bhl-forms 0.4.13 → 0.4.14
This diff represents the content of publicly available package versions that have been released to one of the supported registries. The information contained in this diff is provided for informational purposes only and reflects changes between package versions as they appear in their respective public registries.
- package/dist/forms/childAndFamily.es.js +35 -90
- package/dist/forms/childAndFamily.iife.js +1 -1
- package/dist/forms/childAndFamily.json +1 -1
- package/dist/forms/civilLawsuit.es.js +35 -81
- package/dist/forms/civilLawsuit.iife.js +1 -1
- package/dist/forms/civilLawsuit.json +1 -1
- package/dist/forms/criminal.es.js +5 -5
- package/dist/forms/criminal.iife.js +1 -1
- package/dist/forms/criminal.json +1 -1
- package/dist/forms/generalLegalPopUnder.es.js +5 -5
- package/dist/forms/generalLegalPopUnder.iife.js +1 -1
- package/dist/forms/generalLegalPopUnder.json +1 -1
- package/package.json +1 -1
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@@ -382,15 +382,6 @@ const col2Radio = (updates) => {
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return radio(updates)
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};
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const sbsRadio = (updates) => {
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updates.legendClass = 'legend-left required';
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updates.fieldsetClass = '$reset side-by-side';
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updates.optionsClass = 't-pl-1';
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updates.innerClass = 't-flex t-items-center';
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updates.wrapperClass = 't-mb-3';
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return radio(updates)
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};
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const sbs2ColRadio = (updates) => {
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updates.legendClass = 'legend-left-flex md:t-max-w-[40%] required';
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updates.fieldsetClass = '$reset side-by-side-flex';
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@@ -482,12 +473,6 @@ const sbsDate = (updates) => {
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return date(updates)
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};
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const applicantOccupation = (scope) => sbsText({
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name: scope ? scope + ':' + 'Applicant_Occupation' : 'Applicant_Occupation',
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label: "What is the Applicant's Occupation?",
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placeholder: "Occupation"
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});
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const applicantAge = (scope) => sbsText({
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name: scope ? scope + ':' + 'Applicant_Age' : 'Applicant_Age',
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@@ -503,59 +488,6 @@ const applicantAge = (scope) => sbsText({
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}
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});
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const applicantDisabilityHowObtain = (scope) => sbsSelect({
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name: scope ? scope + ':' + 'Applicant_Disability_How_Obtain' : 'Applicant_Disability_How_Obtain',
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label: 'How Did Applicant Obtain the Disability Policy?',
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options: [
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"Employer",
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"Self",
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"Other"
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]
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});
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const applicantPreviouslyAppliedLtdBenefits = (scope) => sbsRadio({
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name: scope ? scope + ':' + 'Applicant_Previously_Apply_Ltd_Benefits' : 'Applicant_Previously_Apply_Ltd_Benefits',
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label: 'Has Applicant Previously Applied for Long Term Disability Benefits?',
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options: [
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"Yes, claim pending",
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"Yes, claim denied",
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"No"
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]
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});
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const applicantMonthlySalary = (scope) => sbsSelect({
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name: scope ? scope + ':' + 'Applicant_Monthly_Salary' : 'Applicant_Monthly_Salary',
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label: "Applicant's Monthly Salary/Pay When Last at Work:",
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options: [
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"< $1,000",
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"$1,000 - $2,000",
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"$2,000 - $3,000",
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"$3,000 - $4,000",
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"$4,000 - $5,000",
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"$5,000 - $6,000",
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"$6,000 - $7,000",
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"$7,000 - $8,000",
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"$8,000 - $9,000",
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"$9,000 - $10,000",
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">$10,000"
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]
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});
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const applicantReceivedDisabilityBenefits = (scope) => sbsRadio({
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name: scope ? scope + ':' + 'Applicant_Received_Disability_Benefits' : 'Applicant_Received_Disability_Benefits',
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label: 'Has Applicant Ever Received Long Term Disability Benefits for this Claim?',
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options: [
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"Yes, currently receiving",
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"Yes, appealing a decision to stop payment of benefits",
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"No"
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]
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});
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const applicantLTDisabilityPolicy = (scope) => sbsYesNoRadio({
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name: scope ? scope + ':' + 'Applicant_Lt_Disability_Policy' : 'Applicant_Lt_Disability_Policy',
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label: 'Does Applicant have a Long Term Disability Policy?'
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});
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const atFault = (scope) => sbsYesNoRadio({
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name: scope ? scope + ':' + 'At_Fault' : 'At_Fault',
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label: 'Were You at Fault?'
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@@ -668,6 +600,16 @@ const degreeOfInterest = (scope, help) => sbsSelect({
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const degreeOfInterestHelp = (scope) => degreeOfInterest(scope, 'No payment necessary to speak with lawyers.');
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const disabilityConditionStopWork = (scope) => sbsYesNoRadio({
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name: scope ? scope + ':' + 'Disability_Condition_Stop_Work' : 'Disability_Condition_Stop_Work',
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label: 'Do You Expect To Be Out Of Work For At Least a Year Due To Your Health?'
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});
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const disabilityWorkHistory = (scope) => sbsYesNoRadio({
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name: scope ? scope + ':' + 'Disability_Work_History' : 'Disability_Work_History',
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label: 'Have You Had a Full-Time Job Within the Past 5 Years?'
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});
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const doctorTreatment = (scope) => sbsYesNoRadio({
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name: scope ? scope + ':' + 'Doctor_Treatment' : 'Doctor_Treatment',
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label: 'Have You Recently Been Treated by a Doctor, Hospital or Clinic?',
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@@ -893,6 +835,11 @@ const roleInMatterProbate = (scope) => sbsSelect({
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]
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});
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const socialSecurityDisabilityReceivingBenefits = (scope) => sbsYesNoRadio({
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name: scope ? scope + ':' + 'Social_Security_Disability_Receiving_Benefits' : 'Social_Security_Disability_Receiving_Benefits',
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label: 'Are You Currently Receiving Social Security Disability Benefits?'
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});
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const TCPAConsent = () => ({
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$formkit: 'checkbox',
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label: '$meta.tcpaLanguage',
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@@ -1110,23 +1057,6 @@ const GuardianshipQuestions = () => group(
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}
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);
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const LongTermDisabilityQuestions = (condition, scope) => group(
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'LongTermDisabilityQuestions',
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{
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if: (condition || '$get(Type_Of_Legal_Problem).value == "Long Term Disability"'),
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children: [
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haveAttorney(scope),
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applicantOccupation(scope),
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applicantAge(scope),
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applicantLTDisabilityPolicy(scope),
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applicantDisabilityHowObtain(scope),
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applicantPreviouslyAppliedLtdBenefits(scope),
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applicantReceivedDisabilityBenefits(scope),
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applicantMonthlySalary(scope)
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]
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}
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);
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const PersonalInjuryQuestions = (condition, scope) => group(
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'PersonalInjuryQuestions',
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{
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@@ -1153,6 +1083,21 @@ const PowerofAttorneyQuestions = (condition, scope) => group(
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}
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);
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const SocialSecurityDisabilityAndInsuranceQuestions = (condition, scope) => group(
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'SocialSecurityDisabilityAndInsuranceQuestions',
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{
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if: (condition || '$get(Type_Of_Legal_Problem).value == "Social Security Disability and Insurance"'),
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children: [
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haveAttorney(scope),
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applicantAge(scope),
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disabilityConditionStopWork(scope),
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disabilityWorkHistory(scope),
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socialSecurityDisabilityReceivingBenefits(scope),
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doctorTreatment(scope)
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]
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}
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);
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const WillsAndTrustsQuestions = (condition, scope) => group(
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'WillsAndTrustsQuestions',
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{
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@@ -1455,20 +1400,20 @@ function duiAndDWICrossSellQuestions(updates = {}) {
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)
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}
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function
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function ssdiCrossSellQuestions(updates = {}) {
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'
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'ssdiCrossSellQuestions',
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[
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crossSellQuestionsStepHeadline({ headline: 'You May Be Entitled To Benefits' }),
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crossSellQuestionsStepSubHeadline({ subheadline: 'Tell us about your disability:' }),
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SocialSecurityDisabilityAndInsuranceQuestions("true", 'CrossSell:Social_Security_Disability_and_Insurance'),
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comments(
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{
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label: 'Description:',
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placeholder: 'Please describe your situation in a few words...',
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inputClass: '!t-h-16'
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},
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autoAndCarAccidentCrossSellQuestions(),
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personalInjuryCrossSellQuestions(),
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duiAndDWICrossSellQuestions(),
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ssdiCrossSellQuestions(),
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powerOfAttorneyCrossSellQuestions(),
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willsAndTrustsCrossSellQuestions(),
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firstAndLastV2(),
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var childAndFamily=function(){"use strict";function e(){return Object.assign({},...arguments)}const t='$getKey($meta, "commentsPlaceholders." + $get(Type_Of_Legal_Problem).value, $meta.defaultCommentsPlaceholder)',a='$getKey($meta, "finalHeadlines." + $get(Type_Of_Legal_Problem).value, $meta.defaultFinalHeadline)',i='$getKey($meta, "finalSubHeadlines." + $get(Type_Of_Legal_Problem).value, $meta.defaultFinalSubHeadline)',n={type:"form",id:"form",config:{validationVisibility:"submit"},onSubmit:'$submit($submitUrl, $prepData, $handleRedirect, "text/plain; charset=UTF-8")',plugins:"$plugins",actions:!1,anchorElement:"form-anchor",useLocalStorage:!0,prepop:{fromURL:!0},errorCodes:{403:{message:"An Error Occurred",abort:!1},409:{abort:!1},429:"An Error Occurred",504:{message:"An Error Occurred",abort:!1}},formClass:"!t-max-w-[40rem]"};const r={tcpaLanguage:"By checking this box, I a) agree to the Terms of Use, and b) consent to be contacted by lawyers, lawyer networks, and partners of this website using live, autodialed, pre-recorded, or artificial voice calls, as well as text messages. Your consent is not required as a condition of purchasing any goods or services. To submit this request without this consent, call 878-213-4937."};const o={$el:"div",children:[{$el:"div",attrs:{id:"form-anchor",class:"t-absolute",style:{top:"-30px",left:0}}}],attrs:{class:"t-relative"}};const l={$el:"div",if:"$activeStep === $lastStep()",attrs:{class:"t-flex t-justify-center t-items-center t-text-sm t-text-gray-500"},children:[{$el:"img",attrs:{loading:"lazy",alt:"",style:{border:0},width:"25",height:"25",src:"https://d27hmee62k45vz.cloudfront.net/lock_icon_1.jpeg"}},{$el:"span",children:"Secure & Encrypted",attrs:{class:"t-pl-2 t-pt-1 t-font-medium"}}]};function s(t){return e(l,t)}const d=[{$formkit:"hidden",name:"vertical",value:"Legal"},{$formkit:"hidden",name:"TCPA_Language",value:"$meta.tcpaLanguage"},{$formkit:"hidden",name:"gclid",value:null},{$formkit:"hidden",name:"campaignid",value:null},{$formkit:"hidden",name:"s",value:null}],p={"*":"https://listings.ziplawyer.com/api/v1/redirect?zone_id=4&category=${properties.Type_Of_Legal_Problem}&Degree_Of_Interest=${properties.Degree_Of_Interest}&zip_code=${properties.Zip}&sub_id=${properties.vid}"};const u=t=>e({$formkit:"checkbox",validation:"required",validationMessages:{required:"Field is required"}},t),c=e=>(e&&e.legendClass||(e.legendClass="required"),e.fieldsetClass="$reset",e.optionsClass="t-pl-2 t-pt-3 t-grid t-grid-cols-1 md:t-grid-cols-2",e.innerClass="t-items-start",e.wrapperClass="$reset t-flex t-cursor-pointer t-mb-3",u(e)),m=t=>e({$formkit:"radio",validation:"required",validationMessages:{required:"Field is required"},optionsClass:"t-pt-3 t-pl-1",legendClass:"required"},t),f=e=>(e.legendClass="legend-left required",e.fieldsetClass="$reset side-by-side",e.optionsClass="t-pl-1",e.innerClass="t-flex t-items-center",e.wrapperClass="t-mb-3",m(e)),y=e=>(e.options=["Yes","No"],(e=>(e.legendClass="legend-left t-pb-1 required",e.fieldsetClass="$reset side-by-side t-items-center",e.optionsClass="t-mt-1 t-grid t-grid-cols-1 md:t-grid-cols-2-125 t-items-center",e.innerClass="t-flex t-items-center",e.optionClass="t-pr-1",m(e)))(e)),h=t=>(t.labelClass="required",t.wrapperClass="side-by-side t-items-center",t.innerClass="select-height-content",t.helpClass="t-mt-2.5 md:t-text-right md:t-mt-[-5px]",(t=>e({$formkit:"select",placeholder:"Please Select",validation:"required",validationMessages:{required:"Field is required"},inputClass:"t-bg-white",labelClass:"required"},t))(t)),g=t=>(t.wrapperClass="side-by-side t-items-center",(t=>e({$formkit:"text",validation:"required",validationMessages:{required:"Field is required"},labelClass:"required"},t))(t)),b=t=>(t.wrapperClass="side-by-side t-items-center",(t=>e({$formkit:"DatePicker",validation:"required",validationMessages:{required:"Field is required"},labelClass:"required t-block t-mb-3 t-font-semibold t-text-base formkit-invalid:t-text-red-500",innerClass:"t-border t-border-gray-400 formkit-invalid:t-border-red-500 t-rounded t-mb-1 focus-within:t-border-blue-500"},t))(t)),_=e=>g({name:e?e+":Applicant_Occupation":"Applicant_Occupation",label:"What is the Applicant's Occupation?",placeholder:"Occupation"}),v=e=>g({name:e?e+":Applicant_Age":"Applicant_Age",label:"Age of Applicant?",placeholder:"Age between 18 and 65",maxlength:2,inputmode:"numeric",validation:"required|min:18,max:65",validationMessages:{required:"Applicant Age is required",min:"Invalid Age - must be between 18 and 65",max:"Invalid Age - must be between 18 and 65"}}),C=e=>h({name:e?e+":Applicant_Disability_How_Obtain":"Applicant_Disability_How_Obtain",label:"How Did Applicant Obtain the Disability Policy?",options:["Employer","Self","Other"]}),x=e=>f({name:e?e+":Applicant_Previously_Apply_Ltd_Benefits":"Applicant_Previously_Apply_Ltd_Benefits",label:"Has Applicant Previously Applied for Long Term Disability Benefits?",options:["Yes, claim pending","Yes, claim denied","No"]}),w=e=>h({name:e?e+":Applicant_Monthly_Salary":"Applicant_Monthly_Salary",label:"Applicant's Monthly Salary/Pay When Last at Work:",options:["< $1,000","$1,000 - $2,000","$2,000 - $3,000","$3,000 - $4,000","$4,000 - $5,000","$5,000 - $6,000","$6,000 - $7,000","$7,000 - $8,000","$8,000 - $9,000","$9,000 - $10,000",">$10,000"]}),$=e=>f({name:e?e+":Applicant_Received_Disability_Benefits":"Applicant_Received_Disability_Benefits",label:"Has Applicant Ever Received Long Term Disability Benefits for this Claim?",options:["Yes, currently receiving","Yes, appealing a decision to stop payment of benefits","No"]}),I=e=>y({name:e?e+":Applicant_Lt_Disability_Policy":"Applicant_Lt_Disability_Policy",label:"Does Applicant have a Long Term Disability Policy?"}),P=e=>y({name:e?e+":At_Fault":"At_Fault",label:"Were You at Fault?"}),k=()=>{return(e={label:"I'd also like a consultation for bankruptcy or debt elimination (optional)",help:"Note: you will be contacted separately by a bankruptcy/debt expert",name:"CrossSell_Bankruptcy",id:"CrossSell_Bankruptcy",if:'$getVal($get(form), "Type_Of_Legal_Problem") != "Bankruptcy" && ($getVal($get(form), "Degree_Of_Interest") == "Absolutely Can\'t Afford" || $getVal($get(form), "Degree_Of_Interest") == "Maybe" || $getVal($get(form), "Degree_Of_Interest") == "Probably")',validation:null,helpClass:"!t-text-sm"}).legendClass="legend-left required",e.fieldsetClass="$reset side-by-side",e.optionsClass="t-pl-1",e.innerClass="t-flex t-items-center",e.wrapperClass="t-mb-3",u(e);var e},A=e=>h({name:e?e+":Blood_Alcohol_Content_Test":"Blood_Alcohol_Content_Test",label:"Blood Alcohol Content Measured by Test:",options:["No Test","0.00% - 0.04%","0.05% - 0.08%","0.09% - 0.12%","0.13% - 0.16%","0.17% - 0.20%","More than 0.20%","Don't know"]}),S=()=>{return(e={label:"Type of Help Needed:",name:"Type_Of_Legal_Problem",id:"Type_Of_Legal_Problem",options:["Child Custody","Child Support","Adoption","Family Issues","Guardianship","Divorce and Separation","Not Sure or Other"]}).legendClass="required",e.fieldsetClass="$reset",e.optionsClass="t-pl-2 t-pt-3 t-grid t-grid-cols-1 md:t-grid-cols-2",e.innerClass="t-items-start",e.wrapperClass="$reset t-flex t-cursor-pointer t-mb-3",m(e);var e},D=e=>h({name:e?e+":Child_Home":"Child_Home",label:"With Whom Do the Children Currently Live?",options:["Mother","Father","Grandparents","Other"]}),T=e=>h({name:e?e+":Child_Primary_Caregiver":"Child_Primary_Caregiver",label:"Who is the Primary 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