Update justification header, remove payor code (#170)

from business name dropdown

apcd-cms/src/apps/extension/templates/extension_submission_form/extension_submission_form.html

@@ -42,7 +42,7 @@ <h4>Extension Information</h4>
                 <select name='business-name_1' required='required' class="choicefield" id='business-name_1'>
                   {% for submitter in submitters %}
                   <option class="dropdown-text" value={{submitter.submitter_id}}>{{submitter.org_name}} - ID:
-                    {{submitter.submitter_id}} Payor Code: {{submitter.payor_code}}</option>
+                    {{submitter.submitter_id}}</option>
                   {% endfor %}
                 </select>
                 </div>
@@ -101,7 +101,7 @@ <h4 id="extension-header_5" style="display:none">
 
             <hr />
 
-            <h4>Request Justification</h4>
+            <h4>Request and Justification</h4>
 
             <div class="field-wrapper textarea required">
               Provide rationale for the exception request, outlining the reasons why the