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'; InstaMed.launchInContext(); } else { Ext.isSecure = /^http/i.test(window.location.protocol); InstaMed.isNativeApplication = false; InstaMed.isConsumerApp = false; InstaMed.TitleBarMargins = '17 0 0 0'; InstaMed.isMobile = true; InstaMed.isResponsive = true; InstaMed.isInContextMode = false; InstaMed.passedInMetaDataToken = ''; InstaMed.isInAccessibilityMode = false; InstaMed.userAgentParameter = ''; InstaMed.logoutPage = '../../Form/PaymentPortal/Logout?id=CALVERTHEALTH.MEDICAL'; InstaMed.isLightWeightMode = false; InstaMed.isReturnUrlUpdateParent = false; InstaMed.isClientSidePostData = false; InstaMed.isDesktop = false; InstaMed.isTablet = false; InstaMed.isDesktopOrTablet = false; InstaMed.isMobileOrTablet = true; InstaMed.isLoggedIn = false; InstaMed.useHistory = false; InstaMed.hasReturnUrl = false; InstaMed.hasCancelUrl = false; InstaMed.isNewRequiredFeild = true; InstaMed.browserTabID = 'E267FAAD49B346AFA2F6C1884798EBAC'; InstaMed.sessionTimeoutUrl = '../../Form/PaymentPortal/Logout?id=CALVERTHEALTH.MEDICAL'; InstaMed.page = 'Form/PaymentPortal/Default'; Ext.SSL_SECURE_URL = Ext.isSecure && Ext.isIE ? 'javascript:""' : 'about:blank'; Ext.BLANK_IMAGE_URL = 'http://cdn.instamed.com/V_2023_R1/Content/Images/General/BlankImage.gif'; InstaMed.UniqueClientID = 'f52a9bdd74ec41b1b93f869c1a228fa3'; Ext.scopeResetCSS=true; InstaMed.contentUrl = 'http://cdn.instamed.com/V_2023_R1/'; var webPropertyId = 'UA-16010902-1'; InstaMed.doIdleLogout = true; InstaMed.isSSO = false; InstaMed.isSelfService = false; LogoutTimer.init(); var myMask = null; InstaMed.errorMessageSummaryTitle = 'Please correct the following errors'; InstaMed.requiredErrorLabel = 'Required'; Ext.ns('Ext.app.REMOTING_API'); Ext.app.REMOTING_API = { "id": null, "url": "../../api/PaymentPortal/Default", "type": "remoting", "namespace": null, "actions": { "PreferencesController": [ { "name": "openWindowToUpdateEmailAddress", "len": 1 }, { "name": "get_MerchantStoreTerminalAlias", "len": 0 }, { "name": "openWindowToEnterMobilePhoneNumber", "len": 1 }, { "name": "openWindowToEnterMobilePhoneNumberConfirmationCode", "len": 1 }, { "name": "updateSecurityQuestions", "len": 1 }, { "name": "disableTwoFactorAuthFromPopUp", "len": 1 }, { "name": "verifyTextEnrollment", "len": 1 }, { "name": "confirmMobilePhoneNumber", "len": 1 }, { "name": "getUserMobilePhoneNumber", "len": 0 }, { "name": "navigateToTextMsgEnroll", "len": 1 }, { "name": "removeMobilePhoneNumber", "len": 1 }, { "name": "navigateToTextMsgEnrollTwoFAOnly", "len": 1 }, { "name": "enableTwoFactorAuth", "len": 1 }, { "name": "cancelTwoFAChangeFromPopup", "len": 1 }, { "name": "isUserRequireMobilePhoneNumberUpdate", "len": 0 }, { "name": "updateEmailAndPreference", "len": 1 }, { "name": "isUserRequireEmailAndPreferenceUpdate", "len": 0 }, { "name": "loadPatientData", "len": 0 }, { "name": "saveStatementPreferences", "len": 1 }, { "name": "updateMobilePhoneNumber", "len": 1 }, { "name": "loadPatientAccountPreferences", "len": 2 }, { "name": "deleteUserBiometricInfo", "len": 1 }, { "name": "sendNewMobilePhoneNumberConfirmationCode", "len": 1 }, { "name": "saveEmailPreferences", "len": 1 }, { "name": "updateCommunicationDeliverySettings", "len": 1 } ], "GridController": [ { "name": "exportDataToFile", "len": 1 }, { "name": "saveColumnSortConfiguration", "len": 1 }, { "name": "saveColumnConfiguration", "len": 1 }, { "name": "updateCharts", "len": 1 }, { "name": "export", "formHandler": true, "len": 1 } ], "PatientPortalLoginController": [ { "name": "checkSession", "len": 1 }, { "name": "changeLanguage", "len": 1 }, { "name": "showBiometricLogin", "len": 1 }, { "name": "authenticateBiometricInfo", "len": 1 }, { "name": "closeAppBanner", "len": 1 }, { "name": "verifyTextEnrollment", "len": 1 }, { "name": "navigateAfterLogin", "len": 1 }, { "name": "navigateFromEStatement", "len": 1 }, { "name": "forgotPassword", "len": 1 }, { "name": "submit", "len": 1 }, { "name": "deleteBiometricInfo", "len": 1 }, { "name": "navigateBackFromTwoFactor", "len": 1 }, { "name": "patientMatchSubmit", "len": 1 }, { "name": "skipTextEnrollment", "len": 1 }, { "name": "authenticateTwoFactor", "len": 1 }, { "name": "redirectToLogin", "len": 1 }, { "name": "getBackButtonOverride", "len": 1 }, { "name": "patientPortalNavigateBack", "len": 1 }, { "name": "saveEStatementPreference", "len": 1 }, { "name": "canUserResetPassword", "len": 3 }, { "name": "redirectToLoginEmailForm", "len": 1 }, { "name": "logout", "len": 1 }, { "name": "sendMobilePhoneNumberConfirmationCode", "len": 1 }, { "name": "navigateTo", "len": 1 }, { "name": "patientPortalHeaderBack", "len": 1 }, { "name": "registerUserBiometricInfo", "len": 1 }, { "name": "dualLogin", "len": 1 } ], "QuickPayOptimizedProviderLandingController": [ { "name": "navigatePayHereLink", "len": 1 }, { "name": "paymentPlanFlow", "len": 1 }, { "name": "submitPatient", "len": 1 }, { "name": "prepopulateDigitalPayoutQuickPayCode", "len": 1 }, { "name": "navigateCollectPaymentLink", "len": 1 }, { "name": "checkQuickPayCode", "len": 1 }, { "name": "payNow", "len": 1 }, { "name": "onPatientChange", "len": 1 }, { "name": "checkQuickPayCodeOnly", "len": 1 } ], "PushNotificationController": [ { "name": "navigateByPushNotification", "len": 1 } ], "SignUpController": [ { "name": "navigateFromSignUp", "len": 0 }, { "name": "completeSignUp", "len": 1 }, { "name": "redirectToSignUpForm", "len": 1 }, { "name": "redirectToSignUp", "len": 1 }, { "name": "sendAccountCreatedEvent", "len": 1 }, { "name": "signUp", "len": 1 }, { "name": "isEnterPayeeManuallyFlow", "len": 0 }, { "name": "verifyTextEnrollment", "len": 1 }, { "name": "dualSignUp", "len": 1 }, { "name": "isDigitalPayoutFlow", "len": 0 }, { "name": "skipTextEnrollment", "len": 1 }, { "name": "isPatientMatchFlow", "len": 0 } ], "ResetPasswordController": [ { "name": "changePassword", "len": 1 }, { "name": "navigateFromEnterCode", "len": 1 }, { "name": "requestPasswordReset", "len": 1 }, { "name": "validateAnswer", "len": 3 }, { "name": "isDualLoginSignUpFlow", "len": 0 }, { "name": "sendResetText", "len": 1 }, { "name": "submit", "len": 1 }, { "name": "resendPasswordResetCode", "len": 1 }, { "name": "getUserId", "len": 0 }, { "name": "sendEmail", "len": 2 }, { "name": "navigateFromSelectMethodForm", "len": 1 }, { "name": "getUserInitials", "len": 1 }, { "name": "pPPResetPassword", "len": 1 }, { "name": "generateResetCode", "len": 0 }, { "name": "sendResetEmail", "len": 1 }, { "name": "navigateFromForgotPassword", "len": 1 } ], "PaymentActionController": [ { "name": "selectLineItem", "len": 1 }, { "name": "viewTransaction", "len": 1 }, { "name": "getNextScheduledTransaction", "len": 1 }, { "name": "getSystemWideDefault", "len": 1 }, { "name": "displayPatientInformationMutliAccount", "len": 3 }, { "name": "getAuthorization", "len": 3 }, { "name": "getVirtualCardEntityID", "len": 1 }, { "name": "getPaymentPlanStatus", "len": 1 }, { "name": "getDisclaimer", "len": 1 }, { "name": "closeSSOReceipt", "len": 1 }, { "name": "voidTransactionFromHistory", "len": 1 }, { "name": "canReturnEcheck", "len": 1 }, { "name": "eCheckRefundTransactionFromHistory", "len": 1 }, { "name": "getBasePaymentTransaction", "len": 2 }, { "name": "returnToProfile", "len": 1 }, { "name": "viewReceiptByData", "len": 5 }, { "name": "canAdjustEcheck", "len": 1 }, { "name": "cancel", "len": 1 }, { "name": "doReturnEcheck", "len": 1 }, { "name": "getNumberOfPaymentsRemaining", "len": 1 }, { "name": "printAll", "len": 1 }, { "name": "emailReceipt", "len": 1 }, { "name": "getReceiptConfigurationList", "len": 1 }, { "name": "downloadReceipt", "len": 1 }, { "name": "downloadCheckImage", "len": 1 }, { "name": "cancelVirtualCard", "len": 1 }, { "name": "downloadCouponImage", "len": 1 }, { "name": "voidTransaction", "len": 1 }, { "name": "viewCheckImage", "len": 1 }, { "name": "eCheckReturn", "len": 1 }, { "name": "populateReceiptByData", "len": 5 }, { "name": "getPayeeName", "len": 3 }, { "name": "viewRefund", "len": 1 }, { "name": "creditCardRefundTransaction", "len": 2 }, { "name": "getPaymentPlan", "len": 1 }, { "name": "emailAllReceipts", "len": 1 }, { "name": "sendEmailReceipt", "len": 3 }, { "name": "canRefund", "len": 1 }, { "name": "eCheckRefundTransaction", "len": 2 }, { "name": "getBalanceRemaining", "len": 1 }, { "name": "collectNow", "len": 1 }, { "name": "eCheckAdjustment", "len": 1 }, { "name": "viewReceiptForTransaction", "len": 5 }, { "name": "viewVoid", "len": 1 }, { "name": "returnCodes", "len": 1 }, { "name": "canVoid", "len": 2 }, { "name": "populateReceipt", "len": 3 }, { "name": "displayMultiARLine", "len": 8 }, { "name": "copyPrimaryToSecondaryTransactionFieldsCommon", "len": 2 }, { "name": "creditCardRefundTransactionFromHistory", "len": 1 }, { "name": "doeCheckAdjustment", "len": 1 }, { "name": "viewReceipt", "len": 1 }, { "name": "getTransactionByData", "len": 2 }, { "name": "multiARRefundTransaction", "len": 1 }, { "name": "getTransaction", "len": 1 }, { "name": "getMultipleAccountReceiptText", "len": 3 } ], "QuickPayLoginController": [ { "name": "login", "len": 1 }, { "name": "forgotPassword", "len": 1 }, { "name": "navigateToQuickPayLogin", "len": 1 }, { "name": "navigateBack", "len": 1 }, { "name": "navigateToQuickPaySignup", "len": 1 } ], "IdleTimerController": [ { "name": "setRemainingIdleTime", "len": 0 }, { "name": "submit", "len": 1 }, { "name": "getRemainingIdleTime", "len": 1 } ], "TextMessageEnrollmentController": [ { "name": "resendEnrollmentText", "len": 1 }, { "name": "updateMobilePhoneNumberFromPopUp", "len": 1 }, { "name": "updateMobilePhoneNumber", "len": 1 }, { "name": "verifyTextEnrollment", "len": 1 }, { "name": "enableTwoStepVerification", "len": 1 }, { "name": "updateUserTextCommPreference", "len": 1 }, { "name": "sendEnrollmentText", "len": 1 }, { "name": "skipTextEnrollment", "len": 1 } ], "QuickPaySignUpController": [ { "name": "signUp", "len": 1 }, { "name": "skip", "len": 1 } ], "PaymentHistoryController": [ { "name": "search", "len": 1 }, { "name": "cancelVirtualCards", "len": 1 }, { "name": "getSearchData", "len": 2 }, { "name": "cancelPaymentPlan", "len": 1 }, { "name": "getAdditionalColumns", "len": 0 }, { "name": "getData", "len": 1 }, { "name": "searchPayableTransactions", "len": 1 }, { "name": "getPaymentHistoryData", "len": 1 }, { "name": "searchHealthExpenses", "len": 1 }, { "name": "getScheduledPaymentData", "len": 2 }, { "name": "searchScheduledPayments", "len": 1 }, { "name": "getPayableTransactions", "len": 2 }, { "name": "viewPaymentReceipt", "len": 1 }, { "name": "quickPayViewAccountSummary", "len": 1 } ], "PaymentReceiptController": [ { "name": "redirectToSignUp", "len": 1 }, { "name": "goToSignUpOrLogin", "len": 1 }, { "name": "goToReceipt", "len": 1 } ] }, "descriptor": "Ext.app.REMOTING_API" }; Ext.app.REMOTING_API.maxRetries = 0; Ext.app.REMOTING_API.timeout = 300 * 1000; Ext.app.REMOTING_API.enableBuffer = false; Ext.Direct.addProvider(Ext.app.REMOTING_API); Ext.app.REMOTING_API.requestKey = 'AE5F9D9B85CD53146992F32F46FD290947F3B9AA195F4EEB9D4D0B549A9B4B7A'; Ext.app.REMOTING_API.alias = 'CALVERTHEALTH.MEDICAL'; Ext.app.REMOTING_API.corporateID = ''; Ext.app.REMOTING_API.token = ''; function headerPatientPortalBack() { var nav = InstaMed.getNavigationView(); if(!Ext.Msg.isHidden()) { Ext.Msg.close(); } else if(nav.lastForm.length > 1) { nav.back(); } else { PerformAction({}, PatientPortalLoginController.patientPortalHeaderBack); } } Ext.define('MyApp.view.amountfield', { extend: 'Ext.field.Text', alias: 'widget.amountfield', config: { maxLength: 10, }, listeners: {blur: function(field, event, opts ){ field.doFormatAmount(field,event,opts); } }, doFormatAmount: function(field, event, opts ){ var s = new String(field.getValue()); if(s != null && s != '') { s = s.replace(/,/g,''); s = s.replace(/\$/g,''); field.setValue(Ext.util.Format.usMoney(s)); } }, getValue: function() { var val = new String(Ext.field.Number.superclass.getValue.call(this)); if(val == "null"){val = null;} return val; }, getSubmitValue: function() { var val = this.getValue(); if(val != null){ val = val.replace(/\$/g,''); } return val; }, transformOriginalValue: function(v) { if(v != undefined && v != null && v != '') { var s = new String(v); s = s.replace(/,/g,''); s = s.replace(/\$/g,''); var val = Ext.util.Format.usMoney(s); if(val == '$NaN.undefined') { val = ''; } return val; } return v; }, reset: function() { var me = this; Ext.field.Number.superclass.reset.call(this); me.enteredDigits = []; me.totalDigitsEntered = 0; }, setValue: function(v) { if(v==null || v==undefined || v==''){ this.enteredDigits = []; this.totalDigitsEntered = 0; } if(!this.hasFocus) { if (v == '$') { v = ''; } else { v = this.transformOriginalValue(v); } } v = new String(v).replace(/[^\$\d\.\,]/g,''); if(v.indexOf('.')!=-1 && v.indexOf('.') == v.length-4){ v = v.substring(0, v.indexOf('.') + 3); v = this.transformOriginalValue(v); } if(!this.KeyUpMode) { this.enteredDigits = []; this.totalDigitsEntered = 0; var count = 0; if(v) { var chars = v.split(''); for(var i = 0; i < chars.length; i++) { var c = chars[i]; if(c >= '0' && c <= '9') { this.enteredDigits.push(c); this.totalDigitsEntered++; } } } } Ext.field.Text.superclass.setValue.call(this,v); this.setInputValue(v); } }); Ext.define('Ext.InstaMed.FormPanel',{ extend: 'Ext.form.Panel', alias: 'widget.form', config: { defaultSubmitButton: null } }); Ext.define('Ext.InstaMed.FormPanel',{ extend: 'Ext.form.Panel', alias: 'widget.form', config: { defaultSubmitButton: null } }); InstaMed.pages = new Array(); Ext.Date.monthNames = [ 'January', 'February', 'March', 'April', 'May', 'June', 'July', 'August', 'September', 'October', 'November', 'December'] Ext.Date.dayNames = [ 'Sunday', 'Monday', 'Tuesday', 'Wednesday', 'Thursday', 'Friday', 'Saturday'] Ext.define('MyApp.view.NavigationView',{ extend: 'InstaMed.navigation.View', alias: 'widget.mynavigationview', config: { name: 'NavigationView', cls: 'im-white-panel', useLogo: true , configInnerStates:[0], configActiveItem:0, configLastForm:[new Object()], mobilePrimaryActionButtonInTitleBar: false, mobileSecondaryActionButtonInTitleBar: false, navigationBar: false , items: [ { xtype: 'container', name: 'NavPageQuickPayProviderLanding', layout: {type: 'vbox', pack: 'start'}, cls: 'im-top-background-floated-form-template', showBackButton: false, scrollable: 'true', id: 'NavPageQuickPayProviderLanding', items: [ { xtype: 'container', docked: 'top', scrollable: null, id: 'NavPageQuickPayProviderLanding_container', items: [ { xtype: 'instamedNavigationBar', name: 'headerBar', layout: {type: 'hbox'}, hidden: false, cls: 'im-ignore-custom-colors im-ignore-background', scrollable: null, id: 'NavPageQuickPayProviderLanding_headerBar', items: [ { xtype: 'spacer' , id: 'NavPageQuickPayProviderLanding_spacer', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} } , { xtype: 'titlebar', maxWidth: 1272, cls: 'largeTwelveColumn mediumTwelveColumn smallTwelveColumn xsmallTwelveColumn im-ignore-custom-colors im-ignore-background', scrollable: null, id: 'NavPageQuickPayProviderLanding_titlebar', plugins: 'responsive', responsiveConfig: {'width >= 1272':{title :'',},'width < 1272':{title : ' ',},}, items: [ { xtype: 'button', accessibleText: 'Back', iconCls: 'x-ma ma-arrow-back', align: 'left' , name: 'TitleBarNavigationViewBack', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-icon-link-style white hiddenlg noprint', id: 'NavPageQuickPayProviderLanding_TitleBarNavigationViewBack', plugins: 'responsive', responsiveConfig: {'width > 1272':{iconCls :'',},'width <= 1272':{iconCls : 'x-ma ma-arrow-back',},}, listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Start'; }} } , { xtype: 'image', width: 127, height: 40, src: 'http://cdn.instamed.com/V_2023_R1/Content/Images/General/instamed-tagged-white.png?id=CALVERTHEALTH.MEDICAL', align: 'left' , cls: 'x-clickable x-image-size-contain', id: 'NavPageQuickPayProviderLanding_image', plugins: 'responsive', responsiveConfig: {'width >= 1272':{hidden : false,},'width < 1272':{hidden :true,},}, listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Start'; }} } , { xtype: 'button' , name: 'HeaderTitlebarButton', ui: 'white', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-link-style im-center-header-button white noprint', id: 'NavPageQuickPayProviderLanding_HeaderTitlebarButton' } , { xtype: 'button', text: 'Pay Any Healthcare Bill', align: 'right' , name: 'PayAnyHealthcareBillButton', ui: 'white', margin: '', ariaRole: 'button', cls: 'x-button-link-style x-border hiddenxs hiddensm white noprint', id: 'NavPageQuickPayProviderLanding_button_PayAnyHealthcareBill', listeners: {tap: function() { if(InstaMed.isLoggedIn) { window.location.href ='../../Form/PaymentPortal/Dashboard?id=CALVERTHEALTH.MEDICAL&pageStep=NavFindProvider'; } else { window.location.href ='../../Form/PaymentPortal/Start?pageStep=NavFindProvider'; }}} } , { xtype: 'button', text: 'Pay Bills', iconCls: 'x-ma ma-search', iconAlign: 'top', align: 'right' , name: 'PayAnyHealthcareBillIcon', margin: '', ariaRole: 'button', cls: 'x-button-icon-ontop-link-style white hiddenmd hiddenlg noprint', id: 'NavPageQuickPayProviderLanding_button_PayBills', listeners: {tap: function() { if(InstaMed.isLoggedIn) { window.location.href ='../../Form/PaymentPortal/Dashboard?pageStep=NavFindProvider'; } else { window.location.href ='../../Form/PaymentPortal/Start?pageStep=NavFindProvider'; }}} } , { xtype: 'button', accessibleText: 'Log In or Sign Up', iconCls: 'x-ma ma-account-circle', align: 'right' ,menu:[ { xtype: 'menuitem', text: 'Log In', handler: function() { PerformAction({}, PatientPortalLoginController.redirectToLogin,null); } , id: 'menuitem_LogIn'} , { xtype: 'menuitem', text: 'Sign Up', handler: function() { PerformAction({}, SignUpController.redirectToSignUp,null); } , id: 'menuitem_SignUp'} , ] , name: 'LoginOrSignUpProfileIcon', margin: '', ariaRole: 'button', cls: 'x-button-icon-link-style white noprint', id: 'NavPageQuickPayProviderLanding_button_LoginOrSignUpProfileIcon', plugins: 'responsive', responsiveConfig: {'!InstaMed.isLoggedIn && width > 960':{hidden: true,},'!InstaMed.isLoggedIn && width <= 960':{hidden: false,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=LoginOrSignUpProfileIcon]')[0].getMenu().hide(); }} } , { xtype: 'button', text: '', align: 'right' ,menu:[ { xtype: 'menuitem', text: 'Dashboard', handler: function(){ window.location.href='../../Form/PaymentPortal/Dashboard'; } , id: 'menuitem_Dashboard'} , { xtype: 'menuitem', text: 'Help', handler: function() { window.open('http://help.instamed.com/patients/s/?dc_label=Patients')} , id: 'menuitem_Help'} , { xtype: 'menuitem', text: 'Log Out', handler: function(){ window.location.href='../../Form/PaymentPortal/Logout?id=CALVERTHEALTH.MEDICAL'; } , id: 'menuitem_LogOut'} , ] , name: 'Profile', ui: 'white', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-link-style white noprint', id: 'NavPageQuickPayProviderLanding_button_Profile', plugins: 'responsive', responsiveConfig: {'InstaMed.isLoggedIn && width > 960':{hidden: false,},'InstaMed.isLoggedIn && width <= 960':{hidden: true,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=Profile]')[0].getMenu().hide(); }} } , { xtype: 'container', align: 'right', name: 'LoginOrSignUpContainer', layout: {type: 'hbox'}, scrollable: null, id: 'NavPageQuickPayProviderLanding_LoginOrSignUpContainer', plugins: 'responsive', responsiveConfig: {'!InstaMed.isLoggedIn && width > 960':{hidden: false,},'!InstaMed.isLoggedIn && width <= 960':{hidden: true,},}, items: [ { xtype: 'button', text: 'Log In', align: 'right' , name: 'LoginForDualLogin', ui: 'white', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-link-style hiddenxs hiddensm white noprint', id: 'NavPageQuickPayProviderLanding_button_LoginForDualLogin', listeners: {tap: function() { PerformAction({}, PatientPortalLoginController.redirectToLogin,null); }} } , { xtype: 'label', html: 'or', align: 'right', name: 'Or', ui: 'body1-white', cls: 'hiddenxs hiddensm body1-white', id: 'NavPageQuickPayProviderLanding_Or' } , { xtype: 'button', text: 'Sign Up', align: 'right' , name: 'SignUpForDualLogin', ui: 'white', margin: '', ariaRole: 'button', cls: 'x-button-link-style hiddenxs hiddensm white noprint', id: 'NavPageQuickPayProviderLanding_button_SignUpForDualLogin', listeners: {tap: function() { PerformAction({}, SignUpController.redirectToSignUp,null); }} } ] } , { xtype: 'button', accessibleText: 'Profile', iconCls: 'x-ma ma-account-circle', align: 'right' ,menu:[ { xtype: 'menuitem', text: 'Dashboard', handler: function(){ window.location.href='../../Form/PaymentPortal/Dashboard'; } , id: 'menuitem_Dashboard_1'} , { xtype: 'menuitem', text: 'Help', handler: function() { window.open('http://help.instamed.com/patients/s/?dc_label=Patients')} , id: 'menuitem_Help_1'} , { xtype: 'menuitem', text: 'Log Out', handler: function(){ window.location.href='../../Form/PaymentPortal/Logout?id=CALVERTHEALTH.MEDICAL'; } , id: 'menuitem_LogOut_1'} , ] , name: 'ProfileIcon', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-icon-link-style white noprint', id: 'NavPageQuickPayProviderLanding_button_ProfileIcon', plugins: 'responsive', responsiveConfig: {'InstaMed.isLoggedIn && width > 960':{hidden: true,},'InstaMed.isLoggedIn && width <= 960':{hidden: false,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=ProfileIcon]')[0].getMenu().hide(); }} } ] } , { xtype: 'spacer' , id: 'NavPageQuickPayProviderLanding_spacer_1', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} } ] } ] } , { xtype: 'panel', dock: 'top', frame: false, scrollable: 'true', id: 'panel', items: [ { xtype: 'container', layout: {type: 'hbox'}, cls: 'mainContent MainContentWithHeaerAndSubheader ', scrollable: null, id: 'container', items: [ { xtype: 'container', flex: 1, scrollable: null, id: 'container_1', items: [ { xtype: 'container', cls: 'im-top-background-floated-form-template-top', scrollable: null, id: 'container_2', items: [ { xtype: 'container', maxWidth: 1272, cls: 'im-top-background-floated-form-template-top-content', scrollable: null, id: 'container_3', items: [ { xtype: 'container', cls: 'im-top-background-floated-form-template-top-content-side-info', scrollable: null, id: 'container_4', items: [ { xtype: 'container', scrollable: null, id: 'container_5', items: [ { xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'container_6', items: [ { xtype: 'spacer' , id: 'spacer' } , { xtype: 'container', cls: 'im-base-responsive-white-provider-logo', scrollable: null, id: 'container_7', items: [ { xtype: 'image', src: '../../ContentHandler.aspx?URL=/Images/Database/CALVERT.PHYSICIAN.AS@instamed.net/rebecca.kelley@instamed.com/[DEFAULT]Logo/638175913767880723&id=CALVERTHEALTH.MEDICAL&crop=true&maxWidth=150&maxHeight=64' , cls: 'im-base-responsive-white-provider-logo-content', id: 'image' } ] } , { xtype: 'spacer' , id: 'spacer_1' } ] } , { xtype: 'container', cls: 'im-center-text-wrapper', scrollable: null, id: 'container_8', items: [ { xtype: 'container', margin: '16 0 0 0', scrollable: null, id: 'container_9', items: [ { xtype: 'label', html: 'Calvert Health', ui: 'title-white-300-responsive-20-20-38', cls: 'title-white-300-responsive-20-20-38', id: 'label' } ] } ] } , { xtype: 'container', cls: 'im-center-text-wrapper', scrollable: null, id: 'container_10', items: [ { xtype: 'container', margin: '8 0 0 0', scrollable: null, id: 'container_11', items: [ { xtype: 'label', html: 'PO Box 11755, Newark, NJ 07101-4755', ui: 'subheading-white-300-responsive-14-14-16', cls: 'subheading-white-300-responsive-14-14-16', id: 'label_1' } ] } ] } , { xtype: 'container', cls: 'im-center-text-wrapper', scrollable: null, id: 'container_12', items: [ { xtype: 'label', html: '(410) 535-8248', ui: 'subheading-white-300-responsive-14-14-16', cls: 'subheading-white-300-responsive-14-14-16', id: 'label_2' } ] } ] } ] } ] } ] } , { xtype: 'container', maxWidth: 1272, cls: 'im-top-background-floated-form-template-formcontainer', scrollable: null, id: 'container_13', items: [ { xtype: 'container', cls: 'im-top-background-floated-form-template-formcontainer-form', scrollable: null, id: 'container_14', items: [ { xtype: 'form', preventHeader: true, bodyCls: 'mypanel', api: { }, defaultSubmitButton: 'PayNow', name: 'formSearchPayment', border: 'true', itemId: 'formSearchPayment', scrollable: null, id: 'formSearchPayment', items: [ { xtype: 'errorbox' , name: 'ValidationSummary', ui: 'ErrorBox', hidden: true, cls: 'ErrorBox', id: 'ValidationSummary' } , { xtype: 'instamedHeading1', text: 'Make a Payment', ui: 'headline-font', cls: 'headline-font', id: 'formSearchPayment_instamedHeading1' } , { xtype: 'textfield', allowBlank: false, allowOnlyWhitespace: false, maxLength: 200, maxLength: 200, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Email', label: 'Email', component: {"type":"email","pattern":null}, inputType: 'email', hidden: false, labelSeparator: ' ', required: true, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Email is required', autoComplete: 'on' , name: 'EmailAddress', margin: '', id: 'formSearchPayment_EmailAddress', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} } , { xtype: 'textfield', allowBlank: false, allowOnlyWhitespace: false, maxLength: 80, maxLength: 80, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Account Number', label: 'Account Number', hidden: false, labelSeparator: ' ', required: true, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Account Number is required', autoComplete: 'on' , name: 'QuickPayComboID', margin: '', dynamicToolTipText: 'Enter Account Number or Quick Pay Code from your Statement.', id: 'formSearchPayment_QuickPayComboID', tooltip: {html:"Enter Account Number or Quick Pay Code from your Statement.", trackMouse:"True"}, listeners: {action: submitOnEnter,blur: function() { var listenerArgs = arguments; Ext.Array.each([function(cmp){if(cmp.validate){cmp.validate();}},function() { PerformAction({QuickPayCode:InstaMed.get('QuickPayComboID').getValue(),ProviderAlias:InstaMed.get('ProviderAlias').getValue()}, QuickPayOptimizedProviderLandingController.checkQuickPayCode,null); }], function(func) { func.apply(this, listenerArgs); }); },change: function(cmp){ var value = cmp.getValue(); var queryLength = [7,8,9]; if(queryLength.indexOf(value.length)!=-1){ PerformAction({QuickPayCode:InstaMed.get('QuickPayComboID').getValue(),ProviderAlias:InstaMed.get('ProviderAlias').getValue()}, QuickPayOptimizedProviderLandingController.checkQuickPayCode,this,null,null,true,null,null,true); } }} } , { xtype: 'textfield', maxLength: 80, maxLength: 80, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Medical Record Number', label: 'Medical Record Number', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Medical Record Number is required', autoComplete: 'on' , name: 'PatientMedicalRecordNumber', margin: '', id: 'formSearchPayment_PatientMedicalRecordNumber', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} } , { xtype: 'textfield', maxLength: 80, maxLength: 80, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'MRN #', label: 'MRN #', hidden: false, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'MRN # is required', autoComplete: 'on' , name: 'GuarantorID', margin: '', dynamicToolTipText: 'MRN should begin with an \"M\"', id: 'formSearchPayment_GuarantorID', tooltip: {html:"MRN should begin with an \"M\"", trackMouse:"True"}, listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} } , { xtype: 'textfield', maxLength: 35, maxLength: 35, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Guarantor First Name', label: 'Guarantor First Name', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Guarantor First Name is required', autoComplete: 'on' , name: 'GuarantorFirstName', margin: '', id: 'formSearchPayment_GuarantorFirstName', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} } , { xtype: 'textfield', maxLength: 60, maxLength: 60, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Guarantor Last Name', label: 'Guarantor Last Name', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Guarantor Last Name is required', autoComplete: 'on' , name: 'GuarantorLastName', margin: '', id: 'formSearchPayment_GuarantorLastName', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} } , { xtype: 'textfield', maxLength: 35, maxLength: 35, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'First Name', label: 'First Name', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'First Name is required', autoComplete: 'on' , name: 'PatientFirstName', margin: '', id: 'formSearchPayment_PatientFirstName', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} } , { xtype: 'textfield', allowBlank: false, allowOnlyWhitespace: false, maxLength: 60, maxLength: 60, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Last Name', label: 'Last Name', hidden: false, labelSeparator: ' ', required: true, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Last Name is required', autoComplete: 'on' , name: 'PatientLastName', margin: '', id: 'formSearchPayment_PatientLastName', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} } , { xtype: 'textfield', maxLength: 25, maxLength: 25, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Middle', label: 'Middle', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Middle is required', autoComplete: 'on' , name: 'PatientMiddleName', margin: '', id: 'formSearchPayment_PatientMiddleName', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} } , { xtype: 'datepickerfield', picker: { cancelButton: false, toolbar : { items : [ { text : 'Clear', align : 'left', handler : function(btn) { var picker = btn.up('datepicker'); picker.fireEvent('change', picker, null); picker.setValue(picker.config.value); picker.hide(); } } ] } , value: new Date(), yearFrom: 1900, yearTo: 2029 }, floatedPicker: { xtype: 'datepanel', minDate: new Date('1/1/1900 12:00:00 AM'), maxDate: new Date('12/31/2029 12:00:00 AM'), yearPicker: { start: 1900, end: 2029, } }, minDate: new Date('1/1/1900 12:00:00 AM'), maxDate: new Date('12/31/2029 12:00:00 AM'), submitFormat: 'm/d/Y', showToday: true, badFormatMessage: 'Date of Birth format is MM/DD/YYYY', validateOnBlank: false , fieldLabel: 'Date of Birth', label: 'Date of Birth', hidden: true, labelSeparator: ' ', placeholder: 'MM/DD/YYYY', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Date of Birth is required', autoComplete: 'on' , name: 'PatientBirthDate', margin: '', dynamicToolTipText: 'Patient\'s date of birth (MM/DD/YYYY).', id: 'formSearchPayment_PatientBirthDate', tooltip: {html:"Patient\'s date of birth (MM/DD/YYYY).", trackMouse:"True"}, listeners: {blur: function() { var listenerArgs = arguments; Ext.Array.each([function(cmp){ var value = cmp.getValue(); if(value && typeof value == 'string') { value = new Date(value); } cmp.setValue(value); if(InstaMed.isResponsive){ cmp.setInputValue(value); } },function(cmp){if(cmp.validate){cmp.validate();}}], function(func) { func.apply(this, listenerArgs); }); }} } , { xtype: 'textfield', maxLength: 14, maxLength: 14, enforceMaxLength: true, minLength: 10, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Phone Number', label: 'Phone Number', component: {"type":"tel","pattern":null}, inputType: 'tel', hidden: true, labelSeparator: ' ', placeholder: '(215) 555-5555', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Phone Number is required', autoComplete: 'on' , name: 'PatientPhoneNumber', margin: '', id: 'formSearchPayment_PatientPhoneNumber', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}},change: function(field, event, opts ){ var s = new String(field.getValue()); if(s != null && s != '') { s = s.replace(/[-,()\s]/g,''); var newValue='('; newValue+=s.substring(0,3); if(s.length>3) { newValue+=') '; } newValue+=s.substring(3,6); if(s.length>6) { newValue+='-'; } newValue+=s.substring(6,10); if(isNaN(parseInt(newValue.substring(1,3)))){ newValue = ''; } field.setValue(newValue); if(InstaMed.isResponsive){ field.setInputValue(newValue); } } }} } , { xtype: 'textfield', allowBlank: false, allowOnlyWhitespace: false, maxLength: 10, maxLength: 10, enforceMaxLength: true, minLength: 3, selectOnFocus: true, autoCorrect: false, fieldLabel: 'ZIP Code', label: 'ZIP Code', hidden: false, labelSeparator: ' ', required: true, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'ZIP Code is required', autoComplete: 'on' , name: 'PatientZip', margin: '', id: 'formSearchPayment_PatientZip', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}},change: function(field, event, opts ){ var s = new String(field.getValue()); if(s != null && s != '') { s = s.replace(/[^0-9]/g,''); if(s.length>5) { s = [s.slice(0,5),'-',s.slice(5,9)].join(''); } field.setValue(s); if(InstaMed.isResponsive){ field.setInputValue(s); } } }} } , { xtype: 'textfield', maxLength: 100, maxLength: 100, enforceMaxLength: true, minLength: 0, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Statement Number', label: 'Statement Number', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Statement Number is required', autoComplete: 'off' , name: 'StatementNumber', margin: '', id: 'formSearchPayment_StatementNumber', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} } , { xtype: 'datepickerfield', picker: { cancelButton: false, toolbar : { items : [ { text : 'Clear', align : 'left', handler : function(btn) { var picker = btn.up('datepicker'); picker.fireEvent('change', picker, null); picker.setValue(picker.config.value); picker.hide(); } } ] } , value: new Date(), yearFrom: 1900, yearTo: 2029 }, floatedPicker: { xtype: 'datepanel', minDate: new Date('1/1/1900 12:00:00 AM'), maxDate: new Date('12/31/2029 12:00:00 AM'), yearPicker: { start: 1900, end: 2029, } }, minDate: new Date('1/1/1900 12:00:00 AM'), maxDate: new Date('12/31/2029 12:00:00 AM'), submitFormat: 'm/d/Y', showToday: true, badFormatMessage: 'Statement Date format is MM/DD/YYYY', validateOnBlank: false , fieldLabel: 'Statement Date', label: 'Statement Date', hidden: true, labelSeparator: ' ', placeholder: 'MM/DD/YYYY', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Statement Date is required', autoComplete: 'off' , name: 'StatementDate', margin: '', id: 'formSearchPayment_StatementDate', listeners: {blur: function() { var listenerArgs = arguments; Ext.Array.each([function(cmp){ var value = cmp.getValue(); if(value && typeof value == 'string') { value = new Date(value); } cmp.setValue(value); if(InstaMed.isResponsive){ cmp.setInputValue(value); } },function(cmp){if(cmp.validate){cmp.validate();}}], function(func) { func.apply(this, listenerArgs); }); }} } , { xtype: 'amountfield', regex: /^[\$]?\d{1,3}(\,?\d{3,3})*(\.(\d|\d\d))?$/i, regexText: 'Please enter a valid dollar amount.', maxLength: 12, maxLength: 12, enforceMaxLength: true, minLength: 0, selectOnFocus: true, autoCorrect: false, maskRe: /[\$\d\.\,]/i, fieldLabel: 'Amount Due', label: 'Amount Due', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Amount Due is required', autoComplete: 'off' , name: 'AmountDue', margin: '', id: 'formSearchPayment_AmountDue', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} } , { xtype: 'textfield', maxLength: 100, maxLength: 100, enforceMaxLength: true, minLength: 0, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Dynamic Field 1', label: 'Dynamic Field 1', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Dynamic Field 1 is required', autoComplete: 'off' , name: 'DynamicField1', margin: '', id: 'formSearchPayment_DynamicField1', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} } , { xtype: 'textfield', maxLength: 100, maxLength: 100, enforceMaxLength: true, minLength: 0, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Dynamic Field 2', label: 'Dynamic Field 2', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Dynamic Field 2 is required', autoComplete: 'off' , name: 'DynamicField2', margin: '', id: 'formSearchPayment_DynamicField2', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} } , { xtype: 'textfield', maxLength: 100, maxLength: 100, enforceMaxLength: true, minLength: 0, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Dynamic Field 3', label: 'Dynamic Field 3', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Dynamic Field 3 is required', autoComplete: 'off' , name: 'DynamicField3', margin: '', id: 'formSearchPayment_DynamicField3', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} } , { xtype: 'textfield', maxLength: 80, maxLength: 80, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Dynamic Field 4', label: 'Dynamic Field 4', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Dynamic Field 4 is required', autoComplete: 'off' , name: 'DynamicField4', margin: '', id: 'formSearchPayment_DynamicField4', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} } , { xtype: 'hiddenfield' , fieldLabel: 'ProviderAlias', label: 'ProviderAlias', labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'ProviderAlias is required', autoComplete: 'on' , name: 'ProviderAlias', margin: '', id: 'formSearchPayment_ProviderAlias', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} } , { xtype: 'container', margin: '0 0 16 0', scrollable: null, id: 'formSearchPayment_container', items: [ { xtype: 'button', text: 'Pay Now' , name: 'PayNow', ui: 'wide', margin: '', ariaRole: 'button', cls: 'x-button-action wide noprint', id: 'formSearchPayment_button_PayNow', listeners: {tap: function(cmp, newValue, oldValue, eOpts) { myForm = InstaMed.findParentForm(cmp); PerformAction(myForm.getValues(),QuickPayOptimizedProviderLandingController.payNow,cmp,undefined,undefined,undefined,undefined,undefined); }} } ] } , { xtype: 'container', html: 'Don\'t have the information above? Pay Here', cls: 'donthaveinformation', scrollable: null, id: 'formSearchPayment_container_1' } ] } ] } ] } , { xtype: 'container', cls: 'im-top-background-floated-form-template-subcontent', scrollable: null, id: 'container_15', items: [ { xtype: 'container', scrollable: null, id: 'container_16', items: [ { xtype: 'container', html: '', cls: 'im-slim-iframe-container', scrollable: null, id: 'container_17', listeners: {painted: function() { var id = this.id; var div = document.getElementById(id) var iFrameArray = div.getElementsByTagName('iframe'); if(iFrameArray && iFrameArray.length==1) { var iFrame = iFrameArray[0]; { iFrame.width= Ext.Viewport.getWindowWidth(); iFrame.height= 375; } } }} } , { xtype: 'container', html: '', cls: 'im-slim-iframe-container im-quick-pay-optimized-landing-subcontent-second', scrollable: null, id: 'container_18', listeners: {painted: function() { var id = this.id; var div = document.getElementById(id) var iFrameArray = div.getElementsByTagName('iframe'); if(iFrameArray && iFrameArray.length==1) { var iFrame = iFrameArray[0]; { iFrame.width= Ext.Viewport.getWindowWidth(); iFrame.height= 374; } } }} } ] } ] } ] } ] } ] } , { xtype: 'spacer' , flex: 1, id: 'spacer_2' } , { xtype: 'container', layout: {type: 'hbox'}, hidden: false, cls: 'x-panel-footer im-powered-by', scrollable: null, id: 'container_19', items: [ { xtype: 'spacer' , id: 'spacer_3' } , { xtype: 'container', maxWidth: 1272, layout: {type: 'hbox'}, cls: 'largeTwelveColumn mediumTwelveColumn ', scrollable: null, id: 'NavPageQuickPayProviderLanding_container_1', items: [ { xtype: 'image' , name: 'poweredbylogo', cls: 'hidden hiddenxs hiddensm', id: 'NavPageQuickPayProviderLanding_poweredbylogo' } , { xtype: 'container', cls: 'copyrightContainer hiddenxs hiddensm', scrollable: null, id: 'NavPageQuickPayProviderLanding_container_2', items: [ { xtype: 'spacer' , cls: 'hiddenmd hiddenlg', id: 'NavPageQuickPayProviderLanding_spacer_2' } , { xtype: 'button', text: '© 2023 InstaMed. All Rights Reserved.' , name: 'copyrightFooter', ui: 'dark-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style dark-grey noprint', id: 'NavPageQuickPayProviderLanding_button_copyrightFooter' } , { xtype: 'spacer' , cls: 'hiddenmd hiddenlg', id: 'NavPageQuickPayProviderLanding_spacer_3' } ] } , { xtype: 'spacer' , cls: 'hiddenxs hiddensm', id: 'NavPageQuickPayProviderLanding_spacer_4' } , { xtype: 'container', cls: 'linkButtonContainer hiddenxs hiddensm', scrollable: null, id: 'NavPageQuickPayProviderLanding_container_3', items: [ { xtype: 'button', text: 'Security', iconCls: 'x-ma ma-lock-outline' , ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavPageQuickPayProviderLanding_button_Security', listeners: {tap: function() { InstaMed.popupNewWindow('http://www.instamed.com/security/','open-window');}} } , { xtype: 'button', text: 'Privacy' , ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavPageQuickPayProviderLanding_button_Privacy', listeners: {tap: function() { InstaMed.popupNewWindow('http://www.instamed.com/privacy-statement/','open-window');}} } , { xtype: 'button', text: 'Terms' , ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavPageQuickPayProviderLanding_button_Terms', listeners: {tap: function() { InstaMed.popupNewWindow('http://www.instamed.com/terms-of-use/','open-window');}} } , { xtype: 'button', text: 'Help' , ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavPageQuickPayProviderLanding_button_Help', listeners: {tap: function() { InstaMed.popupNewWindow('../../Form/PaymentPortal/ContactUs?id=CALVERTHEALTH.MEDICAL','open-window');}} } , { xtype: 'button', text: 'English', align: 'right' ,menu:[ { xtype: 'menuitem', text: 'English', handler: function(cmp) { PerformAction({Language:'en'}, PatientPortalLoginController.changeLanguage,cmp); } , name: 'en', cls: 'hiddenxs hiddensm', id: 'menuitem_en'} , { xtype: 'menuitem', text: 'Español', handler: function(cmp) { PerformAction({Language:'es'}, PatientPortalLoginController.changeLanguage,cmp); } , name: 'es', cls: 'hiddenxs hiddensm', id: 'menuitem_es'} , { xtype: 'menuitem', text: 'Français', handler: function(cmp) { PerformAction({Language:'fr'}, PatientPortalLoginController.changeLanguage,cmp); } , name: 'fr', cls: 'hiddenxs hiddensm', id: 'menuitem_fr'} , ] , name: 'ForeignLanguages', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavPageQuickPayProviderLanding_button_ForeignLanguages' } ] } , { xtype: 'container', cls: 'hiddenmd hiddenlg', scrollable: null, id: 'NavPageQuickPayProviderLanding_container_4', items: [ { xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavPageQuickPayProviderLanding_container_5', items: [ { xtype: 'spacer' , id: 'NavPageQuickPayProviderLanding_spacer_5' } , { xtype: 'image' , name: 'poweredbylogo', cls: 'hidden', id: 'NavPageQuickPayProviderLanding_poweredbylogo_1' } , { xtype: 'spacer' , id: 'NavPageQuickPayProviderLanding_spacer_6' } ] } , { xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavPageQuickPayProviderLanding_container_6', items: [ { xtype: 'spacer' , id: 'NavPageQuickPayProviderLanding_spacer_7' } , { xtype: 'container', cls: 'copyrightContainer', scrollable: null, id: 'NavPageQuickPayProviderLanding_container_7', items: [ { xtype: 'spacer' , cls: 'hiddenmd hiddenlg', id: 'NavPageQuickPayProviderLanding_spacer_8' } , { xtype: 'button', text: '© 2023 InstaMed. All Rights Reserved.' , name: 'copyrightFooter', ui: 'dark-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style dark-grey noprint', id: 'NavPageQuickPayProviderLanding_button_copyrightFooter_1' } , { xtype: 'spacer' , cls: 'hiddenmd hiddenlg', id: 'NavPageQuickPayProviderLanding_spacer_9' } ] } , { xtype: 'spacer' , id: 'NavPageQuickPayProviderLanding_spacer_10' } ] } , { xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavPageQuickPayProviderLanding_container_8', items: [ { xtype: 'spacer' , id: 'NavPageQuickPayProviderLanding_spacer_11' } , { xtype: 'container', cls: 'linkButtonContainer ', scrollable: null, id: 'NavPageQuickPayProviderLanding_container_9', items: [ { xtype: 'button', text: 'Security', iconCls: 'x-ma ma-lock-outline' , ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavPageQuickPayProviderLanding_button_Security_1', listeners: {tap: function() { InstaMed.popupNewWindow('http://www.instamed.com/security/','open-window');}} } , { xtype: 'button', text: 'Privacy' , ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavPageQuickPayProviderLanding_button_Privacy_1', listeners: {tap: function() { InstaMed.popupNewWindow('http://www.instamed.com/privacy-statement/','open-window');}} } , { xtype: 'button', text: 'Terms' , ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavPageQuickPayProviderLanding_button_Terms_1', listeners: {tap: function() { InstaMed.popupNewWindow('http://www.instamed.com/terms-of-use/','open-window');}} } , { xtype: 'button', text: 'Help' , ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavPageQuickPayProviderLanding_button_Help_1', listeners: {tap: function() { InstaMed.popupNewWindow('../../Form/PaymentPortal/ContactUs?id=CALVERTHEALTH.MEDICAL','open-window');}} } ] } , { xtype: 'spacer' , id: 'NavPageQuickPayProviderLanding_spacer_12' } ] } , { xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavPageQuickPayProviderLanding_container_10', items: [ { xtype: 'spacer' , id: 'NavPageQuickPayProviderLanding_spacer_13' } , { xtype: 'container', scrollable: null, id: 'NavPageQuickPayProviderLanding_container_11', items: [ { xtype: 'button', text: 'English', align: 'right' ,menu:[ { xtype: 'menuitem', text: 'English', handler: function(cmp) { PerformAction({Language:'en'}, PatientPortalLoginController.changeLanguage,cmp); } , name: 'en', cls: 'hiddenmd hiddenlg', id: 'menuitem_en_1'} , { xtype: 'menuitem', text: 'Español', handler: function(cmp) { PerformAction({Language:'es'}, PatientPortalLoginController.changeLanguage,cmp); } , name: 'es', cls: 'hiddenmd hiddenlg', id: 'menuitem_es_1'} , { xtype: 'menuitem', text: 'Français', handler: function(cmp) { PerformAction({Language:'fr'}, PatientPortalLoginController.changeLanguage,cmp); } , name: 'fr', cls: 'hiddenmd hiddenlg', id: 'menuitem_fr_1'} , ] , name: 'ForeignLanguages', ui: 'grey', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavPageQuickPayProviderLanding_button_ForeignLanguages_1' } ] } , { xtype: 'spacer' , id: 'NavPageQuickPayProviderLanding_spacer_14' } ] } ] } ] } , { xtype: 'spacer' , id: 'spacer_4' } ] } ] } , { xtype: 'window', title: 'Inactivity Alert', titleAlign: 'center', itemId: 'NavPageIdleTimeoutForm', flex: 1, defaultFocus: 'button', closable: true, modal: true, draggable: false, constrainHeader: true, constrainTo: 'mainBorderPanel', closeAction: 'hide', name: 'NavPageIdleTimeoutForm', maxWidth: 400, flex: 1, id: 'NavPageIdleTimeoutForm', listeners: {beforeshow: function(){ InstaMed.query("Logout") && InstaMed.query("Logout").setVisible(InstaMed.isLoggedIn); if(!InstaMed.isSSO){ InstaMed.query("IdleTimerNotification") && InstaMed.query("IdleTimerNotification").setHtml && InstaMed.query("IdleTimerNotification").setHtml(InstaMed.isLoggedIn ? "You have been idle for 12 minutes. If you do not select Continue or you make no selection in 3 minutes and 0 seconds, you will be automatically logged out.":"You have been idle for 12 minutes. If you do not select Continue or you make no selection in 3 minutes and 0 seconds, your session will be refreshed and you may lose any unprocessed information."); InstaMed.query("IdleTimerNotification") && InstaMed.query("IdleTimerNotification").setTitle && InstaMed.query("IdleTimerNotification").setTitle(InstaMed.isLoggedIn ? "Automatic Logout":"Inactivity Alert"); } },show: function(cmp) { Ext.each(Ext.DomQuery.select('.x-panel-body', Ext.DomQuery.selectNode('.x-window[id=NavPageIdleTimeoutForm]')), function(p) { Ext.get(p.id).scrollTo('top', 0); }); }}, items: [ { xtype: 'form', preventHeader: true, bodyCls: 'mypanel', api: { submit: IdleTimerController.submit }, defaultSubmitButton: 'btnContinue', name: 'MyFormPanel', ui: 'flat', itemId: 'MyFormPanel', flex: 1, cls: 'flat', scrollable: null, id: 'MyFormPanel', items: [ { xtype: 'errorbox' , name: 'ValidationSummary', ui: 'ErrorBox', flex: 1, hidden: true, cls: 'ErrorBox', id: 'ValidationSummary_1' } , { xtype: 'label', html: 'You have been idle for 12 minutes. If you do not select Continue or you make no selection in 3 minutes and 0 seconds, your session will be refreshed and you may lose any unprocessed information.', name: 'IdleTimerNotification', flex: 1, id: 'MyFormPanel_IdleTimerNotification' } , { xtype: 'container', flex: 1, scrollable: null, id: 'MyFormPanel_container', items: [ { xtype: 'container', layout: {type: 'hbox', pack: 'start', align: 'bottom'}, flex: 1, cls: 'buttonContainer', scrollable: null, id: 'MyFormPanel_container_1', items: [ { xtype: 'spacer' , flex: 1, id: 'MyFormPanel_spacer' } , { xtype: 'button', text: 'Logout' , name: 'Logout', ui: 'secondary', flex: 1, margin: '', hidden: true, ariaRole: 'button', cls: 'secondary noprint', id: 'MyFormPanel_button_Logout', listeners: {tap: function() { LogoutTimer.logOut(); }} } , { xtype: 'button', text: 'Continue' , name: 'btnContinue', ui: 'secondary', flex: 1, margin: '', ariaRole: 'button', cls: 'secondary noprint', id: 'MyFormPanel_button_Continue', listeners: {tap: function(cmp, newValue, oldValue, eOpts) { LogoutTimer.resetMainTimer(); myForm = InstaMed.findParentForm(cmp); PerformAction(myForm.getValues(),IdleTimerController.submit,cmp); } } } ] } ] } ] } ] } ] } }); Ext.Loader.setConfig({ enabled: false }); Ext.application({ name: 'MyApp', launch: function() { Ext.create('MyApp.view.NavigationView', {fullscreen: true}); } }); LogoutTimer && setTimeout(LogoutTimer.reinitiateMainTimer,5000); }