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Copy pathsite-information-page.component.html
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106 lines (92 loc) · 3.67 KB
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<app-page [busy]="busy">
<app-page-header>PharmaNet Site Registration</app-page-header>
<app-site-progress-indicator [inProgress]="!isSubmitted"></app-site-progress-indicator>
<form (ngSubmit)="onSubmit()"
[formGroup]="formState.form"
novalidate
autocomplete="off">
<section class="mb-3">
<app-page-subheader2>
<ng-container appPageSubheader2Title>{{ title }}</ng-container>
<ng-container appPageSubheader2Summary>
Provide this site's information.
</ng-container>
</app-page-subheader2>
<div class="row">
<div class="col">
<app-doing-business-as-form-field label="Site Name (e.g., facility name, clinic name, or pharmacy name)"
[doingBusinessAs]="formState.siteName"></app-doing-business-as-form-field>
</div>
</div>
<div class="row">
<div class="col">
<mat-form-field class="w-100">
<mat-label>Site Mnemonic (Optional)</mat-label>
<input matInput
[formControl]="formState.mnemonic">
</mat-form-field>
</div>
</div>
<div class="row"
*ngIf="isPharmacyPhoneRequired()">
<div class="col">
<mat-form-field class="w-100">
<mat-label>Pharmacy Phone Number</mat-label>
<input matInput
[formControl]="formState.pharmacyPhone"
mask="(000) 000-0000">
<mat-error *ngIf="formState.pharmacyPhone.hasError('phone')">Must be a valid phone number</mat-error>
</mat-form-field>
</div>
</div>
<div class="row">
<div class="col">
<app-page-subheader2>
<ng-container appPageSubheader2Summary>
Site ID/PEC Code
</ng-container>
</app-page-subheader2>
<mat-slide-toggle #hasSiteID
class="my-2 mb-3"
color="primary"
(change)="onToggleChange($event)"
[checked]="formState.pec.value">
Do you have a Site ID for this location?
</mat-slide-toggle>
<div *ngIf="hasSiteID?.checked">
<mat-form-field class="w-100">
<mat-label></mat-label>
<input matInput
[formControl]="formState.pec"
appToUppercase />
<mat-error *ngIf="formState.pec.hasError('required')">Required</mat-error>
<mat-error *ngIf="formState.pec.hasError('assignable')">
Site ID/PEC Code exists in another organization
</mat-error>
</mat-form-field>
</div>
</div>
</div>
<div class="row">
<div class="col">
<app-page-subheader2>
<ng-container appPageSubheader2Summary>
Provide your site’s street or physical address. Do not use a PO Box.
</ng-container>
</app-page-subheader2>
<app-address-form [form]="formState.physicalAddress"
[formControlNames]="formControlNames"
[inBc]="true"
[showManualButton]="true"
[showAddressFields]="showAddressFields"></app-address-form>
</div>
</div>
</section>
</form>
<app-page-footer [isInitialEnrolment]="!isCompleted"
[hasSecondaryAction]="true"
primaryActionLabel="Save and Continue"
(save)="onSubmit()"
(back)="onBack()"
(continue)="onBack()"></app-page-footer>
</app-page>