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="col three">
<h4 class="float-left">Document Request Codes
<span class="required" style="font-size: 14px;">Minimum of one set is required; maximum six sets.</span>
</h4>
<div class="icon-function" [class.disabled]="form.invalid || codeList.length>=6" style="margin-right: 12px;">
<label for="AAA">Add New Set</label>
<img id="AAA" src="./../../assets/images/ic_add_circle_blue_24px.svg" (click)="addRow()" (keydown.enter)="addRow()" [tabIndex]="(!(form.invalid || codeList.length>=6)&&(tabbable)?'0':'-1')"
title="Add New Set" alt="add new set">
</div>
</div>
<form [formGroup]="form">
<div class="col three">
<div class="row">
<div class="label text-field multi-label">
<label for="IPT_selectLvl_requestCode_{{ form.controls['codeList']['controls'].length-1 }}" style="width: 99px">Select Level/Line
</label>
<label for="IPT_selectHccsc_requestCode_{{ form.controls['codeList']['controls'].length-1 }}">Healthcare Claim Status Cat. Code
<img id="IMG_required_requestCode_1" src="./../../../../assets/images/ic_asterisk_red_16px.svg" alt="Required" title="Required">
</label>
<label for="IPT_loincCode_requestCode_{{ form.controls['codeList']['controls'].length-1 }}">LOINC Code
<img id="IMG_required_requestCode_2" src="./../../../../assets/images/ic_asterisk_red_16px.svg" alt="Required" title="Required">
</label>
<label for="IPT_loincMod1_requestCode_{{ form.controls['codeList']['controls'].length-1 }}">LOINC Modifier 1
<span class="info">Optional</span>
</label>
<label for="IPT_loincMod2_requestCode_{{ form.controls['codeList']['controls'].length-1 }}">LOINC Modifier 2
<span class="info">Optional</span>
</label>
</div>
<ng-container formArrayName="codeList" *ngFor="let item of form.controls['codeList']['controls']; let i = index;">
<ng-container [formGroupName]="i">
<div class="multi-code">
<select id="IPT_selectLvl_requestCode_{{i}}" #checklevel formControlName="levelDropDown" style="width: 99px" [attr.disabled]="levelCode==='C'?'': null"
[class.disabled]="levelCode==='C'" (change)="onChangeDropdown($event)" [tabIndex]="tabbable?'0':'-1'">
<option selected value="0">Claim</option>
<option *ngFor="let row of lineIdArray; let i = index;" [value]="row">Line {{''+ row}}</option>
</select>
<select id="IPT_selectHccsc_requestCode_{{i}}" formControlName="healthCareClaimStatusCode" name="healthCareClaimStatusCode"
[tabIndex]="tabbable?'0':'-1'">
<option value="0" selected>Select Category Code</option>
<option *ngFor="let code of healthCareClaimStatusCodes" [value]="code.cd">{{code.stcCd + " "+ code.stcCdDesc}}</option>
</select>
<select id="IPT_loincCode_requestCode_{{i}}" formControlName="loincCode{{i}}" type="text" placeholder="Select LOINC Code"
name="loincCode{{i}}" [tabIndex]="tabbable?'0':'-1'">
<option value="0" selected>Select LOINC Code</option>
<ng-container *ngIf="checklevel.value === '0'">
<option *ngFor="let code of loincCodesClaimLevel" [value]="code.cd">{{code.stcCd + " "+ code.stcCdDesc}}</option>
</ng-container>
<ng-container *ngIf="checklevel.value !== '0'">
<option *ngFor="let code of loincCodesLineLevel" [value]="code.cd">{{code.stcCd + " "+ code.stcCdDesc}}</option>
</ng-container>
</select>
<select id="IPT_loincMod1_requestCode_{{i}}" formControlName="loincCodeModifier1" type="text" placeholder="Select LOINC Modifier Code"
name="loincCodeModifier1" [tabIndex]="tabbable?'0':'-1'">
<option value="0" selected>Select LOINC Modifier 1</option>
<option *ngFor="let code of loincCodeModifiers" [value]="code.cd">{{code.stcCd + " "+ code.stcCdDesc}}</option>
</select>
<select id="IPT_loincMod2_requestCode_{{i}}" formControlName="loincCodeModifier2" [attr.disabled]="item['controls']['loincCodeModifier1']['value'] === '0'?'': null"
[class.disabled]="item['controls']['loincCodeModifier1']['value'] === '0'" type="text" placeholder="Select LOINC Modifier Code"
name="loincCodeModifier2" [tabIndex]="tabbable?'0':'-1'">
<option value="0" selected>Select LOINC Modifier 2</option>
<option *ngFor="let code of loincCodeModifiers" [value]="code.cd">{{code.stcCd + " "+ code.stcCdDesc}}</option>
</select>
<!-- <input formControlName="isClaim{{i}}" type="radio" attr.name="isClaim{{i}}" id="IPT_lineLevelC_requestCode_{{i}}" [value]="'C'"
checked>
<label for="IPT_lineLevelC_requestCode_{{i}}" style="padding-right: 12px;">Claim</label>
<input formControlName="isClaim{{i}}" type="radio" attr.name="isClaim{{i}}" id="IPT_lineLevelL_requestCode_{{i}}" [value]="'L'">
<label for="IPT_lineLevelL_requestCode_{{i}}" style="padding-right: 30px;">Line</label> -->
<!-- <input formControlName="lineNumber{{i}}" type="text" attr.name="lineNumber{{i}}" id="IPT_lineNumber_requestCode_{{i}}" placeholder="Enter Line Number"
title="Enter Single Line Number"> -->
<img id="IMG_removeSet_requestCode_1" src="./../../../../assets/images/ic_close_circle_red_24px.svg" class="remove-set" *ngIf="i>0"
(click)="removeRow(i)" title="Remove Codeset" alt="remove codeset" (keydown.enter)="removeRow(i)" [tabIndex]="tabbable?'0':'-1'">
</div>
</ng-container>
</ng-container>
</div>
</div>
</form>