2023-04-16 19:33:13 +08:00
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import{d as fe,ac as _e,a4 as he,a3 as we,u as be,ad as ge,A as W,U as C,q as xe,a7 as Ue,r as L,c as X,ae as P,a as _,af as ye,ag as Q,b as Ne,ah as Pe,e as d,o as c,g as m,h as e,i as a,v as p,j as n,k as r,t as o,ai as Z,C as De,R as D,F as b,z as g,y as ke,l as Me,aj as Se,w as ee,ak as Ve,J as Ce,_ as Be}from"./index-cd9e6ac8.js";import{A as Ie,U as Ee}from"./patient.mutations-36815db6.js";/* empty css */const Oe={class:"flex whitespace-nowrap w-full"},$e=e("span",{class:"text-gray-700 w-4/12"},"Patient Unique Identifier",-1),qe={class:"w-full"},Ae={class:"text-orange-600 w-4/12"},Fe={class:"flex whitespace-nowrap w-full"},Re=e("span",{class:"text-gray-700 w-4/12"},"First Name",-1),Ye={class:"w-full"},je={class:"text-orange-600 w-4/12"},Te={class:"flex whitespace-nowrap mb-2 w-full"},Le=e("span",{class:"text-gray-700 w-4/12"},"Middle Name",-1),Ke={class:"w-full"},Ge={class:"text-orange-600 w-4/12"},He={class:"flex whitespace-nowrap w-full"},ze=e("span",{class:"text-gray-700 w-4/12"},"Last Name",-1),Je={class:"w-full"},We={class:"text-orange-600 w-4/12"},Xe={class:"flex whitespace-nowrap my-2 w-full"},Qe=e("span",{class:"text-gray-700 w-4/12"},"Age/DOB Estimated?",-1),Ze={class:"w-full flex justify-between items-center"},et={class:"flex justify-start items-center gap-x-2 ml-4"},tt={for:"estimateYears"},st=e("span",{class:"mr-1"},"Years",-1),lt={for:"estimateMonths"},nt=e("span",{class:"mr-1"},"Months",-1),it={for:"estimateDays"},at=e("span",{class:"mr-1"},"Days",-1),ot={class:"text-orange-600 w-4/12"},dt={class:"flex whitespace-nowrap mb-2 w-full"},ut=e("span",{class:"text-gray-700 w-4/12"},"Date of Birth",-1),rt={class:"w-full"},ct=["disabled"],mt={class:"text-orange-600 w-4/12"},pt={class:"flex whitespace-nowrap mb-2 w-full"},vt=e("span",{class:"text-gray-700 w-4/12"},"Age",-1),ft={class:"w-full"},_t={class:"text-orange-600 w-4/12"},ht={class:"flex whitespace-nowrap mb-2 w-full"},wt=e("span",{class:"text-gray-700 w-4/12"},"Gender",-1),bt={class:"w-full"},gt=e("option",null,null,-1),xt=["value"],Ut={class:"text-orange-600 w-4/12"},yt={class:"flex whitespace-nowrap mb-2 w-full"},Nt=e("span",{class:"text-gray-700 w-4/12"},"Mobile Number",-1),Pt={class:"w-full"},Dt={class:"text-orange-600 w-4/12"},kt={class:"flex whitespace-nowrap mb-2 w-full"},Mt=e("span",{class:"text-gray-700 w-4/12"},"Consent to SMS",-1),St={class:"w-full"},Vt={class:"text-orange-600 w-4/12"},Ct={class:"flex whitespace-nowrap mb-2 w-full"},Bt=e("span",{class:"text-gray-700 w-4/12"},"Primary Referrer",-1),It={class:"w-full"},Et={class:"text-orange-600 w-4/12"},Ot={class:"flex whitespace-nowrap mb-2 w-full"},$t={class:"text-gray-700 w-4/12 flex justify-between items-center"},qt=e("span",{class:"mr-4"},"Extra Ids:",-1),At={class:"w-full border-gray-200"},Ft={class:"flex justify-around items-center w-full"},Rt=e("span",null,"Identification",-1),Yt=["onUpdate:modelValue"],jt=e("option",null,null,-1),Tt=["value"],Lt=e("span",null,"Value",-1),Kt=["onUpdate:modelValue"],Gt=["onClick"],Ht=e("hr",{class:"my-2"},null,-1),zt={class:"grid grid-cols-3 gap-x-4 mb-4"},Jt={class:"col-span-1"},Wt={class:"flex gap-x-2 items-center whitespace-nowrap w-full"},Xt=e("span",{class:"text-gray-700 w-4/12"},"Country",-1),Qt=e("option",{value:null},null,-1),Zt=["value"],es={class:"text-orange-600 w-4/12"},ts={class:"col-span-1"},ss={class:"flex gap-x-2 items-center whitespace-nowrap col-span-1 w-full"},ls=e("span",{class:"text-gray-700 w-4/12"},"Province",-1),ns=e("option",{value:null},null,-1),is=["value"],as={class:"text-orange-600 w-4/12"},os={class:"col-span-1"},ds={class:"flex gap-x-2 items-center whitespace-nowrap col-span-1 w-full"},us=e("span",{class:"text-gray-700 w-4/12"},"District",-1),rs=e("option",{value:null},null,-1),cs=["value"],ms={class:"text-orange-600 w-4/12"},ps=e("hr",null,null,-1),vs=e("button",{type:"submit",class:"-mb-4 w-1/5 border border-sky-800 bg-sky-800 text-white rounded-sm px-4 py-2 m-2 transition-colors duration-500 ease select-none hover:bg-sky-800 focus:outline-none focus:shadow
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