<%@ taglib uri="/tags/struts-bean" prefix="bean" %>
<%@ taglib uri="/tags/struts-html" prefix="html" %>
<%@ taglib uri="/tags/struts-logic" prefix="logic" %>
<%@ taglib uri="/tags/struts-tiles" prefix="tiles" %>
<%@ taglib uri="/tags/struts-nested" prefix="nested" %>
<%@ taglib uri="/tags/esr-core" prefix="esrcore" %>
<%@ taglib uri="/tags/struts-bean-el" prefix="bean-el" %>
<%@ taglib uri="http://struts.apache.org/tags-html" prefix="html-el" %>

<table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShell" role="presentation">
<html:form action="/eligibilityEditReview.do" method="post">
  <%@ include file="/admin/csrfgentoken.jsp" %>
 <tr>
  <td>
   <table width="100%" cellpadding="0" cellspacing="0" border="0" class="moduleShellTableBody" role="presentation">
    <tr width="100%">
	 <td width="100%">
	  <table width="100%" border="0" cellspacing="0" cellpadding="0" class="moduleShellTableHead" role="presentation">
	   <tr>
		<td class="moduleBlueBox">&nbsp;</td>
		<td width="890" class="moduleHeadline"><bean-el:message key="eligibilityEditReview.title"/></td>
	   </tr>
	  </table>
	 </td>
    </tr>
	<tr width="100%">
	 <td width="100%">
	  <table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShellLowTableHead" role="presentation">
	   <tr>
	    <td class="moduleBrownBox">&nbsp;</td>
	    <td width="35%" align="right" style="padding-right:5px;"><bean-el:message key="label.category"/></td>
	    <td width="30%" align="left" style="padding-left:5px;"><b><bean-el:message key="label.current"/></b></td>
	    <td halign="left" style="padding-left:5px;"><b><bean-el:message key="label.proposed"/></b></td>
	   </tr>
	  </table>
	 </td>
	</tr>
    <tr width="100%">
     <TD width="100%">
	  <table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShellTableBody" role="presentation">
	   <tr>
	      <td width="38%" class="moduleLabel"><bean-el:message key="label.enrollmentStatus"/>:</td>
	      <td width="30%" class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="enrollStatus"/></td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="enrollStatusProposed"/></td>
	   </tr>
	   <tr>
	      <td class="moduleLabel"><bean-el:message key="label.enrollmentApplicationDate"/>:</td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="appDate"/></td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="applicationDateProposed"/></td>
	   </tr>
	   <tr>
	      <td class="moduleLabel"><bean-el:message key="label.eligStatus"/>:</td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="eligStatus"/></td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="eligStatusProposed"/></td>
	   </tr>
	   <tr>
	      <td class="moduleLabel"><bean-el:message key="label.eligStatusDate"/>:</td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="eligStatusDate"/></td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="eligStatusDateProposed"/></td>
	   </tr>
	   <tr>
	      <td class="moduleLabel"><bean-el:message key="label.eligVerificationSource"/>:</td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="eligVerSourceFacility"/></td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="eligVerSourceFacilityProposed"/></td>
	   </tr>
	   <tr>
	      <td class="moduleLabel"><bean-el:message key="label.eligVerificationMethod"/>:</td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="eligVerMethod"/></td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="eligVerMethodProposed"/></td>
	   </tr>
	   <tr>
	      <td class="moduleLabel"><bean-el:message key="label.primaryEligCode"/>:</td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="primaryEligCode"/></td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="primaryEligCodeProposed"/></td>
	   </tr>
	   <tr valign="top">
	      <td class="moduleLabel"><bean-el:message key="label.secondaryEligibilityCodes"/>:</td>
	      <td class="moduleValue">
		   <table width="100%" border="0" cellspacing="0" cellpadding="0" role="presentation">
			<logic:notEmpty name="eligibilityEditReviewActionForm" property="otherEligCodes">
			 <logic:iterate id="elig" name="eligibilityEditReviewActionForm" property="otherEligCodes" type="gov.va.med.esr.common.model.ee.Eligibility">
			  <tr>
			   <td class="moduleValue"><esrcore:displayValue name="elig" property="type.description"/></td>
			  </tr>
			 </logic:iterate>
			</logic:notEmpty>
		   </table>
	      </td>
	      <td class="moduleValue">
		   <table width="100%" border="0" cellspacing="0" cellpadding="0" role="presentation">
			<logic:notEmpty name="eligibilityEditReviewActionForm" property="otherEligCodesProposed">
			 <logic:iterate id="elig" name="eligibilityEditReviewActionForm" property="otherEligCodesProposed" type="gov.va.med.esr.common.model.ee.Eligibility">
			  <tr>
			   <td class="moduleValue"><esrcore:displayValue name="elig" property="type.description"/></td>
			  </tr>
			 </logic:iterate>
			</logic:notEmpty>
		   </table>
	      </td>
	   </tr>
	   <tr valign="top">
	      <td class="moduleLabel"><bean-el:message key="label.otherEligibilityFactors"/>:</td>
	      <td class="moduleValue">
		   <table width="100%" border="0" cellspacing="0" cellpadding="0" role="presentation">
			<logic:notEmpty name="eligibilityEditReviewActionForm" property="otherEligFactors">
			 <logic:iterate id="elig" name="eligibilityEditReviewActionForm" property="otherEligFactors" type="gov.va.med.esr.common.model.ee.Eligibility">
			  <tr>
			   <td class="moduleValue"><esrcore:displayValue name="elig" property="factor.description"/></td>
			  </tr>
			 </logic:iterate>
			</logic:notEmpty>
		   </table>
	      </td>
	      <td class="moduleValue">
		   <table width="100%" border="0" cellspacing="0" cellpadding="0">
			<logic:notEmpty name="eligibilityEditReviewActionForm" property="otherEligFactorsProposed" role="presentation">
			 <logic:iterate id="elig" name="eligibilityEditReviewActionForm" property="otherEligFactorsProposed" type="gov.va.med.esr.common.model.ee.Eligibility">
			  <tr>
			   <td class="moduleValue"><esrcore:displayValue name="elig" property="factor.description"/></td>
			  </tr>
			 </logic:iterate>
			</logic:notEmpty>
		   </table>
	      </td>
	   </tr>
	   <tr>
	      <td class="moduleLabel"><bean-el:message key="label.enrollmentPriority"/>:</td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="enrollmentPriority"/></td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="enrollmentPriorityProposed"/></td>
	   </tr>
	   <tr>
	      <td class="moduleLabel"><bean-el:message key="label.serviceConnected"/>:</td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="scIndicator"/></td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="scIndicatorProposed"/></td>
	   </tr>
	   <tr>
	      <td class="moduleLabel"><bean-el:message key="label.serviceConnectedPercent"/>:</td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="scPercentage"/></td>
	      <td class="moduleValue style4"><span class="style6"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="scPercentageProposed"/></span></td>
	   </tr>
	   <tr>
	      <td class="moduleLabel"><bean-el:message key="label.lastEdited"/>:</td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="editedDate"/></td>
	      <td class="moduleValue style4"><span class="style6"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="editedDateProposed"/></span></td>
	   </tr>
	   <tr>
	      <td class="moduleLabel"><bean-el:message key="label.sourceOfUpdate"/>:</td>
	      <td class="moduleValue"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="editedBy"/></td>
	      <td class="moduleValue style4"><span class="style6"><esrcore:displayValue name="eligibilityEditReviewActionForm" property="editedByProposed"/></span></td>
	   </tr>
	   <tr>
	      <td class="moduleLabel">&nbsp;</td>
	      <td class="moduleValue">&nbsp;</td>
	      <td class="moduleValue style1">&nbsp;</td>
	   </tr>
	   <tr>
	    <td class="moduleValue" colspan="3" align="center">
        <table width="100%" border="0" align="center" cellspacing="0" cellpadding="0" role="presentation">
          <tr>
            <td width="45%"><img alt=""  src="../images/spacer.gif"/></td>
            <td><img alt=""  src="../images/buttonEndLeft.gif" /></td>
            <td><html-el:submit property="methodName" style="width:100; vertical-align: top;" styleClass="buttonText"><bean-el:message key="button.submit"/></html-el:submit></td>
            <td><img alt=""  src="../images/buttonEndRight.gif"/></td>
            <td width="1%"><img alt=""  src="../images/spacer.gif"/></td>
            <td><img alt=""  src="../images/buttonEndLeft.gif"/></td>
            <td><html-el:submit property="methodName" style="width:100; vertical-align: top;" styleClass="buttonText"><bean-el:message key="button.discardChanges"/></html-el:submit></td>
            <td><img alt=""  src="../images/buttonEndRight.gif"/></td>
            <td width="45%"><img alt=""  src="../images/spacer.gif"/></td>
          </tr>
        </table>
	    </td>
	   </tr>
      </table>
     </td>
    </tr>
   </table>
  </td>
 </tr>
</html:form>
</table>
