consumerportal
Version:
mydna Custimised for you
113 lines (95 loc) • 4.21 kB
HTML
<script>
(function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){
(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),
m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)
})(window,document,'script','//www.google-analytics.com/analytics.js','ga');
ga('create', 'UA-69139205-6', 'auto');
ga('set', {
page: '/acctmgmt/findpatient.html',
title: 'Find Patient'
});
ga('send', 'pageview');
</script>
<div class="container">
<div class="row">
<div class="col-md-6 image-responsive-center center">
<div class='content_block content_blocks_padding'>
<div class="alert alert-danger" ng-show="(vm.showErrors == true && myForm.$invalid) || vm.errorCode == '404' || vm.errorCode == '409'">
<p ng-show="vm.showErrors == true && myForm.$invalid">Please correct the highlighted fields.</p>
<p ng-show="vm.errorCode == '404'">No account can be found using the details you entered.</p>
<p ng-show="vm.errorCode == '409'">Patient already registered. <a href="#acctmgmt/forgotpassword">Click here</a>
to retrieve your password or <a href="#/login">Login</a> now.</p>
</div>
<div class="pageinfo good" ng-show="vm.showErrors == true && myForm.$valid">
<p>All issues have been resolved.</p>
</div>
<h1>Register</h1>
<form novalidate ng-submit="" name="myForm" autocomplete="off">
<h3>Have you had a myDNA test?</h3>
<p>To access your results, we need you to confirm a few personal details so that we can link your test results to your patient profile.</p>
<div class="spacer"></div>
<div class="formdata">
<label>myDNA Patient #</label>
<input
type="text"
ng-model="vm.frm.PatientNumber" id="PatientNumber" name="PatientNumber"
ng-required="true" mydna-validator="numberOnly"
class="form-control"
ng-class="{'error-branch': vm.showErrors == true && myForm.PatientNumber.$invalid}"
tabindex="{{vm.tabIndexValue}}"
/>
<div class="errorWrap">
<div
ng-messages="myForm.PatientNumber.$error"
ng-show="vm.showErrors == true && myForm.PatientNumber.$invalid">
<div ng-message="required">Enter a myDNA Patient #</div>
<div ng-message="mydnaValidator">Invalid myDNA Patient #</div>
</div>
</div>
<div class="spacer"></div>
<label>Last Name</label>
<input
type="text" class="form-control"
ng-model="vm.frm.LastName" id="LastName" name="LastName"
ng-minlength="2" ng-required="true"
ng-class="{'error-branch' : vm.showErrors == true && myForm.LastName.$invalid}"
tabindex="{{vm.tabIndexValue}}"
/>
<div class="errorWrap">
<div
ng-messages="myForm.LastName.$error" ng-show="vm.showErrors == true && myForm.LastName.$invalid"
>
<div ng-message="required">Enter a Last Name</div>
<div ng-message="minlength">Last Name is too short</div>
</div>
</div>
<div class="spacer"></div>
<label>Date of Birth</label>
<input rsmdatedropdowns date-format="dd/MM/yyyy" ng-required="true" name="dob" id="dob" ng-model="vm.frm.dob"
day-div-class="day-container"
day-class="form-control day-selector"
month-div-class="month-container"
month-class="form-control month-selector"
year-div-class="year-container"
year-class="form-control year-selector"
ng-class="{'error-branch' : vm.showErrors == true && myForm.dob.$invalid}"
ng-required="true"
tabindex="{{vm.tabIndexValue}}"
/>
<div class="errorWrap">
<div ng-show="vm.showErrors && myForm.dob.$invalid">
Enter a valid date (dd/mm/yyyy)
</div>
</div>
</div>
<div class="spacer"></div>
<div class="buttons-inner">
<button class="btn btn-primary"
tabindex="{{vm.tabIndexValue}}"
ng-click="vm.search()">Find Details</button>
</div>
</form>
</div>
</div>
</div>
</div>