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index.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<link rel="stylesheet" href="Resources/Stylesheets/basics.css">
<link rel="stylesheet" href="Resources/Stylesheets/homepage.css">
<link rel="stylesheet" href="Resources/Stylesheets/funcClasses.css">
<script src="https://cdnjs.cloudflare.com/ajax/libs/jquery/3.5.1/jquery.min.js"></script>
<script src="https://cdn.jsdelivr.net/npm/axios/dist/axios.min.js"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/moment.js/2.27.0/moment.min.js"></script>
<!-- <script src="./Resources/JS/main.js"></script> -->
<script defer src="Resources/JS/test.js"></script>
<title>AOC Covid Vaccination | Home </title>
</head>
<body>
<div class="wrapper">
<div class="appointment_made_modal"></div>
<div class="terms_and_c_modal"></div>
<div class="user_top_part">
<img src="https://aoc-bookings.netlify.app/Resources/Images/AOCLogoF.jpg" alt="This is a picture of the WHMC logo">
AOC COVID BOOKINGS
</div>
<span class="notice">* You must complete all of these Questions.</span>
<div class="blocking_form_modal_outer">
<div class="blocking_form_modal_content">
<p>Unfortunately you don't qualify under government guidelines and thus are not eligible at
the moment to be administered this vaccine, we will update this page as soon as you are.
Please ring your GP or have a look at the HSE <a href="https://www.hse.ie/eng/health/immunisation/hcpinfo/covid19vaccineinfo4hps/faqscovidvacc/" class="faq_hover">FAQ</a> for further info.
</p>
<a href="index.html" class="blocking_form_modal_btn">Try Again Soon</a>
</div>
</div>
<div class="create_appointment_form">
<form action="" method="post">
<h3>Have you had Anaphylaxis(serious systemic allergic reaction requiring medical intervention) following a previous dose of the vaccine or any of it's constituents? </h3>
<div class="Anaphylaxis_decision_container container">
<div class="Anaphylaxis_Yes_container card_container">
<input type="radio" name="Anaphylaxis_decision" id="Anaphylaxis_Yes" class="Anaphylaxis_Yes vaccine_decider" value="Yes" required>
<label for="Anaphylaxis_Yes" class="label_radio">Yes</label>
</div>
<div class="Anaphylaxis_No_container card_container">
<input type="radio" name="Anaphylaxis_decision" id="Anaphylaxis_No" class="Anaphylaxis_No vaccine_decider" value="No">
<label for="Anaphylaxis_No" class="label_radio">No</label>
</div>
</div>
<h3>Have you been diagnosed with COVID-19 within the last 4 weeks?</h3>
<div class="Had_Covid_Container container">
<div class="Covid_Yes_container card_container">
<input type="radio" name="Covid_decision" id="Covid_Yes" class="Covid_Yes vaccine_decider" value="Yes" required>
<label for="Covid_Yes" class="label_radio">Yes</label>
</div>
<div class="Covid_No_container card_container">
<input type="radio" name="Covid_decision" id="Covid_No" class="Covid_No vaccine_decider" value="No">
<label for="Covid_No" class="label_radio">No</label>
</div>
</div>
<h3>Have you had another vaccine within the last 14 days?</h3>
<div class="Had_Vaccine_Container container">
<div class="Covid_Vaccine_Yes_container card_container">
<input type="radio" name="Covid_Vaccine_decision" id="Covid_Vaccine_Yes" class="Covid_Vaccine_Yes vaccine_decider" value="Yes" required>
<label for="Covid_Vaccine_Yes" class="label_radio">Yes</label>
</div>
<div class="Covid_Vaccine_No_container card_container">
<input type="radio" name="Covid_Vaccine_decision" id="Covid_Vaccine_No" class="Covid_Vaccine_No vaccine_decider" value="No">
<label for="Covid_Vaccine_No" class="label_radio">No</label>
</div>
</div>
<h3>Do you have a bleeding disorder or on anticoagulation therapy?</h3>
<div class="Bleeding_Disorder_Container container">
<div class="Bleeding_Disorder_Yes_container card_container">
<input type="radio" name="Bleeding_Disorder_decision" id="Bleeding_Disorder_Yes" class="Bleeding_Disorder_Yes" value="Yes" required>
<label for="Bleeding_Disorder_Yes" class="label_radio">Yes</label>
</div>
<div class="Bleeding_Disorder_No_container card_container">
<input type="radio" name="Bleeding_Disorder_decision" id="Bleeding_Disorder_No" class="Bleeding_Disorder_No" value="No">
<label for="Bleeding_Disorder_No" class="label_radio">No</label>
</div>
</div>
<div class="firstName_container container">
<label for="firstName">First Name</label>
<input type="text" name="firstName" id="firstName" class="name" required>
</div>
<div class="surname_container container">
<label for="surname">Surname</label>
<input type="text" name="Surname" id="surname" class="name" required>
</div>
<div class="dob_container container">
<label for="dob">Date Of Birth (DD/MM/YYYY)</label>
<input type="text" name="DOB" id="dob" placeholder="DD/MM/YYYY" maxlength="10"
pattern="^((\d{1,2})(\/)(\d{1,2})(\/)(\d{4}))" title="Please enter a dob in the form DD/MM/YYYY" required>
</div>
<!-- <div class="gender_container container">
<label for="gender">Gender</label>
<input type="text" name="Gender" id="gender" class="name" required>
</div> -->
<div class="email_container container">
<label for="email">Email</label>
<input type="text" name="Email" id="email" class="name" required>
</div>
<div class="mobile_container container">
<label for="mobile">Mobile No. (No Spaces)</label>
<input type="tel" name="Mobile" id="mobile" pattern="[0-9]{3}[0-9]{3}[0-9]{4}" title="Please enter a valid mobile number in the form 0861234567" required>
</div>
<!-- <div class="alternate_mobile_container container">
<label for="alternate_mobile">Alternate_mobile No. (No Spaces)</label>
<input type="tel" name="Alternate_Mobile" id="alternate_mobile" pattern="[0-9]{3}[0-9]{3}[0-9]{4}" title="Please enter a valid mobile number in the form 0861234567" required>
</div> -->
<!-- <div class="address_line_one_container container">
<label for="address_line_one">Address Line 1(Street)</label>
<input type="text" name="Address_Line_One" id="address_line_one" required>
</div>
<div class="address_line_two_container container">
<label for="address_line_two">Address Line 2(City)</label>
<input type="text" name="Address_Line_Two" id="address_line_two" required>
</div> -->
<!-- <div class="county_container container">
<label for="county">County</label>
<input type="text" name="County" id="county" required>
</div> -->
<!-- <h3>Choose an option from below</h3>
<div class="card_decision_container container">
<div class="medical_card_container card_container">
<input type="radio" name="card_decision" id="Medical Card" class="Medical_Card" value="Medical_Card">
<label for="Medical_Card" class="label_radio">I have a Medical Card</label>
</div>
<div class="PPS_number_container card_container">
<input type="radio" name="card_decision" id="PPS_Number" class="PPS_Number" value="PPS_Number">
<label for="PPS_Number" class="label_radio">I have my PPS Number</label>
</div>
</div>
<div class="pps_number_input_container">
<label for="PPS_Number_Input">PPS Number.</label>
<input type="text" name="PPS_Number_Input" id="PPS_Number_Input" pattern="(^[0-9]{7}[A-Z]{1,2})" title="Please enter a valid pps number in the form 0000000AB" placeholder="1234567AB">
</div> -->
<!-- <h3>Choose a desired method / destination from below</h3>
<div class="destination_decision_container container">
<div class="surgery_container decision_container">
<input type="radio" name="destination_decision" id="Surgery" class="Surgery" value="Surgery">
<label for="Surgery" class="label_radio">Surgery</label>
</div>
<div class="drive_through_container decision_container">
<input type="radio" name="destination_decision" id="Drive_Through" class="Drive_Through" value="Drive_Through">
<label for="Drive_Through" class="label_radio">Drive Through</label>
</div>
</div>
<div class="car_reg_container container">
<label for="car_reg">Car Reg.</label>
<input type="text" name="Car_Reg_Input" id="car_reg" pattern="(^[0-9]{1,3})-([A-Z]{1,2})-([0-9]{1,5})" title="Please enter a valid car registration number in the form ???-??-?????" placeholder="02-D-15679">
</div> -->
<h3>Choose a month from below</h3>
<div class="months_container container">
<h1 class="month" data-month="0">January</h1>
<h1 class="month" data-month="1">February</h1>
<h1 class="month" data-month="2">March</h1>
<h1 class="month" data-month="3">April</h1>
<h1 class="month" data-month="4">May</h1>
<h1 class="month" data-month="5">June</h1>
<h1 class="month" data-month="6">July</h1>
<h1 class="month" data-month="7">August</h1>
<h1 class="month" data-month="8">September</h1>
<h1 class="month" data-month="9">October</h1>
<h1 class="month" data-month="10">November</h1>
<h1 class="month" data-month="11">December</h1>
</div>
<div class="calendar_container_m">
<h3>Choose a date from below</h3>
<div class="keyContainer">
<div class="available_container keyState">
<div class="circleState availableState"></div>
<h5>Available</h5>
</div>
<div class="closed_container keyState">
<div class="circleState closedState"></div>
<h5>Closed</h5>
</div>
<div class="full_container keyState">
<div class="circleState fullState"></div>
<h5>Full</h5>
</div>
<div class="full_container keyState">
<div class="circleState selectedState"></div>
<h5>Selected</h5>
</div>
</div>
<div class="calendar_container container">
</div>
</div>
<div class="time_slot_container_m">
<h3>Choose a timeslot from below</h3>
<div class="keyContainer">
<div class="available_container keyState">
<div class="circleState availableState"></div>
<h5>Available</h5>
</div>
<div class="closed_container keyState">
<div class="circleState closedState"></div>
<h5>Not Available</h5>
</div>
<div class="full_container keyState">
<div class="circleState fullState"></div>
<h5>Full</h5>
</div>
<div class="full_container keyState">
<div class="circleState selectedState"></div>
<h5>Selected</h5>
</div>
</div>
<div class="time_slot_container container">
</div>
</div>
<div class="terms_container container">
<div class="t_and_c_outer">
<div class="terms_and_conditions_container">
<embed src= "Resources/Documents/Comiraty Pizer vaccine.pdf" width= "950" height= "575">
</div>
</div>
<!-- <div class="open_terms_btn">Terms and Conditions</div> -->
<div class="accept_btn">
<input type="checkbox" name="accept_terms" id="accept_terms_checkbox" required>
<label for="accept_terms_checkbox" class="accept_terms_checkbox_label">I have read the medical information above and I consent to get this vaccination.</label>
</div>
<br>
<label >Further information available <a class="faq_hover"href="https://westernhousemedicalcentre.ie">here.</a></label>
</div>
<input type="submit" value="Create Appointment" id="create_appointment_btn">
</form>
</div>
</div>
</body>
</html>