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| # | Location | File | Last Modified |
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| 1 | Fri Jun 9 19:51:43 2017 UTC | ||
| 2 | eHealth_Exch (eHealth Exchange Enhancements) Build 3 docs & code_May_2017.zip\VAP_CIF_CODE0502.zip\VAP_CIF_CODE0502\VAP_CIF_CODE0502\nvap-web\src\main\webapp\WEB-INF\web | modifyNwHINOrgRestrictions.jsp | Fri Apr 21 20:15:58 2017 UTC |
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| 1 | <%@taglib uri="http: //java.sun .com/jsp/j stl/core" prefix="c" %> | |||||
| 2 | <%@taglib uri="http: //java.sun .com/jsp/j stl/functi ons" prefi x="fn"%> | |||||
| 3 | <%@taglib uri="http: //java.sun .com/jsp/j stl/fmt" p refix="fmt "%> | |||||
| 4 | <%@taglib tagdir="/W EB-INF/tag s/cpp" pre fix="cpp"% > | |||||
| 5 | <%@taglib tagdir="/W EB-INF/tag s/date" pr efix="date "%> | |||||
| 6 | ||||||
| 7 | <script ty pe="text/j avascript" > | |||||
| 8 | jQuery (document) .ready(fun ction () { | |||||
| 9 | se tFocus(mul tiSelectLi stForm.aut henticatin gFacility) ; | |||||
| 10 | op t.init(doc ument.mult iSelectLis tForm); | |||||
| 11 | }); | |||||
| 12 | </script> | |||||
| 13 | ||||||
| 14 | <div> | |||||
| 15 | <p cla ss="detail Text"> | |||||
| 16 | Th e Veteran has a righ t to reque st the | |||||
| 17 | De partment o f Veterans Affairs ( VA) to res trict or l imit the | |||||
| 18 | sh aring of h is/her ele ctronic he alth infor mation thr ough <c:ou t value="$ {organizat ionName}"/ > | |||||
| 19 | by designati ng which n on-VA heal thcare pro vider orga nizations | |||||
| 20 | he /she does NOT wish t o receive his/her in formation. A restric tion | |||||
| 21 | re quest may be filed e ven if the Veteran d oes not ha ve an auth orization | |||||
| 22 | on file perm itting the disclosur e of his/h er health informatio n to | |||||
| 23 | no n-VA healt hcare prov ider organ izations. Note that until an | |||||
| 24 | au thorizatio n is on fi le, the re striction request wi ll remain in an | |||||
| 25 | <s trong>inac tive</stro ng> status . Any rest riction re quest subm itted will apply | |||||
| 26 | ON LY to the sharing of electroni c health i nformation through | |||||
| 27 | <s trong><c:o ut value=" ${organiza tionName}" /></strong >. | |||||
| 28 | </p> | |||||
| 29 | ||||||
| 30 | <p cla ss="detail Text"> | |||||
| 31 | In dicate whi ch non-VA health car e provider | |||||
| 32 | or ganization participa ting in <c :out value ="${organi zationName }"/> the V eteran doe s NOT | |||||
| 33 | wi sh to rece ive their electronic health in formation. By comple ting the | |||||
| 34 | Re striction on VA Form 10-0525a, the Veter an is rest ricting th e VA | |||||
| 35 | fr om sharing his/her h ealth info rmation fo r treatmen t purposes | |||||
| 36 | wi th the non -VA health care prov ider organ izations p articipati ng | |||||
| 37 | in the <c:ou t value="$ {organizat ionName}"/ > and part nering wit h VA. | |||||
| 38 | </p> | |||||
| 39 | ||||||
| 40 | <p cla ss="detail Text"> | |||||
| 41 | Th e VA will not share the Vetera n health | |||||
| 42 | in formation with the s elected no n-VA healt h care pro vider | |||||
| 43 | or ganization s through <c:out val ue="${orga nizationNa me}"/> eve n if the V eteran lat er signs | |||||
| 44 | an authoriza tion. | |||||
| 45 | </p> | |||||
| 46 | </div> | |||||
| 47 | ||||||
| 48 | <div class ="form-con tainer"> | |||||
| 49 | <field set> | |||||
| 50 | <l egend>Rest rict</lege nd> | |||||
| 51 | <d iv> | |||||
| 52 | <input c hecked="ch ecked" tit le="Choose the radio button to select Pa tient Auth orizes sha ring of he alth recor ds with <c :out value ="${organi zationName }"/> provi ders and o rganizatio ns with th e followin g exclusio ns:" type= "radio" na me="consen tGroup" va lue="autho rizeExclus ion" onCli ck="formSh ow('multiS electAutho rizeForm') " aria-lab elledby="f orConsentG roup" /> | |||||
| 53 | <span id ="forConse ntGroup"> | |||||
| 54 | Vete ran Restri cts sharin g of healt h records with <c:ou t value="$ {organizat ionName}"/ > provider s and orga nizations with the f ollowing e xclusions: | |||||
| 55 | </span> | |||||
| 56 | <br /> < br /> | |||||
| 57 | </ div> | |||||
| 58 | <f orm name=" multiSelec tListForm" id="multi SelectList Form" acti on="Patien tDetails.d o_sec" met hod="POST" enctype=" multipart/ form-data" onsubmit= "return do Submit(thi s)"> | |||||
| 59 | <input t ype="hidde n" name="i cn" value= "<c:out va lue="${pat ientDemogr aphics.icn }"/>" /> | |||||
| 60 | <input t ype="hidde n" name="r equestId" value="<c: out value= "${request Id}"/>" /> | |||||
| 61 | <input t ype="hidde n" name="n ewLeft" va lue="" /> | |||||
| 62 | <input t ype="hidde n" name="n ewRight" v alue="" /> | |||||
| 63 | <input t ype="hidde n" name="c onsentType " value="N wHIN Organ ization Re striction Modificati on" /> | |||||
| 64 | <input t ype="hidde n" name="p urposeOfUs e" value=" TREATMENT" /> | |||||
| 65 | ||||||
| 66 | <div id= "multiSele ctAuthoriz eForm"> | |||||
| 67 | <tab le bgcolor ="#eff2ff" > | |||||
| 68 | <tr> | |||||
| 69 | <td co lspan="3"> | |||||
| 70 | Th ere must b e at least one non-V A health c are | |||||
| 71 | pr ovider org anization -- other t han Depart ment of De fense | |||||
| 72 | (D oD) --- in the "All Providers and Organi zations <s trong>(unr estricted) </strong>" | |||||
| 73 | se lection bo x AND at l east one n on-VA heal th care pr ovider | |||||
| 74 | or ganization in the "< c:out valu e="${organ izationNam e}"/> Prov iders and Organizati ons | |||||
| 75 | wh o will NOT have acce ss to the records <s trong>(res tricted)</ strong>" b ox. | |||||
| 76 | <b r /> <br / > | |||||
| 77 | ||||||
| 78 | <p class="de tailText"> | |||||
| 79 | * NOTE: You cannot restrict DoD, VA pa tient info rmation is always sh ared with the DoD. | |||||
| 80 | <br /> < br /> | |||||
| 81 | </ p> | |||||
| 82 | </td> | |||||
| 83 | </tr> | |||||
| 84 | <tr> | |||||
| 85 | <td> | |||||
| 86 | <l abel for=" list1" cla ss="vap-re g-label">< strong>All Providers and Organ izations ( unrestrict ed)</stron g></label> | |||||
| 87 | </td> | |||||
| 88 | <td>&n bsp; &nbs p;</td> | |||||
| 89 | <td> | |||||
| 90 | <l abel for=" list2" cla ss="vap-re g-label">< strong>${o rganizatio nName} Pro viders and Organizat ions who w ill NOT ha ve access to the rec ords (rest ricted)</s trong></la bel> | |||||
| 91 | </td> | |||||
| 92 | </tr> | |||||
| 93 | <tr> | |||||
| 94 | <td> | |||||
| 95 | <s elect styl e="width: 310px;" cl ass="listS elect" nam e="list1" id="list1" multiple= "multiple" size="10" onDblClic k="opt.tra nsferRight ();enableR estrictAft erValidati on('signat ureDate', 'option1', 'list1', 'list2', ' Authorize' );"> | |||||
| 96 | <c:if te st="${!emp ty authori zedOrganiz ations}"> | |||||
| 97 | <c:f orEach var ="r" items ="${author izedOrgani zations}" varStatus= "i"> | |||||
| 98 | <c:choose> | |||||
| 99 | <c:whe n test="${ r.orgNumbe r eq '200 DOD'}"> | |||||
| 100 | <o ption valu e="<c:out value="${r .orgNumber }"/>"><c:o ut value=" ${r.orgNam e}"/>  ; &nb sp; & nbsp;</opt ion> | |||||
| 101 | </c:wh en> | |||||
| 102 | <c:oth erwise> | |||||
| 103 | <o ption valu e="<c:out value="${r .orgNumber }"/>"><c:o ut value=" ${r.orgNam e}"/>  ; &nb sp; & nbsp;</opt ion> | |||||
| 104 | </c:ot herwise> | |||||
| 105 | </c:choose > | |||||
| 106 | </c: forEach> | |||||
| 107 | </c:if> | |||||
| 108 | </ select> | |||||
| 109 | </td> | |||||
| 110 | <td va lign="midd le" align= "left"> | |||||
| 111 | <i nput style ="width: 1 25px; heig ht: 30px;" type="but ton" title ="Move all the Organ izations t o the righ t box" cla ss="midBut ton" name= "right" va lue="Move All >&g t;" onclic k="opt.tra nsferAllRi ght();enab leRestrict AfterValid ation('sig natureDate ', 'option 1', 'list1 ', 'list2' , 'Authori ze');" /> | |||||
| 112 | <b r /> | |||||
| 113 | <i nput type= "button" t itle="Move the Selec ted Organi zations to the right box" clas s="midButt on" style= "width: 12 5px; heigh t: 30px;" name="righ t" VALUE=" Move Selec ted >" onclick="o pt.transfe rRight();e nableRestr ictAfterVa lidation(' signatureD ate', 'opt ion1', 'li st1', 'lis t2', 'Auth orize');" /> | |||||
| 114 | <b r /><br /> | |||||
| 115 | <i nput type= "button" t itle="Move the selec ted Organi zations to the left box" class ="midButto nLeft" sty le="width: 125px; he ight: 30px ;" name="l eft" VALUE ="< Mov e Selected " onclick= "opt.trans ferLeft(); enableRest rictAfterV alidation( 'signature Date', 'op tion1', 'l ist1', 'li st2', 'Aut horize');" /> | |||||
| 116 | <b r /> | |||||
| 117 | <i nput type= "button" t itle="Clea r all sele ctions" cl ass="midBu tton" name ="left" st yle="width : 125px; h eight: 30p x;" value= "Clear" on click="opt .transferA llLeft();d isableObje ct('Author ize');" /> | |||||
| 118 | </td> | |||||
| 119 | <td> | |||||
| 120 | <s elect name ="list2" c lass="list Select" ti tle="${org anizationN ame} Provi ders and O rganizatio ns who wil l NOT have access to the recor ds (restri cted)" mul tiple="mul tiple" siz e="10" id= "list2" on DblClick=" opt.transf erLeft();e nableRestr ictAfterVa lidation(' signatureD ate', 'opt ion1', 'li st1', 'lis t2', 'Auth orize');" style="wid th: 310px; "> | |||||
| 121 | <c:if te st="${!emp ty exclude dOrganizat ions}"> | |||||
| 122 | <c:f orEach var ="r" items ="${exclud edOrganiza tions}" va rStatus="i "> | |||||
| 123 | <option va lue="<c:ou t value="$ {r.orgNumb er}"/>"><c :out value ="${r.orgN ame}"/>&nb sp; & nbsp;  ; </o ption> | |||||
| 124 | </c: forEach> | |||||
| 125 | </c:if> | |||||
| 126 | </ select> | |||||
| 127 | </td> | |||||
| 128 | </tr> | |||||
| 129 | </ta ble> | |||||
| 130 | <br /> <br /> | |||||
| 131 | </div> | |||||
| 132 | <div> | |||||
| 133 | <lab el for="au thenticati ngFacility "> | |||||
| 134 | Authentica ting Facil ity | |||||
| 135 | <img alt=" Required f ield" src= "res/star- icon_grey_ bg.png" /> | |||||
| 136 | </la bel> | |||||
| 137 | <sel ect id="au thenticati ngFacility " name="us erFacility " style="w idth: 250p x; overflo w: auto;"> | |||||
| 138 | <c:forEach var="f" i tems="${al lowedFacil ities}"> | |||||
| 139 | <optio n value="< c:out valu e="${f.fac ilityStati on}"/>" | |||||
| 140 | <c :choose> | |||||
| 141 | <c:when test="${f. facilitySt ation eq d efaultUser Facility.f acilitySta tion}"> | |||||
| 142 | sele cted | |||||
| 143 | </c:when > | |||||
| 144 | <c:when test="${co okie.facil ity.value == f.facil ityStation }"> | |||||
| 145 | sele cted | |||||
| 146 | </c:when > | |||||
| 147 | </ c:choose>> | |||||
| 148 | <c :choose> | |||||
| 149 | <c:when test="${f. facilityNa me != ''}" > | |||||
| 150 | <c:o ut value=" ${f.facili tyName}"/> | |||||
| 151 | </c:when > | |||||
| 152 | <c:other wise> | |||||
| 153 | <c:o ut value=" ${fn:split (f.facilit yDns, '.') [0]}"/> | |||||
| 154 | </c:othe rwise> | |||||
| 155 | </ c:choose> | |||||
| 156 | (< c:out valu e="${f.fac ilityStati on}"/>) | |||||
| 157 | </opti on> | |||||
| 158 | </c:forEac h> | |||||
| 159 | </se lect> | |||||
| 160 | <br /> <br /> | |||||
| 161 | </div> | |||||
| 162 | <div> | |||||
| 163 | <lab el for="op tion1"> | |||||
| 164 | 10-0525a F orm Valida tion | |||||
| 165 | <img alt=" Required f ield" src= "res/star- icon_grey_ bg.png" /> | |||||
| 166 | </la bel> | |||||
| 167 | <inp ut type="c heckbox" t itle="sele ct Form Va lidation c heckbox if Restricti on Form 10 -0525a was received and valida ted. requi red field" onclick=" enableRest rictAfterV alidation( 'signature Date', 'op tion1', 'l ist1', 'li st2', 'Aut horize');" name="opt ion1" id=" option1" v alue="Rest riction Fo rm Receive d and Vali dated" /> | |||||
| 168 | Rest riction Fo rm Receive d and Vali dated | |||||
| 169 | <br /> <br /> | |||||
| 170 | </div> | |||||
| 171 | <div> | |||||
| 172 | <lab el for="si gnatureDat e"> | |||||
| 173 | Patient Si gnature Da te | |||||
| 174 | <img alt=" Required f ield" src= "res/star- icon_grey_ bg.png" /> | |||||
| 175 | </la bel> | |||||
| 176 | <dat e:date id= "signature Date" name ="signatur eDate" onk eyup="enab leRestrict AfterValid ation('sig natureDate ', 'option 1', 'list1 ', 'list2' , 'Authori ze');"/> < i>mm/dd/yy yy</i> | |||||
| 177 | <br /> | |||||
| 178 | </div> | |||||
| 179 | <c:choos e> | |||||
| 180 | <c:w hen test=" ${isFormUp loadAllowe d}"> | |||||
| 181 | <div> | |||||
| 182 | <label for="file "> | |||||
| 183 | Up load Conse nt Form<br /> | |||||
| 184 | <i > | |||||
| 185 | <span st yle="font- weight: no rmal;">(Ma x file siz e: <c:out value="${m axFileUplo adSize/100 0000}"/> m egabytes)< /span> | |||||
| 186 | </ i> | |||||
| 187 | </labe l> | |||||
| 188 | <input title="Br owse and U pload Cons ent Form" name="uplo aded" type ="file" id ="file" ac cept="appl ication/pd f" /> | |||||
| 189 | </div> | |||||
| 190 | </c: when> | |||||
| 191 | </c:choo se> | |||||
| 192 | <br /> < br /> | |||||
| 193 | <div> | |||||
| 194 | <lab el for="co mments">Co mments</la bel> | |||||
| 195 | <tex tarea id=" comments" name="comm ents" styl e="width: 300px; hei ght: 60px; "></textar ea> | |||||
| 196 | <br /> | |||||
| 197 | </div> | |||||
| 198 | <br /> | |||||
| 199 | <div ali gn="center "> | |||||
| 200 | <inp ut id="Aut horize" cl ass="butto n" type="s ubmit" dis abled="dis abled" val ue="Restri ct" name=" optIn" tit le="Author ize" /> | |||||
| 201 | </div> | |||||
| 202 | </ form> | |||||
| 203 | </fiel dset> | |||||
| 204 | </div> |
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