Hugging Face's logo

Spaces:
SyedomarAli
/
form
Running

App Files Community
SyedomarAli commited on
Commit
0c20164
·
verified ·
1 Parent(s): 1b30143

Main Field Sub Field

Browse files

Personal
General Info
Patient ID Dropdown Data Fields
Last Name
First Name
Middle Name
Preferred Name
Suffix
Birthdate
Account Number
Customer Type
Facility Master
Facility Resident
Patient
Prior System Key
Facility Search Field
Billing Address
Address
Address
City
State
County
Country
Postal Code
_____-____
Custom Fields
S&S and Elig and Deduct
Incont Campaign
Successful
Unsuccessful
Compress Campaign
Successful
Unsuccessful
Mailer - Incont Campaign
Successful
Unsuccessful
Clamp On Rail Campaign
Successful
Unsuccessful
BP Machines Campaign
Successful
Unsuccessful
Extended Info
Hold Account
Hold Billing Statements
HIPAA Signature on file
Discount Percent %
Tax Zone
Search Field
Branch Office
New Hampshire Medical Supply
NHMS BRA
NHMS BSC
Account Group
"1-9
A-Z"
PT Security Group
PCAs Name list
User 1
Text Field
Patient Hub Email Address
Not Invited
Place of Service
12 Home to 17 Walkin Retail clinic
Date of Admission
Date Selection
Date of Discharge
Date Selection
Delivery Addresses
Active Addresses Only
Address
City
State
County
Country
Postal Code
_____-____
Description
Text Field
Phone
(___) ___-____
Zone (None)
create form - Initial Deployment

Files changed (3) hide show
  1. README.md +7 -5
  2. index.html +407 -18
  3. prompts.txt +84 -0
README.md CHANGED
@@ -1,10 +1,12 @@
1
  ---
2
- title: Form
3
- emoji: 📚
4
- colorFrom: pink
5
- colorTo: green
6
  sdk: static
7
  pinned: false
 
 
8
  ---
9
 
10
- Check out the configuration reference at https://huggingface.co/docs/hub/spaces-config-reference
 
1
  ---
2
+ title: form
3
+ emoji: 🐳
4
+ colorFrom: green
5
+ colorTo: pink
6
  sdk: static
7
  pinned: false
8
+ tags:
9
+ - deepsite
10
  ---
11
 
12
+ Check out the configuration reference at https://huggingface.co/docs/hub/spaces-config-reference
index.html CHANGED
@@ -1,19 +1,408 @@
1
- <!doctype html>
2
- <html>
3
- <head>
4
- <meta charset="utf-8" />
5
- <meta name="viewport" content="width=device-width" />
6
- <title>My static Space</title>
7
- <link rel="stylesheet" href="style.css" />
8
- </head>
9
- <body>
10
- <div class="card">
11
- <h1>Welcome to your static Space!</h1>
12
- <p>You can modify this app directly by editing <i>index.html</i> in the Files and versions tab.</p>
13
- <p>
14
- Also don't forget to check the
15
- <a href="https://huggingface.co/docs/hub/spaces" target="_blank">Spaces documentation</a>.
16
- </p>
17
- </div>
18
- </body>
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
19
  </html>
 
1
+ <!DOCTYPE html>
2
+ <html lang="en">
3
+ <head>
4
+ <meta charset="UTF-8">
5
+ <meta name="viewport" content="width=device-width, initial-scale=1.0">
6
+ <title>Patient Information Form</title>
7
+ <script src="https://cdn.tailwindcss.com"></script>
8
+ <script src="https://unpkg.com/feather-icons"></script>
9
+ <script src="https://cdn.jsdelivr.net/npm/feather-icons/dist/feather.min.js"></script>
10
+ <link href="https://fonts.googleapis.com/css2?family=Inter:wght@300;400;500;600;700&display=swap" rel="stylesheet">
11
+ <style>
12
+ .form-section {
13
+ transition: all 0.3s ease;
14
+ }
15
+ .form-section:hover {
16
+ box-shadow: 0 4px 6px -1px rgba(0, 0, 0, 0.1), 0 2px 4px -1px rgba(0, 0, 0, 0.06);
17
+ }
18
+ .dropdown-arrow {
19
+ transition: transform 0.2s ease;
20
+ }
21
+ .dropdown-toggle:focus + .dropdown-arrow {
22
+ transform: rotate(180deg);
23
+ }
24
+ input:focus, select:focus, textarea:focus {
25
+ outline: none;
26
+ box-shadow: 0 0 0 2px rgba(59, 130, 246, 0.5);
27
+ }
28
+ </style>
29
+ </head>
30
+ <body class="bg-gray-50 font-inter">
31
+ <div class="container mx-auto px-4 py-8 max-w-6xl">
32
+ <div class="bg-white rounded-lg shadow-md overflow-hidden mb-8">
33
+ <div class="bg-blue-600 px-6 py-4">
34
+ <h1 class="text-2xl font-bold text-white flex items-center">
35
+ <i data-feather="user" class="mr-2"></i>
36
+ Patient Information Form
37
+ </h1>
38
+ </div>
39
+
40
+ <form class="p-6 space-y-8">
41
+ <!-- Personal Information Section -->
42
+ <div class="form-section bg-white border border-gray-200 rounded-lg p-6">
43
+ <div class="flex items-center justify-between mb-4">
44
+ <h2 class="text-lg font-semibold text-gray-800">Personal Information</h2>
45
+ <i data-feather="chevron-down" class="text-gray-500 dropdown-arrow"></i>
46
+ </div>
47
+
48
+ <div class="grid grid-cols-1 md:grid-cols-2 lg:grid-cols-3 gap-6">
49
+ <div>
50
+ <label class="block text-sm font-medium text-gray-700 mb-1">Patient ID</label>
51
+ <select class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm focus:ring-blue-500 focus:border-blue-500">
52
+ <option value="">Select Patient ID</option>
53
+ <!-- Dropdown options would be populated here -->
54
+ </select>
55
+ </div>
56
+
57
+ <div>
58
+ <label class="block text-sm font-medium text-gray-700 mb-1">Last Name</label>
59
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
60
+ </div>
61
+
62
+ <div>
63
+ <label class="block text-sm font-medium text-gray-700 mb-1">First Name</label>
64
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
65
+ </div>
66
+
67
+ <div>
68
+ <label class="block text-sm font-medium text-gray-700 mb-1">Middle Name</label>
69
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
70
+ </div>
71
+
72
+ <div>
73
+ <label class="block text-sm font-medium text-gray-700 mb-1">Preferred Name</label>
74
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
75
+ </div>
76
+
77
+ <div>
78
+ <label class="block text-sm font-medium text-gray-700 mb-1">Suffix</label>
79
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
80
+ </div>
81
+
82
+ <div>
83
+ <label class="block text-sm font-medium text-gray-700 mb-1">Birthdate</label>
84
+ <input type="date" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
85
+ </div>
86
+
87
+ <div>
88
+ <label class="block text-sm font-medium text-gray-700 mb-1">Account Number</label>
89
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
90
+ </div>
91
+
92
+ <div>
93
+ <label class="block text-sm font-medium text-gray-700 mb-1">Customer Type</label>
94
+ <select class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
95
+ <option value="">Select Type</option>
96
+ <option value="facility_master">Facility Master</option>
97
+ <option value="facility_resident">Facility Resident</option>
98
+ <option value="patient">Patient</option>
99
+ </select>
100
+ </div>
101
+
102
+ <div>
103
+ <label class="block text-sm font-medium text-gray-700 mb-1">Prior System Key</label>
104
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
105
+ </div>
106
+
107
+ <div>
108
+ <label class="block text-sm font-medium text-gray-700 mb-1">Facility</label>
109
+ <div class="relative">
110
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm" placeholder="Search facility...">
111
+ <i data-feather="search" class="absolute right-3 top-2.5 text-gray-400"></i>
112
+ </div>
113
+ </div>
114
+ </div>
115
+ </div>
116
+
117
+ <!-- Billing Address Section -->
118
+ <div class="form-section bg-white border border-gray-200 rounded-lg p-6">
119
+ <div class="flex items-center justify-between mb-4">
120
+ <h2 class="text-lg font-semibold text-gray-800">Billing Address</h2>
121
+ <i data-feather="chevron-down" class="text-gray-500 dropdown-arrow"></i>
122
+ </div>
123
+
124
+ <div class="grid grid-cols-1 md:grid-cols-2 gap-6">
125
+ <div class="col-span-2">
126
+ <label class="block text-sm font-medium text-gray-700 mb-1">Address</label>
127
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
128
+ </div>
129
+
130
+ <div class="col-span-2">
131
+ <label class="block text-sm font-medium text-gray-700 mb-1">Address 2</label>
132
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
133
+ </div>
134
+
135
+ <div>
136
+ <label class="block text-sm font-medium text-gray-700 mb-1">City</label>
137
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
138
+ </div>
139
+
140
+ <div>
141
+ <label class="block text-sm font-medium text-gray-700 mb-1">State</label>
142
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
143
+ </div>
144
+
145
+ <div>
146
+ <label class="block text-sm font-medium text-gray-700 mb-1">County</label>
147
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
148
+ </div>
149
+
150
+ <div>
151
+ <label class="block text-sm font-medium text-gray-700 mb-1">Country</label>
152
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
153
+ </div>
154
+
155
+ <div>
156
+ <label class="block text-sm font-medium text-gray-700 mb-1">Postal Code</label>
157
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm" placeholder="_____-____">
158
+ </div>
159
+ </div>
160
+ </div>
161
+
162
+ <!-- Campaign Information Section -->
163
+ <div class="form-section bg-white border border-gray-200 rounded-lg p-6">
164
+ <div class="flex items-center justify-between mb-4">
165
+ <h2 class="text-lg font-semibold text-gray-800">Campaign Information</h2>
166
+ <i data-feather="chevron-down" class="text-gray-500 dropdown-arrow"></i>
167
+ </div>
168
+
169
+ <div class="grid grid-cols-1 md:grid-cols-2 lg:grid-cols-3 gap-6">
170
+ <div>
171
+ <label class="block text-sm font-medium text-gray-700 mb-1">Incont Campaign</label>
172
+ <select class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
173
+ <option value="">Select Status</option>
174
+ <option value="successful">Successful</option>
175
+ <option value="unsuccessful">Unsuccessful</option>
176
+ </select>
177
+ </div>
178
+
179
+ <div>
180
+ <label class="block text-sm font-medium text-gray-700 mb-1">Compress Campaign</label>
181
+ <select class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
182
+ <option value="">Select Status</option>
183
+ <option value="successful">Successful</option>
184
+ <option value="unsuccessful">Unsuccessful</option>
185
+ </select>
186
+ </div>
187
+
188
+ <div>
189
+ <label class="block text-sm font-medium text-gray-700 mb-1">Mailer - Incont Campaign</label>
190
+ <select class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
191
+ <option value="">Select Status</option>
192
+ <option value="successful">Successful</option>
193
+ <option value="unsuccessful">Unsuccessful</option>
194
+ </select>
195
+ </div>
196
+
197
+ <div>
198
+ <label class="block text-sm font-medium text-gray-700 mb-1">Clamp On Rail Campaign</label>
199
+ <select class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
200
+ <option value="">Select Status</option>
201
+ <option value="successful">Successful</option>
202
+ <option value="unsuccessful">Unsuccessful</option>
203
+ </select>
204
+ </div>
205
+
206
+ <div>
207
+ <label class="block text-sm font-medium text-gray-700 mb-1">BP Machines Campaign</label>
208
+ <select class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
209
+ <option value="">Select Status</option>
210
+ <option value="successful">Successful</option>
211
+ <option value="unsuccessful">Unsuccessful</option>
212
+ </select>
213
+ </div>
214
+ </div>
215
+ </div>
216
+
217
+ <!-- Extended Information Section -->
218
+ <div class="form-section bg-white border border-gray-200 rounded-lg p-6">
219
+ <div class="flex items-center justify-between mb-4">
220
+ <h2 class="text-lg font-semibold text-gray-800">Extended Information</h2>
221
+ <i data-feather="chevron-down" class="text-gray-500 dropdown-arrow"></i>
222
+ </div>
223
+
224
+ <div class="grid grid-cols-1 md:grid-cols-2 lg:grid-cols-3 gap-6">
225
+ <div class="flex items-center space-x-2">
226
+ <input type="checkbox" id="holdAccount" class="h-4 w-4 text-blue-600 focus:ring-blue-500 border-gray-300 rounded">
227
+ <label for="holdAccount" class="text-sm font-medium text-gray-700">Hold Account</label>
228
+ </div>
229
+
230
+ <div class="flex items-center space-x-2">
231
+ <input type="checkbox" id="holdBilling" class="h-4 w-4 text-blue-600 focus:ring-blue-500 border-gray-300 rounded">
232
+ <label for="holdBilling" class="text-sm font-medium text-gray-700">Hold Billing Statements</label>
233
+ </div>
234
+
235
+ <div class="flex items-center space-x-2">
236
+ <input type="checkbox" id="hipaa" class="h-4 w-4 text-blue-600 focus:ring-blue-500 border-gray-300 rounded">
237
+ <label for="hipaa" class="text-sm font-medium text-gray-700">HIPAA Signature on file</label>
238
+ </div>
239
+
240
+ <div>
241
+ <label class="block text-sm font-medium text-gray-700 mb-1">Discount Percent</label>
242
+ <div class="relative">
243
+ <input type="number" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm" placeholder="%">
244
+ <span class="absolute right-3 top-2.5 text-gray-500">%</span>
245
+ </div>
246
+ </div>
247
+
248
+ <div>
249
+ <label class="block text-sm font-medium text-gray-700 mb-1">Tax Zone</label>
250
+ <div class="relative">
251
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm" placeholder="Search tax zone...">
252
+ <i data-feather="search" class="absolute right-3 top-2.5 text-gray-400"></i>
253
+ </div>
254
+ </div>
255
+
256
+ <div>
257
+ <label class="block text-sm font-medium text-gray-700 mb-1">Branch Office</label>
258
+ <select class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
259
+ <option value="">Select Branch</option>
260
+ <option value="nhms">New Hampshire Medical Supply</option>
261
+ <option value="nhms_bra">NHMS BRA</option>
262
+ <option value="nhms_bsc">NHMS BSC</option>
263
+ </select>
264
+ </div>
265
+
266
+ <div>
267
+ <label class="block text-sm font-medium text-gray-700 mb-1">Account Group</label>
268
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm" placeholder="1-9 A-Z">
269
+ </div>
270
+
271
+ <div>
272
+ <label class="block text-sm font-medium text-gray-700 mb-1">PT Security Group</label>
273
+ <select class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
274
+ <option value="">Select PCA</option>
275
+ <!-- PCA options would be populated here -->
276
+ </select>
277
+ </div>
278
+
279
+ <div>
280
+ <label class="block text-sm font-medium text-gray-700 mb-1">User 1</label>
281
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
282
+ </div>
283
+
284
+ <div>
285
+ <label class="block text-sm font-medium text-gray-700 mb-1">Patient Hub Email Address</label>
286
+ <select class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
287
+ <option value="not_invited">Not Invited</option>
288
+ <!-- Other options would be here -->
289
+ </select>
290
+ </div>
291
+
292
+ <div>
293
+ <label class="block text-sm font-medium text-gray-700 mb-1">Place of Service</label>
294
+ <select class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
295
+ <option value="">Select Place</option>
296
+ <option value="12">12 Home</option>
297
+ <option value="17">17 Walkin Retail clinic</option>
298
+ <!-- Other options would be here -->
299
+ </select>
300
+ </div>
301
+
302
+ <div>
303
+ <label class="block text-sm font-medium text-gray-700 mb-1">Date of Admission</label>
304
+ <input type="date" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
305
+ </div>
306
+
307
+ <div>
308
+ <label class="block text-sm font-medium text-gray-700 mb-1">Date of Discharge</label>
309
+ <input type="date" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
310
+ </div>
311
+ </div>
312
+ </div>
313
+
314
+ <!-- Delivery Addresses Section -->
315
+ <div class="form-section bg-white border border-gray-200 rounded-lg p-6">
316
+ <div class="flex items-center justify-between mb-4">
317
+ <h2 class="text-lg font-semibold text-gray-800">Delivery Addresses</h2>
318
+ <i data-feather="chevron-down" class="text-gray-500 dropdown-arrow"></i>
319
+ </div>
320
+
321
+ <div class="flex items-center mb-4">
322
+ <input type="checkbox" id="activeOnly" class="h-4 w-4 text-blue-600 focus:ring-blue-500 border-gray-300 rounded">
323
+ <label for="activeOnly" class="ml-2 text-sm font-medium text-gray-700">Active Addresses Only</label>
324
+ </div>
325
+
326
+ <div class="grid grid-cols-1 md:grid-cols-2 gap-6">
327
+ <div class="col-span-2">
328
+ <label class="block text-sm font-medium text-gray-700 mb-1">Address</label>
329
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
330
+ </div>
331
+
332
+ <div>
333
+ <label class="block text-sm font-medium text-gray-700 mb-1">City</label>
334
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
335
+ </div>
336
+
337
+ <div>
338
+ <label class="block text-sm font-medium text-gray-700 mb-1">State</label>
339
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
340
+ </div>
341
+
342
+ <div>
343
+ <label class="block text-sm font-medium text-gray-700 mb-1">County</label>
344
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
345
+ </div>
346
+
347
+ <div>
348
+ <label class="block text-sm font-medium text-gray-700 mb-1">Country</label>
349
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
350
+ </div>
351
+
352
+ <div>
353
+ <label class="block text-sm font-medium text-gray-700 mb-1">Postal Code</label>
354
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm" placeholder="_____-____">
355
+ </div>
356
+
357
+ <div class="col-span-2">
358
+ <label class="block text-sm font-medium text-gray-700 mb-1">Description</label>
359
+ <input type="text" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
360
+ </div>
361
+
362
+ <div>
363
+ <label class="block text-sm font-medium text-gray-700 mb-1">Phone</label>
364
+ <input type="tel" class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm" placeholder="(___) ___-____">
365
+ </div>
366
+
367
+ <div>
368
+ <label class="block text-sm font-medium text-gray-700 mb-1">Zone</label>
369
+ <select class="w-full px-3 py-2 border border-gray-300 rounded-md shadow-sm">
370
+ <option value="">None</option>
371
+ <!-- Zone options would be populated here -->
372
+ </select>
373
+ </div>
374
+ </div>
375
+ </div>
376
+
377
+ <!-- Form Actions -->
378
+ <div class="flex justify-end space-x-4 pt-6">
379
+ <button type="button" class="px-4 py-2 border border-gray-300 rounded-md shadow-sm text-sm font-medium text-gray-700 bg-white hover:bg-gray-50 focus:outline-none focus:ring-2 focus:ring-offset-2 focus:ring-blue-500">
380
+ Cancel
381
+ </button>
382
+ <button type="submit" class="px-4 py-2 border border-transparent rounded-md shadow-sm text-sm font-medium text-white bg-blue-600 hover:bg-blue-700 focus:outline-none focus:ring-2 focus:ring-offset-2 focus:ring-blue-500">
383
+ Save Patient
384
+ </button>
385
+ </div>
386
+ </form>
387
+ </div>
388
+ </div>
389
+
390
+ <script>
391
+ feather.replace();
392
+
393
+ // Add interactivity to dropdown sections
394
+ document.querySelectorAll('.form-section').forEach(section => {
395
+ const header = section.querySelector('.flex.items-center.justify-between');
396
+ const content = section.querySelectorAll('div:not(.flex.items-center.justify-between)');
397
+ const arrow = section.querySelector('.dropdown-arrow');
398
+
399
+ header.addEventListener('click', () => {
400
+ content.forEach(el => {
401
+ el.classList.toggle('hidden');
402
+ });
403
+ arrow.classList.toggle('rotate-180');
404
+ });
405
+ });
406
+ </script>
407
+ </body>
408
  </html>
prompts.txt ADDED
@@ -0,0 +1,84 @@
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
1
+ Main Field Sub Field
2
+ Personal
3
+ General Info
4
+ Patient ID Dropdown Data Fields
5
+ Last Name
6
+ First Name
7
+ Middle Name
8
+ Preferred Name
9
+ Suffix
10
+ Birthdate
11
+ Account Number
12
+ Customer Type
13
+ Facility Master
14
+ Facility Resident
15
+ Patient
16
+ Prior System Key
17
+ Facility Search Field
18
+ Billing Address
19
+ Address
20
+ Address
21
+ City
22
+ State
23
+ County
24
+ Country
25
+ Postal Code
26
+ _____-____
27
+ Custom Fields
28
+ S&S and Elig and Deduct
29
+ Incont Campaign
30
+ Successful
31
+ Unsuccessful
32
+ Compress Campaign
33
+ Successful
34
+ Unsuccessful
35
+ Mailer - Incont Campaign
36
+ Successful
37
+ Unsuccessful
38
+ Clamp On Rail Campaign
39
+ Successful
40
+ Unsuccessful
41
+ BP Machines Campaign
42
+ Successful
43
+ Unsuccessful
44
+ Extended Info
45
+ Hold Account
46
+ Hold Billing Statements
47
+ HIPAA Signature on file
48
+ Discount Percent %
49
+ Tax Zone
50
+ Search Field
51
+ Branch Office
52
+ New Hampshire Medical Supply
53
+ NHMS BRA
54
+ NHMS BSC
55
+ Account Group
56
+ "1-9
57
+ A-Z"
58
+ PT Security Group
59
+ PCAs Name list
60
+ User 1
61
+ Text Field
62
+ Patient Hub Email Address
63
+ Not Invited
64
+ Place of Service
65
+ 12 Home to 17 Walkin Retail clinic
66
+ Date of Admission
67
+ Date Selection
68
+ Date of Discharge
69
+ Date Selection
70
+ Delivery Addresses
71
+ Active Addresses Only
72
+ Address
73
+ City
74
+ State
75
+ County
76
+ Country
77
+ Postal Code
78
+ _____-____
79
+ Description
80
+ Text Field
81
+ Phone
82
+ (___) ___-____
83
+ Zone (None)
84
+ create form