1import{ai as vt,j as e,b4 as A,ay as ye,ax as U,aD as z,J as g,B as S,aA as c,Q as Nt,k as ia,R as Ta,V as q,W as Ve,C as Ne,a as Ce,n as ca,i as ze,F as da,_ as we,Y as Ct,e as wt,c as St,b as Pa,I as ge,ah as je,bo as Ue,br as kt,av as y,aC as B,aF as La,a2 as $t,H as Dt}from"./index-SYQM90QS.js";import{r as W}from"./vendor-charts-BPWpdejw.js";import{g as qe,a as m,b as u,c as h,e as f,d as x,f as Ba,u as At,t as Et,F as Tt}from"./form-BkHmC2j0.js";import{T as R}from"./textarea-C7lSvrqA.js";import{S as M,a as F,b as _,c as H,d as b}from"./select-BDNu_m1Z.js";import{A as Pt,a as ne,b as re,c as oe}from"./accordion-Bm1ZGN5X.js";import{S as Lt}from"./StaffCombobox-BAWmsuOw.js";import{T as It}from"./trophy-Cy18LKuG.js";import{D as Pe}from"./download-Cti7qiHf.js";import{S as Ia}from"./save-DVHb9oJ0.js";import{T as Rt}from"./trending-up-CrVu7Xhw.js";import{U as Ye}from"./upload-DJLV_oyq.js";import{U as Ot}from"./user-Cq-jc68k.js";import{A as Mt}from"./accessibility-C-GkNqD8.js";import{P as Ft}from"./phone-CnVwM4Ly.js";import"./index-BompFPCB.js";import"./chevron-up-Bu0uOApn.js";import"./index-C1kOzw4l.js";import"./chevrons-up-down-CED7-_-4.js";/** 2 * @license lucide-react v0.453.0 - ISC 3 * 4 * This source code is licensed under the ISC license. 5 * See the LICENSE file in the root directory of this source tree. 6 */const _t=vt("CreditCard",[["rect",{width:"20",height:"14",x:"2",y:"5",rx:"2",key:"ynyp8z"}],["line",{x1:"2",x2:"22",y1:"10",y2:"10",key:"1b3vmo"}]]),E=c().optional(),Le=U(["","yes","no"]).optional(),Ht=ye({bankBranchAddress:E,bankAccountType:E,bankStatementOnFile:Le,emergencyName:E,emergencyRelationship:E,emergencyPhone:E,emergencyStreet:E,emergencyCity:E,emergencyState:E,emergencyZip:E,childrenElsewhereCount:E,childrenElsewhereAges:E,childrenCustody:E,overnightVisitation:Le,overnightVisitationDetails:E,acceptableBedroomSizes:z(U(["studio","1_bedroom","2_bedroom","3_bedroom"])).optional(),rentAssistedOnly:Le,hasDisability:Le,disabilityVerifiedBy:E,applicationPhoneSource:U(["","client","staff","custom"]).optional(),applicationPhone:E,applicationEmailSource:U(["","client","staff","custom"]).optional(),applicationEmail:E,identityVerificationEmail:E,employmentStatus:E,lastWorkedDate:E,lastEmployer:E,notEmployedSince:E,inFacility:Le,facilityName:E,facilityContact:E,facilityAdmitDate:E}).passthrough().default({}),pa={bankBranchAddress:"Bank branch address",bankAccountType:"Bank account type",bankStatementOnFile:"Bank statement on file",emergencyName:"Emergency contact name",emergencyRelationship:"Emergency contact relationship",emergencyPhone:"Emergency contact phone",emergencyStreet:"Emergency contact street",emergencyCity:"Emergency contact city",emergencyState:"Emergency contact state",emergencyZip:"Emergency contact ZIP",childrenElsewhereCount:"Number of children living elsewhere",childrenElsewhereAges:"Ages of children living elsewhere",childrenCustody:"Custody arrangement",overnightVisitation:"Overnight visitation",overnightVisitationDetails:"Overnight visitation details",acceptableBedroomSizes:"Acceptable bedroom sizes",rentAssistedOnly:"Rent-assisted housing only",hasDisability:"Client reports a disability",disabilityVerifiedBy:"Disability verified by",applicationPhoneSource:"Application phone source",applicationPhone:"Application phone",applicationEmailSource:"Application email source",applicationEmail:"Application email",identityVerificationEmail:"Identity-verification email",employmentStatus:"Employment status",lastWorkedDate:"Last worked date",lastEmployer:"Last employer",notEmployedSince:"Not employed since",inFacility:"Currently in a facility",facilityName:"Facility name",facilityContact:"Facility contact",facilityAdmitDate:"Facility admission date"};function me({title:j,description:n,children:T}){return e.jsxs("fieldset",{className:"ta-detail-group",children:[e.jsx("legend",{children:j}),e.jsx("p",{children:n}),e.jsx("div",{className:"ta-detail-grid",children:T})]})}function I({name:j,type:n="text",multiline:T=!1}){const{control:N}=qe();return e.jsx(m,{control:N,name:`applicationDetails.${j}`,render:({field:P})=>e.jsxs(u,{children:[e.jsx(h,{children:pa[j]}),e.jsx(x,{children:T?e.jsx(R,{...P,value:typeof P.value=="string"?P.value:"","data-testid":`input-application-${j}`}):e.jsx(g,{...P,type:n,value:typeof P.value=="string"?P.value:"","data-testid":`input-application-${j}`})}),e.jsx(f,{})]})})}function Ie({name:j}){const{control:n}=qe();
6return e.jsx(m,{control:n,name:`applicationDetails.${j}`,render:({field:T})=>e.jsxs(u,{children:[e.jsx(h,{children:pa[j]}),e.jsx(x,{children:e.jsxs(M,{value:typeof T.value=="string"&&T.value?T.value:"unanswered",onValueChange:N=>T.onChange(N==="unanswered"?"":N),children:[e.jsx(F,{"data-testid":`select-application-${j}`,children:e.jsx(_,{})}),e.jsxs(H,{children:[e.jsx(b,{value:"unanswered",children:"Not answered"}),e.jsx(b,{value:"yes",children:"Yes"}),e.jsx(b,{value:"no",children:"No"})]})]})}),e.jsx(f,{})]})})}function Ra({kind:j,clientValue:n}){const{control:T,watch:N,setValue:P}=qe(),V=`applicationDetails.application${j}Source`,K=`applicationDetails.application${j}`,O=N(V);return e.jsxs("div",{className:"space-y-3",children:[e.jsx(m,{control:T,name:V,render:({field:Z})=>e.jsxs(u,{children:[e.jsxs(h,{children:["Application ",j.toLowerCase()," source"]}),e.jsx(x,{children:e.jsxs(M,{value:Z.value||"unanswered",onValueChange:C=>{Z.onChange(C==="unanswered"?"":C),P(K,"",{shouldDirty:!0})},children:[e.jsx(F,{"data-testid":`select-application-${j.toLowerCase()}-source`,children:e.jsx(_,{})}
6),e.jsxs(H,{children:[e.jsx(b,{value:"unanswered",children:"Not selected"}),e.jsx(b,{value:"client",children:"Client"}),e.jsx(b,{value:"staff",children:"Staff"}),e.jsx(b,{value:"custom",children:"Custom contact"})]})]})}),e.jsx(Ba,{children:O==="staff"||O==="custom"?"Enter the intended contact explicitly below. 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Reasonable accommodation requests remain in the existing housing application questions; disability does not automatically mean an accommodation is needed.",children:[e.jsx(Ie,{name:"hasDisability"}),e.jsx(I,{name:"disabilityVerifiedBy"})]});case"employment":return e.jsxs(me,{title:"Employment history",description:"Capture current status and the most recent employment details. Leave dates blank when unknown.",children:[e.jsx(I,{name:"employmentStatus"}),e.jsx(I,{name:"lastEmployer"}),e.jsx(I,{name:"lastWorkedDate",type:"date"}),e.jsx(I,{name:"notEmployedSince",type:"date"})]});case"facility":return e.jsxs(me,{title:"Current facility placement",description:"If applicable, record the facility and the contact who can help coordinate the housing transition. Unknown is not No.",children:[e.jsx(Ie,{name:"inFacility"}),e.jsx(I,{name:"facilityName"}),e.jsx(I,{name:"facilityContact"}),e.jsx(I,{name:"facilityAdmitDate",type:"date"})]})}}const Oa=ye({clientId:c(),staffId:c().optional(),assessmentDate:c().optional(),middleName:c().optional(),sex:c().optional(),maritalStatus:c().optional(),applicationDetail
6s:Ht,currentAddress:c().optional(),previousAddress:c().optional(),yearsAtPreviousAddress:c().optional(),needsWheelchairTransport:B().default(!1),needsHousing:B().default(!0),housingStatus:c().optional(),housingSetting:c().optional(),preferredTown1:c().optional(),preferredTown2:c().optional(),preferredTown3:c().optional(),preferredTowns:z(c()).optional(),transportationPreference:c().optional(),walkToPreferences:c().optional(),unitSize:c().optional(),housingType:c().optional(),floorPreference:c().optional(),accessibilityFeatures:z(c()).optional(),needsElevator:B().default(!1),needsNoStairs:B().default(!1),needsAccessibleBathroom:B().default(!1),amenities:z(c()).optional(),otherHouseholdMembers:c().optional(),currentRent:c().optional(),housingBarriers:z(c()).optional(),housingHistoryNotes:c().optional(),longTermWaitlistInterest:B().default(!1),owesMoneyToPreviousLandlord:B().default(!1),previousEviction:B().default(!1),previousHousingAssistance:B().default(!1),previousLandlordInfo:c().optional(),hasPreviousLandlord:U(["","yes","no"]).optional(),previousLandlordName:c().optional(),previousLandlordPhone:c().optional(),notApplicableSections:z(c()).optional(),hasId:B().default(!1),hasBirthCertificate:B().default(!1),placeOfBirth:c().optional(),motherName:c().optional(),motherMaidenName:c().optional(),fatherName:c().optional(),hasSocialSecurityCard:B().default(!1),socialSecurityNumber:c().optional(),hasBankAccount:B().default(!1),bankName:c().optional(),hasBankStatements:U(["","yes","no"]).optional(),monthlyIncome:c().optional(),hasProofOfIncome:B().default(!1),isVeteran:B().default(!1),disabilityTypes:z(c()).optional(),disabilityNotes:c().optional(),socialWorkerContact:c().optional(),topPriorities:c().optional(),planOfAction:c().optional(),recommendations:c().optional(),householdMembers:z(ye({name:c().optional().default(""),relationship:c().optional().default(""),dob:c().optional().default(""),ssnLast4:c().optional().default(""),ftStudent:U(["yes","no","na"]).default("na"),gender:c().optional().default(""),placeOfBirth:c().optional().default(""),disabled:U(["yes","no","na"]).default("na"),citizen:U(["yes","no","na"]).default("na"),race:c().optional().default(""),ethnicity:c().optional().default(""),occupation:c().optional().default("")})).optional().default([]),householdChangesExpected:c().optional(),householdChangesNotes:c().optional(),hasFullTimeStudent:c().optional(),studentChangesExpected:c().optional(),primarySpokenLanguage:c().optional(),primaryWrittenLanguage:c().optional(),incomeDetails:La(ye({status:U(["yes","no","na"]).default("na"),amount:c().optional(),frequency:c().optional(),sourceName:c().optional(),sourceAddress:c().optional()})).optional().default({}),assetDetails:La(ye({status:U(["yes","no","na"]).default("na"),value:c().optional()})).optional().default({}),taxReturnFiledLastYear:c().optional(),incomeChangesExpected:c().optional(),incomeChangesNotes:c().optional(),closedAccountsLastYear:c().optional(),disposedAssetsLast2Years:c().optional(),noIncomeAffidavit:c().optional(),noAssetsAffidavit:c().optional(),race:z(c()).optional().default([]),ethnicity:c().optional(),citizenshipStatus:c().optional(),livingSituationType:c().optional(),monthlyUtilities:c().optional(),everConvicted:c().optional(),convictionType:c().optional(),convictionYears:c().optional(),currentlyUsingIllegalDrugs:c().optional(),sexOffenderRegistry:c().optional(),otherNamesUsed:c().optional(),statesLived:z(c()).optional().default([]),domesticViolenceSurvivor:c().optional(),forcedToLeaveResidence:c().optional(),priorityReasons:z(c()).optional().default([]),homelessCertifications:z(c()).optional().default([]),residenceLeftAddress:c().optional(),localPreferenceChoice:c().optional(),dateLeftResidence:c().optional(),currentHousingSituationDetails:c().optional(),secondaryContactName:c().optional(),secondaryContactAddress:c().optional(),secondaryContactPhone:c().optional(),secondaryContactEmail:c().optional(),employmentLocation:c().optional(),childrenSchoolLocation:c().optional(),veteranDatesOfService:c().optional(),veteranServiceConnectedDisability:c().optional(),veteranFamilyMember:c().optional(),deceasedVeteranServiceDeath:c().optional(),housingAgencyEmployee:c().optional(),housingAgencyEmployeeDetails:c().optional(),reasonableAccommodationNeeded:c().optional(),reasonableAccommodationDetail
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${p(s.gender)}`:"",s.placeOfBirth?`Place of Birth: ${p(s.placeOfBirth)}`:"",s.race?`Race: ${p(se(We,s.race))}`:"",s.ethnicity?`Ethnicity: ${p(se(Da,s.ethnicity))}`:"",s.occupation?`Occupation: ${p(se(Ha,s.occupation))}`:""].filter(Boolean).join(" • ");return`<tr>${$(p(s.name))}${$(p(s.relationship))}${$(p(s.dob))}${$(p(s.ssnLast4))}${$(w(s.ftStudent))}${$(w(s.disabled))}${$(w(s.citizen))}</tr>`+(k?`<tr><td colspan="7" style="border:1px solid #e5e7eb;padding:5px 10px;font-size:10px;color:#4b5563;">${k}</td></tr>`:"")}).join("")} 38 </table>`:'<table style="width:100%;border-collapse:collapse;margin:0;"><tr><td style="border:1px solid #e5e7eb;padding:8px 12px;font-size:11px;color:#9ca3af;">No additional household members reported.</td></tr></table>'}`,jt=` 39 ${Y("BACKGROUND & SCREENING")} 40 <table style="width:100%;border-collapse:collapse;margin:0;"> 41 ${d("Ever Convicted of a Crime",w(t.everConvicted))} 42 ${d("Conviction Type",t.convictionType?se(st,t.convictionType):"")} 43 ${d("Conviction Year(s)",p(t.convictionYears))} 44 ${d("On Sex-Offender Registry",w(t.sexOffenderRegistry))} 45 ${d("Currently Using Illegal Drugs",w(t.currentlyUsingIllegalDrugs))} 46 ${d("Convicted of Drug-Related / Violent Crime",w(t.drugViolentCrimeConviction))} 47 ${t.drugViolentCrimeExplain?d("Drug / Violent Crime Explanation",p(t.drugViolentCrimeExplain)):""} 48 ${d("Pending Criminal Matters",w(t.pendingCriminalMatters))} 49 ${t.pendingCriminalMattersExplain?d("Pending Criminal Matters Explanation",p(t.pendingCriminalMattersExplain)):""} 50 ${d("Survivor of Domestic Violence (VAWA)",w(t.domesticViolenceSurvivor))} 51 ${d("Other Names Used",p(t.otherNamesUsed))} 52 ${d("States Lived In",t.statesLived&&t.statesLived.length?p(t.statesLived.join(", ")):"None")} 53 ${d("Household Changes Expected (12 mo)",w(t.householdChangesExpected))} 54 ${d("Anyone 18+ a Full-Time Student",w(t.hasFullTimeStudent))} 55 ${d("Student Status Changes Expected",w(t.studentChangesExpected))} 56 ${d("Income Changes Expected (12 mo)",w(t.incomeChangesExpected))} 57 ${d("Filed Tax Return Last Year",w(t.taxReturnFiledLastYear))} 58 ${d("Bank Accounts Closed Last Year",w(t.closedAccountsLastYear))} 59 ${d("Disposed / Gifted Assets (2 yr)",w(t.disposedAssetsLast2Years))} 60 ${d("Needs Zero-Income Affidavit",w(t.noIncomeAffidavit))} 61 ${d("Needs No-Assets Certification",w(t.noAssetsAffidavit))} 62 </table> 63 ${t.householdChangesNotes?X("Household Change Notes:",p(t.householdChangesNotes)):""} 64 ${t.incomeChangesNotes?X("Income Change Notes:",p(t.incomeChangesNotes)):""}`,bt=ht?` 65 ${Y("CHAMP APPLICATION DETAILS")} 66 <table style="width:100%;border-collapse:collapse;margin:0;"> 67 ${d("Forced to Leave Last Residence",w(t.forcedToLeaveResidence))} 68 ${d("Priority Situation",_e(Ma,t.priorityReasons))} 69 ${d("Homeless Certifications",_e(Fa,t.homelessCertifications))} 70 ${d("Address of Residence Left",p(t.residenceLeftAddress))} 71 ${d("Date Left Residence",p(t.dateLeftResidence))} 72 ${d("Local Preference Claimed As",t.localPreferenceChoice?se(nt,t.localPreferenceChoice):"")} 73 ${d("Household Expenses",_e(_a,t.householdExpenses))} 74 ${d("Employment Location",p(t.employmentLocation))} 75 ${d("Child's School Location",p(t.childrenSchoolLocation))} 76 ${d("Relationship to Veteran",p(t.veteranFamilyMember))} 77 ${d("Veteran Dates of Service",p(t.veteranDatesOfService))} 78 ${d("Service-Connected Disability",w(t.veteranServiceConnectedDisability))} 79 ${d("Deceased Veteran (Service-Connected Death)",w(t.deceasedVeteranServiceDeath))} 80 ${d("Needs Reasonable Accommodation",w(t.reasonableAccommodationNeeded))} 81 ${d("Board Member / Employee of Housing Agency",w(t.housingAgencyEmployee))} 82 ${t.housingAgencyEmployeeDetails?d("Agency & Role Detail",p(t.housingAgencyEmployeeDetails)):""} 83 ${d("Disposed / Transferred Assets (3 yr)",w(t.assetTransferLast3Years))} 84 ${d("Asset Transfer Amount",t.assetTransferAmount?"$"+p(t.assetTransferAmount):"")} 85 ${d("Asset Transfer Value",t.assetTransferValue?"$"+p(t.assetTransferValue):"")} 86 ${d("Asset Transfer Date",p(t.assetTransferDate))} 87 ${d("Real Estate Details",p(t.realEstateDetails))} 88 </table>
89 ${t.currentHousingSituationDetails?X("Current Housing Situation Detail:",p(t.currentHousingSituationDetails)):""} 90 ${t.reasonableAccommodationDetails?X("Accommodation Detail:",p(t.reasonableAccommodationDetails)):""} 91 ${t.secondaryContactName||t.secondaryContactPhone||t.secondaryContactEmail||t.secondaryContactAddress?` 92 ${sa("Secondary / Emergency Contact")} 93 <table style="width:100%;border-collapse:collapse;margin:0;"> 94 ${d("Name",p(t.secondaryContactName))} 95 ${d("Phone",p(t.secondaryContactPhone))} 96 ${d("Email",p(t.secondaryContactEmail))} 97 ${d("Address",p(t.secondaryContactAddress))} 98 </table>`:""} 99 ${oa.length?` 100 ${sa("Previous Residences â Last 3 Addresses (Legacy Entries Retained)")} 101 <table style="width:100%;border-collapse:collapse;margin:0;"> 102 <tr>${["Address","Move In – Out","Leaseholder","Landlord","Court Action","Deposit Returned"].map(Q).join("")}</tr> 103 ${oa.map(s=>`<tr>${$(p([s.address,s.city,s.state,s.zip].filter(Boolean).join(", "))+"<br>Monthly rent: "+p(s.rent||"Not answered")+"<br>Utilities included: "+p(s.utilitiesIncluded==="yes"?"Yes":s.utilitiesIncluded==="no"?"No":"Not answered")+"<br>Reason for leaving: "+p(s.reasonForLeaving||"Not answered"))}${$(p([s.dateMovedIn,s.dateMovedOut].filter(Boolean).join(" â ")))}${$(p([s.leaseholderFirstName,s.leaseholderLastName].filter(Boolean).join(" ")))}${$(p([s.landlordName,s.landlordPhone,s.landlordAddress].filter(Boolean).join(", ")))}${$(w(s.landlordCourtAction))}${$(w(s.securityDepositReturned))}</tr>`).join("")} 104 </table>`:""} 105 ${la.length?` 106 ${sa("Personal References")} 107 <table style="width:100%;border-collapse:collapse;margin:0;"> 108 <tr>${["Name","Relationship","Phone","Address"].map(Q).join("")}</tr> 109 ${la.map(s=>`<tr>${$(p(s.name))}${$(p(s.relationship))}${$(p(s.phone))}${$(p(s.address))}</tr>`).join("")} 110 </table>`:""}`:"",yt=ut+pt+xt+gt+jt+bt,ft=` 111 <!DOCTYPE html> 112 <html> 113 <head> 114 <meta charset="utf-8"> 115 <title>Initial Assessment - ${p(l)}</title> 116 <style> 117 @page { margin: 0.6in; } 118 body { font-family: 'Segoe UI', Arial, sans-serif; margin: 0; padding: 28px; line-height: 1.45; color: #111827; } 119 table { border-collapse: collapse; } 120 </style> 121 </head> 122 <body> 123 <table style="width:100%;border-collapse:collapse;margin:0;"> 124 <tr> 125 <td style="background-color:#0f766e;padding:14px 18px;width:76px;vertical-align:middle;"> 126 <table style="border-collapse:collapse;"><tr><td style="background-color:#ffffff;padding:6px 8px;"><img src="${et}" alt="CareRemedy Inc." style="height:44px;width:auto;" /></td></tr></table> 127 </td> 128 <td style="background-color:#0f766e;vertical-align:middle;padding:8px 12px;"> 129 <table style="border-collapse:collapse;"> 130 <tr><td style="background-color:#0f766e;font-size:21px;color:#ffffff;font-weight:bold;padding:0;">Initial Assessment</td></tr> 131 <tr><td style="background-color:#0f766e;font-size:11px;color:#ccfbf1;padding:0;">Care Remedy Inc. | Confidential Record</td></tr> 132 <tr><td style="background-color:#0f766e;font-size:9px;color:#99f6e4;padding:0;">Generated ${new Date().toLocaleDateString("en-US",{year:"numeric",month:"long",day:"numeric"})} at ${new Date().toLocaleTimeString("en-US",{hour:"2-digit",minute:"2-digit"})}</td></tr> 133 </table> 134 </td> 135 <td style="background-color:#0f766e;text-align:right;vertical-align:middle;font-size:11px;color:#ccfbf1;padding:14px 18px;"> 136 Housing Assistance Program<br>Case Management Services 137 </td> 138 </tr> 139 </table> 140 <table style="width:100%;border-collapse:collapse;margin:0 0 14px 0;"> 141 <tr><td style="background-color:#14b8a6;font-size:1px;line-height:1px;height:3px;padding:0;"> </td></tr> 142 </table> 143 144 <table style="width:100%;border-collapse:collapse;margin:0;"> 145 <tr><td style="background-color:#f0fdfa;border:1px solid #99f6e4;padding:9px 14px;font-size:16px;color:#115e59;font-weight:bold;">${p(l)}</td></tr> 146 </table> 147 <table style="width:100%;border-collapse:collapse;margin:0 0 4px 0;"> 148 ${d("Middle Name",p(t.middleName))} 149 ${d("Sex",t.sex?se(rt,t.sex):"")} 150 ${d("Marital Status",p(t.maritalStatus||"Not answered"))} 151 ${d("Date of Birth",o?p(new Date(o+"T00:00:00").toLocaleDateString("en-US",{year:"numeric",month:"long",day:"numeric"})):"")} 152 ${d("Senior Age Indicator (62+)",ua(o)===null?"Unable to determine":ua(o)?"Yes â program review required":"No â program review required")} 153 ${d("Phone",p(v))} 154 ${d("Email",p(te))} 155 ${d("Program",ve?xe(ve):"")} 156 ${d("Assessment Date",p(Za))} 157 ${d("Conducted By",p(Ja))} 158 </table> 159 160 ${Y("CURRENT LIVING SITUATION")} 161 <table style="width:100%;border-collapse:collapse;margin:0;"> 162 ${d("Current Address",p(t.currentAddress))} 163 ${d("Previous Address",p(t.previousAddress))} 164 ${d("Years at Previous Address",p(t.yearsAtPreviousAddress))} 165 ${d("Living Situation",t.livingSituationType?se(tt,t.livingSituationType):"")} 166 ${d("Monthly Utilities (out of pocket)",t.monthlyUtilities?"$"+p(t.monthlyUtilities):"")} 167 ${d("Needs Wheelchair Transport",J(t.needsWheelchairTrans
167port))} 168 </table> 169 170 ${Y("HOUSING PREFERENCES")} 171 <table style="width:100%;border-collapse:collapse;margin:0;"> 172 ${d("Housing Status",xe(t.housingStatus))} 173 ${d("Housing Setting",xe(t.housingSetting))} 174 ${d("Preferred Towns",De(t.preferredTowns?.length?t.preferredTowns:[t.preferredTown1,t.preferredTown2,t.preferredTown3].filter(Boolean)))} 175 ${d("Transportation Preference",p(t.transportationPreference))} 176 ${d("Walk-to Preferences",p(t.walkToPreferences))} 177 ${d("Unit Size",xe(t.unitSize))} 178 ${d("Housing Type",xe(t.housingType))} 179 ${d("Floor Preference",xe(t.floorPreference))} 180 ${d("Accessibility Features",De(t.accessibilityFeatures))} 181 ${d("Elevator Required",J(t.needsElevator))} 182 ${d("No Stairs Required",J(t.needsNoStairs))} 183 ${d("Accessible Bathroom Required",J(t.needsAccessibleBathroom))} 184 ${d("Sensory-Accessible Unit Required",J(t.needsSensoryAccessibleUnit))} 185 ${d("Amenities",De(t.amenities))} 186 ${d("Other Household Members",p(t.otherHouseholdMembers))} 187 </table> 188 189 ${Y("HOUSING HISTORY")} 190 <table style="width:100%;border-collapse:collapse;margin:0;"> 191 ${d("Current Rent",p(t.currentRent))} 192 ${d("Housing Barriers",De(t.housingBarriers))} 193 ${d("Long-Term Waitlist Interest",J(t.longTermWaitlistInterest))} 194 ${d("Owes Previous Landlord",J(t.owesMoneyToPreviousLandlord))} 195 ${d("Owes Money to a Housing Program",w(t.owesMoneyHousingProgram))} 196 ${t.owesMoneyExplain?d("Money Owed Explanation",p(t.owesMoneyExplain)):""} 197 ${d("Previous Eviction",J(t.previousEviction))} 198 ${d("Evicted from a Housing Program",w(t.evictionHousingProgram))} 199 ${t.evictionExplain?d("Eviction Explanation",p(t.evictionExplain)):""} 200 ${d("Previous Housing Assistance",J(t.previousHousingAssistance))} 201 ${d("Has a Previous Landlord",t.hasPreviousLandlord==="yes"?"Yes":t.hasPreviousLandlord==="no"?"No":"Not answered")} 202 ${t.hasPreviousLandlord==="yes"?d("Previous Landlord Name",p(t.previousLandlordName))+d("Previous Landlord Phone",p(t.previousLandlordPhone))+d("Previous Landlord Contact Details",p(t.previousLandlordInfo)):""} 203 </table> 204 ${t.priorSubsidyDetails?X("Prior Subsidy Details:",p(t.priorSubsidyDetails)):""} 205 ${t.housingHistoryNotes?X("Notes:",p(t.housingHistoryNotes)):""} 206 207 ${Y("DOCUMENTATION STATUS")} 208 <table style="width:100%;border-collapse:collapse;margin:0;"> 209 ${d("Valid ID",Ae(t.hasId))} 210 ${d("Birth Certificate",Ae(t.hasBirthCertificate))} 211 ${d("Social Security Card",Ae(t.hasSocialSecurityCard))} 212 ${d("Social Security Number",p(t.socialSecurityNumber))} 213 ${d("Has a Bank Account",Ae(t.hasBankAccount))} 214 ${t.hasBankAccount?d("Bank Name",p(t.bankName)):""} 215 ${t.hasBankAccount?d("Has Copies of Bank Statements",t.hasBankStatements==="yes"?"Yes":t.hasBankStatements==="no"?"No":"Not answered"):""} 216 ${d("Proof of Income",Ae(t.hasProofOfIncome))} 217 ${d("Place of Birth",p(t.placeOfBirth))} 218 ${d("Mother's Name",p(t.motherName))} 219 ${d("Mother's Maiden Name",p(t.motherMaidenName))} 220 ${d("Father's Name",p(t.fatherName))} 221 ${d("Monthly Income",p(t.monthlyIncome)||(Be.length?He(na):""))} 222 </table> 223 224 ${Y("PERSONAL INFORMATION")} 225 <table style="width:100%;border-collapse:collapse;margin:0;"> 226 ${d("Veteran Status",J(t.isVeteran))} 227 ${d("Disability Types",De(t.disabilityTypes))} 228 ${d("Social Worker Contact",p(t.socialWorkerContact))} 229 </table> 230 ${t.disabilityNotes?X("Disability Notes:",p(t.disabilityNotes)):""} 231 232 ${yt} 233 234 ${Y("HOUSING APPLICATION READINESS")} 235 <table style="width:100%;border-collapse:collapse;margin:0;"> 236 ${Object.entries(pa).map(([s,k])=>
236{const D=t.applicationDetails?.[s],L=Array.isArray(D)?D.map(Te=>String(Te).replace(/_/g," ")).join(", "):D==="yes"?"Yes":D==="no"?"No":D;return d(k,p(L||"Not answered"))}).join("")} 237 </table> 238 ${X("Occupancy review:","Acceptable bedroom sizes are preferences only. Children and overnight visitation do not automatically qualify a household for a two-bedroom unit. Housing program review and supporting documentation are required.")} 239 240 ${Y("ASSESSMENT SUMMARY")} 241 ${X("Top Priorities:",t.topPriorities?p(t.topPriorities):'<span style="color:#9ca3af;">Not specified</span>')} 242 ${X("Plan of Action:",t.planOfAction?p(t.planOfAction):'<span style="color:#9ca3af;">Not specified</span>')} 243 ${X("Recommendations:",t.recommendations?p(t.recommendations):'<span style="color:#9ca3af;">None</span>')} 244 245 <table style="width:100%;border-collapse:collapse;margin-top:44px;"> 246 <tr> 247 <td style="width:290px;border-bottom:1px solid #374151;height:28px;padding:0;"> </td> 248 <td style="width:60px;padding:0;"> </td> 249 <td style="width:290px;border-bottom:1px solid #374151;height:28px;padding:0;"> </td> 250 </tr> 251 <tr> 252 <td style="font-size:11px;color:#6b7280;padding:4px 0 0 0;">Staff Signature / Date</td> 253 <td style="padding:0;"> </td> 254 <td style="font-size:11px;color:#6b7280;padding:4px 0 0 0;">Participant Signature / Date</td> 255 </tr> 256 </table> 257 258 <table style="width:100%;border-collapse:collapse;margin-top:28px;"> 259 <tr><td style="border-top:1px solid #e5e7eb;padding:10px 0 0 0;font-size:8px;color:#9ca3af;">CONFIDENTIALITY NOTICE: This document contains Protected Health Information (PHI) subject to HIPAA regulations (45 CFR Parts 160 and 164). Unauthorized disclosure, copying, or distribution is strictly prohibited. If you received this document in error, please destroy it immediately and notify Care Remedy Inc.</td></tr> 260 </table> 261 <table style="width:100%;margin-top:12px;padding-top:16px;border-top:2px solid #e5e7eb;" cellpadding="0" cellspacing="0"> 262 <tr> 263 <td style="font-size:11px;color:#9ca3af;vertical-align:top;"> 264 CareRemedy Inc. - Confidential<br> 265 Generated ${new Date().toLocaleDateString("en-US",{year:"numeric",month:"long",day:"numeric"})} at ${new Date().toLocaleTimeString("en-US",{hour:"2-digit",minute:"2-digit"})} 266 </td> 267 <td style="font-size:11px;color:#9ca3af;text-align:right;vertical-align:top;"> 268 Assessment ID: ${n?.id?.substring(0,8)||"Draft"}<br> 269 Client ID: ${j.substring(0,8)} 270 </td> 271 </tr> 272 </table> 273 </body> 274 </html> 275 `;try{const s=await fetch("/api/assessments/download",{method:"POST",headers:{"Content-Type":"application/json"},credentials:"include",body:JSON.stringify({htmlContent:ft,clientId:j,format:a,clientName:l})});if(!s.ok)throw new Error("Download failed");const k=await s.blob(),D=window.URL.createObjectURL(k),L=document.createElement("a");L.href=D;const Te=l.replace(/[^a-zA-Z0-9]/g,"_");L.download=`Initial_Assessment_${Te}_${new Date().toISOString().split("T")[0]}.${a}`,document.body.appendChild(L),L.click(),window.URL.revokeObjectURL(D),document.body.removeChild(L),N({title:"Assessment Downloaded",description:a==="docx"?"Word document downloaded successfully.":"Open the file and use Ctrl+P to save as PDF."})}catch(s){console.error("Download error:",s),N({title:"Download Failed",description:"Please try again or contact support.",variant:"destructive"})}},wa=i.watch(),Wa={participant:["staffId","assessmentDate","currentAddress"],documents:["hasId","hasBirthCertificate","hasSocialSecurityCard"],housing:["housingStatus","housingSetting","preferredTown1","unitSize","housingType"],history:["previousAddress","yearsAtPreviousAddress"],income:["monthlyIncome","hasProofOfIncome","hasBankAccount","bankName","hasBankStatements"],accessibility:["disabilityTypes"],contacts:["socialWorkerContact"],application:["primarySpokenLanguage","householdChangesExpected","incomeChangesExpected"],plan:["topPriorities","planOfAction","recommendations"]},qa=a=>
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text-primary-foreground border-primary":"bg-background hover:bg-muted"}`,"data-testid":`tri-prevres-deposit-${r}-${o}`,children:o==="na"?"N/A":o.toUpperCase()},o))})]}),e.jsx("div",{className:"md:col-span-1 flex justify-end",children:e.jsx(S,{type:"button",variant:"ghost",size:"sm",onClick:()=>{const o=[...a.value];o.splice(r,1),a.onChange(o)},"data-testid":`button-remove-previous-residence-${r}`,children:e.jsx(je,{className:"h-4 w-4"})})})]},r)})]})})]}),e.jsxs("div",{className:"space-y-3",children:[e.jsxs("div",{className:"flex items-center justify-between gap-2",children:[e.jsx("h4",{className:"text-sm font-semibold",children:"Personal references"}),e.jsx(S,{type:"button",variant:"outline",size:"sm",onClick:()=>{const a=i.getValues("personalReferences")||[];i.setValue("personalReferences",[...a,{name:"",relationship:"",phone:"",address:""}],{shouldDirty:!0})},"data-testid":"button-add-personal-reference",children:"+ Add reference"})]}),e.jsx(m,{control:i.control,name:"personalReferences",render:({field:a})=>e.jsxs("div",{className:"space-y-2",children:[(a.value||[]).length===0&&e.jsx("p",{className:"text-xs text-muted-foreground",children:"No personal references added."}),(a.value||[]).map((t,r)=>{const l=o=>{const v=[...a.value];v[r]={...v[r],...o},a.onChange(v)};return e.jsxs("div",{className:"grid grid-cols-1 md:grid-cols-12 gap-2 items-end border rounded-md p-3","data-testid":`row-personal-reference-${r}`,children:[e.jsxs("div",{className:"md:col-span-3",children:[e.jsx(y,{className:"text-xs",children:"Name"}),e.jsx(g,{value:t.name||"",onChange:o=>l({name:o.target.value}),"data-testid":`input-ref-name-${r}`})]}),e.jsxs("div",{className:"md:col-span-3",children:[e.jsx(y,{className:"text-xs",children:"Relationship"}),e.jsx(g,{value:t.relationship||"",onChange:o=>l({relationship:o.target.value}),"data-testid":`input-ref-rel-${r}`})]}),e.jsxs("div",{className:"md:col-span-2",children:[e.jsx(y,{className:"text-xs",children:"Phone"}),e.jsx(g,{value:t.phone||"",onChange:o=>l({phone:o.target.value}),"data-testid":`input-ref-phone-${r}`})]}),e.jsxs("div",{className:"md:col-span-3",children:[e.jsx(y,{className:"text-xs",children:"Address"}),e.jsx(g,{value:t.address||"",onChange:o=>l({address:o.target.value}),"data-testid":`input-ref-address-${r}`})]}),e.jsx("div",{className:"md:col-span-1 flex justify-end",children:e.jsx(S,{type:"button",variant:"ghost",size:"sm",onClick:()=>{const o=[...a.value];o.splice(r,1),a.onChange(o)},"data-testid":`button-remove-personal-reference-${r}`,children:e.jsx(je,{className:"h-4 w-4"})})})]},r)})]})})]}),e.jsxs("div",{className:"space-y-3",children:[e.jsx("h4",{className:"text-sm font-semibold",children:"Criminal record follow-ups"}),e.jsxs("div",{className:"grid grid-cols-1 md:grid-cols-2 gap-3",children:[e.jsx(m,{control:i.control,name:"pendingCriminalMatters",render:({field:a})=>e.jsxs(u,{className:"border rounded-md p-3 bg-card",children:[e.jsx(h,{className:"text-sm",children:"Any pending criminal matters?"}),e.jsx(G,{value:a.value,onChange:a.onChange,testid:"pending-criminal"})]})}),e.jsx(m,{control:i.control,name:"drugViolentCrimeConviction",render:({field:a})=>e.jsxs(u,{className:"border rounded-md p-3 bg-card",children:[e.jsx(h,{className:"text-sm",children:"Ever convicted of a drug-related or violent crime?"}),e.jsx(G,{value:a.value,onChange:a.onChange,testid:"drug-violent-crime"})]})}),e.jsx(m,{control:i.control,name:"pendingCriminalMattersExplain",render:({field:a})=>e.jsxs(u,{children:[e.jsx(h,{className:"text-sm",children:"Explanation (if yes)"}),e.jsx(x,{children:e.jsx(R,{placeholder:"Explainâ¦",...a,"data-testid":"input-pending-criminal-explain"})})]})}),e.jsx(m,{control:i.control,name:"drugViolentCrimeExplain",render:({field:a})=>e.jsxs(u,{children:[e.jsx(h,{className:"text-sm",children:"Explanation (if yes)"}),e.jsx(x,{children:e.jsx(R,{placeholder:"Explainâ¦",...a,"data-testid":"input-drug-violent-crime-ex
275plain"})})]})})]})]}),e.jsxs("div",{className:"space-y-3",children:[e.jsx("h4",{className:"text-sm font-semibold",children:"Rental history â housing programs"}),e.jsxs("div",{className:"grid grid-cols-1 md:grid-cols-2 gap-3",children:[e.jsx(m,{control:i.control,name:"owesMoneyHousingProgram",render:({field:a})=>e.jsxs(u,{className:"border rounded-md p-3 bg-card",children:[e.jsx(h,{className:"text-sm",children:"Do you owe money to any housing program?"}),e.jsx(G,{value:a.value,onChange:a.onChange,testid:"owes-money"})]})}),e.jsx(m,{control:i.control,name:"evictionHousingProgram",render:({field:a})=>e.jsxs(u,{className:"border rounded-md p-3 bg-card",children:[e.jsx(h,{className:"text-sm",children:"Ever evicted from a housing program?"}),e.jsx(G,{value:a.value,onChange:a.onChange,testid:"eviction-program"})]})}),e.jsx(m,{control:i.control,name:"owesMoneyExplain",render:({field:a})=>e.jsxs(u,{children:[e.jsx(h,{className:"text-sm",children:"Explanation (if yes)"}),e.jsx(x,{children:e.jsx(R,{placeholder:"Explainâ¦",...a,"data-testid":"input-owes-money-explain"})})]})}),e.jsx(m,{control:i.control,name:"evictionExplain",render:({field:a})=>e.jsxs(u,{children:[e.jsx(h,{className:"text-sm",children:"Explanation (if yes)"}),e.jsx(x,{children:e.jsx(R,{placeholder:"Explainâ¦",...a,"data-testid":"input-eviction-explain"})})]})}),e.jsx(m,{control:i.control,name:"priorSubsidyDetails",render:({field:a})=>e.jsxs(u,{className:"md:col-span-2",children:[e.jsx(h,{className:"text-sm",children:"Prior subsidy detail (head-of-household name at the time, agency, still living there, move-out date, lease compliance)"}),e.jsx(x,{children:e.jsx(R,{placeholder:"Provide detailsâ¦",...a,"data-testid":"input-prior-subsidy-details"})})]})})]})]})]})]})]}),e.jsxs(ne,{value:"plan","data-section":"plan",className:"border rounded-md",children:[e.jsx(re,{className:"px-4 hover:no-underline",children:ae("plan",e.jsx(ca,{className:"h-4 w-4"}))}),e.jsxs(oe,{className:"px-4 pb-4 cv-auto",children:[de("plan"),e.jsxs("div",{className:"space-y-4",children:[e.jsx(m,{control:i.control,name:"topPriorities",render:({field:a})=>e.jsxs(u,{children:[e.jsx(h,{children:"Top Priorities"}),e.jsx(x,{children:e.jsx(R,{placeholder:"What are the immediate priorities for this client?",...a,"data-testid":"input-top-priorities"})}),e.jsx(f,{})]})}),e.jsx(m,{control:i.control,name:"planOfAction",render:({field:a})=>e.jsxs(u,{children:[e.jsx(h,{children:"Plan of Action"}),e.jsx(x,{children:e.jsx(R,{placeholder:"Outline the steps to help this client achieve housing",...a,"data-testid":"input-plan-of-action"})}),e.jsx(f,{})]})}),e.jsx(m,{control:i.control,name:"recommendations",render:({field:a})=>e.jsxs(u,{children:[e.jsx(h,{children:"Recommendations"}),e.jsx(x,{children:e.jsx(R,{placeholder:"Any additional recommendations or notes for the case",...a,"data-testid":"input-recommendations"})}),e.jsx(f,{})]})})]})]})]})]}),e.jsx("div",{className:"flex justify-end pt-4 border-t",children:e.jsxs(S,{type:"submit",disabled:Se||fe.status==="saving","data-testid":"button-save-assessment-bottom",children:[Se?e.jsx(we,{className:"h-4 w-4 animate-spin"}):e.jsx(Ia,{className:"h-4 w-4"}),e.jsx("span",{className:"ml-2",children:n||ba?"Update Assessment":"Save Assessment"})]})})]})})}export{ps as InitialAssessmentForm};
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