interface/patient_file/front_payment.php

   1 <?php
   2
   3 /**
   4  * Front payment gui.
   5  *
   6  * @package   OpenEMR
   7  * @link      http://www.open-emr.org
   8  * @author    Rod Roark <rod@sunsetsystems.com>
   9  * @author    Brady Miller <brady.g.miller@gmail.com>
  10  * @author    Stephen Waite <stephen.waite@open-emr.org>
  11  * @copyright Copyright (c) 2006-2020 Rod Roark <rod@sunsetsystems.com>
  12  * @copyright Copyright (c) 2017-2018 Brady Miller <brady.g.miller@gmail.com>
  13  * @copyright Copyright (c) 2024 Stephen Waite <stephen.waite@open-emr.org>
  14  * @license   https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  15  */
  16
  17 require_once("../globals.php");
  18 require_once("$srcdir/patient.inc.php");
  19 require_once("$srcdir/payment.inc.php");
  20 require_once("$srcdir/forms.inc.php");
  21 require_once("../../custom/code_types.inc.php");
  22 require_once("$srcdir/options.inc.php");
  23 require_once("$srcdir/encounter_events.inc.php");
  24
  25 use OpenEMR\Billing\BillingUtilities;
  26 use OpenEMR\Common\Acl\AclMain;
  27 use OpenEMR\Common\Csrf\CsrfUtils;
  28 use OpenEMR\Common\Twig\TwigContainer;
  29 use OpenEMR\Common\Utils\FormatMoney;
  30 use OpenEMR\Core\Header;
  31 use OpenEMR\Events\Billing\Payments\PostFrontPayment;
  32 use OpenEMR\OeUI\OemrUI;
  33 use OpenEMR\PaymentProcessing\Sphere\SpherePayment;
  34 use OpenEMR\Services\FacilityService;
  35 use Symfony\Component\EventDispatcher\EventDispatcher;
  36
  37
  38 if (!empty($_REQUEST['receipt']) && empty($_POST['form_save'])) {
  39     if (!AclMain::aclCheckCore('acct', 'bill') && !AclMain::aclCheckCore('acct', 'rep_a') && !AclMain::aclCheckCore('patients', 'rx')) {
  40         echo (new TwigContainer(null, $GLOBALS['kernel']))->getTwig()->render('core/unauthorized.html.twig', ['pageTitle' => xl("Receipt for Payment")]);
  41         exit;
  42     }
  43 } else {
  44     if (!AclMain::aclCheckCore('acct', 'bill', '', 'write')) {
  45         if (!empty($_POST['form_save'])) {
  46             $pageTitle = xl("Receipt for Payment");
  47         } else {
  48             $pageTitle = xl("Record Payment");
  49         }
  50         echo (new TwigContainer(null, $GLOBALS['kernel']))->getTwig()->render('core/unauthorized.html.twig', ['pageTitle' => $pageTitle]);
  51         exit;
  52     }
  53 }
  54
  55 $pid = (!empty($_REQUEST['hidden_patient_code']) && ($_REQUEST['hidden_patient_code'] > 0)) ? $_REQUEST['hidden_patient_code'] : $pid;
  56
  57 $facilityService = new FacilityService();
  58
  59 ?>
  60 <!DOCTYPE html>
  61 <html>
  62 <head>
  63 <?php Header::setupHeader(['opener']);?>
  64     <?php if ($GLOBALS['payment_gateway'] == 'Stripe') { ?>
  65         <script src="https://js.stripe.com/v3/"></script>
  66     <?php } ?>
  67     <?php if ($GLOBALS['payment_gateway'] == 'AuthorizeNet') {
  68         // Must be loaded from their server
  69         $script = "https://jstest.authorize.net/v1/Accept.js"; // test script
  70         if ($GLOBALS['gateway_mode_production']) {
  71             $script = "https://js.authorize.net/v1/Accept.js"; // Production script
  72         } ?>
  73         <script src=<?php echo $script; ?> charset="utf-8"></script>
  74     <?php } ?>
  75 <?php
  76
  77 // Display a row of data for an encounter.
  78 //
  79 $var_index = 0;
  80 function echoLine($iname, $date, $charges, $ptpaid, $inspaid, $duept, $encounter = 0, $copay = 0, $patcopay = 0)
  81 {
  82     global $var_index;
  83     $var_index++;
  84     $balance = $charges - $ptpaid - $inspaid;
  85     $balance = (round($duept, 2) != 0) ? 0 : $balance;//if balance is due from patient, then insurance balance is displayed as zero
  86     $encounter = $encounter ? $encounter : '';
  87     echo " <tr id='tr_" . attr($var_index) . "' >\n";
  88     echo "  <td>" . text(oeFormatShortDate($date)) . "</td>\n";
  89     echo "  <td class='text-center' id='" . attr($date) . "'>" . text($encounter) . "</td>\n";
  90     echo "  <td class='text-center' id='td_charges_$var_index' >" . text(FormatMoney::getBucks($charges)) . "</td>\n";
  91     echo "  <td class='text-center' id='td_inspaid_$var_index' >" . text(FormatMoney::getBucks($inspaid * -1)) . "</td>\n";
  92     echo "  <td class='text-center' id='td_ptpaid_$var_index' >" . text(FormatMoney::getBucks($ptpaid * -1)) . "</td>\n";
  93     echo "  <td class='text-center' id='td_patient_copay_$var_index' >" . text(FormatMoney::getBucks($patcopay)) . "</td>\n";
  94     echo "  <td class='text-center' id='td_copay_$var_index' >" . text(FormatMoney::getBucks($copay)) . "</td>\n";
  95     echo "  <td class='text-center' id='balance_$var_index'>" . text(FormatMoney::getBucks($balance)) . "</td>\n";
  96     echo "  <td class='text-center' id='duept_$var_index'>" . text(FormatMoney::getBucks(round($duept, 2) * 1)) . "</td>\n";
  97     echo "  <td class='text-right'><input type='text' class='form-control' name='" . attr($iname) . "'  id='paying_" . attr($var_index) . "' " .
  98         " value='' onchange='coloring();calctotal()'  autocomplete='off' " .
  99         "onkeyup='calctotal()'/></td>\n";
 100     echo " </tr>\n";
 101 }
 102
 103 // We use this to put dashes, colons, etc. back into a timestamp.
 104 //
 105 function decorateString($fmt, $str)
 106 {
 107     $res = '';
 108     while ($fmt) {
 109         $fc = substr($fmt, 0, 1);
 110         $fmt = substr($fmt, 1);
 111         if ($fc == '.') {
 112             $res .= substr($str, 0, 1);
 113             $str = substr($str, 1);
 114         } else {
 115             $res .= $fc;
 116         }
 117     }
 118
 119     return $res;
 120 }
 121
 122 // Compute taxes from a tax rate string and a possibly taxable amount.
 123 //
 124 function calcTaxes($row, $amount)
 125 {
 126     $total = 0;
 127     if (empty($row['taxrates'])) {
 128         return $total;
 129     }
 130
 131     $arates = explode(':', $row['taxrates']);
 132     if (empty($arates)) {
 133         return $total;
 134     }
 135
 136     foreach ($arates as $value) {
 137         if (empty($value)) {
 138             continue;
 139         }
 140
 141         $trow = sqlQuery("SELECT option_value FROM list_options WHERE " .
 142                 "list_id = 'taxrate' AND option_id = ? AND activity = 1 LIMIT 1", array($value));
 143         if (empty($trow['option_value'])) {
 144             echo "<!-- Missing tax rate '" . text($value) . "'! -->\n";
 145             continue;
 146         }
 147
 148         $tax = sprintf("%01.2f", $amount * $trow['option_value']);
 149         // echo "<!-- Rate = '$value', amount = '$amount', tax = '$tax' -->\n";
 150         $total += $tax;
 151     }
 152
 153     return $total;
 154 }
 155
 156 $now = time();
 157 $today = date('Y-m-d', $now);
 158 $timestamp = date('Y-m-d H:i:s', $now);
 159
 160 $patdata = sqlQuery("SELECT " .
 161     "p.fname, p.mname, p.lname, p.pubpid,p.pid, i.copay " .
 162     "FROM patient_data AS p " .
 163     "LEFT OUTER JOIN insurance_data AS i ON " .
 164     "i.pid = p.pid AND i.type = 'primary' " .
 165     "WHERE p.pid = ? ORDER BY i.date DESC LIMIT 1", array($pid));
 166
 167 $invoice_refno = BillingUtilities::updateInvoiceRefNumber();
 168
 169 $alertmsg = ''; // anything here pops up in an alert box
 170
 171 // If the Save button was clicked...
 172 if (!empty($_POST['form_save'])) {
 173     if (!CsrfUtils::verifyCsrfToken($_POST["csrf_token_form"])) {
 174         CsrfUtils::csrfNotVerified();
 175     }
 176
 177     $form_pid = $_POST['form_pid'];
 178     $form_method = trim($_POST['form_method']);
 179     $form_source = trim($_POST['form_source'] ?? ''); // check number not always entered
 180     $patdata = getPatientData($form_pid, 'fname,mname,lname,pubpid');
 181     $NameNew = $patdata['fname'] . " " . $patdata['lname'] . " " . $patdata['mname'];
 182
 183     //Update the invoice_refno
 184     sqlStatement(
 185         "update form_encounter set invoice_refno=? where encounter=? and pid=? ",
 186         array($invoice_refno, $encounter, $form_pid)
 187     );
 188
 189     if ($_REQUEST['radio_type_of_payment'] == 'pre_payment') {
 190             $payment_id = sqlInsert(
 191                 "insert into ar_session set " .
 192                 "payer_id = ?" .
 193                 ", patient_id = ?" .
 194                 ", user_id = ?" .
 195                 ", closed = ?" .
 196                 ", reference = ?" .
 197                 ", check_date =  now() , deposit_date = now() " .
 198                 ",  pay_total = ?" .
 199                 ", payment_type = 'patient'" .
 200                 ", description = ?" .
 201                 ", adjustment_code = 'pre_payment'" .
 202                 ", post_to_date = now() " .
 203                 ", payment_method = ?",
 204                 array(0, $form_pid, $_SESSION['authUserID'], 0, $form_source, $_REQUEST['form_prepayment'], $NameNew, $form_method)
 205             );
 206
 207          frontPayment($form_pid, 0, $form_method, $form_source, $_REQUEST['form_prepayment'], 0, $timestamp);//insertion to 'payments' table.
 208     }
 209
 210     if ($_POST['form_upay'] && $_REQUEST['radio_type_of_payment'] != 'pre_payment') {
 211         foreach ($_POST['form_upay'] as $enc => $payment) {
 212             $payment = floatval($payment);
 213             if ($amount = $payment) {
 214                  $zero_enc = $enc;
 215                 if ($_REQUEST['radio_type_of_payment'] == 'invoice_balance') {
 216                     if (!$enc) {
 217                         $enc = calendar_arrived($form_pid);
 218                     }
 219                 } else {
 220                     if (!$enc) {
 221                            $enc = calendar_arrived($form_pid);
 222                     }
 223                 }
 224
 225                 //----------------------------------------------------------------------------------------------------
 226                   //Fetching the existing code and modifier
 227                   $ResultSearchNew = sqlStatement(
 228                       "SELECT * FROM billing LEFT JOIN code_types ON billing.code_type=code_types.ct_key " .
 229                       "WHERE code_types.ct_fee=1 AND billing.activity!=0 AND billing.pid =? AND encounter=? ORDER BY billing.code,billing.modifier",
 230                       array($form_pid, $enc)
 231                   );
 232                 if ($RowSearch = sqlFetchArray($ResultSearchNew)) {
 233                     $Codetype = $RowSearch['code_type'];
 234                     $Code = $RowSearch['code'];
 235                     $Modifier = $RowSearch['modifier'];
 236                 } else {
 237                     $Codetype = '';
 238                     $Code = '';
 239                     $Modifier = '';
 240                 }
 241
 242                 //----------------------------------------------------------------------------------------------------
 243                 if ($_REQUEST['radio_type_of_payment'] == 'copay') {//copay saving to ar_session and ar_activity tables
 244                     $session_id = sqlInsert(
 245                         "INSERT INTO ar_session (payer_id,user_id,reference,check_date,deposit_date,pay_total," .
 246                         " global_amount,payment_type,description,patient_id,payment_method,adjustment_code,post_to_date) " .
 247                         " VALUES ('0',?,?,now(),now(),?,'','patient','COPAY',?,?,'patient_payment',now())",
 248                         array($_SESSION['authUserID'], $form_source, $amount, $form_pid, $form_method)
 249                     );
 250
 251                     sqlBeginTrans();
 252                     $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM       ar_activity WHERE pid = ? AND encounter = ?", array($form_pid, $enc));
 253                     $insrt_id = sqlInsert(
 254                         "INSERT INTO ar_activity (pid,encounter,sequence_no,code_type,code,modifier,payer_type,post_time,post_user,session_id,pay_amount,account_code)" .
 255                         " VALUES (?,?,?,?,?,?,0,now(),?,?,?,'PCP')",
 256                         array($form_pid, $enc, $sequence_no['increment'], $Codetype, $Code, $Modifier, $_SESSION['authUserID'], $session_id, $amount)
 257                     );
 258                     sqlCommitTrans();
 259
 260                     frontPayment($form_pid, $enc, $form_method, $form_source, $amount, 0, $timestamp);//insertion to 'payments' table.
 261                 }
 262
 263                 if ($_REQUEST['radio_type_of_payment'] == 'invoice_balance' || $_REQUEST['radio_type_of_payment'] == 'cash') {                //Payment by patient after insurance paid, cash patients similar to do not bill insurance in feesheet.
 264                     if ($_REQUEST['radio_type_of_payment'] == 'cash') {
 265                         sqlStatement(
 266                             "update form_encounter set last_level_closed=? where encounter=? and pid=? ",
 267                             array(4, $enc, $form_pid)
 268                         );
 269                         sqlStatement(
 270                             "update billing set billed=? where encounter=? and pid=?",
 271                             array(1, $enc, $form_pid)
 272                         );
 273                     }
 274
 275                           $adjustment_code = 'patient_payment';
 276                           $payment_id = sqlInsert(
 277                               "insert into ar_session set " .
 278                               "payer_id = ?" .
 279                               ", patient_id = ?" .
 280                               ", user_id = ?" .
 281                               ", closed = ?" .
 282                               ", reference = ?"   .
 283                               ", check_date =  now() , deposit_date = now() " .
 284                               ",  pay_total = ?" .
 285                               ", payment_type = 'patient'" .
 286                               ", description = ?" .
 287                               ", adjustment_code = ?" .
 288                               ", post_to_date = now() " .
 289                               ", payment_method = ?",
 290                               array(0, $form_pid, $_SESSION['authUserID'], 0, $form_source, $amount, $NameNew, $adjustment_code, $form_method)
 291                           );
 292
 293                     //--------------------------------------------------------------------------------------------------------------------
 294
 295                             frontPayment($form_pid, $enc, $form_method, $form_source, 0, $amount, $timestamp);//insertion to 'payments' table.
 296
 297                     //--------------------------------------------------------------------------------------------------------------------
 298
 299                             $resMoneyGot = sqlStatement(
 300                                 "SELECT sum(pay_amount) as PatientPay FROM ar_activity where pid =? and " .
 301                                 "encounter = ? and payer_type = 0 and account_code = 'PCP' AND deleted IS NULL",
 302                                 array($form_pid, $enc)
 303                             );//new fees screen copay gives account_code='PCP'
 304                             $rowMoneyGot = sqlFetchArray($resMoneyGot);
 305                             $Copay = $rowMoneyGot['PatientPay'];
 306
 307                     //--------------------------------------------------------------------------------------------------------------------
 308
 309                             //Looping the existing code and modifier
 310                             $ResultSearchNew = sqlStatement(
 311                                 "SELECT * FROM billing LEFT JOIN code_types ON billing.code_type=code_types.ct_key WHERE code_types.ct_fee=1 " .
 312                                 "AND billing.activity!=0 AND billing.pid =? AND encounter=? ORDER BY billing.code,billing.modifier",
 313                                 array($form_pid, $enc)
 314                             );
 315                     while ($RowSearch = sqlFetchArray($ResultSearchNew)) {
 316                         $Codetype = $RowSearch['code_type'];
 317                         $Code = $RowSearch['code'];
 318                         $Modifier = $RowSearch['modifier'];
 319                         $Fee = $RowSearch['fee'];
 320
 321                         $resMoneyGot = sqlStatement(
 322                             "SELECT sum(pay_amount) as MoneyGot FROM ar_activity where pid = ? AND deleted IS NULL " .
 323                             "and code_type=? and code=? and modifier=? and encounter =? and !(payer_type=0 and account_code='PCP')",
 324                             array($form_pid, $Codetype, $Code, $Modifier, $enc)
 325                         );
 326                         //new fees screen copay gives account_code='PCP'
 327                         $rowMoneyGot = sqlFetchArray($resMoneyGot);
 328                         $MoneyGot = $rowMoneyGot['MoneyGot'];
 329
 330                         $resMoneyAdjusted = sqlStatement(
 331                             "SELECT sum(adj_amount) as MoneyAdjusted FROM ar_activity where " .
 332                             "pid = ? and code_type = ? and code = ? and modifier = ? and encounter = ? AND deleted IS NULL",
 333                             array($form_pid, $Codetype, $Code, $Modifier, $enc)
 334                         );
 335                         $rowMoneyAdjusted = sqlFetchArray($resMoneyAdjusted);
 336                         $MoneyAdjusted = $rowMoneyAdjusted['MoneyAdjusted'];
 337
 338                         $Remainder = $Fee - $Copay - $MoneyGot - $MoneyAdjusted;
 339                         $Copay = 0;
 340                         if (round($Remainder, 2) != 0 && $amount != 0) {
 341                             if ($amount - $Remainder >= 0) {
 342                                 $insert_value = $Remainder;
 343                                 $amount = $amount - $Remainder;
 344                             } else {
 345                                 $insert_value = $amount;
 346                                 $amount = 0;
 347                             }
 348
 349                               sqlBeginTrans();
 350                               $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($form_pid, $enc));
 351                               sqlStatement(
 352                                   "insert into ar_activity set " .
 353                                   "pid = ?" .
 354                                   ", encounter = ?" .
 355                                   ", sequence_no = ?" .
 356                                   ", code_type = ?" .
 357                                   ", code = ?" .
 358                                   ", modifier = ?" .
 359                                   ", payer_type = ?" .
 360                                   ", post_time = now() " .
 361                                   ", post_user = ?" .
 362                                   ", session_id = ?" .
 363                                   ", pay_amount = ?" .
 364                                   ", adj_amount = ?" .
 365                                   ", account_code = 'PP'",
 366                                   array($form_pid, $enc, $sequence_no['increment'], $Codetype, $Code, $Modifier, 0, $_SESSION['authUserID'], $payment_id, $insert_value, 0)
 367                               );
 368                               sqlCommitTrans();
 369                         }//if
 370                     }//while
 371                     if ($amount != 0) {//if any excess is there.
 372                               sqlBeginTrans();
 373                                 $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($form_pid, $enc));
 374                                 sqlStatement(
 375                                     "insert into ar_activity set " .
 376                                     "pid = ?" .
 377                                     ", encounter = ?" .
 378                                     ", sequence_no = ?" .
 379                                     ", code_type = ?" .
 380                                     ", code = ?" .
 381                                     ", modifier = ?" .
 382                                     ", payer_type = ?" .
 383                                     ", post_time = now() " .
 384                                     ", post_user = ?" .
 385                                     ", session_id = ?" .
 386                                     ", pay_amount = ?" .
 387                                     ", adj_amount = ?" .
 388                                     ", account_code = 'PP'",
 389                                     array($form_pid, $enc, $sequence_no['increment'], $Codetype, $Code, $Modifier, 0, $_SESSION['authUserID'], $payment_id, $amount, 0)
 390                                 );
 391                                 sqlCommitTrans();
 392                     }
 393
 394                     //--------------------------------------------------------------------------------------------------------------------
 395                 }//invoice_balance
 396             }//if ($amount = 0 + $payment)
 397         }//foreach
 398     }//if ($_POST['form_upay'])
 399 }//if ($_POST['form_save'])
 400
 401 if (!empty($_POST['form_save']) || !empty($_REQUEST['receipt'])) {
 402     if (!empty($_REQUEST['receipt'])) {
 403         $form_pid = $_GET['patient'];
 404         $timestamp = decorateString('....-..-.. ..:..:..', $_GET['time']);
 405     }
 406
 407     // Get details for what we guess is the primary facility.
 408     $frow = $facilityService->getPrimaryBusinessEntity(array("useLegacyImplementation" => true));
 409
 410     // Get the patient's name and chart number.
 411     $patdata = getPatientData($form_pid, 'fname,mname,lname,pubpid');
 412
 413     // Re-fetch payment info.
 414     $payrow = sqlQuery("SELECT " .
 415     "SUM(amount1) AS amount1, " .
 416     "SUM(amount2) AS amount2, " .
 417     "MAX(method) AS method, " .
 418     "MAX(source) AS source, " .
 419     "MAX(dtime) AS dtime, " .
 420     // "MAX(user) AS user " .
 421     "MAX(user) AS user, " .
 422     "MAX(encounter) as encounter " .
 423     "FROM payments WHERE " .
 424     "pid = ? AND dtime = ?", array($form_pid, $timestamp));
 425
 426     // Create key for deleting, just in case.
 427     $ref_id = ($_REQUEST['radio_type_of_payment'] == 'copay') ? $session_id : $payment_id;
 428     $payment_key = $form_pid . '.' . preg_replace('/[^0-9]/', '', $timestamp) . '.' . $ref_id;
 429
 430     if ($_REQUEST['radio_type_of_payment'] != 'pre_payment') {
 431         // get facility from encounter
 432         $tmprow = sqlQuery("SELECT `facility_id` FROM `form_encounter` WHERE `encounter` = ?", array($payrow['encounter']));
 433         $frow = $facilityService->getById($tmprow['facility_id']);
 434     } else {
 435         // if pre_payment, then no encounter yet, so get main office address
 436         $frow = $facilityService->getPrimaryBillingLocation();
 437     }
 438
 439     // Now proceed with printing the receipt.
 440     ?>
 441
 442 <title><?php echo xlt('Receipt for Payment'); ?></title>
 443     <?php Header::setupHeader(); ?>
 444 <script>
 445
 446     <?php require($GLOBALS['srcdir'] . "/restoreSession.php"); ?>
 447
 448 $(function () {
 449     var win = top.printLogSetup ? top : opener.top;
 450     win.printLogSetup(document.getElementById('printbutton'));
 451 });
 452
 453 function closeHow(e) {
 454     if (opener) {
 455         dlgclose();
 456         return;
 457     }
 458     top.activateTabByName('pat', true);
 459     top.tabCloseByName(window.name);
 460 }
 461
 462 // This is action to take before printing and is called from restoreSession.php.
 463 function printlog_before_print() {
 464     let divstyle = document.getElementById('hideonprint').style;
 465     divstyle.display = 'none';
 466     // currently exit is not hidden by default in case receipt print is not needed
 467     // and left here for future option to force users to print via global etc..
 468     // can still print later via reports.
 469     divstyle = document.getElementById('showonprint').style;
 470     divstyle.display = '';
 471 }
 472
 473 // Process click on Delete button.
 474 function deleteme() {
 475     dlgopen('deleter.php?payment=' + <?php echo js_url($payment_key); ?> + '&csrf_token_form=' + <?php echo js_url(CsrfUtils::collectCsrfToken()); ?>, '_blank', 500, 450);
 476     return false;
 477 }
 478
 479 // Called by the deleteme.php window on a successful delete.
 480 function imdeleted() {
 481     if (opener) {
 482         dlgclose(); // we're in reports/leftnav and callback reloads.
 483     } else {
 484         window.history.back(); // this is us full screen.
 485     }
 486 }
 487
 488 // Called to switch to the specified encounter having the specified DOS.
 489 // This also closes the popup window.
 490 function toencounter(enc, datestr, topframe) {
 491     top.restoreSession();
 492     top.goToEncounter(enc);
 493     if (opener) dlgclose();
 494 }
 495
 496 </script>
 497 <style>
 498     @media print {
 499         #donebutton {
 500             display: none;
 501         }
 502     }
 503     .main-section {
 504         display: grid;
 505         grid-template-columns: 50% auto;
 506         grid-template-areas: "section-2 section-1";
 507     }
 508     .section-1 {
 509         grid-area: section-1;
 510         height: fit-content;
 511         align-self: center;
 512         padding-left: 208px;
 513         margin-top: -7em;
 514     }
 515     .section-2 {
 516         grid-area: section-2;
 517         text-align: left;
 518     }
 519     table,td,th {
 520         border: 1px solid black; text-align: left;
 521     }
 522     table {
 523         border-collapse: collapse; width: 100%;
 524     }
 525     th,td {
 526         padding: 7px;
 527     }
 528     .table td {
 529         padding: 7px;
 530     }
 531     .mini_table {
 532         width: 100%;
 533     }
 534     table.mini_table>tbody>tr>th {
 535         background-color: var(--secondary);
 536         text-align: center;
 537     }
 538     body>table.mini_table>tbody>tr>td {
 539         text-align: center;
 540     }
 541     body>table.mini_table>tbody>tr>td {
 542         border: 1px solid #fff;
 543     }
 544     body>table.mini_table>tbody>tr>th {
 545         border: 1px solid var(--secondary);
 546     }
 547     .bg-color {
 548         background-color: var(--secondary);
 549         padding: 2px;
 550         font-weight: 600;
 551         -webkit-print-color-adjust: exact;
 552     }
 553     .bg-color-w {
 554         background-color: var(--secondary);
 555         font-weight: 600;
 556         -webkit-print-color-adjust: exact!important; }
 557     @media print {
 558         body {
 559             -webkit-print-color-adjust: exact !important;
 560         }
 561
 562         tr.bg-color-w{
 563             background-color: var(--secondary)!important;
 564             -webkit-print-color-adjust: exact;
 565         }
 566         tr.bg-color{
 567             background-color: var(--secondary) !important;
 568             -webkit-print-color-adjust: exact;
 569         }
 570     }
 571 </style>
 572 </head>
 573 <body>
 574     <div class="container mt-3">
 575         <div class="row">
 576             <!-- Omega -->
 577             <div class="col-12 justify-content-center">
 578                 <h2 class="text-center"><?php echo xlt('Receipt for Payment'); ?></h2>
 579                 <div class="main-section mb-5 mt-10">
 580                     <div class="section-2">
 581                         <p style="font-weight:600;">
 582                             <bold class="bg-color"><?php echo text($frow['name']) ?></bold> <br /> <br />
 583                             <?php echo text($frow['street']) ?><br />
 584                             <?php echo text($frow['city'] . ', ' . $frow['state']) . ' ' . text($frow['postal_code']) ?><br />
 585                             <?php echo text("[Phone]" . $frow['phone']) ?><br />
 586                             <?php echo text("[Email] " . $frow['email']) ?><br />
 587
 588
 589                             <br />
 590                             <?php echo xlt('How Paid'); ?>:
 591                             <?php echo generate_display_field(array('data_type' => '1', 'list_id' => 'payment_method'), $payrow['method']); ?>
 592
 593                             <br />
 594                             <?php echo xlt('Check or Reference Number'); ?>:
 595                             <?php echo text($payrow['source']); ?>
 596
 597                             <br />
 598                             <?php
 599                             if ($_REQUEST['radio_type_of_payment'] == 'pre_payment') {
 600                                 echo xlt('Pre-payment Amount');
 601                             } else {
 602                                 echo xlt('Amount for Past Balance');
 603                             }
 604                             ?>:
 605                             <?php echo text(oeFormatMoney($payrow['amount2'])); ?>
 606
 607                             <br />
 608                             <?php echo xlt('Amount for This Visit'); ?>:
 609                             <?php echo text(oeFormatMoney($payrow['amount1'])); ?>
 610
 611                             <br />
 612                             <?php echo xlt('Received By'); ?>:
 613                             <?php echo text($payrow['user']); ?>
 614                         </p>
 615
 616                     </div>
 617                     <div class="section-1">
 618                         <?php if (file_exists($GLOBALS['OE_SITE_WEBROOT'] . "/images/logo_1.png")) { ?>
 619                             <img src=<?php echo $GLOBALS['OE_SITE_WEBROOT'] . "/images/logo_1.png" ?> alt="facility_logo" class="img-fluid">
 620                         <?php } ?>
 621
 622                         <table class="mini_table text-center">
 623                             <tr>
 624                                 <th><?php echo xlt('Invoice No.'); ?></th>
 625                                 <th><?php echo xlt('Date'); ?></th>
 626                             </tr>
 627                             <tr class="text-center">
 628                                 <td class="text-center"><?php echo text($invoice_refno); ?></td>
 629                                 <td class="text-center"><?php echo text(oeFormatSDFT(strtotime($payrow['dtime']))); ?></td>
 630                             </tr>
 631                         </table>
 632                     </div>
 633                 </div>
 634
 635                 <div class="table-responsive">
 636
 637                     <table>
 638                         <!-- Omega Itemized Invoice -->
 639                         <tr class="bg-color-w">
 640                             <th><?php echo xlt('Description'); ?></th>
 641                             <th><?php echo xlt('Price'); ?></th>
 642                             <th><?php echo xlt('Qty'); ?></th>
 643                             <th><?php echo xlt('Total'); ?></th>
 644                         </tr>
 645                         <!-- Omega Itemized Invoice -->
 646                         <?php
 647                             $row_data = sqlStatement(
 648                                 "SELECT * FROM billing WHERE " .
 649                                 "pid = ? AND encounter = ? AND " .
 650                                 // "code_type != 'COPAY' AND activity = 1 AND fee != 0 " .
 651                                 "code_type != 'COPAY' AND activity = 1 " .
 652                                 "ORDER BY id",
 653                                 array($pid,$encounter)
 654                             );
 655                         while ($each_row = sqlFetchArray($row_data)) {
 656                             ?>
 657                                 <tr>
 658                                     <td><?php echo text($each_row['code_text']); ?></td>
 659                                     <td><?php echo text($each_row['fee']); ?></td>
 660                                     <td><?php echo text($each_row['units']); ?></td>
 661                                     <td><?php echo text($each_row['fee'] * $each_row['units']); ?></td>
 662                                 </tr>
 663                         <?php } ?>
 664
 665                         <?php
 666                             $query = "SELECT s.sale_id, s.sale_date, s.prescription_id, s.fee, " .
 667                             "s.quantity, s.encounter, s.drug_id, d.name, r.provider_id " .
 668                             "FROM drug_sales AS s " .
 669                             "LEFT JOIN drugs AS d ON d.drug_id = s.drug_id " .
 670                             "LEFT OUTER JOIN prescriptions AS r ON r.id = s.prescription_id " .
 671                             "WHERE s.pid = ? AND s.encounter = ? AND s.billed = 0 " .
 672                             "ORDER BY s.encounter DESC, s.sale_id ASC";
 673                             $dres = sqlStatement($query, array($pid, $encounter));
 674                         while ($myproducts = sqlFetchArray($dres)) {
 675                             ?>
 676                             <tr>
 677                                 <td><?php echo text($myproducts['name']); ?></td>
 678                                 <td><?php echo text($myproducts['fee']); ?></td>
 679                                 <td><?php echo text($myproducts['quantity']); ?></td>
 680                                 <td><?php echo text($myproducts['fee'] * $myproducts['quantity']); ?></td>
 681                             </tr>
 682                         <?php } ?>
 683
 684                         <tr>
 685                             <td style="border-right-color:white !important;"></td>
 686                             <td ></td>
 687                             <td class="text-right bg-color-w"><?php echo text("Total"); ?></td>
 688                             <td class="text-left bg-color-w"><?php echo text(oeFormatMoney($payrow['amount1'] + $payrow['amount2'])); ?></td>
 689                         </tr>
 690
 691                     </table>
 692
 693                 </div>
 694                 <div id='hideonprint' class="text-center pt-4">
 695                     <button type="button" class="btn btn-primary btn-print" value='<?php echo xla('Print'); ?>' id='printbutton'>
 696                         <?php echo xlt('Print'); ?>
 697                     </button>
 698
 699                     <?php
 700                     $todaysenc = todaysEncounterIf($pid);
 701                     if ($todaysenc && $todaysenc != $encounter) {
 702                         echo "&nbsp;<input type='button' class='btn btn-primary' " .
 703                         "value='" . xla('Open Today`s Visit') . "' " .
 704                         "onclick='toencounter(" . attr_js($todaysenc) . ", " . attr_js($today) . ", (opener ? opener.top : top))' />\n";
 705                     }
 706                     ?>
 707
 708                     <?php if (AclMain::aclCheckCore('admin', 'super') || AclMain::aclCheckCore('acct', 'bill')) {
 709                         // allowing biller to delete payments ?>
 710                     <button type="button" class="btn btn-danger btn-delete" value='<?php echo xla('Delete'); ?>' onclick="deleteme()">
 711                         <?php echo xlt('Delete'); ?>
 712                     </button>
 713                     <?php } ?>
 714                 </div>
 715                 <div class='mt-3 text-center' id='showonprint'>
 716                     <button type="button" class="btn btn-secondary btn-cancel" value='<?php echo xla('Exit'); ?>' id='donebutton' onclick="closeHow(event)">
 717                         <?php echo xlt('Exit'); ?>
 718                     </button>
 719                 </div>
 720             </div>
 721         </div>
 722     </div>
 723 </body>
 724
 725     <?php
 726     //
 727     // End of receipt printing logic.
 728     //
 729 } else {
 730     //
 731     // Here we display the form for data entry.
 732     //
 733     ?>
 734 <title><?php echo xlt('Record Payment'); ?></title>
 735
 736 <style>
 737     #ajax_div_patient {
 738         position: absolute;
 739         z-index:10;
 740         background-color: #FBFDD0;
 741         border: 1px solid #ccc;
 742         padding: 10px;
 743     }
 744 </style>
 745 <!--Removed standard dependencies 12/29/17 as not needed any longer since moved to a tab/frame not popup.-->
 746
 747 <!-- supporting javascript code -->
 748 <script>
 749     var mypcc = '1';
 750 </script>
 751     <?php include_once("{$GLOBALS['srcdir']}/ajax/payment_ajax_jav.inc.php"); ?>
 752 <script>
 753     document.onclick=HideTheAjaxDivs;
 754 </script>
 755
 756     <?php Header::setupAssets('topdialog'); ?>
 757
 758 <script src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-creditcardvalidator/jquery.creditCardValidator.js"></script>
 759
 760 <script>
 761     var chargeMsg = <?php echo xlj('Payment was successfully authorized and charged. Thank You.'); ?>;
 762     var publicKey = <?php echo json_encode($cryptoGen->decryptStandard($GLOBALS['gateway_public_key'])); ?>;
 763     var apiKey = <?php echo json_encode($cryptoGen->decryptStandard($GLOBALS['gateway_api_key'])); ?>;
 764 $(function() {
 765     $('#openPayModal').on('show.bs.modal', function () {
 766         let total = $("[name='form_paytotal']").val();
 767         let prepay = $("#form_prepayment").val();
 768         if (Number(total) < 1) {
 769             if (Number(prepay) < 1) {
 770                 let error = <?php echo xlj("Please enter a payment amount"); ?>;
 771                 alert(error);
 772                 return false;
 773             }
 774             total = prepay;
 775         }
 776         $("#form_method").val('credit_card');
 777         $("#payTotal").text(total);
 778         $("#paymentAmount").val(total);
 779     });
 780 });
 781     <?php require($GLOBALS['srcdir'] . "/restoreSession.php"); ?>
 782 function closeHow(e) {
 783     if (opener) {
 784         dlgclose();
 785         return;
 786     }
 787     top.activateTabByName('pat', true);
 788     top.tabCloseByName(window.name);
 789 }
 790 function calctotal() {
 791     var f = document.forms[0];
 792     var total = 0;
 793     for (var i = 0; i < f.elements.length; ++i) {
 794         var elem = f.elements[i];
 795         var ename = elem.name;
 796         if (ename.indexOf('form_upay[') == 0 || ename.indexOf('form_bpay[') == 0) {
 797             if (elem.value.length > 0) total += Number(elem.value);
 798         }
 799     }
 800     f.form_paytotal.value = Number(total).toFixed(2);
 801     return true;
 802 }
 803
 804 function coloring() {
 805     for (var i = 1; ; ++i) {
 806         if (document.getElementById('paying_' + i)) {
 807             paying = document.getElementById('paying_' + i).value * 1;
 808             patient_balance = document.getElementById('duept_' + i).innerHTML * 1;
 809
 810             //balance=document.getElementById('balance_'+i).innerHTML*1;
 811             if (patient_balance > 0 && paying > 0) {
 812                 if (paying > patient_balance) {
 813                    document.getElementById('paying_' + i).style.background = '#FF0000';
 814                 }
 815                 else if (paying < patient_balance) {
 816                     document.getElementById('paying_' + i).style.background = '#99CC00';
 817                 }
 818                 else if (paying == patient_balance) {
 819                     document.getElementById('paying_' + i).style.background = 'var(--white)';
 820                 }
 821             } else {
 822                 document.getElementById('paying_' + i).style.background = 'var(--white)';
 823             }
 824         }
 825         else {
 826             break;
 827         }
 828     }
 829 }
 830
 831 function CheckVisible(MakeBlank) { //Displays and hides the check number text box.
 832     if (document.getElementById('form_method').options[document.getElementById(
 833             'form_method').selectedIndex].value == 'check_payment' || document.getElementById(
 834             'form_method').options[document.getElementById('form_method').selectedIndex]
 835         .value == 'bank_draft') {
 836         document.getElementById('check_number').disabled = false;
 837     } else {
 838         document.getElementById('check_number').disabled = true;
 839     }
 840 }
 841
 842 function validate(notSubmit = false) {
 843     var f = document.forms[0];
 844     let ok = -1;
 845     top.restoreSession();
 846     issue = 'no';
 847     // prevent an empty form submission
 848     let flgempty = true;
 849     for (let i = 0; i < f.elements.length; ++i) {
 850         let ename = f.elements[i].name;
 851         if (f.elements[i].value == 'pre_payment' && f.elements[i].checked === true) {
 852             if (Number(f.elements.namedItem("form_prepayment").value) !== 0) {
 853                 flgempty = false;
 854             }
 855             break;
 856         }
 857         if (ename.indexOf('form_upay[') === 0 || ename.indexOf('form_bpay[') === 0) {
 858             if (Number(f.elements[i].value) !== 0) flgempty = false;
 859         }
 860     }
 861     if (flgempty) {
 862         alert(<?php echo xlj('A Payment is Required!. Please input a payment line item entry.'); ?>);
 863         return false;
 864     }
 865     // continue validation.
 866     if (((document.getElementById('form_method').options[document.getElementById('form_method').selectedIndex].value == 'check_payment' ||
 867             document.getElementById('form_method').options[document.getElementById('form_method').selectedIndex].value == 'bank_draft') &&
 868             document.getElementById('check_number').value == '')) {
 869         alert(<?php echo xlj('Please Fill the Check or Reference Number'); ?>);
 870         document.getElementById('check_number').focus();
 871         return false;
 872     }
 873     if (document.getElementById('radio_type_of_payment_self1').checked == false &&
 874         document.getElementById('radio_type_of_payment1').checked == false &&
 875         document.getElementById('radio_type_of_payment2').checked == false &&
 876         document.getElementById('radio_type_of_payment4').checked == false) {
 877         alert(<?php echo xlj('Please Select Type Of Payment.'); ?>);
 878         return false;
 879     }
 880     if (document.getElementById('radio_type_of_payment_self1').checked == true ||
 881         document.getElementById('radio_type_of_payment1').checked == true) {
 882         for (var i = 0; i < f.elements.length; ++i) {
 883             var elem = f.elements[i];
 884             var ename = elem.name;
 885             if (ename.indexOf('form_upay[0') == 0) //Today is this text box.
 886             {
 887                 if (elem.value * 1 > 0) {//A warning message, if the amount is posted with out encounter.
 888                     if (confirm(<?php echo xlj('If patient has appointment click OK to create encounter otherwise, cancel this and then create an encounter for today visit.'); ?>)) {
 889                         ok = 2;
 890                     } else {
 891                         elem.focus();
 892                         return false;
 893                     }
 894                 }
 895                 break;
 896             }
 897         }
 898     }
 899
 900     if (document.getElementById('radio_type_of_payment1').checked == true){//CO-PAY
 901         var total = 0;
 902         for (var i = 0; i < f.elements.length; ++i) {
 903             var elem = f.elements[i];
 904             var ename = elem.name;
 905             if (ename.indexOf('form_upay[0]') == 0) {//Today is this text box.
 906                 if (f.form_paytotal.value * 1 != elem.value * 1) {//Total CO-PAY is not posted against today
 907                 //A warning message, if the amount is posted against an old encounter.
 908                     if (confirm(<?php echo xlj('You are posting against an old encounter?'); ?>)) {
 909                         ok = 1;
 910                     } else {
 911                         elem.focus();
 912                         return false;
 913                     }
 914                 }
 915                 break;
 916             }
 917         }
 918     }//Co Pay
 919     else if (document.getElementById('radio_type_of_payment2').checked == true) {//Invoice Balance
 920         for (var i = 0; i < f.elements.length; ++i) {
 921             var elem = f.elements[i];
 922             var ename = elem.name;
 923             if (ename.indexOf('form_upay[0') == 0) {
 924                 if (elem.value * 1 > 0) {
 925                     alert(<?php echo xlj('Invoice Balance cannot be posted. No Encounter is created.'); ?>);
 926                     return false;
 927                 }
 928                 break;
 929             }
 930         }
 931     }
 932     if (notSubmit) {
 933         return true;
 934     }
 935     if (ok === -1) {
 936         if (confirm(<?php echo xlj('Would you like to save?'); ?>)) {
 937             return true;
 938         }
 939         else {
 940             return false;
 941         }
 942     }
 943     return ok;
 944 }
 945
 946 function cursor_pointer() { //Point the cursor to the latest encounter(Today)
 947     var f = document.forms[0];
 948     var total = 0;
 949     for (var i = 0; i < f.elements.length; ++i) {
 950         var elem = f.elements[i];
 951         var ename = elem.name;
 952         if (ename.indexOf('form_upay[') == 0) {
 953             elem.focus();
 954             break;
 955         }
 956     }
 957 }
 958 //=====================================================
 959 function make_it_hide_enc_pay() {
 960     document.getElementById('td_head_insurance_payment').style.display = "none";
 961     document.getElementById('td_head_patient_co_pay').style.display = "none";
 962     document.getElementById('td_head_co_pay').style.display = "none";
 963     document.getElementById('td_head_insurance_balance').style.display = "none";
 964     for (var i = 1; ; ++i) {
 965         var td_inspaid_elem = document.getElementById('td_inspaid_' + i)
 966         var td_patient_copay_elem = document.getElementById('td_patient_copay_' + i)
 967         var td_copay_elem = document.getElementById('td_copay_' + i)
 968         var balance_elem = document.getElementById('balance_' + i)
 969         if (td_inspaid_elem) {
 970             td_inspaid_elem.style.display = "none";
 971             td_patient_copay_elem.style.display = "none";
 972             td_copay_elem.style.display = "none";
 973             balance_elem.style.display = "none";
 974         } else {
 975             break;
 976         }
 977     }
 978     document.getElementById('td_total_4').style.display = "none";
 979     document.getElementById('td_total_7').style.display = "none";
 980     document.getElementById('td_total_8').style.display = "none";
 981     document.getElementById('td_total_6').style.display = "none";
 982     document.getElementById('table_display').width = "420px";
 983 }
 984 //=====================================================
 985 function make_visible() {
 986     document.getElementById('td_head_rep_doc').style.display = "";
 987     document.getElementById('td_head_description').style.display = "";
 988     document.getElementById('td_head_total_charge').style.display = "none";
 989     document.getElementById('td_head_insurance_payment').style.display = "none";
 990     document.getElementById('td_head_patient_payment').style.display = "none";
 991     document.getElementById('td_head_patient_co_pay').style.display = "none";
 992     document.getElementById('td_head_co_pay').style.display = "none";
 993     document.getElementById('td_head_insurance_balance').style.display = "none";
 994     document.getElementById('td_head_patient_balance').style.display = "none";
 995     for (var i = 1; ; ++i) {
 996         var td_charges_elem = document.getElementById('td_charges_' + i)
 997         var td_inspaid_elem = document.getElementById('td_inspaid_' + i)
 998         var td_ptpaid_elem = document.getElementById('td_ptpaid_' + i)
 999         var td_patient_copay_elem = document.getElementById('td_patient_copay_' + i)
1000
1001         var td_copay_elem = document.getElementById('td_copay_' + i)
1002         var balance_elem = document.getElementById('balance_' + i)
1003         var duept_elem = document.getElementById('duept_' + i)
1004         if (td_charges_elem) {
1005             td_charges_elem.style.display = "none";
1006             td_inspaid_elem.style.display = "none";
1007             td_ptpaid_elem.style.display = "none";
1008             td_patient_copay_elem.style.display = "none";
1009             td_copay_elem.style.display = "none";
1010             balance_elem.style.display = "none";
1011             duept_elem.style.display = "none";
1012         } else {
1013             break;
1014         }
1015     }
1016     document.getElementById('td_total_7').style.display = "";
1017     document.getElementById('td_total_8').style.display = "";
1018     document.getElementById('td_total_1').style.display = "none";
1019     document.getElementById('td_total_2').style.display = "none";
1020     document.getElementById('td_total_3').style.display = "none";
1021     document.getElementById('td_total_4').style.display = "none";
1022     document.getElementById('td_total_5').style.display = "none";
1023     document.getElementById('td_total_6').style.display = "none";
1024     document.getElementById('table_display').width = "505px";
1025 }
1026
1027 function make_it_hide() {
1028     document.getElementById('td_head_rep_doc').style.display = "none";
1029     document.getElementById('td_head_description').style.display = "none";
1030     document.getElementById('td_head_total_charge').style.display = "";
1031     document.getElementById('td_head_insurance_payment').style.display = "";
1032     document.getElementById('td_head_patient_payment').style.display = "";
1033     document.getElementById('td_head_patient_co_pay').style.display = "";
1034     document.getElementById('td_head_co_pay').style.display = "";
1035     document.getElementById('td_head_insurance_balance').style.display = "";
1036     document.getElementById('td_head_patient_balance').style.display = "";
1037     for (var i = 1; ; ++i) {
1038         var td_charges_elem = document.getElementById('td_charges_' + i)
1039         var td_inspaid_elem = document.getElementById('td_inspaid_' + i)
1040         var td_ptpaid_elem = document.getElementById('td_ptpaid_' + i)
1041         var td_patient_copay_elem = document.getElementById('td_patient_copay_' + i)
1042
1043         var td_copay_elem = document.getElementById('td_copay_' + i)
1044         var balance_elem = document.getElementById('balance_' + i)
1045         var duept_elem = document.getElementById('duept_' + i)
1046         if (td_charges_elem) {
1047             td_charges_elem.style.display = "";
1048             td_inspaid_elem.style.display = "";
1049             td_ptpaid_elem.style.display = "";
1050             td_patient_copay_elem.style.display = "";
1051             td_copay_elem.style.display = "";
1052             balance_elem.style.display = "";
1053             duept_elem.style.display = "";
1054         } else {
1055             break;
1056         }
1057     }
1058     document.getElementById('td_total_1').style.display = "";
1059     document.getElementById('td_total_2').style.display = "";
1060     document.getElementById('td_total_3').style.display = "";
1061     document.getElementById('td_total_4').style.display = "";
1062     document.getElementById('td_total_5').style.display = "";
1063     document.getElementById('td_total_6').style.display = "";
1064     document.getElementById('td_total_7').style.display = "";
1065     document.getElementById('td_total_8').style.display = "";
1066     document.getElementById('table_display').width = "635px";
1067 }
1068
1069 function make_visible_radio() {
1070     document.getElementById('tr_radio1').style.display = "";
1071     document.getElementById('tr_radio2').style.display = "none";
1072 }
1073
1074 function make_hide_radio() {
1075     document.getElementById('tr_radio1').style.display = "none";
1076     document.getElementById('tr_radio2').style.display = "";
1077 }
1078
1079 function make_visible_row() {
1080     document.getElementById('table_display').style.display = "";
1081     document.getElementById('table_display_prepayment').style.display = "none";
1082 }
1083
1084 function make_hide_row() {
1085     document.getElementById('table_display').style.display = "none";
1086     document.getElementById('table_display_prepayment').style.display = "";
1087 }
1088
1089 function make_self() {
1090     make_visible_row();
1091     make_it_hide();
1092     make_it_hide_enc_pay();
1093     document.getElementById('radio_type_of_payment_self1').checked = true;
1094     cursor_pointer();
1095 }
1096
1097 function make_insurance() {
1098     make_visible_row();
1099     make_it_hide();
1100     cursor_pointer();
1101     document.getElementById('radio_type_of_payment1').checked = true;
1102 }
1103 </script>
1104
1105 <style>
1106 @media (min-width: 992px) {
1107     .modal-lg {
1108         width: 1000px !Important;
1109     }
1110 }
1111 </style>
1112 <title><?php echo xlt('Record Payment'); ?></title>
1113     <?php $NameNew = $patdata['fname'] . " " . $patdata['lname'] . " " . $patdata['mname']; ?>
1114     <?php
1115     $arrOeUiSettings = array(
1116     'heading_title' => xl('Accept Payment'),
1117     'include_patient_name' => true,// use only in appropriate pages
1118     'expandable' => false,
1119     'expandable_files' => array(),//all file names need suffix _xpd
1120     'action' => "",//conceal, reveal, search, reset, link or back
1121     'action_title' => "",
1122     'action_href' => "",//only for actions - reset, link or back
1123     'show_help_icon' => false,
1124     'help_file_name' => ""
1125     );
1126     $oemr_ui = new OemrUI($arrOeUiSettings);
1127     ?>
1128 </head>
1129 <body>
1130     <div class="container mt-3"><!--begin container div for form-->
1131         <div class="row">
1132             <div class="col-sm-12">
1133                 <?php echo  $oemr_ui->pageHeading() . "\r\n"; ?>
1134             </div>
1135         </div>
1136         <div class="row">
1137             <div class="col-sm-12">
1138                 <form class="form form-vertical" method='post' action='front_payment.php<?php echo (!empty($payid)) ? "?payid=" . attr_url($payid) : ""; ?>' onsubmit='return validate();'>
1139                     <input type="hidden" name="csrf_token_form" value="<?php echo attr(CsrfUtils::collectCsrfToken()); ?>" />
1140                     <input name='form_pid' type='hidden' value='<?php echo attr($pid) ?>' />
1141                     <fieldset>
1142                         <legend><?php echo xlt('Payment'); ?></legend>
1143                         <?php
1144                             $prepayment_bal = get_unallocated_patient_balance($pid);
1145                         if ($prepayment_bal > 0) : ?>
1146                                 <div class="col-12 oe-custom-line">
1147                                     <label class="control-label" for="unallocated"><?php
1148                                                 echo xlt('Patient has an unallocated pre-payment amount of ') .
1149                                                     text($prepayment_bal); ?></label><br>
1150                                     <a href="../billing/edit_payment.php?payment_id=<?php
1151                                         echo attr_url(get_unallocated_payment_id($pid)); ?>"
1152                                        target="_self"><?php echo xlt('Apply unallocated pre-payments here') ?></a>
1153                                 </div><br>
1154                             <?php endif;  ?>
1155                         <div class="col-12 oe-custom-line">
1156                             <label class="control-label" for="form_method"><?php echo xlt('Payment Method'); ?>:</label>
1157                             <select class="form-control" id="form_method" name="form_method" onchange='CheckVisible("yes")'>
1158                                 <?php
1159                                 $query1112 = "SELECT * FROM `list_options` where activity=1 AND list_id=?  ORDER BY seq, title ";
1160                                 $bres1112 = sqlStatement($query1112, array('payment_method'));
1161                                 while ($brow1112 = sqlFetchArray($bres1112)) {
1162                                     if ($brow1112['option_id'] == 'electronic' || $brow1112['option_id'] == 'bank_draft') {
1163                                         continue;
1164                                     }
1165                                     echo "<option value='" . attr($brow1112['option_id']) . "'" .
1166                                         ($brow1112['is_default'] ? ' selected' : '') . ">" . text(xl_list_label($brow1112['title'])) . "</option>";
1167                                 }
1168                                 ?>
1169                             </select>
1170                         </div>
1171                         <div class="col-12 oe-custom-line">
1172                             <label class="control-label" for="check_number"><?php echo xlt('Check or Reference Number'); ?>:</label>
1173                             <div id="ajax_div_patient" style="display:none;"></div>
1174                             <input type='text' id="check_number" name='form_source' class='form-control' value='<?php echo attr($payrow['source'] ?? ''); ?>' />
1175                         </div>
1176                         <div class="col-12 oe-custom-line">
1177                             <label class="control-label" for="form_discount"><?php echo xla('Patient Coverage'); ?>:</label>
1178                             <div class="pl-3">
1179                                 <label class="radio-inline">
1180                                     <input id="radio_type_of_coverage1" name="radio_type_of_coverage" onclick="make_visible_radio();make_self();" type="radio" value="self"><?php echo xlt('Self'); ?>
1181                                 </label>
1182                                 <label class="radio-inline">
1183                                     <input checked="checked" id="radio_type_of_coverag2" name="radio_type_of_coverage" onclick="make_hide_radio();make_insurance();" type="radio" value="insurance"><?php echo xlt('Insurance'); ?>
1184                                 </label>
1185                             </div>
1186                         </div>
1187                         <div class="col-12 oe-custom-line">
1188                             <label class="control-label" for=""><?php echo xlt('Payment against'); ?>:</label>
1189                             <div id="tr_radio1" style="padding-left:15px; display:none"><!-- For radio Insurance -->
1190                                 <label class="radio-inline">
1191                                   <input id="radio_type_of_payment_self1" name="radio_type_of_payment" onclick="make_visible_row();make_it_hide_enc_pay();cursor_pointer();" type="radio" value="cash"><?php echo xlt('Encounter Payment'); ?>
1192                                 </label>
1193                             </div>
1194                             <div id="tr_radio2" style="padding-left:15px"><!-- For radio self -->
1195                                 <label class="radio-inline">
1196                                   <input checked="checked" id="radio_type_of_payment1" name="radio_type_of_payment" onclick="make_visible_row();cursor_pointer();" type="radio" value="copay"><?php echo xlt('Co Pay'); ?>
1197                                 </label>
1198                                 <label class="radio-inline">
1199                                   <input id="radio_type_of_payment2" name="radio_type_of_payment" onclick="make_visible_row();" type="radio" value="invoice_balance"><?php echo xlt('Invoice Balance'); ?><br />
1200                                 </label>
1201                                 <label class="radio-inline">
1202                                   <input id="radio_type_of_payment4" name="radio_type_of_payment" onclick="make_hide_row();" type="radio" value="pre_payment"><?php echo xlt('Pre Pay'); ?>
1203                                 </label>
1204                             </div>
1205                         </div>
1206                         <div class="col-12 oe-custom-line">
1207                             <div id="table_display_prepayment" style="display:none">
1208                                 <label class="control-label" for="form_prepayment"><?php echo xlt('Pre Payment'); ?>:</label>
1209                                 <input name='form_prepayment' id='form_prepayment'class='form-control' type='text' value ='' />
1210                             </div>
1211                         </div>
1212                     </fieldset>
1213                     <fieldset>
1214                         <legend><?php echo xlt('Collect For'); ?></legend>
1215                         <div class="table-responsive">
1216                             <table class="table" id="table_display">
1217                                 <thead>
1218                                     <tr class="table-active" id="tr_head">
1219                                         <th class="font-weight-bold" width="70"><?php echo xlt('DOS'); ?></th>
1220                                         <th class="font-weight-bold" width="65"><?php echo xlt('Encounter'); ?></th>
1221                                         <th class="font-weight-bold text-center" id="td_head_total_charge" width="80"><?php echo xlt('Total Charge'); ?></th>
1222                                         <th class="font-weight-bold text-center" id="td_head_rep_doc" style='display:none' width="70"><?php echo xlt('Report/ Form'); ?></th>
1223                                         <th class="font-weight-bold text-center" id="td_head_description" style='display:none' width="200"><?php echo xlt('Description'); ?></th>
1224                                         <th class="font-weight-bold text-center" id="td_head_insurance_payment" width="80"><?php echo xlt('Insurance Payment'); ?></th>
1225                                         <th class="font-weight-bold text-center" id="td_head_patient_payment" width="80"><?php echo xlt('Patient Payment'); ?></th>
1226                                         <th class="font-weight-bold text-center" id="td_head_patient_co_pay" width="55"><?php echo xlt('Co Pay Paid'); ?></th>
1227                                         <th class="font-weight-bold text-center" id="td_head_co_pay" width="55"><?php echo xlt('Required Co Pay'); ?></th>
1228                                         <th class="font-weight-bold text-center" id="td_head_insurance_balance" width="80"><?php echo xlt('Insurance Balance'); ?></th>
1229                                         <th class="font-weight-bold text-center" id="td_head_patient_balance" width="80"><?php echo xlt('Patient Balance'); ?></th>
1230                                         <th class="font-weight-bold text-center" width="50"><?php echo xlt('Paying'); ?></th>
1231                                     </tr>
1232                                 </thead>
1233                                 <?php
1234                                 $encs = array();
1235
1236                                 // Get the unbilled service charges and payments by encounter for this patient.
1237                                 //
1238                                 $query = "SELECT fe.encounter, b.code_type, b.code, b.modifier, b.fee, " .
1239                                 "LEFT(fe.date, 10) AS encdate ,fe.last_level_closed " .
1240                                 "FROM  form_encounter AS fe left join billing AS b  on " .
1241                                 "b.pid = ? AND b.activity = 1  AND " . //AND b.billed = 0
1242                                 "b.code_type != 'TAX' AND b.fee != 0 " .
1243                                 "AND fe.pid = b.pid AND fe.encounter = b.encounter " .
1244                                 "where fe.pid = ? " .
1245                                 "ORDER BY b.encounter";
1246                                 $bres = sqlStatement($query, array($pid, $pid));
1247                                 //
1248                                 while ($brow = sqlFetchArray($bres)) {
1249                                     $key = 0 - $brow['encounter'];
1250                                     if (empty($encs[$key])) {
1251                                         $encs[$key] = array(
1252                                         'encounter' => $brow['encounter'],
1253                                         'date' => $brow['encdate'],
1254                                         'last_level_closed' => $brow['last_level_closed'],
1255                                         'charges' => 0,
1256                                         'payments' => 0);
1257                                     }
1258
1259                                     if ($brow['code_type'] === 'COPAY') {
1260                                         //$encs[$key]['payments'] -= $brow['fee'];
1261                                     } else {
1262                                         $encs[$key]['charges'] += $brow['fee'];
1263                                         // Add taxes.
1264                                         $sql_array = array();
1265                                         $query = "SELECT taxrates FROM `codes` WHERE " .
1266                                         "code_type = ? AND " .
1267                                         "code = ? AND ";
1268                                         array_push($sql_array, ($code_types[$brow['code_type']]['id'] ?? null), $brow['code']);
1269                                         if ($brow['modifier']) {
1270                                             $query .= "modifier = ?";
1271                                             array_push($sql_array, $brow['modifier']);
1272                                         } else {
1273                                             $query .= "(modifier IS NULL OR modifier = '')";
1274                                         }
1275
1276                                         $query .= " LIMIT 1";
1277                                         $trow = sqlQuery($query, $sql_array);
1278                                         $encs[$key]['charges'] += calcTaxes($trow, $brow['fee']);
1279                                     }
1280                                 }
1281
1282                                 // Do the same for unbilled product sales.
1283                                 //
1284                                 $query = "SELECT fe.encounter, s.drug_id, s.fee, " .
1285                                 "LEFT(fe.date, 10) AS encdate,fe.last_level_closed " .
1286                                 "FROM form_encounter AS fe left join drug_sales AS s " .
1287                                 "on s.pid = ? AND s.fee != 0 " . //AND s.billed = 0
1288                                 "AND fe.pid = s.pid AND fe.encounter = s.encounter " .
1289                                 "where fe.pid = ? " .
1290                                 "ORDER BY s.encounter";
1291
1292                                 $dres = sqlStatement($query, array($pid, $pid));
1293                                 //
1294                                 while ($drow = sqlFetchArray($dres)) {
1295                                     $key = 0 - $drow['encounter'];
1296                                     if (empty($encs[$key])) {
1297                                         $encs[$key] = array(
1298                                         'encounter' => $drow['encounter'],
1299                                         'date' => $drow['encdate'],
1300                                         'last_level_closed' => $drow['last_level_closed'],
1301                                         'charges' => 0,
1302                                         'payments' => 0);
1303                                     }
1304
1305                                     $encs[$key]['charges'] += $drow['fee'];
1306                                     // Add taxes.
1307                                     $trow = sqlQuery("SELECT taxrates FROM `drug_templates` WHERE drug_id = ? " .
1308                                     "ORDER BY selector LIMIT 1", array($drow['drug_id']));
1309                                     $encs[$key]['charges'] += calcTaxes($trow, $drow['fee']);
1310                                 }
1311
1312                                 ksort($encs, SORT_NUMERIC);
1313                                 $gottoday = false;
1314                                 //Bringing on top the Today always
1315                                 foreach ($encs as $key => $value) {
1316                                     $dispdate = $value['date'];
1317                                     if (strcmp($dispdate, $today) == 0 && !$gottoday) {
1318                                         $gottoday = true;
1319                                         break;
1320                                     }
1321                                 }
1322
1323                                 // If no billing was entered yet for today, then generate a line for
1324                                 // entering today's co-pay.
1325                                 //
1326                                 if (!$gottoday) {
1327                                     echoLine("form_upay[0]", date("Y-m-d"), 0, 0, 0, 0 /*$duept*/);//No encounter yet defined.
1328                                 }
1329
1330                                 $gottoday = false;
1331                                 foreach ($encs as $key => $value) {
1332                                     $enc = $value['encounter'];
1333                                     $dispdate = $value['date'];
1334                                     if (strcmp($dispdate, $today) == 0 && !$gottoday) {
1335                                         $dispdate = date("Y-m-d");
1336                                         $gottoday = true;
1337                                     }
1338                                     //------------------------------------------------------------------------------------
1339                                     $inscopay = BillingUtilities::getCopay($pid, $dispdate);
1340                                     $patcopay = BillingUtilities::getPatientCopay($pid, $enc);
1341                                     //Insurance Payment
1342                                     //-----------------
1343                                     $drow = sqlQuery(
1344                                         "SELECT  SUM(pay_amount) AS payments, " .
1345                                         "SUM(adj_amount) AS adjustments  FROM ar_activity WHERE " .
1346                                         "deleted IS NULL AND pid = ? and encounter = ? and " .
1347                                         "payer_type != 0 and account_code!='PCP' ",
1348                                         array($pid, $enc)
1349                                     );
1350                                     $dpayment = $drow['payments'];
1351                                     $dadjustment = $drow['adjustments'];
1352                                     //Patient Payment
1353                                     //---------------
1354                                     $drow = sqlQuery(
1355                                         "SELECT  SUM(pay_amount) AS payments, " .
1356                                         "SUM(adj_amount) AS adjustments  FROM ar_activity WHERE " .
1357                                         "deleted IS NULL AND pid = ? and encounter = ? and " .
1358                                         "payer_type = 0 and account_code!='PCP' ",
1359                                         array($pid, $enc)
1360                                     );
1361                                     $dpayment_pat = $drow['payments'];
1362
1363                                     //------------------------------------------------------------------------------------
1364                                     //NumberOfInsurance
1365                                     $ResultNumberOfInsurance = sqlStatement("SELECT COUNT( DISTINCT TYPE ) NumberOfInsurance FROM `insurance_data`
1366                                     where pid = ? and provider>0 ", array($pid));
1367                                     $RowNumberOfInsurance = sqlFetchArray($ResultNumberOfInsurance);
1368                                     $NumberOfInsurance = $RowNumberOfInsurance['NumberOfInsurance'] * 1;
1369                                     //------------------------------------------------------------------------------------
1370                                     $duept = 0;
1371                                     if ((($NumberOfInsurance == 0 || $value['last_level_closed'] == 4 || $NumberOfInsurance == $value['last_level_closed']))) {//Patient balance
1372                                         $brow = sqlQuery("SELECT SUM(fee) AS amount FROM `billing` WHERE " .
1373                                             "pid = ? and encounter = ? AND activity = 1", array($pid, $enc));
1374                                         $srow = sqlQuery("SELECT SUM(fee) AS amount FROM `drug_sales` WHERE " .
1375                                             "pid = ? and encounter = ? ", array($pid, $enc));
1376                                         $drow = sqlQuery("SELECT SUM(pay_amount) AS payments, " .
1377                                             "SUM(adj_amount) AS adjustments FROM ar_activity WHERE " .
1378                                             "deleted IS NULL AND pid = ? and encounter = ? ", array($pid, $enc));
1379                                         $duept = $brow['amount'] + $srow['amount'] - $drow['payments'] - $drow['adjustments'];
1380                                     }
1381
1382                                     echoLine(
1383                                         "form_upay[$enc]",
1384                                         $dispdate,
1385                                         $value['charges'],
1386                                         $dpayment_pat,
1387                                         ($dpayment + $dadjustment),
1388                                         $duept,
1389                                         $enc,
1390                                         $inscopay,
1391                                         $patcopay
1392                                     );
1393                                 }
1394                                 // Continue with display of the data entry form.
1395                                 ?>
1396
1397                                 <tr class="table-active">
1398                                     <td class="font-weight-bold" id='td_total_1'></td>
1399                                     <td class="font-weight-bold" id='td_total_2'></td>
1400                                     <td class="font-weight-bold" id='td_total_3'></td>
1401                                     <td class="font-weight-bold" id='td_total_4'></td>
1402                                     <td class="font-weight-bold" id='td_total_5'></td>
1403                                     <td class="font-weight-bold" id='td_total_6'></td>
1404                                     <td class="font-weight-bold" id='td_total_7'></td>
1405                                     <td class="font-weight-bold" id='td_total_8'></td>
1406                                     <td class="font-weight-bold text-right"><?php echo xlt('Total');?></td>
1407                                     <td class="font-weight-bold text-right">
1408                                         <input type='text' class='form-control text-success' name='form_paytotal' value='' readonly />
1409                                     </td>
1410                                 </tr>
1411                             </table>
1412                         </div>
1413                     </fieldset>
1414                     <div class="form-group">
1415                         <div class="col-sm-12 text-left position-override">
1416                             <div class="form-group" role="group" id="button-group">
1417                                 <button type='submit' class="btn btn-primary btn-save" name='form_save' value='<?php echo xla('Generate Invoice');?>'><?php echo xlt('Generate Invoice');?></button>
1418                                 <?php if (!empty($GLOBALS['cc_front_payments']) && $GLOBALS['payment_gateway'] != 'InHouse') {
1419                                     if ($GLOBALS['payment_gateway'] == 'Sphere') {
1420                                         echo SpherePayment::renderSphereHtml('clinic');
1421                                     } else {
1422                                         echo '<button type="button" class="btn btn-success btn-transmit mx-1" data-toggle="modal" data-target="#openPayModal">' . xlt("Credit Card Pay") . '</button>';
1423                                         if (!empty($GLOBALS['cc_stripe_terminal'])) {
1424                                             echo '<button type="button" class="btn btn-success btn-transmit mx-1" onclick="posDialog()">' . xlt("POS Payment") . '</button>';
1425                                         }
1426                                     }
1427                                 }  ?>
1428                                 <button type='button' class="btn btn-secondary btn-cancel" value='<?php echo xla('Cancel'); ?>' onclick='closeHow(event)'><?php echo xlt('Cancel'); ?></button>
1429                                 <input type="hidden" name="hidden_patient_code" id="hidden_patient_code" value="<?php echo attr($pid);?>"/>
1430                                 <input type='hidden' name='ajax_mode' id='ajax_mode' value='' />
1431                                 <input type='hidden' name='mode' id='mode' value='' />
1432                             </div>
1433                         </div>
1434                     </div>
1435                 </form>
1436             </div>
1437         </div>
1438         <script>
1439         calctotal();
1440         </script>
1441         <!-- credit payment modal -->
1442         <div id="openPayModal" class="modal fade" role="dialog">
1443             <div class="modal-dialog">
1444                 <div class="modal-content">
1445                     <div class="modal-header">
1446                         <h4><?php echo xlt('Submit Payment for Authorization'); ?></h4>
1447                     </div>
1448                     <div class="modal-body">
1449                         <?php if ($GLOBALS['payment_gateway'] == 'AuthorizeNet') { ?>
1450                             <form id='paymentForm' method='post' action='./front_payment_cc.php'>
1451                                 <fieldset>
1452                                     <div class="form-group">
1453                                         <label
1454                                             class="control-label"><?php echo xlt('Name on Card'); ?></label>
1455                                         <div class="controls">
1456                                             <input name="cardHolderName" id="cardHolderName" type="text" class="form-control"
1457                                                 pattern="\w+ \w+.*"
1458                                                 title="<?php echo xla('Fill your first and last name'); ?>"
1459                                                 value="<?php echo attr($patdata['fname']) . ' ' . attr($patdata['lname']) ?>" />
1460                                         </div>
1461                                     </div>
1462                                     <div class="form-group">
1463                                         <div class="row">
1464                                             <div class="col-sm-6">
1465                                                 <label class="control-label"><?php echo xlt('Card Number'); ?></label>
1466                                                 <input name="cardNumber" id="cardNumber" type="text"
1467                                                     class="form-control"
1468                                                     autocomplete="off" maxlength="19" pattern="\d"
1469                                                     onchange="validateCC()"
1470                                                     title="<?php echo xla('Card Number'); ?>" value="" />&nbsp;&nbsp;
1471                                             </div>
1472                                             <span class="col-sm-6">
1473                                                     <label class="control-label"><?php echo xlt('Entry Status'); ?></label>
1474                                                     <h5 name="cardtype" id="cardtype" style="color:#cc0000;"><?php echo xlt('Validating') ?></h5>
1475                                                 </span>
1476                                         </div>
1477                                     </div>
1478                                     <div class="form-group">
1479                                         <label
1480                                             class="control-label"><?php echo xlt('Card Expiry Date and Card Holders Zip'); ?></label>
1481                                         <div class="row">
1482                                             <div class="col-md-4">
1483                                                 <select name="month" id="expMonth" class="form-control">
1484                                                     <option value=""><?php echo xlt('Select Month'); ?></option>
1485                                                     <option value="01"><?php echo xlt('January'); ?></option>
1486                                                     <option value="02"><?php echo xlt('February'); ?></option>
1487                                                     <option value="03"><?php echo xlt('March'); ?></option>
1488                                                     <option value="04"><?php echo xlt('April'); ?></option>
1489                                                     <option value="05"><?php echo xlt('May'); ?></option>
1490                                                     <option value="06"><?php echo xlt('June'); ?></option>
1491                                                     <option value="07"><?php echo xlt('July'); ?></option>
1492                                                     <option value="08"><?php echo xlt('August'); ?></option>
1493                                                     <option value="09"><?php echo xlt('September'); ?></option>
1494                                                     <option value="10"><?php echo xlt('October'); ?></option>
1495                                                     <option value="11"><?php echo xlt('November'); ?></option>
1496                                                     <option value="12"><?php echo xlt('December'); ?></option>
1497                                                 </select>
1498                                             </div>
1499                                             <div class="col-md-4">
1500                                                 <select name="year" id="expYear" class="form-control">
1501                                                     <option value=""><?php echo xlt('Select Year'); ?></option>
1502                                                     <option value="2021">2021</option>
1503                                                     <option value="2022">2022</option>
1504                                                     <option value="2023">2023</option>
1505                                                     <option value="2024">2024</option>
1506                                                     <option value="2025">2025</option>
1507                                                     <option value="2026">2026</option>
1508                                                     <option value="2027">2027</option>
1509                                                     <option value="2028">2028</option>
1510                                                     <option value="2028">2029</option>
1511                                                     <option value="2028">2030</option>
1512                                                 </select>
1513                                             </div>
1514                                             <div class="col-md-4">
1515                                                 <input name="zip" id="cczip" type="text" class="form-control"
1516                                                     pattern="\d"
1517                                                     title="<?php echo xla('Enter Your Zip'); ?>"
1518                                                     placeholder="<?php echo xla('Card Holder Zip'); ?>"
1519                                                     value="<?php echo attr($patdata['postal_code']) ?>" />
1520                                             </div>
1521                                         </div>
1522                                     </div>
1523                                     <div class="form-group">
1524                                         <label class="control-label"><?php echo xlt('Card CVV'); ?></label>
1525                                         <div class="row">
1526                                             <div class="col-md-3">
1527                                                 <input name="cardCode" id="cardCode" type="text" class="form-control"
1528                                                     autocomplete="off" maxlength="4" onfocus="validateCC()"
1529                                                     title="<?php echo xla('Three or four digits at back of your card'); ?>"
1530                                                     value="" />
1531                                             </div>
1532                                             <div class="col-md-3">
1533                                                 <img src='./../../portal/images/img_cvc.png' style='height: 40px; width: auto'>
1534                                             </div>
1535                                             <div class="col-md-6">
1536                                                 <h4 style="display: inline-block;"><?php echo xlt('Payment Amount'); ?>:&nbsp;
1537                                                     <strong><span id="payTotal"></span></strong></h4>
1538                                             </div>
1539                                         </div>
1540                                     </div>
1541                                     <input type='hidden' name='pid' id='pid' value='<?php echo attr($pid) ?>' />
1542                                     <input type='hidden' name='mode' id='mode' value='' />
1543                                     <input type='hidden' name='cc_type' id='cc_type' value='' />
1544                                     <input type='hidden' name='payment' id='paymentAmount' value='' />
1545                                     <input type='hidden' name='invValues' id='invValues' value='' />
1546                                     <input type="hidden" name="dataValue" id="dataValue" />
1547                                     <input type="hidden" name="dataDescriptor" id="dataDescriptor" />
1548                                 </fieldset>
1549                             </form>
1550                         <?php }
1551                         if ($GLOBALS['payment_gateway'] == 'Stripe') { ?>
1552                             <form class="form" method="post" name="payment-form" id="payment-form">
1553                                 <fieldset>
1554                                     <div class="form-group">
1555                                         <label for="cardHolderName" class="control-label"><?php echo xlt('Name on Card'); ?></label>
1556                                         <input name="cardHolderName" id="cardHolderName" type="text"
1557                                             class="form-control"
1558                                             pattern="\w+ \w+.*"
1559                                             title="<?php echo xla('Fill your first and last name'); ?>"
1560                                             value="<?php echo attr($patdata['fname']) . ' ' . attr($patdata['lname']) ?>" />
1561                                     </div>
1562                                     <div class="form-group">
1563                                         <label for="card-element"><?php echo xlt('Credit or Debit Card') ?></label>
1564                                         <div class="form-group" id="card-element"></div>
1565                                         <div class="text-danger" id="card-errors" role="alert"></div>
1566                                     </div>
1567                                     <div class="form-row">
1568                                         <?php echo xlt('Payment Amount'); ?>:&nbsp;<span id="payTotal"></span>
1569                                     </div>
1570                                     <input type='hidden' name='mode' id='mode' value='' />
1571                                     <input type='hidden' name='cc_type' id='cc_type' value='' />
1572                                     <input type='hidden' name='payment' id='paymentAmount' value='' />
1573                                     <input type='hidden' name='invValues' id='invValues' value='' />
1574                                     <input type='hidden' name='encs' id='encs' value='' />
1575                                 </fieldset>
1576                             </form>
1577                         <?php } ?>
1578                     </div>
1579                     <!-- Body  -->
1580                     <div class="modal-footer">
1581                         <div class="button-group">
1582                             <button type="button" class="btn btn-default" data-dismiss="modal"><?php echo xlt('Cancel'); ?></button>
1583                             <?php
1584                             if ($GLOBALS['payment_gateway'] == 'AuthorizeNet') { ?>
1585                                 <button id="payAurhorizeNet" class="btn btn-primary"
1586                                     onclick="sendPaymentDataToAnet(event)"><?php echo xlt('Pay Now'); ?></button>
1587                             <?php }
1588                             if ($GLOBALS['payment_gateway'] == 'Stripe') { ?>
1589                                 <button id="stripeSubmit" class="btn btn-primary"><?php echo xlt('Pay Now'); ?></button>
1590                             <?php } ?>
1591                         </div>
1592                     </div>
1593                 </div>
1594             </div>
1595         </div>
1596
1597         <?php if ($GLOBALS['payment_gateway'] == 'AuthorizeNet') {
1598             // Include Authorize.Net dependency to tokenize card.
1599             // Will return a token to use for payment request keeping
1600             // credit info off the server.
1601             ?>
1602             <script>
1603                 var ccerr = <?php echo xlj('Invalid Credit Card Number'); ?>
1604
1605                     // In House CC number Validation
1606                     $('#cardNumber').validateCreditCard(function (result) {
1607                         var r = (result.card_type === null ? '' : result.card_type.name.toUpperCase())
1608                         var v = (result.valid === true ? ' Valid Number' : ' Validating')
1609                         if (result.valid === true) {
1610                             document.getElementById("cardtype").style.color = "#00aa00";
1611                         } else {
1612                             document.getElementById("cardtype").style.color = "#aa0000";
1613                         }
1614                         $('#cardtype').text(r + v);
1615                     });
1616
1617                 // Authorize.net
1618                 function validateCC() {
1619                     var result = $('#cardNumber').validateCreditCard();
1620                     var r = (result.card_type == null ? '' : result.card_type.name.toUpperCase())
1621                     var v = (result.valid === true ? ' Valid Card Number' : ' Invalid Card Number')
1622                     if (result.valid === true) {
1623                         document.getElementById("cardtype").style.color = "#00aa00";
1624                     } else {
1625                         document.getElementById("cardtype").style.color = "#aa0000";
1626                     }
1627                     $('#cardtype').text(r + v);
1628                     $('#cc_type').val(r);
1629                     if (!result.valid) {
1630                         alert(ccerr);
1631                         return false;
1632                     }
1633                     else {
1634                         return true;
1635                     }
1636                 }
1637
1638                 function sendPaymentDataToAnet(e) {
1639                     e.preventDefault();
1640                     const authData = {};
1641                     authData.clientKey = publicKey;
1642                     authData.apiLoginID = apiKey;
1643
1644                     const cardData = {};
1645                     cardData.cardNumber = document.getElementById("cardNumber").value;
1646                     cardData.month = document.getElementById("expMonth").value;
1647                     cardData.year = document.getElementById("expYear").value;
1648                     cardData.cardCode = document.getElementById("cardCode").value;
1649                     cardData.fullName = document.getElementById("cardHolderName").value;
1650                     cardData.zip = document.getElementById("cczip").value;
1651
1652                     const secureData = {};
1653                     secureData.authData = authData;
1654                     secureData.cardData = cardData;
1655
1656                     Accept.dispatchData(secureData, acceptResponseHandler);
1657
1658                     function acceptResponseHandler(response) {
1659                         if (response.messages.resultCode === "Error") {
1660                             let i = 0;
1661                             let errorMsg = '';
1662                             while (i < response.messages.message.length) {
1663                                 errorMsg = errorMsg + response.messages.message[i].code + ": " +response.messages.message[i].text;
1664                                 console.log(errorMsg);
1665                                 i = i + 1;
1666                             }
1667                             alert(errorMsg);
1668                         } else {
1669                             paymentFormUpdate(response.opaqueData);
1670                         }
1671                     }
1672                 }
1673
1674                 function paymentFormUpdate(opaqueData) {
1675                     // this is card tokenized
1676                     document.getElementById("dataDescriptor").value = opaqueData.dataDescriptor;
1677                     document.getElementById("dataValue").value = opaqueData.dataValue;
1678                     let oForm = document.forms['paymentForm'];
1679                     oForm.elements['mode'].value = "AuthorizeNet";
1680                     // empty out the fields before submitting to server.
1681                     document.getElementById("cardNumber").value = "";
1682                     document.getElementById("expMonth").value = "";
1683                     document.getElementById("expYear").value = "";
1684                     document.getElementById("cardCode").value = "";
1685
1686                     // Submit payment to server
1687                     fetch('./front_payment_cc.php', {
1688                         method: 'POST',
1689                         body: new FormData(oForm)
1690                     }).then((response) => {
1691                         if (!response.ok) {
1692                             throw Error(response.statusText);
1693                         }
1694                         return response.json();
1695                     }).then(function(data) {
1696                         if(data.status !== 'ok') {
1697                             alert(data);
1698                             return;
1699                         }
1700                         document.getElementById("check_number").value = data.authCode;
1701                         alert(chargeMsg + "\n" + 'Auth: ' + data.authCode + ' TransId: ' + data.transId);
1702                         $("[name='form_save']").click();
1703                     }).catch(function(error) {
1704                         alert(error)
1705                     });
1706                 }
1707             </script>
1708         <?php }  // end authorize.net ?>
1709
1710         <?php if ($GLOBALS['payment_gateway'] == 'Stripe') { // Begin Include Stripe ?>
1711             <script>
1712                 // await validation function.
1713                 const waitValidate = async (state = false) => {
1714                     return await validate(state);
1715                 }
1716                 const stripe = Stripe(publicKey);
1717                 const elements = stripe.elements();
1718                 const style = {
1719                     base: {
1720                         color: '#32325d',
1721                         lineHeight: '1.2rem',
1722                         fontSmoothing: 'antialiased',
1723                         '::placeholder': {
1724                             color: '#ccc'
1725                         }
1726                     },
1727                     invalid: {
1728                         color: '#f42c03',
1729                         iconColor: '#ff0000'
1730                     }
1731
1732                 };
1733                 // Create an instance of the card Element.
1734                 const card = elements.create('card', {style: style});
1735                 // Add an instance of the card Element into the `card-element` <div>.
1736                 card.mount('#card-element');
1737                 // Handle real-time validation errors from the card Element.
1738                 card.addEventListener('change', function (event) {
1739                     let displayError = document.getElementById('card-errors');
1740                     if (event.error) {
1741                         displayError.textContent = event.error.message;
1742                     } else {
1743                         displayError.textContent = '';
1744                     }
1745                 });
1746                 // Handle form submission.
1747                 let form = document.getElementById('stripeSubmit');
1748                 form.addEventListener('click', function (event) {
1749                     event.preventDefault();
1750                     stripe.createToken(card).then(function (result) {
1751                         if (result.error) {
1752                             // Inform the user if there was an error.
1753                             let errorElement = document.getElementById('card-errors');
1754                             errorElement.textContent = result.error.message;
1755                         } else {
1756                             // Send the token to server.
1757                             stripeTokenHandler(result.token);
1758                         }
1759                     });
1760                 });
1761
1762                 // Submit the form with the token ID.
1763                 function stripeTokenHandler(token) {
1764                     // below for manual cc audit
1765                     const encDates = (() => {
1766                         let i = 0, c;
1767                         let invDates = '';
1768                         $('#table_display tbody tr').each(function () {
1769                             if (this.className == 'table-active') {
1770                                 return false;
1771                             }
1772                             if(i > 4) {
1773                                 return false; // breaks on max 5 encounters
1774                             }
1775                             invDates += 'item' + ++i + ': ';
1776                             c = 0;
1777                             $(this).find('td').each(function() {
1778                                 if (++c < 3) {
1779                                     invDates += this.innerText + ' ';
1780                                 }
1781                             })
1782                         });
1783                         return invDates;
1784                     })();
1785                     // Insert the token ID into the form so it gets submitted to the server
1786                     let oForm = document.forms['payment-form'];
1787                     oForm.elements['mode'].value = "Stripe";
1788                     oForm.elements['encs'].value = encDates;
1789
1790                     let hiddenInput = document.createElement('input');
1791                     hiddenInput.setAttribute('type', 'hidden');
1792                     hiddenInput.setAttribute('name', 'stripeToken');
1793                     hiddenInput.setAttribute('value', token.id);
1794                     oForm.appendChild(hiddenInput);
1795
1796                     // Submit payment to server
1797                     fetch('./front_payment_cc.php', {
1798                         method: 'POST',
1799                         body: new FormData(oForm)
1800                     }).then((response) => {
1801                         if (!response.ok) {
1802                             throw Error(response.statusText);
1803                         }
1804                         return response.json();
1805                     }).then(function (data) {
1806                         if (data.status !== 'ok') {
1807                             alert(data);
1808                             return;
1809                         }
1810                         document.getElementById("check_number").value = data.transId;
1811                         alert(chargeMsg + "\n" + 'Auth: ' + data.authCode + ' TransId: ' + data.transId);
1812                         $("[name='form_save']").click();
1813                     }).catch(function (error) {
1814                         alert(error.message);
1815                     });
1816                 }
1817                 // terminal
1818                 <?php if (!empty($GLOBALS['cc_stripe_terminal'])) { ?>
1819                 // Dialog function for Stripe terminal payment.
1820                 // Will post on successful credit payment.
1821                 function posDialog() {
1822                     // to pass validation check and saving a user having to click.
1823                     $("#form_method").val('credit_card');
1824                     // let's validate prior to collect payment from terminal
1825                     // we'll use an await and validate promise to proceed.
1826                     waitValidate(true).then((validateOk) => {
1827                         // validation failed for some reason that user is aware
1828                         // by alerts or a quite fail we'll handle.
1829                         if (validateOk === false || typeof validateOk === 'undefined') {
1830                             return false;
1831                         }
1832                         // if 2 then need an encounter so credit is no no!
1833                         // 1 would be posting against old encounter. will allow.
1834                         if (validateOk === 2) {
1835                             alert(xl("Must have an encounter to take credit card payment."));
1836                             return true;
1837                         }
1838                         let total = $("[name='form_paytotal']").val();
1839                         let prepay = $("#form_prepayment").val();
1840                         // just to be sure. validate() should catch...
1841                         if (Number(total) < 1) {
1842                             if (Number(prepay) < 1) {
1843                                 let error = xl("Please enter a payment amount");
1844                                 alert(error);
1845                                 return false;
1846                             }
1847                             total = prepay;
1848                         }
1849                         $("#payTotal").text(total);
1850                         $("#paymentAmount").val(total);
1851                         let title = xl("POS Payment");
1852                         let url = "./front_payment_terminal.php?total=" + encodeURIComponent(total);
1853                         dlgopen(url, 'terminal', 'modal-md', '550', '', title, {
1854                             buttons: [
1855                                 {text: xl('Cancel'), close: false, id: "closeBtn", style: 'secondary btn-cancel'}
1856                             ]
1857                         });
1858                     });
1859                 }
1860                 <?php } ?>
1861             </script>
1862         <?php } ?>
1863
1864         <?php
1865         if ($GLOBALS['payment_gateway'] == 'Sphere') {
1866             echo (new SpherePayment('clinic', $pid))->renderSphereJs();
1867         }
1868         ?>
1869
1870     </div><!--end of container div of accept payment i.e the form-->
1871     <?php
1872         $oemr_ui->oeBelowContainerDiv();
1873 } // forms else close
1874 ?>
1875 </body>
1876 <?php $GLOBALS['kernel']->getEventDispatcher()->dispatch(new PostFrontPayment(), PostFrontPayment::ACTION_POST_FRONT_PAYMENT, 10); ?>
1877 </html>