1"use strict";(self.webpackChunk_N_E=self.webpackChunk_N_E||[]).push([[4713],{4713:(e,s,t)=>{t.d(s,{A:()=>g});var a=t(7876),l=t(8048),n=t(4440),i=t(223),r=t(9099),c=t(4232),o=t(9200),x=t.n(o),m=t(1408);t(5833);var d=t(7460),u=t(2276),h=t(9368),p=t(8482),f=t(2128),N=t(1423),j=t(9454),y=t(8230),b=t.n(y);let g=e=>{let{font:s}=e,[t,o]=(0,c.useState)(1),[y,g]=(0,c.useState)(!1),v=(0,r.useRouter)(),q=m.Ik().shape({fname:m.Yj().required("Required"),surname:m.Yj().required("Required"),gender:m.Yj().required("Required"),dob:m.Yj().required("Required"),moNumber:m.Yj().required("Required"),email:m.Yj().required("Required"),confirmEmail:m.Yj().oneOf([m.KR("email")],"Email must be match").required("This field is required"),streetAddress:m.Yj().required("Required"),suburb:m.Yj().required("Required"),state:m.Yj().required("Required"),postCode:m.Yj().required("Required"),medicareNumber:m.Yj().matches(/^\d{10}$/,"Only ten-digit number allowed"),medicareReference:m.Yj().matches(/^\d{1}$/,"Only one-digit number allowed"),file:m.gl().required(),payerName:m.Yj().required("Required")}),w=async(e,s)=>{let{resetForm:t}=s;g(!0),console.log(null==e?void 0:e.file[0]);let a=(0,N.A)();j.A.set("transaction_unique_id",a,{expires:15/1440});let l="";var i=new Date,r="".concat(i.getHours()).concat(i.getMinutes()).concat(i.getSeconds()),c=null==e?void 0:e.file[0];if(c){var o=(0,f.KR)(p.I,"documentId/".concat(r,"-").concat(c.name));let s=(0,f.bp)(o,c);s.on("state_changed",e=>{let{bytesTransferred:s,totalBytes:t}=e},e=>{console.error(e)},()=>{console.log(!0),(0,f.qk)(s.snapshot.ref).then(async s=>{function a(e){let s=new Date(e),t=s.getTimezoneOffset(),a=new Date(s.getTime()-(t-240)*6e4);return(0,n.default)(a,"yyyy-MM-dd")}l=s;let i=a(e.startDate),r=a(e.endDate);console.log(i),console.log(r);let c=[{text:"Musculoskeletal pain (Any joint pains including back pain, upper limbs and lower limb pains) questionnaire for medical certificate",style:"header"},{text:"Note: NO REFUNDS. Sick notes are issued for a maximum of Three consecutive calendar days. Illnesses exceeding this require in-person consultation. Back-dated certificates are only provided for the previous day. If this is unexpected please quit and do not book an appointment.",style:"bodyText"}
1,{text:"Please select the Dates you need the medical certificate for",style:"question"},{columns:[{text:"Start Date",style:"question"},{text:"End Date",style:"question"}]},{columns:[{text:i,style:"answer"},{text:r,style:"answer"}]},{text:"Have you had a medical certificate from Panraa clinics for full three days in the last 10 Days ",style:"question"},{text:e.certificate_in_last_seven_days,style:"answer"},{text:"Note: If this is a carerâs certificate for yourself as being the carer of an unwell child or unwell person, please fill this form with details of the unwell child or unwell person and write your name as carer when asked. The certificate will have the name of the patient and carer. Thanks",style:"bodyText"},{text:"I confirm that I have pain in my back or one of the joints or muscles of my body including upper limb lower limb or neck pain",style:"question"},{text:e.questionOne,style:"answer"},{text:"Please write in the box where you have pain e.g: lower back pain ",style:"question"},{text:e.questionTwo,style:"answer"},{text:"I confirm that I feel fine and that this doesnât require investigation or assessment",style:"question"},{text:e.questionThree,style:"answer"},{text:"I confirm that I donot have any numbness or weakness in the area involved",style:"question"},{text:e.questionFour,style:"answer"},{text:"I confirm that I am able to walk without support and able to move and use all four limbs",style:"question"},{text:e.questionFive,style:"answer"},{text:"I confirm that I have not been in a Motor Vehicle accident in the last 2 weeks",style:"question"},{text:e.questionSix,style:"answer"},{text:"I confirm that the pain is mild and is relieved with simple Panadol or Neurofen",style:"question"},{text:e.questionSeven,style:"answer"},{text:"I confirm that I do not have fever, rigor, chills, neck stiffness and rash on the body",style:"question"},{text:e.questionEight,style:"answer"},{text:"I confirm that I do NOT have any of the following symptoms currently",style:"question"},{ul:["Chest pain","Shortness of breath on minimal exertion e.g. like having a shower or walking indoor.","Uncontrollable cough","Fever, rigors and chills","Drenching sweats","Completely bed ridden due to severe illness","Unable to swallow fluids or saliva","Weakness or numbness down one side","Slurred speech"]},{text:e.questionNine,style:"answer"},{text:"I confirm that I have no difficulty in passing urine and stools",style:"question"},{text:e.questionTen,style:"answer"},{text:"I confirm that I can use all four limbs without any issues",style:"question"},{text:e.questionEleven,style:"answer"},{text:"I confirm that itâs a mild pain and I do not have to see my GP in person",style:"question"},{text:e.questionTwelve,style:"answer"},{text:"I confirm that if I feel unwell I will make sure to see my GP or go to ED",style:"question"},{text:e.questionThirteen,style:"answer"},{text:"I confirm that my age is 18 years or above?",style:"question"},{text:e.questionFourteen,style:"answer"},{text:"I confirm that this certificate is not for work cover /TAC claims or any form of injury or insurance claim",style:"question"},{text:e.questionFifteen,style:"answer"},{text:"Parents and Adult guardians of under 18-year-old children must provide their Full name, Mobile number, and Email address in the space provided below.",style:"question"},{text:e.questionSeventeen,style:"answer"},{text:"Consents",style:"question"},{text:"You must consent to all declarations in order to use this service.",style:"question"},{ul:["I confirm that I understand the limitations of an online consultation","I confirm that I am aware that this may not replace the need for a face to face consultation and examination with my GP","I confirm that if I have any concerns about any aspect of my health I will consult with my regular GP","I confirm that I take responsibility for informing my GP of this consultation and any subsequent health issues","I confirm that I understand Panraa Clinics is not liable for damages which arise from my failure to inform my GP or other healthcare professional about treatment I receive from the website","I confirm that I agree to the website privacy policy and terms and conditions","I confirm that I have read the refund policy in the FAQs section and I agree to this policy","I confirm and understand that this medical certificate if issued will not be used to cover Court, Parole, and Bail absences and will not be presented for any legal matters."]},{text:e.consents,style:"answer"},{text:"Personal Details",style:"question"},{columns:[{text:"First Name",style:"question"},{text:"Surname",style:"question"},{text:"Gender",style:"question"}]},{columns:[{text:e.fname,style:"answer"},{text:e.surname,style:"answer"},{text:e.gender,style:"answer"}]},{columns:[{text:"Date of Birth",style:"question"},{text:"Mobile Phone",style:"question"},{text:"Email",style:"question"}]},{columns:[{style:"answer",text:e.dob},{style:"answer",text:e.moNumber},{style:"answer",text:e.email}]},{columns:[{text:"Confirm Email",style:"question"}]},{columns:[{style:"answer",text:e.confirmEmail}]},{text:"Address",style:"question"},{columns:[{text:"Street Address",style:"question"}]},{columns:[{style:"answer",text:e.streetAddress}]},{columns:[{text:"Address Line 2",style:"question"}]},{columns:[{style:"answer",text:e.addressLine2}]},{columns:[{text:"Suburb",style:"question"},{text:"State",style:"question"}]},{columns:[{style:"answer",text:e.suburb},{style:"answer",text:e.state}]},{columns:[{text:"Postcode",style:"question"}]},{columns:[{style:"answer",text:e.postCode}]},{columns:[{text:"Medicare Number",style:"question"},{text:"Medicare Reference",style:"question"}]},{columns:[{style:"answer",text:e.medicareNumber},{style:"answer",text:e.medicareReference}]},{columns:[{text:"Medicare Expiry Date",style:"question"},{text:"Uploaded Document Id",style:"question"}]},{columns:[{style:"answer",text:e.medicareExpiryDate},{style:"link",text:"Click Here",link:l}]},{columns:[{text:"Please enter the full name of the person whose credit card is being used so we can match this consult to payment thanks",style:"question"}]},{columns:[{style:"answer",text:e.payerName}]}];try{let s=await fetch("/api/getPatientByMedicare",{method:"POST",body:JSON.stringify(e)});if(s.ok){let e=await s.json();localStorage.setItem("patientId",null==e?void 0:e.patientId);try{let s=await fetch("/api/generatePdf",{method:"POST",body:JSON.stringify(c)}),a=await s.json();console.log("onSubmitData -",a);try{let s=await fetch("/api/addCorrespondenceIn",{method:"POST",body:JSON.stringify({pdfLink:a.pdfLink,patientId:e.patientId})}),l=await s.json();console.log("onSubmitCorresData -",l),v.push("https://buy.stripe.com/8wM17Xad3a1K0JG7sG"),t(),g(!1)}catch(e){console.error("An error occurred while submitting the form:",e)}}catch(e){console.error("An error occurred while submitting the form:",e)}}else try{if((await fetch("/api/submitForm",{method:"POST",body:JSON.stringify(e)})).ok){let s=await fetch("/api/getPatientByMedicare",{method:"POST",body:JSON.stringify(e)});if(s.ok){let e=await s.json();localStorage.setItem("patientId",null==e?void 0:e.patientId);try{let s=await fetch("/api/generatePdf",{method:"POST",body:JSON.stringify(c)}),a=await s.json();console.log("onSubmitData -",a);try{let s=await fetch("/api/addCorrespondenceIn",{method:"POST",body:JSON.stringify({pdfLink:a.pdfLink,patientId:e.patientId})}),l=await s.json();console.log("onSubmitCorresData -",l),v.push("https://buy.stripe.com/8wM17Xad3a1K0JG7sG"),t(),g(!1)}catch(e){console.error("An error occurred while submitting the form:",e)}}catch(e){console.error("An error occurred while submitting the form:",e)}}else console.error("Form submission failed.")}else console.error("Form submission failed.")}catch(e){console.error("An error occurred while submitting the form:",e)}}catch(e){console.error("An error occurred while submitting the form:",e)}})})}};return(0,a.jsxs)("div",{children:[(0,a.jsxs)("p",{className:"".concat(s.className," text-center text-sm text-slate-100 font-light mb-7 xl:mb-9 xl:text-base"),children:["ââ Step ",t," / 20 ââ"]}
1),(0,a.jsx)("div",{children:(0,a.jsx)(i.l1,{initialValues:{certificate_in_last_seven_days:"",questionOne:"",questionTwo:"",questionThree:"",questionFour:"",questionFive:"",questionSix:"",questionSeven:"",questionEight:"",questionNine:"",questionTen:"",questionEleven:"",questionTwelve:"",questionThirteen:"",questionFourteen:"",questionFifteen:"",startDate:null,endDate:null,questionSeventeen:"",consents:!1,fname:"",surname:"",gender:"",dob:"",moNumber:"",email:"",confirmEmail:"",streetAddress:"",addressLine2:"",suburb:"",state:"",postCode:"",medicareNumber:"",medicareReference:"",medicareExpiryDate:"",file:"",payerName:""},validationSchema:q,onSubmit:w,children:e=>{let{values:n,errors:r,touched:c,submitCount:m,setFieldValue:p}=e;return(0,a.jsx)(i.lV,{className:"st-form",children:(e=>{let{values:n,errors:r,touched:c,submitCount:m,setFieldValue:p}=e;switch(t){case 1:return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card",children:[(0,a.jsxs)("div",{className:"text-cyan-950 bg-cyan-100 p-2 text-xs mb-5 rounded-sm xl:mb-7 xl:text-sm",children:[(0,a.jsxs)("p",{children:[(0,a.jsx)("span",{className:"font-medium",children:"Note:"})," ",(0,a.jsx)("strong",{children:"NO REFUNDS."})," Sick notes are issued for a maximum of ",(0,a.jsx)("strong",{children:"Three"})," consecutive calendar days. Illnesses exceeding this require in-person consultation. Back-dated certificates are only provided for the previous day. If this is unexpected please quit and do not book an appointment."]}),(0,a.jsx)("br",{}),(0,a.jsxs)("p",{children:["If you wish to get a certificate for carer, click here: ",(0,a.jsx)(b(),{className:"font-bold",href:"/carers-certificate",target:"_blank",rel:"noopener noreferrer",children:"Carer's Certificate"})]})]}),(0,a.jsx)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left xl:text-2xl xl:tracking-[-0.6px] mb-4"),children:"Please select the Dates
1you need the medical certificate for"}),(0,a.jsxs)("div",{className:"flex flex-col gap-8 md:flex-row md:gap-40",children:[(0,a.jsxs)("label",{htmlFor:"startDate",className:"inline-flex flex-col-reverse gap-2 items-start ",children:[(0,a.jsx)(i.D0,{children:()=>(0,a.jsx)(x(),{selected:n.startDate,onChange:e=>p("startDate",e),minDate:(0,l.default)(new Date,-1),maxDate:new Date,dateFormat:"dd/MM/yyyy",showDisabledMonthNavigation:!0})}),(0,a.jsxs)("p",{className:"".concat(s.className," text-slate-950 text-left xl:text-xl "),children:["Start Date"," ",(0,a.jsx)("span",{className:"text-xl text-red-700 -mt-2",children:"*"})]})]}),n.startDate&&(0,a.jsxs)("label",{htmlFor:"endDate",className:"inline-flex flex-col-reverse gap-2 items-start ",children:[(0,a.jsx)(i.D0,{children:()=>(0,a.jsx)(x(),{selected:n.endDate,onChange:e=>p("endDate",e),minDate:n.startDate,maxDate:(0,l.default)(n.startDate,2),dateFormat:"dd/MM/yyyy",showDisabledMonthNavigation:!0})}),(0,a.jsxs)("p",{className:"".concat(s.className," text-slate-950 text-left xl:text-xl"),children:["End Date"," ",(0,a.jsx)("span",{className:"text-xl text-red-700 -mt-2",children:"*"})]})]})]})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),disabled:1==t,children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t+1)},disabled:!!(null==n.startDate||null==n.endDate||n.endDate<n.startDate||n.endDate>(0,l.default)(n.startDate,2)),className:"".concat(s.className," button-ternary"),children:[(0,a.jsx)("span",{className:"mt-1",children:"Next"}),(0,a.jsx)(d.g,{icon:u.vmR})]})]})]});case 2:return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card flex flex-col gap-4 xl:gap-5",children:[(0,a.jsxs)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left xl:text-2xl xl:tracking-[-0.6px]"),children:["Have you had a medical certificate from Panraa clinics for full three days in the last 10 Days"," ",(0,a.jsx)("span",{className:"text-xl text-red-700 -mt-2",children:"*"})]}),(0,a.jsxs)("div",{className:"flex items-center gap-16 xl:gap-20",children:[(0,a.jsxs)("label",{htmlFor:"yes",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"certificate_in_last_seven_days",id:"yes",value:"Yes"}),"Yes"]}),(0,a.jsxs)("label",{htmlFor:"no",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"certificate_in_last_seven_days",id:"no",value:"No"}),"No"]})]}),"Yes"==n.certificate_in_last_seven_days&&(0,a.jsx)("span",{className:"text-red-700 bg-red-100 text-xs px-1.5 py-1 xl:text-sm",children:"Please quit now as your appointment will be automatically cancelled and no refund provided because we donot provide extensions under any circumstances, the consult will not be even presented to the doctor"})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t+1)},disabled:"No"!=n.certificate_in_last_seven_days,className:"".concat(s.className," button-ternary"),children:[(0,a.jsx)("span",{className:"mt-1",children:"Next"}),(0,a.jsx)(d.g,{icon:u.vmR})]})]})]});case 3:return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card flex flex-col gap-4 xl:gap-5",children:[(0,a.jsxs)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left xl:text-2xl xl:tracking-[-0.6px]"),children:["I confirm that I have pain in my back or one of the joints or muscles of my body including upper limb lower limb or neck pain"," ",(0,a.jsx)("span",{className:"text-xl text-red-700 -mt-2",children:"*"})]}),(0,a.jsxs)("div",{className:"flex items-center gap-16 xl:gap-20",children:[(0,a.jsxs)("label",{htmlFor:"yes",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionOne",id:"yes",value:"Yes"}),"Yes"]}),(0,a.jsxs)("label",{htmlFor:"no",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionOne",id:"no",value:"No"}),"No"]})]}),"No"==n.questionOne&&(0,a.jsx)("span",{className:"text-red-700 bg-red-100 text-xs px-1.5 py-1 xl:text-sm",children:"Maybe you have a different issue, please go back and try a different option."})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t+1)},disabled:"Yes"!=n.questionOne,className:"".concat(s.className," button-ternary"),children:[(0,a.jsx)("span",{className:"mt-1",children:"Next"}),(0,a.jsx)(d.g,{icon:u.vmR})]})]})]});case 4:return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card flex flex-col gap-4 xl:gap-5",children:[(0,a.jsxs)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left xl:text-2xl xl:tracking-[-0.6px]"),children:["Please write in the box where you have pain e.g: lower back pain"," ",(0,a.jsx)("span",{className:"text-xl text-red-700 -mt-2",children:"*"})]}),(0,a.jsx)(i.D0,{type:"text",name:"questionTwo"})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t+1)},disabled:""!=!n.questionTwo,className:"".concat(s.className," button-ternary"),children:[(0,a.jsx)("span",{className:"mt-1",children:"Next"}),(0,a.jsx)(d.g,{icon:u.vmR})]})]})]});case 5:return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card flex flex-col gap-4 xl:gap-5",children:[(0,a.jsxs)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left xl:text-2xl xl:tracking-[-0.6px]"),children:["I confirm that I feel fine and that this doesnât require investigation or assessment"," ",(0,a.jsx)("span",{className:"text-xl text-red-700 -mt-2",children:"*"})]}),(0,a.jsxs)("div",{className:"flex items-center gap-16 xl:gap-20",children:[(0,a.jsxs)("label",{htmlFor:"yes",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionThree",id:"yes",value:"Yes"}),"Yes"]}),(0,a.jsxs)("label",{htmlFor:"no",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionThree",id:"no",value:"No"}),"No"]})]}),"No"==n.questionThree&&(0,a.jsx)("span",{className:"text-red-700 bg-red-100 text-xs px-1.5 py-1 xl:text-sm",children:"Please see your GP for clinical examination and investigations, sorry this platform is not for you."})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t+1)},disabled:"Yes"!=n.questionThree,className:"".concat(s.className," button-ternary"),children:[(0,a.jsx)("span",{className:"mt-1",children:"Next"}),(0,a.jsx)(d.g,{icon:u.vmR})]})]})]});case 6:return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card flex flex-col gap-4 xl:gap-5",children:[(0,a.jsxs)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left xl:text-2xl xl:tracking-[-0.6px]"),children:["I confirm that I donot have any numbness or weakness in the area involved ",(0,a.jsx)("span",{className:"text-xl text-red-700 -mt-2",children:"*"})]}),(0,a.jsxs)("div",{className:"flex items-center gap-16 xl:gap-20",children:[(0,a.jsxs)("label",{htmlFor:"yes",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionFour",id:"yes",value:"Yes"}),"Yes"]}),(0,a.jsxs)("label",{htmlFor:"no",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionFour",id:"no",value:"No"}),"No"]})]}),"No"==n.questionFour&&(0,a.jsx)("span",{className:"text-red-700 bg-red-100 text-xs px-1.5 py-1 xl:text-sm",children:"Please see your GP for clinical examination and investigations, sorry this platform is not for you."})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t+1)},disabled:"Yes"!=n.questionFour,className:"".concat(s.className," button-ternary"),children:[(0,a.jsx)("span",{className:"mt-1",children:"Next"}),(0,a.jsx)(d.g,{icon:u.vmR})]})]})]});case 7:return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card flex flex-col gap-4 xl:gap-5",children:[(0,a.jsxs)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left xl:text-2xl xl:tracking-[-0.6px]"),children:["I confirm that I am able to walk without support and able to move and use all four limbs",(0,a.jsx)("span",{className:"text-xl text-red-700 -mt-2",children:"*"})]}),(0,a.jsxs)("div",{className:"flex items-center gap-16 xl:gap-20",children:[(0,a.jsxs)("label",{htmlFor:"yes",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionFive",id:"yes",value:"Yes"}),"Yes"]}),(0,a.jsxs)("label",{htmlFor:"no",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionFive",id:"no",value:"No"}),"No"]})]}),"No"==n.questionFive&&(0,a.jsx)("span",{className:"text-red-700 bg-red-100 text-xs px-1.5 py-1 xl:text-sm",children:"Please see your GP for clinical examination and investigations, sorry this platform is not for you"})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t+1)},disabled:"Yes"!=n.questionFive,className:"".concat(s.className," button-ternary"),children:[(0,a.jsx)("span",{className:"mt-1",children:"Next"}),(0,a.jsx)(d.g,{icon:u.vmR})]})]})]});case 8:return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card flex flex-col gap-4 xl:gap-5",children:[(0,a.jsxs)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left xl:text-2xl xl:tracking-[-0.6px]"),children:["I confirm that I have not been in a Motor Vehicle accident in the last 2 weeks",(0,a.jsx)("span",{className:"text-xl text-red-700 -mt-2",children:"*"})]}),(0,a.jsxs)("div",{className:"flex items-center gap-16 xl:gap-20",children:[(0,a.jsxs)("label",{htmlFor:"yes",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionSix",id:"yes",value:"Yes"}),"Yes"]}),(0,a.jsxs)("label",{htmlFor:"no",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionSix",id:"no",value:"No"}),"No"]})]}),"No"==n.questionSix&&(0,a.jsx)("span",{className:"text-red-700 bg-red-100 text-xs px-1.5 py-1 xl:text-sm",children:"Please see your GP for clinical examination and investigations, sorry this platform is not for you"})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t+1)},disabled:"Yes"!=n.questionSix,className:"".concat(s.className," button-ternary"),children:[(0,a.jsx)("span",{className:"mt-1",children:"Next"}),(0,a.jsx)(d.g,{icon:u.vmR})]})]})]});case 9:return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card flex flex-col gap-4 xl:gap-5",children:[(0,a.jsxs)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left xl:text-2xl xl:tracking-[-0.6px]"),children:["I confirm that the pain is mild and is relieved with simple Panadol or Neurofen",(0,a.jsx)("span",{className:"text-xl text-red-700 -mt-2",children:"*"})]}),(0,a.jsxs)("div",{className:"flex items-center gap-16 xl:gap-20",children:[(0,a.jsxs)("label",{htmlFor:"YesSeven",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionSeven",id:"YesSeven",value:"Yes"}),"Yes"]}),(0,a.jsxs)("label",{htmlFor:"NoSeven",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionSeven",id:"NoSeven",value:"No"}),"No"]})]}),"No"==n.questionSeven&&(0,a.jsx)("span",{className:"text-red-700 bg-red-100 text-xs px-1.5 py-1 xl:text-sm",children:"Please see your GP for clinical examination and investigations, sorry this platform is not for you"})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t+1)},disabled:"Yes"!=n.questionSeven,className:"".concat(s.className," button-ternary"),children:[(0,a.jsx)("span",{className:"mt-1",children:"Next"}),(0,a.jsx)(d.g,{icon:u.vmR})]})]})]});case 10:return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card flex flex-col gap-4 xl:gap-5",children:[(0,a.jsxs)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left xl:text-2xl xl:tracking-[-0.6px]"),children:["I confirm that I do n
1ot have fever, rigor, chills, neck stiffness and rash on the body",(0,a.jsx)("span",{className:"text-xl text-red-700 -mt-2",children:"*"})]}),(0,a.jsxs)("div",{className:"flex items-center gap-16 xl:gap-20",children:[(0,a.jsxs)("label",{htmlFor:"yes",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionEight",id:"yes",value:"Yes"}),"Yes"]}),(0,a.jsxs)("label",{htmlFor:"no",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionEight",id:"no",value:"No"}),"No"]})]}),"No"==n.questionEight&&(0,a.jsx)("span",{className:"text-red-700 bg-red-100 text-xs px-1.5 py-1 xl:text-sm",children:"Please see your GP for clinical examination and investigations, sorry this platform is not for you"})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t+1)},disabled:"Yes"!=n.questionEight,className:"".concat(s.className," button-ternary"),children:[(0,a.jsx)("span",{className:"mt-1",children:"Next"}),(0,a.jsx)(d.g,{icon:u.vmR})]})]})]});case 11:return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card flex flex-col gap-4 xl:gap-5",children:[(0,a.jsxs)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left xl:text-2xl xl:tracking-[-0.6px]"),children:["I confirm that I do NOT have any of the following symptoms currently",(0,a.jsx)("span",{className:"text-xl text-red-700 -mt-2",children:"*"})]}),(0,a.jsxs)("ul",{className:"text-slate-700 list-disc list-inside",children:[(0,a.jsx)("li",{children:"Chest pain"}),(0,a.jsx)("li",{children:"Shortness of breath on minimal exertion e.g. like having a shower or walking indoor."}),(0,a.jsx)("li",{children:"Uncontrollable cough"}),(0,a.jsx)("li",{children:"Fever, rigors and chills"}),(0,a.jsx)("li",{children:"Drenching sweats"}),(0,a.jsx)("li",{children:"Completely bed ridden due to severe illness"}),(0,a.jsx)("li",{children:"Unable to swallow fluids or saliva"}),(0,a.jsx)("li",{children:"Weakness or numbness down one side"}),(0,a.jsx)("li",{children:" Slurred speech"})]}),(0,a.jsxs)("div",{className:"flex items-center gap-16 xl:gap-20",children:[(0,a.jsxs)("label",{htmlFor:"yes",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionNine",id:"yes",value:"Yes"}),"Yes"]}),(0,a.jsxs)("label",{htmlFor:"no",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionNine",id:"no",value:"No"}),"No"]})]}),"No"==n.questionNine&&(0,a.jsx)("span",{className:"text-red-700 bg-red-100 text-xs px-1.5 py-1 xl:text-sm",children:"Please see your GP for clinical examination and investigations, sorry this platform is not for you"})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t+1)},disabled:"Yes"!=n.questionNine,className:"".concat(s.className," button-ternary"),children:[(0,a.jsx)("span",{className:"mt-1",children:"Next"}),(0,a.jsx)(d.g,{icon:u.vmR})]})]})]});case 12:return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card flex flex-col gap-4 xl:gap-5",children:[(0,a.jsxs)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left xl:text-2xl xl:tracking-[-0.6px]"),children:["I confirm that I have no difficulty in passing urine and stools"," ",(0,a.jsx)("span",{className:"text-xl text-red-700 -mt-2",children:"*"})]}),(0,a.jsxs)("div",{className:"flex items-center gap-16 xl:gap-20",children:[(0,a.jsxs)("label",{htmlFor:"yes",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionTen",id:"yes",value:"Yes"}),"Yes"]}),(0,a.jsxs)("label",{htmlFor:"no",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionTen",id:"no",value:"No"}),"No"]})]}),"No"==n.questionTen&&(0,a.jsx)("span",{className:"text-red-700 bg-red-100 text-xs px-1.5 py-1 xl:text-sm",children:"Please see your GP for clinical examination and investigations, sorry this platform is not for you"})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t+1)},disabled:"Yes"!=n.questionTen,className:"".concat(s.className," button-ternary"),children:[(0,a.jsx)("span",{className:"mt-1",children:"Next"}),(0,a.jsx)(d.g,{icon:u.vmR})]})]})]});case 13:return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card flex flex-col gap-4 xl:gap-5",children:[(0,a.jsxs)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left xl:text-2xl xl:tracking-[-0.6px]"),children:["I confirm that I can use all four limbs without any issues"," ",(0,a.jsx)("span",{className:"text-xl text-red-700 -mt-2",children:"*"})]}),(0,a.jsxs)("div",{className:"flex items-center gap-16 xl:gap-20",children:[(0,a.jsxs)("label",{htmlFor:"yes",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionEleven",id:"yes",value:"Yes"}),"Yes"]}),(0,a.jsxs)("label",{htmlFor:"no",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionEleven",id:"no",value:"No"}),"No"]})]}),"No"==n.questionEleven&&(0,a.jsx)("span",{className:"text-red-700 bg-red-100 text-xs px-1.5 py-1 xl:text-sm",children:"Please see your GP for clinical examination and investigations, sorry this platform is not for you"})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t+1)},disabled:"Yes"!=n.questionEleven,className:"".concat(s.className," button-ternary"),children:[(0,a.jsx)("span",{className:"mt-1",children:"Next"}),(0,a.jsx)(d.g,{icon:u.vmR})]})]})]});case 14:return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card flex flex-col gap-4 xl:gap-5",children:[(0,a.jsxs)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left xl:text-2xl xl:tracking-[-0.6px]"),children:["I confirm that itâs a mild pain and I do not have to see my GP in person",(0,a.jsx)("span",{className:"text-xl text-red-700 -mt-2",children:"*"})]}),(0,a.jsxs)("div",{className:"flex items-center gap-16 xl:gap-20",children:[(0,a.jsxs)("label",{htmlFor:"yes",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionTwelve",id:"yes",value:"Yes"}),"Yes"]}),(0,a.jsxs)("label",{htmlFor:"no",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionTwelve",id:"no",value:"No"}),"No"]})]}),"No"==n.questionTwelve&&(0,a.jsx)("span",{className:"text-red-700 bg-red-100 text-xs px-1.5 py-1 xl:text-sm",children:"Please see your GP for clinical examination and investigations, sorry this platform is not for you"})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t+1)},disabled:"Yes"!=n.questionTwelve,className:"".concat(s.className," button-ternary"),children:[(0,a.jsx)("span",{className:"mt-1",children:"Next"}),(0,a.jsx)(d.g,{icon:u.vmR})]})]})]});case 15:return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card flex flex-col gap-4 xl:gap-5",children:[(0,a.jsxs)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left xl:text-2xl xl:tracking-[-0.6px]"),children:["I confirm that if I feel unwell I will make sure to see my GP or go to ED",(0,a.jsx)("span",{className:"text-xl text-red-700 -mt-2",children:"*"})]}),(0,a.jsxs)("div",{className:"flex items-center gap-16 xl:gap-20",children:[(0,a.jsxs)("label",{htmlFor:"yes",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionThirteen",id:"yes",value:"Yes"}),"Yes"]}),(0,a.jsxs)("label",{htmlFor:"no",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionThirteen",id:"no",value:"No"}),"No"]})]}),"No"==n.questionThirteen&&(0,a.jsx)("span",{className:"text-red-700 bg-red-100 text-xs px-1.5 py-1 xl:text-sm",children:"Please see your GP for clinical examination and investigations, sorry this platform is not for you"})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t+1)},disabled:"Yes"!=n.questionThirteen,className:"".concat(s.className," button-ternary"),children:[(0,a.jsx)("span",{className:"mt-1",children:"Next"}),(0,a.jsx)(d.g,{icon:u.vmR})]})]})]});case 16:return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card flex flex-col gap-4 xl:gap-5",children:[(0,a.jsxs)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left xl:text-2xl xl:tracking-[-0.6px]"),children:["I confirm that my age is 18 years or above?"," ",(0,a.jsx)("span",{className:"text-xl text-red-700 -mt-2",children:"*"})]}),(0,a.jsxs)("div",{className:"flex items-center gap-16 xl:gap-20",children:[(0,a.jsxs)("label",{htmlFor:"yes",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionFourteen",id:"yes",value:"Yes"}),"Yes"]}),(0,a.jsxs)("label",{htmlFor:"no",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionFourteen",id:"no",value:"No"}),"No"]})]}),"No"==n.questionFourteen&&(0,a.jsx)("span",{className:"text-red-700 bg-red-100 text-xs px-1.5 py-1 xl:text-sm",children:"Please see your GP for clinical examination and investigations, sorry this platform is not for you"})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t+1)},disabled:"Yes"!=n.questionFourteen,className:"".concat(s.className," button-ternary"),children:[(0,a.jsx)("span",{className:"mt-1",children:"Next"}),(0,a.jsx)(d.g,{icon:u.vmR})]})]})]});case 17:return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card flex flex-col gap-4 xl:gap-5",children:[(0,a.jsxs)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left xl:text-2xl xl:tracking-[-0.6px]"),children:["I confirm that this certificate is not for work cover /TAC claims or any form of injury or insurance claim"," ",(0,a.jsx)("span",{className:"text-xl text-red-700 -mt-2",children:"*"})]}),(0,a.jsxs)("div",{className:"flex items-center gap-16 xl:gap-20",children:[(0,a.jsxs)("label",{htmlFor:"yes",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionFifteen",id:"yes",value:"Yes"}),"Yes"]}),(0,a.jsxs)("label",{htmlFor:"no",className:"".concat(s.className," text-slate-950 text-lg inline-flex gap-2 items-center xl:gap-2.5 xl:text-xl"),children:[(0,a.jsx)(i.D0,{type:"radio",name:"questionFifteen",id:"no",value:"No"}),"No"]})]}),"No"==n.questionFifteen&&(0,a.jsx)("span",{className:"text-red-700 bg-red-100 text-xs px-1.5 py-1 xl:text-sm",children:"Please see your GP for clinical examination and investigations, sorry this platform is not for you"})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t+1)},disabled:"Yes"!=n.questionFifteen,className:"".concat(s.className," button-ternary"),children:[(0,a.jsx)("span",{className:"mt-1",children:"Next"}),(0,a.jsx)(d.g,{icon:u.vmR})]})]})]});case 18:return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card flex flex-col gap-4 xl:gap-5",children:[(0,a.jsx)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left xl:text-2xl xl:tracking-[-0.6px]"),children:"Parents and Adult guardians of under 18-year-old children must provide their Full name, Mobile number, and Email address in the space provided below."}),(0,a.jsx)(i.D0,{type:"text",name:"questionSeventeen",id:"thirteen"})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t+1)},className:"".concat(s.className," button-ternary"),children:[(0,a.jsx)("span",{className:"mt-1",children:"Next"}),(0,a.jsx)(d.g,{icon:u.vmR})]})]})]});case 19:return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card flex flex-col gap-4 xl:gap-5",children:[(0,a.jsx)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left xl:text-2xl xl:tracking-[-0.6px]"),children:"Consents"}),(0,a.jsx)("p",{className:"text-slate-700 font-medium",children:"You must consent to all declarations in order to use this service."}),(0,a.jsxs)("ul",{className:"".concat(s.className," space-y-2 text-slate-700 xl:text-lg list-disc list-inside"),children:[(0,a.jsx)("li",{children:"I confirm that I understand the limitations of an online consultation"}),(0,a.jsx)("li",{children:"I confirm that I am aware that this may not replace the need for a face to face consultation and examination with my GP"}),(0,a.jsx)("li",{children:"I confirm that if I have any concerns about any aspect of my health I will consult with my regular GP"}),(0,a.jsx)("li",{children:"I confirm that I take responsibility for informing my GP of this consultation and any subsequent health issues"}),(0,a.jsx)("li",{children:"I confirm that I understand Panraa Clinics
1is not liable for damages which arise from my failure to inform my GP or other healthcare professional about treatment I receive from the website"}),(0,a.jsx)("li",{children:"I confirm that I agree to the website privacy policy and terms and conditions"}),(0,a.jsx)("li",{children:"I confirm that I have read the refund policy in the FAQs section and I agree to this policy"}),(0,a.jsx)("li",{children:"I confirm and understand that this medical certificate if issued will not be used to cover Court, Parole, and Bail absences and will not be presented for any legal matters."})]}),(0,a.jsxs)("label",{className:"".concat(s.className," font-medium text-slate-950"),children:[(0,a.jsx)(i.D0,{type:"checkbox",className:"!mt-0",name:"consents",id:"consents"}),(0,a.jsx)("span",{className:"ml-2",children:"I agree with all consents"})]})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t+1)},disabled:!n.consents,className:"".concat(s.className," button-ternary"),children:[(0,a.jsx)("span",{className:"mt-1",children:"Next"}),(0,a.jsx)(d.g,{icon:u.vmR})]})]})]});case 20:var f;return(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("div",{className:"question-card",children:[(0,a.jsx)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left mb-4 xl:mb-6 xl:text-2xl xl:tracking-[-0.6px]"),children:"Personal Details"}),(0,a.jsxs)("div",{className:"grid gap-5 md:grid-cols-2 mb-5 xl:gap-7",children:[(0,a.jsxs)("div",{className:"flex flex-col gap-2",children:[(0,a.jsxs)("label",{htmlFor:"fname",className:"".concat(s.className," st-form-label"),children:["First Name",(0,a.jsx)("span",{className:"text-rose-600",children:" *"})]}),(0,a.jsx)(i.D0,{className:r.fname&&c.fname&&m>0&&"border !border-rose-600",name:"fname",id:"fname",maxLength:"40",type:"text",placeholder:"Eg. John"}),r.fname&&c.fname&&m>0&&(0,a.jsx)("span",{className:"".concat(s.className," text-xs text-rose-700"),children:"This field is required"})]}),(0,a.jsxs)("div",{className:"flex flex-col gap-2",children:[(0,a.jsxs)("label",{htmlFor:"surname",className:"".concat(s.className," st-form-label"),children:["Surname",(0,a.jsx)("span",{className:"text-rose-600",children:" *"})]}),(0,a.jsx)(i.D0,{className:r.fname&&c.fname&&m>0&&"border !border-rose-600",name:"surname",id:"surname",maxLength:"40",type:"text",placeholder:"Eg. Doe"}),r.surname&&c.surname&&m>0&&(0,a.jsx)("span",{className:"".concat(s.className," text-xs text-rose-700"),children:"This field is required"})]}),(0,a.jsxs)("div",{className:"flex flex-col gap-2",children:[(0,a.jsxs)("label",{htmlFor:"gender",className:"".concat(s.className," st-form-label"),children:["Gender",(0,a.jsx)("span",{className:"text-rose-600",children:" *"})]}),(0,a.jsxs)(i.D0,{className:r.fname&&c.fname&&m>0&&"border !border-rose-600",as:"select",name:"gender",id:"gender",placeholder:"Select gender",children:[(0,a.jsx)("option",{}),(0,a.jsx)("option",{value:"Male",children:"Male"}),(0,a.jsx)("option",{value:"Female",children:"Female"}),(0,a.jsx)("option",{value:"Prefer Not to Answer",children:"Prefer Not to Answer"})]}),r.gender&&c.gender&&m>0&&(0,a.jsx)("span",{className:"".concat(s.className," text-xs text-rose-700"),children:"This field is required"})]}),(0,a.jsxs)("div",{className:"flex flex-col gap-2",children:[(0,a.jsxs)("label",{htmlFor:"dob",className:"".concat(s.className," st-form-label"),children:["Date of Birth",(0,a.jsx)("span",{className:"text-rose-600",children:" *"})]}),(0,a.jsx)(i.D0,{className:r.fname&&c.fname&&m>0&&"border !border-rose-600",type:"date",name:"dob",id:"dob",maxLength:"40",placeholder:"DD/MM/YYYY"}),r.dob&&c.dob&&m>0&&(0,a.jsx)("span",{className:"".concat(s.className," text-xs text-rose-700"),children:"This field is required"})]}),(0,a.jsxs)("div",{className:"flex flex-col gap-2",children:[(0,a.jsxs)("label",{htmlFor:"moNumber",className:"".concat(s.className," st-form-label"),children:["Mobile Phone",(0,a.jsx)("span",{className:"text-rose-600",children:" *"})]}),(0,a.jsx)(i.D0,{className:r.fname&&c.fname&&m>0&&"border !border-rose-600",type:"tel",name:"moNumber",id:"moNumber",maxLength:"40",placeholder:"Eg. 1234567890"}),r.moNumber&&c.moNumber&&m>0&&(0,a.jsx)("span",{className:"".concat(s.className," text-xs text-rose-700"),children:"This field is required"})]}),(0,a.jsxs)("div",{className:"flex flex-col gap-2",children:[(0,a.jsxs)("label",{htmlFor:"email",className:"".concat(s.className," st-form-label"),children:["Email",(0,a.jsx)("span",{className:"text-rose-600",children:" *"})]}),(0,a.jsx)(i.D0,{className:r.fname&&c.fname&&m>0&&"border !border-rose-600",type:"email",name:"email",id:"email",placeholder:"Eg. [email protected]"}),r.email&&c.email&&m>0&&(0,a.jsx)("span",{className:"".concat(s.className," text-xs text-rose-700"),children:"This field is required"})]}),(0,a.jsxs)("div",{className:"flex flex-col gap-2",children:[(0,a.jsxs)("label",{htmlFor:"confirmEmail",className:"".concat(s.className," st-form-label"),children:["Confirm Email",(0,a.jsx)("span",{className:"text-rose-600",children:" *"})]}),(0,a.jsx)(i.D0,{className:r.fname&&c.fname&&m>0&&"border !border-rose-600",type:"email",name:"confirmEmail",id:"c
1onfirmEmail",placeholder:"Eg. [email protected]"}),r.confirmEmail&&c.confirmEmail&&m>0&&(0,a.jsx)("span",{className:"text-xs text-rose-700",children:r.confirmEmail})]})]}),(0,a.jsx)("p",{className:"".concat(s.className," text-xl text-slate-950 text-left mb-2 xl:text-2xl xl:tracking-[-0.6px]"),children:"Address"}),(0,a.jsxs)("div",{className:"grid gap-4 md:grid-cols-2 mb-5",children:[(0,a.jsxs)("div",{className:"flex flex-col gap-2 md:col-span-2",children:[(0,a.jsxs)("label",{htmlFor:"streetAddress",className:"".concat(s.className," st-form-label"),children:["Street Address",(0,a.jsx)("span",{className:"text-rose-600",children:" *"})]}),(0,a.jsx)(i.D0,{className:r.fname&&c.fname&&m>0&&"border !border-rose-600",name:"streetAddress",id:"streetAddress",maxLength:"40",type:"text",placeholder:"Type hereâ¦"}),r.streetAddress&&c.streetAddress&&m>0&&(0,a.jsx)("span",{className:"text-xs text-rose-700",children:"This field is required"})]}),(0,a.jsxs)("div",{className:"flex flex-col gap-2 md:col-span-2",children:[(0,a.jsx)("label",{htmlFor:"addressLine2",className:"".concat(s.className," st-form-label"),children:"Address Line 2"}),(0,a.jsx)(i.D0,{className:r.fname&&c.fname&&m>0&&"border !border-rose-600",name:"addressLine2",id:"addressLine2",type:"text",placeholder:"Type hereâ¦"}),r.addressLine2&&c.addressLine2&&m>0&&(0,a.jsx)("span",{className:"text-xs text-rose-700",children:"This field is required"})]}),(0,a.jsxs)("div",{className:"flex flex-col gap-2",children:[(0,a.jsxs)("label",{htmlFor:"suburb",className:"".concat(s.className," st-form-label"),children:["Suburb",(0,a.jsx)("span",{className:"text-rose-600",children:" *"})]}),(0,a.jsx)(i.D0,{className:r.fname&&c.fname&&m>0&&"border !border-rose-600",name:"suburb",id:"suburb",type:"text",placeholder:"Eg. Herston"}),r.suburb&&c.suburb&&m>0&&(0,a.jsx)("span",{className:"".concat(s.className," text-xs text-rose-700"),children:"This field is required"})]}),(0,a.jsxs)("div",{className:"flex flex-col gap-2",children:[(0,a.jsxs)("label",{htmlFor:"state",className:"".concat(s.className," st-form-label"),children:["State",(0,a.jsx)("span",{className:"text-rose-600",children:" *"})]}),(0,a.jsx)(i.D0,{className:r.fname&&c.fname&&m>0&&"border !border-rose-600",name:"state",id:"state",type:"text",placeholder:"Eg. Queensland"}),r.state&&c.state&&m>0&&(0,a.jsx)("span",{className:"".concat(s.className," text-xs text-rose-700"),children:"This field is required"})]}),(0,a.jsxs)("div",{className:"flex flex-col gap-2",children:[(0,a.jsxs)("label",{htmlFor:"postCode",className:"".concat(s.className," st-form-label"),children:["Postcode",(0,a.jsx)("span",{className:"text-rose-600",children:" *"})]}),(0,a.jsx)(i.D0,{className:r.fname&&c.fname&&m>0&&"border !border-rose-600",name:"postCode",id:"postCode",type:"text",placeholder:"Eg. 4006"}),r.postCode&&c.postCode&&m>0&&(0,a.jsx)("span",{className:"".concat(s.className," text-xs text-rose-700"),children:"This field is required"})]})]}),(0,a.jsxs)("div",{className:"grid gap-4 md:grid-cols-2 ",children:[(0,a.jsxs)("div",{className:"flex flex-col gap-2",children:[(0,a.jsx)("label",{htmlFor:"medicareNumber",className:"".concat(s.className," st-form-label"),children:"Medicare Number"}),(0,a.jsx)(i.D0,{className:r.fname&&c.fname&&m>0&&"border !border-rose-600",name:"medicareNumber",id:"medicareNumber",type:"text",placeholder:"10 digits long"}),r.medicareNumber&&c.medicareNumber&&m>0&&(0,a.jsx)("span",{className:"text-xs text-rose-700",children:r.medicareNumber})]}),(0,a.jsxs)("div",{className:"flex flex-col gap-2",children:[(0,a.jsx)("label",{htmlFor:"medicareReference",className:"".concat(s.className," st-form-label"),children:"Medicare Reference"}),(0,a.jsx)(i.D0,{className:r.fname&&c.fname&&m>0&&"border !border-rose-600",name:"medicareReference",id:"medicareReference",type:"number",placeholder:"Single number next to your name"}),r.medicareReference&&c.medicareReference&&m>0&&(0,a.jsx)("span",{className:"text-xs text-rose-700",children:r.medicareReference})]}),(0,a.jsxs)("div",{className:"flex flex-col gap-2",children:[(0,a.jsx)("label",{htmlFor:"medicareExpiryDate",className:"".concat(s.className," st-form-label"),children:"Medicare Expiry Date"}),(0,a.jsx)(i.D0,{className:r.fname&&c.fname&&m>0&&"border !border-rose-600",name:"medicareExpiryDate",id:"medicareExpiryDate",type:"text",placeholder:"MM/YYYY"}),r.medicareExpiryDate&&c.medicareExpiryDate&&m>0&&(0,a.jsx)("span",{className:"text-xs text-rose-700",children:"This field is required"})]}),(0,a.jsxs)("div",{className:"flex flex-col gap-2 md:col-span-2",children:[(0,a.jsxs)("label",{htmlFor:"file",className:"".concat(s.className," text-xs st-form-label"),children:["Please upload a photo ID that shows your full legal name, Date of birth and photo",(0,a.jsx)("span",{className:"text-rose-600",children:" *"}),(0,a.jsx)("br",{}),(0,a.jsxs)("span",{children:["E.g. Australian Drivers license/Passport or overseas passport",(0,a.jsx)("br",{}),"For children please Upload an adult guardian/Parent photo ID"]})]}),(0,a.jsx)(h.A,{setFieldValue:p,font:s}),(null==n?void 0:n.file)&&(0,a.jsxs)("span",{className:"".concat(s.className," st-form-label mt-2"),children:["Selected file - ",(0,a.jsx)("strong",{children:null==n||null==(f=n.file[0])?void 0:f.name})]}),r.file&&c.file&&m>0&&(0,a.jsx)("span",{className:"text-xs text-rose-700",children:"This field is required"})]}),(0,a.jsxs)("div",{className:"flex flex-col gap-2 md:col-span-2",children:[(0,a.jsxs)("label",{htmlFor:"payerName",className:"".concat(s.className," st-form-label"),children:["Please enter the full name of the person whose credit card is being used so we can match this consult to payment thanks"," ",(0,a.jsx)("span",{className:"text-rose-600",children:" *"})]}),(0,a.jsx)(i.D0,{className:r.payerName&&c.payerName&&m>0&&"border !border-rose-600",name:"payerName",id:"payerName",maxLength:"40",type:"text",placeholder:"Eg. John Michael Doe"}),r.payerName&&c.payerName&&m>0&&(0,a.jsx)("span",{className:"".concat(s.className," text-xs text-rose-700"),children:"This field is required"})]})]})]}),(0,a.jsxs)("div",{className:"flex items-center justify-between",children:[(0,a.jsxs)("button",{type:"button",onClick:e=>{e.preventDefault(),o(t-1)},className:"".concat(s.className," button-outline"),children:[(0,a.jsx)(d.g,{icon:u.Uec}),(0,a.jsx)("span",{className:"mt-1",children:"Previous"})]}),(0,a.jsx)("button",{type:"submit",disabled:!!y,className:"".concat(s.className," button-ternary disabled:cursor-wait"),children:y?(0,a.jsxs)(a.Fragment,{children:[(0,a.jsxs)("svg",{"aria-hidden":"true",className:"w-5 h-5 text-slate-200 animate-spin fill-white",viewBox:"0 0 100 101",fill:"none",xmlns:"http://www.w3.org/2000/svg",children:[(0,a.jsx)("path",{d:"M100 50.5908C100 78.2051 77.6142 100.591 50 100.591C22.3858 100.591 0 78.2051 0 50.5908C0 22.9766 22.3858 0.59082 50 0.59082C77.6142 0.59082 100 22.9766 100 50.5908ZM9.08144 50.5908C9.08144 73.1895 27.4013 91.5094 50 91.5094C72.5987 91.5094 90.9186 73.1895 90.9186 50.5908C90.9186 27.9921 72.5987 9.67226 50 9.67226C27.4013 9.67226 9.08144 27.9921 9.08144 50.5908Z",fill:"currentColor"}),(0,a.jsx)("path",{d:"M93.9676 39.0409C96.393 38.4038 97.8624 35.9116 97.0079 33.5539C95.2932 28.8227 92.871 24.3692 89.8167 20.348C85.8452 15.1192 80.8826 10.7238 75.2124 7.41289C69.5422 4.10194 63.2754 1.94025 56.7698 1.05124C51.7666 0.367541 46.6976 0.446843 41.7345 1.27873C39.2613 1.69328 37.813 4.19778 38.4501 6.62326C39.0873 9.04874 41.5694 10.4717 44.0505 10.
11071C47.8511 9.54855 51.7191 9.52689 55.5402 10.0491C60.8642 10.7766 65.9928 12.5457 70.6331 15.2552C75.2735 17.9648 79.3347 21.5619 82.5849 25.841C84.9175 28.9121 86.7997 32.2913 88.1811 35.8758C89.083 38.2158 91.5421 39.6781 93.9676 39.0409Z",fill:"currentFill"})]}),(0,a.jsx)("span",{className:"sr-only",children:"Loading..."})]}):"Submit"})]})]});default:return(0,a.jsx)(a.Fragment,{children:"Something Went Wrong..."})}})({values:n,errors:r,touched:c,submitCount:m,setFieldValue:p})})}})})]})}},8482:(e,s,t)=>{t.d(s,{I:()=>c});var a=t(6042),l=t(6559),n=t(9586),i=t(2128);let r=a.Dk.length?(0,a.Sx)():(0,a.Wp)({apiKey:"AIzaSyA7ZSoxX2Y2BOIOVnTvvmx__wUEtja358w",authDomain:"panraaclinic.firebaseapp.com",projectId:"panraaclinic",storageBucket:"panraaclinic.appspot.com",messagingSenderId:"803689447757",appId:"1:803689447757:web:bb14efd8cdb3bc91c1f704"});(0,l.xI)(r),(0,n.aU)(r);let c=(0,i.c7)(r)},9368:(e,s,t)=>{t.d(s,{A:()=>n});var a=t(7876);t(4232);var l=t(3608);let n=e=>{let{setFieldValue:s,font:t}=e,{getRootProps:n,getInputProps:i,isDragActive:r}=(0,l.VB)({accept:{"image/jpeg":[],"image/jpg":[],"application/pdf":[]},onDrop:e=>{console.log(e),s("file",e)}});return(0,a.jsx)("div",{children:(0,a.jsxs)("div",{...n({className:"dropzone"}),className:"px-5 py-5 w-full text-sm border-none rounded-lg placeholder:text-slate-400 focus:ring-cyan-500 focus:border-cyan-500 bg-cyan-50 placeholder:text-sm flex flex-col items-center justify-center gap-3.5",children:[(0,a.jsx)("svg",{xmlns:"http://www.w3.org/2000/svg",width:"41.857",height:"29.3",viewBox:"0 0 41.857 29.3",children:(0,a.jsx)("path",{id:"cloud-arrow-up-solid",d:"M9.418,61.3A9.42,9.42,0,0,1,6.292,42.994c-.007-.177-.013-.353-.013-.53a10.465,10.465,0,0,1,19.536-5.219,6.275,6.275,0,0,1,9.765,5.219,6.349,6.349,0,0,1-.419,2.263A8.371,8.371,0,0,1,33.486,61.3Zm5.167-14.192A1.568,1.568,0,0,0,16.8,49.325l2.551-2.551v8.77a1.57,1.57,0,1,0,3.139,0v-8.77l2.551,2.551a1.568,1.568,0,0,0,2.217-2.217l-5.232-5.232a1.563,1.563,0,0,0-2.217,0l-5.232,5.232Z",transform:"translate(0 -32)",fill:"#22d3ee"})}),(0,a.jsx)("p",{className:"text-sm text-slate-400",children:"Click to select files"}),(0,a.jsx)("p",{className:"text-xs text-slate-400 -mt-2",children:"JPEG,JPG,PDF"}),(0,a.jsx)("button",{type:"button",className:"".concat(t.className," px-6 py-2.5 bg-sky-700 text-sky-50 rounded-full hover:bg-sky-800 text-sm font-semibold tracking-[-0.28px]"),children:"Upload"}),(0,a.jsx)("input",{...i()})]})})}}}]);
Line numbers count LF bytes from the start of the resource, as the search results do. Vendor segments are library code the classifier recognised; they are stored but not indexed. Bytes are shown as Latin1 characters, one per byte.