Project Claire: intake step2.html
From PikaDocs
Last modified: August 25, 2005
<!-- intake_step2.html = Income | Assets Eligibility subtemplate -->
<!-- called from intakes.php at line 56 -->
<script type="text/javascript" src="/pika/js/pop_up_help.js"></script>
<!-- "content-container" DIV -->
<div class="content-container">
<!-- "side-content" DIV -->
<div class="side-content">
<!-- primary client info -->
<h2>Primary Client</h2>
<p>
<a href='%%[base_url]%%/contacts.php/%%[contact_id]%%/?intake_id=%%[intake_id]%%'>%%[client_name]%%</a><br />
Address:<br />
%%[client_address]%%<br />
Phone: %%[client_phone]%%<br />
Notes: %%[phone_notes]%%<br />
Language: %%[language,language,text]%%<br />
DOB: %%[birth_date]%%<br />
%%[client_remove]%%
</p>
%%[client_list]%%
%%[case_charges]%%
%%[opposing_list]%%
%%[other_contacts_list]%%
<!-- intake workflow -->
<h2>Intake Workflow</h2>
<ul>
<li><a href="%%[base_url]%%/intakes.php/%%[intake_id]%%/step1/">Step 1: Citizenship</a></li>
<li><a href="%%[base_url]%%/intakes.php/%%[intake_id]%%/step1b/">Step 1b: Eligible Alien</a></li>
<li><a href="%%[base_url]%%/intakes.php/%%[intake_id]%%/step2/">Step 2: Income|Assets</a></li>
</ul>
</div> <!-- "side-content" closing DIV -->
<!-- "main-content" DIV -->
<div class="main-content"> <!-- "wrapper" for "main content" area -->
<h2>Step 2: Income | Assets Screening</h2>
<!-- FORM element closes at bottom of template -->
<form action="%%[base_url]%%/ops/update_intake.php" method="post" name="ws">
<div id="intake-calculators"> <!-- wrapper for positioning all caculator elements -->
<!-- # of household members -->
<div class="household">
<span class="label">Adults</span>
<br />
<input type="text" name="adults" value="%%[adults]%%" tabindex="1" onchange="ph_change();" />
</div>
<div class="household">
<span class="label">Children</span>
<br />
<input type="text" name="children" value="%%[children]%%" tabindex="1" onchange="ph_change();" />
</div>
<div class="household">
<span class="label">Helped</span>
<br />
<input type="text" name="persons_helped" value="%%[persons_helped]%%" tabindex="1" />
</div>
<!-- wage calculator -->
<div class="wage-calculator">
<span class="label">Hourly rate x weekly hours</span>
<br />
$ <input type="text" name="dontuse1" onchange="calcWage();" tabindex="3" /> X <input type="text" name="dontuse2" onchange="calcWage();" tabindex="3" /> = $ <input type="text" name="dontuse3" tabindex="3" />
</div>
<div id="wage-button">
<input id="grid" class="initial-intake" type="image" src="images/buttons/grid.gif" onclick="sendToGrid();" alt="Send wage calculation to the income grid." title="Send wage calculation to the income grid." />
</div>
</div> <!-- "calculator" closing DIV -->
<!-- TABLE container for financial eligibility input/select elements -->
<!-- row = type of income ~ frequency ~ amount | type of asset ~ value -->
<table id="eligibility-grid">
<colgroup id="income-type">
<col span="3" />
</colgroup>
<colgroup span="2">
<col id="asset-type" span="1" />
<col span="1" />
</colgroup>
<thead>
<tr> <!-- table column headings -->
<th scope="col">Income Type</th>
<th scope="col">Frequency</th>
<th scope="col">Amount</th>
<th scope="col">Asset Type</th>
<th class="last" scope="col">Value</th>
</tr>
</thead>
<tbody> <!-- opening TBODY content -->
<tr id="first-row"> <!-- row 1 -->
<td>%%[income_type0,income_type]%%</td>
<td>%%[income_freq0,income_freq]%%</td>
<td>$ <input type="text" name="annual0" value="%%[annual0]%%" tabindex="1" /></td>
<td class="asset">%%[asset_type0,asset_type]%%</td>
<td>$ <input type="text" name="asset0" tabindex="1" onchange="asset_change();" value="%%[asset0]%%" /></td>
</tr>
<tr> <!-- row 2 -->
<td>%%[income_type1,income_type]%%</td>
<td>%%[income_freq1,income_freq]%%</td>
<td>$ <input type="text" name="annual1" value="%%[annual1]%%" tabindex="1" /></td>
<td class="asset">%%[asset_type1,asset_type]%%</td>
<td>$ <input type="text" name="asset1" tabindex="1" onchange="asset_change();" value="%%[asset1]%%" /></td>
</tr>
<tr> <!-- row 3 -->
<td>%%[income_type2,income_type]%%</td>
<td>%%[income_freq2,income_freq]%%</td>
<td>$ <input type="text" name="annual2" value="%%[annual2]%%" tabindex="1" /></td>
<td class="asset">%%[asset_type2,asset_type]%%</td>
<td>$ <input type="text" name="asset2" tabindex="1" onchange="asset_change();" value="%%[asset2]%%" /></td>
</tr>
<tr> <!-- row 4 -->
<td>%%[income_type3,income_type]%%</td>
<td>%%[income_freq3,income_freq]%%</td>
<td>$ <input type="text" name="annual3" value="%%[annual3]%%" tabindex="1" /></td>
<td class="asset">%%[asset_type3,asset_type]%%</td>
<td>$ <input type="text" name="asset3" tabindex="1" onchange="asset_change();" value="%%[asset3]%%" /></td>
</tr>
<tr> <!-- row 5 -->
<td>%%[income_type4,income_type]%%</td>
<td>%%[income_freq4,income_freq]%%</td>
<td>$ <input type="text" name="annual4" value="%%[annual4]%%" tabindex="1" /></td>
<td class="asset">%%[asset_type4,asset_type]%%</td>
<td>$ <input type="text" name="asset4" tabindex="1" onchange="asset_change();" value="%%[asset4]%%" /></td>
</tr>
<tr id="total-row"> <!-- row 6 = totals -->
<td> </td>
<td colspan="2"><b>Total:</b> $ <input type="text" name="income" tabindex="1" value="%%[income]%%" readonly="readonly" /><input type="hidden" name="income_only" /></td>
<td colspan="2"><b>Total:</b> $ <input type="text" name="assets" tabindex="1" value="%%[assets]%%" readonly="readonly" /></td>
</tr>
</tbody> <!-- closing TBODY content -->
</table> <!-- "eligibility-grid" closing TABLE -->
<!-- calculate poverty ... income justification -->
<div id="poverty-wrapper"> <!-- "wrapper" for "poverty" DIVs -->
<div class="poverty01">
<h4>% of Poverty</h4>
<input id="calculate" class="initial-intake" type="image" src="images/buttons/calculate.gif" tabindex="1" onclick="calc_poverty();" alt="Calculate percentage of poverty" title="Calculate percentage of poverty" />
<input id="percentage" type="text" name="poverty" value="%%[poverty]%%" readonly="readonly" />
<input type="hidden" name="poverty_income_only" />%
</div>
<div class="poverty02">
<h4>Income Justification</h4>
%%[just_income,just_income]%%
</div>
</div> <!-- "poverty-wrapper" closing DIV -->
<div class="step2-help">
<ul>
<li><a class="context-help" href="javascript:popUp('%%[base_url]%%/helpdocs/help_financial.html')" title="Click to see definitions and applicable rules for each of these terms.">Income table</a></li>
<li><a class="context-help" href="javascript:popUp('%%[base_url]%%/helpdocs/help_financial.html')" title="Click to see definitions and applicable rules for each of these terms.">Asset rules</a></li>
<li><a class="context-help" href="javascript:popUp('%%[base_url]%%/helpdocs/help_financial.html')" title="Click to see definitions and applicable rules for each of these terms.">Over-income rules</a></li>
</ul>
</div>
<!-- notes field -->
<div class="notes">
Intake Notes:
<br />
<textarea id="intake-notes" name="intake_notes" cols="" rows="5" tabindex="1">%%[intake_notes]%%</textarea>
</div>
<input type="hidden" name="intake_id" value="%%[intake_id]%%" />
<!-- submit buttons -->
<div class="input-submit-step">
<input class="button initial-intake" type="submit" name="button_press_1" value="Eligible" tabindex="1" onclick="return Require(ws,'adults,children,income_type0,annual0,asset0,asset_type0')" onmouseover="this.className='button button-hover'" onmouseout="this.className='button initial-intake'" title="Confirm the prospective client is financially eligible and go to the new client contact page." />
<input class="button initial-intake" type="submit" name="button_press_2" value="Not Eligible" tabindex="1" onclick="return confirm('Are you sure you want to\nreject this intake and\ndelete all intake data?');" onmouseover="this.className='button button-hover'" onmouseout="this.className='button initial-intake'" title="Confirm the prospective client is NOT financially eligible and DELETE this intake record." />
<input class="button initial-intake" type="submit" name="button_press_3" value="Save" tabindex="1" onmouseover="this.className='button button-hover'" onmouseout="this.className='button initial-intake'" title="Save this intake record." />
</div>
</form> <!-- closing FORM -->
</div> <!-- "main-content" closing DIV -->
</div> <!-- "content-container" closing DIV -->
<!-- additional validation scripts -->
<script type="text/javascript">
<!--
document.ws.children.focus();
//-->
</script>
<script type="text/javascript" src="%%[base_url]%%/js/case_elig.js.php"></script>
<script type="text/javascript">
<!--
// The second (non-adjusted) Income field needs to be calculated on each page view (it's not in the DB.)
income_change();
//-->
<!--
function Require(obForm,szFields)
{
var fields = szFields.split(",")
var szMissing= new Array();
for (x=0;x<fields.length;x++) {
if (obForm.elements[fields[x]].value.length==0) {
szMissing[szMissing.length]=new String(fields[x]);
}
}
if (szMissing.length) {
alert("The field"+((szMissing.length>1)?"s ":" ")+szMissing.join(",")+" must be filled in first");
return false
}
return true;
}
//-->
</script>
<script type="text/javascript">
<!--
var old_ssn_length = 0;
function pika_ssn(what)
{
if (what.value.length == 3 && old_ssn_length == 2)
{
what.value += '-';
}
if (what.value.length == 6 && old_ssn_length == 5)
{
what.value += '-';
}
old_ssn_length = what.value.length;
}
//-->
</script>
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