r\n                    template.fields.discloseToAddressLine1.validations\r\n                      .required\r\n                  }\r\n                />\r\n              </label>\r\n              <input\r\n                {...formik.getFieldProps(\"discloseToAddressLine1\")}\r\n                type=\"text\"\r\n                maxLength={\r\n                  template.fields.discloseToAddressLine1.validations.maxLength\r\n                    .value\r\n                }\r\n                name=\"discloseToAddressLine1\"\r\n                style={config.page.form.styles.hint}\r\n                id=\"discloseToAddressLine1\"\r\n                maxLength={template.fields.discloseToAddressLine1.validations.maxLength.value}\r\n                className={inputClasses(\r\n                  formik.touched.discloseToAddressLine1 &&\r\n                  formik.errors.discloseToAddressLine1\r\n                )}\r\n                placeholder={template.fields.discloseToAddressLine1.hint}\r\n              />\r\n              {formik.touched.discloseToAddressLine1 &&\r\n                formik.errors.discloseToAddressLine1 && (\r\n                  <span className=\"input-error-text\">\r\n                    {formik.errors.discloseToAddressLine1}\r\n                  </span>\r\n                )}\r\n            </div>\r\n\r\n\r\n\r\n\r\n            <div className=\"form-field org-address2-field\">\r\n              {template.fields.discloseToAddressLine2.label && (\r\n                <label htmlFor=\"discloseToAddressLine2\">\r\n                  <span style={template.styles.label}>\r\n                    {template.fields.discloseToAddressLine2.label}\r\n                  </span>{\" \"}\r\n                  <Required\r\n                    value={\r\n                      template.fields.discloseToAddressLine2.validations\r\n                        .required.value\r\n                    }\r\n                  />\r\n                </label>\r\n              )}\r\n              <input\r\n                {...formik.getFieldProps(\"discloseToAddressLine2\")}\r\n                type=\"text\"\r\n                maxLength={template.fields.discloseToAddressLine2.validations.maxLength.value}\r\n                maxLength={\r\n                  template.fields.discloseToAddressLine2.validations.maxLength\r\n                    .value\r\n                }\r\n                name=\"discloseToAddressLine2\"\r\n                id=\"discloseToAddressLine2\"\r\n                style={config.page.form.styles.hint}\r\n                className={inputClasses(\r\n                  formik.touched.discloseToAddressLine2 &&\r\n                  formik.errors.discloseToAddressLine2\r\n                )}\r\n                placeholder={template.fields.discloseToAddressLine2.hint}\r\n              />\r\n              {formik.touched.discloseToAddressLine2 &&\r\n                formik.errors.discloseToAddressLine2 && (\r\n                  <span className=\"input-error-text\">\r\n                    {formik.errors.discloseToAddressLine2}\r\n                  </span>\r\n                )}\r\n            </div>\r\n          </div>\r\n\r\n          <div className=\"form-field city-field\">\r\n            {template.fields.discloseToCity.label && (\r\n              <label htmlFor=\"discloseToCity\">\r\n                <span style={template.styles.label}>\r\n                  {template.fields.discloseToCity.label}\r\n                </span>{\" \"}\r\n                <Required\r\n                  value={\r\n                    template.fields.discloseToCity.validations.required\r\n                      .value\r\n                  }\r\n                />\r\n              </label>\r\n            )}\r\n            <input\r\n              {...formik.getFieldProps(\"discloseToCity\")}\r\n              type=\"text\"\r\n              name=\"discloseToCity\"\r\n              style={config.page.form.styles.hint}\r\n              className={inputClasses(\r\n                formik.touched.discloseToPhone && formik.errors.discloseCity\r\n              )}\r\n              maxLength={\r\n                template.fields.discloseToCity.validations.maxLength.value\r\n              }\r\n              onKeyPress={(e)=>{\r\n                (!e.key.match(/[a-zA-Z\\s\\-]/)) && e.preventDefault();\r\n              }}\r\n              placeholder={template.fields.discloseToCity.hint}\r\n            />\r\n            {formik.touched.discloseToCity &&\r\n              formik.errors.discloseToCity && (\r\n                <span className=\"input-error-text\">\r\n                  {formik.errors.discloseToCity}\r\n                </span>\r\n              )}\r\n          </div>\r\n\r\n          <div className=\"form-field state-field\">\r\n            <div className=\"form-group\">\r\n              {template.fields.discloseToState.label && (\r\n                <label htmlFor=\"discloseToState\">\r\n                  <span style={template.styles.label}>\r\n                    {template.fields.discloseToState.label}\r\n                  </span>{\" \"}\r\n                  <Required\r\n                    value={\r\n                      template.fields.discloseToState.validations.required\r\n                        .value\r\n                    }\r\n                  />\r\n                </label>\r\n              )}\r\n              <input\r\n                {...formik.getFieldProps(\"discloseToState\")}\r\n                type=\"text\"\r\n                name=\"discloseToState\"\r\n                style={config.page.form.styles.hint}\r\n                className={inputClasses(\r\n                  formik.touched.discloseToPhone &&\r\n                  formik.errors.discloseState\r\n                )}\r\n                maxLength={\r\n                  template.fields.discloseToState.validations.maxLength.value\r\n                }\r\n                onKeyPress={(e)=>{\r\n                  (!e.key.match(/[a-zA-Z]/)) && e.preventDefault()\r\n                }}\r\n                placeholder={template.fields.discloseToState.hint}\r\n              />\r\n              {formik.touched.discloseToState &&\r\n                formik.errors.discloseToState && (\r\n                  <span className=\"input-error-text\">\r\n                    {formik.errors.discloseToState}\r\n                  </span>\r\n                )}\r\n            </div>\r\n          </div>\r\n\r\n          <div className=\"form-field zip-field\">\r\n            <div className=\"form-group\">\r\n              {template.fields.discloseToZip.label && (\r\n                <label htmlFor=\"discloseToZip\">\r\n                  <span style={template.styles.label}>\r\n                    {template.fields.discloseToZip.label}\r\n                  </span>{\" \"}\r\n                  <Required\r\n                    value={\r\n                      template.fields.discloseToZip.validations.required.value\r\n                    }\r\n                  />\r\n                </label>\r\n              )}\r\n              <input\r\n                {...formik.getFieldProps(\"discloseToZip\")}\r\n                type=\"text\"\r\n                name=\"discloseToZip\"\r\n                style={config.page.form.styles.hint}\r\n                maxLength={template.fields.discloseToZip.validations.maxLength.value}\r\n                onKeyPress={(e)=>{\r\n                  (isNaN(Number(e.key))) && e.preventDefault()\r\n                  if (e.target.value.length === 5) {\r\n                    e.target.value = e.target.value.concat('-')\r\n                  }\r\n                }}\r\n                className={inputClasses(\r\n                  formik.touched.discloseToZip && formik.errors.discloseToZip\r\n                )}\r\n                placeholder={template.fields.discloseToZip.hint}\r\n              />\r\n              {formik.touched.discloseToZip &&\r\n                formik.errors.discloseToZip && (\r\n                  <span className=\"input-error-text\">\r\n                    {formik.errors.discloseToZip}\r\n                  </span>\r\n                )}\r\n            </div>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n          </div>\r\n\r\n          <div id='rep-and-caseNumber-container'>\r\n            <div className=\"form-field rep-question-field\">\r\n              <label htmlFor=\"repDesc\" className='non-textbox-label'>\r\n                {\" \"}\r\n                <span style={template.styles.label}>\r\n                  {template.fields.repRole.label}\r\n                </span>{\" \"}\r\n                <Required value={template.fields.repRole.validations.required.value} />\r\n              </label>\r\n\r\n              <RadioButtonGroup\r\n                id=\"rep-radio-options\"\r\n                value={formik.values.repRole}\r\n                error={formik.errors.repRole}\r\n                touched={formik.touched.repRole}\r\n                onChange={formik.setFieldValue}\r\n                onBlur={formik.setFieldTouched}\r\n              >\r\n                <span id=\"rep-radio-options\">\r\n                  {template.fields.repRole.entries.map((option, index) => (\r\n                    // <span\r\n                    //     style={template.styles.list}\r\n                    //     key={option.value}\r\n                    //     className=\"form-check\"\r\n                    // >\r\n                    <Field\r\n                      config={config}\r\n                      key={index}\r\n                      component={RadioButton}\r\n                      name=\"repRole\"\r\n                      id={option.value}\r\n                      checked={formik.getFieldProps(\"repRole\").value == option.value ? true : false}\r\n                      value={option.value}\r\n                      label={option.label}\r\n                    />\r\n                    // </span>\r\n                  ))}\r\n                </span>\r\n              </RadioButtonGroup>\r\n            </div>\r\n\r\n            <div className=\"form-field caseNumber-field\">\r\n              <label htmlFor=\"caseNumber\">\r\n                {\" \"}\r\n                <span style={template.styles.label}>\r\n                  {template.fields.caseNumber.label}\r\n                </span>{\" \"}\r\n                <Required\r\n                  value={\r\n                    template.fields.caseNumber.validations.required.value\r\n                  }\r\n                />\r\n              </label>\r\n              <input\r\n                {...formik.getFieldProps(\"caseNumber\")}\r\n                type=\"text\"\r\n                name=\"caseNumber\"\r\n                style={config.page.form.styles.hint}\r\n                maxLength={template.fields.caseNumber.validations.maxLength.value}\r\n                className={inputClasses(\r\n                  formik.touched.caseNumber &&\r\n                  formik.errors.caseNumber\r\n                )}\r\n                placeholder={template.fields.caseNumber.hint}\r\n              />\r\n              {/* {formik.touched.caseNumber &&\r\n                formik.errors.caseNumber && (\r\n                  <span className=\"input-error-text\">\r\n                    {formik.errors.caseNumber}\r\n                  </span>\r\n                )} */}\r\n            </div>\r\n          </div>\r\n\r\n\r\n        </div>\r\n\r\n\r\n      </div>\r\n      :\r\n      <></>\r\n  )\r\n}","import React from 'react';\r\nimport { Field } from \"formik\";\r\n// import Required from \"../Required\";\r\n// import RadioButtonGroup from \"../RadioButtonGroup\";\r\n// import RadioButton from \"../RadioButton\";\r\n\r\n\r\nexport const AdditionalInfoSection = ({ formik, template, inputClasses, config }) => {\r\n    return (\r\n        config.page.form.sections.additionalInfoSection.active ?\r\n            <div id='additionalInfoSection' className='form-section'>\r\n\r\n\r\n                <h2\r\n                    style={template.styles.section}\r\n                    className=\"section-heading\">\r\n                    {template.title}\r\n                </h2>\r\n\r\n                <div className='form-fields'>\r\n\r\n                    <div className=\"form-field additionalInfo-textbox\">\r\n                        <label htmlFor=\"repDesc\" className='non-textbox-label'>\r\n                            {\" \"}\r\n                            <span style={template.styles.label}>\r\n                                {template.fields.repDesc.label}\r\n                            </span>{\" \"}\r\n\r\n                        </label>\r\n                        <textarea\r\n                            {...formik.getFieldProps(\"repDesc\")}\r\n                            name=\"repDesc\"\r\n                            style={template.styles.hint}\r\n                            className={inputClasses(\r\n                                formik.touched.repDesc &&\r\n                                formik.errors.repDesc\r\n                            )}\r\n                            placeholder={template.fields.repDesc.hint}\r\n                        />\r\n                        {formik.touched.repDesc &&\r\n                            formik.errors.repDesc && (\r\n                                <span className=\"input-error-text\">\r\n                                    {formik.errors.repDesc}\r\n                                </span>\r\n                            )}\r\n                    </div>\r\n\r\n                </div>\r\n            </div>\r\n            :\r\n            <></>\r\n    )\r\n}","import React, {useState, useEffect} from 'react';\r\nimport Modal from \"react-modal\";\r\nimport axios from \"axios\";\r\n// import '../form/styles/css/summaryPage/summaryPage.css';\r\nimport '../form/styles/sass/summaryPage/summaryPage.scss';\r\nimport {getwayApi} from '../../../config/Constants'\r\nimport PBV from '../../assets/pbv.png'\r\nimport { setNestedObjectValues } from 'formik';\r\n// import logo from './styles/assets/verisma_logo.png';\r\n// import {\r\n//     registerLocales as registerLocalesForDatePickers,\r\n//     modalCustomStyles\r\n//   } from \"../../config/Configuration\";\r\n\r\n\r\nexport const SummaryModal = ({config, userInput, submitData, isModelOpen, setSummary, logo, formId, formik}) => {\r\n    const [closeModal, setCloseModal] = useState(isModelOpen)\r\n    const [facValues, setFacValues] = useState(null)\r\n    \r\n    \r\n    const formHasCustomFacilities = config.context.organization === '1007229' || config.context.organization === '1007342' || config.context.organization === '1007343' || config.context.organization === '1007307'\r\n    const THRForm = config.context.organization === '1007451'\r\n    const guthrieForm = config.context.organization === '1007163'\r\n    \r\n    useEffect(()=>{\r\n        if (formik.values.infoToReleaseGroup.length === 0 && formik.values.infoToReleaseGroupOther.length !== 0) {\r\n            formik.setFieldValue('infoToReleaseGroup', ['00000'])\r\n        }\r\n        return () => {\r\n            formik.values.infoToReleaseGroup.includes('00000') && formik.setFieldValue('infoToReleaseGroup', [])\r\n        } \r\n    })\r\n    \r\n    useEffect(()=>{\r\n        !Array.isArray(formik.values.facilitiesGroup) &&\r\n        formik.setFieldValue('facilitiesGroup', [userInput.facilitiesGroup]); \r\n        /* Called for forms w/ Radio Buttons for facilities as they add the facility to the formik object as a string, \r\n        rather than an array of strings (which pdf/vrm expects) */\r\n    })\r\n\r\n    useEffect(() => {\r\n        const phoneValue = formik.values.discloseToPhone\r\n        !phoneValue.includes('-') && formik.setFieldValue('discloseToPhone', `${phoneValue.slice(0, 3)}-${phoneValue.slice(3, 6)}-${phoneValue.slice(6, 10)}${phoneValue[10] ? phoneValue.slice(10, phoneValue.length) : \"\"}`)\r\n    }, [formik.values.discloseToPhone])\r\n\r\n    useEffect(()=>{\r\n        if (formHasCustomFacilities) {\r\n            const facGroup = formik.values.facilitiesGroup\r\n            let originalFacilityGroupValue = facGroup\r\n            \r\n            \r\n            return () => {\r\n                formik.setFieldValue('facilitiesGroup', originalFacilityGroupValue)\r\n            }\r\n        }\r\n    }, [])\r\n\r\n    useEffect(()=>{\r\n        if (formHasCustomFacilities) {\r\n            delete formik.values.facilitySelected\r\n            setFacValues(formik.values)\r\n    \r\n            return ()=>{\r\n                formik.setFieldValue('facilitySelected', true)\r\n            }\r\n        }\r\n    }, [formik.values.facilitySelected])\r\n\r\n    \r\n    useEffect(()=>{\r\n        formik.setFieldValue('ReleaseMode', formik.values.deliveryMethodGroup)\r\n    }, [formik.values.deliveryMethodGroup])\r\n\r\n    console.log(formik.values)\r\n\r\n    \r\n    const facilitiesGroup = config.page.form.sections.authorizationToReleaseSection.fields.facilitiesGroup.entries;\r\n\r\n    const facilityList = () => {\r\n        const facilityFields = config.page.form.sections.authorizationToReleaseSection.fields\r\n\r\n        if (formHasCustomFacilities && typeof userInput.facilitiesGroup !== 'string') {\r\n            return (\r\n                <>\r\n                    <div>\r\n                        <p style={{display:'inline'}}>{userInput.facilitiesGroup[0].customFacName1}</p> \r\n                        {userInput.facilitiesGroup[0].customFacName1 && userInput.facilitiesGroup[0].customFacAddress1 && <p style={{display:'inline'}}>, </p>} \r\n                        <p style={{display:'inline'}}>{userInput.facilitiesGroup[0].customFacAddress1}</p> \r\n                        {userInput.facilitiesGroup[0].customFacAddress1 && userInput.facilitiesGroup[0].customFacDoctor1 && <p style={{display:'inline'}}>, </p>} \r\n                        <p style={{display:'inline'}}>{userInput.facilitiesGroup[0].customFacDoctor1}</p> \r\n                    </div>\r\n                    <div>\r\n                        <p style={{display:'inline'}}>{userInput.facilitiesGroup[0].customFacName2}</p> \r\n                        {userInput.facilitiesGroup[0].customFacName2 && userInput.facilitiesGroup[0].customFacAddress2 && <p style={{display:'inline'}}> , </p>} \r\n                        <p style={{display:'inline'}}>{userInput.facilitiesGroup[0].customFacAddress2}</p>\r\n                        {userInput.facilitiesGroup[0].customFacAddress2 && userInput.facilitiesGroup[0].customFacDoctor2 && <p style={{display:'inline'}}>, </p>} \r\n                        <p style={{display:'inline'}}>{userInput.facilitiesGroup[0].customFacDoctor2}</p>  \r\n                    </div>\r\n                    <div>\r\n                        <p style={{display:'inline'}}>{userInput.facilitiesGroup[0].customFacName3}</p> \r\n                        {userInput.facilitiesGroup[0].customFacName3 && userInput.facilitiesGroup[0].customFacAddress3 && <p style={{display:'inline'}}> , </p>} \r\n                        <p style={{display:'inline'}}>{userInput.facilitiesGroup[0].customFacAddress3}</p>\r\n                        {userInput.facilitiesGroup[0].customFacAddress3 && userInput.facilitiesGroup[0].customFacDoctor3 && <p style={{display:'inline'}}>, </p>} \r\n                        <p style={{display:'inline'}}>{userInput.facilitiesGroup[0].customFacDoctor3}</p>  \r\n                    </div>\r\n                    <div>\r\n                        <p style={{display:'inline'}}>{userInput.facilitiesGroup[0].customFacName4}</p> \r\n                        {userInput.facilitiesGroup[0].customFacName4 && userInput.facilitiesGroup[0].customFacAddress4 && <p style={{display:'inline'}}> , </p>} \r\n                        <p style={{display:'inline'}}>{userInput.facilitiesGroup[0].customFacAddress4}</p>\r\n                        {userInput.facilitiesGroup[0].customFacAddress4 && userInput.facilitiesGroup[0].customFacDoctor4 && <p style={{display:'inline'}}>, </p>} \r\n                        <p style={{display:'inline'}}>{userInput.facilitiesGroup[0].customFacDoctor4}</p>  \r\n                    </div>\r\n                </>\r\n            )\r\n        }\r\n        \r\n        if (typeof userInput.facilitiesGroup === 'string') {\r\n            return <p>{userInput.facilitiesGroup}</p>\r\n        }\r\n\r\n        let outPatientFacilityList = [];\r\n        const regFacilityList = userInput.facilitiesGroup.map((facility) => {\r\n            if (typeof facility === 'object') {\r\n                for (let property in facility) {\r\n                    if (typeof property === 'string' && property.length > 0) {\r\n                        outPatientFacilityList.push(<p>{facility[property]}</p>)\r\n                    }\r\n                }\r\n            }\r\n            else {\r\n                let regFacilities = [];\r\n                let outPatientFacilites = [];\r\n                let longTermFacilites = [];\r\n                \r\n                regFacilities = facilityFields.facilitiesGroup.entries.map((entry)=>{\r\n                    if(facility === entry.key) {return <p>{entry.value}</p>}\r\n                })\r\n                outPatientFacilites = facilityFields.outPatientGroup && facilityFields.outPatientGroup.entries.map((entry)=>{\r\n                    if(facility === entry.key) {return <p>{entry.value}</p>}\r\n                })\r\n                longTermFacilites = facilityFields.longTermGroup && facilityFields.longTermGroup.entries.map((entry)=>{\r\n                    if(facility === entry.key) {return <p>{entry.value}</p>}\r\n                })\r\n                // console.log(outPatientFacilites, longTermFacilites)\r\n                return [...regFacilities, ...(outPatientFacilites || []), ...(longTermFacilites || [])]\r\n            }\r\n        })\r\n        const fullFacilityList = regFacilityList.concat(outPatientFacilityList);\r\n        // console.log(fullFacilityList, fullFacilityList.push(userInput.otherFac), userInput.otherFac)\r\n        return fullFacilityList;\r\n    }\r\n    \r\n    const ValidationErrorPopupBody = () => (\r\n        <div id='summary-modal-sections'>\r\n\r\n{/* ====================================================================================================================================================================================================== */}\r\n            \r\n            <div id='details-section' className='summary-section'>\r\n                <div className='summary-section-title-div' style={{borderColor: config.page.form.components.summaryModal.section.styles.borderColor}}>\r\n                    <p className='summary-section-title' style={config.page.form.components.summaryModal.section.styles}>{config.page.form.components.summaryModal.detailSummaryLabel}</p>\r\n                </div>\r\n                <div id='summary-section-details-field-div' className='summary-section-field-div'>\r\n                    \r\n                    \r\n\r\n                    {(userInput.caseNumber)?<SummaryField config={config} label={config.page.form.sections.repContactInfoSection.fields.caseNumber.label} value={userInput.caseNumber} />:<></>}\r\n                    \r\n                    {/* {console.log(facilityList())} */}\r\n                    <SummaryField config={config} label={config.page.form.sections.authorizationToReleaseSection.title} value={ facilityList() } other={userInput.otherFac.length > 0 ? true : false}/>\r\n                    {userInput.otherFac.length > 0 && <p style={{marginBottom: 20}}>{guthrieForm ? 'Guthrie Medical Group:' + ' ' + userInput.otherFac : userInput.otherFac}</p>}\r\n\r\n                    <SummaryField config={config} label={config.page.form.sections.informationToReleaseSection.title} value={\r\n                        (()=>{\r\n                            let info = config.page.form.sections.informationToReleaseSection.fields.infoToReleaseGroup.entries.map( x => {\r\n                                if(userInput.infoToReleaseGroup.includes(x.key) && x.key !== \"otherItem\"){\r\n                                    \r\n                                    return <p className='summary-field-value release-info-value' style={{marginBottom:0}}>{x.value} </p>\r\n                                }\r\n                                else if(userInput.infoToReleaseGroup.includes(x.key) && x.key === \"otherItem\"){\r\n                                    \r\n                                    return <p className='summary-field-value release-info-value' style={{marginBottom:0}}>{userInput.infoToReleaseGroupOther} </p>\r\n                                }\r\n                            })\r\n                            let abstracts = (config.page.form.sections.informationToReleaseSection.fields.infoToReleaseAbstracts) ? \r\n                                config.page.form.sections.informationToReleaseSection.fields.infoToReleaseAbstracts.entries.map( x => {\r\n                                    if(userInput.infoToReleaseGroup.includes(x.key) && x.key !== \"otherItem\"){\r\n                                        return <p className='summary-field-value release-info-value' style={{marginBottom:0}}>{x.tooltip} </p>\r\n                                    }\r\n                                })\r\n                                :\r\n                                ''\r\n\r\n                            \r\n                            // if(userInput.certBox === true){\r\n                            //     info.push(<p className='summary-field-value release-info-value' style={{marginBottom:0}}>{config.page.form.sections.informationToReleaseSection.fields.certBox.summaryText} </p>) \r\n                            // }\r\n                            return(\r\n                                <div id='release-info-value-container'>\r\n                                    {info}\r\n                                    {(config.page.form.sections.informationToReleaseSection.fields.infoToReleaseAbstracts) ? abstracts : <></>}\r\n                                    {userInput.infoToReleaseGroupOther !== \"\" && <p>{userInput.infoToReleaseGroupOther}</p>}\r\n                                    {userInput.releaseFromDate.toLocaleDateString( config.page.locale)} - {userInput.releaseToDate.toLocaleDateString(config.page.locale)}\r\n                                    {(userInput.certBox === true) ? <p className='summary-field-value release-info-value' style={{fontWeight: 700, fontStyle:'italic'}}>{config.page.form.sections.informationToReleaseSection.fields.certBox.summaryText}</p>:<></>}\r\n                                </div>\r\n                            )\r\n                        })()\r\n                    }  />\r\n                    \r\n                    \r\n                    {THRForm && <SummaryField config={config} label={config.page.form.sections.deliveryMethodSection.title} value={\r\n                        userInput.ReleaseMode === '2' ? 'Email' : userInput.ReleaseMode === '5' ? 'Mail Paper Records' : 'CD/DVD'\r\n                        // config.page.form.sections.deliveryMethodSection.fields.ReleaseMode.entries.map( x => {\r\n                        //         return <p>{x.value}</p>\r\n                        // })\r\n                        // <p>userInput.ReleaseMode</p>\r\n                    } />}\r\n                    \r\n                    <SummaryField config={config} label={config.page.form.sections.supportingDocsSection.title} value={userInput.supportingDoc.map( x => {\r\n                                    return  <p>{x.name}</p>\r\n                                })\r\n                        } />\r\n\r\n                    <SummaryField config={config} label={config.page.form.sections.additionalInfoSection.title} value={\r\n                        config.page.form.sections.repContactInfoSection.fields.repRole.entries.map( x => {\r\n                            if(userInput.repRole == x.value){\r\n                                return <p>{userInput.repDesc}</p>\r\n                            }\r\n                        })\r\n                    } classes={'bottom-summary-field'}/>\r\n                </div>\r\n            </div>\r\n\r\n            <div id='upper-sections'>\r\n                \r\n                <div id='requestor-section' className='summary-section'>\r\n                    <div className='summary-section-title-div' style={{borderColor: config.page.form.components.summaryModal.section.styles.borderColor}}>\r\n                        <p className='summary-section-title' style={config.page.form.components.summaryModal.section.styles}>{config.page.form.sections.repContactInfoSection.title}</p>\r\n                    </div>\r\n                    <div className='summary-section-field-div'>\r\n                        <SummaryField config={config} label={'NAME'} value={`${userInput.discloseToFName} ${userInput.discloseToMName} ${userInput.discloseToLName}`}/>\r\n                        <SummaryField config={config} label={config.page.form.sections.repContactInfoSection.fields.discloseToEmail.label} value={userInput.discloseToEmail}/>\r\n                        <SummaryField config={config} label={config.page.form.sections.repContactInfoSection.fields.discloseToPhone.label} value={userInput.discloseToPhone}/>\r\n                        {(userInput.discloseToFax)?<SummaryField config={config} label={config.page.form.sections.repContactInfoSection.fields.discloseToFax.label} value={userInput.discloseToFax}/>:<></>}\r\n                        <SummaryField config={config} label={config.page.form.sections.repContactInfoSection.fields.discloseToOrgName.label} value={userInput.discloseToOrgName}/>\r\n                        <SummaryField config={config} label={config.page.form.sections.repContactInfoSection.fields.discloseToAddressLine1.label} value={`${userInput.discloseToAddressLine1} ${userInput.discloseToAddressLine2} ${userInput.discloseToCity} ${userInput.discloseToState} ${userInput.discloseToZip}`} />\r\n                        <SummaryField config={config} label={config.page.form.components.summaryModal.reppedPartyLabel} value={\r\n                            config.page.form.sections.repContactInfoSection.fields.repRole.entries.map( x => {\r\n                                if(userInput.repRole == x.value){\r\n                                    return ( <p>{x.label} </p> )\r\n                                }\r\n                            })\r\n                    } classes={'bottom-summary-field'} />\r\n                    </div>\r\n                </div>\r\n                \r\n\r\n                <div id='patientInfo-section' className='summary-section'>\r\n                    <div className='summary-section-title-div' style={{borderColor: config.page.form.components.summaryModal.section.styles.borderColor}}>\r\n                        <p className='summary-section-title' style={config.page.form.components.summaryModal.section.styles}>{config.page.form.sections.patientInformationSection.title}</p>\r\n                    </div>\r\n                    <div className='summary-section-field-div'>\r\n                        <SummaryField config={config} label={config.page.form.sections.discloseToSection.fields.discloseToName.label} value={`${userInput.patientInfoFirstName} ${userInput.patientInfoMiddleInitial} ${userInput.patientInfoLastName}`}/>\r\n                        {(userInput.patientInfoOtherName) ? <SummaryField config={config} label={config.page.form.sections.patientInformationSection.fields.patientInfoOtherName.label} value={userInput.patientInfoOtherName}/> : <></>}\r\n                        <SummaryField config={config} label={config.page.form.sections.patientInformationSection.fields.patientInfoDob.label} value={userInput.patientInfoDob.toLocaleDateString()} classes={'bottom-summary-field'}/>\r\n                    </div>\r\n                </div>\r\n            </div>\r\n        </div>\r\n      );\r\n\r\n      useEffect(()=>{\r\n        window.onpopstate = () => setSummary(false)\r\n    })\r\n    \r\n    // console.log(config.page.form.components.summaryModal.styles.logo, 'logo style');\r\n    // console.log(config.page.form.components.summaryModal, 'summary Modal');\r\n    // console.log(config.page.form.components.summaryModal.styles.logo.width, 'logo width');\r\n\r\n      return(\r\n        <Modal\r\n          ariaHideApp={false}\r\n          isOpen={closeModal}\r\n          onRequestClose={() => {setCloseModal(false); setSummary(false)}}\r\n        //   style={modalCustomStyles}\r\n          className='summary-modal'\r\n          style={{backgroundColor: config.page.form.components.summaryModal.styles.backgroundColor}}\r\n        >\r\n          <div id='summary-modal-content-container'>\r\n         \r\n            <img id='summary-modal-logo' style={config.page.form.styles.logos.summary} src={`${getwayApi}/api/client/logo/${formId}`} >\r\n            \r\n            </img>\r\n            \r\n              <h3 id=\"summary-modal-title\" style={config.page.form.components.summaryModal.header.styles}>{config.page.form.components.summaryModal.header.text}\r\n               \r\n            {/* <button style={{float:\"right\"}}\r\n                className=\"btn btn-outline-dark\"\r\n                //onClick={() => submitData(userInput)}\r\n                onClick= {() => {setCloseModal(false); setSummary(false)}}\r\n            >\r\n                    <span aria-hidden=\"true\">&times;</span>\r\n                </button> */}\r\n              </h3>\r\n            \r\n            {ValidationErrorPopupBody()}\r\n            \r\n            <div id='summary-submission-container'>\r\n                <p id='summary-disclaimer' style={config.page.form.components.summaryModal.disclaimer.styles}>{config.page.form.components.summaryModal.disclaimer.text}</p>\r\n                \r\n                <div id='summary-buttons'>  \r\n                    <button\r\n                        id='summary-back-button'\r\n                        className=\"summary-button\"\r\n                        style={config.page.form.styles.buttons.cancel}\r\n                        onClick= {() => {setCloseModal(false); setSummary(false)}}\r\n                        // onClick={() => submitData(userInput)}\r\n                        >\r\n                        {config.page.form.components.summaryModal.buttons.goBackLabel}\r\n                    </button>\r\n\r\n                    <button\r\n                        id='summary-submit-button'\r\n                        className=\"summary-button\"\r\n                        style={config.page.form.styles.buttons.act}\r\n                        onClick={() => {\r\n                            console.log(facValues); \r\n                            formHasCustomFacilities ? submitData(facValues) : submitData(userInput) \r\n                            console.log(userInput)}}\r\n                        // onClick={() => {console.log(userInput)}}\r\n                        >\r\n                        {config.page.form.components.summaryModal.buttons.submitLabel}\r\n                    </button>\r\n                </div>\r\n                <img src={PBV} className='pbv-image' alt=\"Powered by Verisma\" />\r\n            </div>\r\n          </div>\r\n        </Modal>\r\n    );\r\n}\r\n\r\nconst SummaryField = (props) => {\r\n    return(\r\n        <div className={`summary-field ${props.classes}`} \r\n        style={props.other ? {marginBottom: 0} : {}}\r\n        >\r\n            <p className='summary-field-label' style={props.config.page.form.components.summaryModal.label.styles}>{props.label}</p>\r\n            <span className='summary-field-value' style={props.config.page.form.components.summaryModal.value.styles}>\r\n                {props.value}\r\n            </span>\r\n        </div>\r\n    )\r\n}","import React from 'react';\r\nimport { connect } from 'formik';\r\nclass ErrorFocus extends React.Component {\r\n    isObject(value) {\r\n        return value && typeof value === 'object' && value.constructor === Object;\r\n    }\r\n    getKeysRecursively = (object) => {\r\n        if (!this.isObject(object)) {\r\n            return ''\r\n        }\r\n        const currentKey = Object.keys(object)[0]\r\n        if (!this.getKeysRecursively(object[currentKey])) {\r\n            return currentKey\r\n        }\r\n        return currentKey + \".\" + this.getKeysRecursively(object[currentKey])\r\n    }\r\n    componentDidUpdate(prevProps) {\r\n        const { isSubmitting, isValidating, errors } = prevProps.formik;\r\n        const keys = Object.keys(errors);\r\n        // console.log(prevProps)\r\n        if (keys.length > 0 && prevProps.errorToFocus) {\r\n            const selectorKey = this.getKeysRecursively(errors)\r\n            const selector = `[name=\"${selectorKey}\"] `;\r\n            \r\n            const errorElement = document.querySelector(selector);\r\n            if(errorElement){\r\n                // console.log(selector)\r\n                prevProps.setErrorToFocus(false);\r\n                errorElement.focus();\r\n            }\r\n        }\r\n    }\r\n    render() {\r\n        return null;\r\n    }\r\n}\r\nexport default connect(ErrorFocus);","import { Formik } from 'formik';\r\nimport React from 'react';\r\nimport './styles.scss'\r\n\r\nconst BaptistFormHeader = ({imgPlacement, config, getwayApi, formId}) => {\r\n    return (\r\n        <div id='logo-and-title-container'>\r\n          <img className={imgPlacement[config.page.form.logo.position]} id='form-logo' src={`${getwayApi}/api/client/logo/${formId}`} alt={config.page.form.logo.alt} style={{ ...config.page.form.styles.logos.form }} />\r\n          <h1 style={config.page.form.styles.heading} id={\"form-title\"} > {config.page.form.heading.text} </h1>\r\n          {\r\n            config.context.organization === '1007291' &&\r\n            <>\r\n            <h2 style={{...config.page.form.styles.heading, fontSize: '1.25em', marginTop:5}} className='baptist-subheader'>Attorney Requests ONLY</h2>\r\n            <h2 style={{...config.page.form.styles.heading, fontSize: '1.25em', marginTop:5}} className='baptist-subheader'>(Subpoenas and Depositions will not be accepted via this form)</h2>\r\n            </>\r\n          }\r\n        </div>\r\n    )\r\n}\r\n\r\nexport default BaptistFormHeader","import { Formik } from 'formik';\r\nimport React from 'react';\r\nimport BaptistFormHeader from '../orgs/7291/formHeader'\r\n\r\nexport const LogoAndTitle = ({imgPlacement, config, getwayApi, formId}) => {\r\n\r\n    if (config.context.organization === '1007291') { return <BaptistFormHeader imgPlacement={imgPlacement} config={config} getwayApi={getwayApi} formId={formId}/> }\r\n    \r\n    return (\r\n        <div id='logo-and-title-container'>\r\n          <img className={imgPlacement[config.page.form.logo.position]} id='form-logo' src={`${getwayApi}/api/client/logo/${formId}`} alt={config.page.form.logo.alt} style={{ ...config.page.form.styles.logos.form }} />\r\n          <h1 style={config.page.form.styles.heading} id={\"form-title\"} > {config.page.form.heading.text} </h1>\r\n        </div>\r\n    )\r\n}","import React, {useEffect, useState} from 'react';\r\nimport PBV_icon from '../assets/pbv.png'\r\nimport {getwayApi} from '../../config/Constants'\r\n\r\n\r\nexport const LoadingScreen = ({ config, formId, loadingMessage }) => {\r\n\r\n    const [delay, setDelay] = useState(false)\r\n    \r\n    useEffect(()=>{\r\n        setTimeout(()=>{setDelay(true)}, 10000)\r\n    })\r\n    \r\n    return (\r\n        <div className='loader-page' style={{ borderColor: 'red', borderWidth: 1 }}>\r\n            <div className='spinner-container'>\r\n                <div className='spinner' ></div>\r\n                <p className='loading-message'>{loadingMessage}</p>\r\n                {delay && <p className='loading-message delay-message'>We seem to have hit a snag. <strong>Try refreshing the page</strong></p>}\r\n            </div>\r\n            <img src={PBV_icon} alt=\"powered by verisma icon\" className='pbv-icon' />\r\n        </div>\r\n    );\r\n}\r\n\r\n\r\n// export const LoadingScreen = () => {\r\n//    return(\r\n//     <div style={{marginTop: \"50%\"}}>\r\n//         <h4 className=\"text-center\">Loading</h4>\r\n//         <div style={{margin: \"0 auto\"}} class=\"sk-chase\">\r\n//             <div class=\"sk-chase-dot\"></div>\r\n//             <div class=\"sk-chase-dot\"></div>\r\n//             <div class=\"sk-chase-dot\"></div>\r\n//             <div class=\"sk-chase-dot\"></div>\r\n//             <div class=\"sk-chase-dot\"></div>\r\n//             <div class=\"sk-chase-dot\"></div>\r\n//         </div>\r\n//   </div>\r\n//    );\r\n// }","import React, {useState} from 'react';\r\nimport './styles.scss'\r\nimport ErrorIcon from '../../assets/error-icon.png'\r\nimport PBVLogo from '../../assets/pbv.png'\r\n\r\nconst SubmissionErrorScreen = ({errorInfo, orgLogo, formSpec, failedSubmissionData, setFailedSubmissionData, setNextPage, setSubmissionError, formik, setShowSummary}) => {\r\n    \r\n    // const [failedSubmissionData, setFailedSubmissionData] = useState(null)\r\n    console.log(errorInfo)\r\n    \r\n    return (\r\n        <div id='submission-error-screen'>\r\n            <img className='org-logo' src={orgLogo} alt=\"organization logo\" style={{width: formSpec.page.form.styles.logos.form.width}} />\r\n            <div id='submission-error-content'>\r\n                <div id='submission-error-message'>\r\n                    <img id='error-icon'src={ErrorIcon} alt=\"error\" />\r\n                    <h1>Something went wrong</h1>\r\n                    <div>\r\n                        <p>We’re sorry, but we ran into an issue submitting your request.</p>\r\n                        <p>Our team is working to resolve the problem.</p>\r\n                    </div>\r\n                </div>\r\n                <p id='se-error-code'>Error Code: {`${errorInfo.error.response.status}789-1`}</p>\r\n                <button id='error-button' style={formSpec.page.form.styles.buttons.act} onClick={\r\n                    (e)=>{\r\n                        // set nextPage to false\r\n                        // formik.setValues(failedSubmissionData)\r\n                        failedSubmissionData && setFailedSubmissionData(failedSubmissionData)\r\n                        setNextPage(false)\r\n                        // set errorInfo to false\r\n                        setSubmissionError(false)\r\n                        setShowSummary(false)\r\n                        // set the formik values to failedSubmissionData\r\n                    }\r\n                    }>Back to Form\r\n                </button>\r\n            </div>\r\n            <img className='org-logo' src={PBVLogo} alt=\"Powered By Verisma\" style={{width: 110, marginTop: 40}} />\r\n        </div>\r\n    )\r\n}\r\n\r\nexport default SubmissionErrorScreen;","import React, { useEffect, useState } from \"react\";\r\nimport {\r\n  registerLocales as registerLocalesForDatePickers,\r\n  modalCustomStyles\r\n} from \"../../../config/Configuration\";\r\nimport { Formik } from \"formik\";\r\nimport FormikProps from \"../../../formik/refactorOut/FormikProps\";\r\nimport Modal from \"react-modal\";\r\nimport PatientInfomation from \"./sections/PatientInformationSection\";\r\nimport AuthorizationToRelease from \"./sections/AuthorizationToReleaseSection\";\r\nimport InformationToRelease from \"./sections/InformationToReleaseSection\";\r\nimport DisclosureOfSensitiveInformation from \"./sections/DisclosureOfSensitiveInformationSection\";\r\nimport PurposeOfDisclosure from \"./sections/PurposeOfDisclosureSection\";\r\nimport DeliveryMethod from \"./sections/DeliveryMethodSection\";\r\nimport DiscloseToSection from \"./sections/DiscloseToSection\";\r\nimport ReleaseDatesSection from \"./sections/ReleaseDatesSection\";\r\nimport {CaseNumberSection} from './sections/CaseNumberSection';\r\nimport {SupportingDocsSection}  from './sections/SupportingDocsSection';\r\nimport ValidationErrorPopupBody from \"./ValidationSummaryPopupBody/ValidationErrorPopupBody\";\r\nimport { mapErrorsToSection } from \"../../../functions/mapErrorsToSection\";\r\nimport { inputClasses } from \"../../../formik/refactorOut/styles\";\r\nimport { hideErrorModalAction } from \"../../../context/actions/hideErrorModalAction\";\r\nimport { showErrorModalAction } from \"../../../context/actions/showErrorModalAction\";\r\nimport {RepContactInfoSection} from './sections/RepContactInfoSection';\r\nimport {AdditionalInfoSection} from './sections/AdditionalInfoSection';\r\nimport {TempPage} from '../../../formik/refactorOut/TempPage';\r\nimport axios from \"axios\";\r\nimport {SummaryModal} from '../SummaryModal/SummaryModal';\r\n// import {LoadingScreen} from '../../components/LoadingScreen';\r\nimport { spaEndpointHost, vraUX, apiHost, getwayApi } from \"../../../config/Constants\";\r\nimport './styles/sass/requestForm.scss'\r\nimport './sections/styles/formSections.scss'\r\nimport vzaLogoHoriz from './styles/assets/verisma_logo.png';\r\nimport ErrorFocus from '../../../formik/refactorOut/ErrorFocus'\r\nimport {TriLogoAndBanner} from './orgs/7042/components'\r\nimport {LogoAndTitle} from './sections/LogoAndTitle';\r\nimport {LoadingScreen} from '../../components/LoadingScreen'\r\nimport SubmissionErrorScreen from '../SubmissionError/view';\r\nimport {convertFormData} from './Logic'\r\n\r\nregisterLocalesForDatePickers();\r\n\r\nconst DynamicForm = (props) => {\r\n  \r\n  const imgPlacement = {\r\n    center: \"center-block\",\r\n    left: \"float-left\",\r\n    right: \"float-right\"\r\n  }\r\n  \r\n  const { config, fields, validations, showErrorModal, errors } = props.formInfo;\r\n  const { dispatch } = props;\r\n  const [nextPage, setNextPage] = useState(false)\r\n  const [apiResponse, setApiResponse] = useState(null)\r\n  const [showSummary, setShowSummary] = useState(false);\r\n  const [errorTofocus, setErrorTofocus] = useState(false);\r\n  const [submissionError, setSubmissionError] = useState(false)\r\n  const [failedSubmissionData, setFailedSubmissionData] = useState(null)\r\n  const [localFormik, setLocalFormik] = useState(null)\r\n  const session = props.session;\r\n  const dbFormSpec = config;\r\n\r\n  const tripatiteOrg = config.context.organization === '1007042' || config.context.organization === '1007239' || config.context.organization === '1007101' || config.context.organization === '1006987';\r\n  const THRForm = config.context.organization === '1007451'\r\n//api/client/logo/\r\n//console.log(\"Dynamic from:\");\r\n//console.log(props.form);\r\n//console.log(formSpecJSON);\r\n\r\n\r\n// const config = formSpecJSON;\r\n\r\nconst resetSubmissionData = (formik) => {\r\n  const FSD = failedSubmissionData\r\n  setFailedSubmissionData(false)\r\n  formik.setValues(failedSubmissionData); \r\n}\r\n\r\nuseEffect(() => {\r\n    document.title = config.page.title;\r\n  }, [config]);\r\n\r\n  const submitFileData = (url, session) => {\r\n    return async (file) => {\r\n      const fileReader = new FileReader();\r\n\r\n      function getByteArray(file) {\r\n        return new Promise(function(resolve, reject) {\r\n            fileReader.readAsArrayBuffer(file);\r\n            fileReader.onload = function(ev) {\r\n                const array = new Uint8Array(ev.target.result);\r\n                const fileByteArray = [];\r\n                for (let i = 0; i < array.length; i++) {\r\n                    fileByteArray.push(array[i]);\r\n                }\r\n                resolve(fileByteArray);  // successful\r\n            }\r\n            fileReader.onerror = reject; // call reject if error\r\n        })\r\n      }\r\n    \r\n      let submissionPayload = new FormData();\r\n      submissionPayload.append(\"fileName\", file.name);\r\n      submissionPayload.append(\"contentType\", file.type);\r\n      submissionPayload.append(\"sessionId\", session);\r\n      submissionPayload.append(\"fileByte\",  file);\r\n      \r\n        await axios\r\n          .post(`${url}/api/session/supportingdoc/upload`, submissionPayload, {headers: {'Content-Type': 'multipart/form-data'}})\r\n          .then(res => {\r\n            // console.log(res);\r\n            \r\n          })\r\n          .catch(err => {\r\n            if(err.response !== undefined)\r\n              console.log(err.response)            \r\n          });\r\n    }\r\n  }\r\n\r\n  const deleteFileData = (url, session) => {\r\n    return async (filename) => {\r\n      //api/session/supportingdoc/remove/{sessionId}/{filename}\r\n\r\n      await axios\r\n      .delete(`${url}/api/session/supportingdoc/remove/${session}/${filename}`)\r\n      .then(res => {\r\n        // console.log(res);\r\n        \r\n      })\r\n      .catch(err => {\r\n        if(err.response !== undefined)\r\n          console.log(err.response)            \r\n      });\r\n\r\n    }\r\n  }\r\n\r\n\r\n  const submitUserData = (url, session, esign, organization, formid) => {\r\n    return async (formData, actions) => {\r\n        setNextPage(true);\r\n        formData = convertFormData(formData, organization, dbFormSpec, localFormik)\r\n        let submissionPayload;\r\n        let fileData;\r\n        let subData = formData;\r\n        \r\n        const config = {headers: {'content-type': 'multipart/form-data'}}\r\n        subData.esign = esign;\r\n        subData.releaseFromDate = subData.releaseFromDate.toDateString();\r\n        subData.releaseToDate = subData.releaseToDate.toDateString();\r\n        subData.patientInfoDob = subData.patientInfoDob.toDateString();\r\n        subData.session = session;\r\n        subData.organizationId = organization;\r\n        subData.formId = formid;\r\n\r\n        if(subData.supportingDoc){\r\n          submissionPayload = new FormData();\r\n          let counter = 1;\r\n          fileData = subData.supportingDoc.map(x => {\r\n            submissionPayload.append(`file${counter}`, x)\r\n            counter++;\r\n            return {\r\n              name: x.name,\r\n              type: x.type,\r\n              size: x.size\r\n            }\r\n          });\r\n          \r\n         \r\n          subData.fileData = fileData;\r\n\r\n          delete subData.supportingDoc;\r\n          \r\n          submissionPayload.append('userData', JSON.stringify(subData));\r\n          \r\n          \r\n        }else{\r\n          submissionPayload = {data: JSON.stringify(subData)}\r\n          config = {headers: {'content-type': 'application/json'}}\r\n        }\r\n\r\n        // create file data object\r\n        // list of files\r\n        const apiUrl = `${url}/api/submission`;\r\n        \r\n        await axios\r\n          .post(apiUrl, submissionPayload, config)\r\n          .then(res => {\r\n            window.location = res.data.url;\r\n            \r\n          })\r\n          .catch(err => {\r\n            if(err.response !== undefined)\r\n              console.log(err.response)\r\n              setFailedSubmissionData(formData)\r\n              setSubmissionError({error: err})\r\n            \r\n            // TODO; map infrastructure error to domain error\r\n            \r\n          });\r\n    }\r\n}\r\n\r\nif(!nextPage){\r\n  return (\r\n    <div id='request-form'>\r\n        {/* // ================================================== Error Validation Modal ================================================== */}\r\n        <Modal\r\n          ariaHideApp={false}\r\n          isOpen={showErrorModal}\r\n          onRequestClose={() => dispatch(hideErrorModalAction())}\r\n          style={modalCustomStyles}\r\n        >\r\n          <div id='validation-modal-container'>\r\n            <div id='validation-modal-heading' style={config.page.form.styles.validationModal.heading}>\r\n              {config.page.form.components.validationModal.headingText}\r\n            </div>\r\n            \r\n            <ValidationErrorPopupBody\r\n              messages={config.page.form.components.validationModal}\r\n              styles={config.page.form.styles.validationModal}\r\n              errors={errors}\r\n            />\r\n            \r\n            <div style={{ padding: 20 }} className=\"text-center\">\r\n              <button\r\n                className=\"btn btn-light \"\r\n                onClick={() => {\r\n                  \r\n                  dispatch(hideErrorModalAction())}}\r\n              >\r\n                {config.page.form.components.validationModal.okButtonText}\r\n              </button>\r\n            </div>\r\n          </div>\r\n        </Modal>\r\n        \r\n        {/* {config.page.form.styles.externalStyles &&\r\n          <style>\r\n            {config.page.form.styles.externalStyles.map(style => {\r\n              return `@import url('${style.importUrl}');`;\r\n            })}\r\n          </style>\r\n        } */}\r\n        \r\n        {/*================================================== Logo & Title Section ================================================== */}\r\n        \r\n\r\n      {tripatiteOrg ?\r\n        <TriLogoAndBanner config={config} getwayApi={getwayApi} formId={props.formId} imgPlacement={imgPlacement}/>\r\n        :\r\n        <LogoAndTitle imgPlacement={imgPlacement} config={config} getwayApi={getwayApi} formId={props.formId}/>\r\n      }\r\n        \r\n        {/*================================================== Form ================================================== */}\r\n        <Formik\r\n          initialValues={fields}\r\n          validationSchema={validations}\r\n          onSubmit={(values, {setStatus, setErrors}) => {\r\n            dispatch(hideErrorModalAction())\r\n            window.history.pushState({summary: true}, window.location.href) \r\n            return setShowSummary(true)\r\n            // TODO; initialize some form of processing indicator\r\n            // TODO; persist user state (key, value, type) and route to the request summary page\r\n            // e.g. { \"key\" : \"patientInfoFirstName\", \"value\" : \"John\", \"type\" : \"Textbox\"}\r\n          }}\r\n        >\r\n          {formik => {\r\n            const { isValid, errors, dirty, handleSubmit } = formik;\r\n            !localFormik && setLocalFormik(formik)\r\n            // failedSubmissionData && resetSubmissionData(formik)\r\n            return (\r\n              <form id='form-sections'\r\n                onSubmit={e => {\r\n                  e.preventDefault();\r\n                  isValid ?\r\n                    handleSubmit(e)\r\n                    :\r\n                    setErrorTofocus(true);\r\n                    dispatch( showErrorModalAction(mapErrorsToSection(config, errors)) );\r\n                  // TODO; trigger UI validation messages on failed validation (touched/errors) without adding handleSubmit(e)\r\n                }}\r\n              >\r\n                  <RepContactInfoSection formik={formik} inputClasses={inputClasses} template={{...config.page.form.sections.repContactInfoSection, styles: { ...config.page.form.styles }}} styles={config.page.form.styles} orgId={config.context.organization} selectorMatch={config.page.form.components.selectorMatch} config={config} />\r\n                  <PatientInfomation formik={formik} inputClasses={inputClasses} template={{ ...config.page.form.sections.patientInformationSection, styles: { ...config.page.form.styles }, locale: config.page.locale }} styles={config.page.form.styles} config={config} />\r\n                  <InformationToRelease formik={formik} inputClasses={inputClasses} template={{ ...config.page.form.sections.informationToReleaseSection, styles: { ...config.page.form.styles }, locale: config.page.locale }} config={config}/>\r\n                  <SupportingDocsSection formik={formik} template={{ section: config.page.form.sections.supportingDocsSection, styles:{ ...config.page.form.styles } }} fileSubmissionAction={submitFileData(getwayApi, session)} fileDeletionAction={deleteFileData(getwayApi, session)} config={config}/>\r\n                  <AuthorizationToRelease formik={formik} inputClasses={inputClasses} config={config} template={{ ...config.page.form.sections.authorizationToReleaseSection, styles: { ...config.page.form.styles } }} />\r\n                  {THRForm && <DeliveryMethod formik={formik} inputClasses={inputClasses} template={{ ...config.page.form.sections.deliveryMethodSection, styles: { ...config.page.form.styles } }} config={config}/>}\r\n                  <DiscloseToSection formik={formik} inputClasses={inputClasses} template={{ ...config.page.form.sections.discloseToSection, styles: { ...config.page.form.styles } }} config={config}/>\r\n                  <DisclosureOfSensitiveInformation formik={formik} inputClasses={inputClasses} template={{ ...config.page.form.sections .disclosureOfSensitiveInformation, styles: { ...config.page.form.styles } }} config={config}/>\r\n                  <PurposeOfDisclosure formik={formik} inputClasses={inputClasses} template={{ ...config.page.form.sections.purposeOfDisclosureSection, styles: { ...config.page.form.styles } }} config={config}/>\r\n                  <AdditionalInfoSection formik={formik} inputClasses={inputClasses} config={config} template={{ ...config.page.form.sections.additionalInfoSection, styles: { ...config.page.form.styles }}} />\r\n                  <ReleaseDatesSection formik={formik} inputClasses={inputClasses} template={{ ...config.page.form.sections.releaseDatesSection, styles: { ...config.page.form.styles } }} config={config} supportingDocsSection={config.page.form.sections.supportingDocsSection} dirty={dirty}/>\r\n                \r\n                {/*================================================== Submit & Cancel Buttons ==================================================*/}\r\n                \r\n                  {/* <div id='submit-button-section' className='form-section'>\r\n                    <button disabled={!dirty} style={config.page.form.styles.buttons.act} id='submit-button' type=\"submit\" > {config.page.form.components.submitButton.text} </button>\r\n                  </div>   */}\r\n                  {/* TODO; remove when date picker/formik issue is resolved */}\r\n               \r\n                {/*================================================== Summary Modal ==================================================*/}\r\n                \r\n                {showSummary && <SummaryModal formik={formik} formId={props.formId} config={config} userInput={formik.values} submitData={submitUserData(apiHost, session, props.esign, config.context.organization, props.formId)} isModelOpen={true} setSummary={setShowSummary}/>}\r\n                <ErrorFocus {...formik} errorToFocus={errorTofocus} setErrorToFocus={setErrorTofocus}/>\r\n              </form>\r\n            );\r\n          }}\r\n        </Formik>\r\n      </div>\r\n    );\r\n    } else if (nextPage && !submissionError) {\r\n      return (\r\n      <LoadingScreen loadingMessage={(props.formInfo.fields.discloseToPhone === \"\") ? \"Loading the form. We'll be just a moment.\" : \"Finalizing your request. We'll be just a moment.\"}/>\r\n      )\r\n    }\r\n    else{\r\n      return (\r\n        <SubmissionErrorScreen errorInfo={submissionError} orgLogo={`${getwayApi}/api/client/logo/${props.formId}`} formSpec={config} failedSubmissionData={failedSubmissionData} setFailedSubmissionData={setFailedSubmissionData} setNextPage={setNextPage} setSubmissionError={setSubmissionError} formik={localFormik} setShowSummary={setShowSummary}/>\r\n      )\r\n    }\r\n};\r\n\r\nexport default DynamicForm;\r\n","export const convertFormData = (formData, org, formSpec, formik) => {\r\n    \r\n    // console.log(formik)\r\n    const pdf_releaseItemsList = []\r\n    formData.infoToReleaseGroup.forEach((releaseCode, index) => {\r\n        formSpec.page.form.sections.informationToReleaseSection.fields.infoToReleaseGroup.entries.forEach((releaseItemEntry, index) => {\r\n            if (releaseCode === releaseItemEntry.key) {\r\n                pdf_releaseItemsList.push(releaseItemEntry.value)\r\n            }\r\n        })\r\n    })\r\n    if (formData.infoToReleaseGroupOther) {\r\n        pdf_releaseItemsList.push(formData.infoToReleaseGroupOther)\r\n    }\r\n    // formik.setFieldValue(\"pdf_releaseItemsList\", pdf_releaseItemsList)\r\n    formData.pdf_releaseItemsList = pdf_releaseItemsList.join('  |  ');\r\n    formData.pdf_facilityList = formData.facilitiesGroup.join(', ').concat((formData.otherFac) ? ', ' + formData.otherFac : '')\r\n    \r\n    if (org === '1007307') {\r\n        let carbonFacilitiesGroupFormat = []\r\n        formData.facilitiesGroup.forEach((facility, index) => {\r\n            let carbonFacility = \"\"\r\n            for (let i = 1; i < 5; i++) {\r\n                if (facility[`customFacName${i}`] || facility[`customFacDoctor${i}`]) {\r\n                    // carbonFacility += ` ${i > 1 ? '|' : ''} ${facility[`customFacName${i}`] ? 'Facililty: ' + facility[`customFacName${i}`] + ',' : ''} ${facility[`customFacAddress${i}`] ? 'Address: ' + facility[`customFacAddress${i}`] + ',' : ''} ${facility[`customFacDoctor${i}`] ? 'Physician: ' + facility[`customFacDoctor${i}`] : ''}`\r\n                    carbonFacility += `${\r\n                        i > 1 && (facility[`customFacName${i}`] || facility[`customFacAddress${i}`] || facility[`customFacDoctor${i}`])\r\n                          ? '    |    '\r\n                          : ''\r\n                      }${facility[`customFacName${i}`] ? 'Facility: ' + facility[`customFacName${i}`] : ''}${\r\n                        facility[`customFacAddress${i}`] ? ', Address: ' + facility[`customFacAddress${i}`] : ''\r\n                      }${facility[`customFacDoctor${i}`] ? ', Physician: ' + facility[`customFacDoctor${i}`] : ''}`;\r\n                      \r\n                }\r\n            }\r\n            carbonFacilitiesGroupFormat.push(carbonFacility)\r\n        })\r\n        \r\n        console.log(carbonFacilitiesGroupFormat)\r\n        formData.facilitiesGroup = carbonFacilitiesGroupFormat;\r\n        formData.facilitiesList = carbonFacilitiesGroupFormat.join();\r\n    }\r\n    else if (org === '1007342' || org === '1007229' || org === '1007042' || org === '1007239' || org === '1007101') {\r\n        \r\n        let convertedFacilitiesGroup = [`${formData.facilitiesGroup}`]\r\n        \r\n\r\n        formData.facilitiesObj = formData.facilitiesGroup;\r\n        formData.facilitiesGroup = convertedFacilitiesGroup;\r\n        console.log(formData.facilitiesGroup)\r\n    }\r\n    else {\r\n    }\r\n    return formData\r\n    \r\n    \r\n\r\n}","import {HIDE_ERROR_MODAL} from './actionTypes';\r\n\r\nexport const hideErrorModalAction = () => {\r\n  return {\r\n    type: HIDE_ERROR_MODAL,\r\n    payload: {      \r\n      showErrorModal: false\r\n    }\r\n  }\r\n}","export const INITIALIZE = \"INITIALIZE\";\r\nexport const SHOW_ERROR_MODAL = \"SHOW_ERROR_MODAL\";\r\nexport const HIDE_ERROR_MODAL = \"HIDE_ERROR_MODAL\";\r\n\r\n\r\n","import {SHOW_ERROR_MODAL} from './actionTypes';\r\n\r\nexport const showErrorModalAction = (errors) => {\r\n  return {\r\n    type: SHOW_ERROR_MODAL,\r\n    payload: {\r\n      errors,\r\n      showErrorModal: true\r\n    }\r\n  }\r\n}\r\n\r\n","import {\r\n  INITIALIZE,\r\n  SHOW_ERROR_MODAL,\r\n  HIDE_ERROR_MODAL\r\n} from \"./actions/actionTypes\";\r\n\r\nexport const formReducer = (state = {}, action) => {\r\n  switch (action.type) {\r\n    case INITIALIZE: {\r\n      return { ...state, ...action.payload };\r\n    }\r\n    case SHOW_ERROR_MODAL: {\r\n      return { ...state, ...action.payload };\r\n    }\r\n    case HIDE_ERROR_MODAL: {\r\n      return { ...state, ...action.payload };\r\n    }\r\n\r\n    default:\r\n      return state;\r\n  }\r\n};\r\n","import React, {useState, useEffect} from 'react';\r\nimport axios from \"axios\";\r\nimport './styles/sass/captcha.scss'\r\nimport { spaEndpointHost, vraUX, apiHost, getwayApi, captchaUrl } from \"../../../config/Constants\";\r\nimport {inputClasses} from '../../../formik/refactorOut/styles'\r\nimport PBV_icon from '../../assets/pbv.png'\r\n\r\nexport const CaptchaContainer = ({setCaptcha, form, formId}) => {\r\n    const [captchaRespObj, setCaptchaRespObj] = useState(null);\r\n    const [userCatchaInput, setUserCatchaInput] = useState('');\r\n    const [errorState, setErrorState] = useState(false);\r\n\r\n    \r\n\r\n    useEffect(() => {\r\n        const doFetch = async () => {\r\n    \r\n          try {\r\n            // NOTE; axios is currently pointing to file system json file.  Use the router match prop to construct the appropriate url\r\n            // to retrieve the configuration (and pesisted form state specific to the session if it is a back request)\r\n            // simulating userState example below\r\n            \r\n            \r\n    \r\n            await axios\r\n            .get(`${captchaUrl}/api/captcha`)\r\n              .then(res => {\r\n                setCaptchaRespObj(res.data)\r\n                \r\n              })\r\n              .catch(err => {\r\n               \r\n              });\r\n            } catch (error) {\r\n              console.log(error)\r\n          }\r\n        };\r\n    \r\n        doFetch();\r\n      }, [false]);\r\n\r\n      const submitCaptchaData = async () => {\r\n         \r\n    \r\n        try {\r\n          // NOTE; axios is currently pointing to file system json file.  Use the router match prop to construct the appropriate url\r\n          // to retrieve the configuration (and pesisted form state specific to the session if it is a back request)\r\n          // simulating userState example below\r\n  \r\n          await axios\r\n          .post(`${captchaUrl}/api/captcha/${captchaRespObj.id}/match/${userCatchaInput}`)\r\n            .then(res => {\r\n                // console.log(res.data)\r\n              setCaptcha(res.data)\r\n              if(!res.data){\r\n                console.log(\"bad captcha\")\r\n                setErrorState(true)\r\n              }\r\n             \r\n            })\r\n            .catch(err => {\r\n               console.log(\"bad captcha\")\r\n                setErrorState(true)\r\n               \r\n            });\r\n          } catch (error) {\r\n            console.log(\"bad captcha\")\r\n            setErrorState(true)\r\n        }\r\n      };\r\n\r\n      // console.log(form, 'formCaptcha')\r\n      \r\n      if(form === null){\r\n        return <p></p>\r\n      }\r\n      const formStyles = form.config.page.form.styles\r\n      const formSpec = form.config.page.form\r\n      \r\n      \r\n  return (\r\n    <div id='captcha-page'>\r\n      <div id='captcha-container' className=\"\">\r\n        <img id='captcha-logo' src={`${getwayApi}/api/client/logo/${formId}`} style={form.config.page.form.styles.logos.captcha} />\r\n        <div id='security-check-sentence'><p style={{ ...formSpec.components.captcha.header.styles }}>{formSpec.components.captcha.header.text}</p> </div>\r\n        {\r\n          captchaRespObj != null &&\r\n          <div id='captcha-content'>            \r\n            <p id='security-check-subtext' style={{ ...formStyles.label, marginBottom: 30 }}>{formSpec.components.captcha.instruction}</p>\r\n            <img id='captcha-image' src={`data:image/png;base64, ${captchaRespObj.image}`}></img>\r\n\r\n            <input id='captcha-input'\r\n              onKeyDown={(e) => { e.keyCode === 13 && submitCaptchaData() }}\r\n              placeholder={formSpec.components.captcha.textBoxHint}\r\n              onChange={\r\n                e => { setUserCatchaInput(e.target.value); }\r\n              }\r\n            >\r\n            </input>\r\n            {errorState && <small>Invalid Capatcha</small>}\r\n            <button\r\n              id='captcha-button'\r\n              style={formStyles.buttons.act}\r\n              onClick={e => submitCaptchaData()}\r\n            >\r\n              {formSpec.components.captcha.buttonText}\r\n            </button>\r\n          </div>\r\n        }\r\n\r\n      </div>\r\n      <img src={PBV_icon} alt=\"Powered by Verisma\" className='pbv-icon' />\r\n    </div>\r\n\r\n  );\r\n}\r\n\r\n\r\n","import * as moment from \"moment\";\r\n\r\nconst phoneVals = {\r\n    noDash: /^\\d\\d\\d\\d\\d\\d\\d\\d\\d\\d$/,\r\n    noDash1: /^\\d\\d\\d\\d\\d\\d\\d\\d\\d\\d\\sx\\d$/,\r\n    noDash2: /^\\d\\d\\d\\d\\d\\d\\d\\d\\d\\d\\sx\\d\\d$/,\r\n    noDash3: /^\\d\\d\\d\\d\\d\\d\\d\\d\\d\\d\\sx\\d\\d\\d$/,\r\n    \r\n    dash: /^\\d\\d\\d-\\d\\d\\d-\\d\\d\\d\\d$/,\r\n    dash1: /^\\d\\d\\d-\\d\\d\\d-\\d\\d\\d\\d\\sx\\d$/,\r\n    dash2: /^\\d\\d\\d-\\d\\d\\d-\\d\\d\\d\\d\\sx\\d\\d$/,\r\n    dash3: /^\\d\\d\\d-\\d\\d\\d-\\d\\d\\d\\d\\sx\\d\\d\\d$/,\r\n}\r\n\r\n// export const phoneRegex = /^(\\+\\d{1,2}\\s)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$/;\r\nexport const phoneRegex = new RegExp(phoneVals.dash.source + '|' + phoneVals.dash1.source + '|' +  phoneVals.dash2.source + '|' +  phoneVals.dash3.source);\r\nexport const faxRegex = new RegExp(phoneVals.dash.source + '|' + phoneVals.dash1.source + '|' +  phoneVals.dash2.source + '|' +  phoneVals.dash3.source);\r\nexport const zipRegex = /^([0-9]{5})(?:[-\\s]*([0-9]{4}))?$/;\r\nexport const dateCantBeInFuture = moment().add(0, \"days\");\r\nexport const minimumYearsOld = (years) => moment().add(years, \"years\");\r\nexport const maxYearAgo = years => moment().subtract(years, \"years\");\r\nexport const dateIsBefore = (before, after) => moment(before).isSameOrBefore(after);\r\n\r\n\r\n// Acceptable phone formats\r\n// 1234567890\r\n// 1234567890 x1\r\n// 1234567890 x12\r\n// 1234567890 x123\r\n\r\n// 123-456-7890\r\n// 123-456-7890 x1\r\n// 123-456-7890 x12\r\n// 123-456-7890 x123\r\n","import * as Yup from \"yup\";\r\n\r\nimport {\r\n  phoneRegex,\r\n  zipRegex,\r\n  dateCantBeInFuture,\r\n  minimumYearsOld,\r\n  maxYearAgo,\r\n} from \"./validationFunctions\";\r\n\r\nconst whichFieldsAreActive = (fields) => {\r\n  const fieldsToValidate = {};\r\n\r\n  if(fields.patientInfoFirstName.active){\r\n    fieldsToValidate.patientInfoFirstName = Yup.string()\r\n      .max(\r\n        fields.patientInfoFirstName.validations.maxLength.value,\r\n        fields.patientInfoFirstName.validations.maxLength.message\r\n      )\r\n      .required(\r\n        () =>\r\n          fields.patientInfoFirstName.validations.required\r\n            .value &&\r\n          fields.patientInfoFirstName.validations.required.message\r\n      )\r\n  }\r\n  if(fields.patientInfoLastName.active){\r\n    fieldsToValidate.patientInfoLastName = Yup.string()\r\n      .max(\r\n        fields.patientInfoLastName.validations.maxLength.value,\r\n        fields.patientInfoLastName.validations.maxLength.message\r\n      )\r\n      .required(\r\n        () =>\r\n          fields.patientInfoLastName.validations.required.value &&\r\n          fields.patientInfoLastName.validations.required.message\r\n      )\r\n  }\r\n\r\n  if(fields.patientInfoDob.active){\r\n    fieldsToValidate.patientInfoDob =Yup.date()\r\n      .required(\r\n        () =>\r\n          fields.patientInfoDob.validations.required.value &&\r\n          fields.patientInfoDob.validations.required.message\r\n      )\r\n      // .max(\r\n      //   dateCantBeInFuture,\r\n      //   section.fields.patientInfoDob.validations.notFutureDate.message\r\n      // )\r\n    \r\n      .test(\r\n        \"patientInfoDob\",\r\n        fields.patientInfoDob.validations.maxYearsAgo.message,\r\n        function(date){\r\n          var todaysDate = new Date();\r\n          var enteredDate = new Date(date);\r\n          return enteredDate.getFullYear() >= 1900;\r\n        }\r\n      ).nullable()\r\n      .test(\r\n        \"patientInfoDob\",\r\n        fields.patientInfoDob.validations.notFutureDate.message,\r\n        function(date){\r\n          var todaysDate = new Date();\r\n          var enteredDate = new Date(date);\r\n          return todaysDate > enteredDate;\r\n        }\r\n      )\r\n  }\r\n\r\n  if(fields.patientInfoOtherName.active){\r\n    fieldsToValidate.patientInfoOtherName = Yup.string()\r\n      .required(\r\n        () =>\r\n          fields.patientInfoOtherName.validations.required\r\n            .value &&\r\n          fields.patientInfoOtherName.validations.required.message\r\n      )\r\n      .max(\r\n        40,\r\n        fields.patientInfoOtherName.validations.maxLength.message\r\n      )\r\n  }\r\n  if(fields.patientInfoMrn.active){\r\n    fieldsToValidate.patientInfoMrn = Yup.string()\r\n      .required(\r\n        () =>\r\n          fields.patientInfoMrn.validations.required.value &&\r\n          fields.patientInfoMrn.validations.required.message\r\n      )\r\n      .max(\r\n        fields.patientInfoMrn.validations.maxLength.value,\r\n        fields.patientInfoMrn.validations.maxLength.message\r\n      )\r\n  \r\n  }\r\n\r\n\r\n  if(fields.patientInfoEmail.active){\r\n    fieldsToValidate.patientInfoEmail = Yup.string()\r\n      .required(\r\n        () =>\r\n          fields.patientInfoEmail.validations.required.value &&\r\n          fields.patientInfoEmail.validations.required.message\r\n      )\r\n      .email(\r\n        fields.patientInfoEmail.validations.validEmail.message\r\n      )\r\n      .test(\r\n        \"emailValidatation\",\r\n        fields.patientInfoEmail.validations.validEmail.message,\r\n        function(email) {\r\n          return /^\\w+@[a-zA-Z_]+?\\.[a-zA-Z]{2,3}$/.test(email)\r\n        }\r\n      )\r\n  }\r\n  if(fields.patientInfoEmailConfirmation.active){\r\n    fieldsToValidate.patientInfoEmailConfirmation = Yup.string()\r\n      .required(\r\n        () =>\r\n          fields.patientInfoEmailConfirmation.validations.required\r\n            .value &&\r\n          fields.patientInfoEmailConfirmation.validations.required\r\n            .message\r\n      )\r\n      .email(\r\n        fields.patientInfoEmailConfirmation.validations.validEmail\r\n          .message\r\n      )\r\n      .test(\r\n        \"emailValidatation\",\r\n        fields.patientInfoEmail.validations.validEmail.message,\r\n        function(email) {\r\n          return /^\\w+@[a-zA-Z_]+?\\.[a-zA-Z]{2,3}$/.test(email)\r\n        }\r\n      )\r\n      .oneOf(\r\n        [\r\n          Yup.ref(\r\n            fields.patientInfoEmailConfirmation.validations\r\n              .mustMatch.value\r\n          ),\r\n          null\r\n        ],\r\n        fields.patientInfoEmailConfirmation.validations.mustMatch\r\n          .message\r\n      )\r\n  }\r\n\r\n  if(fields.patientInfoPhone.active){\r\n    fieldsToValidate.patientInfoPhone =  Yup.string()\r\n      .required(\r\n        () =>\r\n          fields.patientInfoPhone.validations.required.value &&\r\n          fields.patientInfoPhone.validations.required.message\r\n      )\r\n      .max(\r\n        fields.patientInfoPhone.validations.maxLength\r\n          .value,\r\n        fields.patientInfoPhone.validations.maxLength\r\n          .message\r\n      )\r\n      .matches(\r\n        phoneRegex,\r\n        fields.patientInfoPhone.validations.validPhone.message\r\n      )\r\n  \r\n  }\r\n\r\n  if(fields.patientInfoPhoneConfirmation.active){\r\n    fieldsToValidate.patientInfoPhoneConfirmation = Yup.string()\r\n      .required(\r\n        () =>\r\n          fields.patientInfoPhoneConfirmation.validations.required\r\n            .value &&\r\n          fields.patientInfoPhoneConfirmation.validations.required\r\n            .message\r\n      )\r\n      .max(\r\n        fields.patientInfoPhoneConfirmation.validations.maxLength\r\n          .value,\r\n        fields.patientInfoPhoneConfirmation.validations.maxLength\r\n          .message\r\n      )\r\n      .matches(\r\n        phoneRegex,\r\n        fields.patientInfoPhoneConfirmation.validations.validPhone\r\n          .message\r\n      )\r\n      .oneOf(\r\n        [\r\n          Yup.ref(\r\n            fields.patientInfoPhoneConfirmation.validations\r\n              .mustMatch.value\r\n          ),\r\n          null\r\n        ],\r\n        fields.patientInfoPhoneConfirmation.validations.mustMatch\r\n          .message\r\n      )\r\n  \r\n  }\r\n\r\n  if(fields.patientInfoAddressLine1.active){\r\n    fieldsToValidate.patientInfoAddressLine1 = Yup.string()\r\n      .required(\r\n        () =>\r\n          fields.patientInfoAddressLine1.validations.required\r\n            .value &&\r\n          fields.patientInfoAddressLine1.validations.required\r\n            .message\r\n      )\r\n      .max(\r\n        fields.patientInfoAddressLine1.validations.maxLength\r\n          .value,\r\n        fields.patientInfoAddressLine1.validations.maxLength\r\n          .message\r\n      )\r\n  \r\n  }\r\n\r\n  if(fields.patientInfoAddressLine2.active){\r\n    fieldsToValidate.patientInfoAddressLine2 = Yup.string()\r\n      .required(\r\n        () =>\r\n          fields.patientInfoAddressLine2.validations.required\r\n            .value &&\r\n          fields.patientInfoAddressLine2.validations.required\r\n            .message\r\n      )\r\n      .max(\r\n        fields.patientInfoAddressLine2.validations.maxLength\r\n          .value,\r\n        fields.patientInfoAddressLine2.validations.maxLength\r\n          .message\r\n      )\r\n  \r\n  }\r\n\r\n  \r\n  if(fields.patientInfoCity.active){\r\n    fieldsToValidate.patientInfoCity = Yup.string()\r\n      .required(\r\n        () =>\r\n          fields.patientInfoCity.validations.required.value &&\r\n          fields.patientInfoCity.validations.required.message\r\n      )\r\n      .max(\r\n        fields.patientInfoCity.validations.maxLength.value,\r\n        fields.patientInfoCity.validations.maxLength.message\r\n      )\r\n  \r\n  }\r\n\r\n  if(fields.patientInfoState.active){\r\n    fieldsToValidate.patientInfoState =  Yup.string()\r\n      .required(\r\n        () =>\r\n          fields.patientInfoState.validations.required.value &&\r\n          fields.patientInfoState.validations.required.message\r\n      )\r\n      .max(\r\n        fields.patientInfoState.validations.maxLength.value,\r\n        fields.patientInfoState.validations.maxLength.message\r\n      )\r\n  \r\n  }\r\n\r\n  if(fields.patientInfoZip.active){\r\n    fieldsToValidate.patientInfoZip = Yup.string()\r\n      .required(\r\n        () =>\r\n          fields.patientInfoZip.validations.required.value &&\r\n          fields.patientInfoZip.validations.required.message\r\n      )\r\n      .max(\r\n        fields.patientInfoZip.validations.maxLength.value,\r\n        fields.patientInfoZip.validations.maxLength.message\r\n      )\r\n      .matches(\r\n        zipRegex,\r\n        fields.patientInfoZip.validations.validZipcode.message\r\n      )\r\n  \r\n  }\r\n\r\n  return fieldsToValidate;\r\n}\r\n\r\nexport const patientInformationValidations = section => {\r\n    if (section.active) {\r\n    return Yup.object().shape(       \r\n      whichFieldsAreActive(section.fields)\r\n      \r\n    );\r\n  }  \r\n};\r\n","import * as Yup from \"yup\";\r\n\r\nexport const authorizationToReleaseValidations = (section, formSpec) => {\r\n  console.log(formSpec)\r\n  \r\n  if (section.active) {\r\n    return Yup.object().shape({    \r\n      \r\n      facilitiesGroup: Yup.string().when(\"physiciansGroup\", {\r\n        is: val => val.length === 0,\r\n        then: Yup.string().required(\r\n          section.fields.facilitiesGroup.validations.required\r\n            .message\r\n        )\r\n      }),\r\n\r\n      facilitySelected: (formSpec.context.organization.includes('7229') || formSpec.context.organization.includes('7342') || formSpec.context.organization.includes('7307')) && Yup.string()\r\n      .required(\r\n        () =>\r\n          true &&\r\n          'Please provide the name and address of at least one medical provider'\r\n      ),\r\n      \r\n      allOrNameGroup: Yup.string().when(\"physiciansGroup\", {\r\n        is: val => val.length === 1,\r\n        then: Yup.string().required(\r\n          section.fields.allOrNameGroup.validations.required\r\n            .message\r\n        )\r\n      }),\r\n      namedPhysicians: Yup.string().when(\"allOrNameGroup\", {\r\n        is: val => val === \"namePhysicians\",\r\n        then: Yup.string().required(\r\n          section.fields.namedPhysicians.validations.required\r\n            .message\r\n        )\r\n      }),\r\n\r\n      otherFac: Yup.string()\r\n        .required(\r\n          () =>\r\n          formSpec.context.organization.includes('7451') &&\r\n            'Please provide the name of a facility in the text box'\r\n        )\r\n        .test(\r\n          \"otherFac\",\r\n          section.fields.otherFac.validations.required.message,\r\n          function(item) {\r\n           \r\n            const facs  = this.parent.facilitiesGroup.split(',');\r\n            if(facs.includes(\"otherFac\"))\r\n              return item && facs.includes(\"otherFac\");\r\n            else return facs.length > 0;\r\n          }\r\n        )\r\n        .max(\r\n          section.fields.otherFac.validations.maxLength\r\n            .value,\r\n          section.fields.otherFac.validations.maxLength\r\n            .message\r\n        )\r\n    });\r\n  }\r\n};\r\n","import * as Yup from \"yup\";\r\nimport {\r\n  dateCantBeInFuture,\r\n  dateIsBefore\r\n} from \"./validationFunctions\";\r\n\r\nexport const informationToReleaseValidations = section => {\r\n  if (section.active) {\r\n    return Yup.object().shape({\r\n      releaseFromDate: Yup.date()\r\n        .required(\r\n          () =>\r\n            section.fields.releaseFromDate.validations.required.value &&\r\n            section.fields.releaseFromDate.validations.required.message\r\n        ).nullable()\r\n        .max(\r\n          dateCantBeInFuture,\r\n          section.fields.releaseFromDate.validations.notFutureDate.message\r\n        )\r\n        .test(\r\n          \"releaseFromDate\",\r\n          section.fields.releaseFromDate.validations.notFutureDate.message,\r\n          function(date){\r\n            var todaysDate = new Date();\r\n            var enteredDate = new Date(date);\r\n            return todaysDate > enteredDate;\r\n          }\r\n        ),\r\n      releaseToDate: Yup.date()\r\n        .required(\r\n          () =>\r\n            section.fields.releaseToDate.validations.required.value &&\r\n            section.fields.releaseToDate.validations.required.message\r\n        ).nullable()\r\n        .max(\r\n          dateCantBeInFuture,\r\n          section.fields.releaseToDate.validations.notFutureDate.message\r\n        )\r\n        .test(\r\n          \"afterFromDate\",\r\n          section.fields.releaseToDate.validations.notBeforeDate.message,\r\n          function(releaseToDate) {\r\n            const { releaseFromDate } = this.parent;\r\n            if (releaseFromDate && releaseToDate) {\r\n              return dateIsBefore(releaseFromDate, releaseToDate);\r\n            }\r\n          }\r\n        )\r\n        .test(\r\n          \"afterFromDate\",\r\n          section.fields.releaseToDate.validations.notFutureDate.message,\r\n          function(date){\r\n            var todaysDate = new Date();\r\n            var enteredDate = new Date(date);\r\n            return todaysDate > enteredDate;\r\n          }\r\n        ),\r\n        infoToReleaseGroup: Yup.array()\r\n          .when('infoToReleaseGroupOther', {\r\n            is: (value) => !value || value.length === 0,\r\n            then: Yup.array().required(section.fields.infoToReleaseGroup.validations.required.message)\r\n          }),\r\n          // .required(\r\n          //   () =>\r\n          //   section.fields.infoToReleaseGroup.validations.required.value &&\r\n          //   section.fields.infoToReleaseGroup.validations.required.message\r\n          // ),\r\n      infoToReleaseGroupOther: Yup.string()\r\n        .test(\r\n          \"infoToReleaseGroupOther\",\r\n          section.fields.infoToReleaseGroupOther.validations.required.message,\r\n          function(item) {\r\n           \r\n            const { infoToReleaseGroup } = this.parent;\r\n            if(infoToReleaseGroup.includes(\"otherItem\"))\r\n              return item && infoToReleaseGroup.includes(\"otherItem\");\r\n            else return true;\r\n          }\r\n        )\r\n        .max(\r\n          section.fields.infoToReleaseGroupOther.validations.maxLength\r\n            .value,\r\n          section.fields.infoToReleaseGroupOther.validations.maxLength\r\n            .message\r\n        )\r\n    });\r\n  }\r\n}\r\n","import * as Yup from \"yup\";\r\n\r\nconst isDeliveryRadioBoxActive = (fields) => {\r\n  if(fields.deliveryMethodGroup.active){\r\n    return {\r\n      deliveryMethodGroup: Yup.string().required(\r\n        () =>\r\n          fields.deliveryMethodGroup.validations.required\r\n            .value &&\r\n          fields.deliveryMethodGroup.validations.required\r\n            .message\r\n      )\r\n    }\r\n  }\r\n\r\n}\r\n\r\nexport const deliveryMethodValidations = section => {\r\n  if (section.active) {\r\n    if (section.active) {\r\n      return Yup.object().shape(\r\n        isDeliveryRadioBoxActive(section.fields)\r\n      );\r\n    }\r\n  }\r\n};\r\n","import * as Yup from \"yup\";\r\nimport { dateIsBefore } from \"./validationFunctions\";\r\n\r\n// NOTE; use formLevelValidations for validations that cross\r\n// section boundaries and all included sections have an active status\r\n// e.g. Information to Release 'From Date' must be after Patient Information 'Birth Date'\r\n\r\nexport const formLevelValidations = form => {\r\n  const { patientInformationSection, informationToReleaseSection } = form.sections;\r\n\r\n  // Information to Release 'From Date' must be after Patient Information 'Birth Date'\r\n  if (patientInformationSection.active && informationToReleaseSection.active) {\r\n    return Yup.object().shape({\r\n      releaseFromDate: Yup.date().test(\r\n        \"dateIsAfter\",\r\n        form.validations.releaseStartAfterDateOfBirth.message,\r\n        function(releaseDate) {\r\n          const otherDate = this.parent[\r\n            form.validations.releaseStartAfterDateOfBirth.ref\r\n          ];\r\n          if (releaseDate && otherDate) {\r\n            return dateIsBefore(otherDate, releaseDate);\r\n          }\r\n        }\r\n      )\r\n    });\r\n  }\r\n};\r\n","import { patientInformationValidations } from \"./patientInformationValidations\";\r\nimport { authorizationToReleaseValidations } from \"./authorizationToReleaseValidations\";\r\nimport { informationToReleaseValidations } from \"./informationToReleaseValidations\";\r\nimport { deliveryMethodValidations } from \"./deliveryMethodValidations\";\r\nimport { purposeOfDisclosureValidations } from \"./purposeOfDisclosureValidations\";\r\nimport { discloseToValidations } from \"./discloseToValidations\";\r\nimport { formLevelValidations } from \"./formLevelValidations\";\r\nimport {supportingDocsValidations} from './supportingDocsValidations';\r\nimport {caseNumberValidations} from \"./caseNumberValidations\"\r\nimport {repContactInfoValidations} from './repContactInfoValidations';\r\nimport {additionalInfoValidations} from './additionalInfoValidations';\r\n\r\nexport const allValidations = data => {\r\n  const {\r\n    patientInformationSection,\r\n    authorizationToReleaseSection,\r\n    supportingDocsSection,\r\n    discloseToSection,\r\n    informationToReleaseSection,\r\n    deliveryMethodSection,\r\n    purposeOfDisclosureSection,\r\n    caseNumberSection,\r\n    repContactInfoSection,\r\n    additionalInfoSection\r\n  } = data.page.form.sections;\r\n\r\n  // console.log(repContactInfoSection)\r\n\r\n  return patientInformationValidations(patientInformationSection)\r\n    .concat(authorizationToReleaseValidations(authorizationToReleaseSection, data))\r\n    .concat(discloseToValidations(discloseToSection))\r\n    .concat(informationToReleaseValidations(informationToReleaseSection))\r\n    .concat(deliveryMethodValidations(deliveryMethodSection))\r\n    .concat(purposeOfDisclosureValidations(purposeOfDisclosureSection))\r\n    .concat(supportingDocsValidations(supportingDocsSection))\r\n    .concat(formLevelValidations(data.page.form))\r\n    .concat(caseNumberValidations(repContactInfoSection.fields.caseNumber))\r\n    .concat(repContactInfoValidations(repContactInfoSection))\r\n    .concat(additionalInfoValidations(additionalInfoSection));\r\n};\r\n","import * as Yup from \"yup\";\r\n\r\nimport {\r\n  phoneRegex,\r\n  zipRegex,\r\n} from \"./validationFunctions\";\r\n\r\nexport const discloseToValidations = section => {\r\n  if (section.active) {\r\n    return Yup.object().shape({\r\n      discloseToEntityGroup: Yup.string().required(\r\n        section.fields.discloseToEntityGroup.validations.required.message\r\n      ),\r\n      discloseToName: Yup.string().when(\"discloseToEntityGroup\", {\r\n        is: \"namedPersonEntity\",\r\n        then: Yup.string().required(\r\n          () =>\r\n            section.fields.discloseToName.validations.required.value &&\r\n            section.fields.discloseToName.validations.required.message\r\n        )\r\n      }),\r\n      discloseToPhone: Yup.string().when(\"discloseToEntityGroup\", {\r\n        is: \"namedPersonEntity\",\r\n        then: Yup.string()\r\n          .required(\r\n            () =>\r\n              section.fields.discloseToPhone.validations.required.value &&\r\n              section.fields.discloseToPhone.validations.required.message\r\n          )\r\n          .max(\r\n            section.fields.discloseToPhone.validations.maxLength\r\n              .value,\r\n              section.fields.discloseToPhone.validations.maxLength\r\n              .message\r\n          )\r\n          .matches(\r\n            phoneRegex,\r\n            section.fields.discloseToPhone.validations.validPhone.message\r\n          )\r\n      }),\r\n      discloseToFax: Yup.string().when(\"discloseToEntityGroup\", {\r\n        is: \"namedPersonEntity\",\r\n        then: Yup.string().matches(\r\n          phoneRegex,\r\n          section.fields.discloseToFax.validations.validPhone.message\r\n        )\r\n        .max(\r\n          section.fields.discloseToFax.validations.maxLength\r\n            .value,\r\n            section.fields.discloseToFax.validations.maxLength\r\n            .message\r\n        )\r\n      }),\r\n      discloseToAddressLine1: Yup.string().when(\"discloseToEntityGroup\", {\r\n        is: \"namedPersonEntity\",\r\n        then: Yup.string()\r\n          .required(\r\n            () =>\r\n              section.fields.discloseToAddressLine1.validations.required\r\n                .value &&\r\n              section.fields.discloseToAddressLine1.validations.required\r\n                .message\r\n          )\r\n          .max(\r\n            section.fields.discloseToAddressLine1.validations.maxLength\r\n              .value,\r\n            section.fields.discloseToAddressLine1.validations.maxLength\r\n              .message\r\n          )\r\n      }),\r\n      discloseToAddressLine2: Yup.string().when(\"discloseToEntityGroup\", {\r\n        is: \"namedPersonEntity\",\r\n        then: Yup.string()\r\n          .required(\r\n            () =>\r\n              section.fields.discloseToAddressLine2.validations.required\r\n                .value &&\r\n              section.fields.discloseToAddressLine2.validations.required\r\n                .message\r\n          )\r\n          .max(\r\n            section.fields.discloseToAddressLine2.validations.maxLength\r\n              .value,\r\n            section.fields.discloseToAddressLine2.validations.maxLength\r\n              .message\r\n          )\r\n      }),\r\n      discloseToCity: Yup.string().when(\"discloseToEntityGroup\", {\r\n        is: \"namedPersonEntity\",\r\n        then: Yup.string()\r\n          .required(\r\n            () =>\r\n              section.fields.discloseToCity.validations.required.value &&\r\n              section.fields.discloseToCity.validations.required.message\r\n          )\r\n          .max(\r\n            section.fields.discloseToCity.validations.maxLength.value,\r\n            section.fields.discloseToCity.validations.maxLength.message\r\n          )\r\n      }),\r\n      discloseToState: Yup.string().when(\"discloseToEntityGroup\", {\r\n        is: \"namedPersonEntity\",\r\n        then: Yup.string()\r\n          .required(\r\n            () => {\r\n              // console.log(section)\r\n             return section.fields.discloseToState.validations.required.value &&\r\n              section.fields.discloseToState.validations.required.message\r\n            }\r\n          )\r\n          .max(\r\n            section.fields.discloseToState.validations.maxLength.value,\r\n            section.fields.discloseToState.validations.maxLength.message\r\n          )\r\n      }),\r\n      discloseToZip: Yup.string().when(\"discloseToEntityGroup\", {\r\n        is: \"namedPersonEntity\",\r\n        then: Yup.string()\r\n          .required(\r\n            () =>\r\n              section.fields.discloseToZip.validations.required.value &&\r\n              section.fields.discloseToZip.validations.required.message\r\n          )\r\n          .matches(\r\n            zipRegex,\r\n            section.fields.discloseToZip.validations.validZipcode.message\r\n          )\r\n      })\r\n    });\r\n  }  \r\n};\r\n\r\n\r\n\r\n","import * as Yup from \"yup\";\r\n\r\nexport const purposeOfDisclosureValidations = section => {\r\n  if (section.active) {\r\n    return Yup.object().shape({\r\n      disclosurePurposeGroup: Yup.string().required(\r\n        () =>\r\n          section.fields.disclosurePurposeGroup.validations.required.value &&\r\n          section.fields.disclosurePurposeGroup.validations.required.message\r\n      ),\r\n      disclosurePurposeGroupOther: Yup.string()\r\n        .when(\"disclosurePurposeGroup\", {\r\n          is: val => val === \"other\",\r\n          then: Yup.string().required(\r\n            section.fields.disclosurePurposeGroupOther.validations.required\r\n              .message\r\n          )\r\n        })\r\n        .max(\r\n          section.fields.disclosurePurposeGroupOther.validations.maxLength\r\n            .value,\r\n          section.fields.disclosurePurposeGroupOther.validations.maxLength\r\n            .message\r\n        )\r\n    });\r\n  }\r\n};\r\n","import * as Yup from \"yup\";\r\n\r\nexport const supportingDocsValidations = section => {\r\n  // console.log(section.fields.supportingDoc.validations)\r\n    if (section.active) {\r\n        return Yup.object().shape({\r\n            supportingDoc: Yup.array().required(\r\n              section.fields.supportingDoc.validations.required.message\r\n            )\r\n            .test(\r\n                'is-file-type',\r\n                section.fields.supportingDoc.validations.fileType.message,\r\n                function checkIfFilesAreCorrectType(files){\r\n                    let valid = true\r\n                    if (files) {\r\n                      files.map(file => {\r\n                        if (!['application/pdf'].includes(file.type)) {\r\n                          valid = false\r\n                        }\r\n                      })\r\n                    }\r\n                    return valid\r\n                  }\r\n              )\r\n              .test(\r\n                'file-limit',\r\n                section.fields.supportingDoc.validations.fileLimit.message,\r\n                function checkIfFilesAreCorrectType(files){\r\n                    \r\n                    if (files) {\r\n                      return files.length <= 3;\r\n                    }\r\n                    return true;\r\n                  }\r\n              )\r\n              .test(\r\n                'is-file-big',\r\n                section.fields.supportingDoc.validations.fileSize.message,\r\n                function checkIfFilesAreCorrectType(files){\r\n                    let valid = true\r\n                    if (files) {\r\n                      files.map(file => {\r\n                        if (['application/pdf'].includes(file.size < 10000000)) {\r\n                          valid = false\r\n                        }\r\n                      })\r\n                    }\r\n                    return valid\r\n                  }\r\n              )\r\n        });\r\n    }  \r\n};","import * as Yup from \"yup\";\r\n\r\nexport const caseNumberValidations = section => {\r\n// const fields = section.fields;\r\n// console.log(section)\r\nif(section.active){\r\n    return Yup.object().shape({\r\n        caseNumber: Yup.string()\r\n        .max(\r\n            section.validations.maxLength.value,\r\n            section.validations.maxLength.message\r\n            )\r\n            .required(\r\n                () =>\r\n                section.validations.required\r\n                    .value &&\r\n                    section.validations.required\r\n                    .message\r\n              )\r\n    });\r\n}\r\n}","import * as Yup from \"yup\";\r\n\r\nimport {\r\n    phoneRegex,\r\n    zipRegex,\r\n    faxRegex,\r\n  } from \"./validationFunctions\";\r\n  \r\n\r\n\r\nexport const repContactInfoValidations = section => {\r\n    if (section.active) {\r\n      return Yup.object().shape({\r\n        repRole: Yup.string()\r\n        .required(\r\n          () =>\r\n            section.fields.repRole.validations.required.value &&\r\n            section.fields.repRole.validations.required.message\r\n        ),\r\n        discloseToOrgName:  Yup.string()\r\n        .max(\r\n          section.fields.discloseToOrgName.validations.maxLength.value,\r\n          section.fields.discloseToOrgName.validations.maxLength.message\r\n        )\r\n        .required(\r\n          () =>\r\n            section.fields.discloseToOrgName.validations.required.value &&\r\n            section.fields.discloseToOrgName.validations.required.message\r\n        ),\r\n        discloseToFName:  Yup.string().required(\r\n            () =>\r\n              section.fields.discloseToFName.validations.required.value &&\r\n              section.fields.discloseToFName.validations.required.message\r\n          ),\r\n          discloseToLName:  Yup.string().required(\r\n            () =>\r\n              section.fields.discloseToLName.validations.required.value &&\r\n              section.fields.discloseToLName.validations.required.message\r\n          ),\r\n        discloseToPhone: Yup.string()\r\n        .required(\r\n          () =>\r\n            section.fields.discloseToPhone.validations.required.value &&\r\n            section.fields.discloseToPhone.validations.required.message\r\n        )\r\n        .matches(\r\n          phoneRegex,\r\n          section.fields.discloseToPhone.validations.validPhone.message\r\n        ),\r\n        discloseToEmail: Yup.string()\r\n        .required(\r\n          () =>\r\n          section.fields.discloseToEmail.validations.required.value &&\r\n            section.fields.discloseToEmail.validations.required.message\r\n        )\r\n        .email(\r\n          section.fields.discloseToEmail.validations.validEmail.message\r\n        )\r\n        .max(\r\n          section.fields.discloseToEmail.validations.maxLength.value,\r\n          section.fields.discloseToEmail.validations.maxLength.message\r\n        ),\r\n        discloseToFax: Yup.string()\r\n        .matches(\r\n          faxRegex,\r\n          'Fax number is not valid'\r\n        ),\r\n        discloseToAddressLine1:  Yup.string()\r\n        .required(\r\n          () =>\r\n            section.fields.discloseToAddressLine1.validations.required\r\n              .value &&\r\n            section.fields.discloseToAddressLine1.validations.required\r\n              .message\r\n        )\r\n        .max(\r\n          section.fields.discloseToAddressLine1.validations.maxLength\r\n            .value,\r\n          section.fields.discloseToAddressLine1.validations.maxLength\r\n            .message\r\n        ),\r\n        discloseToAddressLine2: Yup.string()\r\n        \r\n        .max(\r\n          section.fields.discloseToAddressLine2.validations.maxLength\r\n            .value,\r\n          section.fields.discloseToAddressLine2.validations.maxLength\r\n            .message\r\n        ),\r\n        discloseToCity:  Yup.string()\r\n        .required(\r\n          () =>\r\n            section.fields.discloseToCity.validations.required.value &&\r\n            section.fields.discloseToCity.validations.required.message\r\n        )\r\n        .matches(/^[A-Za-z\\s-]+$/, 'City must contain only letters, spaces, and dashes')\r\n        .max(\r\n          section.fields.discloseToCity.validations.maxLength.value,\r\n          section.fields.discloseToCity.validations.maxLength.message\r\n        ),\r\n        discloseToState:  Yup.string()\r\n        .required(\r\n          () => {\r\n           return section.fields.discloseToState.validations.required.value &&\r\n            section.fields.discloseToState.validations.required.message\r\n          }\r\n        )\r\n        .matches(/^[A-Za-z]{2}$/, 'State must contain only letters')\r\n        .max(\r\n          section.fields.discloseToState.validations.maxLength.value,\r\n          section.fields.discloseToState.validations.maxLength.message\r\n        ),\r\n        discloseToMName: Yup.string()\r\n        .max(\r\n          section.fields.discloseToMName.validations.maxLength.value,\r\n          section.fields.discloseToMName.validations.maxLength.message\r\n        ),\r\n        discloseToZip: Yup.string()\r\n        .required(\r\n          () =>\r\n            section.fields.discloseToZip.validations.required.value &&\r\n            section.fields.discloseToZip.validations.required.message\r\n        )\r\n        .matches(\r\n          zipRegex,\r\n          section.fields.discloseToZip.validations.validZipcode.message\r\n        )\r\n      });\r\n    }  \r\n  };\r\n  \r\n  \r\n  \r\n  ","import * as Yup from \"yup\";\r\n\r\nexport const additionalInfoValidations = section => {\r\n    if(section.active){\r\n        return Yup.object().shape( {    \r\n           \r\n            repDesc: Yup.string()\r\n            .max(\r\n                section.fields.repDesc.validations.maxLength.value,\r\n                section.fields.repDesc.validations.maxLength.message\r\n              )\r\n            \r\n          \r\n    })}\r\n}","import { initializeFormAction } from \"../context/actions/initializeFormAction\";\r\nimport {getwayApi} from \"../config/Constants\";\r\nimport axios from \"axios\";\r\n\r\nexport const fetchFormData = async (setError, setLoading, session, dispatch, setEsign, setFormId) => {\r\n    setError(false);\r\n    setLoading(true);\r\n\r\n    try {\r\n      // NOTE; axios is currently pointing to file system json file.  Use the router match prop to construct the appropriate url\r\n      // to retrieve the configuration (and pesisted form state specific to the session if it is a back request)\r\n      // simulating userState example below\r\n      \r\n      const userState = { patientInfoFields: { patientInfoFirstName: \"\" } };\r\n\r\n      await axios.get(`${getwayApi}/api/session/client/${session.id}`)\r\n        .then(res => {\r\n          setEsign(res.data.esign)\r\n          setFormId(res.data.formId)\r\n          // console.log(res.data.formId)\r\n          dispatch(initializeFormAction(session, JSON.parse(res.data.formSpecs), userState));\r\n          setLoading(false);\r\n        })\r\n        .catch(err => {\r\n          setLoading(false);\r\n          console.log('error:', err)\r\n          // TODO; map infrastructure error to domain error\r\n          setError(err);\r\n        });\r\n      } catch (error) {\r\n        setLoading(false);\r\n        console.log(error)\r\n        // TODO; map infrastructure error to domain error\r\n      setError(error);\r\n    }\r\n  };","import * as moment from 'moment';\r\nimport {INITIALIZE} from './actionTypes';\r\nimport { allValidations } from '../../formik/validations';\r\n\r\nexport const initializeFormAction = (client, config, data) => {\r\n  console.log(\"intialize test\")\r\n  /* \r\n  NOTE; \r\n  the fields defined here must match the the fields in each section \r\n  in the configuration file and persisted user state.  the initialization\r\n  process configures the initial values for the Formik library \r\n\r\n  if a section is active the fields are spread to the fields object\r\n  if there is persisted user state it is spread to the fields object\r\n  */\r\n  let fields = {};\r\n\r\n  const additionalInfoSection = config.page.form.sections.additionalInfoSection;\r\n  const additionalInfoFields = {\r\n   \r\n    repDesc: \"\"\r\n  }\r\n  \r\n  if(additionalInfoSection.active){\r\n    fields = {...fields, ...additionalInfoFields}\r\n  }\r\n\r\n  const repContactInfoSection = config.page.form.sections.repContactInfoSection;\r\n  const repContactInfoFields = {\r\n    discloseToOrgName: \"\",\r\n    discloseToFName : \"\",\r\n    discloseToMName : \"\",\r\n    discloseToLName: \"\",\r\n    discloseToPhone: \"\",\r\n    discloseToEmail: \"\",\r\n    discloseToAddressLine1: \"\",\r\n    discloseToAddressLine2: \"\",\r\n    discloseToCity: \"\",\r\n    discloseToState: \"\",\r\n    discloseToZip: \"\",\r\n    repRole: \"\",\r\n    requestorNameId: 0,\r\n    requestorContactId: 0\r\n\r\n\r\n  }\r\n\r\n  if(repContactInfoSection.active){\r\n    fields = { ...fields, ...repContactInfoFields };\r\n  }\r\n\r\n  const supportingDocSec = config.page.form.sections.supportingDocsSection;\r\n  if(supportingDocSec.active){\r\n     // required doc section\r\n    const supportingdocFields = {\r\n      supportingDoc: []\r\n    }\r\n\r\n    //add if section is active\r\n    fields = {...fields, ...supportingdocFields}\r\n    //fields = {...fields, data.suppportDoc}\r\n  }\r\n \r\n// case number section\r\n  const caseNumberSection = config.page.form.sections.repContactInfoSection.fields.caseNumber;\r\n  const caseNumberField = {caseNumber: \"\"}\r\n\r\n  if(caseNumberSection.active){\r\n    fields = { ...fields, ...caseNumberField };\r\n  }\r\n\r\n  // PATIENT INFORMATION SECTION\r\n  // section template\r\n  const patientInfoFields = {\r\n    \r\n  };\r\n  const patientInfo = config.page.form.sections.patientInformationSection;\r\n  for (let [key, value] of Object.entries(patientInfo.fields)) {\r\n    if(value.active){\r\n      patientInfoFields[key] = \"\";\r\n    }\r\n}\r\n\r\n  if (patientInfo.active) {\r\n    // configuration\r\n    fields = { ...fields, ...patientInfoFields };\r\n\r\n    // user state\r\n    if (data.patientInfoFields)\r\n      fields = { ...fields, ...data.patientInfoFields };\r\n  }\r\n\r\n  // AUTHORIZATION TO RELEASE SECTION\r\n  // section template\r\n  const authorizationToReleaseFields = {\r\n    facilitiesGroup: [],\r\n    physiciansGroup: [],\r\n    allOrNameGroup: \"\",\r\n    namedPhysicians: \"\",\r\n    otherFac: \"\",\r\n    // ReleaseMode: '',\r\n    releasemodePDF: ''\r\n  };\r\n  const authorizationToRelease =\r\n    config.page.form.sections.authorizationToReleaseSection;\r\n  if (authorizationToRelease.active) {\r\n    // configuration\r\n    fields = { ...fields, ...authorizationToReleaseFields };\r\n\r\n    // user state\r\n    if (data.authorizationToReleaseFields)\r\n      fields = {\r\n        ...fields,\r\n        ...data.authorizationToReleaseFields\r\n      };\r\n  }\r\n\r\n  // DISCLOSE TO SECTION\r\n  // section template\r\n  const discloseToFields = {\r\n    discloseToEntityGroup: \"\",\r\n    discloseToName: \"\",\r\n    discloseToPhone: \"\",\r\n    discloseToFax: \"\",\r\n    discloseToAddressLine1: \"\",\r\n    discloseToAddressLine2: \"\",\r\n    discloseToCity: \"\",\r\n    discloseToState: \"\",\r\n    discloseToZip: \"\"\r\n  };\r\n  const discloseTo = config.page.form.sections.discloseToSection;\r\n  if (discloseTo.active) {\r\n    // configuration\r\n    fields = { ...fields, ...discloseToFields };\r\n\r\n    // user state\r\n    if (data.discloseToFields)\r\n      fields = { ...fields, ...data.discloseToFields };\r\n  }\r\n\r\n  // INFORMATION TO RELEASE SECTION\r\n  // section template\r\n  const informationToReleaseFields = {\r\n    infoToReleaseGroup: [],\r\n    infoToReleaseGroupOther: \"\",\r\n    releaseToDate: \"\",\r\n    releaseFromDate: \"\"\r\n  };\r\n  const infoToRelease = config.page.form.sections.informationToReleaseSection;\r\n\r\n  if(infoToRelease.fields.certBox.active){\r\n    informationToReleaseFields.certBox = false;\r\n  }\r\n  if (infoToRelease.active) {\r\n    // configuration\r\n    fields = { ...fields, ...informationToReleaseFields };\r\n\r\n    // user state\r\n    if (data.infoToReleaseFields)\r\n      fields = { ...fields, ...data.infoToReleaseFields };\r\n  }\r\n\r\n  // SENSITIVE INFORMATION SECTION\r\n  // section template\r\n  const sensitiveInfoFields = {\r\n    sensitiveInfo: []\r\n  };\r\n  const sensitiveInfo =\r\n    config.page.form.sections.disclosureOfSensitiveInformation;\r\n  if (sensitiveInfo.active) {\r\n    // configuration\r\n    fields = { ...fields, ...sensitiveInfoFields };\r\n\r\n    // user state\r\n    if (data.sensitiveInfoFields)\r\n      fields = { ...fields, ...data.sensitiveInfoFields };\r\n  }\r\n\r\n  // DELIVERY METHODS SECTION\r\n  // section template\r\n  const deliveryMethodFields = {\r\n    ReleaseMode: ''\r\n  };\r\n  const deliveryMethod = config.page.form.sections.deliveryMethodSection;\r\n  if (deliveryMethod.active && deliveryMethod.fields.deliveryMethodGroup.active) {\r\n    // configuration\r\n    fields = { ...fields, ...deliveryMethodFields };\r\n\r\n    // user state\r\n    if (data.deliveryMethodFields)\r\n      fields = { ...fields, ...data.deliveryMethodFields };\r\n  }\r\n\r\n  // PURPOSE OF DISCLOSURE SECTION\r\n  // section template\r\n  const purposeOfDisclosureFields = {\r\n    disclosurePurposeGroup: \"\",\r\n    disclosurePurposeGroupOther: \"\"\r\n  };\r\n  const purposeOfDisclosure =\r\n    config.page.form.sections.purposeOfDisclosureSection;\r\n  if (purposeOfDisclosure.active) {\r\n    // configuration\r\n    fields = { ...fields, ...purposeOfDisclosureFields };\r\n\r\n    // user state\r\n    if (data.purposeOfDisclosureFields)\r\n      fields = {\r\n        ...fields,\r\n        ...data.purposeOfDisclosureFields\r\n      };\r\n  }\r\n  \r\n  // TODO; these dates should come from the API\r\n  // RELEASE DATES SECTION\r\n  // section template\r\n  const releaseDatesFields = {\r\n    todaysDate: moment().format(\"MM/DD/YYYY\"),\r\n   \r\n     \r\n  };\r\n  const releaseDates = config.page.form.sections.releaseDatesSection;\r\n \r\n    if(config.page.form.sections.releaseDatesSection.fields.consentExpirationDate.active){\r\n      releaseDatesFields.consentExpirationDate =  moment()\r\n      .add(config.page.form.sections.releaseDatesSection.fields.consentExpirationDate.age, \"d\")\r\n      .format(\"MM/DD/YYYY\")\r\n    }\r\n  if (releaseDates.active) {\r\n    // configuration\r\n    fields = { ...fields, ...releaseDatesFields };\r\n\r\n    // user state\r\n    if (data.releaseDatesFields)\r\n      fields = { ...fields, ...data.releaseDatesFields };\r\n  }\r\n\r\n  const validations = allValidations(config);\r\n\r\n  return {\r\n    type: INITIALIZE,\r\n    payload: {\r\n      client,\r\n      fields,\r\n      config,\r\n      validations\r\n    }\r\n  }\r\n}","import React, { useEffect, useState, useReducer } from \"react\";\r\nimport DynamicForm from \"./screens/form/DynamicForm\";\r\nimport \"react-datepicker/dist/react-datepicker.css\";\r\nimport \"../App.scss\";\r\nimport { formReducer } from \"../context/formReducer\";\r\nimport {CaptchaContainer} from './screens/captcha/CaptchaContainer';\r\nimport {fetchFormData} from '../functions/apiCalls'\r\nimport {LoadingScreen} from './components/LoadingScreen'\r\n\r\nconst DynamicFormContainer = ({session}) => {\r\n  \r\n  const envt = window.location.origin;\r\n  const [formInfo, dispatch] = useReducer(formReducer, null);\r\n  const [loading, setLoading] = useState(false);\r\n  const [formId, setFormId] = useState(\"\");\r\n  const [isCaptchaValid, setIsCaptchaValid] = useState(envt === 'https://app-vra-test.azurewebsites.net' || envt === 'https://app-vra-dev.azurewebsites.net' || envt === 'http://localhost:3000' ? true : false);\r\n  \r\n  const [error, setError] = useState(null);\r\n  const [esign, setEsign] = useState(true)\r\n  \r\n  // console.log(session)\r\n  // console.log('form:', formInfo)\r\n  \r\n  // There will be two entry points into the form\r\n  // 1. initial request which will need default values for the included form elements\r\n  //    and some values may need to be populated if it is a 'known/authenticated' user request\r\n  // 2. a 'back' request from the summary view (or subsequent adobe esign view) which will\r\n  //    require all fields to be popluated from the persistence mechanism\r\n  // Formik uses the initialValues object to populate the form controls and\r\n  // validationSchema to determine what must be valid to have a valid form\r\n  // TODO; decide how will you persist and reconstiture the data / merge it back into 'initialValues' attribute of the form for 'back' requests\r\n  // NOTE; configure your axios url using match properties from react router to grab the session/form info\r\n  // console.log('session:', session)\r\n  \r\n  // console.log(formInfo)\r\n  useEffect(() => {\r\n    fetchFormData(setError, setLoading, session, dispatch, setEsign, setFormId);\r\n  }, [session]);\r\n\r\n  return (\r\n    <div id='page-container'>\r\n      {loading && <LoadingScreen loadingMessage={\"Loading the form. We'll be just a moment.\"}/>}\r\n      {!isCaptchaValid && <CaptchaContainer setCaptcha={(e) => setIsCaptchaValid(e)} form={formInfo} formId={formId}/>}\r\n      {isCaptchaValid && formInfo && <DynamicForm formInfo={formInfo} dispatch={dispatch} session={session.id} esign={esign} formId={formId}/>}\r\n      {/* TODO; error UI */}\r\n      {error && <div>TODO: Error Component {error}</div>}\r\n    </div>\r\n  );\r\n};\r\n\r\nexport default DynamicFormContainer;\r\n","import React, {useEffect, useState} from 'react';\r\nimport ReactHtmlParser from 'react-html-parser';\r\nimport axios from \"axios\";\r\nimport {apiHost, getwayApi } from '../../../config/Constants';\r\nimport {LoadingScreen} from '../../components/LoadingScreen'\r\nimport './styles/css/confirmation.css';\r\nimport './styles/css/confirmation.css';\r\nimport copyIcon from './styles/assets/copy-icon.png';\r\nimport vzaLogo from '../form/styles/assets/verisma_logo.png';\r\nimport PBV from '../../assets/pbv.png'\r\n\r\n\r\n\r\nexport const ConfirmationPage = ({session, config, formId}) => {\r\n    const [userData, setUserData] = useState(null);\r\n    \r\n    const doFetch = async () => {\r\n        try {\r\n          await axios\r\n          .get(`${apiHost}/api/accessCode?session=${session}`)\r\n            .then(res => {\r\n              setUserData(res.data);         \r\n            })\r\n            .catch(err => {\r\n                         \r\n            });\r\n          } catch (error) {\r\n         \r\n        }\r\n      };\r\n    useEffect(() => {\r\n      doFetch();  \r\n    },[]);\r\n    \r\n    \r\n    \r\n    // console.log(config);\r\n\r\n    if(config && userData){\r\n    \r\n        \r\n\r\n        return(\r\n            \r\n            <div id='confirmation-content-container' className='page'>\r\n                \r\n                <img id='confirmation-logo' \r\n                style={config.context.logo} \r\n                // style={{width:97, height:28.06, marginBottom: 37}} \r\n                src={`${getwayApi}/api/client/logo/${formId}`} \r\n                // src={vzaLogo} \r\n\r\n                />\r\n                \r\n                {/* =========================================================================================TITLE===================================================================================================== */}\r\n                <h2 id='confirmation-headline' style={{fontFamily: config.context.title.styles.fontFamily, fontWeight: config.context.title.styles.fontWeight, color: config.context.title.styles.color, fontSize :config.context.title.styles.fontSize}}> {config.context.title.text}</h2>\r\n                {/* =========================================================================================TITLE===================================================================================================== */}\r\n                \r\n                <div id='confirmation-paragraphs-container'>\r\n\r\n                    {/* <h6 style={config.context.requestorName} >{userData.name},</h6> */}\r\n                    \r\n                    {/* <div id='' style={config.context.textBody.bodyStyle}> */}\r\n                        \r\n                        <p className='confirmation-p-text' style={config.context.textBody.bodyStyle}> {ReactHtmlParser(config.context.textBody.paragraphs.formSend.replace(\"(email address here)\", userData.email))} </p>\r\n                        \r\n                        <p className='confirmation-p-text' style={config.context.textBody.bodyStyle}> {ReactHtmlParser(config.context.textBody.paragraphs.releaseSend)} </p>\r\n                       \r\n                        \r\n                \r\n                </div>\r\n\r\n                <div id='confirmation-tracking-container'>\r\n                    <p id='tracking-header' style={config.context.trackRequest.trackHeader.styles}>{config.context.trackRequest.trackHeader.text}</p>\r\n                    {/* <div id='tracking-number-and-copy-icon'> */}\r\n                        <p id='tracking-number' style={config.context.trackRequest.number.styles}>{userData.vrmAccessCode}</p>\r\n                        {/* <img id='tracking-copy-icon' src={copyIcon} style={config.context.trackRequest.copyIcon.styles}></img> */}\r\n                    {/* </div> */}\r\n                    <div id='tracking-button' style={config.context.trackRequest.trackingButton.styles} onClick={()=>{window.open(`${config.context.trackRequest.trackingButton.trackingLink}${userData.vrmAccessCode}`, '_blank')}}>\r\n                        <p id='tracking-button-text'>{config.context.trackRequest.trackingButton.text}</p>\r\n                    </div>\r\n                    <img src={PBV} className='conf-pbv-image' alt=\"Powered by Verisma\" />\r\n                </div>\r\n                \r\n                <div id='confirmation-feedback-container' style={config.context.survey.container.styles}>\r\n                    <div id='confirmation-feedback-text-container'>\r\n                        <h5 style={config.context.survey.titleStyle}>{config.context.survey.titleText}</h5>\r\n                        {/* <p style={config.context.survey.bodyStyle}> {config.context.survey.bodyText} {ReactHtmlParser(config.context.survey.linkText.replace(\"(survey link)\", userData.specProps.SurveryLink))}</p> */}\r\n                        <a href='https://is.gd/vraasurvey' target=\"_blank\" style={config.context.survey.bodyStyle}>{config.context.survey.bodyText}</a> \r\n                        \r\n                        {/* <p style={config.context.survery.linkStyle}> {ReactHtmlParser(config.context.survery.linkText.replace(\"(survery link)\", userData.specProps.SurveryLink))} </p> */}\r\n                    \r\n                    </div>\r\n                </div>\r\n            \r\n            </div>\r\n        );\r\n    }else{\r\n        return(\r\n            <LoadingScreen loadingMessage={\"Finalizing your request. We'll be just a moment.\"}/>\r\n        )\r\n    }\r\n}","import React, {useEffect, useState} from 'react';\r\nimport {getwayApi} from '../../../config/Constants';\r\nimport {ConfirmationPage} from './ConfirmationPage'\r\nimport axios from \"axios\";\r\n\r\nexport const ConfirmationPageContainer = ({session}) => {\r\n    const [config, setConfig] = useState(null);\r\n    const [loading, setLoading] = useState(true);\r\n\r\n    const doFetch = async () => {  \r\n        try {\r\n          await axios\r\n          .get(`${getwayApi}/api/session/conformation/${session.id}`)\r\n            .then(res => {\r\n              \r\n              setConfig(res.data)\r\n              setLoading(false) \r\n            })\r\n            \r\n            .catch(err => {\r\n              console.log(err)   \r\n            });\r\n          } \r\n          \r\n          catch (error) {\r\n            console.log(error)  \r\n        }\r\n      };\r\n\r\n      useEffect(() => {\r\n        doFetch();\r\n        \r\n      },[]);\r\n\r\n      \r\n\r\n      \r\n      return(\r\n          <>\r\n            {loading && <div>loading</div>}\r\n            {/* {!loading && <ConfirmationPage session={session.id} config={JSON.parse(config.confirmSpecs)} textImage = {config.textImage} trackingLink={config.trackingLink} surveryLink={config.surveryLink} formId={config.formId}/>} */}\r\n            {!loading && <ConfirmationPage session={session.id} config={JSON.parse(config.confirmSpecs)} textImage = {config.textImage} trackingLink={config.trackingLink} surveryLink={config.surveryLink} formId={config.formId}/>}\r\n          </>\r\n      )\r\n\r\n      \r\n}","import React from \"react\";\r\nimport { BrowserRouter as Router, Switch, Route } from \"react-router-dom\";\r\nimport DynamicFormContainer from \"./UI/DynamicFormContainer\";\r\nimport {ConfirmationPageContainer} from './UI/screens/confirmationPage/ConfirmationPageContainer';\r\nimport { ApplicationInsights } from '@microsoft/applicationinsights-web'\r\nimport {instkey} from './config/Constants'\r\nimport './App.scss'\r\n\r\n// Helper to get the session token from cookies (requires cookie not be HttpOnly)\r\nconst getSessionFromCookie = () => {\r\n  const cookieString = document.cookie;\r\n  const cookies = cookieString.split(';');\r\n  const sessionCookie = cookies.find(cookie => cookie.trim().startsWith(\"SessionToken=\"));\r\n  return sessionCookie ? sessionCookie.split('=')[1] : null;\r\n};\r\n\r\n// Get a tab-specific session using sessionStorage.\r\n// If a token is already saved for this tab, use it. Else, get it from the cookie and save it.\r\nconst getTabSessionToken = () => {\r\n  let token = sessionStorage.getItem(\"SessionToken\");\r\n  if (!token) {\r\n    token = getSessionFromCookie();\r\n    if (token) {\r\n      sessionStorage.setItem(\"SessionToken\", token);\r\n    }\r\n  }\r\n  return token;\r\n};\r\n\r\nconst appInsights = new ApplicationInsights({ config: { instrumentationKey: instkey } });\r\nappInsights.loadAppInsights();\r\nappInsights.trackPageView();\r\n\r\nconst App = () => {\r\n\r\n  // Use the tab-specific token from sessionStorage (or cookie if not yet stored)\r\n  const session = {\r\n    id: getTabSessionToken(), // Uses the API's session token, saved per tab in sessionStorage.\r\n    form: 3\r\n  };\r\n\r\n  return (\r\n    <Router basename={\"/build\"}>\r\n      <div className=\"app\">\r\n        <Switch>\r\n          <Route path=\"/\" exact render={() => <DynamicFormContainer session={session} />}/>\r\n          <Route path=\"/confirmationPage\" render={() => <ConfirmationPageContainer session={session} />}/>\r\n            {/* <Route path=\"/tempconfirmationPage\" render={() =>  <TempConfirmationPage accessCode = {parseableQueryString.get(\"accessCode\")}/>} /> */}\r\n            {/* TODO; <Route path=\"/review\" exact component={ReviewContainer} />  */}\r\n            {/* TODO; add 404 route - generic page or redirect to client page*/}\r\n        </Switch>\r\n      </div>\r\n    </Router>\r\n  );\r\n};\r\n\r\nexport default App;\r\n","import \"core-js/es/string\";\r\nimport \"react-app-polyfill/ie11\";\r\nimport \"react-app-polyfill/ie9\";\r\nimport \"react-app-polyfill/stable\";\r\nimport React from \"react\";\r\nimport ReactDOM from \"react-dom\";\r\nimport \"bootstrap/dist/css/bootstrap.min.css\";\r\nimport App from \"./App\";\r\n\r\nReactDOM.render(<App />, document.getElementById(\"root\"));\r\n","module.exports = __webpack_public_path__ + \"static/media/info-circle.1d7ff502.png\";"],"sourceRoot":""}