Chicago · tomschenkjr · Oct 19, 2017 · Oct 16, 2017 · Oct 17, 2017 · Oct 17, 2017
diff --git a/docs/apply.md b/docs/apply.md
@@ -0,0 +1,76 @@
+<p>If your institution is interested in participating in the Lead Safe program, please fill-out the following application to the Chicago Department of Public Health. All applications must have a clinician and technical contact identified before application, meet the <a href="#">eligibility requirements</a> and agree to the <a href="#">terms of service</a>. Clinicians must be licensed doctors who will help their health network use Lead Safe as part of the hospital's daily operations. The technical contact should be able to work to connect electronic medical records to the Lead Safe API. If you have any questions, please contact <a href="mailto:HealthyHomes@cityofchicago.org">HealthyHomes@cityofchicago.org</a>.</p>
+
+<form method="POST" action="http://formspree.io/developers@cityofchicago.org">
+  <h3>Please select from one of the eligible health networks</h3>
+  <select name="health-network" onchange="" onclick="return false;" class="selector">
+    <option value="Advocate Christ Medical Center">Advocate Christ Medical Center, 4440 West 95th Street</option>
+    <option value="Advocate Illinois Masonic Medical Center">Advocate Illinois Masonic Medical Center, 836 West Wellington</option>
+    <option value="Advocate Trinity Hospital">Advocate Trinity Hospital, 2320 East 93rd Street</option>
+    <option value="Ann &amp; Robert H. Lurie Children's Hospital of Chicago">Ann &amp; Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue</option>
+    <option value="Holy Cross Hospital">Holy Cross Hospital, 2701 West 68th Street</option>
+    <option value="Jackson Park Hosp. Foundation">Jackson Park Hosp. Foundation, 7531 Stony Island Avenue</option>
+    <option value="John H. Stroger Hospital of Cook County">John H. Stroger Hospital of Cook County, 1901 West Harrison Street</option>
+    <option value="LaRabida Children's Hospital">LaRabida Children's Hospital, 6501 S. Promontory Drive</option>
+    <option value="Little Company of Mary Hospital and Health Care Centers">Little Company of Mary Hospital and Health Care Centers, 2800 West 95th Street</option>
+    <option value="Loretto Hospital">Loretto Hospital, 645 South Central Avenue</option>
+    <option value="Louis A. Weiss Memorial Hospital">Louis A. Weiss Memorial Hospital, 4646 North Marine Drive</option>
+    <option value="Mercy Hospital &amp; Medical Center">Mercy Hospital &amp; Medical Center, 2525 South Michigan Avenue</option>
+    <option value="Methodist Hospital of Chicago">Methodist Hospital of Chicago, 5025 North Paulina Street</option>
+    <option value="Mount Sinai Hospital Medical Center">Mount Sinai Hospital Medical Center, 2750 W. 15th Street</option>
+    <option value="Northwestern Memorial Hospital">Northwestern Memorial Hospital, 211 East Ontario</option>
+    <option value="Norwegian American Hospital">Norwegian American Hospital, 1044 North Francisco Avenue</option>
+    <option value="Presence Our Lady of the Resurrection Medical Center">Presence Our Lady of the Resurrection Medical Center, 5645 West Addison Street</option>
+    <option value="Presence Resurrection Medical Center">Presence Resurrection Medical Center, 7435 West Talcott Avenue</option>
+    <option value="Presence Saint Francis Hospital">Presence Saint Francis Hospital, 355 Ridge Avenue</option>
+    <option value="Presence Saint Joseph Hospital Chicago">Presence Saint Joseph Hospital Chicago, 2900 North Lake Shore Drive</option>
+    <option value="Presence Saint Mary Of Nazareth Hospital">Presence Saint Mary Of Nazareth Hospital, 2233 West Divison Street</option>
+    <option value="Presence St. Elizabeth's Hospital">Presence St. Elizabeth's Hospital, 1431 North Claremont</option>
+    <option value="Provident Hospital of Cook County">Provident Hospital of Cook County, 500 East 51st Street</option>
+    <option value="Roseland Community Hospital">Roseland Community Hospital, 45 West 111th Street</option>
+    <option value="Rush University Medical Center">Rush University Medical Center, 1653 West Congress Parkway</option>
+    <option value="Shriners Hospitals for Children - Chicago">Shriners Hospitals for Children - Chicago, 2211 North Oak Park</option>
+    <option value="South Shore Hospital, Corp.">South Shore Hospital, Corp., 8012 South Crandon Ave.</option>
+    <option value="St. Anthony Hospital">St. Anthony Hospital, 2875 West 19th Street</option>
+    <option value="St. Bernard Hospital">St. Bernard Hospital, 326 West 64th Street</option>
+    <option value="Swedish Covenant Hospital">Swedish Covenant Hospital, 5145 North California Avenue</option>
+    <option value="Thorek Memorial Hospital">Thorek Memorial Hospital, 850 West Irving Park Road</option>
+    <option value="University of Chicago Medical Center">University of Chicago Medical Center, 5841 South Maryland</option>
+    <option value="University of Illinois Medical Center at Chicago">University of Illinois Medical Center at Chicago, 740 West Taylor Avenue</option>
+</select>
+
+  <h3 style="padding-top: 80px">Please provide information on the lead clinical contact</h3>
+
+  <div class="apply-form-subsection">
+    <i class="material-icons md-36">person</i>  <input type="text" name="clinical-point-of-contact" placeholder="Full name of clinical contact" class="apply-placeholder"><br />
+    <i class="material-icons md-36">assignment</i> <input type="text" name="clinical-title" placeholder="Job title" class="apply-placeholder"><br />
+    <i class="material-icons md-36">local_hospital</i><input type="text" name="national-provider-identifer" placeholder="National Provider Identifier" maxlength="10" class="apply-placeholder"><br />
+    <i class="material-icons md-36">fingerprint</i> <input type="text" name="illinois-physician-license" placeholder="Illinois Physician License" maxlength="9" class="apply-placeholder"><br />
+    <i class="material-icons md-36">place</i> <input type="text" name="clinical-address" placeholder="Work address" class="apply-placeholder"><br />
+    <i class="material-icons md-36">phone</i> <input type="tel" name="clinical-telephone" placeholder="Office phone number" class="apply-placeholder"><br />
+    <i class="material-icons md-36">email</i> <input type="_replyto" name="clinical-email" placeholder="Work-issued email" class="apply-placeholder"><br />
+  </div>
+
+  <h3>Please provide contact information for the technical advisor</h3>
+
+  <div class="apply-form-subsection">
+    <i class="material-icons md-36">person</i> <input type="text" name="technical-point-of-contact" placeholder="Full name of technical contact" class="apply-placeholder" class="apply-placeholder"><br />
+    <i class="material-icons md-36">assignment</i> <input type="text" name="technical-title" placeholder="Job title" class="apply-placeholder"><br />
+    <i class="material-icons md-36">place</i> <input type="text" name="technical-address" placeholder="Work address" class="apply-placeholder"><br />
+    <i class="material-icons md-36">phone</i> <input type="tel" name="technical-telephone" placeholder="Office phone number" class="apply-placeholder"><br />
+    <i class="material-icons md-36">email</i> <input type="email" name="technical-email" placeholder="Work-issued email" class="apply-placeholder"><br />
+  </div>
+
+  <h3>Eligibility Criteria</h3>
+
+  <input type="checkbox" name="eligibility-criteria" value="certifies-eligibility">I have read the <a href="#">eligibility criteria</a> and certify that this institution meets the minimum standards.
+  <br />
+
+  <h3>Terms of Service</h3>
+
+  <input type="checkbox" name="accept-terms-of-service" value="accepts-terms-of-service">I accept the <a href="#">Terms of Service</a><br />
+  <br />
+  <button type="submit" class="btn">Send</button>
+  <input type="hidden" name="_subject" value="Test submission: Lead Safe API Request" />
+  <input type="hidden" name="_cc" value="developers@cityofchicago.org" />
+
+</form>
diff --git a/docs/assets/images/favicon.png b/docs/assets/images/favicon.png
diff --git a/docs/javascript/extra.js b/docs/javascript/extra.js
@@ -0,0 +1,110 @@
+window.onload = function(){
+  crear_select();
+}
+
+var Navegador_ = (window.navigator.userAgent||window.navigator.vendor||window.opera),
+		Firfx = /Firefox/i.test(Navegador_),
+		Mobile_ = /Android|webOS|iPhone|iPad|iPod|BlackBerry/i.test(Navegador_),
+	FirfoxMobile = (Firfx && Mobile_);
+
+var li = new Array();
+function crear_select(){
+var div_cont_select = document.querySelectorAll("[data-mate-select='active']");
+var select_ = '';
+for (var e = 0; e < div_cont_select.length; e++) {
+div_cont_select[e].setAttribute('data-indx-select',e);
+div_cont_select[e].setAttribute('data-selec-open','false');
+var ul_cont = document.querySelectorAll("[data-indx-select='"+e+"'] > .cont_list_select_mate > ul");
+ select_ = document.querySelectorAll("[data-indx-select='"+e+"'] >select")[0];
+ if (Mobile_ || FirfoxMobile) { 
+select_.addEventListener('change', function () {
+ _select_option(select_.selectedIndex,e);
+});
+ }
+var select_optiones = select_.options;
+document.querySelectorAll("[data-indx-select='"+e+"']  > .selecionado_opcion ")[0].setAttribute('data-n-select',e);
+document.querySelectorAll("[data-indx-select='"+e+"']  > .icon_select_mate ")[0].setAttribute('data-n-select',e);
+for (var i = 0; i < select_optiones.length; i++) {
+li[i] = document.createElement('li');
+if (select_optiones[i].selected == true || select_.value == select_optiones[i].innerHTML ) {
+li[i].className = 'active';
+document.querySelector("[data-indx-select='"+e+"']  > .selecionado_opcion ").innerHTML = select_optiones[i].innerHTML;
+};
+li[i].setAttribute('data-index',i);
+li[i].setAttribute('data-selec-index',e);
+// funcion click al selecionar 
+li[i].addEventListener( 'click', function(){  _select_option(this.getAttribute('data-index'),this.getAttribute('data-selec-index')); });
+
+li[i].innerHTML = select_optiones[i].innerHTML;
+ul_cont[0].appendChild(li[i]);
+
+    }; // Fin For select_optiones
+  }; // fin for divs_cont_select
+} // Fin Function 
+
+
+
+var cont_slc = 0;
+function open_select(idx){
+var idx1 =  idx.getAttribute('data-n-select');
+  var ul_cont_li = document.querySelectorAll("[data-indx-select='"+idx1+"'] .cont_select_int > li");
+var hg = 0;
+var slect_open = document.querySelectorAll("[data-indx-select='"+idx1+"']")[0].getAttribute('data-selec-open');
+var slect_element_open = document.querySelectorAll("[data-indx-select='"+idx1+"'] select")[0];
+ if (Mobile_ || FirfoxMobile) { 
+  if (window.document.createEvent) { // All
+  var evt = window.document.createEvent("MouseEvents");
+  evt.initMouseEvent("mousedown", false, true, window, 0, 0, 0, 0, 0, false, false, false, false, 0, null);
+	slect_element_open.dispatchEvent(evt);
+} else if (slect_element_open.fireEvent) { // IE
+  slect_element_open.fireEvent("onmousedown");
+}
+}else {
+
+
+  for (var i = 0; i < ul_cont_li.length; i++) {
+hg += ul_cont_li[i].offsetHeight;
+}; 
+ if (slect_open == 'false') {  
+ document.querySelectorAll("[data-indx-select='"+idx1+"']")[0].setAttribute('data-selec-open','true');
+ document.querySelectorAll("[data-indx-select='"+idx1+"'] > .cont_list_select_mate > ul")[0].style.height = hg+"px";
+ document.querySelectorAll("[data-indx-select='"+idx1+"'] > .icon_select_mate")[0].style.transform = 'rotate(180deg)';
+}else{
+ document.querySelectorAll("[data-indx-select='"+idx1+"']")[0].setAttribute('data-selec-open','false');
+ document.querySelectorAll("[data-indx-select='"+idx1+"'] > .icon_select_mate")[0].style.transform = 'rotate(0deg)';
+ document.querySelectorAll("[data-indx-select='"+idx1+"'] > .cont_list_select_mate > ul")[0].style.height = "0px";
+ }
+}
+
+} // fin function open_select
+
+function salir_select(indx){
+var select_ = document.querySelectorAll("[data-indx-select='"+indx+"'] > select")[0];
+ document.querySelectorAll("[data-indx-select='"+indx+"'] > .cont_list_select_mate > ul")[0].style.height = "0px";
+document.querySelector("[data-indx-select='"+indx+"'] > .icon_select_mate").style.transform = 'rotate(0deg)';
+ document.querySelectorAll("[data-indx-select='"+indx+"']")[0].setAttribute('data-selec-open','false');
+}
+
+
+function _select_option(indx,selc){
+ if (Mobile_ || FirfoxMobile) { 
+selc = selc -1;
+}
+    var select_ = document.querySelectorAll("[data-indx-select='"+selc+"'] > select")[0];
+
+  var li_s = document.querySelectorAll("[data-indx-select='"+selc+"'] .cont_select_int > li");
+  var p_act = document.querySelectorAll("[data-indx-select='"+selc+"'] > .selecionado_opcion")[0].innerHTML = li_s[indx].innerHTML;
+var select_optiones = document.querySelectorAll("[data-indx-select='"+selc+"'] > select > option");
+for (var i = 0; i < li_s.length; i++) {
+if (li_s[i].className == 'active') {
+li_s[i].className = '';
+};
+li_s[indx].className = 'active';
+
+};
+select_optiones[indx].selected = true;
+  select_.selectedIndex = indx;
+  select_.onchange();
+  salir_select(selc); 
+}
+
diff --git a/docs/stylesheets/extra.css b/docs/stylesheets/extra.css
@@ -0,0 +1,47 @@
+.selector {
+	position: relative; 
+	float: left; 
+	min-height: 60px; 
+	box-shadow: 1px 2px 10px -2px rgba(0,0,0,0.3); 
+	border-radius: 3px; 
+	font-size: 16px; 
+	margin-left: 10px; 
+	padding-left: 10px;
+}
+
+.apply-form-subsection {
+	padding-left: 10%;
+}
+
+
+/* Material Icons */
+
+.material-icons {
+	font-size: 36px; 
+	color: #757575; 
+	position: relative; 
+	top: 10px; 
+	margin-right: 10px; 
+	padding-bottom: 10px
+}
+
+.apply-placeholder {
+	font-size: 16px; 
+	display: inline-block; 
+	min-width: 200px; 
+	width: 50%; 
+	border-bottom: 1px solid #DCDCDC; 
+	box-sizing: border-box;
+}
+
+.btn {
+	background-color: #EF5350; 
+	font-size: 16px; 
+	color: #fff; 
+	border-radius: 8px; 
+	display: inline-block; 
+	padding: 15px 32px; 
+	text-decoration: none; 
+	border: none; 
+	cursor: pointer
+}
diff --git a/mkdocs.yml b/mkdocs.yml
@@ -8,6 +8,7 @@ site_url: http://dev.cityofchicago.org/docs/lead-free
 # Page Tree
 pages:
 - Home: index.md
+- 'Apply for Lead Safe': 'apply.md'
 
 # Copyright
 copyright: Copyright &copy; 2016-2017 <a href="http://www.cityofchicago.org">City of Chicago</a> and licensed under <a href="http://creativecommons.org/licenses/by-sa/4.0/">Creative Commons Attribution-ShareAlike 4.0 International</a>.
@@ -22,8 +23,8 @@ site_favicon: 'assets/images/favicon.png'
 extra:
   logo: 'assets/images/city-seal-inverse-small.png'
   palette:
-    primary: 'blue grey'
-    accent: 'light blue'
+    primary: 'blue'
+    accent: 'red'
   social:
     - type: 'twitter'
       link: 'https://twitter.com/ChicagoCDO'
@@ -33,6 +34,10 @@ extra:
       link: 'mailto:developers@cityofchicago.org'
     - type: 'home'
       link: 'http://dev.cityofchicago.org'
+extra_css:
+  - 'stylesheets/extra.css'
+extra_javascript:
+  - 'javascripts/extra.js'
 
 # Google Analytics
 # google_analytics: