src/applications/ivc-champva/10-7959C/config/form.js
import React from 'react';
import environment from '@department-of-veterans-affairs/platform-utilities/environment';
import { externalServices } from 'platform/monitoring/DowntimeNotification';
import get from 'platform/utilities/data/get';
import manifest from '../manifest.json';
import IntroductionPage from '../containers/IntroductionPage';
import ConfirmationPage from '../containers/ConfirmationPage';
import transformForSubmit from './submitTransformer';
import { nameWording } from '../helpers/utilities';
import FileFieldWrapped from '../components/FileUploadWrapper';
import { prefillTransformer } from './prefillTransformer';
import SubmissionError from '../../shared/components/SubmissionError';
import {
applicantNameDobSchema,
applicantSsnSchema,
applicantAddressInfoSchema,
applicantContactInfoSchema,
applicantGenderSchema,
blankSchema,
} from '../chapters/applicantInformation';
import {
applicantHasMedicareSchema,
applicantMedicareClassSchema,
applicantMedicarePartACarrierSchema,
applicantMedicarePartBCarrierSchema,
applicantMedicarePharmacySchema,
applicantHasMedicareDSchema,
applicantMedicarePartDCarrierSchema,
applicantMedicareABUploadSchema,
applicantMedicareDUploadSchema,
} from '../chapters/medicareInformation';
import {
applicantHasInsuranceSchema,
applicantProviderSchema,
applicantInsuranceEobSchema,
applicantInsuranceSOBSchema,
applicantInsuranceThroughEmployerSchema,
applicantInsurancePrescriptionSchema,
applicantInsuranceTypeSchema,
applicantMedigapSchema,
applicantInsuranceCommentsSchema,
applicantInsuranceCardSchema,
} from '../chapters/healthInsuranceInformation';
import { formSignatureSchema } from '../chapters/formSignature';
import CustomAttestation from '../components/CustomAttestation';
import { UPLOADS_COMPLETE_PATH } from './constants';
import GetFormHelp from '../../shared/components/GetFormHelp';
import { hasReq } from '../../shared/components/fileUploads/MissingFileOverview';
import SupportingDocumentsPage from '../components/SupportingDocumentsPage';
import { MissingFileConsentPage } from '../components/MissingFileConsentPage';
// import mockdata from '../tests/e2e/fixtures/data/test-data.json';
// Control whether we show the file overview page by calling `hasReq` to
// determine if any files have not been uploaded. Defaults to false (hide the page)
// if anything goes sideways.
function showFileOverviewPage(formData) {
try {
return hasReq(formData, true, true) || hasReq(formData, false, true);
} catch {
return false;
}
}
// (First Name Posessive);
function fnp(formData) {
return nameWording(formData, undefined, undefined, true);
}
/** @type {PageSchema} */
const formConfig = {
rootUrl: manifest.rootUrl,
urlPrefix: '/',
submitUrl: `${environment.API_URL}/ivc_champva/v1/forms`,
// submit: () =>
// Promise.resolve({ attributes: { confirmationNumber: '123123123' } }),
trackingPrefix: '10-7959C-',
introduction: IntroductionPage,
confirmation: ConfirmationPage,
v3SegmentedProgressBar: true,
showReviewErrors: !environment.isProduction(),
footerContent: GetFormHelp,
submissionError: SubmissionError,
formId: '10-7959C',
dev: {
showNavLinks: false,
collapsibleNavLinks: true,
},
downtime: {
dependencies: [externalServices.pega],
},
preSubmitInfo: {
required: true,
CustomComponent: CustomAttestation,
},
customText: {
reviewPageTitle: 'Review form',
appType: 'form',
},
CustomReviewTopContent: () => <h3>Review and sign</h3>,
saveInProgress: {
messages: {
inProgress:
'Your CHAMPVA other health insurance certification application (10-7959C) is in progress.',
expired:
'Your saved CHAMPVA other health insurance certification application (10-7959C) has expired. If you want to apply for CHAMPVA other health insurance certification, please start a new application.',
saved:
'Your CHAMPVA other health insurance certification application has been saved.',
},
},
version: 0,
prefillEnabled: true,
prefillTransformer,
transformForSubmit,
savedFormMessages: {
notFound:
'Please start over to apply for CHAMPVA other health insurance certification.',
noAuth:
'Please sign in again to continue your application for CHAMPVA other health insurance certification.',
},
title: 'File for CHAMPVA Other Health Insurance Certification',
subTitle: 'CHAMPVA Other Health Insurance Certification (VA Form 10-7959c)',
defaultDefinitions: {},
chapters: {
applicantInformation: {
title: 'Beneficiary information',
pages: {
applicantNameDob: {
// initialData: mockdata.data,
path: 'applicant-info',
title: 'Beneficiary’s name',
...applicantNameDobSchema,
},
applicantIdentity: {
path: 'applicant-identification-info',
title: formData => `${fnp(formData)} identification information`,
...applicantSsnSchema,
},
applicantAddressInfo: {
path: 'applicant-mailing-address',
title: formData => `${fnp(formData)} mailing address`,
...applicantAddressInfoSchema,
},
//
// TODO: add prefill address page if user authenticated
//
// TODO: have conditional logic to check if third party and app
// is under age 18 (contact page)
applicantContactInfo: {
path: 'applicant-contact-info',
title: formData => `${fnp(formData)} contact information`,
...applicantContactInfoSchema,
},
applicantGender: {
path: 'applicant-gender',
title: formData => `${fnp(formData)} sex listed at birth`,
...applicantGenderSchema,
},
},
},
medicareInformation: {
title: 'Medicare information',
pages: {
hasMedicareAB: {
path: 'medicare-ab-status',
title: formData => `${fnp(formData)} Medicare status`,
...applicantHasMedicareSchema,
},
medicareClass: {
path: 'medicare-plan',
title: formData => `${fnp(formData)} Medicare coverage`,
depends: formData => get('applicantMedicareStatus', formData),
...applicantMedicareClassSchema,
},
pharmacyBenefits: {
path: 'medicare-pharmacy',
title: formData => `${fnp(formData)} Medicare pharmacy benefits`,
depends: formData =>
get('applicantMedicareStatus', formData) &&
['advantage', 'other'].includes(
get('applicantMedicareClass', formData),
),
...applicantMedicarePharmacySchema,
},
// If 'yes' to previous question:
partACarrier: {
path: 'medicare-a-carrier',
title: formData => `${fnp(formData)} Medicare Part A carrier`,
depends: formData => get('applicantMedicareStatus', formData),
...applicantMedicarePartACarrierSchema,
},
partBCarrier: {
path: 'medicare-b-carrier',
title: formData => `${fnp(formData)} Medicare Part B carrier`,
depends: formData => get('applicantMedicareStatus', formData),
...applicantMedicarePartBCarrierSchema,
},
medicareABCards: {
path: 'medicare-ab-upload',
title: 'Medicare card for hospital and medical coverage',
depends: formData => get('applicantMedicareStatus', formData),
CustomPage: FileFieldWrapped,
CustomPageReview: null,
...applicantMedicareABUploadSchema,
},
hasMedicareD: {
path: 'medicare-d-status',
title: formData => `${fnp(formData)} Medicare Part D status`,
depends: formData => get('applicantMedicareStatus', formData),
...applicantHasMedicareDSchema,
},
partDCarrier: {
path: 'medicare-d-carrier',
title: formData => `${fnp(formData)} Medicare Part D carrier`,
depends: formData =>
get('applicantMedicareStatus', formData) &&
get('applicantMedicareStatusD', formData),
...applicantMedicarePartDCarrierSchema,
},
medicareDCards: {
path: 'medicare-d-upload',
title: 'Medicare Part D card',
depends: formData =>
get('applicantMedicareStatus', formData) &&
get('applicantMedicareStatusD', formData),
CustomPage: FileFieldWrapped,
CustomPageReview: null,
customPageUsesPagePerItemData: true,
...applicantMedicareDUploadSchema,
},
},
},
healthcareInformation: {
title: 'Health insurance information',
pages: {
hasPrimaryHealthInsurance: {
path: 'insurance-status',
title: formData => `${fnp(formData)} health insurance`,
...applicantHasInsuranceSchema(true),
},
primaryType: {
path: 'insurance-plan',
depends: formData => get('applicantHasPrimary', formData),
title: formData =>
`${fnp(formData)} ${
formData.applicantPrimaryProvider
} insurance plan`,
...applicantInsuranceTypeSchema(true),
},
primaryMedigap: {
path: 'insurance-medigap',
depends: formData =>
get('applicantHasPrimary', formData) &&
get('applicantPrimaryInsuranceType', formData) === 'medigap',
title: formData =>
`${fnp(formData)} ${
formData.applicantPrimaryProvider
} Medigap information`,
...applicantMedigapSchema(true),
},
primaryProvider: {
path: 'insurance-info',
depends: formData => get('applicantHasPrimary', formData),
title: formData => `${fnp(formData)} health insurance information`,
...applicantProviderSchema(true),
},
primaryThroughEmployer: {
path: 'insurance-type',
depends: formData => get('applicantHasPrimary', formData),
title: formData =>
`${fnp(formData)} type of insurance for ${
formData.applicantPrimaryProvider
}`,
...applicantInsuranceThroughEmployerSchema(true),
},
primaryPrescription: {
path: 'insurance-prescription',
depends: formData => get('applicantHasPrimary', formData),
title: formData =>
`${fnp(formData)} ${
formData.applicantPrimaryProvider
} prescription coverage`,
...applicantInsurancePrescriptionSchema(true),
},
primaryEob: {
path: 'insurance-eob',
depends: formData =>
get('applicantHasPrimary', formData) &&
get('applicantPrimaryHasPrescription', formData),
title: formData =>
`${fnp(formData)} ${
formData.applicantPrimaryProvider
} explanation of benefits`,
...applicantInsuranceEobSchema(true),
},
primaryScheduleOfBenefits: {
path: 'insurance-sob',
depends: formData =>
get('applicantHasPrimary', formData) &&
get('applicantPrimaryHasPrescription', formData) &&
!get('applicantPrimaryEob', formData),
title: formData =>
`${fnp(formData)} ${
formData.applicantPrimaryProvider
} schedule of benefits`,
CustomPage: FileFieldWrapped,
CustomPageReview: null,
...applicantInsuranceSOBSchema(true),
},
primaryCard: {
path: 'insurance-upload',
depends: formData => get('applicantHasPrimary', formData),
title: formData => `${fnp(formData)} health insurance card`,
CustomPage: FileFieldWrapped,
CustomPageReview: null,
...applicantInsuranceCardSchema(true),
},
primaryComments: {
path: 'insurance-comments',
depends: formData => get('applicantHasPrimary', formData),
title: formData =>
`${fnp(formData)} ${
formData.applicantPrimaryProvider
} additional comments`,
...applicantInsuranceCommentsSchema(true),
},
hasSecondaryHealthInsurance: {
path: 'secondary-insurance',
depends: formData => get('applicantHasPrimary', formData),
title: formData => `${fnp(formData)} additional health insurance`,
...applicantHasInsuranceSchema(false),
},
secondaryType: {
path: 'secondary-insurance-plan',
depends: formData =>
get('applicantHasPrimary', formData) &&
get('applicantHasSecondary', formData),
title: formData =>
`${fnp(formData)} ${
formData.applicantSecondaryProvider
} insurance plan`,
...applicantInsuranceTypeSchema(false),
},
secondaryMedigap: {
path: 'secondary-insurance-medigap',
depends: formData =>
get('applicantHasPrimary', formData) &&
get('applicantHasSecondary', formData) &&
get('applicantSecondaryInsuranceType', formData) === 'medigap',
title: formData =>
`${fnp(formData)} ${
formData.applicantSecondaryProvider
} Medigap information`,
...applicantMedigapSchema(false),
},
secondaryProvider: {
path: 'secondary-insurance-info',
depends: formData =>
get('applicantHasPrimary', formData) &&
get('applicantHasSecondary', formData),
title: formData => `${fnp(formData)} health insurance information`,
...applicantProviderSchema(false),
},
secondaryThroughEmployer: {
path: 'secondary-insurance-type',
depends: formData =>
get('applicantHasPrimary', formData) &&
get('applicantHasSecondary', formData),
title: formData =>
`${fnp(formData)} type of insurance for ${
formData.applicantSecondaryProvider
}`,
...applicantInsuranceThroughEmployerSchema(false),
},
secondaryPrescription: {
path: 'secondary-insurance-prescription',
depends: formData =>
get('applicantHasPrimary', formData) &&
get('applicantHasSecondary', formData),
title: formData =>
`${fnp(formData)} ${
formData.applicantSecondaryProvider
} prescription coverage`,
...applicantInsurancePrescriptionSchema(false),
},
secondaryEob: {
path: 'secondary-insurance-eob',
depends: formData =>
get('applicantHasPrimary', formData) &&
get('applicantHasSecondary', formData) &&
get('applicantSecondaryHasPrescription', formData),
title: formData =>
`${fnp(formData)} ${
formData.applicantSecondaryProvider
} explanation of benefits`,
...applicantInsuranceEobSchema(false),
},
secondaryScheduleOfBenefits: {
path: 'secondary-insurance-sob',
depends: formData =>
get('applicantHasPrimary', formData) &&
get('applicantHasSecondary', formData) &&
get('applicantSecondaryHasPrescription', formData) &&
!get('applicantSecondaryEob', formData),
title: formData =>
`${fnp(formData)} ${
formData.applicantSecondaryProvider
} schedule of benefits`,
CustomPage: FileFieldWrapped,
CustomPageReview: null,
...applicantInsuranceSOBSchema(false),
},
secondaryCard: {
path: 'secondary-insurance-card-upload',
depends: formData =>
get('applicantHasPrimary', formData) &&
get('applicantHasSecondary', formData),
title: formData => `${fnp(formData)} health insurance card`,
CustomPage: FileFieldWrapped,
CustomPageReview: null,
...applicantInsuranceCardSchema(false),
},
secondaryComments: {
path: 'secondary-insurance-comments',
depends: formData =>
get('applicantHasPrimary', formData) &&
get('applicantHasSecondary', formData),
title: formData =>
`${fnp(formData)} ${
formData.applicantSecondaryProvider
} additional comments`,
...applicantInsuranceCommentsSchema(false),
},
},
},
fileUpload: {
title: 'File Upload',
pages: {
supportingFilesReview: {
path: 'supporting-files',
title: 'Upload your supporting files',
depends: formData => showFileOverviewPage(formData),
CustomPage: SupportingDocumentsPage,
CustomPageReview: null,
uiSchema: {
'ui:options': {
keepInPageOnReview: false,
},
},
schema: blankSchema,
},
missingFileConsent: {
path: 'consent-mail',
title: 'Upload your supporting files',
depends: formData => showFileOverviewPage(formData),
CustomPage: MissingFileConsentPage,
CustomPageReview: null,
uiSchema: {
'ui:options': {
keepInPageOnReview: false,
},
},
schema: blankSchema,
},
},
},
formSignature: {
title: 'Form signature',
pages: {
formSignature: {
path: UPLOADS_COMPLETE_PATH,
title: 'Form signature',
...formSignatureSchema,
},
},
},
},
};
export default formConfig;