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Amendment.tsx
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import {
ActionForm,
DatePicker,
FormControl,
FormField,
FormItem,
FormLabel,
FormMessage,
Input,
RequiredIndicator,
} from "@/components";
import { formSchemas } from "@/formSchemas";
import { FAQ_TAB } from "@/router";
import { Link } from "react-router";
import { getFAQLinkForAttachments } from "../../faqLinks";
interface AmendmentFormProps {
waiverId?: string;
}
export const AmendmentForm = ({ waiverId }: AmendmentFormProps) => {
return (
<ActionForm
schema={formSchemas["capitated-amendment"]}
title="1915(b) Comprehensive (Capitated) Waiver Amendment Details"
breadcrumbText="1915(b) Comprehensive (Capitated) Waiver Amendment"
fields={({ control }) => (
<>
<div className="flex flex-col">
<FormLabel className="font-semibold" htmlFor="1975b">
Waiver Authority
</FormLabel>
<span className="text-lg font-thin" id="1975b">
1915(b)
</span>
</div>
{waiverId !== undefined ? (
<div>
<p className="font-semibold">Existing Waiver Number to Amend</p>
<p className="text-lg font-thin" data-testid="existing-waiver-id">
{waiverId}
</p>
</div>
) : (
<FormField
control={control}
name="waiverNumber"
render={({ field }) => (
<FormItem>
<FormLabel className="font-semibold" data-testid="existing-waiver-label">
Existing Waiver Number to Amend <RequiredIndicator />
</FormLabel>
<p className="text-neutral-500">
Enter the existing waiver number you are seeking to amend in the format it was
approved, using a dash after the two character state abbreviation.
</p>
<FormControl className="max-w-sm">
<Input
ref={field.ref}
value={field.value}
onChange={(e) => field.onChange(e.currentTarget.value.toUpperCase())}
/>
</FormControl>
<FormMessage />
</FormItem>
)}
/>
)}
<FormField
control={control}
name="id"
render={({ field }) => (
<FormItem>
<div className="flex gap-4">
<FormLabel className="font-semibold" data-testid="1915b-waiver-amendment-label">
1915(b) Waiver Amendment Number <RequiredIndicator />
</FormLabel>
<Link
to="/faq/waiver-amendment-id-format"
target={FAQ_TAB}
rel="noopener noreferrer"
className="text-blue-900 underline"
>
What is my 1915(b) Waiver Amendment Number?
</Link>
</div>
<p className="text-neutral-500">
The Waiver Number must be in the format of SS-####.R##.## or SS-#####.R##.##. For
amendments, the last two digits start with {"'01'"} and ascends.
</p>
<FormControl className="max-w-sm">
<Input
ref={field.ref}
value={field.value}
onChange={(e) => field.onChange(e.currentTarget.value.toUpperCase())}
/>
</FormControl>
<FormMessage />
</FormItem>
)}
/>
<FormField
control={control}
name="proposedEffectiveDate"
render={({ field }) => (
<FormItem className="max-w-lg">
<FormLabel className="text-lg font-semibold block">
Proposed Effective Date of 1915(b) Waiver Amendment <RequiredIndicator />
</FormLabel>
<FormControl className="max-w-sm">
<DatePicker
onChange={(date) => field.onChange(date.getTime())}
date={field.value ? new Date(field.value) : undefined}
dataTestId="proposedEffectiveDate"
/>
</FormControl>
<FormMessage />
</FormItem>
)}
/>
</>
)}
attachments={{
faqLink: getFAQLinkForAttachments("capitated-amendment"),
}}
defaultValues={{ id: "", waiverNumber: waiverId ?? "" }}
documentPollerArgs={{
property: "id",
documentChecker: (check) => check.recordExists,
}}
/>
);
};