Sensitive data notice. The real application will require consent, a privacy policy, document retention rules, and private storage before launch. In this prototype nothing you type is saved.
  1. Step 1 About you
  2. Step 2 Care needed
  3. Step 3 Eligibility
  4. Step 4 Documents
  5. Step 5 Review

About you

Care needed

Do not include sensitive medical detail in this prototype.

Eligibility

Documents

No file is actually uploaded. Inputs are visual only. In production, documents will be uploaded to private storage with a strict retention policy.

Review & submit

Reviewers will see the summary below.