interface/patient_file/encounter/copay.php

   1 <?php
   2 include_once("../../globals.php");
   3
   4 // This may be more appropriate to move to the library
   5 // later
   6 function getInsuranceCompanies($pid)
   7 {
   8     $res = sqlStatement("SELECT * FROM insurance_data WHERE pid = '$pid' " .
   9     "ORDER BY type ASC, date DESC");
  10     $prevtype = '';
  11     for ($iter = 0; $row = sqlFetchArray($res); $iter++) {
  12         if (strcmp($row['type'], $prevtype) == 0) {
  13             continue;
  14         }
  15
  16         $prevtype = $row['type'];
  17         $all[$iter] = $row;
  18     }
  19
  20     return $all;
  21 }
  22
  23 //the number of rows to display before resetting and starting a new column:
  24 $N=10
  25 ?>
  26 <html>
  27 <head>
  28 <script type="text/javascript">
  29 function cleartext(atrib)
  30 {
  31 document.copay_form.code.value=document.copay_form.codeH.value;
  32 document.copay_form.codeH.value="";
  33 }
  34 </script>
  35
  36
  37 <?php html_header_show();?>
  38 <link rel="stylesheet" href="<?php echo $css_header;?>" type="text/css">
  39 </head>
  40 <body class="body_bottom">
  41
  42 <table border='0' cellspacing='0' cellpadding='0' height='100%'>
  43 <tr>
  44
  45 <td valign=top>
  46
  47 <dl>
  48
  49 <form method='post' name='copay_form' action="diagnosis.php?mode=add&type=COPAY&text=copay"
  50  target='Diagnosis' onsubmit='return top.restoreSession()'>
  51
  52 <dt><span class=title><?php xl('Copay', 'e'); ?></span></dt>
  53
  54 <br>
  55 <input type=hidden name=code>
  56 <span class='text'><?php xl('$', 'e'); ?> </span><input type='entry' name='codeH' value='' size='5' />
  57
  58 <input type="SUBMIT" value="<?php xl('Save', 'e');?>" onclick="cleartext('clear')"><br><br>
  59
  60
  61 <div<?php if ($GLOBALS['simplified_copay']) {
  62     echo " style='display:none;'";
  63 } ?>>
  64 <input type="RADIO" name="payment_method" value="cash" checked><?php xl('cash', 'e'); ?>
  65 <input type="RADIO" name="payment_method" value="credit card"><?php xl('credit', 'e'); ?>
  66 <input type="RADIO" name="payment_method" value="check"><?php xl('check', 'e'); ?>
  67 <input type="RADIO" name="payment_method" value="other"><?php xl('other', 'e'); ?><br><br>
  68 <input type="RADIO" name="payment_method" value="insurance"><?php xl('insurance', 'e'); ?>
  69 <?php
  70 if ($ret=getInsuranceCompanies($pid)) {
  71     if (sizeof($ret)>0) {
  72         echo "<select name=insurance_company>\n";
  73         foreach ($ret as $iter) {
  74             $plan_name = trim($iter['plan_name']);
  75             if ($plan_name != '') {
  76                 echo "<option value='"
  77                 .$plan_name
  78                 ."'>".$plan_name ."\n";
  79             }
  80         }
  81
  82         echo "</select>\n";
  83     }
  84 }
  85 ?>
  86 <br><br>
  87 <input type="RADIO" name="payment_method" value="write off"><?php xl('write off', 'e'); ?>
  88
  89 </div>
  90
  91 </form>
  92
  93 </dl>
  94
  95 </td>
  96 </tr>
  97 </table>
  98
  99 </body>
 100 </html>