2 include_once("../../globals.php");
4 include_once("$srcdir/patient.inc");
12 <link rel
=stylesheet href
="<?echo $css_header;?>" type
="text/css">
16 <body
<?
echo $top_bg_line;?
> topmargin
=0 rightmargin
=0 leftmargin
=2 bottommargin
=0 marginwidth
=2 marginheight
=0>
18 <a href
="demographics_full.php" target
=Main
><font
class=title
>Demographics
</font
><font
class=more
><?
echo $tmore;?
></font
></a
>
19 <table border
="0" width
="100%">
21 <td align
="left" valign
="top">
24 <table border
=0 cellpadding
=0>
27 $result = getPatientData($pid);
28 $result2 = getEmployerData($pid);
32 <td valign
=top
><span
class=bold
>Name
: </span
><span
class=text
><?
echo $result{"title"}?
> <?
echo $result{"fname"}?
> <?
echo $result{"mname"}?
> <?
echo $result{"lname"}?
></span
><br
>
33 <span
class=bold
>Number
: </span
><span
class=text
><?
echo $result{"pubpid"}?
></span
>
37 if ($result{"DOB"} != "0000-00-00") {
39 <span
class=bold
>DOB
: </span
>
42 echo $result{"DOB_TS"};
46 <td valign
=top
><?
if ($result{"sex"} != ""){?
><span
class=bold
>Sex
: </span
><?
}?
><span
class=text
><?
echo $result{"sex"}?
></span
></td
>
47 <td valign
=top
><?
if ($result{"ss"} != "") {?
><span
class=bold
>S
.S
.: </span
><?
}?
><span
class=text
><?
echo $result{"ss"}?
></span
></td
>
52 <?
if (($result{"street"} != "") ||
($result{"city"} != "") ||
($result{"state"} != "") ||
($result{"country_code"} != "") ||
($result{"postal_code"} != "")) {?
>
53 <span
class=bold
>Address
: </span
>
55 <br
><span
class=text
><?
echo $result{"street"}?
><br
><?
echo $result{"city"}?
><?
if($result{"city"} != ""){echo ", ";}?
><?
echo $result{"state"};?
>
56 <?
if($result{"country_code"} != ""){ echo ", "; }?
><?
echo $result{"country_code"}?
>
58 echo $result{"postal_code"}?
>
62 if ( ($result{"contact_relationship"} != "") ||
63 ($result{"phone_contact"} != "") ||
64 ($result{"phone_home"} != "") ||
65 ($result{"phone_biz"} != "") ||
66 ($result{"email"} != "") ||
67 ($result{"phone_cell"} != "") ){
69 <span
class=bold
>Emergency Contact
: </span
><?
}?
><span
class=text
><?
echo $result{"contact_relationship"}?
><?
echo " "?
>
72 if ($result{"phone_contact"} != "") {
73 echo " " . $result{"phone_contact"};
75 if ($result{"phone_home"} != "") {
77 echo $result{"phone_home"};
79 if ($result{"phone_biz"} != "") {
81 echo $result{"phone_biz"};
83 if ($result{"phone_cell"} != "") {
85 echo $result{"phone_cell"};
87 if ($result{"email"} != "") {
88 echo "<br>Email: </span>";
89 echo '<a class=link_submit href="mailto:' . $result{"email"} . '">' . $result{"email"} . '</a>';
97 if ($result{"status"} != "") {
98 echo "<span class=bold>Marital Status: </span>";
99 echo "<span class=text>" . $result{"status"} . "</span>";
106 <td colspan
=2 valign
=top
>
108 $result{"hipaa_mail"}=='NO' ?
$opt_out='DOES NOT ALLOW' : $opt_out='ALLOWS' ;
109 echo "Patient $opt_out Mailed Information";
112 <td colspan
=2 valign
=top
>
114 $result{"hipaa_voice"}=='NO' ?
$opt_out='DOES NOT ALLOW' : $opt_out='ALLOWS' ;
115 echo "Patient $opt_out Voice Messages";
121 <?
if ($result{"occupation"} != "") {?
><span
class=bold
>Occupation
: </span
><span
class=text
><?
echo $result{"occupation"}?
></span
><br
><?
}?
>
122 <?
if ($result2{"name"} != "") {?
><span
class=bold
>Employer
: </span
><span
class=text
><?
echo $result2{"name"}?
></span
><?
}?
>
125 <?
if (($result2{"street"} != "") ||
($result2{"city"} != "") ||
($result2{"state"} != "") ||
($result2{"country"} != "") ||
($result2{"postal_code"} != "")) {?
>
126 <span
class=bold
>Employer Address
:</span
>
132 <?
echo $result2{"street"}?
><br
><?
echo $result2{"city"}?
><?
if($result2{"city"} != ""){echo ", ";}?
><?
echo $result2{"state"}?
>
133 <?
if($result2{"country"} != ""){echo ", ";}?
><?
echo $result2{"country"}?
>
134 <?
if($result2{"postal_code"} != ""){echo " ";}?
>
135 <?
echo $result2{"postal_code"}?
>
144 <?
if ($result{"ethnoracial"} != "") {?
><span
class=bold
>Race
/Ethnicity
: </span
><span
class=text
><?
echo $result{"ethnoracial"};?
></span
><br
><?
}?
>
145 <?
if ($result{"language"} != "") {?
><span
class=bold
>Language
: </span
><span
class=text
><?
echo ucfirst($result{"language"});?
></span
><br
><?
}?
>
146 <?
if ($result{"interpretter"} != "") {?
><span
class=bold
>Interpretter
: </span
><span
class=text
><?
echo $result{"interpretter"};?
></span
><br
><?
}?
>
147 <?
if ($result{"family_size"} != "") {?
><span
class=bold
>Family Size
: </span
><span
class=text
><?
echo $result{"family_size"};?
></span
><br
><?
}?
>
153 function print_as_money($money) {
154 preg_match("/(\d*)\.?(\d*)/",$money,$moneymatches);
155 $tmp = wordwrap(strrev($moneymatches[1]),3,",",1);
156 $ccheck = strrev($tmp);
157 if ($ccheck[0] == ",") {
158 $tmp = substr($ccheck,1,strlen($ccheck)-1);
160 if ($moneymatches[2] != "") {
161 return "$ " . strrev($tmp) . "." . $moneymatches[2];
163 return "$ " . strrev($tmp);
167 <?
if ($result{"financial_review"} != "0000-00-00 00:00:00") {?
><span
class=bold
>Financial Review Date
: </span
><span
class=text
><?
echo date("n/j/Y",strtotime($result{"financial_review"}));?
></span
><br
><?
}?
>
168 <?
if ($result{"monthly_income"} != "") {?
><span
class=bold
>Monthly Income
: </span
><span
class=text
><?
echo print_as_money($result{"monthly_income"});?
></span
><br
><?
}?
>
169 <?
if ($result{"migrantseasonal"} != "") {?
><span
class=bold
>Migrant
/Seasonal
: </span
><span
class=text
><?
echo $result{"migrantseasonal"};?
></span
><br
><?
}?
>
170 <?
if ($result{"homeless"} != "") {?
><span
class=bold
>Homeless
, etc
.: </span
><span
class=text
><?
echo $result{"homeless"};?
></span
><br
><?
}?
>
175 <td
><?
if ($result{"genericname1"} != "") {?
><span
class=bold
><?
=$result{"genericname1"}?
></span
>:<?
}?
> </td
>
176 <td
><?
if ($result{"genericval1"} != "") {?
><span
class=text
><?
=$result{"genericval1"}?
></span
><?
}?
></td
>
179 <td
><?
if ($result{"genericname2"} != "") {?
><span
class=bold
><?
=$result{"genericname2"}?
></span
>:<?
}?
> </td
>
180 <td
><?
if ($result{"genericval2"} != "") {?
><span
class=text
><?
=$result{"genericval2"}?
></span
><?
}?
></td
>
190 //////////////////////////////////REFERRAL SECTION
191 if ($result{"referrer"} != "" ||
$result{"referrerID"} != "")
196 <span
class=bold
>Primary Provider
: </span
><span
class=text
><?
=getProviderName($result['providerID'])?
></span
><br
>
197 <!--<span
class=bold
>Primary Provider ID
: </span
><span
class=text
><?
=$result{"referrerID"}?
></span
>-->
203 /////////////////////////////////INSURANCE SECTION
204 $result3 = getInsuranceData($pid, "primary");
205 if ($result3{"provider"}) {
209 <span
class=bold
>Primary Insurance Provider
:</span
><br
><span
class=text
><?
echo $result3{"provider_name"}?
></span
><br
>
210 <span
class=text
>Policy Number
: <?
echo $result3{"policy_number"}?
><br
>
211 Plan Name
: <?
=$result3{"plan_name"}?
><br
>
212 Group Number
: <?
echo $result3{"group_number"}?
></span
>
216 <span
class=bold
>Subscriber
: </span
><br
><span
class=text
><?
=$result3{"subscriber_fname"}?
> <?
=$result3{"subscriber_mname"}?
> <?
=$result3{"subscriber_lname"}?
> <?
if ($result3{"subscriber_relationship"} != "") {echo "(".$result3{"subscriber_relationship"}.")";}?
><br
>
217 S
.S
.: <?
echo $result3{"subscriber_ss"}?
> D
.O
.B
.: <?
if ($result3{"subscriber_DOB"} != "0000-00-00 00:00:00") {echo $result3{"subscriber_DOB"};}?
><br
>
218 Phone
: <?
echo $result3{"subscriber_phone"}?
>
223 <span
class=bold
>Subscriber Address
: </span
><br
><span
class=text
><?
echo $result3{"subscriber_street"}?
><br
><?
echo $result3{"subscriber_city"}?
><?
if($result3{"subscriber_state"} != ""){echo ", ";}?
><?
echo $result3{"subscriber_state"}?
><?
if($result3{"subscriber_country"} != ""){echo ", ";}?
><?
echo $result3{"subscriber_country"}?
> <?
echo " ".$result3{"subscriber_postal_code"}?
></span
>
228 <span
class=bold
>Subscriber Employer
: </span
><br
><span
class=text
><?
echo $result3{"subscriber_employer"}?
><br
><?
echo $result3{"subscriber_employer_street"}?
><br
><?
echo $result3{"subscriber_employer_city"}?
><?
if($result3{"subscriber_employer_city"} != ""){echo ", ";}?
><?
echo $result3{"subscriber_employer_state"}?
><?
if($result3{"subscriber_employer_country"} != ""){echo ", ";}?
><?
echo $result3{"subscriber_employer_country"}?
> <?
echo " ".$result3{"subscriber_employer_postal_code"}?
></span
>
233 <tr
><td
><?
if ($result3{"copay"} != "") {?
><span
class=bold
>CoPay
: </span
><span
class=text
><?
=$result3{"copay"}?
></span
><?
}?
></td
></tr
>
241 $result4 = getInsuranceData($pid, "secondary");
242 if ($result4{"provider"} != "") {
246 <span
class=bold
>Secondary Insurance Provider
:</span
><br
><span
class=text
><?
echo $result4{"provider_name"}?
></span
><br
>
247 <span
class=text
>Policy Number
: <?
echo $result4{"policy_number"}?
><br
>
248 Plan Name
: <?
=$result4{"plan_name"}?
><br
>
249 Group Number
: <?
echo $result4{"group_number"}?
></span
>
253 <span
class=bold
>Subscriber
: </span
><br
><span
class=text
><?
=$result4{"subscriber_fname"}?
> <?
=$result4{"subscriber_mname"}?
> <?
=$result4{"subscriber_lname"}?
> <?
if ($result4{"subscriber_relationship"} != "") {echo "(".$result4{"subscriber_relationship"}.")";}?
><br
>
254 S
.S
.: <?
echo $result4{"subscriber_ss"}?
> D
.O
.B
.: <?
if ($result4{"subscriber_DOB"} != "0000-00-00 00:00:00") {echo $result4{"subscriber_DOB"};}?
><br
>
255 Phone
: <?
echo $result4{"subscriber_phone"}?
>
260 <span
class=bold
>Subscriber Address
: </span
><br
><span
class=text
><?
echo $result4{"subscriber_street"}?
><br
><?
echo $result4{"subscriber_city"}?
><?
if($result4{"subscriber_state"} != ""){echo ", ";}?
><?
echo $result4{"subscriber_state"}?
><?
if($result4{"subscriber_country"} != ""){echo ", ";}?
><?
echo $result4{"subscriber_country"}?
> <?
echo " ".$result4{"subscriber_postal_code"}?
></span
>
265 <span
class=bold
>Subscriber Employer
: </span
><br
><span
class=text
><?
echo $result4{"subscriber_employer"}?
><br
><?
echo $result4{"subscriber_employer_street"}?
><br
><?
echo $result4{"subscriber_employer_city"}?
><?
if($result4{"subscriber_employer_city"} != ""){echo ", ";}?
><?
echo $result4{"subscriber_employer_state"}?
><?
if($result4{"subscriber_employer_country"} != ""){echo ", ";}?
><?
echo $result4{"subscriber_employer_country"}?
> <?
echo " ".$result4{"subscriber_employer_postal_code"}?
></span
>
270 <tr
><td
><?
if ($result4{"copay"} != "") {?
><span
class=bold
>CoPay
: </span
><span
class=text
><?
=$result4{"copay"}?
></span
><?
}?
></td
></tr
>
279 $result5 = getInsuranceData($pid, "tertiary");
280 if ($result5{"provider"}) {
284 <span
class=bold
>Tertiary Insurance Provider
:</span
><br
><span
class=text
><?
echo $result5{"provider_name"}?
></span
><br
>
285 <span
class=text
>Policy Number
: <?
echo $result5{"policy_number"}?
><br
>
286 Plan Name
: <?
=$result5{"plan_name"}?
><br
>
287 Group Number
: <?
echo $result5{"group_number"}?
></span
>
291 <span
class=bold
>Subscriber
: </span
><br
><span
class=text
><?
=$result5{"subscriber_fname"}?
> <?
=$result5{"subscriber_mname"}?
> <?
=$result5{"subscriber_lname"}?
> <?
if ($result5{"subscriber_relationship"} != "") {echo "(".$result5{"subscriber_relationship"}.")";}?
><br
>
292 S
.S
.: <?
echo $result5{"subscriber_ss"}?
> D
.O
.B
.: <?
if ($result5{"subscriber_DOB"} != "0000-00-00 00:00:00") {echo $result5{"subscriber_DOB"};}?
><br
>
293 Phone
: <?
echo $result5{"subscriber_phone"}?
>
298 <span
class=bold
>Subscriber Address
: </span
><br
><span
class=text
><?
echo $result5{"subscriber_street"}?
><br
><?
echo $result5{"subscriber_city"}?
><?
if($result5{"subscriber_state"} != ""){echo ", ";}?
><?
echo $result5{"subscriber_state"}?
><?
if($result5{"subscriber_country"} != ""){echo ", ";}?
><?
echo $result5{"subscriber_country"}?
> <?
echo " ".$result5{"subscriber_postal_code"}?
></span
>
303 <span
class=bold
>Subscriber Employer
: </span
><br
><span
class=text
><?
echo $result5{"subscriber_employer"}?
><br
><?
echo $result5{"subscriber_employer_street"}?
><br
><?
echo $result5{"subscriber_employer_city"}?
><?
if($result5{"subscriber_employer_city"} != ""){echo ", ";}?
><?
echo $result5{"subscriber_employer_state"}?
><?
if($result5{"subscriber_employer_country"} != ""){echo ", ";}?
><?
echo $result5{"subscriber_employer_country"}?
> <?
echo " ".$result5{"subscriber_employer_postal_code"}?
></span
>
308 <tr
><td
><?
if ($result5{"copay"} != "") {?
><span
class=bold
>CoPay
: </span
><span
class=text
><?
=$result5{"copay"}?
></span
><?
}?
></td
></tr
>
322 <td align
="right" valign
="top">
325 //postnuke doesn't make it easy to set globals/get/post
326 //didn't want to use an ifram here so I had to fake a page
327 //load environment by setting the things that would have
328 //been passed in the querystring
330 include_once("$srcdir/calendar.inc");
335 $_GET['module'] = "PostCalendar";
336 $_GET['func'] = "search";
337 $_GET['Date'] = pc_getDate();
339 $_GET['patient_id'] = intval($pid);
340 $_GET['submit'] = "listapps";
341 global $func,$Date,$module;
342 $module = "PostCalendar";
344 $Date = $_GET['Date'];
345 $submit = "listapps";
347 $patient_id = $_GET['patient_id'];
349 //now that the environment is set, include the page, it will
350 //behave as though it was loaded in an iframe with the querystring
352 chdir("../../main/calendar");
353 include("index.php");