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

<app-ars-base [title]="title">
<article>
<!-- Error Message -->
<app-messages [errorStatus]="errorStatus" [errorMsg]="errorMsg"> </app-messages>
<!-- Adds Cushion -->
<div class="row"></div>
<div class="container fade-in">
<!-- Card Tabs -->
<div class="card-tabs blue-tab">
<section>
<!-- Tab 1 -->
<input id="tab1" (click)="clearAdvancedForm()" type="radio" checked="checked" name="tabs" #primaryRadioButton
role="tab" aria-label="Quick Search Tab. To switch tabs, use arrow keys." />
<label for="tab1" class="tab-label">Quick Search</label>
<!-- Tab 1 Contnet -->
<div class="tab-content">
<div class="col three">
<div class="card-head">
<h3>Quick Search</h3>
<span>Enter criteria to find matching Requests for Additional Information.</span>
</div>
<form [formGroup]="primaryForm" (ngSubmit)="primarySearch()" novalidate>
<div class="col two">
<label class="label text-field" for="primarySearchParam">Submission ID, PDI, Claim ID, Patient ID, and/or Provider NPI Only</label>
<input appAutofocus type="text" id="primarySearchParam" name="primarySearchParam" formControlName="primarySearchParam" [(ngModel)]="primaryModel.number"
placeholder="Enter Search Criteria" class="big-box">
</div>
<div class="row bottom col two">
<button class="button primary button-align" type="submit" id="primarySearch" [disabled]="disableSearch?disableSearch:primaryForm.get('primarySearchParam').invalid"
[class.disabled]="disableSearch?disableSearch:primaryForm.get('primarySearchParam').invalid">Search</button>
<button class="button secondary button-align" type="button" id="primaryClear" (click)="clearPrimary()" [disabled]="disableSearch"
[class.disabled]="disableSearch">Reset Form</button>
</div>
</form>
</div>
</div>
<!-- Tab 2 -->
<input id="tab2" (click)="clearPrimary(); validateDates()" type="radio" name="tabs" #advancedRadioButton role="tab" />
<label for="tab2" class="tab-label">Advanced Search</label>
<!-- Tab 2 Content -->
<div class="tab-content">
<div class="col three no-flow">
<div class="card-head">
<h3>Advanced Search</h3>
<span>Enter any combination of parameters to find matching attachments.</span>
</div>
</div>
<form [formGroup]="advancedForm" (ngSubmit)="advancedSearch()" novalidate>
<div class="col one">
<label class="label text-field" for="pdiClaimId">PDI or Claim ID
<!-- <span class="required">Required</span> -->
<span class="error" role="alert" aria-live="assertive" *ngIf="advancedForm.get('pdiClaimId').invalid && advancedForm.get('pdiClaimId').touched">Enter a valid Number.</span>
</label>
<input type="text" id="pdiClaimId" name="pdiClaimId" formControlName="pdiClaimId" [(ngModel)]="advancedModel.number" placeholder="Enter Number">
</div>
<div class="col one">
<label class="label text-field" for="billingProvider">Billing Provider Name
<span class="error" role="alert" aria-live="assertive" *ngIf="advancedForm.get('billingProvider').invalid && advancedForm.get('billingProvider').touched">Enter a valid Name.</span>
</label>
<input type="text" id="billingProvider" name="billingProvider" formControlName="billingProvider" placeholder="Enter Name"
[(ngModel)]="advancedModel.providerName">
</div>
<div class="col one no-flow">
<label class="label text-field" for="providerNpi">Provider NPI
<span class="error" role="alert" aria-live="assertive" *ngIf="advancedForm.get('providerNpi').invalid && advancedForm.get('providerNpi').touched">Enter a valid Number.</span>
</label>
<input type="text" id="providerNpi" name="providerNpi" formControlName="providerNpi" placeholder="Enter Number" [(ngModel)]="advancedModel.providerNpi"
maxlength="10">
</div>
<div class="col one">
<label class="label text-field" for="providerTin">Provider TIN
<span class="error" role="alert" aria-live="assertive" *ngIf="advancedForm.get('providerTin').invalid && advancedForm.get('providerTin').touched">Enter a valid Number.</span>
</label>
<input type="text" id="providerTin" name="providerTin" formControlName="providerTin" placeholder="Enter Number" [(ngModel)]="advancedModel.providerTin"
maxlength="9">
</div>
<div class="col one">
<label class="label text-field" for="patientLastname">Patient Last Name</label>
<input type="text" id="patientLastname" formControlName="patientLastname" name="patientLastname" placeholder="Enter Name"
[(ngModel)]="advancedModel.patientLastName">
</div>
<div class="col one no-flow">
<label class="label text-field" for="patientFirstName">Patient First Name</label>
<input type="text" id="patientFirstName" name="patientFirstName" formControlName="patientFirstName" placeholder="Enter Name"
[(ngModel)]="advancedModel.patientfirstName">
</div>
<div class="col one">
<label class="label text-field" for="patientIdentifier">Patient Identifier
<span class="error" role="alert" aria-live="assertive" *ngIf="advancedForm.get('patientIdentifier').invalid && advancedForm.get('patientIdentifier').touched">Enter a valid Number.</span>
</label>
<input type="text" id="patientIdentifier" name="patientIdentifier" formControlName="patientIdentifier" placeholder="Enter Number"
[(ngModel)]="advancedModel.patientIdentifier">
</div>
<div class="col one">
<label class="label text-field" for="patientcontrolNumber">Patient Control Number
<span class="error" role="alert" aria-live="assertive" *ngIf="advancedForm.get('patientcontrolNumber').invalid && advancedForm.get('patientcontrolNumber').touched">Enter a valid Number.</span>
</label>
<input type="text" id="patientcontrolNumber" name="patientcontrolNumber" formControlName="patientcontrolNumber" placeholder="Enter Number"
[(ngModel)]="advancedModel.patientControlNumber">
</div>
<div class="col one no-flow">
<label class="label text-field" for="medicalRecordNumber">Medical Record Number
<span class="error" role="alert" aria-live="assertive" *ngIf="advancedForm.get('medicalRecordNumber').invalid && advancedForm.get('medicalRecordNumber').touched">Enter a valid Number.</span>
</label>
<input type="text" id="medicalRecordNumber" formControlName="medicalRecordNumber" name="medicalRecordNumber" placeholder="Enter Number"
[(ngModel)]="advancedModel.medicalRecordNumber">
</div>
<div class="col one">
<app-calendar [monthId]="'SPN_currentMonth_1'" [dateRangeError]="dateRangeError" [parentControlName]="'serviceStartDate'" [parentFormGroup]="advancedForm" [id]="'serviceStartDate'" [label]="'Service Start Date'"></app-calendar>
</div>
<div class="col one">
<app-calendar [monthId]="'SPN_currentMonth_2'" [dateRangeError]="dateRangeError" [parentControlName]="'serviceEndDate'" [parentFormGroup]="advancedForm" [id]="'serviceEndDate'" [label]="'Service End Date'"></app-calendar>
</div>
<div class="row bottom col two">
<button class="button primary" [disabled]="disableSearch?disableSearch:advancedForm.invalid" [class.disabled]="disableSearch?disableSearch:advancedForm.invalid"
type="submit" id="advancedSearch">Search</button>
<button class="button secondary" type="button" (click)="clearAdvancedForm()" id="advancedClear" [disabled]="disableSearch"
[class.disabled]="disableSearch">Reset Form</button>
</div>
</form>
</div>
</section>
</div>
</div>
<div *ngIf="showResults" class="container">
<div class="row results">
<div class="col three">
<div class="card-head">
<h4>Search Results</h4>
</div>
</div>
<div class="col three">
<app-table (notify)="updateTable()" [tempColumn]="'submissionId'" [columns]="tableColumns" [loading]="loading" (imgNotify)="viewSubmissionDetails($event)"
[rows]="searchResults" [paginationSettings]="paginationSettings" [tableSettings]=tableSettings></app-table>
</div>
<div class="row"></div>
</div>
</div>
</article>
</app-ars-base>