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| 1 | +{% set serviceHome = '/live/start' %} |
| 2 | +{% set servicePhase = 'beta' %} |
| 3 | +{% set feedbackType = 'step' %} |
| 4 | +{% set section = '2' %} |
| 5 | + |
| 6 | +{% extends 'layout.html' %} |
| 7 | + |
| 8 | +{% set heading = 'Contact details for David' %} |
| 9 | + |
| 10 | +{% block pageTitle %} |
| 11 | + {{ heading }} - {{ data.presets[0].servicename }} - NHS |
| 12 | +{% endblock %} |
| 13 | + |
| 14 | +{% block outerContent %} |
| 15 | + {{ backLink({ |
| 16 | + "href": "javascript:history.go(-1)", |
| 17 | + "text": "Go back", |
| 18 | + "classes": "nhsuk-u-margin-top-4 nhsuk-u-margin-bottom-0" |
| 19 | + }) }} |
| 20 | +{% endblock %} |
| 21 | + |
| 22 | +{% block content %} |
| 23 | + |
| 24 | + <div class="nhsuk-grid-row"> |
| 25 | + <div class="nhsuk-grid-column-two-thirds"> |
| 26 | + |
| 27 | + <form action="confirm-contact-details-answer" method="post" autocomplete="off"> |
| 28 | + |
| 29 | + {% include 'live/includes/step.html' %} |
| 30 | + |
| 31 | + <h1 class="nhsuk-heading-l">{{ heading }}</h1> |
| 32 | + |
| 33 | + <p>These contact details will be used by:</p> |
| 34 | + <ul> |
| 35 | + <li>the GP surgery so that they can contact you about this registration or other health care services</li> |
| 36 | + <li>the NHS to update the contact details on the patient's health record</li> |
| 37 | + </ul> |
| 38 | + <h2 style="font-size: 1.5rem;">NHS login details</h2> |
| 39 | + |
| 40 | + <dl class="nhsuk-summary-list"> |
| 41 | + |
| 42 | + <div class="nhsuk-summary-list__row"> |
| 43 | + <dt class="nhsuk-summary-list__key"> |
| 44 | + Contact telephone number |
| 45 | + </dt> |
| 46 | + <dd class="nhsuk-summary-list__value"> |
| 47 | + 07799123456 |
| 48 | + </dd> |
| 49 | + </div> |
| 50 | + |
| 51 | + </dl> |
| 52 | + |
| 53 | + {{ radios({ |
| 54 | + "idPrefix": "use-contacts-login", |
| 55 | + "name": "use-contacts-login", |
| 56 | + "classes": "nhsuk-radios", |
| 57 | + "fieldset": { |
| 58 | + "legend": { |
| 59 | + "text": "Do you want to be contacted using these contact details?", |
| 60 | + "classes": "nhsuk-fieldset__legend--m", |
| 61 | + "isPageHeading": false |
| 62 | + } |
| 63 | + }, |
| 64 | + "items": [ |
| 65 | + { |
| 66 | + "value": "Yes", |
| 67 | + "text": "Yes, use these details", |
| 68 | + checked: checked("use-contacts-login", "Yes") |
| 69 | + }, |
| 70 | + { |
| 71 | + "value": "No", |
| 72 | + "text": "No, use different details", |
| 73 | + checked: checked("use-contacts-login", "No") |
| 74 | + } |
| 75 | + ] |
| 76 | + }) }} |
| 77 | + |
| 78 | + {{ button({ |
| 79 | + "text": "Continue" |
| 80 | + }) }} |
| 81 | + |
| 82 | + </form> |
| 83 | + </div> |
| 84 | + </div> |
| 85 | + |
| 86 | +{% include 'live/includes/devmode.html' %} |
| 87 | + |
| 88 | +{% endblock %} |
| 89 | + |
| 90 | +{% block footer %} |
| 91 | + {% include 'live/includes/footer.html' %} |
| 92 | +{% endblock %} |
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