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<!-- Use this page as the index for your project --> | ||
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<!-- ADDING CUSTOM CSS - Add your custom CSS or Sass in /app/assets/sass/main.scss --> | ||
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<!-- Extends the layout from /views/layout.html --> | ||
{% extends 'layout.html' %} | ||
<!-- | ||
In /views/layout.html you can: | ||
- change the header and footer | ||
- add custom CSS and JavaScript | ||
--> | ||
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<!-- Set the page title --> | ||
{% block pageTitle %} | ||
Overseas Healthcare Service RINA | ||
{% endblock %} | ||
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<!-- For adding a breadcrumb --> | ||
<!-- Code examples can be found at https://service-manual.nhs.uk/design-system/components/breadcrumbs --> | ||
{% block beforeContent %} | ||
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{% endblock %} | ||
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<!-- For adding a back link --> | ||
<!-- Code examples can be found at https://service-manual.nhs.uk/design-system/components/back-link --> | ||
{% block outerContent %} | ||
{% endblock %} | ||
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<!-- For adding page content --> | ||
<!-- Page layout code can be found at https://service-manual.nhs.uk/design-system/styles/layout --> | ||
{% block content %} | ||
<div class="nhsBSA-sidebar-container"> | ||
<div class="nhsBSA-sidebar-wrapper"> | ||
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<!-- content - start --> | ||
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<div class="nhsBSA-sidebar-content"> | ||
<div class="nhsuk-grid-column-one-half ul-padding-left-lrg ul-padding-top-lrg"> | ||
<h1 class="app-page-heading"> | ||
<span class="nhsuk-caption-l"> | ||
Create H001 | ||
<span class="nhsuk-u-visually-hidden"> - </span> | ||
</span> | ||
Additional information | ||
</h1> | ||
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<fieldset class="nhsuk-fieldset"> | ||
<legend class="nhsuk-fieldset__legend nhsuk-fieldset__legend--l"> | ||
<h2 class="nhsuk-fieldset__heading nhsuk-heading-m">Additional information/Change in circumstances (optional)</h2> | ||
</legend> | ||
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<div class="nhsuk-form-group nhsuk-u-margin-top-9"> | ||
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<fieldset class="nhsuk-fieldset"> | ||
<label class="nhsuk-label" for="example"> | ||
Notification/Request for additional information (optional) | ||
</label> | ||
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<div class="nhsuk-radios"> | ||
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<div class="nhsuk-radios__item"> | ||
<input class="nhsuk-radios__input" id="example-1" name="example" type="radio" value="yes"> | ||
<label class="nhsuk-label nhsuk-radios__label" for="example-1"> | ||
Notification of additional information | ||
</label> | ||
</div> | ||
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<div class="nhsuk-radios__item"> | ||
<input class="nhsuk-radios__input" id="example-2" name="example" type="radio" value="no"> | ||
<label class="nhsuk-label nhsuk-radios__label" for="example-2"> | ||
Request for additional information | ||
</label> | ||
</div> | ||
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<div class="nhsuk-form-group nhsuk-u-margin-top-4"> | ||
<label class="nhsuk-label" for="example"> | ||
Further details (optional) | ||
</label> | ||
<textarea class="nhsuk-textarea nhsuk-u-width-full" id="example" name="example" rows="5" aria-describedby="example-hint"></textarea> | ||
</div> | ||
</div> | ||
</fieldset> | ||
</div> | ||
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<h3 class="nhsuk-u-margin-top-9">Attached documents (optional)</h3> | ||
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<div class="nhsuk-form-group"> | ||
<label class="nhsuk-label" for="select-1"> | ||
Predefined Documents (optional) | ||
</label> | ||
<select class="nhsuk-select nhsuk-u-width-two-thirds" id="select-1" name="select-1"> | ||
<option value="1" selected>Choose a predefined document</option> | ||
<option value="2">[01] Application</option> | ||
<option value="3">[02] Certificate of death</option> | ||
<option value="3">[03] Invoices</option> | ||
<option value="3">[04] Statement of income</option> | ||
<option value="3">[05] Claim</option> | ||
<option value="3">[06] Medical evidence</option> | ||
<option value="3">[07] Work certificate</option> | ||
<option value="3">[08] Birth certificate</option> | ||
<option value="3">[09] Marriage certificat</option> | ||
<option value="3">[10] Diploma(s)</option> | ||
<option value="3">[11] Medical report</option> | ||
<option value="3">[12] Medical certificate</option> | ||
<option value="3">[99] Other</option> | ||
</select> | ||
</div> | ||
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<h3 class="nhsuk-u-margin-top-9">Other documents attached</h3> | ||
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<h4 class="nhsuk-u-margin-top-4">Additional documents</h4> | ||
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<div class="nhsuk-form-group"> | ||
<label class="nhsuk-label" for="example"> | ||
Document (optional) | ||
</label> | ||
<input class="nhsuk-input nhsuk-u-width-full" id="example" name="example" type="text" value=""> | ||
</div> | ||
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</fieldset> | ||
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<a href="missing-address-step-3-case-management" title="Continue to next section"> | ||
<button class="nhsuk-button nhsuk-u-margin-top-6" data-module="nhsuk-button" type="submit"> | ||
Save draft | ||
</button> | ||
</a> | ||
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<p class="nhsuk-u-margin-top-9">SED API version: 0.16.3 build preview 1, Model version: 4.1.0</p> | ||
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</div> | ||
</div> | ||
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<!-- content - end --> | ||
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<div class="nhsBSA-sidebar-nav"> | ||
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<div class="nhsuk-grid-row"> | ||
<div class="nhsuk-grid-column-full"> | ||
<div class="nhsuk-back-link"> | ||
<a class="nhsuk-back-link__link" href="javascript:history.go(-1)"> | ||
<svg class="nhsuk-icon nhsuk-icon__chevron-left" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24" aria-hidden="true" height="24" width="24"> | ||
<path d="M8.5 12c0-.3.1-.5.3-.7l5-5c.4-.4 1-.4 1.4 0s.4 1 0 1.4L10.9 12l4.3 4.3c.4.4.4 1 0 1.4s-1 .4-1.4 0l-5-5c-.2-.2-.3-.4-.3-.7z"></path> | ||
</svg> | ||
Go back</a> | ||
</div> | ||
</div> | ||
</div> | ||
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<!-- nav - start --> | ||
<ul class="nhsuk-header__navigation-list sidebar-nav"> | ||
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<li class="nhsuk-header__navigation-item"> | ||
<a class="nhsuk-header__navigation-link" href="sed-create-h001-person"> | ||
Person details | ||
</a> | ||
</li> | ||
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<li class="nhsuk-header__navigation-item"> | ||
<a class="nhsuk-header__navigation-link " href="sed-create-h001-address"> | ||
Address | ||
</a> | ||
</li> | ||
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<li class="nhsuk-header__navigation-item"> | ||
<a class="nhsuk-header__navigation-link" href="sed-create-h001-request"> | ||
Request for personal information | ||
</a> | ||
</li> | ||
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<li class="nhsuk-header__navigation-item"> | ||
<a class="nhsuk-header__navigation-link" href="sed-create-h001-notification"> | ||
Notify a change of information | ||
</a> | ||
</li> | ||
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<li class="nhsuk-header__navigation-item active"> | ||
<a class="nhsuk-header__navigation-link" href="sed-create-h001-additional"> | ||
Additional information | ||
</a> | ||
</li> | ||
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</ul> | ||
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<!-- nav - end --> | ||
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</div> | ||
</div> | ||
</div> | ||
{% endblock %} |
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