bhl-forms 0.4.4 → 0.4.6

package/dist/forms/civilLawsuit.es.js

@@ -669,6 +669,80 @@ const sbsDate = (updates) => {
   return date(updates)
 };
 
+const applicantOccupation = (scope) => sbsText({
+  name: scope ? scope + ':' + 'Applicant_Occupation' : 'Applicant_Occupation',
+  label: "What is the Applicant's Occupation?",
+  placeholder: "Occupation"
+});
+
+
+const applicantAge = (scope) => sbsText({
+  name: scope ? scope + ':' + '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',
+  }
+});
+
+const applicantDisabilityHowObtain = (scope) => sbsSelect({
+  name: scope ? scope + ':' + 'Applicant_Disability_How_Obtain' : 'Applicant_Disability_How_Obtain',
+  label: 'How Did Applicant Obtain the Disability Policy?',
+  options: [
+    "Employer",
+    "Self",
+    "Other"
+  ]
+});
+
+const applicantPreviouslyAppliedLtdBenefits = (scope) => sbsRadio({
+  name: scope ? scope + ':' + '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"
+  ]
+});
+
+const applicantMonthlySalary = (scope) => sbsSelect({
+  name: scope ? scope + ':' + '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"
+  ]
+});
+
+const applicantReceivedDisabilityBenefits = (scope) => sbsRadio({
+  name: scope ? scope + ':' + '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"
+  ]
+});
+
+const applicantLTDisabilityPolicy = (scope) => sbsYesNoRadio({
+  name: scope ? scope + ':' + 'Applicant_Lt_Disability_Policy' : 'Applicant_Lt_Disability_Policy',
+  label: 'Does Applicant have a Long Term Disability Policy?'
+});
+
 const atFault = (scope) => sbsYesNoRadio({
   name: scope ? scope + ':' + 'At_Fault' : 'At_Fault',
   label: 'Were You at Fault?'
@@ -683,6 +757,21 @@ const bankruptcyCrossSell = () => sbsCheckbox({
   helpClass: "!t-text-sm"
 });
 
+const bloodContentAlcholTest = (scope) => sbsSelect({
+  name: scope ? scope + ':' + '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"
+  ]
+});
+
 const businessServices = () => sbsSelect({
   label: 'Legal Services Needed for Your Business:',
   id: 'Business_Services',
@@ -707,6 +796,18 @@ const businessType = () => sbs2ColRadio({
   ]
 });
 
+const causeOfInjury = (scope) => sbsSelect({
+  name: scope ? scope + ':' + 'Cause_Of_Injury' : 'Cause_Of_Injury',
+  label: 'Cause of Injury:',
+  options: [
+    "Traumatic Physical Injury (Accident)",
+    "Repeated Trauma Injury",
+    "Mental Injury",
+    "Occupational Disease",
+    "Not Sure"
+  ]
+});
+
 const civilDefense = (updates) => sbs2ItemRadio(merge({
   name: 'Civil_Defense',
   id: 'Civil_Defense',
@@ -738,6 +839,39 @@ const civilLawsuitTOLPDisplay = (updates) => col2Radio(merge({
   ]
 }, updates));
 
+const childHome = (scope) => sbsSelect({
+  name: scope ? scope + ':' + 'Child_Home' : 'Child_Home',
+  label: 'With Whom Do the Children Currently Live?',
+  options: [
+    'Mother',
+    'Father',
+    'Grandparents',
+    'Other'
+  ]
+});
+
+const childPrimaryCaregiver = (scope) => sbsSelect({
+  name: scope ? scope + ':' + 'Child_Primary_Caregiver' : 'Child_Primary_Caregiver',
+  label: 'Who is the Primary Caregiver?',
+  options: [
+    'Mother',
+    'Father',
+    'Other'
+  ]
+});
+
+const childRelationship = (scope) => sbsSelect({
+  name: scope ? scope + ':' + 'Child_Relationship' : 'Child_Relationship',
+  label: 'Your Relationship to Child(ren):',
+  options: [
+    'Father',
+    'Mother',
+    'Grandparent',
+    'Aunt/Uncle',
+    'Other'
+  ]
+});
+
 const claimStatus = (scope) => sbsSelect({
   name: scope ? scope + ':' + 'Claim_Status' : 'Claim_Status',
   label: "Status of Claim:",
@@ -749,10 +883,10 @@ const claimStatus = (scope) => sbsSelect({
   ]
 });
 
-const comments = (updates) => textArea(
+const comments = (updates, scope) => textArea(
   merge({
+    name: scope ? scope + ':' + 'Comments' : 'Comments',
     label: 'Please briefly describe your situation in a few words:',
-    name: 'Comments',
     placeholder: 'For Example: "I would like help with child support payments" or "I need help with visitation rights"'
   }, updates)
 );
@@ -823,6 +957,19 @@ const employerType = () => sbsSelect({
   ]
 });
 
+const estateLegalServicesNeeded = (scope) => sbsSelect({
+  name: scope ? scope + ':' + 'Estate_Legal_Services_Needed' : 'Estate_Legal_Services_Needed',
+  label: "Legal Services Needed for Your Estate:",
+  options: [
+    "Charitable Giving",
+    "Contested Wills",
+    "Drafting Wills or Trust",
+    "Estate Administration",
+    "Asset Protection",
+    "Other"
+  ]
+});
+
 const firstName = () => sbsText({
   $formkit: 'text',
   label: 'First Name:',
@@ -838,6 +985,11 @@ const haveAttorney = (scope) => sbsYesNoRadio({
   label: 'Already Working with An Attorney?'
 });
 
+const haveChildren = (scope) => sbsYesNoRadio({
+  name: scope ? scope + ':' + 'Have_Children' : 'Have_Children',
+  label: 'Do You Have Children?'
+});
+
 const incidentDate = (scope) => sbsDate({
   name: scope ? scope + ':' + 'Incident_Date' : 'Incident_Date',
   label: 'Date of Incident:',
@@ -864,6 +1016,20 @@ const lawsuitOtherParty = () => sbsSelect({
   ]
 });
 
+const lawyerPaymentMethod = (scope) => sbsSelect({
+  name: scope ? scope + ':' + 'Lawyer_Payment_Method' : 'Lawyer_Payment_Method',
+  label: 'How Will You Pay for Legal Fees if You Hire a Lawyer?',
+  help: 'No payment necessary to speak with lawyers.',
+  options: [
+    'Cash',
+    'Check',
+    'Credit Card',
+    'Friend',
+    'Family',
+    'Other'
+  ]
+});
+
 
 const legalCrossSells$1 = () => col2Checkbox({
   id: 'Legal_CrossSells',
@@ -936,6 +1102,19 @@ const legalCrossSells$1 = () => col2Checkbox({
   }
 });
 
+const maritalStatus = (scope) => sbsSelect({
+  name: scope ? scope + ':' + 'Marital_Status' : 'Marital_Status',
+  label: 'Marital Status:',
+  options: [
+    'Unmarried, Living Together',
+    'Unmarried, Do Not Live Together',
+    'Married, Living Together',
+    'Separated',
+    'Divorced',
+    'Other'
+  ]
+});
+
 const medicalMalpracticeInjuries = () => sbsSelect({
   label: "Injuries from Medical Malpractice:",
   name: 'Medical_Malpractice_Injuries',
@@ -965,6 +1144,11 @@ const numEmployeesOfBusiness = () => sbsSelect({
   ]
 });
 
+const pendingCharges = (scope) => sbsYesNoRadio({
+  name: scope ? scope + ':' + 'Pending_Charges' : 'Pending_Charges',
+  label: 'Do you currently have any pending charges?'
+});
+
 const phone = () => sbsText({
   $formkit: 'tel',
   name: 'Primary_Phone',
@@ -998,6 +1182,11 @@ const primaryInjury = (scope) => sbs2ColRadio({
   ]
 });
 
+const priorAlcoholOffenses = (scope) => sbsYesNoRadio({
+  name: scope ? scope + ':' + 'Prior_Alcohol_Offenses' : 'Prior_Alcohol_Offenses',
+  label: 'Any Prior Alcohol Related Offenses?'
+});
+
 const policeReportFiled = (scope) => sbsYesNoRadio({
   name: scope ? scope + ':' + 'Police_Report_Filed' : 'Police_Report_Filed',
   label: 'Was a Police Report Filed?'
@@ -1019,6 +1208,17 @@ const realEstateArea = () => sbsSelect({
   ]
 });
 
+const roleInMatterProbate = (scope) => sbsSelect({
+  name: scope ? scope + ':' + 'Role_In_Matter_Probate' : 'Role_In_Matter_Probate',
+  label: "What Is Your Role in this Matter?",
+  options: [
+    "Preparing My Will",
+    "Executor",
+    "Heir",
+    "Other"
+  ]
+});
+
 const TCPAConsent = () => ({
   $formkit: 'checkbox',
   label: '$meta.tcpaLanguage',
@@ -1034,6 +1234,46 @@ const TCPAConsent = () => ({
   }
 });
 
+const typeOfAlcoholTest = (scope) => sbsSelect({
+  name: scope ? scope + ':' + 'Type_Of_Alcohol_Test' : 'Type_Of_Alcohol_Test',
+  label: 'Type of Alcohol Test Performed?',
+  options: [
+    "No Test",
+    "Refused Test",
+    "Breath Test",
+    "Blood Test",
+    "Urine Test",
+    "Don't Know"
+  ]
+});
+
+const typeOfAssets = (scope) => col2Checkbox({
+  name: scope ? scope + ':' + 'Type_Of_Assets' : 'Type_Of_Assets',
+  label: 'Type of Assets:',
+  options: [
+    "Business Interests",
+    "Cash",
+    "Life Insurance Policies",
+    "Pensions/Retirement",
+    "Personal Possessions",
+    "Property",
+    "Stock/Bonds"
+  ]
+});
+
+const valueOfAssets = (scope) => sbsSelect({
+  name: scope ? scope + ':' + 'Value_Of_Assets' : 'Value_Of_Assets',
+  label: 'Value of Your Assets?',
+  options: [
+    "Less than 50K",
+    "50K to 100K",
+    "100K to 250K",
+    "250K to 500K",
+    "500K to 1M",
+    "More than 1M"
+  ]
+});
+
 const wouldLikeLawyerTo = () => sbsRadio({
   label: 'I Would Like a Lawyer to:',
   name: 'Would_Like_Lawyer_To',
@@ -1106,6 +1346,21 @@ const BusinessLawyersQuestions = () => group(
   }
 );
 
+const ChildCustodyQuestions = (condition, scope) => group(
+  'ChildCustodyQuestions',
+  {
+    if: (condition || '$get(Type_Of_Legal_Problem).value == "Child Custody"'),
+    children: [
+      haveAttorney(scope),
+      childRelationship(scope),
+      childHome(scope),
+      childPrimaryCaregiver(scope),
+      degreeOfInterest(scope),
+      lawyerPaymentMethod(scope)
+    ]
+  }
+);
+
 const FileLawsuitQuestions = () => group(
   'FileLawsuitQuestions',
   {
@@ -1144,6 +1399,36 @@ const ConsumerLawyersQuestions = () => group(
   }
 );
 
+const DivorceQuestions = (condition, scope) => group(
+  'DivorceQuestions',
+  {
+    if: (condition || '$get(Type_Of_Legal_Problem).value == "Divorce and Separation"'),
+    children: [
+      haveAttorney(scope),
+      maritalStatus(scope),
+      haveChildren(scope),
+      degreeOfInterest(scope),
+      lawyerPaymentMethod(scope)
+    ]
+  }
+);
+
+const DUIAndDWIQuestions = (condition, scope) => group(
+  'DUIAndDWIQuestions',
+  {
+    if: (condition || '$get(Type_Of_Legal_Problem).value == "DUI and DWI"'),
+    children: [
+      haveAttorney(scope),
+      incidentDate(scope),
+      priorAlcoholOffenses(scope),
+      typeOfAlcoholTest(scope),
+      bloodContentAlcholTest(scope),
+      pendingCharges(scope),
+      degreeOfInterestHelp(scope)
+    ]
+  }
+);
+
 const EmploymentAndWorkplaceQuestions = () => group(
   'EmploymentAndWorkplaceQuestions',
   {
@@ -1157,6 +1442,23 @@ const EmploymentAndWorkplaceQuestions = () => group(
   }
 );
 
+const LongTermDisabilityQuestions = (condition, scope) => group(
+  'LongTermDisabilityQuestions',
+  {
+    if: (condition || '$get(Type_Of_Legal_Problem).value == "Long Term Disability"'),
+    children: [
+      haveAttorney(scope),
+      applicantOccupation(scope),
+      applicantAge(scope),
+      applicantLTDisabilityPolicy(scope),
+      applicantDisabilityHowObtain(scope),
+      applicantPreviouslyAppliedLtdBenefits(scope),
+      applicantReceivedDisabilityBenefits(scope),
+      applicantMonthlySalary(scope)
+    ]
+  }
+);
+
 const MedicalMalpracticeQuestions = () => group(
   'MedicalMalpracticeQuestions',
   {
@@ -1187,6 +1489,17 @@ const PersonalInjuryQuestions = (condition, scope) => group(
   }
 );
 
+const PowerofAttorneyQuestions = (condition, scope) => group(
+  'PowerofAttorneyQuestions',
+  {
+    if: (condition || '$get(Type_Of_Legal_Problem).value == "Power of Attorney"'),
+    children: [
+      haveAttorney(scope),
+      degreeOfInterestHelp(scope)
+    ]
+  }
+);
+
 const PropertyDamageQuestions = () => group(
   'PropertyDamageQuestions',
   {
@@ -1213,6 +1526,36 @@ const RealEstateQuestions = () => group(
   }
 );
 
+const WillsAndTrustsQuestions = (condition, scope) => group(
+  'WillsAndTrustsQuestions',
+  {
+    if: (condition || '$get(Type_Of_Legal_Problem).value == "Wills and Trusts"'),
+    children: [
+      haveAttorney(scope),
+      valueOfAssets(scope),
+      typeOfAssets(scope),
+      roleInMatterProbate(scope),
+      estateLegalServicesNeeded(scope),
+      degreeOfInterestHelp(scope)
+    ]
+  }
+);
+
+const WorkersCompensationQuestions = (condition, scope) => group(
+  'WorkersCompensationQuestions',
+  {
+    if: (condition || '$get(Type_Of_Legal_Problem).value == "Workers Compensation"'),
+    children: [
+      haveAttorney(scope),
+      incidentDate(scope),
+      claimStatus(scope),
+      primaryInjury(scope),
+      causeOfInjury(scope),
+      doctorTreatment(scope)
+    ]
+  }
+);
+
 const NotSureOrOtherQuestions = () => group(
   'NotSureOrOtherQuestions',
   {
@@ -1259,6 +1602,26 @@ function questionsStepHeadline(updates) {
   }
 }
 
+function crossSellQuestionsStepHeadline(updates) {
+  return {
+    $el: 'h3',
+    children: updates.headline || 'Tell Us About Your Situation',
+    attrs: {
+      class: 't-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-1'
+    }
+  }
+}
+
+function crossSellQuestionsStepSubHeadline(updates) {
+  return {
+    $el: 'h5',
+    children: updates.subheadline || 'Tell us about your situation:',
+    attrs: {
+      class: 't-flex t-justify-center t-text-dark t-text-center !t-text-lg t-font-semibold t-pb-4 t-pt-0 t-px-3'
+    }
+  }
+}
+
 
 function commentsStepHeadline(updates) {
   return {
@@ -1440,6 +1803,182 @@ function firstAndLastV2(updates = {}) {
   )
 }
 
+
+function autoAndCarAccidentCrossSellQuestions(updates = {}) {
+  return step(
+    'autoAndCarAccidentCrossSellQuestions',
+    [
+      crossSellQuestionsStepHeadline({ headline: 'You May Be Entitled To Compensation' }),
+      crossSellQuestionsStepSubHeadline({ subheadline: 'Tell us about your accident:' }),
+      AutoAndCarAccidentsQuestions("true", 'CrossSell:Auto_and_Car_Accidents'),
+      comments(
+        {
+          label: 'Accident Description:',
+          placeholder: 'Please describe your accident in a few words...',
+          inputClass: '!t-h-16'
+        },
+        'CrossSell:Auto_and_Car_Accidents'
+      )
+    ],
+    updates.nextOnEnter
+  )
+}
+
+function childCustodyCrossSellQuestions(updates = {}) {
+  return step(
+    'childCustodyCrossSellQuestions',
+    [
+      crossSellQuestionsStepHeadline({ headline: 'Child Custody Information' }),
+      ChildCustodyQuestions("true", 'CrossSell:Child_Custody'),
+      comments(
+        {
+          label: 'Description:',
+          placeholder: 'Please describe your situation in a few words...',
+          inputClass: '!t-h-16'
+        },
+        'CrossSell:Child_Custody'
+      )
+    ],
+    updates.nextOnEnter
+  )
+}
+
+function divorceAndSeparationCrossSellQuestions(updates = {}) {
+  return step(
+    'divorceAndSeparationCrossSellQuestions',
+    [
+      crossSellQuestionsStepHeadline({ headline: 'Divorce or Separation Information' }),
+      DivorceQuestions("true", 'CrossSell:Divorce_and_Separation'),
+      comments(
+        {
+          label: 'Description:',
+          placeholder: 'Please describe your situation in a few words...',
+          inputClass: '!t-h-16'
+        },
+        'CrossSell:Divorce_and_Separation'
+      )
+    ],
+    updates.nextOnEnter
+  )
+}
+
+function duiAndDWICrossSellQuestions(updates = {}) {
+  return step(
+    'duiAndDWICrossSellQuestions',
+    [
+      crossSellQuestionsStepHeadline({ headline: 'About Your DUI/DWI' }),
+      DUIAndDWIQuestions("true", 'CrossSell:DUI_and_DWI'),
+      comments(
+        {
+          label: 'Incident Description:',
+          placeholder: 'Please describe your incident in a few words...',
+          inputClass: '!t-h-16'
+        },
+        'CrossSell:DUI_and_DWI'
+      )
+    ],
+    updates.nextOnEnter
+  )
+}
+
+function longTermDisabilityCrossSellQuestions(updates = {}) {
+  return step(
+    'longTermDisabilityCrossSellQuestions',
+    [
+      crossSellQuestionsStepHeadline({ headline: 'You May Be Entitled To Benefits' }),
+      crossSellQuestionsStepSubHeadline({ subheadline: 'Tell us about your disability:' }),
+      LongTermDisabilityQuestions("true", 'CrossSell:Long_Term_Disability'),
+      comments(
+        {
+          label: 'Description:',
+          placeholder: 'Please describe your situation in a few words...',
+          inputClass: '!t-h-16'
+        },
+        'CrossSell:Long_Term_Disability'
+      )
+    ],
+    updates.nextOnEnter
+  )
+}
+
+function personalInjuryCrossSellQuestions(updates = {}) {
+  return step(
+    'personalInjuryCrossSellQuestions',
+    [
+      crossSellQuestionsStepHeadline({ headline: 'You May Be Entitled To Compensation' }),
+      crossSellQuestionsStepSubHeadline({ subheadline: 'Tell us about your injury:' }),
+      PersonalInjuryQuestions("true", 'CrossSell:Personal_Injury'),
+      comments(
+        {
+          label: 'Injury Description:',
+          placeholder: 'Please describe your injury in a few words...',
+          inputClass: '!t-h-16'
+        },
+        'CrossSell:Personal_Injury'
+      )
+    ],
+    updates.nextOnEnter
+  )
+}
+
+function powerOfAttorneyCrossSellQuestions(updates = {}) {
+  return step(
+    'powerOfAttorneyCrossSellQuestions',
+    [
+      crossSellQuestionsStepHeadline({ headline: 'Power of Attorney Information' }),
+      PowerofAttorneyQuestions("true", 'CrossSell:Power_of_Attorney'),
+      comments(
+        {
+          label: 'Description:',
+          placeholder: 'Please describe your situation in a few words...',
+          inputClass: '!t-h-16'
+        },
+        'CrossSell:Power_of_Attorney'
+      )
+    ],
+    updates.nextOnEnter
+  )
+}
+
+function willsAndTrustsCrossSellQuestions(updates = {}) {
+  return step(
+    'willsAndTrustsCrossSellQuestions',
+    [
+      crossSellQuestionsStepHeadline({ headline: 'Will or Trust Information' }),
+      WillsAndTrustsQuestions("true", 'CrossSell:Wills_and_Trusts'),
+      comments(
+        {
+          label: 'Description:',
+          placeholder: 'Please describe your situation in a few words...',
+          inputClass: '!t-h-16'
+        },
+        'CrossSell:Wills_and_Trusts'
+      )
+    ],
+    updates.nextOnEnter
+  )
+}
+
+function workersCompensationCrossSellQuestions(updates = {}) {
+  return step(
+    'workersCompensationCrossSellQuestions',
+    [
+      crossSellQuestionsStepHeadline({ headline: 'You May Be Entitled To Benefits' }),
+      crossSellQuestionsStepSubHeadline({ subheadline: 'Tell us about your injury:' }),
+      WorkersCompensationQuestions("true", 'CrossSell:Workers_Compensation'),
+      comments(
+        {
+          label: 'Injury Description:',
+          placeholder: 'Please describe your injury in a few words...',
+          inputClass: '!t-h-16'
+        },
+        'CrossSell:Workers_Compensation'
+      )
+    ],
+    updates.nextOnEnter
+  )
+}
+
 function civilLawsuitTOLPQuestions(updates = {}) {
   return step(
     'TOLPQuestions',
@@ -1598,6 +2137,15 @@ const schema = [
             nextOnEnter: false
           }),
           legalCrossSells(),
+          autoAndCarAccidentCrossSellQuestions(),
+          personalInjuryCrossSellQuestions(),
+          workersCompensationCrossSellQuestions(),
+          duiAndDWICrossSellQuestions(),
+          longTermDisabilityCrossSellQuestions(),
+          powerOfAttorneyCrossSellQuestions(),
+          willsAndTrustsCrossSellQuestions(),
+          divorceAndSeparationCrossSellQuestions(),
+          childCustodyCrossSellQuestions(),
           firstAndLastV2(),
           contactInfoV2({
             nextOnEnter: false