diff options
Diffstat (limited to 'src/33.html')
| -rw-r--r-- | src/33.html | 49 |
1 files changed, 35 insertions, 14 deletions
diff --git a/src/33.html b/src/33.html index cd20425..7b6737b 100644 --- a/src/33.html +++ b/src/33.html @@ -72,21 +72,42 @@ </div> </div> </div> - <div class="checkbox-group"> - <input type="checkbox" /> - <label>Lorem ipsum dolor sit amet, consectetur adipiscing elit.</label> - </div> - <div class="checkbox-group"> - <input type="checkbox" id="indeterminate"/> - <label>Cursus euismod quis viverra nibh cras pulvinar mattis nunc.</label> - </div> - - <!-- placeholder script to show "indeterminate" status of checkbox. delete me --> - <script>document.getElementById("indeterminate").indeterminate = true;</script> - - <button class="btn primary">Confirm</button> - <button class="btn secondary">Cancel</button> + <form data-auto="mygov-dls-form" id="mygov-dls-form-wrapper" aria-labelledby="mygov-dls-form-heading" novalidate=""> + <fieldset class="fieldset--title__hidden"> + <label class="checkbox mb-none" for="checkbox-confirm"> + <input type="checkbox" id="checkbox-confirm" value="true" ng-reflect-form="[object Object]" ng-reflect-ng-class="[object Object]" aria-required="true" aria-invalid="false" aria-errormessage="checkbox-confirm__validation-messages" class="ng-untouched ng-pristine ng-valid"> + <span class="checkmark"></span> + <span class="label"> + <p>I confirm these documents are accurate and complete.</p> + </span> + </label> + <div class="checkbox mt-none pt-none pb-none"> + <div role="alert" class="error-message" id="checkbox-confirm__validation-messages"> + <span>You must confirm that the documents are accurate and complete</span> + </div> + </div> + + <label class="checkbox checkbox--error mb-none" for="checkbox-consent"> + <input type="checkbox" id="checkbox-consent" value="true" ng-reflect-form="[object Object]" ng-reflect-ng-class="[object Object]" aria-required="true" aria-invalid="false" aria-errormessage="checkbox-consent__validation-messages" class="ng-untouched ng-pristine ng-valid"> + <span class="checkmark"></span> + <span class="label"> + <p>I give consent for these document to be retrieved by Medicare.</p> + </span> + </label> + + <div class="checkbox mt-none pt-none pb-none"> + <div role="alert" class="error-message" id="checkbox-confirm__validation-messages"> + <span>You must confirm that you agree to give consent for the documents to be retrieved</span> + </div> + </div> + + <div _ngcontent-set-c83="" class="button-container"> + <label data-auto="submission-button" class="btn btn--primary" type="submit"> Submit documents</label> + <label _ngcontent-set-c83="" class="btn btn--secondary" ng-reflect-router-link="/dls" href="#/dls">Cancel</label> + </div> + </fieldset> + </form> </div> </main> </div> |