Class: PdfFill::Forms::Va1010cg

Inherits:
FormBase
  • Object
show all
Defined in:
lib/pdf_fill/forms/va1010cg.rb

Constant Summary collapse

PDF_INPUT_LOCATIONS = 
OpenStruct.new(
  veteran: {
    name: {
      first: 'form1[0].#subform[14].TextField3[1]',
      middle: 'form1[0].#subform[14].TextField3[2]',
      last: 'form1[0].#subform[14].TextField3[0]'
    },
    ssn: 'form1[0].#subform[14].TextField3[3]',
    dob: 'form1[0].#subform[14].Date[0]',
    gender: 'form1[0].#subform[14].RadioButtonList[0]', # "2" | "3" | "Off"
    address: {
      street: 'form1[0].#subform[14].TextField3[4]',
      city: 'form1[0].#subform[14].TextField3[5]',
      state: 'form1[0].#subform[14].TextField3[6]',
      zip: 'form1[0].#subform[14].TextField3[7]'
    },
    primary_phone: 'form1[0].#subform[14].TextField3[8]',
    alternative_phone: 'form1[0].#subform[14].TextField3[9]',
    email: 'form1[0].#subform[14].TextField3[11]',
    planned_clinic: 'form1[0].#subform[14].TextField3[10]',
    last_treatment_facility: {
      name: 'form1[0].#subform[14].TextField3[12]',
      type: 'form1[0].#subform[14].RadioButtonList[1]' # "1" | "2" | "Off"
    },
    signature: {
      name: 'form1[0].#subform[14].SignatureTextField1[0]',
      date: 'form1[0].#subform[14].Date[2]'
    }
  },
  primaryCaregiver: {
    name: {
      first: 'form1[0].#subform[14].TextField3[14]',
      middle: 'form1[0].#subform[14].TextField3[13]',
      last: 'form1[0].#subform[14].TextField3[15]'
    },
    ssn: 'form1[0].#subform[14].TextField3[16]',
    dob: 'form1[0].#subform[14].Date[1]',
    gender: 'form1[0].#subform[14].RadioButtonList[3]', # "2" | "3" | "Off"
    address: {
      street: 'form1[0].#subform[14].TextField3[17]',
      city: 'form1[0].#subform[14].TextField3[18]',
      state: 'form1[0].#subform[14].TextField3[19]',
      zip: 'form1[0].#subform[14].TextField3[20]'
    },
    primary_phone: 'form1[0].#subform[14].TextField3[21]',
    alternative_phone: 'form1[0].#subform[14].TextField3[22]',
    email: 'form1[0].#subform[14].TextField3[24]',
    vet_relationship: 'form1[0].#subform[14].TextField3[23]',
    has_health_insurance: 'form1[0].#subform[14].RadioButtonList[2]', # "1" | "2" | "Off"
    signature: {
      name: 'form1[0].#subform[15].SignatureTextField2[0]',
      date: 'form1[0].#subform[15].Date[3]'
    }
  },
  secondaryCaregiverOne: {
    name: {
      first: 'form1[0].#subform[15].TextField3[26]',
      middle: 'form1[0].#subform[15].TextField3[27]',
      last: 'form1[0].#subform[15].TextField3[25]'
    },
    ssn: 'form1[0].#subform[15].TextField3[34]',
    dob: 'form1[0].#subform[15].Date[5]',
    gender: 'form1[0].#subform[15].RadioButtonList[4]', # "2" | "3" | "Off"
    address: {
      street: 'form1[0].#subform[15].TextField3[28]',
      city: 'form1[0].#subform[15].TextField3[29]',
      state: 'form1[0].#subform[15].TextField3[30]',
      zip: 'form1[0].#subform[15].TextField3[31]'
    },
    primary_phone: 'form1[0].#subform[15].TextField3[36]',
    alternative_phone: 'form1[0].#subform[15].TextField3[35]',
    email: 'form1[0].#subform[15].TextField3[33]',
    vet_relationship: 'form1[0].#subform[15].TextField3[32]',
    signature: {
      name: 'form1[0].#subform[15].SignatureTextField3[0]',
      date: 'form1[0].#subform[15].Date[4]'
    }
  },
  secondaryCaregiverTwo: {
    name: {
      first: 'form1[0].#subform[16].TextField3[38]',
      middle: 'form1[0].#subform[16].TextField3[39]',
      last: 'form1[0].#subform[16].TextField3[37]'
    },
    ssn: 'form1[0].#subform[16].TextField3[46]',
    dob: 'form1[0].#subform[16].Date[7]',
    gender: 'form1[0].#subform[16].RadioButtonList[5]', # "2" | "3" | "Off"
    address: {
      street: 'form1[0].#subform[16].TextField3[40]',
      city: 'form1[0].#subform[16].TextField3[41]',
      state: 'form1[0].#subform[16].TextField3[42]',
      zip: 'form1[0].#subform[16].TextField3[43]'
    },
    primary_phone: 'form1[0].#subform[16].TextField3[48]',
    alternative_phone: 'form1[0].#subform[16].TextField3[47]',
    email: 'form1[0].#subform[16].TextField3[45]',
    vet_relationship: 'form1[0].#subform[16].TextField3[44]',
    signature: {
      name: 'form1[0].#subform[16].SignatureTextField4[0]',
      date: 'form1[0].#subform[16].Date[6]'
    }
  }
)
KEY = 
{
  # Formatted fields
  'helpers' => {
    'veteran' => {
      'address' => {
        'street' => {
          key: PDF_INPUT_LOCATIONS.veteran[:address][:street],
          limit: 80,
          question_num: 7,
          question_text: 'VETERAN/SERVICEMEMBER > Address > Street'
        }
      },
      'gender' => {
        key: PDF_INPUT_LOCATIONS.veteran[:gender]
      },
      'lastTreatmentFacility' => {
        'type' => {
          key: PDF_INPUT_LOCATIONS.veteran[:last_treatment_facility][:type]
        }
      },
      'signature' => {
        'name' => {
          key: PDF_INPUT_LOCATIONS.veteran[:signature][:name]
        },
        'date' => {
          key: PDF_INPUT_LOCATIONS.veteran[:signature][:date],
          format: 'date'
        }
      },
      'plannedClinic' => {
        key: PDF_INPUT_LOCATIONS.veteran[:planned_clinic]
      }
    },
    'primaryCaregiver' => {
      'address' => {
        'street' => {
          key: PDF_INPUT_LOCATIONS.primaryCaregiver[:address][:street],
          limit: 80,
          question_num: 25,
          question_text: 'PRIMARY FAMILY CAREGIVER > Address > Street'
        }
      },
      'gender' => {
        key: PDF_INPUT_LOCATIONS.primaryCaregiver[:gender]
      },
      'hasHealthInsurance' => {
        key: PDF_INPUT_LOCATIONS.primaryCaregiver[:has_health_insurance]
      },
      'signature' => {
        'name' => {
          key: PDF_INPUT_LOCATIONS.primaryCaregiver[:signature][:name]
        },
        'date' => {
          key: PDF_INPUT_LOCATIONS.primaryCaregiver[:signature][:date],
          format: 'date'
        }
      }
    },
    'secondaryCaregiverOne' => {
      'address' => {
        'street' => {
          key: PDF_INPUT_LOCATIONS.secondaryCaregiverOne[:address][:street],
          limit: 80,
          question_num: 48,
          question_text: 'SECONDARY FAMILY CAREGIVER (1) > Address > Street'
        }
      },
      'gender' => {
        key: PDF_INPUT_LOCATIONS.secondaryCaregiverOne[:gender]
      },
      'signature' => {
        'name' => {
          key: PDF_INPUT_LOCATIONS.secondaryCaregiverOne[:signature][:name]
        },
        'date' => {
          key: PDF_INPUT_LOCATIONS.secondaryCaregiverOne[:signature][:date],
          format: 'date'
        }
      }
    },
    'secondaryCaregiverTwo' => {
      'address' => {
        'street' => {
          key: PDF_INPUT_LOCATIONS.secondaryCaregiverTwo[:address][:street],
          limit: 80,
          question_num: 65,
          question_text: 'SECONDARY FAMILY CAREGIVER (2) > Address > Street'
        }
      },
      'gender' => {
        key: PDF_INPUT_LOCATIONS.secondaryCaregiverTwo[:gender]
      },
      'signature' => {
        'name' => {
          key: PDF_INPUT_LOCATIONS.secondaryCaregiverTwo[:signature][:name]
        },
        'date' => {
          key: PDF_INPUT_LOCATIONS.secondaryCaregiverTwo[:signature][:date],
          format: 'date'
        }
      }
    }
  },
  # Direct input
  'veteran' => {
    'fullName' => {
      'last' => {
        key: PDF_INPUT_LOCATIONS.veteran[:name][:last],
        limit: 29,
        question_num: 1,
        question_text: 'VETERAN/SERVICEMEMBER > Last Name'
      },
      'first' => {
        key: PDF_INPUT_LOCATIONS.veteran[:name][:first],
        limit: 29,
        question_num: 2,
        question_text: 'VETERAN/SERVICEMEMBER > First Name'
      },
      'middle' => {
        key: PDF_INPUT_LOCATIONS.veteran[:name][:middle],
        limit: 29,
        question_num: 3,
        question_text: 'VETERAN/SERVICEMEMBER > Middle Name'
      }
    },
    'ssnOrTin' => {
      key: PDF_INPUT_LOCATIONS.veteran[:ssn]
    },
    'dateOfBirth' => {
      key: PDF_INPUT_LOCATIONS.veteran[:dob],
      format: 'date'
    },
    'address' => {
      'city' => {
        key: PDF_INPUT_LOCATIONS.veteran[:address][:city],
        limit: 29,
        question_num: 8,
        question_text: 'VETERAN/SERVICEMEMBER > Address > City'
      },
      'state' => {
        key: PDF_INPUT_LOCATIONS.veteran[:address][:state],
        limit: 29,
        question_num: 9,
        question_text: 'VETERAN/SERVICEMEMBER > Address > State'
      },
      'postalCode' => {
        key: PDF_INPUT_LOCATIONS.veteran[:address][:zip],
        limit: 29,
        question_num: 10,
        question_text: 'VETERAN/SERVICEMEMBER > Address > Zip Code'
      }
    },
    'primaryPhoneNumber' => {
      key: PDF_INPUT_LOCATIONS.veteran[:primary_phone]
    },
    'alternativePhoneNumber' => {
      key: PDF_INPUT_LOCATIONS.veteran[:alternative_phone]
    },
    'email' => {
      key: PDF_INPUT_LOCATIONS.veteran[:email],
      limit: 79,
      question_num: 13,
      question_text: 'VETERAN/SERVICEMEMBER > Email'
    },
    'lastTreatmentFacility' => {
      'name' => {
        key: PDF_INPUT_LOCATIONS.veteran[:last_treatment_facility][:name],
        limit: 72,
        question_num: 16,
        question_text: 'VETERAN/SERVICEMEMBER > Last Treatment Facility > Name'
      }
    }
  },
  'primaryCaregiver' => {
    'fullName' => {
      'last' => {
        key: PDF_INPUT_LOCATIONS.primaryCaregiver[:name][:last],
        limit: 29,
        question_num: 19,
        question_text: 'PRIMARY FAMILY CAREGIVER > Last Name'
      },
      'first' => {
        key: PDF_INPUT_LOCATIONS.primaryCaregiver[:name][:first],
        limit: 29,
        question_num: 20,
        question_text: 'PRIMARY FAMILY CAREGIVER > First Name'
      },
      'middle' => {
        key: PDF_INPUT_LOCATIONS.primaryCaregiver[:name][:middle],
        limit: 29,
        question_num: 21,
        question_text: 'PRIMARY FAMILY CAREGIVER > Middle Name'
      }
    },
    'ssnOrTin' => {
      key: PDF_INPUT_LOCATIONS.primaryCaregiver[:ssn]
    },
    'dateOfBirth' => {
      key: PDF_INPUT_LOCATIONS.primaryCaregiver[:dob],
      format: 'date'
    },
    'address' => {
      'city' => {
        key: PDF_INPUT_LOCATIONS.primaryCaregiver[:address][:city],
        limit: 29,
        question_num: 26,
        question_text: 'PRIMARY FAMILY CAREGIVER > Address > City'
      },
      'state' => {
        key: PDF_INPUT_LOCATIONS.primaryCaregiver[:address][:state],
        limit: 29,
        question_num: 27,
        question_text: 'PRIMARY FAMILY CAREGIVER > Address > State'
      },
      'postalCode' => {
        key: PDF_INPUT_LOCATIONS.primaryCaregiver[:address][:zip],
        limit: 29,
        question_num: 28,
        question_text: 'PRIMARY FAMILY CAREGIVER > Address > Zip Code'
      }
    },
    'primaryPhoneNumber' => {
      key: PDF_INPUT_LOCATIONS.primaryCaregiver[:primary_phone]
    },
    'alternativePhoneNumber' => {
      key: PDF_INPUT_LOCATIONS.primaryCaregiver[:alternative_phone]
    },
    'email' => {
      key: PDF_INPUT_LOCATIONS.primaryCaregiver[:email],
      limit: 45,
      question_num: 31,
      question_text: 'PRIMARY FAMILY CAREGIVER > Email'
    },
    'vetRelationship' => {
      key: PDF_INPUT_LOCATIONS.primaryCaregiver[:vet_relationship]
    }
  },
  'secondaryCaregiverOne' => {
    'fullName' => {
      'last' => {
        key: PDF_INPUT_LOCATIONS.secondaryCaregiverOne[:name][:last],
        limit: 29,
        question_num: 42,
        question_text: 'SECONDARY FAMILY CAREGIVER (1) > Last Name'
      },
      'first' => {
        key: PDF_INPUT_LOCATIONS.secondaryCaregiverOne[:name][:first],
        limit: 29,
        question_num: 43,
        question_text: 'SECONDARY FAMILY CAREGIVER (1) > First Name'
      },
      'middle' => {
        key: PDF_INPUT_LOCATIONS.secondaryCaregiverOne[:name][:middle],
        limit: 29,
        question_num: 44,
        question_text: 'SECONDARY FAMILY CAREGIVER (1) > Middle Name'
      }
    },
    'ssnOrTin' => {
      key: PDF_INPUT_LOCATIONS.secondaryCaregiverOne[:ssn]
    },
    'dateOfBirth' => {
      key: PDF_INPUT_LOCATIONS.secondaryCaregiverOne[:dob],
      format: 'date'
    },
    'address' => {
      'city' => {
        key: PDF_INPUT_LOCATIONS.secondaryCaregiverOne[:address][:city],
        limit: 29,
        question_num: 49,
        question_text: 'SECONDARY FAMILY CAREGIVER (1) > Address > City'
      },
      'state' => {
        key: PDF_INPUT_LOCATIONS.secondaryCaregiverOne[:address][:state],
        limit: 29,
        question_num: 50,
        question_text: 'SECONDARY FAMILY CAREGIVER (1) > Address > State'
      },
      'postalCode' => {
        key: PDF_INPUT_LOCATIONS.secondaryCaregiverOne[:address][:zip],
        limit: 29,
        question_num: 51,
        question_text: 'SECONDARY FAMILY CAREGIVER (1) > Address > Zip Code'
      }
    },
    'primaryPhoneNumber' => {
      key: PDF_INPUT_LOCATIONS.secondaryCaregiverOne[:primary_phone]
    },
    'alternativePhoneNumber' => {
      key: PDF_INPUT_LOCATIONS.secondaryCaregiverOne[:alternative_phone]
    },
    'email' => {
      key: PDF_INPUT_LOCATIONS.secondaryCaregiverOne[:email],
      limit: 45,
      question_num: 54,
      question_text: 'SECONDARY FAMILY CAREGIVER (1) > Email'
    },
    'vetRelationship' => {
      key: PDF_INPUT_LOCATIONS.secondaryCaregiverOne[:vet_relationship]
    }
  },
  'secondaryCaregiverTwo' => {
    'fullName' => {
      'last' => {
        key: PDF_INPUT_LOCATIONS.secondaryCaregiverTwo[:name][:last],
        limit: 29,
        question_num: 59,
        question_text: 'SECONDARY FAMILY CAREGIVER (2) > Last Name'
      },
      'first' => {
        key: PDF_INPUT_LOCATIONS.secondaryCaregiverTwo[:name][:first],
        limit: 29,
        question_num: 60,
        question_text: 'SECONDARY FAMILY CAREGIVER (2) > First Name'
      },
      'middle' => {
        key: PDF_INPUT_LOCATIONS.secondaryCaregiverTwo[:name][:middle],
        limit: 29,
        question_num: 61,
        question_text: 'SECONDARY FAMILY CAREGIVER (2) > Middle Name'
      }
    },
    'ssnOrTin' => {
      key: PDF_INPUT_LOCATIONS.secondaryCaregiverTwo[:ssn]
    },
    'dateOfBirth' => {
      key: PDF_INPUT_LOCATIONS.secondaryCaregiverTwo[:dob],
      format: 'date'
    },
    'address' => {
      'city' => {
        key: PDF_INPUT_LOCATIONS.secondaryCaregiverTwo[:address][:city],
        limit: 29,
        question_num: 66,
        question_text: 'SECONDARY FAMILY CAREGIVER (2) > Address > City'
      },
      'state' => {
        key: PDF_INPUT_LOCATIONS.secondaryCaregiverTwo[:address][:state],
        limit: 29,
        question_num: 67,
        question_text: 'SECONDARY FAMILY CAREGIVER (2) > Address > State'
      },
      'postalCode' => {
        key: PDF_INPUT_LOCATIONS.secondaryCaregiverTwo[:address][:zip],
        limit: 29,
        question_num: 68,
        question_text: 'SECONDARY FAMILY CAREGIVER (2) > Address > Zip'
      }
    },
    'primaryPhoneNumber' => {
      key: PDF_INPUT_LOCATIONS.secondaryCaregiverTwo[:primary_phone]
    },
    'alternativePhoneNumber' => {
      key: PDF_INPUT_LOCATIONS.secondaryCaregiverTwo[:alternative_phone]
    },
    'email' => {
      key: PDF_INPUT_LOCATIONS.secondaryCaregiverTwo[:email],
      limit: 45,
      question_num: 71,
      question_text: 'SECONDARY FAMILY CAREGIVER (2) > Email'
    },
    'vetRelationship' => {
      key: PDF_INPUT_LOCATIONS.secondaryCaregiverTwo[:vet_relationship]
    }
  }
}.freeze

Instance Method Summary collapse

Methods inherited from FormBase

#combine_both_addr, #combine_full_address, #combine_full_address_extras, #combine_full_name, #combine_hash, #combine_name_addr, #combine_name_addr_extras, #combine_postal_code, #combine_previous_names, date_strftime, #expand_checkbox, #expand_date_range, #expand_signature, #initialize

Constructor Details

This class inherits a constructor from PdfFill::Forms::FormBase

Instance Method Details

#merge_fields(options = {}) ⇒ Object 



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# File 'lib/pdf_fill/forms/va1010cg.rb', line 481

def merge_fields(options = {})
  @form_data['helpers'] = {
    'veteran' => {},
    'primaryCaregiver' => {},
    'secondaryCaregiverOne' => {},
    'secondaryCaregiverTwo' => {}
  }

  merge_address_helpers
  merge_sex_helpers
  merge_signature_helpers if options[:sign]

  merge_primary_caregiver_has_health_insurance_helper
  merge_veteran_last_treatment_facility_helper
  merge_planned_facility_label_helper

  @form_data
end