Dependent: {{ $leadDependent->fullName }}

@if ($loop->first) @else @endif

First Name @error('dependent.'.$key.'.first_name')

@enderror

Middle Name @error('dependent.'.$key.'.middle_name')

@enderror

Last Name @error('dependent.'.$key.'.last_name')

@enderror

Relationship

Gender

Primary Phone

Phone 2

Date of Birth @error('dependent.'.$key.'.dob')

@enderror

Age @error('dependent.'.$key.'.age')

@enderror

Height

Weight

Email @error('dependent.'.$key.'.email')

@enderror

Language

Annual Income

Occupation

SSN

Address is same as contact

is_address_same_as_contact == 1) style="display: none;" @endif>

Address

City

Zipcode

Country

State

Medications

Conditions

Is smoker?

Has diabetes?

Has cancer?

Has heart disease?

PCP Name

PCP ID

PCP Office

MRN

EMPI

Medicare Claim Number

Medicare Part A

Medicare Part B

Medicaid Number

Medicaid Level

Enrollment Eligibility

Scope of Appointment

Medicaid Username

Legal Status

Immigration Document

Alien # {{-- --}}

I-94 # {{-- --}}

Green Card #

Immigration Statuses

Other Statuses

SEVIS ID

Passport

Passport Country

Passport Expiration

EAD Card Number

EAD Card Code

EAD Card Expiration

Naturalization

Exclude from Policies?

@include('modules.leads.includes.upload-document', [ 'linkedEntity' => 'dependent', 'linkedEntityId' => $leadDependent->id, 'key' => $key, 'leadId' => $lead->id, 'documentTypes' => $documentTypes ]) @php $dependentDocuments = $lead->attachments()->where('linked_entity', 'dependent')->where('linked_entity_id', $leadDependent->id)->paginate(10); @endphp

@if ($documents->count() > 0) @include('modules.leads.includes.document-list-dependent', [ 'documents' => $dependentDocuments ])

@endif

First Name @error('dependent.1.first_name')

@enderror

Middle Name @error('dependent.1.middle_name')

@enderror

Last Name @error('dependent.1.last_name')

@enderror

Relationship

@error('dependent.1.relationship')

@enderror

Gender

@error('dependent.1.gender')

@enderror

Primary Phone

Phone2

Date of Birth @error('dependent.1.dob')

@enderror

Age @error('dependent.1.age')

@enderror

Height

Weight

Email @error('dependent.1.email')

@enderror

Language

Annual Income

Occupation

SSN

Address is same as contact

Address

City

Zipcode

Country

State

Medications

Conditions

Is smoker?

Has diabetes?

Has cancer?

Has heart disease?

PCP Name

PCP ID

PCP Office

MRN

EMPI

Medicare Claim Number

Medicare Part A

Medicare Part B

Medicaid Number

Medicaid Level

Enrollment Eligibility

Scope of Appointment

Medicaid Username

Legal Status

Immigration Document

Alien # {{-- USCIS Number, format is A123456789 --}}

I-94 # {{-- I-94 / I-94A Arrival / Departure Record # --}}

Green Card #

Immigration Statuses

Other Statuses

Sevis ID

Passport

Passport Country

Passport Expiration

EAD Card Number

EAD Card Code

EAD Card Expiration

Naturalization

Exclude from Policies?

Dependent: {{ $leadDependent->fullName }}

Primary Information

Basic Information

Address Information

Medical Information

Medicare Information

Legal Information

Upload document

Primary Information

Basic Information

Address Information

Medical Information

Medicare Information

Legal Information