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="accordion ewv" [ngClass]="{'split': isSplitView}">
<input id="{{accordionId}}" type="checkbox" [(ngModel)]="collapseState" role="button" aria-label="Claim-Level Ambulance Information Section">
<label for="{{accordionId}}">Claim-Level Ambulance Information</label>
<!-- Accordion Content -->
<div class="accordion-content row">
<app-messages [ewvNoInfo]="!claimLevel" [ewvMsg]="claimLvlMsg"></app-messages>
<div class="row"></div>
<div *ngIf="claimLevel">
<div class="info-table">
<!-- Claim-level ambulance information: SECTION 1 -->
<div class="col one">
<h4 id="HDG_pickupLocation_claimLvlAmbulanceInfo_1">Pick-Up Location</h4>
<table id="TBL_pickupLocation_claimLvlAmbulanceInfo_1">
<tbody>
<tr>
<th>
Address 1:
</th>
<td>{{claimLevel?.pickupAddressLine1}}</td>
</tr>
<tr>
<th>
Address 2:
</th>
<td>{{claimLevel?.pickupAddressLine2}}</td>
</tr>
<tr>
<th>
City:
</th>
<td>{{claimLevel?.pickupCity}}</td>
</tr>
<tr>
<th>
State:
</th>
<td>{{claimLevel?.pickupState}}</td>
</tr>
<tr>
<th>
ZIP Code:
</th>
<td>{{claimLevel?.pickupZip}}</td>
</tr>
</tbody>
</table>
</div>
<div class="row col one no-flow">
<h4 id="HDG_dropOffLocation_claimLvlAmbulanceInfo_1">Drop-Off Location</h4>
<table id="TBL_dropOffLocation_claimLvlAmbulanceInfo_1">
<tbody>
<tr>
<th>
Address 1:
</th>
<td>{{claimLevel?.dropoffAddressLine1}}</td>
</tr>
<tr>
<th>
Address 2:
</th>
<td>{{claimLevel?.dropoffAddressLine2}}</td>
</tr>
<tr>
<th>
City:
</th>
<td>{{claimLevel?.dropoffCity}}</td>
</tr>
<tr>
<th>
State:
</th>
<td>{{claimLevel?.dropoffState}}</td>
</tr>
<tr>
<th>
ZIP Code:
</th>
<td>{{claimLevel?.dropoffZip}}</td>
</tr>
</tbody>
</table>
</div>
<!-- Claim-level ambulance information: SECTION 2 -->
<div class="row" style="border-bottom: 1px solid #ccc;"></div>
<div class="row col one">
<table id="TBL_transport_claimLvlAmbulanceInfo_1">
<tbody>
<tr>
<th>Transport Reason Code:</th>
<td>{{claimLevel?.transportReasonCode}}</td>
</tr>
<tr>
<th>
Transport Distance Miles:
</th>
<td>{{claimLevel?.transportDistance}}</td>
</tr>
</tbody>
</table>
</div>
<div class="row col one no-flow">
<table id="TBL_transport_claimLvlAmbulanceInfo_2">
<tbody>
<tr>
<th>Round Trip Purpose:</th>
<td>{{claimLevel?.roundTripPurpose}}</td>
</tr>
<tr>
<th>
Stretcher Purpose:
</th>
<td>{{claimLevel?.stretcherPurpose}}</td>
</tr>
</tbody>
</table>
</div>
<!-- Claim-level ambulance information: SECTION 3 -->
<div class="row" style="border-bottom: 1px solid #ccc;"></div>
<div class="row col one">
<table id="TBL_certification_claimLvlAmbulanceInfo_1">
<tbody>
<tr *ngFor="let c of claimLevel.certs">
<th>Certification Indicator:</th>
<td>{{c?.certIndicator}}</td>
</tr>
</tbody>
</table>
</div>
<div *ngIf="claimLevel" class="row col one no-flow">
<table id="TBL_ambulanceConditionCode_claimLvlAmbulanceInfo_1">
<tbody>
<tr *ngFor="let c of claimLevel.certs">
<th>Ambulance Cond. Code:</th>
<td>{{c?.conditionCodes}}</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</div>
</div>