Class: PdfFill::Forms::Va210781a

Inherits:

FormBase

• Object
• FormBase
• PdfFill::Forms::Va210781a

Includes:

CommonPtsd

Defined in:

lib/pdf_fill/forms/va210781a.rb

Constant Summary

ITERATOR =

PdfFill::HashConverter::ITERATOR

KEY =

{
  'veteranFullName' => {
    'first' => {
      key: 'F[0].Page_1[0].ClaimantsFirstName[0]',
      limit: 12,
      question_num: 1,
      question_suffix: 'A',
      question_text: "VETERAN/BENEFICIARY'S FIRST NAME"
    },
    'middleInitial' => {
      key: 'F[0].Page_1[0].ClaimantsMiddleInitial1[0]'
    },
    'last' => {
      key: 'F[0].Page_1[0].ClaimantsLastName[0]',
      limit: 18,
      question_num: 1,
      question_suffix: 'B',
      question_text: "VETERAN/BENEFICIARY'S LAST NAME"
    }
  },
  'veteranSocialSecurityNumber' => {
    'first' => {
      key: 'F[0].Page_1[0].ClaimantsSocialSecurityNumber_FirstThreeNumbers[0]'
    },
    'second' => {
      key: 'F[0].Page_1[0].ClaimantsSocialSecurityNumber_SecondTwoNumbers[0]'
    },
    'third' => {
      key: 'F[0].Page_1[0].ClaimantsSocialSecurityNumber_LastFourNumbers[0]'
    }
  },
  'veteranSocialSecurityNumber1' => {
    'first' => {
      key: 'F[0].Page_2[0].VeteransSocialSecurityNumber_FirstThreeNumbers[0]'
    },
    'second' => {
      key: 'F[0].Page_2[0].VeteransSocialSecurityNumber_SecondTwoNumbers[0]'
    },
    'third' => {
      key: 'F[0].Page_2[0].VeteransSocialSecurityNumber_LastFourNumbers[0]'
    }
  },
  'veteranSocialSecurityNumber2' => {
    'first' => {
      key: 'F[0].Page_3[0].VeteransSocialSecurityNumber_FirstThreeNumbers[0]'
    },
    'second' => {
      key: 'F[0].Page_3[0].VeteransSocialSecurityNumber_SecondTwoNumbers[0]'
    },
    'third' => {
      key: 'F[0].Page_3[0].VeteransSocialSecurityNumber_LastFourNumbers[0]'
    }
  },
  'vaFileNumber' => {
    key: 'F[0].Page_1[0].VAFileNumber[0]'
  },
  'veteranDateOfBirth' => {
    'month' => {
      key: 'F[0].Page_1[0].DOBmonth[0]'
    },
    'day' => {
      key: 'F[0].Page_1[0].DOBday[0]'
    },
    'year' => {
      key: 'F[0].Page_1[0].DOByear[0]'
    }
  },
  'veteranServiceNumber' => {
    key: 'F[0].Page_1[0].VeteransServiceNumber[0]'
  },
  'email' => {
    key: 'F[0].Page_1[0].PreferredEmail[0]'
  },
  'veteranPhone' => {
    key: 'F[0].Page_1[0].PreferredEmail[1]'
  },
  'veteranSecondaryPhone' => {
    key: 'F[0].Page_1[0].PreferredEmail[2]'
  },
  'incidents' => {
    limit: 2,
    first_key: 'incidentDescription',
    question_text: 'INCIDENTS',
    question_num: 8,
    'incidentDate' => {
      'month' => {
        key: "incidentDateMonth[#{ITERATOR}]"
      },
      'day' => {
        key: "incidentDateDay[#{ITERATOR}]"
      },
      'year' => {
        key: "incidentDateYear[#{ITERATOR}]"
      }
    },
    'unitAssignedDates' => {
      'fromMonth' => {
        key: "unitAssignmentDateFromMonth[#{ITERATOR}]"
      },
      'fromDay' => {
        key: "unitAssignmentDateFromDay[#{ITERATOR}]"
      },
      'fromYear' => {
        key: "unitAssignmentDateFromYear[#{ITERATOR}]"
      },
      'toMonth' => {
        key: "unitAssignmentDateToMonth[#{ITERATOR}]"
      },
      'toDay' => {
        key: "unitAssignmentDateToDay[#{ITERATOR}]"
      },
      'toYear' => {
        key: "unitAssignmentDateToYear[#{ITERATOR}]"
      }
    },
    'incidentLocation' => {
      question_num: 8,
      limit: 3,
      first_key: 'row0',
      'row0' => {
        key: "incidentLocationFirstRow[#{ITERATOR}]"
      },
      'row1' => {
        key: "incidentLocationSecondRow[#{ITERATOR}]"
      },
      'row2' => {
        key: "incidentLocationThirdRow[#{ITERATOR}]"
      }
    },
    'unitAssigned' => {
      question_num: 8,
      limit: 3,
      'row0' => {
        key: "unitAssignmentFirstRow[#{ITERATOR}]",
        limit: 30
      },
      'row1' => {
        key: "unitAssignmentSecondRow[#{ITERATOR}]",
        limit: 30
      },
      'row2' => {
        key: "unitAssignmentThirdRow[#{ITERATOR}]",
        limit: 30
      }
    },
    'incidentDescription' => {
      key: "incidentDescription[#{ITERATOR}]"
    },
    'combinedName0' => {
      limit: 80,
      key: "incident_source_name[#{ITERATOR}][0]"
    },
    'combinedAddress0' => {
      limit: 80,
      key: "incident_source_address[#{ITERATOR}][0]"
    },
    'combinedName1' => {
      limit: 80,
      key: "incident_source_name[#{ITERATOR}][1]"
    },
    'combinedAddress1' => {
      limit: 80,
      key: "incident_source_address[#{ITERATOR}][1]"
    },
    'combinedName2' => {
      limit: 80,
      key: "incident_source_name[#{ITERATOR}][2]"
    },
    'combinedAddress2' => {
      limit: 80,
      key: "incident_source_address[#{ITERATOR}][2]"
    },
    'incidentOverflow' => {
      key: '',
      question_text: 'INCIDENTS',
      question_num: 8,
      question_suffix: 'A'
    }
  },
  'otherInformation' => {
    question_text: 'OTHER INFORMATION',
    question_num: 12,
    limit: 11,
    first_key: 'value',
    'value' => {
      question_text: 'OTHER INFORMATION',
      question_num: 12,
      limit: 80,
      key: "F[0].Page_3[0].OtherInformation[#{ITERATOR}]"
    }
  },
  'signature' => {
    key: 'F[0].Page_3[0].signature8[0]'
  },
  'signatureDate' => {
    key: 'F[0].Page_3[0].date9[0]',
    format: 'date'
  },
  'additionalSecondaryIncidentText' => {
    question_num: 15,
    question_text: 'ADDITIONAL INCIDENTS',
    limit: 0,
    key: 'none'
  }
}.freeze

Instance Method Summary

• #merge_fields(_options = {}) ⇒ Object

Methods included from CommonPtsd

#combine_date_range, #expand_incident_date, #expand_incident_location, #expand_incident_unit_assignment, #expand_ssn, #expand_unit_assigned_dates, #expand_veteran_dob, #format_incident, #get_unit_date_overflow, #split_approximate_date

Methods included from FormHelper

#address_block, #combine_date_ranges, #expand_checkbox_as_hash, #extract_country, #extract_middle_i, #format_boolean, #select_checkbox, #select_radio_button, #split_date, #split_postal_code, #split_ssn, #validate_date

Methods inherited from FormBase

#combine_both_addr, #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

# File 'lib/pdf_fill/forms/va210781a.rb', line 220

def merge_fields(_options = {})
  @form_data['veteranFullName'] = extract_middle_i(@form_data, 'veteranFullName')
  @form_data = expand_ssn(@form_data)
  @form_data['veteranDateOfBirth'] = expand_veteran_dob(@form_data)
  expand_incidents(@form_data['incidents'])
  expand_other_information

  expand_signature(@form_data['veteranFullName'])
  @form_data['signature'] = "/es/ #{@form_data['signature']}"

  @form_data
end