<link href="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js"></script> <script src="//code.jquery.com/jquery-1.11.1.min.js"></script> <!------ Include the above in your HEAD tag ----------> <div class="container"> <div class="row"> <section class="content"> <h1>Referral List</h1> <div class="col-md-8 col-md-offset-2"> <div class="panel panel-default"> <div class="panel-body"> <div class="row"> <div style="margin-top:6px;" class="col-md-6"> <form class="navbar-form" role="search"> <div class="input-group add-on"> <input class="form-control" placeholder="Search by patient name" name="srch-term" id="srch-term" type="text"> <div class="input-group-btn"> <button class="btn btn-default" type="submit"><i class="glyphicon glyphicon-search"></i></button> </div> </div> </form> </div> <div class="col-md-6"> <div class=""> <div class="btn-group"> <button type="button" class="btn btn-default btn-filter" data-target="all">New</button> <button type="button" class="btn btn-success btn-filter" data-target="pagado">2 Days Old</button> <button type="button" class="btn btn-warning btn-filter" data-target="pendiente">4 Days Old</button> <button type="button" class="btn btn-danger btn-filter" data-target="cancelado">7 Days Old</button> </div> </div> </div> </div> <div class="row"> <div style="margin-left:15px;margin-bottom:10px;" class="col-md-2"> <div class="dropdown"> <button class="btn btn-primary dropdown-toggle" type="button" data-toggle="dropdown">Program <span class="caret"></span></button> <ul class="dropdown-menu"> <li><a href="#">Veteran's Association</a></li> <li><a href="#">Department of Health</a></li> <li><a href="#">Private</a></li> </ul> </div> </div> <div style="margin-left:15px;margin-bottom:10px;" class="col-md-5"> <div class="dropdown"> <button class="btn btn-primary dropdown-toggle" type="button" data-toggle="dropdown">Status <span class="caret"></span></button> <ul class="dropdown-menu"> <li><a href="#">Veteran's Association</a></li> <li><a href="#">Department of Health</a></li> <li><a href="#">Private</a></li> </ul> </div> </div> <div style='margin-right:3%'> <div class="input-group input-daterange"> <input type="text" class="form-control" value="02-13-2017"> <div class="input-group-addon">to</div> <input type="text" class="form-control" value="02-20-2017"> </div> </div> </div> <div class="table-container"> <table class="table table-filter"> <tbody> <tr data-status="cancelado" data-toggle="modal" data-target="#VAModal"> <td> <div class="ckbox"> <input type="checkbox" id="checkbox2"> <label for="checkbox2"></label> </div> </td> <td> <!--<a href="javascript:;" class="star">--> <!-- <i class="glyphicon glyphicon-star"></i>--> <!--</a>--> </td> <td> <div class="media"> <!--<a href="#" class="pull-left">--> <!-- <img src="https://s3.amazonaws.com/uifaces/faces/twitter/fffabs/128.jpg" class="media-photo">--> <!--</a>--> <div class="media-body"> <span class="media-meta pull-right">Febrero 13, 2016</span> <h4 class="title"> Veteran's Association <span class="pull-right cancelado">(7 Days Old)</span> <span class="pull-right" style="margin-right:14.5%;color:black">Homemaker Service</span> </h4> <p class="summary">Authorization Number: 89519-19 <span class="media-meta pull-right">Visit Scheduling</span> </p> </div> </div> </td> </tr> <tr data-status="pendiente"> <td> <div class="ckbox"> <input type="checkbox" id="checkbox3"> <label for="checkbox3"></label> </div> </td> <td> <!--<a href="javascript:;" class="star">--> <!-- <i class="glyphicon glyphicon-star"></i>--> <!--</a>--> </td> <td> <div class="media"> <!--<a href="#" class="pull-left">--> <!-- <img src="https://s3.amazonaws.com/uifaces/faces/twitter/fffabs/128.jpg" class="media-photo">--> <!--</a>--> <div class="media-body"> <span class="media-meta pull-right">Febrero 16, 2016</span> <h4 class="title"> Department of Health <span class="pull-right pendiente">(4 Days Old)</span> <span class="pull-right" style="margin-right:11%;color:black">Home Health Aide Service</span> </h4> <p style="margin-bottom:0px;" class="summary">Referral Number: SJ16-3196 <span class="media-meta pull-right">Caregiver Onboarding</span> </p> <p class="summary">San Juan Region </p> </div> </div> </td> </tr> <tr data-status="pagado"> <td> <div class="ckbox"> <input type="checkbox" id="checkbox1"> <label for="checkbox1"></label> </div> </td> <td> <!--<a href="javascript:;" class="star">--> <!-- <i class="glyphicon glyphicon-star"></i>--> <!--</a>--> </td> <td> <div class="media"> <!--<a href="#" class="pull-left">--> <!-- <img src="https://s3.amazonaws.com/uifaces/faces/twitter/fffabs/128.jpg" class="media-photo">--> <!--</a>--> <div class="media-body"> <span class="media-meta pull-right">Febrero 18, 2016</span> <h4 class="title"> Veteran's Association <span class="pull-right pagado">(2 Days Old)</span> <span class="pull-right" style="margin-right:14.5%;color:black">Homemaker Service</span> </h4> <p class="summary">Authorization Number: 89519-19 <span class="media-meta pull-right">Needs Collocation</span> </p> </div> </div> </td> </tr> <tr data-status="pagado" class="selected"> <td> <div class="ckbox"> <input type="checkbox" id="checkbox4" checked> <label for="checkbox4"></label> </div> </td> <td> <!--<a href="javascript:;" class="star star-checked">--> <!-- <i class="glyphicon glyphicon-star"></i>--> <!--</a>--> </td> <td> <div class="media"> <!--<a href="#" class="pull-left">--> <!-- <img src="https://s3.amazonaws.com/uifaces/faces/twitter/fffabs/128.jpg" class="media-photo">--> <!--</a>--> <div class="media-body"> <span class="media-meta pull-right">Febrero 18, 2016</span> <h4 class="title"> Private <span class="pull-right pagado">(2 Days Old)</span> <span class="pull-right" style="margin-right:12.75%;color:black">Transportation Service</span> </h4> <p class="summary">Referral Number: 05242017-3 <span class="media-meta pull-right">Needs Assessment</span> </p> </div> </div> </td> </tr> <tr data-status=""> <td> <div class="ckbox"> <input type="checkbox" id="checkbox5"> <label for="checkbox5"></label> </div> </td> <td> <!--<a href="javascript:;" class="star">--> <!-- <i class="glyphicon glyphicon-star"></i>--> <!--</a>--> </td> <td> <div class="media"> <!--<a href="#" class="pull-left">--> <!-- <img src="https://s3.amazonaws.com/uifaces/faces/twitter/fffabs/128.jpg" class="media-photo">--> <!--</a>--> <div class="media-body"> <span class="media-meta pull-right">Febrero 20, 2016</span> <h4 class="title"> Department of Health <span class="pull-right" style="color:black;">(New)</span> <span class="pull-right" style="margin-right:17%;color:black">Home Health Aide Service</span> </h4> <p style="margin-bottom:0px;" class="summary">Referral Number: 0815 <span class="media-meta pull-right">Needs Coordinator</span> </p> <p class="summary">Caguas Region </p> </div> </div> </td> </tr> </tbody> </table> </div> </div> </div> <div class="content-footer"> <p> Page © - 2016 <br> Powered By <a href="https://www.facebook.com/tavo.qiqe.lucero" target="_blank">TavoQiqe</a> </p> </div> </div> </section> </div> </div> <!-- Modal --> <div id="VAModal" class="modal fade" role="dialog"> <div class="modal-dialog modal-lg"> <!-- Modal content--> <div class="modal-content"> <div class="modal-header"> <div class="row"> <div class='col-md-4'> <h3 class="modal-title">Veteran's Association</h4> </div> <div class='col-md-4'> <p style="text-align:center;">2/13/2016 7:55am</p> </div> <div class='col-md-4'> <p class="pull-right">89519-19-05242017-1</p> </div> </div> </div> <div class="modal-body"> <div class="row"> <div class='col-md-6'> <h4 style="text-align:center;">Referral Information</h4> </div> <div class='col-md-6'> <h4 style="text-align:center;">Service Information</h4> </div> </div> <div class="row"> <div class='col-md-6'> <p>Local Title: Choice</p> </div> <div class='col-md-6'> <p>Service Type: Homemaker</p> </div> </div> <div class="row"> <div class='col-md-6'> <p>Referral Author: Santana-Rios, Ramon </p> </div> <div class='col-md-6'> <p>Start Date: 01/27/2017</p> </div> </div> <div class="row"> <div class='col-md-6'> <p>Authorization Number: 89519-19</p> </div> <div class='col-md-6'> <p>End Date: 08/07/2017</p> </div> </div> <div class="row"> <div class='col-md-6'> </div> <div class='col-md-6'> <p>Visit Duration: 3 hours</p> </div> </div> <div class="row"> <div class='col-md-6'> </div> <div class='col-md-6'> <p>Visit Frequency: 3 per week</p> </div> </div> <div class="row"> <div class='col-md-6'> </div> <div class='col-md-6'> <p>Total Visits: 54</p> </div> </div> <div class="row"> <div class='col-md-6'> </div> <div class='col-md-6'> <p>ICD-10: F02.80</p> </div> </div> </div> <div class="modal-footer"> <button type="button" class="btn btn-primary" data-dismiss="modal">Edit</button> <button type="button" class="btn btn-default" data-dismiss="modal">Close</button> </div> </div> </div> </div> <div id="myModal" class="modal fade" role="dialog"> <div class="modal-dialog"> <!-- Modal content--> <div class="modal-content"> <div class="modal-header"> <button type="button" class="close" data-dismiss="modal">×</button> <h4 class="modal-title">Modal Header</h4> <p class="pull-right">89519-19-05242017-1</p> </div> <div class="modal-body"> <p>Some text in the modal.</p> </div> <div class="modal-footer"> <button type="button" class="btn btn-default" data-dismiss="modal">Close</button> </div> </div> </div> </div> <div id="myModal" class="modal fade" role="dialog"> <div class="modal-dialog"> <!-- Modal content--> <div class="modal-content"> <div class="modal-header"> <button type="button" class="close" data-dismiss="modal">×</button> <h4 class="modal-title">Modal Header</h4> <p class="pull-right">89519-19-05242017-1</p> </div> <div class="modal-body"> <p>Some text in the modal.</p> </div> <div class="modal-footer"> <button type="button" class="btn btn-default" data-dismiss="modal">Close</button> </div> </div> </div> </div>

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