.form-field{border-radius:4px;border:1px solid var(--primary-color);padding:6px 12px;outline:none;width:100%}.form-field:disabled{cursor:not-allowed}.form-field[data-error]{border-color:#f14668;background:#ffe6e6}.form-field[data-error]:focus{box-shadow:0 0 0 .125em #f1466840}.validation-error{display:block;color:#f14668;font-size:12px;margin-top:4px}.form-field:focus{box-shadow:0 0 2px .02em var(--primary-color);padding:6px 11px;margin:0 1px}.form-field-label{margin-bottom:4px;display:block;color:#383838}.form-label[data-required=true]:after,.form-field-label[data-required=true]:after{content:" *";color:#f14668}.form-group{margin-bottom:48px}.form-legend{width:100%;padding-inline-start:0;padding-inline-end:0;color:var(--secondary-color);font-size:1.5em}.form-legend:after{content:"";display:inline-block;border-top:1px solid #d1d2d1;width:calc(100% + 16px);margin-left:-8px;transform:translateY(-1rem)}.swal2-bottom-end{margin-right:70px}#app{-webkit-font-smoothing:antialiased;-moz-osx-font-smoothing:grayscale;color:#1a1a1a}.component-container{height:80vh;display:flex;flex-direction:column;align-items:center;justify-content:center}:root{--primary-color: #2078c1;--secondary-color: #1a497e;--tertiary-color: #f15e29}input[type=radio][data-v-b40cdcef]{-webkit-appearance:none;-moz-appearance:none;appearance:none;background-color:#fff;font:inherit;color:var(--primary-color);width:.929em;height:.929em;border:1px solid var(--primary-color);border-radius:50%;transform:translateY(-.05em);display:grid;place-content:center;margin-top:0;cursor:pointer}input[type=radio][data-v-b40cdcef]:checked:before{content:"";width:.5em;height:.5em;border-radius:50%;background-color:var(--primary-color)}span[data-v-b40cdcef]{padding-left:2px}.option[data-v-b40cdcef]{display:flex;justify-content:center;align-items:center;height:38px;font-size:14px;white-space:nowrap;border:1px solid var(--primary-color);border-radius:4px;padding:0 14px 0 8px;-webkit-user-select:none;user-select:none;cursor:pointer}.option[data-active=true][data-v-b40cdcef]{color:#fff;background:var(--primary-color)}.option[data-invalid=true][data-v-b40cdcef]{border:1px solid #f14668}.option[data-invalid=true]>input[data-v-b40cdcef]{border:1px solid #f14668}.option[data-disabled=true][data-v-b40cdcef]{cursor:not-allowed}.option[data-disabled=true][data-active=false][data-v-b40cdcef]{opacity:.5}.options[data-v-b737249e]{display:flex;gap:8px}#submission-details-fields[data-v-5b78299e]{display:grid;width:100%;row-gap:1.5em;column-gap:2em;grid-template-columns:repeat(2,1fr);grid-template-areas:"urgency                  urgency" "type                     type" "previous-submission      previous-submission" "out-of-network-rationale out-of-network-rationale"}.urgency[data-v-5b78299e]{grid-area:urgency}.type[data-v-5b78299e]{grid-area:type}.previous-submission[data-v-5b78299e]{width:35%;grid-area:previous-submission}.out-of-network-rationale[data-v-5b78299e]{width:80%;grid-area:out-of-network-rationale}.text-area[data-v-5b78299e]{resize:none}.units[data-v-5b78299e]{display:inline-block;margin-left:8px;line-height:38px;color:#999}.units-wrapper[data-v-5b78299e]{display:flex;-webkit-user-select:none;user-select:none}.units-wrapper input[data-v-5b78299e]{width:80px;box-sizing:border-box}.nav-section{display:flex;justify-content:space-between;align-content:flex-end}.typeahead[data-v-7b354578]{position:relative}.typeahead-result-list[data-v-7b354578]{position:absolute;max-height:200px;overflow-y:scroll;border:1px solid #f0f0f0;border-radius:4px;margin-top:4px;width:100%;z-index:100}.typeahead-result[data-v-7b354578]{background:#fff;font-size:14px;padding:8px 16px;-webkit-user-select:none;user-select:none;word-wrap:break-word}.typeahead-result[data-v-7b354578]:hover{color:#fff;background:var(--primary-color)}.typeahead-result[data-v-7b354578]:nth-of-type(2n){background:#ededed}.typeahead-result[data-v-7b354578]:nth-of-type(2n):hover{background:var(--primary-color)}.form-field[data-v-7b354578]{width:100%;padding-right:40px;white-space:nowrap;text-overflow:ellipsis}.form-field[data-v-7b354578]:focus{outline:none}.chevron-down-icon[data-v-7b354578],.chevron-up-icon[data-v-7b354578]{position:absolute;top:9px;right:10px;cursor:pointer}.chevron-down-icon[data-v-7b354578]:focus,.chevron-up-icon[data-v-7b354578]:focus{outline:none}.close-icon[data-v-7b354578]{position:absolute;top:9px;right:12px;cursor:pointer}.close-icon[data-v-7b354578]:focus{outline:none}.form-field.disable-error-highlighting[data-v-7b354578]:focus{box-shadow:0 0 2px .02em var(--primary-color);background:#fff;border-color:var(--primary-color)}.patient-information-fields[data-v-7659d486]{display:flex;flex-flow:row wrap;justify-content:flex-start;gap:2em;-moz-column-gap:2em;width:100%}.flx-group[data-v-7659d486]{display:flex;width:324px}.flx-group[width-zero=true][data-v-7659d486]{width:0}.flx-item[data-v-7659d486]{width:324px}.flx-item-md[data-v-7659d486]{width:200px}.flx-item-sm[data-v-7659d486]{width:100px}.patient-ids[data-v-7659d486]{display:flex;gap:2em;-moz-column-gap:2em;width:100%;order:0}.width-fit[data-v-7659d486]{display:none;width:fit-content}.patient-id[data-v-7659d486]{order:0}.medical_record_number[data-v-7659d486]{order:1}.first-name[data-v-7659d486]{order:3}.middle-name[data-v-7659d486]{order:4}.last-name[data-v-7659d486]{order:5}.date-of-birth[data-v-7659d486]{order:6}.ethnicity[data-v-7659d486]{order:7}.phone[data-v-7659d486]{order:8}.gender[data-v-7659d486]{order:9}.phone-number[data-v-7659d486]{flex-grow:1;order:0}.phone-extension[data-v-7659d486]{order:1}.height-and-weight[data-v-7659d486]{order:9}.height[data-v-7659d486]{order:0}.weight[data-v-7659d486]{order:1}.units[data-v-7659d486]{display:inline-block;margin-left:8px;line-height:38px;color:#999}.units-wrapper[data-v-7659d486]{display:flex;-webkit-user-select:none;user-select:none}.units-wrapper input[data-v-7659d486]{width:80px;box-sizing:border-box}.form-group[data-v-02a1ae39]{width:100%}#address-fields[data-v-02a1ae39]{display:flex;flex-flow:row wrap}#address-fields .address-field[data-v-02a1ae39]{flex:none;padding:0 30px 20px 0;width:25%}#address-fields .small[data-v-02a1ae39]{width:20%}#address-fields .medium[data-v-02a1ae39]{width:30%}#address-fields .large[data-v-02a1ae39]{width:65%}@media(max-width:1280px){.form-group[data-v-02a1ae39]{width:100%}#address-fields[data-v-02a1ae39]{display:flex;width:100%;flex-flow:row wrap}#address-fields .address-field[data-v-02a1ae39]{flex:none;width:100%}#address-fields .small[data-v-02a1ae39],#address-fields .medium[data-v-02a1ae39]{width:45%}#address-fields .large[data-v-02a1ae39]{width:100%}}.button[data-v-52db790d]{cursor:pointer;font-weight:700;color:#153d6b;padding:8px;margin:8px}.button[data-v-52db790d]:focus{border:2px solid #a7abaa;margin:6px;border-radius:4px;outline:none}.ms-button[data-v-081d25bd],.wl-rm-button[data-v-081d25bd]{font-weight:400;font-style:normal;letter-spacing:normal;min-height:2.5rem;box-shadow:2px 5px 10px #00000026;border-radius:4px;border-color:transparent;background-color:#2078c1;color:#fff;font-size:1.0265rem;padding:0 1.5rem;line-height:1.125rem;cursor:pointer;transition:all .2s ease-in-out}.ms-button svg[data-v-081d25bd],.wl-rm-button svg[data-v-081d25bd]{width:15px;height:15px;margin-right:5px}.ms-button[data-v-081d25bd]:hover:enabled,.wl-rm-button[data-v-081d25bd]:hover:enabled{opacity:.8}.ms-button[data-v-081d25bd]:disabled,.wl-rm-button[data-v-081d25bd]:disabled{cursor:not-allowed;box-shadow:none;background:#c1c1c1;color:#fff;min-width:7.875rem}.ms-button[data-v-081d25bd]:disabled:hover:enabled,.wl-rm-button[data-v-081d25bd]:disabled:hover:enabled{background:#cecece}.ms-button.small[data-v-081d25bd],.small.wl-rm-button[data-v-081d25bd]{min-height:1.875rem;padding:0 .75rem;font-size:.75rem}.ms-button.wide[data-v-081d25bd],.wide.wl-rm-button[data-v-081d25bd]{min-width:18.75rem}.ms-button.flat[data-v-081d25bd],.flat.wl-rm-button[data-v-081d25bd]{box-shadow:none}.ms-button.outlined[data-v-081d25bd],.outlined.wl-rm-button[data-v-081d25bd]{border:1px solid #2078c1;color:#2078c1;background-color:#fff}.ms-button.outlined[data-v-081d25bd]:hover:enabled,.outlined.wl-rm-button[data-v-081d25bd]:hover:enabled{background-color:#fff}.ms-button.text-button[data-v-081d25bd],.text-button.wl-rm-button[data-v-081d25bd]{border-style:none;color:#2078c1;background-color:transparent;box-shadow:none;font-weight:700}.ms-button.text-button[data-v-081d25bd]:hover:enabled,.text-button.wl-rm-button[data-v-081d25bd]:hover:enabled{background-color:transparent}.wl-rm-button[data-v-081d25bd]{min-height:40px;min-width:8.61rem;border-color:transparent;background-color:#dd3737;color:#fff}.wl-rm-button[data-v-081d25bd]:disabled{min-width:8.61rem}.wl-rm-button.outlined[data-v-081d25bd]{border:1px solid #dd3737;color:#dd3737}.wl-rm-button.strict[data-v-081d25bd]{height:40px;width:8.61rem}.wl-rm-button.text-button[data-v-081d25bd]{color:#dd3737}.wl-rm-button[data-v-081d25bd]{margin:8px 12px}fieldset[data-v-081d25bd]{border:1px solid #153d6b;border-radius:4px;margin-bottom:32px}legend[data-v-081d25bd]{font-size:14px;color:#fff;padding:4px 16px;border-radius:4px}legend[insurance-index="0"][data-v-081d25bd]{background:var(--secondary-color)}legend[insurance-index="1"][data-v-081d25bd]{background:var(--tertiary-color)}legend[insurance-index="2"][data-v-081d25bd]{background:var(--primary-color)}.patient-insurance-fields[data-v-081d25bd]{display:flex;flex-flow:row wrap;justify-content:flex-start;gap:2em;-moz-column-gap:2em;width:100%;padding:2px}.flx-item[data-v-081d25bd]{width:300px}.payer-name[data-v-081d25bd]{order:0}.plan-name[data-v-081d25bd]{order:1}.plan-state[data-v-081d25bd]{order:2}.subscriber-id[data-v-081d25bd]{order:3}.subscriber-name[data-v-081d25bd]{order:4}.member-id[data-v-081d25bd]{order:5}.group-number[data-v-081d25bd]{order:6}.remove[data-v-081d25bd]{order:7;display:flex;width:100%;justify-content:flex-end}.ms-button[data-v-ea92b6e0],.wl-rm-button[data-v-ea92b6e0]{font-weight:400;font-style:normal;letter-spacing:normal;min-height:2.5rem;box-shadow:2px 5px 10px #00000026;border-radius:4px;border-color:transparent;background-color:#2078c1;color:#fff;font-size:1.0265rem;padding:0 1.5rem;line-height:1.125rem;cursor:pointer;transition:all .2s ease-in-out}.ms-button svg[data-v-ea92b6e0],.wl-rm-button svg[data-v-ea92b6e0]{width:15px;height:15px;margin-right:5px}.ms-button[data-v-ea92b6e0]:hover:enabled,.wl-rm-button[data-v-ea92b6e0]:hover:enabled{opacity:.8}.ms-button[data-v-ea92b6e0]:disabled,.wl-rm-button[data-v-ea92b6e0]:disabled{cursor:not-allowed;box-shadow:none;background:#c1c1c1;color:#fff;min-width:7.875rem}.ms-button[data-v-ea92b6e0]:disabled:hover:enabled,.wl-rm-button[data-v-ea92b6e0]:disabled:hover:enabled{background:#cecece}.ms-button.small[data-v-ea92b6e0],.small.wl-rm-button[data-v-ea92b6e0]{min-height:1.875rem;padding:0 .75rem;font-size:.75rem}.ms-button.wide[data-v-ea92b6e0],.wide.wl-rm-button[data-v-ea92b6e0]{min-width:18.75rem}.ms-button.flat[data-v-ea92b6e0],.flat.wl-rm-button[data-v-ea92b6e0]{box-shadow:none}.ms-button.outlined[data-v-ea92b6e0],.outlined.wl-rm-button[data-v-ea92b6e0]{border:1px solid #2078c1;color:#2078c1;background-color:#fff}.ms-button.outlined[data-v-ea92b6e0]:hover:enabled,.outlined.wl-rm-button[data-v-ea92b6e0]:hover:enabled{background-color:#fff}.ms-button.text-button[data-v-ea92b6e0],.text-button.wl-rm-button[data-v-ea92b6e0]{border-style:none;color:#2078c1;background-color:transparent;box-shadow:none;font-weight:700}.ms-button.text-button[data-v-ea92b6e0]:hover:enabled,.text-button.wl-rm-button[data-v-ea92b6e0]:hover:enabled{background-color:transparent}.wl-rm-button[data-v-ea92b6e0]{min-height:40px;min-width:8.61rem;border-color:transparent;background-color:#dd3737;color:#fff}.wl-rm-button[data-v-ea92b6e0]:disabled{min-width:8.61rem}.wl-rm-button.outlined[data-v-ea92b6e0]{border:1px solid #dd3737;color:#dd3737}.wl-rm-button.strict[data-v-ea92b6e0]{height:40px;width:8.61rem}.wl-rm-button.text-button[data-v-ea92b6e0]{color:#dd3737}.editable-text-container[data-v-ea92b6e0]{display:flex;justify-content:space-between;align-items:center;border-radius:4px;margin-bottom:8px}.editable-text[data-v-ea92b6e0]{padding:6px 11px;margin-right:10px;border:1px solid var(--primary-color);border-radius:4px;outline:none;box-sizing:border-box;width:100%}.editable-text[data-v-ea92b6e0]:focus{box-shadow:0 0 2px .02em var(--primary-color)}.editable-text-action[data-v-ea92b6e0]{padding:8px 16px;cursor:pointer;color:#f14668;font-size:14px;border-radius:4px;box-sizing:border-box}.editable-text-action[data-v-ea92b6e0]:focus{border:2px solid #a7abaa;margin:-2px;outline:none}ion-icon[data-v-4e09d02e]{display:inline-block;font-size:24px}.empty-state[data-v-4e09d02e]{display:inline-block;padding:8px 16px;color:#a7abaa;font-weight:700;border-radius:4px;box-sizing:border-box;width:100%}.spacer[data-v-4e09d02e]{margin-top:16px}.nav-section[data-v-4ec01109]{display:flex;justify-content:space-between}.contact-fields{display:flex;flex-flow:row wrap;justify-content:flex-start;gap:2em;-moz-column-gap:2em;width:100%}.flx-item{width:324px}.contact-name{order:0}.phone{display:flex;gap:2em;order:1;width:fit-content}.phone-collapsed{order:1}.phone-number{order:0;width:200px}.phone-extension{order:1;width:100px}.fax-number{order:2;width:200px}.email{order:3}.providerName[data-v-5852f78b]{display:flex;flex-flow:row wrap;justify-content:flex-start;gap:2em;-moz-column-gap:1.5em;width:100%}.providerFirstName[data-v-5852f78b]{width:300px;order:0}.providerLastName[data-v-5852f78b]{width:300px;order:1}.providerOrganizationName[data-v-5852f78b]{width:300px;order:3}.divider[data-v-5852f78b]{order:2;display:flex;justify-content:center;align-items:center;margin-top:24px;color:#66676c;font-size:14px;grid-area:divider}.provider-fields[data-v-53f7b972]{display:flex;flex-flow:row wrap;justify-content:flex-start;gap:2em;-moz-column-gap:2em;width:100%}.flx-item[data-v-53f7b972]{width:324px}.npi[data-v-53f7b972]{order:0}.tin[data-v-53f7b972]{order:1}.network-status[data-v-53f7b972]{order:2}.provider-name[data-v-53f7b972]{order:3;width:100%}.provider-name-collapsed[data-v-53f7b972]{order:3;width:fit-content}.specialty[data-v-53f7b972]{width:30%;order:4}.button[data-v-d27fcb68]{padding:6px 16px;outline:none;border:none;border-radius:4px;color:#fff;box-sizing:border-box;background:var(--primary-color);margin-left:12px;min-width:160px}.arrow[data-v-d27fcb68]{margin-left:8px}.dropdown[data-v-d27fcb68]{float:right;position:relative}.dropdown-content[data-v-d27fcb68]{display:none;min-width:195px;border-radius:4px;background-color:#eee;box-shadow:0 8px 16px #0003;z-index:1;position:absolute}.copy-provider[data-v-d27fcb68]{padding:12px 13px;width:-webkit-fill-available;display:block;text-align:initial;border:none;border-radius:inherit}.copy-provider[data-v-d27fcb68]:focus{outline:none}.copy-provider[data-v-d27fcb68]:hover{cursor:pointer}.copy-provider[data-v-d27fcb68]:hover:focus{background-color:#153d6b;color:#fff}.dropdown:hover .dropdown-content[data-v-d27fcb68]{display:block}.button[data-v-9c71e184]{padding:6px 16px;outline:none;border:none;border-radius:4px;color:#fff;box-sizing:border-box;background:var(--primary-color);margin-left:12px;min-width:160px}.arrow[data-v-9c71e184]{margin-left:8px}.dropdown[data-v-9c71e184]{float:right;position:relative}.dropdown-content[data-v-9c71e184]{display:none;min-width:195px;border-radius:4px;background-color:#eee;box-shadow:0 8px 16px #0003;z-index:1;position:absolute}.copy-provider[data-v-9c71e184]{padding:12px 13px;width:-webkit-fill-available;display:block;text-align:initial;border:none;border-radius:inherit}.copy-provider[data-v-9c71e184]:focus{outline:none}.copy-provider[data-v-9c71e184]:hover{cursor:pointer}.copy-provider[data-v-9c71e184]:hover:focus{background-color:#153d6b;color:#fff}.dropdown:hover .dropdown-content[data-v-9c71e184]{display:block}.nav-section[data-v-f7c5062f],.nav-section[data-v-db377b0b]{display:flex;justify-content:space-between}.information-info-fields[data-v-0ca8b402]{display:flex;flex-flow:row wrap;justify-content:flex-start;gap:2em;-moz-column-gap:2em;width:100%}.flx-item[data-v-0ca8b402]{width:324px}.npi-number[data-v-0ca8b402]{order:0}.tin-number[data-v-0ca8b402]{order:1}.network-status[data-v-0ca8b402]{order:2}.organization-name[data-v-0ca8b402]{order:3}.nav-section[data-v-dfdbd9e6],.nav-section[data-v-a828a92b]{display:flex;justify-content:space-between}#encounter-information-fields[data-v-caf49f12]{display:flex;flex-flow:row wrap}#encounter-information-fields .encounter-info-item[data-v-caf49f12]{flex:none;padding:0 30px 20px 0;width:30%}.ms-button[data-v-6a07b3c7],.wl-rm-button[data-v-6a07b3c7]{font-weight:400;font-style:normal;letter-spacing:normal;min-height:2.5rem;box-shadow:2px 5px 10px #00000026;border-radius:4px;border-color:transparent;background-color:#2078c1;color:#fff;font-size:1.0265rem;padding:0 1.5rem;line-height:1.125rem;cursor:pointer;transition:all .2s ease-in-out}.ms-button svg[data-v-6a07b3c7],.wl-rm-button svg[data-v-6a07b3c7]{width:15px;height:15px;margin-right:5px}.ms-button[data-v-6a07b3c7]:hover:enabled,.wl-rm-button[data-v-6a07b3c7]:hover:enabled{opacity:.8}.ms-button[data-v-6a07b3c7]:disabled,.wl-rm-button[data-v-6a07b3c7]:disabled{cursor:not-allowed;box-shadow:none;background:#c1c1c1;color:#fff;min-width:7.875rem}.ms-button[data-v-6a07b3c7]:disabled:hover:enabled,.wl-rm-button[data-v-6a07b3c7]:disabled:hover:enabled{background:#cecece}.ms-button.small[data-v-6a07b3c7],.small.wl-rm-button[data-v-6a07b3c7]{min-height:1.875rem;padding:0 .75rem;font-size:.75rem}.ms-button.wide[data-v-6a07b3c7],.wide.wl-rm-button[data-v-6a07b3c7]{min-width:18.75rem}.ms-button.flat[data-v-6a07b3c7],.flat.wl-rm-button[data-v-6a07b3c7]{box-shadow:none}.ms-button.outlined[data-v-6a07b3c7],.outlined.wl-rm-button[data-v-6a07b3c7]{border:1px solid #2078c1;color:#2078c1;background-color:#fff}.ms-button.outlined[data-v-6a07b3c7]:hover:enabled,.outlined.wl-rm-button[data-v-6a07b3c7]:hover:enabled{background-color:#fff}.ms-button.text-button[data-v-6a07b3c7],.text-button.wl-rm-button[data-v-6a07b3c7]{border-style:none;color:#2078c1;background-color:transparent;box-shadow:none;font-weight:700}.ms-button.text-button[data-v-6a07b3c7]:hover:enabled,.text-button.wl-rm-button[data-v-6a07b3c7]:hover:enabled{background-color:transparent}.wl-rm-button[data-v-6a07b3c7]{min-height:40px;min-width:8.61rem;border-color:transparent;background-color:#dd3737;color:#fff}.wl-rm-button[data-v-6a07b3c7]:disabled{min-width:8.61rem}.wl-rm-button.outlined[data-v-6a07b3c7]{border:1px solid #dd3737;color:#dd3737}.wl-rm-button.strict[data-v-6a07b3c7]{height:40px;width:8.61rem}.wl-rm-button.text-button[data-v-6a07b3c7]{color:#dd3737}.wl-rm-button[data-v-6a07b3c7]{justify-content:center;align-items:center;height:40px;margin-top:27px;margin-left:10px}.divider[data-v-6a07b3c7]{position:relative;margin:22px 0 31px;border-bottom:1px solid #153d6b}.divider-label[data-v-6a07b3c7]{position:absolute;top:-15px;left:30px;font-size:14px;color:#fff;padding:4px 16px;border-radius:4px}.divider-label[diagnosis-index="0"][data-v-6a07b3c7]{background:var(--secondary-color)}.divider-label[diagnosis-index="1"][data-v-6a07b3c7]{background:var(--tertiary-color)}.divider-label[diagnosis-index="2"][data-v-6a07b3c7]{background:var(--primary-color)}.diagnosis-fields[data-v-6a07b3c7]{display:flex;flex-flow:row wrap;margin-left:2em}.diagnosis-fields .diagnosis-field[data-v-6a07b3c7]{flex:none;width:40%;padding:0 30px 20px 0}.diagnosis-fields .small[data-v-6a07b3c7]{width:20%}.diagnosis-fields .large[data-v-6a07b3c7]{width:50%}.ms-button[data-v-d04b4c80],.wl-rm-button[data-v-d04b4c80]{font-weight:400;font-style:normal;letter-spacing:normal;min-height:2.5rem;box-shadow:2px 5px 10px #00000026;border-radius:4px;border-color:transparent;background-color:#2078c1;color:#fff;font-size:1.0265rem;padding:0 1.5rem;line-height:1.125rem;cursor:pointer;transition:all .2s ease-in-out}.ms-button svg[data-v-d04b4c80],.wl-rm-button svg[data-v-d04b4c80]{width:15px;height:15px;margin-right:5px}.ms-button[data-v-d04b4c80]:hover:enabled,.wl-rm-button[data-v-d04b4c80]:hover:enabled{opacity:.8}.ms-button[data-v-d04b4c80]:disabled,.wl-rm-button[data-v-d04b4c80]:disabled{cursor:not-allowed;box-shadow:none;background:#c1c1c1;color:#fff;min-width:7.875rem}.ms-button[data-v-d04b4c80]:disabled:hover:enabled,.wl-rm-button[data-v-d04b4c80]:disabled:hover:enabled{background:#cecece}.ms-button.small[data-v-d04b4c80],.small.wl-rm-button[data-v-d04b4c80]{min-height:1.875rem;padding:0 .75rem;font-size:.75rem}.ms-button.wide[data-v-d04b4c80],.wide.wl-rm-button[data-v-d04b4c80]{min-width:18.75rem}.ms-button.flat[data-v-d04b4c80],.flat.wl-rm-button[data-v-d04b4c80]{box-shadow:none}.ms-button.outlined[data-v-d04b4c80],.outlined.wl-rm-button[data-v-d04b4c80]{border:1px solid #2078c1;color:#2078c1;background-color:#fff}.ms-button.outlined[data-v-d04b4c80]:hover:enabled,.outlined.wl-rm-button[data-v-d04b4c80]:hover:enabled{background-color:#fff}.ms-button.text-button[data-v-d04b4c80],.text-button.wl-rm-button[data-v-d04b4c80]{border-style:none;color:#2078c1;background-color:transparent;box-shadow:none;font-weight:700}.ms-button.text-button[data-v-d04b4c80]:hover:enabled,.text-button.wl-rm-button[data-v-d04b4c80]:hover:enabled{background-color:transparent}.wl-rm-button[data-v-d04b4c80]{min-height:40px;min-width:8.61rem;border-color:transparent;background-color:#dd3737;color:#fff}.wl-rm-button[data-v-d04b4c80]:disabled{min-width:8.61rem}.wl-rm-button.outlined[data-v-d04b4c80]{border:1px solid #dd3737;color:#dd3737}.wl-rm-button.strict[data-v-d04b4c80]{height:40px;width:8.61rem}.wl-rm-button.text-button[data-v-d04b4c80]{color:#dd3737}.button-wrapper[data-v-d04b4c80]{display:flex;justify-content:space-between;align-items:center;margin:24px 0 10px}.remove[data-v-d04b4c80]{-webkit-user-select:none;user-select:none;color:#f14668;cursor:pointer;border:2px solid #ffffff;border-radius:4px;padding:6px}.remove[data-v-d04b4c80]:focus{border-color:#a7abaa;outline:none}.procedure-label[procedure-index="0"][data-v-6f3136d7]{background:var(--secondary-color)}.procedure-label[procedure-index="1"][data-v-6f3136d7]{background:var(--tertiary-color)}.procedure-label[procedure-index="2"][data-v-6f3136d7]{background:var(--primary-color)}fieldset[data-v-6f3136d7]{border:1px solid #153d6b;border-radius:4px;padding:1em 2em;margin-bottom:32px}legend[data-v-6f3136d7]{font-size:14px;color:#fff;padding:4px 16px;border-radius:4px}.procedure-fields[data-v-6f3136d7]{display:flex;flex-flow:row wrap}.procedure-fields .procedure-field[data-v-6f3136d7]{flex:none;padding:0 30px 20px 0;width:40%}.procedure-fields .small[data-v-6f3136d7]{width:20%}.procedure-fields .large[data-v-6f3136d7]{width:50%}.fqi-textarea{display:flex;width:100%}.fqi-textarea .fqi-input{width:100%}:root{--fq-color-primary: steelblue;--fq-color-primary-light: cornflowerblue;--fq-color-primary-accent: aliceblue;--fq-color-primary-accent-text: royalblue;--fq-color-text: dimgray;--fq-color-muted: darkgray;--fq-color-error: crimson;--fq-color-error-background: mistyrose;--fq-color-white: white;--fq-color-light: gainsboro;--fq-color-stripe: lightgray;--fq-primary-color: var(--fq-color-primary);--fq-primary-light: var(--fq-color-primary-light);--fq-primary-accent: var(--fq-color-primary-accent);--fq-primary-accent-text: var(--fq-color-primary-accent-text);--fq-text-color: var(--fq-color-text);--fq-text-muted: var(--fq-color-muted);--fq-error-color: var(--fq-color-error);--fq-error-background: var(--fq-color-error-background);--fq-background-white: var(--fq-color-white);--fq-background-light: var(--fq-color-light);--fq-background-stripe: var(--fq-color-stripe);--fq-border-color: var(--fq-color-primary-light);--fq-border-light: var(--fq-color-light);--fq-border-muted: var(--fq-color-muted);--fq-border-radius: 4px;--fq-border-radius-tag: 8px;--fq-spacing-xs: 2px;--fq-spacing-sm: 4px;--fq-spacing-md: 6px;--fq-spacing-lg: 8px;--fq-spacing-xl: 12px;--fq-spacing-xxl: 16px;--fq-spacing-3xl: 48px;--fq-input-padding: 6px 12px;--fq-input-height: 38px;--fq-input-min-height: 40px;--fq-font-size-sm: 14px;--fq-font-size-base: 1em;--fq-font-size-lg: 1.5em;--fq-font-weight-normal: normal;--fq-font-weight-bold: bold;--fq-icon-size: 20px;--fq-icon-size-lg: 80px;--fq-focus-shadow: 0 0 2px .02em var(--fq-border-color);--fq-dropdown-shadow: 0 2px 8px rgba(0, 0, 0, .1);--fq-z-dropdown: 1000}.fqi-item{display:flex;flex-direction:column;padding:var(--fq-spacing-sm);box-sizing:border-box}.fqi-item textarea{min-height:var(--fq-input-min-height);resize:vertical}.fqi-item[data-hidden=true]{display:none}.fqi-label{color:var(--fq-text-color);white-space:normal;word-wrap:break-word;overflow-wrap:break-word}.fqi-label[data-required=true]:after{content:" *";color:var(--fq-error-color)}.fqi-input{border:1px solid var(--fq-border-color);border-radius:var(--fq-border-radius);padding:var(--fq-input-padding);outline:none}.fqi-input[data-invalid=true]{border:1px solid var(--fq-error-color);background:var(--fq-error-background)}.fqi-input:focus{box-shadow:var(--fq-focus-shadow)}.fq-icon{width:var(--fq-icon-size);height:var(--fq-icon-size)}.fq-icon-lg{color:var(--fq-primary-color);width:var(--fq-icon-size-lg);height:var(--fq-icon-size-lg)}.fqi-legend{width:100%;color:var(--fq-primary-color);font-size:var(--fq-font-size-lg)}.fqi-legend strong{padding-right:var(--fq-spacing-xl)}.fqi-legend:after{content:"";display:inline-block;border-top:1px solid var(--fq-background-light);width:calc(100% + var(--fq-spacing-xxl));margin-left:calc(-1 * var(--fq-spacing-lg));transform:translateY(-1rem)}.fqi-group{margin-bottom:var(--fq-spacing-3xl)}.fqi-group h3{display:flex;align-items:center;gap:var(--fq-spacing-xs);color:var(--fq-text-color);white-space:normal;word-wrap:break-word;overflow-wrap:break-word}.fqi-group[data-hidden=true]{display:none}.fqi-group-label{display:flex;align-items:center;gap:var(--fq-spacing-lg)}.fqi-options{display:flex;gap:var(--fq-spacing-lg)}.fqi-option{display:flex;flex-direction:row;justify-content:center;align-items:center;height:var(--fq-input-height);font-size:var(--fq-font-size-sm);white-space:nowrap;border:1px solid var(--fq-border-muted);border-radius:var(--fq-border-radius);padding:0 var(--fq-spacing-sm);-webkit-user-select:none;user-select:none;cursor:pointer}.fqi-option label{display:flex;align-items:center;justify-content:center;height:100%;cursor:pointer}.fqi-option input{cursor:pointer}.fqi-option span{display:flex;align-items:center;justify-content:center;cursor:pointer;padding-right:var(--fq-spacing-sm)}.fqi-option[data-active=true]{color:var(--fq-background-white);background:var(--fq-text-muted)}.fqi-option[data-invalid=true]{border:1px solid var(--fq-error-color)}.fqi-option[data-invalid=true]>input{border:1px solid var(--fq-error-color)}.fqi-select{display:flex;justify-content:space-between;align-items:center;width:100%;border:1px solid var(--fq-border-color);border-radius:var(--fq-border-radius);padding:var(--fq-input-padding);outline:none;cursor:default;box-sizing:border-box}.fqi-select .fqi-select-icons{display:flex;gap:var(--fq-spacing-sm);height:100%;justify-content:center;align-items:center}.fqi-select .fqi-icon-hover{cursor:pointer}.fqi-select .fqi-icon-hover:hover{transform:translateY(-1px)}.fqi-select input{width:100%;outline:none;border:none;cursor:default}.fqi-select input[data-invalid=true]{background:var(--fq-error-background)}.fqi-select[data-invalid=true]{border:1px solid var(--fq-error-color);background:var(--fq-error-background)}.fqi-focus{box-shadow:var(--fq-focus-shadow)}.fqi-multiselect{width:100%;position:relative}.fqi-multiselect .fqi-selected-tags{display:flex;flex-wrap:wrap;gap:var(--fq-spacing-sm);min-height:fit-content}.fqi-multiselect .fqi-selected-tags .fqi-tag{display:inline-flex;align-items:center;background:var(--fq-primary-accent);border:1px solid var(--fq-border-color);border-radius:var(--fq-border-radius-tag);padding:var(--fq-spacing-sm) var(--fq-spacing-lg);margin-top:var(--fq-spacing-xs);margin-bottom:var(--fq-spacing-sm);font-size:var(--fq-font-size-sm);color:var(--fq-primary-accent-text)}.fqi-multiselect .fqi-selected-tags .fqi-tag .fqi-tag-remove{background:none;border:none;color:var(--fq-primary-accent-text);cursor:pointer;font-size:var(--fq-spacing-xxl);font-weight:var(--fq-font-weight-bold);margin-left:var(--fq-spacing-sm);padding:0;width:var(--fq-spacing-xxl);height:var(--fq-spacing-xxl);display:flex;align-items:center;justify-content:center;border-radius:50%}.fqi-multiselect .fqi-selected-tags .fqi-tag .fqi-tag-remove:hover{background:#1565c01a}.fqi-single-select{width:100%;position:relative}.fqi-single-select[data-invalid=true] .fqi-select{border:1px solid var(--fq-error-color);background:var(--fq-error-background)}.fqi-multiselect[data-invalid=true] .fqi-tag{border:1px solid var(--fq-error-color)}.fqi-multiselect[data-invalid=true] .fqi-select{border:1px solid var(--fq-error-color);background:var(--fq-error-background)}.fqi-dropdown-list{width:100%;border:1px solid var(--fq-border-light);border-radius:var(--fq-border-radius);outline:none;box-sizing:border-box;list-style-type:none;padding-left:0;margin-top:var(--fq-spacing-sm);margin-bottom:0;position:absolute;top:100%;left:0;right:0;z-index:var(--fq-z-dropdown);background:var(--fq-background-white);box-shadow:var(--fq-dropdown-shadow)}.fqi-dropdown-list .fqi-dropdown-list-item{background:var(--fq-background-white);cursor:pointer;padding:var(--fq-input-padding)}.fqi-dropdown-list .fqi-dropdown-list-item:nth-of-type(2n){background:var(--fq-background-stripe)}.fqi-dropdown-list .fqi-dropdown-list-item.selected{background:var(--fq-primary-accent);color:var(--fq-primary-accent-text)}.fqi-dropdown-list .fqi-dropdown-list-item:hover{color:var(--fq-background-white);background:var(--fq-text-muted)}.ms-button,.pas-button{font-weight:400;font-style:normal;letter-spacing:normal;min-height:2.5rem;box-shadow:2px 5px 10px #00000026;border-radius:4px;border-color:transparent;background-color:#2078c1;color:#fff;font-size:1.0265rem;padding:0 1.5rem;line-height:1.125rem;cursor:pointer;transition:all .2s ease-in-out}.ms-button svg,.pas-button svg{width:15px;height:15px;margin-right:5px}.ms-button:hover:enabled,.pas-button:hover:enabled{opacity:.8}.ms-button:disabled,.pas-button:disabled{cursor:not-allowed;box-shadow:none;background:#c1c1c1;color:#fff;min-width:7.875rem}.ms-button:disabled:hover:enabled,.pas-button:disabled:hover:enabled{background:#cecece}.ms-button.small,.small.pas-button{min-height:1.875rem;padding:0 .75rem;font-size:.75rem}.ms-button.wide,.wide.pas-button{min-width:18.75rem}.ms-button.flat,.flat.pas-button{box-shadow:none}.ms-button.outlined,.outlined.pas-button{border:1px solid #2078c1;color:#2078c1;background-color:#fff}.ms-button.outlined:hover:enabled,.outlined.pas-button:hover:enabled{background-color:#fff}.ms-button.text-button,.text-button.pas-button{border-style:none;color:#2078c1;background-color:transparent;box-shadow:none;font-weight:700}.ms-button.text-button:hover:enabled,.text-button.pas-button:hover:enabled{background-color:transparent}.dim-background{position:absolute;display:flex;flex-direction:column;justify-content:center;align-items:center;width:100%;height:100%;background-color:#7f7f7f;z-index:2}.loading-background-section{display:flex;flex-grow:1;flex-direction:column;justify-content:flex-start;align-items:center;width:100%;height:100%;z-index:2}.loading-spinner{display:inline-block;border:4px solid;border-radius:50%;border-top-color:transparent;color:var(--primary-color);width:20px;height:20px;animation:turn 1s linear infinite;z-index:2;margin:10px}@keyframes turn{0%{transform:rotate(0)}to{transform:rotate(360deg)}}.pas-button{min-height:40px;min-width:7.875rem;border-color:transparent;background-color:var(--primary-color);color:#fff}.pas-button:disabled{min-width:7.875rem}.pas-button.outlined{border:1px solid var(--primary-color);color:var(--primary-color)}.pas-button.strict{height:40px;width:7.875rem}.pas-button.text-button{color:var(--primary-color)}.wl-link,.wl-link:visited,.wl-link:hover,.wl-link:active{color:var(--primary-color);cursor:pointer}.wl-link:hover{opacity:.8}.fade-enter-active,.fade-leave-active{transition:opacity .3s ease}.fade-enter,.fade-leave-to{opacity:0}:root{--fq-color-primary: #1a497e;--fq-color-primary-light: #2078c1;--fq-color-primary-accent: #e3f2fd;--fq-color-primary-accent-text: #1565c0;--fq-color-text: #363636;--fq-color-muted: #a7abaa;--fq-color-error: #f14668;--fq-color-error-background: #feecef;--fq-color-white: #ffffff;--fq-color-light: #f0f0f0;--fq-color-stripe: #eeeeee}.loader-center{display:flex;flex-direction:column;justify-content:center;align-items:center;width:100%;height:100%}.spaced-col{display:flex;flex-direction:column;gap:10px}.auto-answers-text{color:var(--secondary-color)}.ms-button[data-v-bacb34c3],.wl-rm-button[data-v-bacb34c3]{font-weight:400;font-style:normal;letter-spacing:normal;min-height:2.5rem;box-shadow:2px 5px 10px #00000026;border-radius:4px;border-color:transparent;background-color:#2078c1;color:#fff;font-size:1.0265rem;padding:0 1.5rem;line-height:1.125rem;cursor:pointer;transition:all .2s ease-in-out}.ms-button svg[data-v-bacb34c3],.wl-rm-button svg[data-v-bacb34c3]{width:15px;height:15px;margin-right:5px}.ms-button[data-v-bacb34c3]:hover:enabled,.wl-rm-button[data-v-bacb34c3]:hover:enabled{opacity:.8}.ms-button[data-v-bacb34c3]:disabled,.wl-rm-button[data-v-bacb34c3]:disabled{cursor:not-allowed;box-shadow:none;background:#c1c1c1;color:#fff;min-width:7.875rem}.ms-button[data-v-bacb34c3]:disabled:hover:enabled,.wl-rm-button[data-v-bacb34c3]:disabled:hover:enabled{background:#cecece}.ms-button.small[data-v-bacb34c3],.small.wl-rm-button[data-v-bacb34c3]{min-height:1.875rem;padding:0 .75rem;font-size:.75rem}.ms-button.wide[data-v-bacb34c3],.wide.wl-rm-button[data-v-bacb34c3]{min-width:18.75rem}.ms-button.flat[data-v-bacb34c3],.flat.wl-rm-button[data-v-bacb34c3]{box-shadow:none}.ms-button.outlined[data-v-bacb34c3],.outlined.wl-rm-button[data-v-bacb34c3]{border:1px solid #2078c1;color:#2078c1;background-color:#fff}.ms-button.outlined[data-v-bacb34c3]:hover:enabled,.outlined.wl-rm-button[data-v-bacb34c3]:hover:enabled{background-color:#fff}.ms-button.text-button[data-v-bacb34c3],.text-button.wl-rm-button[data-v-bacb34c3]{border-style:none;color:#2078c1;background-color:transparent;box-shadow:none;font-weight:700}.ms-button.text-button[data-v-bacb34c3]:hover:enabled,.text-button.wl-rm-button[data-v-bacb34c3]:hover:enabled{background-color:transparent}.wl-rm-button[data-v-bacb34c3]{min-height:40px;min-width:8.61rem;border-color:transparent;background-color:#dd3737;color:#fff}.wl-rm-button[data-v-bacb34c3]:disabled{min-width:8.61rem}.wl-rm-button.outlined[data-v-bacb34c3]{border:1px solid #dd3737;color:#dd3737}.wl-rm-button.strict[data-v-bacb34c3]{height:40px;width:8.61rem}.wl-rm-button.text-button[data-v-bacb34c3]{color:#dd3737}.wl-rm-button[data-v-bacb34c3]{margin-left:10px}.error[data-v-bacb34c3]{padding-top:2px;color:#f14668}.form-field-label[data-v-bacb34c3]{font-weight:600;font-size:1.2rem;margin:1rem 0}.form-field-label.files-label[data-v-bacb34c3]{margin-top:2rem}.note[data-v-bacb34c3]{color:#c40a0a;margin:10px 0}.remove-file-button[data-v-bacb34c3]{background:transparent;border:none;cursor:pointer;outline:none}.remove-file-button .remove-file-icon[data-v-bacb34c3]{margin-right:.5rem}input[data-v-bacb34c3]{width:.1px;height:.1px;opacity:0;z-index:-1}.pas-button-container[data-v-bacb34c3]{display:flex;cursor:pointer}.pas-input-label[data-v-bacb34c3]{display:block;width:fit-content;flex-basis:fit-content;cursor:pointer}.pas-button[data-v-bacb34c3]{height:35px;width:9.5rem;display:flex;justify-content:center;align-items:center}.attached-files-container[data-v-bacb34c3]{display:flex;flex-direction:column;width:fit-content}.attached-files[data-v-bacb34c3]{display:flex;flex-direction:row;align-items:center;justify-content:space-between;margin-top:10px}.answer-questions[data-v-eeb69499]{margin-bottom:1.5em;display:flex;gap:10px;justify-content:center;align-items:center}.answer-questions .answer-questions-text[data-v-eeb69499]{color:var(--secondary-color)}.answer-questions .answer-questions-button[data-v-eeb69499]{width:200px}.attachment-fields[data-v-eeb69499]{display:grid;row-gap:1.5em;column-gap:2em;grid-template-columns:repeat(2,1fr);grid-template-areas:"physician-order history-any-physical" "other-attachments ."}.physician-order[data-v-eeb69499]{grid-area:physician-order}.history-any-physical[data-v-eeb69499]{grid-area:history-any-physical}.other-attachments[data-v-eeb69499]{grid-area:other-attachments}.nav-section[data-v-eeb69499]{display:flex;justify-content:space-between}.request-success[data-v-02f25826]{display:inline-flex;align-items:center;width:100%;margin:10px 0;padding:10px;border-radius:4px;font-size:16px;cursor:default;background:green;color:#fff}.request-failure[data-v-02f25826]{margin-top:10px;padding:10px;background:#000;border-radius:4px;color:#fff;font-size:16px;min-width:400px;width:auto}.pas-button-container[data-v-02f25826]{display:inline-flex}.show[data-v-02f25826]{display:flex}.hide[data-v-02f25826]{display:none}.submission-id-copy-icon[data-v-02f25826]{margin:0 10px}.submission-id-copy-icon[data-v-02f25826] :hover{cursor:pointer;transform:translateY(-40px)}.submission-id-copy-icon[data-v-02f25826] :active{color:#d3d3d3}.footer{margin:50px 0}.copyright-info{text-align:center}.powered-by{display:flex;justify-content:center;flex-flow:row wrap;border:1px solid #F68A1E;border-radius:4px;margin:50px auto 0;height:4.1875em;width:10.75em}.powered-by-text{width:100%;text-align:center;display:flex;justify-content:center;align-items:center}.powered-by-logo{width:140px;height:26px}.ms-card[data-v-d0d31d57]{box-shadow:0 1px 20px 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