interface/patient_file/summary/demographics.php

   1 <?
   2 include_once("../../globals.php");
   3
   4 include_once("$srcdir/patient.inc");
   5
   6 ?>
   7
   8 <html>
   9 <head>
  10
  11
  12 <link rel=stylesheet href="<?echo $css_header;?>" type="text/css">
  13
  14
  15 </head>
  16 <body <?echo $top_bg_line;?> topmargin=0 rightmargin=0 leftmargin=2 bottommargin=0 marginwidth=2 marginheight=0>
  17
  18 <a href="demographics_full.php" target=Main><font class=title>Demographics</font><font class=more><?echo $tmore;?></font></a>
  19 <table border="0" width="100%">
  20 <tr>
  21 <td align="left" valign="top">
  22
  23
  24 <table border=0 cellpadding=0>
  25
  26 <?
  27 $result = getPatientData($pid);
  28 $result2 = getEmployerData($pid);
  29 ?>
  30
  31 <tr>
  32 <td valign=top><span class=bold>Name: </span><span class=text><?echo $result{"title"}?> <?echo $result{"fname"}?> <?echo $result{"mname"}?> <?echo $result{"lname"}?></span><br>
  33 <span class=bold>Number: </span><span class=text><?echo $result{"pubpid"}?></span>
  34 </td>
  35 <td valign=top>
  36 <?
  37         if ($result{"DOB"} != "0000-00-00") {
  38 ?>
  39 <span class=bold>DOB: </span>
  40 <span class=text>
  41 <?
  42 echo $result{"DOB_TS"};
  43         }
  44 ?>
  45 </span></td>
  46 <td valign=top><? if ($result{"sex"} != ""){?><span class=bold>Sex: </span><?}?><span class=text><?echo $result{"sex"}?></span></td>
  47 <td valign=top><? if ($result{"ss"} != "") {?><span class=bold>S.S.: </span><?}?><span class=text><?echo $result{"ss"}?></span></td>
  48 </tr>
  49
  50 <tr>
  51 <td valign=top>
  52 <? if (($result{"street"} != "") || ($result{"city"} != "") || ($result{"state"} != "") || ($result{"country_code"} != "") || ($result{"postal_code"} != "")) {?>
  53 <span class=bold>Address: </span>
  54 <?}?>
  55 <br><span class=text><?echo $result{"street"}?><br><?echo $result{"city"}?><?if($result{"city"} != ""){echo ", ";}?><?echo $result{"state"};?>
  56 <? if($result{"country_code"} != ""){ echo ", "; }?><?echo $result{"country_code"}?>
  57 <?echo " ";
  58 echo $result{"postal_code"}?>
  59 </span></td>
  60 <td valign=top>
  61 <?
  62         if (    ($result{"contact_relationship"} != "") ||
  63                 ($result{"phone_contact"} != "") ||
  64                 ($result{"phone_home"} != "") ||
  65                 ($result{"phone_biz"} != "") ||
  66                 ($result{"email"} != "")  ||
  67                 ($result{"phone_cell"} != "")    ){
  68 ?>
  69 <span class=bold>Emergency Contact: </span><?}?><span class=text><?echo $result{"contact_relationship"}?><?echo " "?>
  70
  71 <?
  72         if ($result{"phone_contact"} != "") {
  73                 echo " " . $result{"phone_contact"};
  74         }
  75         if ($result{"phone_home"} != "") {
  76                 echo "<br>Home: ";
  77                 echo $result{"phone_home"};
  78         }
  79         if ($result{"phone_biz"} != "") {
  80                 echo "<br>Work: ";
  81                 echo $result{"phone_biz"};
  82         }
  83         if ($result{"phone_cell"} != "") {
  84                 echo "<br>Mobile: ";
  85                 echo $result{"phone_cell"};
  86         }
  87         if ($result{"email"} != "") {
  88                 echo "<br>Email: </span>";
  89                 echo '<a class=link_submit href="mailto:' . $result{"email"} . '">' . $result{"email"} . '</a>';
  90         }
  91 ?>
  92
  93
  94 </td>
  95 <td valign=top>
  96 <?
  97         if ($result{"status"} != "") {
  98                 echo "<span class=bold>Marital Status: </span>";
  99                 echo "<span class=text>" .  $result{"status"} . "</span>";
 100         }
 101 ?>
 102 </td>
 103 <td valign=top></td>
 104 </tr>
 105 <tr>
 106         <td colspan=2 valign=top>
 107         <?
 108                 $result{"hipaa_mail"}=='NO' ? $opt_out='DOES NOT ALLOW' : $opt_out='ALLOWS' ;
 109                 echo "<span class=text>Patient $opt_out Mailed Information </span>";
 110         ?>
 111         </td>
 112         <td colspan=2 valign=top>
 113         <?
 114                 $result{"hipaa_voice"}=='NO' ? $opt_out='DOES NOT ALLOW' : $opt_out='ALLOWS' ;
 115                 echo "<span class=text>Patient $opt_out Voice Messages </span>";
 116         ?>
 117         </td>
 118 </tr>
 119 <tr>
 120 <td valign=top>
 121 <? if ($result{"occupation"} != "") {?><span class=bold>Occupation: </span><span class=text><?echo $result{"occupation"}?></span><br><?}?>
 122 <? if ($result2{"name"} != "") {?><span class=bold>Employer: </span><span class=text><?echo $result2{"name"}?></span><?}?>
 123 </td>
 124 <td valign=top>
 125 <? if (($result2{"street"} != "") || ($result2{"city"} != "") || ($result2{"state"} != "") || ($result2{"country"} != "") || ($result2{"postal_code"} != "")) {?>
 126 <span class=bold>Employer Address:</span>
 127 <?
 128 }
 129 ?>
 130 <br>
 131 <span class=text>
 132 <?echo $result2{"street"}?><br><?echo $result2{"city"}?><?if($result2{"city"} != ""){echo ", ";}?><?echo $result2{"state"}?>
 133 <?if($result2{"country"} != ""){echo ", ";}?><?echo $result2{"country"}?>
 134 <?if($result2{"postal_code"} != ""){echo " ";}?>
 135 <?echo $result2{"postal_code"}?>
 136 </span>
 137 </td>
 138 <td valign=top></td>
 139 </tr>
 140
 141
 142 <tr>
 143 <td valign=top>
 144 <? if ($result{"ethnoracial"} != "") {?><span class=bold>Race/Ethnicity: </span><span class=text><?echo $result{"ethnoracial"};?></span><br><?}?>
 145 <? if ($result{"language"} != "") {?><span class=bold>Language: </span><span class=text><?echo ucfirst($result{"language"});?></span><br><?}?>
 146 <? if ($result{"interpretter"} != "") {?><span class=bold>Interpretter: </span><span class=text><?echo $result{"interpretter"};?></span><br><?}?>
 147 <? if ($result{"family_size"} != "") {?><span class=bold>Family Size: </span><span class=text><?echo $result{"family_size"};?></span><br><?}?>
 148
 149
 150 </td>
 151 <td valign=top>
 152 <?
 153 function print_as_money($money) {
 154 preg_match("/(\d*)\.?(\d*)/",$money,$moneymatches);
 155 $tmp = wordwrap(strrev($moneymatches[1]),3,",",1);
 156 $ccheck = strrev($tmp);
 157 if ($ccheck[0] == ",") {
 158         $tmp = substr($ccheck,1,strlen($ccheck)-1);
 159 }
 160 if ($moneymatches[2] != "") {
 161         return "$ " . strrev($tmp) . "." . $moneymatches[2];
 162 } else {
 163         return "$ " . strrev($tmp);
 164 }
 165 }
 166 ?>
 167 <? if ($result{"financial_review"} != "0000-00-00 00:00:00") {?><span class=bold>Financial Review Date: </span><span class=text><?echo date("n/j/Y",strtotime($result{"financial_review"}));?></span><br><?}?>
 168 <? if ($result{"monthly_income"} != "") {?><span class=bold>Monthly Income: </span><span class=text><?echo print_as_money($result{"monthly_income"});?></span><br><?}?>
 169 <? if ($result{"migrantseasonal"} != "") {?><span class=bold>Migrant/Seasonal: </span><span class=text><?echo $result{"migrantseasonal"};?></span><br><?}?>
 170 <? if ($result{"homeless"} != "") {?><span class=bold>Homeless, etc.: </span><span class=text><?echo $result{"homeless"};?></span><br><?}?>
 171 </td>
 172 <td valign=top>
 173 <table>
 174   <tr>
 175     <td><? if ($result{"genericname1"} != "") {?><span class=bold><?=$result{"genericname1"}?></span>:<?}?> </td>
 176         <td><? if ($result{"genericval1"} != "") {?><span class=text><?=$result{"genericval1"}?></span><?}?></td>
 177   </tr>
 178   <tr>
 179     <td><? if ($result{"genericname2"} != "") {?><span class=bold><?=$result{"genericname2"}?></span>:<?}?> </td>
 180         <td><? if ($result{"genericval2"} != "") {?><span class=text><?=$result{"genericval2"}?></span><?}?></td>
 181   </tr>
 182
 183 </table>
 184
 185 </td>
 186 </tr>
 187
 188
 189 <?php
 190 //////////////////////////////////REFERRAL SECTION
 191 if ($result{"referrer"} != "" || $result{"referrerID"} != "")
 192 {
 193 ?>
 194 <tr>
 195 <td valign=top>
 196 <span class=bold>Primary Provider: </span><span class=text><?=getProviderName($result['providerID'])?></span><br>
 197 <!--<span class=bold>Primary Provider ID: </span><span class=text><?=$result{"referrerID"}?></span>-->
 198 </td>
 199 </tr>
 200 <?php
 201 }
 202
 203 /////////////////////////////////INSURANCE SECTION
 204 $result3 = getInsuranceData($pid, "primary");
 205 if ($result3{"provider"}) {
 206 ?>
 207 <tr>
 208 <td valign=top>
 209 <span class=bold>Primary Insurance Provider:</span><br><span class=text><?echo $result3{"provider_name"}?></span><br>
 210 <span class=text>Policy Number: <?echo $result3{"policy_number"}?><br>
 211 Plan Name: <?=$result3{"plan_name"}?><br>
 212 Group Number: <?echo $result3{"group_number"}?></span>
 213 </td>
 214
 215 <td valign=top>
 216 <span class=bold>Subscriber: </span><br><span class=text><?=$result3{"subscriber_fname"}?> <?=$result3{"subscriber_mname"}?> <?=$result3{"subscriber_lname"}?> <?if ($result3{"subscriber_relationship"} != "") {echo "(".$result3{"subscriber_relationship"}.")";}?><br>
 217 S.S.: <?echo $result3{"subscriber_ss"}?> D.O.B.: <?if ($result3{"subscriber_DOB"} != "0000-00-00 00:00:00") {echo $result3{"subscriber_DOB"};}?><br>
 218 Phone: <? echo $result3{"subscriber_phone"}?>
 219 </span>
 220 </td>
 221
 222 <td valign=top>
 223 <span class=bold>Subscriber Address: </span><br><span class=text><?echo $result3{"subscriber_street"}?><br><?echo $result3{"subscriber_city"}?><?if($result3{"subscriber_state"} != ""){echo ", ";}?><?echo $result3{"subscriber_state"}?><?if($result3{"subscriber_country"} != ""){echo ", ";}?><?echo $result3{"subscriber_country"}?> <?echo " ".$result3{"subscriber_postal_code"}?></span>
 224
 225 </td>
 226
 227 <td valign=top>
 228 <span class=bold>Subscriber Employer: </span><br><span class=text><?echo $result3{"subscriber_employer"}?><br><?echo $result3{"subscriber_employer_street"}?><br><?echo $result3{"subscriber_employer_city"}?><?if($result3{"subscriber_employer_city"} != ""){echo ", ";}?><?echo $result3{"subscriber_employer_state"}?><?if($result3{"subscriber_employer_country"} != ""){echo ", ";}?><?echo $result3{"subscriber_employer_country"}?> <?echo " ".$result3{"subscriber_employer_postal_code"}?></span>
 229
 230 </td>
 231
 232 </tr>
 233 <tr><td><? if ($result3{"copay"} != "") {?><span class=bold>CoPay: </span><span class=text><?=$result3{"copay"}?></span><?}?></td></tr>
 234 <?
 235 }
 236 ?>
 237
 238
 239
 240 <?
 241 $result4 = getInsuranceData($pid, "secondary");
 242 if ($result4{"provider"} != "") {
 243 ?>
 244 <tr>
 245 <td valign=top>
 246 <span class=bold>Secondary Insurance Provider:</span><br><span class=text><?echo $result4{"provider_name"}?></span><br>
 247 <span class=text>Policy Number: <?echo $result4{"policy_number"}?><br>
 248 Plan Name: <?=$result4{"plan_name"}?><br>
 249 Group Number: <?echo $result4{"group_number"}?></span>
 250 </td>
 251
 252 <td valign=top>
 253 <span class=bold>Subscriber: </span><br><span class=text><?=$result4{"subscriber_fname"}?> <?=$result4{"subscriber_mname"}?> <?=$result4{"subscriber_lname"}?> <?if ($result4{"subscriber_relationship"} != "") {echo "(".$result4{"subscriber_relationship"}.")";}?><br>
 254 S.S.: <?echo $result4{"subscriber_ss"}?> D.O.B.: <?if ($result4{"subscriber_DOB"} != "0000-00-00 00:00:00") {echo $result4{"subscriber_DOB"};}?><br>
 255 Phone: <? echo $result4{"subscriber_phone"}?>
 256 </span>
 257 </td>
 258
 259 <td valign=top>
 260 <span class=bold>Subscriber Address: </span><br><span class=text><?echo $result4{"subscriber_street"}?><br><?echo $result4{"subscriber_city"}?><?if($result4{"subscriber_state"} != ""){echo ", ";}?><?echo $result4{"subscriber_state"}?><?if($result4{"subscriber_country"} != ""){echo ", ";}?><?echo $result4{"subscriber_country"}?> <?echo " ".$result4{"subscriber_postal_code"}?></span>
 261
 262 </td>
 263
 264 <td valign=top>
 265 <span class=bold>Subscriber Employer: </span><br><span class=text><?echo $result4{"subscriber_employer"}?><br><?echo $result4{"subscriber_employer_street"}?><br><?echo $result4{"subscriber_employer_city"}?><?if($result4{"subscriber_employer_city"} != ""){echo ", ";}?><?echo $result4{"subscriber_employer_state"}?><?if($result4{"subscriber_employer_country"} != ""){echo ", ";}?><?echo $result4{"subscriber_employer_country"}?> <?echo " ".$result4{"subscriber_employer_postal_code"}?></span>
 266
 267 </td>
 268
 269 </tr>
 270 <tr><td><? if ($result4{"copay"} != "") {?><span class=bold>CoPay: </span><span class=text><?=$result4{"copay"}?></span><?}?></td></tr>
 271 <?
 272 }
 273 ?>
 274
 275
 276
 277
 278 <?
 279 $result5 = getInsuranceData($pid, "tertiary");
 280 if ($result5{"provider"}) {
 281 ?>
 282 <tr>
 283 <td valign=top>
 284 <span class=bold>Tertiary Insurance Provider:</span><br><span class=text><?echo $result5{"provider_name"}?></span><br>
 285 <span class=text>Policy Number: <?echo $result5{"policy_number"}?><br>
 286 Plan Name: <?=$result5{"plan_name"}?><br>
 287 Group Number: <?echo $result5{"group_number"}?></span>
 288 </td>
 289
 290 <td valign=top>
 291 <span class=bold>Subscriber: </span><br><span class=text><?=$result5{"subscriber_fname"}?> <?=$result5{"subscriber_mname"}?> <?=$result5{"subscriber_lname"}?> <?if ($result5{"subscriber_relationship"} != "") {echo "(".$result5{"subscriber_relationship"}.")";}?><br>
 292 S.S.: <?echo $result5{"subscriber_ss"}?> D.O.B.: <?if ($result5{"subscriber_DOB"} != "0000-00-00 00:00:00") {echo $result5{"subscriber_DOB"};}?><br>
 293 Phone: <? echo $result5{"subscriber_phone"}?>
 294 </span>
 295 </td>
 296
 297 <td valign=top>
 298 <span class=bold>Subscriber Address: </span><br><span class=text><?echo $result5{"subscriber_street"}?><br><?echo $result5{"subscriber_city"}?><?if($result5{"subscriber_state"} != ""){echo ", ";}?><?echo $result5{"subscriber_state"}?><?if($result5{"subscriber_country"} != ""){echo ", ";}?><?echo $result5{"subscriber_country"}?> <?echo " ".$result5{"subscriber_postal_code"}?></span>
 299
 300 </td>
 301
 302 <td valign=top>
 303 <span class=bold>Subscriber Employer: </span><br><span class=text><?echo $result5{"subscriber_employer"}?><br><?echo $result5{"subscriber_employer_street"}?><br><?echo $result5{"subscriber_employer_city"}?><?if($result5{"subscriber_employer_city"} != ""){echo ", ";}?><?echo $result5{"subscriber_employer_state"}?><?if($result5{"subscriber_employer_country"} != ""){echo ", ";}?><?echo $result5{"subscriber_employer_country"}?> <?echo " ".$result5{"subscriber_employer_postal_code"}?></span>
 304
 305 </td>
 306
 307 </tr>
 308 <tr><td><? if ($result5{"copay"} != "") {?><span class=bold>CoPay: </span><span class=text><?=$result5{"copay"}?></span><?}?></td></tr>
 309 <?
 310 }
 311 ?>
 312
 313
 314
 315
 316
 317 </table>
 318
 319 </td>
 320
 321
 322 <td align="right" valign="top">
 323 <?php
 324 if (isset($pid)) {
 325 //postnuke doesn't make it easy to set globals/get/post
 326 //didn't want to use an ifram here so I had to fake a page
 327 //load environment by setting the things that would have
 328 //been passed in the querystring
 329
 330 include_once("$srcdir/calendar.inc");
 331
 332 unset($func);
 333 unset($module);
 334 unset($Date);
 335 $_GET['module'] = "PostCalendar";
 336 $_GET['func']   = "search";
 337 $_GET['Date']   = pc_getDate();
 338 $_GET['no_nav'] = 2;
 339 $_GET['patient_id'] = intval($pid);
 340 $_GET['submit'] = "listapps";
 341 global $func,$Date,$module;
 342 $module = "PostCalendar";
 343 $func = "search";
 344 $Date = $_GET['Date'];
 345 $submit = "listapps";
 346 $no_nav = 2;
 347 $patient_id = $_GET['patient_id'];
 348
 349 //now that the environment is set, include the page, it will
 350 //behave as though it was loaded in an iframe with the querystring
 351 //variables set
 352 chdir("../../main/calendar");
 353 include("index.php");
 354 }
 355
 356 ?>
 357
 358
 359 </td>
 360
 361 </tr></table>
 362
 363
 364 <br><br>
 365
 366
 367
 368 <br><br>
 369
 370 </body>
 371 </html>