interface/patient_file/encounter/copay.php

   1 <?php
   2 include_once("../../globals.php");
   3 include_once("$srcdir/sql.inc");
   4
   5 // This may be more appropriate to move to the library
   6 // later
   7 require_once("{$GLOBALS['srcdir']}/sql.inc");
   8 function getInsuranceCompanies($pid) {
   9   $res = sqlStatement("SELECT * FROM insurance_data WHERE pid = '$pid' " .
  10     "ORDER BY type ASC, date DESC");
  11   $prevtype = '';
  12   for($iter = 0; $row = sqlFetchArray($res); $iter++) {
  13     if (strcmp($row['type'], $prevtype) == 0) continue;
  14     $prevtype = $row['type'];
  15     $all[$iter] = $row;
  16   }
  17   return $all;
  18 }
  19
  20 //the number of rows to display before resetting and starting a new column:
  21 $N=10
  22 ?>
  23 <html>
  24 <head>
  25 <script type="text/javascript">
  26 function cleartext(atrib)
  27 {
  28 document.copay_form.code.value=document.copay_form.codeH.value;
  29 document.copay_form.codeH.value="";
  30 }
  31 </script>
  32
  33
  34 <?php html_header_show();?>
  35 <link rel="stylesheet" href="<?php echo $css_header;?>" type="text/css">
  36 </head>
  37 <body class="body_bottom">
  38
  39 <table border='0' cellspacing='0' cellpadding='0' height='100%'>
  40 <tr>
  41
  42 <td valign=top>
  43
  44 <dl>
  45
  46 <form method='post' name='copay_form' action="diagnosis.php?mode=add&type=COPAY&text=copay"
  47  target='Diagnosis' onsubmit='return top.restoreSession()'>
  48
  49 <dt><span class=title><?php xl('Copay','e'); ?></span></dt>
  50
  51 <br>
  52 <input type=hidden name=code>
  53 <span class='text'><?php xl('$','e'); ?> </span><input type='entry' name='codeH' value='' size='5' />
  54
  55 <input type="SUBMIT" value="<?php xl('Save','e');?>" onclick="cleartext('clear')"><br><br>
  56
  57
  58 <div<?php if ($GLOBALS['simplified_copay']) echo " style='display:none;'"; ?>>
  59 <input type="RADIO" name="payment_method" value="cash" checked><?php xl('cash','e'); ?>
  60 <input type="RADIO" name="payment_method" value="credit card"><?php xl('credit','e'); ?>
  61 <input type="RADIO" name="payment_method" value="check"><?php xl('check','e'); ?>
  62 <input type="RADIO" name="payment_method" value="other"><?php xl('other','e'); ?><br><br>
  63 <input type="RADIO" name="payment_method" value="insurance"><?php xl('insurance','e'); ?>
  64 <?php
  65 if ($ret=getInsuranceCompanies($pid)) {
  66         if (sizeof($ret)>0) {
  67                 echo "<select name=insurance_company>\n";
  68                 foreach($ret as $iter) {
  69                         $plan_name = trim($iter['plan_name']);
  70                         if ($plan_name != '') {
  71                                 echo "<option value='"
  72                                 .$plan_name
  73                                 ."'>".$plan_name ."\n";
  74                         }
  75                 }
  76                 echo "</select>\n";
  77         }
  78 }
  79 ?>
  80 <br><br>
  81 <input type="RADIO" name="payment_method" value="write off"><?php xl('write off','e'); ?>
  82
  83 </div>
  84
  85 </form>
  86
  87 </dl>
  88
  89 </td>
  90 </tr>
  91 </table>
  92
  93 </body>
  94 </html>