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5 | 5 | {% load i18n %} |
6 | 6 | {% load bootstrap %} |
7 | 7 |
|
| 8 | +{% block Header %} |
| 9 | + <link rel="stylesheet" href="{% static 'statsite/assets/main.css' %}"> |
| 10 | +{% endblock %} |
| 11 | + |
| 12 | + |
8 | 13 | {% block Content %} |
9 | 14 | <div class="container"> |
10 | 15 |
|
11 | 16 |
|
12 | 17 | <section id="theform"> |
13 | 18 | <article class="ds-u-border--1 ds-u-radius ds-u-padding--2 ds-u-md-padding--4"> |
14 | 19 |
|
15 | | - <section class="ds-l-container preview__grid"> |
16 | | - <div class="ds-l-row ds-u-fill--white"> |
17 | | - <div class="ds-l-col--3"> |
18 | | - <a href="https://mymedicare.gov"> <img src="{% static 'img/medicaregov.png' %}"></a> |
| 20 | +<section class="ds-l-container preview__grid"> |
| 21 | + |
| 22 | + <div class="ds-l-row ds-u-fill--white"> |
| 23 | + <div class="ds-l-col--12 ds-u-text-align--center"> |
| 24 | + <a href="https://mymedicare.gov"> <img src="{% static 'img/medicaregov.png' %}"></a> |
| 25 | + </div> |
19 | 26 | </div> |
20 | | - </div> |
21 | 27 |
|
22 | | - <div class="ds-l-row ds-u-justify-content--ledt ds-u-fill--white"> |
23 | | - <div class="ds-l-col--3"> |
24 | | - {% if not error %} |
25 | | - <form id="authorizationForm" method="post"> |
26 | | - <h2 class="block-center-heading"> |
27 | | - {{ application.name }} wants permission to access your Medicare data. |
28 | | - </h2> |
| 28 | + <div class="ds-l-row ds-u-justify-content--left ds-u-fill--white"> |
| 29 | + <div class="ds-l-md-col--3"> |
| 30 | + {% if application.logo_uri %} |
| 31 | + <div class="ds-u-text-align--center"> |
| 32 | + <img src={{ application.logo_uri }} width="100%"/> |
| 33 | + </div> |
| 34 | + {% endif %} |
| 35 | + |
| 36 | + <div class="ds-u-text-align--center"> |
| 37 | + <h3>{{ application.name }}</h3> |
| 38 | + </div> |
| 39 | + |
| 40 | + {% if application.policy_uri %} |
| 41 | + <div> |
| 42 | + <a href={{ application.policy_uri }} >Privacy Policy </a> |
| 43 | + </div> |
| 44 | + {% endif %} |
| 45 | + |
| 46 | + {% if application.tos_uri %} |
| 47 | + <div> |
| 48 | + <a href={{ application.tos_uri }} >Terms and Conditions</a> |
| 49 | + </div> |
| 50 | + {% endif %} |
| 51 | + </div> |
| 52 | + |
| 53 | + <div class="ds-l-md-col--9"> |
| 54 | + {% if not error %} |
| 55 | + <form id="authorizationForm" method="post"> |
| 56 | + |
| 57 | + <h2 class="block-center-heading"> |
| 58 | + {{ application.name }} wants permission to access your Medicare data. |
| 59 | + </h2> |
29 | 60 |
|
30 | | - <h3>{{ application.name }} will be able to:</h3> |
| 61 | + <h3>{{ application.name }} will be able to:</h3> |
31 | 62 |
|
32 | | - <ul class="ds-c-list" aria-labelledby="unordered-list-id"> |
33 | | - <li>Access your Medicare claims data.</li> |
34 | | - <li>Access your personal details like your name, address, and age.</li> |
35 | | - <li>Store your Medicare data on their systems.</li> |
36 | | - <li>Get updates to your Medicare data unless you revoke access.</li> |
37 | | - </ul> |
| 63 | + <ul class="ds-c-list" aria-labelledby="unordered-list-id"> |
| 64 | + <li>Access your Medicare claims data.</li> |
| 65 | + <li>Access your personal details like your name, address, and age.</li> |
| 66 | + <li>Store your Medicare data on their systems.</li> |
| 67 | + <li>Get updates to your Medicare data unless you revoke access.</li> |
| 68 | + </ul> |
38 | 69 |
|
39 | | - <h3 class="ds-u-color--error">Understand the risks</h3> |
| 70 | + <h3 class="ds-u-color--error">Understand the risks</h3> |
40 | 71 |
|
41 | | - <p> |
42 | | - You have the right to share your health information, but there may be risks. |
43 | | - Be sure to review the app's Privacy Policy and Terms of Conditions. |
44 | | - You can revoke an app's access to your data at any time by logging in to your <a href=https://www.mymedicare.gov>MyMedicare.gov</a> account or calling us at 1-800-633-4227. |
45 | | - </p> |
| 72 | + <p> |
| 73 | + You have the right to share your health information, but there may be risks. |
| 74 | + Be sure to review the app's Privacy Policy and Terms and Conditions. |
| 75 | + You can revoke an app's access to your data at any time by logging in to your <a href=https://www.mymedicare.gov>MyMedicare.gov</a> account or calling us at 1-800-633-4227. |
| 76 | + </p> |
46 | 77 |
|
47 | 78 |
|
48 | | - {% csrf_token %} |
| 79 | + {% csrf_token %} |
49 | 80 |
|
50 | | - {% for field in form %} |
51 | | - {% if field.is_hidden %} |
52 | | - {{ field }} |
53 | | - {% endif %} |
54 | | - {% endfor %} |
| 81 | + {% for field in form %} |
| 82 | + {% if field.is_hidden %} |
| 83 | + {{ field }} |
| 84 | + {% endif %} |
| 85 | + {% endfor %} |
55 | 86 |
|
56 | | - {{ form.non_field_errors }} |
57 | | - </div> |
| 87 | + {{ form.non_field_errors }} |
| 88 | + </div> |
58 | 89 | </div> |
59 | 90 |
|
60 | 91 |
|
61 | | - <center> |
62 | | - <input id="approve" type="submit" class="ds-c-button ds-c-button--primary ds-u-margin-right--6 ds-u-margin-left--6" name="allow" |
63 | | - value="Allow"/> |
| 92 | + <center> |
| 93 | + <input id="approve" type="submit" class="ds-c-button ds-c-button--primary ds-u-margin-right--6 ds-u-margin-left--6" name="allow" value="Allow"/> |
64 | 94 |
|
65 | | - <input type="submit" class="ds-c-button ds-c-button--outline ds-u-margin-top--1 ds-u-display--block ds-u-md-display--inline-block ds-u-margin-left--6 ds-u-margin-right--6" value="Deny" \> |
66 | | - </center> |
67 | | - </form> |
68 | | - |
69 | | - {% else %} |
70 | | - <h2>Error: {{ error.error }}</h2> |
71 | | - <p>{{ error.description }}</p> |
72 | | - {% endif %} |
73 | | - </div> |
| 95 | + <input type="submit" class="ds-c-button ds-c-button--outline ds-u-margin-top--3 ds-u-display--block ds-u-md-display--inline-block ds-u-margin-left--6 ds-u-margin-right--6" value="Deny" \> |
| 96 | + </center> |
| 97 | +</form> |
74 | 98 |
|
75 | | - </section> |
| 99 | + {% else %} |
| 100 | + <h2>Error: {{ error.error }}</h2> |
| 101 | + <p>{{ error.description }}</p> |
| 102 | + {% endif %} |
| 103 | + |
| 104 | +</div> |
| 105 | + |
| 106 | +</section> |
76 | 107 |
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77 | 108 |
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78 | 109 |
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