portal/account/register.php

   1 <?php
   2 /**
   3  * Portal Registration Wizard
   4  *
   5  * @package OpenEMR
   6  * @link    http://www.open-emr.org
   7  * @author  Jerry Padgett <sjpadgett@gmail.com>
   8  * @copyright Copyright (c) 2017-2018 Jerry Padgett <sjpadgett@gmail.com>
   9  * @license https://www.gnu.org/licenses/agpl-3.0.en.html GNU Affero General Public License 3
  10  */
  11
  12 session_start();
  13 session_regenerate_id(true);
  14
  15 unset($_SESSION['itsme']);
  16 $_SESSION['authUser'] = 'portal-user';
  17 $_SESSION['pid'] = true;
  18 $_SESSION['register'] = true;
  19
  20 $_SESSION['site_id'] = isset($_SESSION['site_id']) ? $_SESSION['site_id'] : 'default';
  21 $landingpage = "index.php?site=" . $_SESSION['site_id'];
  22
  23 $ignoreAuth_onsite_portal_two = true;
  24
  25 require_once("../../interface/globals.php");
  26
  27 $res2 = sqlStatement("select * from lang_languages where lang_description = ?", array(
  28     $GLOBALS['language_default']
  29 ));
  30 for ($iter = 0; $row = sqlFetchArray($res2); $iter ++) {
  31     $result2[$iter] = $row;
  32 }
  33 if (count($result2) == 1) {
  34     $defaultLangID = $result2[0]{"lang_id"};
  35     $defaultLangName = $result2[0]{"lang_description"};
  36 } else {
  37     // default to english if any problems
  38     $defaultLangID = 1;
  39     $defaultLangName = "English";
  40 }
  41
  42 if (! isset($_SESSION['language_choice'])) {
  43     $_SESSION['language_choice'] = $defaultLangID;
  44 }
  45 // collect languages if showing language menu
  46 if ($GLOBALS['language_menu_login']) {
  47     // sorting order of language titles depends on language translation options.
  48     $mainLangID = empty($_SESSION['language_choice']) ? '1' : $_SESSION['language_choice'];
  49     if ($mainLangID == '1' && ! empty($GLOBALS['skip_english_translation'])) {
  50         $sql = "SELECT * FROM lang_languages ORDER BY lang_description, lang_id";
  51         $res3 = SqlStatement($sql);
  52     } else {
  53         // Use and sort by the translated language name.
  54         $sql = "SELECT ll.lang_id, " . "IF(LENGTH(ld.definition),ld.definition,ll.lang_description) AS trans_lang_description, " . "ll.lang_description " .
  55              "FROM lang_languages AS ll " . "LEFT JOIN lang_constants AS lc ON lc.constant_name = ll.lang_description " .
  56              "LEFT JOIN lang_definitions AS ld ON ld.cons_id = lc.cons_id AND " . "ld.lang_id = ? " .
  57              "ORDER BY IF(LENGTH(ld.definition),ld.definition,ll.lang_description), ll.lang_id";
  58         $res3 = SqlStatement($sql, array(
  59             $mainLangID
  60         ));
  61     }
  62
  63     for ($iter = 0; $row = sqlFetchArray($res3); $iter ++) {
  64         $result3[$iter] = $row;
  65     }
  66
  67     if (count($result3) == 1) {
  68         // default to english if only return one language
  69         $hiddenLanguageField = "<input type='hidden' name='languageChoice' value='1' />\n";
  70     }
  71 } else {
  72     $hiddenLanguageField = "<input type='hidden' name='languageChoice' value='" . htmlspecialchars($defaultLangID, ENT_QUOTES) . "' />\n";
  73 }
  74
  75 ?>
  76 <!DOCTYPE html>
  77 <html>
  78 <head>
  79 <title><?php echo xlt('New Patient'); ?> | <?php echo xlt('Register'); ?></title>
  80 <meta content='width=device-width, initial-scale=1, maximum-scale=1, user-scalable=no' name='viewport'>
  81 <meta name="description" content="Developed By sjpadgett@gmail.com">
  82
  83 <link href="<?php echo $GLOBALS['assets_static_relative']; ?>/font-awesome-4-6-3/css/font-awesome.min.css" rel="stylesheet" type="text/css" />
  84 <link rel="stylesheet" href="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-datetimepicker-2-5-4/build/jquery.datetimepicker.min.css">
  85 <link href="<?php echo $GLOBALS['assets_static_relative']; ?>/bootstrap-3-3-4/dist/css/bootstrap.min.css" rel="stylesheet" type="text/css" />
  86 <link href="./../assets/css/register.css" rel="stylesheet" type="text/css" />
  87
  88 <script src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-min-3-1-1/index.js" type="text/javascript"></script>
  89
  90 <script src="<?php echo $GLOBALS['assets_static_relative']; ?>/bootstrap-3-3-4/dist/js/bootstrap.min.js" type="text/javascript"></script>
  91 <script type="text/javascript" src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-datetimepicker-2-5-4/build/jquery.datetimepicker.full.min.js"></script>
  92 <script type="text/javascript" src="<?php echo $GLOBALS['assets_static_relative']; ?>/emodal-1-2-65/dist/eModal.js"></script>
  93
  94 <script>
  95 var newPid = 0;
  96 var curPid = 0;
  97 var provider = 0;
  98
  99 $(document).ready(function () {
 100     /* // test data
 101     $("#emailInput").val("me@me.com");
 102     $("#fname").val("Jerry");
 103     $("#lname").val("Padgett");
 104     $("#dob").val("1919-03-03");
 105     // ---------- */
 106     var navListItems = $('div.setup-panel div a'),
 107     allWells = $('.setup-content'),
 108     allNextBtn = $('.nextBtn'),
 109     allPrevBtn = $('.prevBtn');
 110
 111     allWells.hide();
 112
 113     navListItems.click(function (e) {
 114         e.preventDefault();
 115         var $target = $($(this).attr('href')),
 116         $item = $(this);
 117
 118         if (!$item.hasClass('disabled')) {
 119             navListItems.removeClass('btn-primary').addClass('btn-default');
 120             $item.addClass('btn-primary');
 121             allWells.hide();
 122             $target.show();
 123             $target.find('input:eq(0)').focus();
 124         }
 125     });
 126
 127     allPrevBtn.click(function () {
 128         var curStep = $(this).closest(".setup-content"),
 129         curStepBtn = curStep.attr("id"),
 130         prevstepwiz = $('div.setup-panel div a[href="#' + curStepBtn + '"]').parent().prev().children("a");
 131         prevstepwiz.removeAttr('disabled').trigger('click');
 132     });
 133
 134     allNextBtn.click(function () {
 135         var profile = $("#profileFrame").contents();
 136
 137         /* // test data
 138         profile.find("input#street").val("123 Some St.");
 139         profile.find("input#city").val("Brandon");
 140         //--------------------- */
 141
 142         var curStep = $(this).closest(".setup-content"),
 143         curStepBtn = curStep.attr("id"),
 144         nextstepwiz = $('div.setup-panel div a[href="#' + curStepBtn + '"]').parent().next().children("a"),
 145         curInputs = curStep.find("input[type='text'],input[type='email'],select"),
 146         isValid = true;
 147
 148         $(".form-group").removeClass("has-error");
 149         for (var i = 0; i < curInputs.length; i++) {
 150             if (!curInputs[i].validity.valid) {
 151                 isValid = false;
 152                 $(curInputs[i]).closest(".form-group").addClass("has-error");
 153             }
 154         }
 155         if (isValid) {
 156             if (curStepBtn == 'step-1') { // leaving step 1 setup profile frame. Prob not nec but in case
 157                 profile.find('input#fname').val($("#fname").val());
 158                 profile.find('input#mname').val($("#mname").val());
 159                 profile.find('input#lname').val($("#lname").val());
 160                 profile.find('input#dob').val($("#dob").val());
 161                 profile.find('input#email').val($("#emailInput").val());
 162                 profile.find('input[name=allowPatientPortal]').val(['YES']);
 163                 // need these for validation.
 164                 profile.find('select#providerid option:contains("Unassigned")').val('');
 165                 profile.find('select#providerid').attr('required', true);
 166                 profile.find('select#sex option:contains("Unassigned")').val('');
 167                 profile.find('select#sex').attr('required', true);
 168
 169                 var pid = profile.find('input#pid').val();
 170                 if (pid < 1) { // form pid set in promise
 171                     callServer('get_newpid', '', $("#dob").val(), $("#lname").val(), $("#fname").val()); // @TODO escape these
 172                 }
 173             }
 174             nextstepwiz.removeAttr('disabled').trigger('click');
 175         }
 176     });
 177
 178     $("#profileNext").click(function () {
 179         var profile = $("#profileFrame").contents();
 180         var curStep = $(this).closest(".setup-content"),
 181         curStepBtn = curStep.attr("id"),
 182         nextstepwiz = $('div.setup-panel div a[href="#' + curStepBtn + '"]').parent().next().children("a"),
 183         curInputs = $("#profileFrame").contents().find("input[type='text'],input[type='email'],select"),
 184         isValid = true;
 185         $(".form-group").removeClass("has-error");
 186         var flg = 0;
 187         for (var i = 0; i < curInputs.length; i++) {
 188             if (!curInputs[i].validity.valid) {
 189                 isValid = false;
 190                 if (!flg) {
 191                     curInputs[i].scrollIntoView();
 192                     curInputs[i].focus();
 193                     flg = 1;
 194                 }
 195                 $(curInputs[i]).closest(".form-group").addClass("has-error");
 196             }
 197         }
 198         if (isValid) {
 199             provider = profile.find('select#providerid').val();
 200             nextstepwiz.removeAttr('disabled').trigger('click');
 201         }
 202     });
 203
 204     $("#submitPatient").click(function () {
 205         var profile = $("#profileFrame").contents();
 206         var pid = profile.find('input#pid').val();
 207
 208         if (pid < 1) { // Just in case. Can never have too many pid checks!
 209             callServer('get_newpid', '');
 210         }
 211
 212         var isOk = checkRegistration(newPid);
 213         if (isOk) {
 214             // Use portals rest api. flag 1 is write to chart. flag 0 writes an audit record for review in dashboard.
 215             // rest update will determine if new or existing pid for save. In register step-1 we catch existing pid but,
 216             // we can still use update here if we want to allow changing passwords.
 217             //
 218             document.getElementById('profileFrame').contentWindow.page.updateModel(1);
 219             $("#insuranceForm").submit();
 220             //  cleanup is in callServer done promise. This starts end session.
 221         }
 222     });
 223
 224     $('div.setup-panel div a.btn-primary').trigger('click');
 225
 226     $('.datepicker').datetimepicker({
 227         <?php $datetimepicker_timepicker = false; ?>
 228         <?php $datetimepicker_showseconds = false; ?>
 229         <?php $datetimepicker_formatInput = false; ?>
 230         <?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
 231      });
 232
 233     $("#insuranceForm").submit(function (e) {
 234         e.preventDefault();
 235         var url = "account.php?action=new_insurance&pid=" + newPid;
 236         $.ajax({
 237             url: url,
 238             type: 'post',
 239             data: $("#insuranceForm").serialize(),
 240             success: function (serverResponse) {
 241                 doCredentials(newPid) // this is the end for session.
 242                 return false;
 243             }
 244         });
 245     });
 246
 247     $('#selLanguage').on('change', function () {
 248         callServer("set_lang", this.value);
 249     });
 250
 251     $(document.body).on('hidden.bs.modal', function () { //@TODO maybe make a promise for wiz exit
 252         callServer('cleanup');
 253     });
 254
 255     $('#inscompany').on('change', function () {
 256         if ($('#inscompany').val().toUpperCase() === 'SELF') {
 257             $("#insuranceForm input").removeAttr("required");
 258             let message = "<?php echo xls('You have chosen to be self insured or currently do not have insurance. Click next to continue registration.'); ?>";
 259             alert(message);
 260         }
 261     });
 262
 263 }); // ready end
 264
 265 function doCredentials(pid) {
 266     callServer('do_signup', pid);
 267 }
 268
 269 function checkRegistration(pid) {
 270     var profile = $("#profileFrame").contents();
 271     var curStep = $("#step-2"),
 272     curStepBtn = curStep.attr("id"),
 273     nextstepwiz = $('div.setup-panel div a[href="#' + curStepBtn + '"]').parent().next().children("a"),
 274     curInputs = $("#profileFrame").contents().find("input[type='text'],input[type='email'],select"),
 275     isValid = true;
 276     $(".form-group").removeClass("has-error");
 277     var flg = 0;
 278     for (var i = 0; i < curInputs.length; i++) {
 279         if (!curInputs[i].validity.valid) {
 280             isValid = false;
 281             if (!flg) {
 282                 curInputs[i].scrollIntoView();
 283                 curInputs[i].focus();
 284                 flg = 1;
 285             }
 286             $(curInputs[i]).closest(".form-group").addClass("has-error");
 287         }
 288     }
 289
 290     if (!isValid) {
 291         return false;
 292     }
 293
 294     return true;
 295 }
 296
 297 function callServer(action, value, value2, last, first) {
 298     var data = {
 299         'action' : action,
 300         'value' : value,
 301         'dob' : value2,
 302         'last' : last,
 303         'first' : first
 304     }
 305     if (action == 'do_signup') {
 306         data = {
 307             'action': action,
 308             'pid': value
 309         };
 310     }
 311     else if (action == 'notify_admin') {
 312         data = {
 313             'action': action,
 314             'pid': value,
 315             'provider': value2
 316         };
 317     }
 318     else if (action == 'cleanup') {
 319         data = {
 320             'action': action
 321         };
 322     }
 323     // The magic that is jquery ajax.
 324     $.ajax({
 325         type : 'GET',
 326         url : 'account.php',
 327         data : data
 328     }).done(function (rtn) {
 329         if (action == "cleanup") {
 330             window.location.href = "./../index.php" // Goto landing page.
 331         }
 332         else if (action == "set_lang") {
 333             window.location.href = window.location.href;
 334         }
 335         else if (action == "get_newpid") {
 336             if (parseInt(rtn) > 0) {
 337                 newPid = rtn;
 338                 $("#profileFrame").contents().find('input#pubpid').val(newPid);
 339                 $("#profileFrame").contents().find('input#pid').val(newPid);
 340             }
 341             else {
 342                 // After error alert app exit to landing page.
 343                 // Existing user error. Error message is translated in account.lib.php.
 344                 eModal.alert(rtn);
 345             }
 346         }
 347         else if (action == 'do_signup') {
 348             if (rtn == "") {
 349                 let message = "<?php echo xls('Unable to either create credentials or send email.'); ?>";
 350                 alert(message);
 351                 return false;
 352             }
 353             // For production. Here we're finished so do signup closing alert and then cleanup.
 354             callServer('notify_admin', newPid, provider); // pnote notify to selected provider
 355             // alert below for ease of testing.
 356             //alert(rtn); // sync alert.. rtn holds username and password for testing.
 357
 358             let message = "<?php echo xls("Your new credentials have been sent. Check your email inbox and also possibly your spam folder. Once you log into your patient portal feel free to make an appointment or send us a secure message. We look forward to seeing you soon."); ?>"
 359             eModal.alert(message); // This is an async call. The modal close event exits us to portal landing page after cleanup.
 360         }
 361     }).fail(function (err) {
 362         let message = "<?php echo xls('Something went wrong.') ?>";
 363         alert(message);
 364     });
 365 }
 366 </script>
 367 </head>
 368 <body class="skin-blue">
 369     <div class="container">
 370         <div class="stepwiz col-md-offset-3">
 371             <div class="stepwiz-row setup-panel">
 372                 <div class="stepwiz-step">
 373                     <a href="#step-1" type="button" class="btn btn-primary btn-circle">1</a>
 374                     <p><?php echo xlt('Get Started') ?></p>
 375                 </div>
 376                 <div class="stepwiz-step">
 377                     <a href="#step-2" type="button" class="btn btn-default btn-circle" disabled="disabled">2</a>
 378                     <p><?php echo xlt('Profile') ?></p>
 379                 </div>
 380                 <div class="stepwiz-step">
 381                     <a href="#step-3" type="button" class="btn btn-default btn-circle" disabled="disabled">3</a>
 382                     <p><?php echo xlt('Insurance') ?></p>
 383                 </div>
 384                 <div class="stepwiz-step">
 385                     <a href="#step-4" type="button" class="btn btn-default btn-circle" disabled="disabled"><?php echo xlt('Done') ?></a>
 386                     <p><?php echo xlt('Register') ?></p>
 387                 </div>
 388             </div>
 389         </div>
 390 <!-- // Start Forms // -->
 391         <form class="form-inline" id="startForm" role="form" action="" method="post" onsubmit="">
 392             <div class="row setup-content" id="step-1">
 393                 <div class="col-xs-7 col-md-offset-3 text-center">
 394                     <fieldset>
 395                         <legend class='bg-primary'><?php echo xlt('Contact') ?></legend>
 396                         <div class="well">
 397                         <?php if ($GLOBALS['language_menu_login']) { ?>
 398                         <?php if (count($result3) != 1) { ?>
 399                         <div class="form-group row">
 400                             <label for="selLanguage"><?php echo xlt('Language'); ?></label>
 401                             <select class="form-control" id="selLanguage" name="languageChoice">
 402                             <?php
 403                                 echo "<option selected='selected' value='" . htmlspecialchars($defaultLangID, ENT_QUOTES) . "'>" .
 404                                      htmlspecialchars(xl('Default') . " - " . xl($defaultLangName), ENT_NOQUOTES) . "</option>\n";
 405                             foreach ($result3 as $iter) {
 406                                 if ($GLOBALS['language_menu_showall']) {
 407                                     if (! $GLOBALS['allow_debug_language'] && $iter['lang_description'] == 'dummy') {
 408                                         continue; // skip the dummy language
 409                                     }
 410                                     echo "<option value='" . htmlspecialchars($iter['lang_id'], ENT_QUOTES) . "'>" .
 411                                          htmlspecialchars($iter['trans_lang_description'], ENT_NOQUOTES) . "</option>\n";
 412                                 } else {
 413                                     if (in_array($iter['lang_description'], $GLOBALS['language_menu_show'])) {
 414                                         if (! $GLOBALS['allow_debug_language'] && $iter['lang_description'] == 'dummy') {
 415                                             continue; // skip the dummy language
 416                                         }
 417                                         echo "<option value='" . htmlspecialchars($iter['lang_id'], ENT_QUOTES) . "'>" .
 418                                              htmlspecialchars($iter['trans_lang_description'], ENT_NOQUOTES) . "</option>\n";
 419                                     }
 420                                 }
 421                             }
 422                             ?>
 423                           </select>
 424                         </div>
 425                         <?php } } ?>
 426                         <div class="row">
 427                                 <div class="col-sm-12">
 428                                     <div class="form-group inline">
 429                                         <label class="control-label" for="fname"><?php echo xlt('First')?></label>
 430                                         <div class="controls inline-inputs">
 431                                             <input type="text" class="form-control" id="fname" required placeholder="<?php echo xla('First Name'); ?>">
 432                                         </div>
 433                                     </div>
 434                                     <div class="form-group inline">
 435                                         <label class="control-label" for="mname"><?php echo xlt('Middle')?></label>
 436                                         <div class="controls inline-inputs">
 437                                             <input type="text" class="form-control" id="mname" placeholder="<?php echo xla('Full or Initial'); ?>">
 438                                         </div>
 439                                     </div>
 440                                     <div class="form-group inline">
 441                                         <label class="control-label" for="lname"><?php echo xlt('Last Name')?></label>
 442                                         <div class="controls inline-inputs">
 443                                             <input type="text" class="form-control" id="lname" required placeholder="<?php echo xla('Enter Last'); ?>">
 444                                         </div>
 445                                     </div>
 446                                 </div>
 447                             </div>
 448                             <div class="form-group inline">
 449                                 <label class="control-label" for="dob"><?php echo xlt('Birth Date')?></label>
 450                                 <div class="controls inline-inputs">
 451                                     <div class="input-group">
 452                                         <input id="dob" type="text" required class="form-control datepicker" placeholder="<?php echo xla('YYYY-MM-DD'); ?>" />
 453                                     </div>
 454                                 </div>
 455                             </div>
 456                             <div class="row">
 457                                 <div class="col-sm-12 form-group">
 458                                     <label class="control-label" for="email"><?php echo xlt('Enter E-Mail Address')?></label>
 459                                     <div class="controls inline-inputs">
 460                                         <input id="emailInput" type="email" class="form-control" style="width: 100%" required
 461                                             placeholder="<?php echo xla('Enter email address to receive registration.'); ?>" maxlength="100">
 462                                     </div>
 463                                 </div>
 464                             </div>
 465                         </div>
 466                         <button class="btn btn-primary nextBtn btn-sm pull-right" type="button"><?php echo xlt('Next') ?></button>
 467                     </fieldset>
 468                 </div>
 469             </div>
 470         </form>
 471 <!-- Profile Form -->
 472         <form class="form-inline" id="profileForm" role="form" action="account.php" method="post">
 473             <div class="row setup-content" id="step-2" style="display: none">
 474                 <div class="col-md-9 col-md-offset-2 text-center">
 475                     <fieldset>
 476                         <legend class='bg-primary'><?php echo xlt('Profile') ?></legend>
 477                         <div class="well">
 478                             <div class="embed-responsive embed-responsive-16by9">
 479                                 <iframe class="embed-responsive-item" src="../patient/patientdata?pid=0&register=true" id="profileFrame" name="demo"></iframe>
 480                             </div>
 481                         </div>
 482                         <button class="btn btn-primary prevBtn btn-sm pull-left" type="button"><?php echo xlt('Previous') ?></button>
 483                         <button class="btn btn-primary btn-sm pull-right" type="button" id="profileNext"><?php echo xlt('Next') ?></button>
 484                     </fieldset>
 485                 </div>
 486             </div>
 487         </form>
 488 <!-- Insurance Form -->
 489         <form class="form-inline" id="insuranceForm" role="form" action="" method="post">
 490             <div class="row setup-content" id="step-3" style="display: none">
 491                 <div class="col-xs-6 col-md-offset-3 text-center">
 492                     <fieldset>
 493                         <legend class='bg-primary'><?php echo xlt('Insurance') ?></legend>
 494                         <div class="well">
 495                             <div class="form-group inline">
 496                                 <label class="control-label" for="provider"><?php echo xlt('Insurance Company')?></label>
 497                                 <div class="controls inline-inputs">
 498                                     <input type="text" class="form-control" name="provider" id="inscompany" required placeholder="<?php echo xla('Enter Self if None'); ?>">
 499                                 </div>
 500                             </div>
 501                             <div class="form-group inline">
 502                                 <label class="control-label" for=""><?php echo xlt('Plan Name')?></label>
 503                                 <div class="controls inline-inputs">
 504                                     <input type="text" class="form-control" name="plan_name" required placeholder="<?php echo xla('Required'); ?>">
 505                                 </div>
 506                             </div>
 507                             <div class="form-group inline">
 508                                 <label class="control-label" for=""><?php echo xlt('Policy Number')?></label>
 509                                 <div class="controls inline-inputs">
 510                                     <input type="text" class="form-control" name="policy_number" required placeholder="<?php echo xla('Required'); ?>">
 511                                 </div>
 512                             </div>
 513                             <div class="form-group inline">
 514                                 <label class="control-label" for=""><?php echo xlt('Group Number')?></label>
 515                                 <div class="controls inline-inputs">
 516                                     <input type="text" class="form-control" name="group_number" required placeholder="<?php echo xla('Required'); ?>">
 517                                 </div>
 518                             </div>
 519                             <div class="form-group inline">
 520                                 <label class="control-label" for=""><?php echo xlt('Policy Begin Date')?></label>
 521                                 <div class="controls inline-inputs">
 522                                     <input type="text" class="form-control datepicker" name="date" placeholder="<?php echo xla('Policy effective date'); ?>">
 523                                 </div>
 524                             </div>
 525                             <div class="form-group inline">
 526                                 <label class="control-label" for=""><?php echo xlt('Co-Payment')?></label>
 527                                 <div class="controls inline-inputs">
 528                                     <input type="number" class="form-control" name="copay" placeholder="<?php echo xla('Plan copay if known'); ?>">
 529                                 </div>
 530                             </div>
 531                         </div>
 532                         <button class="btn btn-primary prevBtn btn-sm pull-left" type="button"><?php echo xlt('Previous') ?></button>
 533                         <button class="btn btn-primary nextBtn btn-sm pull-right" type="button"><?php echo xlt('Next') ?></button>
 534                     </fieldset>
 535                 </div>
 536             </div>
 537         </form>
 538         <!-- End Insurance. Next what we've been striving towards..the end-->
 539         <div class="row setup-content" id="step-4" style="display: none">
 540             <div class="col-xs-6 col-md-offset-3 text-center">
 541                 <div class="col-md-12">
 542                     <fieldset>
 543                         <legend class='bg-success'><?php echo xlt('Register') ?></legend>
 544                         <div class="well" style="text-align: center">
 545                             <h4 class='bg-success'><?php echo xlt("All set. Click Send Request below to finish registration") ?></h4>
 546                             <hr>
 547                             <p>
 548                             <?php echo xlt("An e-mail with your new account credentials will be sent to the e-mail address supplied earlier. You may still review or edit any part of your information by using the top step buttons to go to the appropriate panels. Note to be sure you have given your correct e-mail address. If after receiving credentials and you have trouble with access to the portal, please contact administration.") ?>
 549                             </p>
 550                         </div>
 551                         <button class="btn btn-primary prevBtn btn-sm pull-left" type="button"><?php echo xlt('Previous') ?></button>
 552                         <hr>
 553                         <button class="btn btn-success btn-sm pull-right" type="button" id="submitPatient"><?php echo xlt('Send Request') ?></button>
 554                     </fieldset>
 555                 </div>
 556             </div>
 557         </div>
 558     </div>
 559 </body>
 560 </html>