Summary Table

Categories	Total Count
PII	0
URL	0
DNS	0
EKL	0
IP	0
PORT	0
VsID	0
CF	0
AI	0
VPD	0
PL	0
Other	0

File Content

<div class="medications evaluation-page" scroll-indicator ng-swipe-left="swipeLeft()" ng-swipe-right="swipeRight()" ng-swipe-disable-mouse>
<div class="evaluation-content">
<p required-field is-required="true" class="required-text">required field</p>
<form name="medicationEntryForm" class="medicationEntryForm" novalidate="novalidate">
<validation-summary></validation-summary>
<p><strong>List any {{medType | lowercase}} medications you currently {{medLabelValues[medType].applicationMethod}} your skin</strong></p>
<div ng-repeat="med in medications track by $index">
<div class="medication-item-first-row row">
<span class="col-xs-11 medication-header" tabindex="0">
{{'Medication ' + ($index + 1) + (medications.length > 1 ? ' of ' + medications.length : '')}}
</span>
<button ng-if="medications.length > 1" class="btn btn-default col-xs-1 delete-med-button" ng-click="removeMedication($index)">
<i class="icon icon-close-1" aria-hidden="true"></i>
<span class="sr-only">{{'Remove Medication ' + ($index + 1) + ' of ' + medications.length}}</span>
</button>
</div>
<div class="row">
<div class="col-sm-12 col-xs-12">
<input-type-ahead
label="Name of {{medType}} Medication #{{($index + 1)}}:"
ng-model='med.name'
ng-required="true"
maxlength="250"
character-counter='true'
ng-id="medNameInput-{{$index}}"
typeahead-min-length='3'
item-template-url='modules/applets/mytelederm/pages/medications/partials/_medication_match.html'
on-select='selectMedication($item, $index)'
use-text-area='true'
items='items'>
</input-type-ahead>
</div>
</div>
<div class="row">
<div class="col-sm-12 col-xs-12">
<fieldset class="medication-frequency-wrapper">
<legend class="text-left legend-label">
<span required-field is-required="true" class="required-text">Medication {{($index + 1)}} How often do you {{medLabelValues[medType].frequency}} this medication?</span>
</legend>
<div class="row">
<div class="full-width">
<div class="col-sm-5 col-xs-12 no-left-padding">
<input-select
ng-id="frequency-{{$index}}"
label="Medication {{($index + 1)}} Frequency:"
name="frequency"
options="medFrequencyItems"
ng-model="med.frequency"
show-null="true"
default-value="Select Frequency"
ng-required="true"
item-change-callback="onFrequencyChange(newValue)">
</input-select>
</div>
<div class="col-sm-7 col-xs-12 no-left-padding" ng-if="med.frequency === 'other'">
<input-text
ng-if="med.frequency === 'other'"
label="Medication {{($index + 1)}} Frequency Comment:"
ng-model='med.frequencyOther'
ng-required="true"
maxlength="100"
character-counter='true'
ng-id="medFrequencyOtherInput-{{$index}}">
</input-text>
</div>
</div>
</div>
<div class="row">
<div class="full-width">
<div class="col-sm-5 col-xs-12 no-left-padding">
<input-select
label="Medication {{($index + 1)}} Unit:"
name="frequencyOptions"
ng-model='med.timeUnit'
ng-required="true"
options="freqOptions"
show-null="true"
default-value="Select Unit"
ng-id="timeUnit-{{$index}}"
item-change-callback="onTimeUnitChange(newValue)">
</input-select>
</div>
<div class="col-sm-7 col-xs-12 no-left-padding" ng-if="med.timeUnit === 'other'">
<input-text
ng-if="med.timeUnit === 'other'"
label="Medication {{($index + 1)}} Unit Comment:"
ng-model='med.timeUnitOther'
ng-required="true"
maxlength="100"
character-counter='true'
ng-id="medFrequencyUnitOtherInput-{{$index}}">
</input-text>
</div>
</div>
</div>
</fieldset>
</div>
</div>
<div class="row">
<div class="col-sm-12 col-xs-12">
<span class="required-field ng-scope" responsive="true">* </span>
<span class="med-label">Medication {{($index + 1)}} {{medLabelValues[medType].dose}}</span>
<input-text
label="Medication {{($index + 1)}} {{medLabelValues[medType].doseHidden}}"
hide-label="true"
ng-model='med.dose'
ng-required="true"
maxlength="100"
character-counter='true'
ng-id="medDoseInput-{{$index}}">
</input-text>
</div>
</div>
<div class="row">
<div class="col-sm-12 col-xs-12">
<span class="required-field ng-scope" responsive="true">* </span>
<span class="med-label">Medication {{($index + 1)}} Doses Missed: How many times did you miss taking your medication in the past {{medLabelValues[medType].dosesMissed}}?</span>
<input-select
label="Medication {{($index + 1)}} Doses Missed"
hide-label="true"
name="dosesMissed"
ng-model='med.missedDoses'
ng-required="true"
options="dosesMissedFrequencyItems"
show-null="true"
default-value="Select Doses Missed"
ng-id="dosesMissed-{{$index}}">
</input-select>
</div>
</div>
</div>
<div class="row">
<div class="col-sm-12 col-xs-12">
<div ng-if="medications.length < 10" class="full-button-wrapper">
<button type="button" class="btn btn-default add-btn" ng-click="addNew()">
<span class="glyphicon glyphicon-plus-sign"></span> Add another {{toTitleCase(medType)}} Medication
</button>
</div>
</div>
</div>
</form>
</div>
</div>
<progress-bar previous="previous()" next="next()" />