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index.html
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<!DOCTYPE html>
<html >
<head>
<meta charset="UTF-8">
<title>HeathCare Record</title>
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/meyer-reset/2.0/reset.min.css">
<link rel="stylesheet" href="css/style.css">
</head>
<body>
<!-- multistep form -->
<form id="msform">
<!-- progressbar -->
<!-- fieldsets -->
<fieldset>
<h2 class="fs-title">Wecome to BlocVac</h2>
<input type="button" name="next" class="next action-button" value="Enter" />
</div>
</div>
</fieldset>
<fieldset>
<h2 class="fs-title">Patient Data Portal</h2>
<h3 class="fs-subtitle">Enter Your Name</h3>
<input type="text" name="email" placeholder="" />
<!--<input type="password" name="pass" placeholder="Password" />--->
<input type="button" name="next" class="next action-button" value="Next" />
</fieldset>
<fieldset>
<h2 class="fs-title">Your Public Integra Id is :</h2>
<div id = "hashCode"> 26a6684d-6254-429e-bd85-ebd03d2b61f7 </div>
<!---<div id = "hashCode"> </div>--->
<input type="button" name="previous" class="previous action-button" value="Previous" />
<input type="button" name="next" class="next action-button" value="Next" />
</fieldset>
<fieldset>
<h2 class="fs-title">Enter Authorized Party to Receive Vaccination Transaction History</h2>
<div class="dropdown">
<select name="one" class="dropdown-select">
<option value="">Select…</option>
<option value="1">Maple Grove High School</option>
<option value="2">Mayo Clinic Rochester, MN</option>
<option value="3">MIT</option>
</select>
</div>
<!---<div id = "hashCode"> </div>--->
<input type="button" name="previous" class="previous action-button" value="Previous" />
<input type="button" name="next" class="next action-button" value="Share" />
</fieldset>
<fieldset>
<h2 class="fs-title">Your Vaccination Record Transaction History Has Been Shared With Maple Grove High School :</h2>
<input type="button" name="next" class="next action-button" value="Done" />
</fieldset>
</form>
<script src='http://cdnjs.cloudflare.com/ajax/libs/jquery/2.1.3/jquery.min.js'></script>
<script src='http://cdnjs.cloudflare.com/ajax/libs/jquery-easing/1.3/jquery.easing.min.js'></script>
<script src="js/index.js"></script>
</body>
</html>