:root {
  --ink: #172125;
  --muted: #5e6a6d;
  --brand: #0b8580;
  --brand-dark: #075e5b;
  --paper: #ffffff;
  --wash: #edf6f3;
  --line: #d9e2df;
  --warning: #8a4b00;
  --error: #a51d2d;
  --success: #176b44;
}

* { box-sizing: border-box; }

body {
  margin: 0;
  background: linear-gradient(150deg, #f7faf9 0%, #e7f3ef 100%);
  color: var(--ink);
  font-family: Lato, sans-serif;
  line-height: 1.55;
}

.site-header {
  align-items: center;
  background: var(--paper);
  border-bottom: 1px solid var(--line);
  display: flex;
  justify-content: space-between;
  padding: 20px max(24px, calc((100vw - 960px) / 2));
}

.site-header img { display: block; height: 34px; width: auto; }
.back-link, .receipt a { color: var(--brand-dark); font-weight: 700; }

main {
  margin: 0 auto;
  max-width: 960px;
  padding: 56px 24px 72px;
}

.hero { max-width: 760px; }
.eyebrow { color: var(--brand); font-size: 13px; font-weight: 900; letter-spacing: .12em; text-transform: uppercase; }
h1 { font-size: clamp(36px, 7vw, 64px); line-height: 1.05; margin: 8px 0 18px; }
.hero > p:last-child { color: var(--muted); font-size: 19px; }

.provider-card, fieldset, .receipt {
  background: var(--paper);
  border: 1px solid var(--line);
  box-shadow: 0 18px 48px rgba(23, 33, 37, .08);
}

.provider-card { margin: 36px 0; padding: 26px 30px; }
.provider-card h2 { margin-top: 0; }
.provider-card dl { display: grid; gap: 12px; margin-bottom: 0; }
.provider-card dl div { display: grid; gap: 4px; grid-template-columns: 170px 1fr; }
.provider-card dt { color: var(--muted); font-weight: 700; }
.provider-card dd { margin: 0; }
.pending { color: var(--warning); }

form { display: grid; gap: 24px; }
fieldset { border-radius: 4px; padding: 28px; }
legend { background: var(--ink); color: #fff; font-size: 18px; font-weight: 900; padding: 8px 14px; }
.form-grid { display: grid; gap: 18px; grid-template-columns: repeat(2, minmax(0, 1fr)); }
.wide { grid-column: 1 / -1; }

label { display: grid; font-weight: 700; gap: 7px; }
input, select, textarea {
  background: #fff;
  border: 1px solid #aebbb7;
  border-radius: 3px;
  color: var(--ink);
  font: inherit;
  padding: 12px 13px;
  width: 100%;
}
textarea { resize: vertical; }
input:focus, select:focus, textarea:focus { border-color: var(--brand); outline: 3px solid rgba(11, 133, 128, .18); }
.claim-type { display: flex; gap: 24px; margin-bottom: 10px; }
.claim-type label, .declaration { align-items: center; display: flex; gap: 9px; }
.claim-type input, .declaration input { height: 18px; width: 18px; }
.help, .legal-note { color: var(--muted); font-size: 13px; }
.declaration { background: var(--wash); padding: 18px; }
.honeypot { left: -9999px; position: absolute; }

button {
  background: var(--brand);
  border: 0;
  border-radius: 3px;
  color: #fff;
  cursor: pointer;
  font: inherit;
  font-weight: 900;
  justify-self: start;
  padding: 14px 22px;
}
button:hover { background: var(--brand-dark); }
button:disabled { cursor: wait; opacity: .65; }
button.secondary { background: var(--ink); }

.status { border-left: 5px solid var(--error); background: #fff1f2; color: var(--error); margin: 0 0 24px; padding: 16px; }
.status.success { border-color: var(--success); background: #edf9f2; color: var(--success); }
.receipt { padding: 36px; text-align: center; }
.receipt .claim-code { display: block; font-size: clamp(26px, 6vw, 42px); letter-spacing: .05em; margin: 20px 0; }
.receipt-provider { border-top: 1px solid var(--line); margin-top: 28px; padding-top: 20px; text-align: left; }
.receipt-details { display: grid; grid-template-columns: minmax(150px, 220px) 1fr; margin: 18px 0 28px; text-align: left; }
.receipt-details dt, .receipt-details dd { border-bottom: 1px solid var(--line); margin: 0; padding: 10px; }
.receipt-details dt { color: var(--muted); font-weight: 700; }
.receipt-details dd { overflow-wrap: anywhere; white-space: pre-wrap; }
.receipt button { margin: 12px; }
.turnstile-container { min-height: 65px; }

footer { background: var(--ink); color: #fff; padding: 28px 24px; text-align: center; }

@media (max-width: 640px) {
  main { padding-top: 36px; }
  .form-grid { grid-template-columns: 1fr; }
  .wide { grid-column: auto; }
  .provider-card dl div { grid-template-columns: 1fr; }
  .receipt-details { grid-template-columns: 1fr; }
  .receipt-details dt { border-bottom: 0; padding-bottom: 0; }
  fieldset { padding: 22px 18px; }
  .claim-type { align-items: flex-start; flex-direction: column; }
}

@media print {
  .site-header, form, .provider-card, .hero, footer, .receipt button, .receipt a { display: none !important; }
  body, main { background: #fff; margin: 0; padding: 0; }
  .receipt { border: 0; box-shadow: none; display: block !important; }
}