src/applications/simple-forms/21-4142/containers/IntroductionPage.jsx
import React from 'react';
import PropTypes from 'prop-types';
import { connect } from 'react-redux';
import { isLOA3, isLoggedIn } from 'platform/user/selectors';
import manifest from '../manifest.json';
import { IntroductionPageView } from '../../shared/components/IntroductionPageView';
const ombInfo = {
resBurden: '10',
ombNumber: '2900-0858',
expDate: '07/31/2024',
};
export const IntroductionPage = ({ route, userIdVerified, userLoggedIn }) => {
const content = {
formTitle: 'Authorize the release of non-VA medical information to VA',
formSubTitle:
'Authorization to disclose information to the Department of Veterans Affairs (VA) (VA Forms 21-4142 and 21-4142a)',
authStartFormText: 'Start the medical release authorization',
saveInProgressText:
'Please complete the 21-4142 form to authorize the release of non-VA medical records to VA.',
displayNonVeteranMessaging: true,
hideSipIntro: userLoggedIn && !userIdVerified,
};
const childContent = (
<>
<p>
Complete this form if you want to give us permission to request your
records from a non-VA source to support your benefit claim. You can also
use this form to authorize the release of records on behalf of a Veteran
you support.
</p>
<h2 className="vads-u-font-size--h3">
What to know before you submit this form
</h2>
<ul className="vads-u-margin-bottom--4">
<li>
If you already provided your private, non-VA medical records to us, or
if you intended to get them yourself, you don’t need to submit this
form. Submitting the form in this case will add time to your claim
process.
</li>
<li>
You don’t need to submit this form to request VA medical records.
</li>
<li>
By law, we can’t pay any fees that may come from requesting your
medical records.
</li>
</ul>
<h2 id="start-your-request">Start your authorization</h2>
<p>
<strong>Note</strong>: You’ll need to sign in with a verified{' '}
<strong>Login.gov</strong> or <strong>ID.me</strong> account or a
Premium <strong>DS Logon</strong> or <strong>My HealtheVet</strong>{' '}
account. If you don’t have any of those accounts, you can create a free{' '}
<strong>Login.gov</strong> or <strong>ID.me</strong> account when you
sign in to start filling out your form.
</p>
{userLoggedIn &&
!userIdVerified /* If User's signed-in but not identity-verified [not LOA3] */ && (
<div className="id-not-verified-content vads-u-margin-top--4">
<va-alert status="continue" uswds>
<h3 slot="headline">
You’ll need to verify your identity to authorize the release of
non-VA medical records to VA
</h3>
<p>
We need to make sure you’re you — and not someone pretending to
be you — before we can give you access to your personal and
health-related information. This helps to keep your information
safe, and to prevent fraud and identity theft.
</p>
<strong>This one-time process takes about 5-10 minutes.</strong>
<p>
<a
href={`/verify?next=${manifest.rootUrl}/introduction`}
className="verify-link vads-c-action-link--green"
>
Verify your identity
</a>
</p>
</va-alert>
<p className="vads-u-margin-top--3">
If you don’t want to verify your identity right now, you can still
download and complete the PDF version of this authorization.
</p>
<p className="vads-u-margin-y--3">
<va-link
download
href="https://www.vba.va.gov/pubs/forms/VBA-21-4142-ARE.pdf"
text="Get VA Form 21-4142 to download"
/>
</p>
</div>
)}
</>
);
return (
<IntroductionPageView
route={route}
content={content}
ombInfo={ombInfo}
childContent={childContent}
/>
);
};
IntroductionPage.propTypes = {
route: PropTypes.shape({
formConfig: PropTypes.shape({
prefillEnabled: PropTypes.bool,
savedFormMessages: PropTypes.shape({}),
}),
pageList: PropTypes.array,
}),
};
const mapStateToProps = state => ({
userIdVerified: isLOA3(state),
userLoggedIn: isLoggedIn(state),
});
export default connect(mapStateToProps)(IntroductionPage);