interface/cmsportal/insurance_form.php

   1 <?php
   2 /**
   3  * Insurance form posting for the WordPress Patient Portal.
   4  *
   5  * LICENSE: This program is free software; you can redistribute it and/or
   6  * modify it under the terms of the GNU General Public License
   7  * as published by the Free Software Foundation; either version 2
   8  * of the License, or (at your option) any later version.
   9  * This program is distributed in the hope that it will be useful,
  10  * but WITHOUT ANY WARRANTY; without even the implied warranty of
  11  * MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
  12  * GNU General Public License for more details.
  13  * You should have received a copy of the GNU General Public License
  14  * along with this program. If not, see <http://opensource.org/licenses/gpl-license.php>;.
  15  *
  16  * @package OpenEMR
  17  * @author  Rod Roark <rod@sunsetsystems.com>
  18  */
  19
  20 $sanitize_all_escapes = true;
  21 $fake_register_globals = false;
  22
  23 require_once("../globals.php");
  24 require_once("$srcdir/patient.inc");
  25 require_once("$srcdir/formdata.inc.php");
  26 require_once("$srcdir/options.inc.php");
  27 require_once("portal.inc.php");
  28
  29 // Consider this a step towards converting the insurance form to layout-based.
  30 // Faking it here makes things easier.
  31 // Also note that some fields like SSN and most of the subscriber employer
  32 // items have been omitted because they are not relevant for claims.
  33 //
  34 $insurance_layout = array(
  35   array('field_id'     => 'type',
  36         'title'        => 'Type',
  37         'uor'          => '2',
  38         'data_type'    => '1',
  39         'list_id'      => 'insurance_types',
  40         'edit_options' => '',
  41        ),
  42   array('field_id'     => 'date',
  43         'title'        => 'Effective Date',
  44         'uor'          => '2',
  45         'data_type'    => '4',               // Text-date
  46         'list_id'      => '',
  47         'edit_options' => '',
  48        ),
  49   array('field_id'     => 'provider',
  50         'title'        => 'Provider',
  51         'uor'          => '2',
  52         'data_type'    => '16',              // Insurance Providers
  53         'list_id'      => '',
  54         'edit_options' => '',
  55        ),
  56   array('field_id'     => 'plan_name',
  57         'title'        => 'Plan Name',
  58         'uor'          => '1',
  59         'data_type'    => '2',               // Text
  60         'list_id'      => '',
  61         'edit_options' => '',
  62        ),
  63   array('field_id'     => 'policy_number',
  64         'title'        => 'Policy Number',
  65         'uor'          => '1',
  66         'data_type'    => '2',               // Text
  67         'list_id'      => '',
  68         'edit_options' => '',
  69        ),
  70   array('field_id'     => 'group_number',
  71         'title'        => 'Group Number',
  72         'uor'          => '1',
  73         'data_type'    => '2',               // Text
  74         'list_id'      => '',
  75         'edit_options' => '',
  76        ),
  77   array('field_id'     => 'subscriber_employer',
  78         'title'        => 'Group Name',
  79         'uor'          => '1',
  80         'data_type'    => '2',               // Text
  81         'list_id'      => '',
  82         'edit_options' => '',
  83        ),
  84   array('field_id'     => 'subscriber_lname',
  85         'title'        => 'Subscriber Last Name',
  86         'uor'          => '2',
  87         'data_type'    => '2',               // Text
  88         'list_id'      => '',
  89         'edit_options' => '',
  90        ),
  91   array('field_id'     => 'subscriber_fname',
  92         'title'        => 'Subscriber First Name',
  93         'uor'          => '1',
  94         'data_type'    => '2',               // Text
  95         'list_id'      => '',
  96         'edit_options' => '',
  97        ),
  98   array('field_id'     => 'subscriber_mname',
  99         'title'        => 'Subscriber Middle Name',
 100         'uor'          => '1',
 101         'data_type'    => '2',               // Text
 102         'list_id'      => '',
 103         'edit_options' => '',
 104        ),
 105   array('field_id'     => 'subscriber_DOB',
 106         'title'        => 'Subscriber DOB',
 107         'uor'          => '2',
 108         'data_type'    => '4',               // Text-date
 109         'list_id'      => '',
 110         'edit_options' => '',
 111        ),
 112   array('field_id'     => 'subscriber_sex',
 113         'title'        => 'Subscriber Sex',
 114         'uor'          => '2',
 115         'data_type'    => '1',               // List
 116         'list_id'      => 'sex',
 117         'edit_options' => '',
 118        ),
 119   array('field_id'     => 'subscriber_relationship',
 120         'title'        => 'Subscriber Relationship',
 121         'uor'          => '2',
 122         'data_type'    => '1',               // List
 123         'list_id'      => 'sub_relation',
 124         'edit_options' => '',
 125        ),
 126   array('field_id'     => 'subscriber_street',
 127         'title'        => 'Subscriber Street',
 128         'uor'          => '1',
 129         'data_type'    => '2',               // Text
 130         'list_id'      => '',
 131         'edit_options' => '',
 132        ),
 133   array('field_id'     => 'subscriber_city',
 134         'title'        => 'Subscriber City',
 135         'uor'          => '1',
 136         'data_type'    => '2',               // Text
 137         'list_id'      => '',
 138         'edit_options' => '',
 139        ),
 140   array('field_id'     => 'subscriber_state',
 141         'title'        => 'Subscriber State',
 142         'uor'          => '1',
 143         'data_type'    => '1',               // List
 144         'list_id'      => 'state',
 145         'edit_options' => '',
 146        ),
 147   array('field_id'     => 'subscriber_postal_code',
 148         'title'        => 'Subscriber Zip',
 149         'uor'          => '1',
 150         'data_type'    => '2',               // Text
 151         'list_id'      => '',
 152         'edit_options' => '',
 153        ),
 154   array('field_id'     => 'subscriber_phone',
 155         'title'        => 'Subscriber Phone',
 156         'uor'          => '1',
 157         'data_type'    => '2',               // Text
 158         'list_id'      => '',
 159         'edit_options' => '',
 160        ),
 161 );
 162
 163 $postid = intval($_REQUEST['postid']);
 164
 165 if ($_POST['bn_save']) {
 166   $newdata = array();
 167   $ptid = intval($_POST['ptid']);
 168   foreach ($insurance_layout as $frow) {
 169     $data_type = $frow['data_type'];
 170     $field_id  = $frow['field_id'];
 171     // newInsuranceData() does not escape for mysql so we have to do it here.
 172     $newdata[$field_id] = add_escape_custom(get_layout_form_value($frow));
 173   }
 174   newInsuranceData(
 175     $ptid,
 176     $newdata['type'],
 177     $newdata['provider'],
 178     $newdata['policy_number'],
 179     $newdata['group_number'],
 180     $newdata['plan_name'],
 181     $newdata['subscriber_lname'],
 182     $newdata['subscriber_mname'],
 183     $newdata['subscriber_fname'],
 184     $newdata['subscriber_relationship'],
 185     '',                                    // subscriber_ss
 186     fixDate($newdata['subscriber_DOB']),
 187     $newdata['subscriber_street'],
 188     $newdata['subscriber_postal_code'],
 189     $newdata['subscriber_city'],
 190     $newdata['subscriber_state'],
 191     '',                                    // subscriber_country
 192     $newdata['subscriber_phone'],
 193     $newdata['subscriber_employer'],
 194     '',                                    // subscriber_employer_street
 195     '',                                    // subscriber_employer_city
 196     '',                                    // subscriber_employer_postal_code
 197     '',                                    // subscriber_employer_state
 198     '',                                    // subscriber_employer_country
 199     '',                                    // copay
 200     $newdata['subscriber_sex'],
 201     fixDate($newdata['date']),
 202     'TRUE',                                // accept_assignment
 203     ''                                     // policy_type
 204   );
 205   // Finally, delete the request from the portal.
 206   $result = cms_portal_call(array('action' => 'delpost', 'postid' => $postid));
 207   if ($result['errmsg']) {
 208     die(text($result['errmsg']));
 209   }
 210   echo "<html><body><script language='JavaScript'>\n";
 211   echo "if (top.restoreSession) top.restoreSession(); else opener.top.restoreSession();\n";
 212   echo "document.location.href = 'list_requests.php';\n";
 213   echo "</script></body></html>\n";
 214   exit();
 215 }
 216
 217 // Get the portal request data.
 218 if (!$postid) die(xlt('Request ID is missing!'));
 219 $result = cms_portal_call(array('action' => 'getpost', 'postid' => $postid));
 220 if ($result['errmsg']) {
 221   die(text($result['errmsg']));
 222 }
 223
 224 // Look up the patient in OpenEMR.
 225 $ptid = lookup_openemr_patient($result['post']['user']);
 226 ?>
 227 <html>
 228 <head>
 229 <?php html_header_show(); ?>
 230 <link rel=stylesheet href="<?php echo $css_header; ?>" type="text/css">
 231
 232 <style type="text/css">@import url(../../library/dynarch_calendar.css);</style>
 233 <style>
 234
 235 tr.head   { font-size:10pt; background-color:#cccccc; text-align:center; }
 236 tr.detail { font-size:10pt; background-color:#ddddff; }
 237 td input  { background-color:transparent; }
 238
 239 </style>
 240
 241 <script type="text/javascript" src="../../library/textformat.js"></script>
 242 <script type="text/javascript" src="../../library/dynarch_calendar.js"></script>
 243 <?php include_once("{$GLOBALS['srcdir']}/dynarch_calendar_en.inc.php"); ?>
 244 <script type="text/javascript" src="../../library/dynarch_calendar_setup.js"></script>
 245 <script type="text/javascript" src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-min-1-2-2/index.js"></script>
 246
 247 <script language="JavaScript">
 248
 249 var mypcc = '<?php echo $GLOBALS['phone_country_code'] ?>';
 250
 251 function myRestoreSession() {
 252  if (top.restoreSession) top.restoreSession(); else opener.top.restoreSession();
 253  return true;
 254 }
 255
 256 // This capitalizes the first letter of each word in the passed input
 257 // element.  It also strips out extraneous spaces.
 258 // Copied from demographics_full.php.
 259 function capitalizeMe(elem) {
 260  var a = elem.value.split(' ');
 261  var s = '';
 262  for(var i = 0; i < a.length; ++i) {
 263   if (a[i].length > 0) {
 264    if (s.length > 0) s += ' ';
 265    s += a[i].charAt(0).toUpperCase() + a[i].substring(1);
 266   }
 267  }
 268  elem.value = s;
 269 }
 270
 271 function validate() {
 272  var f = document.forms[0];
 273  // TBD
 274  return true;
 275 }
 276
 277 </script>
 278 </head>
 279
 280 <body class="body_top">
 281 <center>
 282
 283 <form method='post' action='insurance_form.php' onsubmit='return validate()'>
 284
 285 <input type='hidden' name='ptid'   value='<?php echo attr($ptid);   ?>' />
 286 <input type='hidden' name='postid' value='<?php echo attr($postid); ?>' />
 287
 288 <table width='100%' cellpadding='1' cellspacing='2'>
 289  <tr class='head'>
 290   <th align='left'><?php echo xlt('Field'        ); ?></th>
 291   <th align='left'><?php echo xlt('Current Value'); ?></th>
 292   <th align='left'><?php echo xlt('New Value'    ); ?></th>
 293  </tr>
 294
 295 <?php
 296 $insrow = getInsuranceData($pid, $result['fields']['type']);
 297
 298 foreach ($insurance_layout as $lorow) {
 299   $data_type  = $lorow['data_type'];
 300   $field_id   = $lorow['field_id'];
 301
 302   $list_id = $lorow['list_id'];
 303   $field_title = $lorow['title'];
 304
 305   $currvalue  = '';
 306   if (isset($insrow[$field_id])) $currvalue = $insrow[$field_id];
 307
 308   $newvalue = '';
 309   if (isset($result['fields'][$field_id])) $newvalue = trim($result['fields'][$field_id]);
 310
 311   // Translate $newvalue for certain field types including lists.
 312   if ($newvalue !== '') {
 313     if ($list_id) {
 314       $tmp = sqlQuery("SELECT option_id FROM list_options WHERE " .
 315         "list_id = ? AND title = ? AND activity = 1 ORDER BY option_id LIMIT 1",
 316         array($list_id, $newvalue));
 317       if (isset($tmp['option_id'])) $newvalue = $tmp['option_id'];
 318     }
 319     // Some data types like insurance provider are pretty hopeless, so let the display
 320     // logic generate a "Fix me" message and the user can translate it.
 321   }
 322
 323   echo " <tr class='detail'>\n";
 324   echo "  <td class='bold'>" . text($field_title) . "</td>\n";
 325   echo "  <td>";
 326   echo generate_display_field($lorow, $currvalue);
 327   echo "</td>\n";
 328   echo "  <td>";
 329   generate_form_field($lorow, $newvalue);
 330   echo "</td>\n";
 331   echo " </tr>\n";
 332 }
 333 ?>
 334
 335 </table>
 336
 337 <p>
 338 <input type='submit' name='bn_save' value='<?php echo xla('Save and Delete Request'); ?>' />
 339 &nbsp;
 340 <input type='button' value='<?php echo xla('Back'); ?>' onclick="window.history.back()" />
 341 <!-- Was: onclick="myRestoreSession();location='list_requests.php'" -->
 342 </p>
 343
 344 </form>
 345
 346 <script language="JavaScript">
 347
 348 // Fix inconsistently formatted phone numbers from the database.
 349 var f = document.forms[0];
 350 if (f.form_phone) phonekeyup(f.form_phone, mypcc);
 351
 352 // This is a by-product of generate_form_field().
 353 <?php echo $date_init; ?>
 354
 355 </script>
 356
 357 <!-- include support for the list-add selectbox feature -->
 358 <?php include $GLOBALS['fileroot'] . "/library/options_listadd.inc"; ?>
 359
 360 </center>
 361 </body>
 362 </html>
 363