portal/portal_payment.php

   1 <?php
   2 /**
   3  *
   4  * namespace OnsitePortal
   5  *
   6  * Copyright (C) 2006-2015 Rod Roark <rod@sunsetsystems.com>
   7  * Copyright (C) 2016-2017 Jerry Padgett <sjpadgett@gmail.com>
   8  *
   9  * LICENSE: This program is free software; you can redistribute it and/or
  10  * modify it under the terms of the GNU General Public License
  11  * as published by the Free Software Foundation; either version 3
  12  * of the License, or (at your option) any later version.
  13  * This program is distributed in the hope that it will be useful,
  14  * but WITHOUT ANY WARRANTY; without even the implied warranty of
  15  * MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
  16  * GNU General Public License for more details.
  17  * You should have received a copy of the GNU General Public License
  18  * along with this program. If not, see <http://opensource.org/licenses/gpl-license.php>;.
  19  *
  20  * @package OpenEMR
  21  * @author Rod Roark <rod@sunsetsystems.com>
  22  * @author Jerry Padgett <sjpadgett@gmail.com>
  23  * @link http://www.open-emr.org
  24  *
  25  */
  26 session_start();
  27
  28 if( isset( $_SESSION['pid'] ) && isset( $_SESSION['patient_portal_onsite_two'] ) ){
  29     $pid = $_SESSION['pid'];
  30     $ignoreAuth = true;
  31     $fake_register_globals=false;
  32     $sanitize_all_escapes=true;
  33     require_once ( dirname( __FILE__ ) . "/../interface/globals.php" );
  34 } else{
  35     session_destroy();
  36     $ignoreAuth = false;
  37     $sanitize_all_escapes = true;
  38     $fake_register_globals = false;
  39     require_once ( dirname( __FILE__ ) . "/../interface/globals.php" );
  40     if( ! isset( $_SESSION['authUserID'] ) ){
  41         $landingpage = "index.php";
  42         header( 'Location: ' . $landingpage );
  43         exit();
  44     }
  45 }
  46 require_once ( dirname( __FILE__ ) . "/lib/appsql.class.php" );
  47 require_once ( "$srcdir/acl.inc" );
  48 require_once ( "$srcdir/patient.inc" );
  49 require_once ( "$srcdir/billing.inc" );
  50 require_once ( "$srcdir/payment.inc.php" );
  51 require_once ( "$srcdir/forms.inc" );
  52 require_once ( "$srcdir/sl_eob.inc.php" );
  53 require_once ( "$srcdir/invoice_summary.inc.php" );
  54 require_once ( "../custom/code_types.inc.php" );
  55 require_once ( "$srcdir/formatting.inc.php" );
  56 require_once ( "$srcdir/options.inc.php" );
  57 require_once ( "$srcdir/encounter_events.inc.php" );
  58
  59 $appsql = new ApplicationTable();
  60
  61 $pid = $_REQUEST['hidden_patient_code'] > 0 ? $_REQUEST['hidden_patient_code'] : $pid;
  62
  63 $edata = $appsql->getPortalAudit( $pid, 'review', 'payment' );
  64 $ccdata = array();
  65 $invdata = array();
  66
  67 if( $edata ){
  68     $ccdata = json_decode(aes256Decrypt($edata['checksum']),true);
  69     $invdata = json_decode($edata['table_args'],true);
  70     echo "<script  type='text/javascript'>var jsondata='" . $edata['table_args'] . "';var ccdata='" . $edata['checksum'] . "'</script>";
  71 }
  72 function bucks( $amount ){
  73     if( $amount ){
  74         $amount = oeFormatMoney( $amount );
  75         return $amount;
  76     }
  77     return '';
  78 }
  79 function rawbucks( $amount ){
  80     if( $amount ){
  81         $amount = sprintf( "%.2f", $amount );
  82         return $amount;
  83     }
  84     return '';
  85 }
  86
  87 // Display a row of data for an encounter.
  88 //
  89 $var_index = 0;
  90 function echoLine( $iname, $date, $charges, $ptpaid, $inspaid, $duept, $encounter = 0, $copay = 0, $patcopay = 0 ){
  91     global $var_index;
  92     $var_index ++;
  93     $balance = bucks( $charges - $ptpaid - $inspaid );
  94     $balance = ( round( $duept, 2 ) != 0 ) ? 0 : $balance; // if balance is due from patient, then insurance balance is displayed as zero
  95     $encounter = $encounter ? $encounter : '';
  96     echo " <tr id='tr_" . attr( $var_index ) . "' >\n";
  97     echo "  <td class='detail'>" . text( oeFormatShortDate( $date ) ) . "</td>\n";
  98     echo "  <td class='detail' id='" . attr( $date ) . "' align='left'>" . htmlspecialchars( $encounter, ENT_QUOTES ) . "</td>\n";
  99     echo "  <td class='detail' align='center' id='td_charges_$var_index' >" . htmlspecialchars( bucks( $charges ), ENT_QUOTES ) . "</td>\n";
 100     echo "  <td class='detail' align='center' id='td_inspaid_$var_index' >" . htmlspecialchars( bucks( $inspaid * - 1 ), ENT_QUOTES ) . "</td>\n";
 101     echo "  <td class='detail' align='center' id='td_ptpaid_$var_index' >" . htmlspecialchars( bucks( $ptpaid * - 1 ), ENT_QUOTES ) . "</td>\n";
 102     echo "  <td class='detail' align='center' id='td_patient_copay_$var_index' >" . htmlspecialchars( bucks( $patcopay ), ENT_QUOTES ) . "</td>\n";
 103     echo "  <td class='detail' align='center' id='td_copay_$var_index' >" . htmlspecialchars( bucks( $copay ), ENT_QUOTES ) . "</td>\n";
 104     echo "  <td class='detail' align='center' id='balance_$var_index'>" . htmlspecialchars( bucks( $balance ), ENT_QUOTES ) . "</td>\n";
 105     echo "  <td class='detail' align='center' id='duept_$var_index'>" . htmlspecialchars( bucks( round( $duept, 2 ) * 1 ), ENT_QUOTES ) . "</td>\n";
 106     echo "  <td class='detail' align='right'><input class='form-control' style='width:60px;padding:2px 2px;' type='text' name='" . attr( $iname ) . "'  id='paying_" . attr( $var_index ) . "' " . " value='" . '' . "' onchange='coloring();calctotal()'  autocomplete='off' " . "onkeyup='calctotal()'/></td>\n";
 107     echo " </tr>\n";
 108 }
 109
 110 // We use this to put dashes, colons, etc. back into a timestamp.
 111 //
 112 function decorateString( $fmt, $str ){
 113     $res = '';
 114     while( $fmt ){
 115         $fc = substr( $fmt, 0, 1 );
 116         $fmt = substr( $fmt, 1 );
 117         if( $fc == '.' ){
 118             $res .= substr( $str, 0, 1 );
 119             $str = substr( $str, 1 );
 120         } else{
 121             $res .= $fc;
 122         }
 123     }
 124     return $res;
 125 }
 126
 127 // Compute taxes from a tax rate string and a possibly taxable amount.
 128 //
 129 function calcTaxes( $row, $amount ){
 130     $total = 0;
 131     if( empty( $row['taxrates'] ) ) return $total;
 132     $arates = explode( ':', $row['taxrates'] );
 133     if( empty( $arates ) ) return $total;
 134     foreach( $arates as $value ){
 135         if( empty( $value ) ) continue;
 136         $trow = sqlQuery( "SELECT option_value FROM list_options WHERE " . "list_id = 'taxrate' AND option_id = ? LIMIT 1", array ($value
 137         ) );
 138         if( empty( $trow['option_value'] ) ){
 139             echo "<!-- Missing tax rate '" . text( $value ) . "'! -->\n";
 140             continue;
 141         }
 142         $tax = sprintf( "%01.2f", $amount * $trow['option_value'] );
 143         // echo "<!-- Rate = '$value', amount = '$amount', tax = '$tax' -->\n";
 144         $total += $tax;
 145     }
 146     return $total;
 147 }
 148
 149 $now = time();
 150 $today = date( 'Y-m-d', $now );
 151 $timestamp = date( 'Y-m-d H:i:s', $now );
 152
 153
 154 // $patdata = getPatientData($pid, 'fname,lname,pubpid');
 155
 156 $patdata = sqlQuery( "SELECT " . "p.fname, p.mname, p.lname, p.pubpid,p.pid, i.copay " . "FROM patient_data AS p " . "LEFT OUTER JOIN insurance_data AS i ON " . "i.pid = p.pid AND i.type = 'primary' " . "WHERE p.pid = ? ORDER BY i.date DESC LIMIT 1", array ($pid
 157 ) );
 158
 159 $alertmsg = ''; // anything here pops up in an alert box
 160
 161 // If the Save button was clicked...
 162 if( $_POST['form_save'] ){
 163     // $extra = json_decode($_POST['ajax_mode'], true);
 164     $form_pid = $_POST['form_pid'];
 165     $form_method = trim( $_POST['form_method'] );
 166     $form_source = trim( $_POST['form_source'] );
 167     $patdata = getPatientData( $form_pid, 'fname,mname,lname,pubpid' );
 168     $NameNew = $patdata['fname'] . " " . $patdata['lname'] . " " . $patdata['mname'];
 169
 170     if( $_REQUEST['radio_type_of_payment'] == 'pre_payment' ){
 171         $payment_id = idSqlStatement( "insert into ar_session set " . "payer_id = ?" . ", patient_id = ?" . ", user_id = ?" . ", closed = ?" . ", reference = ?" . ", check_date =  now() , deposit_date = now() " . ",  pay_total = ?" . ", payment_type = 'patient'" . ", description = ?" . ", adjustment_code = 'pre_payment'" . ", post_to_date = now() " . ", payment_method = ?", array (
 172                 0,$form_pid,$_SESSION['authUserID'],0,$form_source,$_REQUEST['form_prepayment'],$NameNew,$form_method
 173         ) );
 174
 175         frontPayment( $form_pid, 0, $form_method, $form_source, $_REQUEST['form_prepayment'], 0, $timestamp ); // insertion to 'payments' table.
 176     }
 177
 178     if( $_POST['form_upay'] && $_REQUEST['radio_type_of_payment'] != 'pre_payment' ){
 179         foreach( $_POST['form_upay'] as $enc => $payment ){
 180             if( $amount = 0 + $payment ){
 181                 $zero_enc = $enc;
 182                 if( $_REQUEST['radio_type_of_payment'] == 'invoice_balance' ){
 183                     ;
 184                 } else{
 185                     if( ! $enc ){
 186                         $enc = calendar_arrived( $form_pid );
 187                     }
 188                 }
 189                 // ----------------------------------------------------------------------------------------------------
 190                 // Fetching the existing code and modifier
 191                 $ResultSearchNew = sqlStatement( "SELECT * FROM billing LEFT JOIN code_types ON billing.code_type=code_types.ct_key " . "WHERE code_types.ct_fee=1 AND billing.activity!=0 AND billing.pid =? AND encounter=? ORDER BY billing.code,billing.modifier", array ($form_pid,$enc
 192                 ) );
 193                 if( $RowSearch = sqlFetchArray( $ResultSearchNew ) ){
 194                     $Codetype = $RowSearch['code_type'];
 195                     $Code = $RowSearch['code'];
 196                     $Modifier = $RowSearch['modifier'];
 197                 } else{
 198                     $Codetype = '';
 199                     $Code = '';
 200                     $Modifier = '';
 201                 }
 202                 // ----------------------------------------------------------------------------------------------------
 203                 if( $_REQUEST['radio_type_of_payment'] == 'copay' ) // copay saving to ar_session and ar_activity tables
 204 {
 205                     $session_id = idSqlStatement( "INSERT INTO ar_session (payer_id,user_id,reference,check_date,deposit_date,pay_total," . " global_amount,payment_type,description,patient_id,payment_method,adjustment_code,post_to_date) " . " VALUES ('0',?,?,now(),now(),?,'','patient','COPAY',?,?,'patient_payment',now())", array (
 206                             $_SESSION['authId'],$form_source,$amount,$form_pid,$form_method
 207                     ) );
 208
 209                     $insrt_id = idSqlStatement( "INSERT INTO ar_activity (pid,encounter,code_type,code,modifier,payer_type,post_time,post_user,session_id,pay_amount,account_code)" . " VALUES (?,?,?,?,?,0,now(),?,?,?,'PCP')", array ($form_pid,$enc,$Codetype,$Code,$Modifier,'3',$session_id,$amount
 210                     ) );
 211
 212                     frontPayment( $form_pid, $enc, $form_method, $form_source, $amount, 0, $timestamp ); // insertion to 'payments' table.
 213                 }
 214                 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.
 215                     if( $_REQUEST['radio_type_of_payment'] == 'cash' ){
 216                         sqlStatement( "update form_encounter set last_level_closed=? where encounter=? and pid=? ", array (4,$enc,$form_pid
 217                         ) );
 218                         sqlStatement( "update billing set billed=? where encounter=? and pid=?", array (1,$enc,$form_pid
 219                         ) );
 220                     }
 221                     $adjustment_code = 'patient_payment';
 222                     $payment_id = idSqlStatement( "insert into ar_session set " . "payer_id = ?" . ", patient_id = ?" . ", user_id = ?" . ", closed = ?" . ", reference = ?" . ", check_date =  now() , deposit_date = now() " . ",  pay_total = ?" . ", payment_type = 'patient'" . ", description = ?" . ", adjustment_code = ?" . ", post_to_date = now() " . ", payment_method = ?", array (
 223                             0,$form_pid,$_SESSION['authUserID'],0,$form_source,$amount,$NameNew,$adjustment_code,$form_method
 224                     ) );
 225
 226                     // --------------------------------------------------------------------------------------------------------------------
 227
 228                     frontPayment( $form_pid, $enc, $form_method, $form_source, 0, $amount, $timestamp ); // insertion to 'payments' table.
 229
 230                     // --------------------------------------------------------------------------------------------------------------------
 231
 232                     $resMoneyGot = sqlStatement( "SELECT sum(pay_amount) as PatientPay FROM ar_activity where pid =? and " . "encounter =? and payer_type=0 and account_code='PCP'", array ($form_pid,$enc
 233                     ) ); // new fees screen copay gives account_code='PCP'
 234                     $rowMoneyGot = sqlFetchArray( $resMoneyGot );
 235                     $Copay = $rowMoneyGot['PatientPay'];
 236
 237                     // --------------------------------------------------------------------------------------------------------------------
 238
 239                     // Looping the existing code and modifier
 240                     $ResultSearchNew = sqlStatement( "SELECT * FROM billing LEFT JOIN code_types ON billing.code_type=code_types.ct_key WHERE code_types.ct_fee=1 " . "AND billing.activity!=0 AND billing.pid =? AND encounter=? ORDER BY billing.code,billing.modifier", array ($form_pid,$enc
 241                     ) );
 242                     while( $RowSearch = sqlFetchArray( $ResultSearchNew ) ){
 243                         $Codetype = $RowSearch['code_type'];
 244                         $Code = $RowSearch['code'];
 245                         $Modifier = $RowSearch['modifier'];
 246                         $Fee = $RowSearch['fee'];
 247
 248                         $resMoneyGot = sqlStatement( "SELECT sum(pay_amount) as MoneyGot FROM ar_activity where pid =? " . "and code_type=? and code=? and modifier=? and encounter =? and !(payer_type=0 and account_code='PCP')", array ($form_pid,$Codetype,$Code,$Modifier,$enc
 249                         ) );
 250                         // new fees screen copay gives account_code='PCP'
 251                         $rowMoneyGot = sqlFetchArray( $resMoneyGot );
 252                         $MoneyGot = $rowMoneyGot['MoneyGot'];
 253
 254                         $resMoneyAdjusted = sqlStatement( "SELECT sum(adj_amount) as MoneyAdjusted FROM ar_activity where " . "pid =? and code_type=? and code=? and modifier=? and encounter =?", array ($form_pid,$Codetype,$Code,$Modifier,$enc
 255                         ) );
 256                         $rowMoneyAdjusted = sqlFetchArray( $resMoneyAdjusted );
 257                         $MoneyAdjusted = $rowMoneyAdjusted['MoneyAdjusted'];
 258
 259                         $Remainder = $Fee - $Copay - $MoneyGot - $MoneyAdjusted;
 260                         $Copay = 0;
 261                         if( round( $Remainder, 2 ) != 0 && $amount != 0 ){
 262                             if( $amount - $Remainder >= 0 ){
 263                                 $insert_value = $Remainder;
 264                                 $amount = $amount - $Remainder;
 265                             } else{
 266                                 $insert_value = $amount;
 267                                 $amount = 0;
 268                             }
 269                             sqlStatement( "insert into ar_activity set " . "pid = ?" . ", encounter = ?" . ", code_type = ?" . ", code = ?" . ", modifier = ?" . ", payer_type = ?" . ", post_time = now() " . ", post_user = ?" . ", session_id = ?" . ", pay_amount = ?" . ", adj_amount = ?" . ", account_code = 'PP'", array (
 270                                     $form_pid,$enc,$Codetype,$Code,$Modifier,0,3,$payment_id,$insert_value,0
 271                             ) );
 272                         } // if
 273                     } // while
 274                     if( $amount != 0 ){ // if any excess is there.
 275                         sqlStatement( "insert into ar_activity set " . "pid = ?" . ", encounter = ?" . ", code_type = ?" . ", code = ?" . ", modifier = ?" . ", payer_type = ?" . ", post_time = now() " . ", post_user = ?" . ", session_id = ?" . ", pay_amount = ?" . ", adj_amount = ?" . ", account_code = 'PP'", array (
 276                                 $form_pid,$enc,$Codetype,$Code,$Modifier,0,3,$payment_id,$amount,0
 277                         ) );
 278                     }
 279                     // --------------------------------------------------------------------------------------------------------------------
 280                 } // invoice_balance
 281             } // if ($amount = 0 + $payment)
 282         } // foreach
 283     } // if ($_POST['form_upay'])
 284 } // if ($_POST['form_save'])
 285
 286 if( $_POST['form_save'] || $_REQUEST['receipt']){
 287
 288     if( $_REQUEST['receipt'] ){
 289         $form_pid = $_GET['patient'];
 290         $timestamp = decorateString( '....-..-.. ..:..:..', $_GET['time'] );
 291     }
 292
 293     // Get details for what we guess is the primary facility.
 294     $frow = sqlQuery( "SELECT * FROM facility " . "ORDER BY billing_location DESC, accepts_assignment DESC, id LIMIT 1" );
 295
 296     // Get the patient's name and chart number.
 297     $patdata = getPatientData( $form_pid, 'fname,mname,lname,pubpid' );
 298
 299     // Re-fetch payment info.
 300     $payrow = sqlQuery( "SELECT " . "SUM(amount1) AS amount1, " . "SUM(amount2) AS amount2, " . "MAX(method) AS method, " . "MAX(source) AS source, " . "MAX(dtime) AS dtime, " .
 301     // "MAX(user) AS user " .
 302     "MAX(user) AS user, " . "MAX(encounter) as encounter " . "FROM payments WHERE " . "pid = ? AND dtime = ?", array ($form_pid,$timestamp
 303     ) );
 304
 305     // Create key for deleting, just in case.
 306     $ref_id = ( $_REQUEST['radio_type_of_payment'] == 'copay' ) ? $session_id : $payment_id;
 307     $payment_key = $form_pid . '.' . preg_replace( '/[^0-9]/', '', $timestamp ) . '.' . $ref_id;
 308
 309     // get facility from encounter
 310     $tmprow = sqlQuery( "
 311     SELECT facility_id
 312     FROM form_encounter
 313     WHERE encounter = ?", array ($payrow['encounter']
 314     ) );
 315     $frow = sqlQuery( "SELECT * FROM facility " . " WHERE id = ?", array ($tmprow['facility_id']
 316     ) );
 317
 318     // Now proceed with printing the receipt.
 319     ?>
 320
 321 <title><?php echo xlt('Receipt for Payment'); ?></title>
 322
 323 <script type="text/javascript" src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-min-1-11-3/index.js"></script>
 324 <script type="text/javascript">
 325 $( document ).ready();
 326 function goHome(){
 327      window.location.replace("./patient/onsiteactivityviews");
 328 }
 329 function notifyPatient(){
 330         var pid = <?php echo attr($pid);?>;
 331         var note = $('#pop_receipt').text();
 332     var formURL = './messaging/handle_note.php';
 333     $.ajax({
 334         url: formURL,
 335         type: "POST",
 336         data: {'task':'add', 'pid':pid, 'inputBody':note, 'title':'Bill/Collect', 'sendto':'-patient-','noteid':'0'},
 337         success: function(data, textStatus, jqXHR) {
 338                 alert('Receipt sent to patient via Messages.')
 339         },
 340         error: function(jqXHR, status, error) {
 341             console.log(status + ": " + error);
 342         }
 343     });
 344 }
 345 </script>
 346 <?php
 347 ob_start();
 348 echo '<htlm><head></head><body style="text-align: center; margin: auto;">';
 349 ?>
 350
 351 <div id='pop_receipt' style='display: block'>
 352         <p>
 353         <h2><?php echo xlt('Receipt for Payment'); ?></h2>
 354         <p><?php echo text($frow['name'])?>
 355                 <br><?php echo text($frow['street'])?>
 356                 <br><?php echo text( $frow['city'] . ', ' . $frow['state'] ) . ' ' . text( $frow['postal_code'] )?>
 357                 <br><?php echo htmlentities($frow['phone'])?>
 358         <p>
 359         <div style="text-align: center; margin: auto;">
 360             <table border='0' cellspacing='8'
 361                 style="text-align: center; margin: auto;">
 362                 <tr>
 363                     <td><?php echo xlt('Date'); ?>:</td>
 364                     <td><?php echo text(oeFormatSDFT(strtotime($payrow['dtime']))) ?></td>
 365                 </tr>
 366                 <tr>
 367                     <td><?php echo xlt('Patient'); ?>:</td>
 368                     <td><?php echo text( $patdata['fname'] ) . " " . text( $patdata['mname'] ) . " " . text( $patdata['lname'] ) . " (" . text( $patdata['pubpid'] ) . ")"?></td>
 369                 </tr>
 370                 <tr>
 371                     <td><?php echo xlt('Paid Via'); ?>:</td>
 372                     <td><?php echo generate_display_field(array('data_type'=>'1','list_id'=>'payment_method'),$payrow['method']); ?></td>
 373                 </tr>
 374                 <tr>
 375                     <td><?php echo xlt('Authorized Id'); ?>:</td>
 376                     <td><?php echo text($payrow['source']) ?></td>
 377                 </tr>
 378                 <tr>
 379                     <td><?php echo xlt('Amount for This Visit'); ?>:</td>
 380                     <td><?php echo text(oeFormatMoney($payrow['amount1'])) ?></td>
 381                 </tr>
 382                 <tr>
 383                     <td><?php echo xlt('Amount for Past Balance'); ?>:</td>
 384                     <td><?php echo text(oeFormatMoney($payrow['amount2'])) ?></td>
 385                 </tr>
 386                 <tr>
 387                     <td><?php echo xlt('Received By'); ?>:</td>
 388                     <td><?php echo text($payrow['user']) ?></td>
 389                 </tr>
 390             </table>
 391         </div>
 392 </div>
 393         <button class='btn btn-sm' type='button' onclick='goHome()' id='returnhome'><?php echo xla('Return Home'); ?></button>
 394         <button class='btn btn-sm' type='button' onclick="notifyPatient()"><?php echo xla('Notify Patient'); ?></button>
 395 </body></html>
 396 <?php
 397  ob_end_flush();
 398 } else{
 399     //
 400     // Here we display the form for data entry.
 401     //
 402     ?>
 403 <title><?php echo xlt('Record Payment'); ?></title>
 404 <style type="text/css">
 405 body {
 406  /* font-family:sans-serif; font-size:10pt; font-weight:normal */
 407 }
 408
 409 .dehead {
 410     color: #000000; /*font-family:sans-serif; font-size:10pt;*/
 411     font-weight: bold
 412 }
 413
 414 .detail {
 415     padding: 1px 1px;
 416     /* width: 65px; */
 417     color: #000000; /*font-family:sans-serif; font-size:10pt; */
 418     font-weight: normal
 419 }
 420 </style>
 421 <script type="text/javascript" src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-creditcardvalidator-1-1-0/jquery.creditCardValidator.js"></script>
 422 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/textformat.js?v=<?php echo $v_js_includes; ?>"></script>
 423
 424 <script type="text/javascript">
 425 var mypcc = '1';
 426 function calctotal() {
 427  var flag=0;
 428  var f = document.forms["payfrm"];
 429  var total = 0;
 430  for (var i = 0; i < f.elements.length; ++i) {
 431   var elem = f.elements[i];
 432   var ename = elem.name;
 433   if (ename.indexOf('form_upay[') == 0 || ename.indexOf('form_bpay[') == 0) {
 434    if (elem.value.length > 0){
 435        total += Number(elem.value);
 436         if(total < 0) flag=1;
 437    }
 438   }
 439  }
 440      f.form_paytotal.value = Number(total).toFixed(2);
 441      if(flag){
 442         $('#payfrm')[0].reset();
 443         alert("<?php echo addslashes( xl('Negative payments not accepted')) ?>")
 444     }
 445  return true;
 446 }
 447 function coloring()
 448  {
 449    for (var i = 1; ; ++i)
 450     {
 451       if(document.getElementById('paying_'+i))
 452        {
 453         paying=document.getElementById('paying_'+i).value*1;
 454         patient_balance=document.getElementById('duept_'+i).innerHTML*1;
 455         //balance=document.getElementById('balance_'+i).innerHTML*1;
 456         if(patient_balance>0 && paying>0)
 457          {
 458             if(paying>patient_balance)
 459              {
 460               document.getElementById('paying_'+i).style.background='#FF0000';
 461              }
 462             else if(paying<patient_balance)
 463              {
 464               document.getElementById('paying_'+i).style.background='#99CC00';
 465              }
 466             else if(paying==patient_balance)
 467              {
 468               document.getElementById('paying_'+i).style.background='#ffffff';
 469              }
 470          }
 471         else
 472          {
 473           document.getElementById('paying_'+i).style.background='#ffffff';
 474          }
 475        }
 476       else
 477        {
 478         break;
 479        }
 480     }
 481  }
 482 function CheckVisible(MakeBlank)
 483  {//Displays and hides the check number text box.
 484    if(document.getElementById('form_method').options[document.getElementById('form_method').selectedIndex].value=='check_payment' ||
 485          document.getElementById('form_method').options[document.getElementById('form_method').selectedIndex].value=='bank_draft'  )
 486    {
 487     document.getElementById('check_number').disabled=false;
 488    }
 489    else
 490    {
 491     document.getElementById('check_number').disabled=true;
 492    }
 493  }
 494 function validate()
 495  {
 496   var f = document.forms["payfrm"];
 497   ok=-1;
 498   //no checks taken here....
 499   issue='no';
 500    /*if(((document.getElementById('form_method').options[document.getElementById('form_method').selectedIndex].value=='check_payment' ||
 501          document.getElementById('form_method').options[document.getElementById('form_method').selectedIndex].value=='bank_draft') &&
 502        document.getElementById('check_number').value=='' ))
 503    {
 504     alert("<?php //echo addslashes( xl('Please Fill the Check/Ref Number')) ?>");
 505     document.getElementById('check_number').focus();
 506     return false;
 507    }*/
 508
 509    if(document.getElementById('radio_type_of_payment_self1').checked==false &&
 510           document.getElementById('radio_type_of_payment1').checked==false
 511            && document.getElementById('radio_type_of_payment2').checked==false
 512            && document.getElementById('radio_type_of_payment4').checked==false)
 513     {
 514       alert("<?php //echo addslashes( xl('Please Select Type Of Payment.')) ?>");
 515        return false;
 516     }
 517   if(document.getElementById('radio_type_of_payment_self1').checked==true ||  document.getElementById('radio_type_of_payment1').checked==true)
 518    {
 519      for (var i = 0; i < f.elements.length; ++i)
 520      {
 521       var elem = f.elements[i];
 522       var ename = elem.name;
 523       if (ename.indexOf('form_upay[0') == 0) //Today is this text box.
 524       {
 525        if(elem.value*1>0)
 526         {//A warning message, if the amount is posted with out encounter.
 527          if(confirm("<?php echo addslashes( xl('Are you sure to post for today?')) ?>"))
 528           {
 529            ok=1;
 530           }
 531          else
 532           {
 533            elem.focus();
 534            return false;
 535           }
 536         }
 537        break;
 538       }
 539     }
 540    }
 541 //CO-PAY
 542   /* if(document.getElementById('radio_type_of_payment1').checked==true)
 543    {
 544      var total = 0;
 545      for (var i = 0; i < f.elements.length; ++i)
 546      {
 547       var elem = f.elements[i];
 548       var ename = elem.name;
 549       if (ename.indexOf('form_upay[') == 0) //Today is this text box.
 550       {
 551        if(f.form_paytotal.value*1!=elem.value*1)//Total CO-PAY is not posted against today
 552         {//A warning message, if the amount is posted against an old encounter.
 553          if(confirm("<?php //echo addslashes( xl('You are posting against an old encounter?')) ?>"))
 554           {
 555            ok=1;
 556           }
 557         // else
 558           {
 559            elem.focus();
 560            return false;
 561           }
 562         }
 563        break;
 564       }
 565     }
 566    }*///Co Pay
 567  else if( document.getElementsByName('form_paytotal')[0].value <= 0 )//total 0
 568   {
 569     alert("<?php echo addslashes( xl('Invalid Total!')) ?>")
 570     return false;
 571   }
 572  if(ok==-1)
 573   {
 574      //return true;
 575      if(confirm("<?php echo addslashes( xl('Payment Validated: Save?')) ?>"))
 576       {
 577        return true;
 578       }
 579      else
 580       {
 581        return false;
 582       }
 583   }
 584 }
 585 function cursor_pointer()
 586  {//Point the cursor to the latest encounter(Today)
 587      var f = document.forms["payfrm"];
 588      var total = 0;
 589      for (var i = 0; i < f.elements.length; ++i)
 590      {
 591       var elem = f.elements[i];
 592       var ename = elem.name;
 593       if (ename.indexOf('form_upay[') == 0)
 594       {
 595        elem.focus();
 596        break;
 597       }
 598     }
 599  }
 600  //=====================================================
 601 function make_it_hide_enc_pay()
 602  {
 603       document.getElementById('td_head_insurance_payment').style.display="none";
 604       document.getElementById('td_head_patient_co_pay').style.display="none";
 605       document.getElementById('td_head_co_pay').style.display="none";
 606       document.getElementById('td_head_insurance_balance').style.display="none";
 607   for (var i = 1; ; ++i)
 608   {
 609        var td_inspaid_elem = document.getElementById('td_inspaid_'+i)
 610     var td_patient_copay_elem = document.getElementById('td_patient_copay_'+i)
 611        var td_copay_elem = document.getElementById('td_copay_'+i)
 612        var balance_elem = document.getElementById('balance_'+i)
 613    if (td_inspaid_elem)
 614    {
 615     td_inspaid_elem.style.display="none";
 616         td_patient_copay_elem.style.display="none";
 617     td_copay_elem.style.display="none";
 618     balance_elem.style.display="none";
 619    }
 620   else
 621    {
 622     break;
 623    }
 624   }
 625   document.getElementById('td_total_4').style.display="none";
 626   document.getElementById('td_total_7').style.display="none";
 627     document.getElementById('td_total_8').style.display="none";
 628   document.getElementById('td_total_6').style.display="none";
 629
 630   document.getElementById('table_display').width="420px";
 631  }
 632
 633  //=====================================================
 634 function make_visible()
 635  {
 636   document.getElementById('td_head_rep_doc').style.display="";
 637   document.getElementById('td_head_description').style.display="";
 638   document.getElementById('td_head_total_charge').style.display="none";
 639   document.getElementById('td_head_insurance_payment').style.display="none";
 640   document.getElementById('td_head_patient_payment').style.display="none";
 641   document.getElementById('td_head_patient_co_pay').style.display="none";
 642   document.getElementById('td_head_co_pay').style.display="none";
 643   document.getElementById('td_head_insurance_balance').style.display="none";
 644   document.getElementById('td_head_patient_balance').style.display="none";
 645   for (var i = 1; ; ++i)
 646   {
 647    var td_charges_elem = document.getElementById('td_charges_'+i)
 648    var td_inspaid_elem = document.getElementById('td_inspaid_'+i)
 649    var td_ptpaid_elem = document.getElementById('td_ptpaid_'+i)
 650    var td_patient_copay_elem = document.getElementById('td_patient_copay_'+i)
 651    var td_copay_elem = document.getElementById('td_copay_'+i)
 652    var balance_elem = document.getElementById('balance_'+i)
 653    var duept_elem = document.getElementById('duept_'+i)
 654    if (td_charges_elem)
 655    {
 656     td_charges_elem.style.display="none";
 657     td_inspaid_elem.style.display="none";
 658     td_ptpaid_elem.style.display="none";
 659     td_patient_copay_elem.style.display="none";
 660     td_copay_elem.style.display="none";
 661     balance_elem.style.display="none";
 662     duept_elem.style.display="none";
 663    }
 664   else
 665    {
 666     break;
 667    }
 668   }
 669   document.getElementById('td_total_7').style.display="";
 670   document.getElementById('td_total_8').style.display="";
 671   document.getElementById('td_total_1').style.display="none";
 672   document.getElementById('td_total_2').style.display="none";
 673   document.getElementById('td_total_3').style.display="none";
 674   document.getElementById('td_total_4').style.display="none";
 675   document.getElementById('td_total_5').style.display="none";
 676   document.getElementById('td_total_6').style.display="none";
 677
 678   document.getElementById('table_display').width="505px";
 679  }
 680 function make_it_hide()
 681  {
 682   document.getElementById('td_head_rep_doc').style.display="none";
 683   document.getElementById('td_head_description').style.display="none";
 684   document.getElementById('td_head_total_charge').style.display="";
 685   document.getElementById('td_head_insurance_payment').style.display="";
 686   document.getElementById('td_head_patient_payment').style.display="";
 687   document.getElementById('td_head_patient_co_pay').style.display="";
 688     document.getElementById('td_head_co_pay').style.display="";
 689   document.getElementById('td_head_insurance_balance').style.display="";
 690   document.getElementById('td_head_patient_balance').style.display="";
 691   for (var i = 1; ; ++i)
 692   {
 693    var td_charges_elem = document.getElementById('td_charges_'+i)
 694    var td_inspaid_elem = document.getElementById('td_inspaid_'+i)
 695    var td_ptpaid_elem = document.getElementById('td_ptpaid_'+i)
 696    var td_patient_copay_elem = document.getElementById('td_patient_copay_'+i)
 697    var td_copay_elem = document.getElementById('td_copay_'+i)
 698    var balance_elem = document.getElementById('balance_'+i)
 699    var duept_elem = document.getElementById('duept_'+i)
 700    if (td_charges_elem)
 701    {
 702     td_charges_elem.style.display="";
 703     td_inspaid_elem.style.display="";
 704     td_ptpaid_elem.style.display="";
 705         td_patient_copay_elem.style.display="";
 706     td_copay_elem.style.display="";
 707     balance_elem.style.display="";
 708     duept_elem.style.display="";
 709    }
 710   else
 711    {
 712     break;
 713    }
 714   }
 715   document.getElementById('td_total_1').style.display="";
 716   document.getElementById('td_total_2').style.display="";
 717   document.getElementById('td_total_3').style.display="";
 718   document.getElementById('td_total_4').style.display="";
 719   document.getElementById('td_total_5').style.display="";
 720   document.getElementById('td_total_6').style.display="";
 721   document.getElementById('td_total_7').style.display="";
 722   document.getElementById('td_total_8').style.display="";
 723
 724   document.getElementById('table_display').width="100%";
 725  }
 726 function make_visible_radio()
 727  {
 728   document.getElementById('tr_radio1').style.display="";
 729   document.getElementById('tr_radio2').style.display="none";
 730  }
 731 function make_hide_radio()
 732  {
 733   document.getElementById('tr_radio1').style.display="none";
 734   document.getElementById('tr_radio2').style.display="";
 735  }
 736 function make_visible_row()
 737  {
 738   document.getElementById('table_display').style.display="";
 739   document.getElementById('table_display_prepayment').style.display="none";
 740  }
 741 function make_hide_row()
 742  {
 743   document.getElementById('table_display').style.display="none";
 744   document.getElementById('table_display_prepayment').style.display="";
 745  }
 746 function make_self()
 747  {
 748   make_visible_row();
 749   make_it_hide();
 750   make_it_hide_enc_pay();
 751   document.getElementById('radio_type_of_payment_self1').checked=true;
 752   cursor_pointer();
 753  }
 754 function make_insurance()
 755  {
 756   make_visible_row();
 757   make_it_hide();
 758   cursor_pointer();
 759   document.getElementById('radio_type_of_payment1').checked=true;
 760  }
 761  //--------------------------------------------------------------------------------------------------//
 762 $('#paySubmit').click( function(e) {
 763     e.preventDefault()
 764     $("#mode").val( "portal-save" );
 765     var inv_values= JSON.stringify(getFormObj('payfrm'));
 766     var extra_values=JSON.stringify(getFormObj('paycredit'));
 767     var extra = "&inv_values="+inv_values+"&extra_values="+extra_values;
 768
 769     var flag = 0
 770     var liburl = './lib/paylib.php';
 771     $.ajax({
 772         type: "POST",
 773         url: liburl,
 774         data: $("#payfrm").serialize()+extra,
 775         beforeSend: function(xhr){
 776                 if( validateCC() !== true) return false;
 777                 if( $('#pin').val() == "" || $('#ccname').val() == "" || $('#ccyear').val() == "" || $('#ccmonth').val() == ""){
 778                  alert("<?php echo addslashes( xl('Invalid Credit Card Values: Please correct')) ?>")
 779                  return false;
 780                 }
 781             if( validate() != true){
 782                 flag = 1;
 783                 alert("<?php echo addslashes( xl('Validation error: Fix and resubmit. This popup info is preserved!')) ?>")
 784                 return false;
 785             }
 786             $("#openPayModal .close").click()
 787         },
 788         error: function(qXHR, textStatus, errorThrow){
 789             console.log("There was an error:"+errorThrow);
 790         },
 791         success: function(templateHtml, textStatus, jqXHR){
 792                 alert("<?php echo addslashes( xl('Payment successfully sent for authorization. You will be notified when payment is posted. Until payment is accepted and you are notified, you may resubmit this payment at anytime with new amounts or different credit card. Thank you')) ?>")
 793             window.location.reload(false);
 794         }
 795     });
 796      if(flag)
 797         $("#openPayModal .close").click();
 798 });
 799  //---------------------------------------------------------------------------------------//
 800 $("#payfrm").on('submit', function(e){
 801     e.preventDefault();
 802     var thisform = this;
 803     $("#mode").val( "review-save" );
 804     var inv_values= JSON.stringify(getFormObj('payfrm'));
 805     var extra_values=JSON.stringify(getFormObj('paycredit'));
 806     var extra = "&inv_values="+inv_values+"&extra_values="+extra_values;
 807
 808     var flag = 0
 809     var liburl ='<?php echo $GLOBALS["webroot"] ?>/portal/lib/paylib.php';
 810     $.ajax({
 811         type: "POST",
 812         url: liburl,
 813         data: $("#payfrm").serialize()+extra,
 814         beforeSend: function(xhr){
 815             if( validate() != true){
 816                 flag = 1;
 817                 alert("<?php echo addslashes( xl('Validation error: Fix and resubmit. Payment values are preserved!')) ?>")
 818                 return false;
 819             }
 820         },
 821         error: function(xhr, textStatus, error){
 822             alert("<?php echo addslashes( xl('There is a Post error')) ?>")
 823             console.log("There was an error:"+textStatus);
 824             return false;
 825         },
 826         success: function(templateHtml, textStatus, jqXHR){
 827             thisform.submit();
 828         }
 829     });
 830 });
 831 function getFormObj(formId) {
 832     var formObj = {};
 833     var inputs = $('#'+formId).serializeArray();
 834     $.each(inputs, function (i, input) {
 835         formObj[input.name] = input.value;
 836     });
 837     return formObj;
 838 }
 839 function formRepopulate(jsondata){
 840     data = $.parseJSON(jsondata);
 841     $.each(data, function(name, val){
 842         var $el = $('[name="'+name+'"]'),
 843             type = $el.attr('type');
 844         switch(type){
 845             case 'checkbox':
 846                 $el.prop('checked',true);
 847                 break;
 848             case 'radio':
 849                 $el.filter('[value="'+val+'"]').prop('checked', true);
 850                 break;
 851             default:
 852                 $el.val(val);
 853         }
 854     });
 855 }
 856 function getAuth(){
 857     var authnum = prompt("<?php echo  xlt('Please enter card comfirmation authorization') ?>", "");
 858     if (authnum != null) {
 859         $('#check_number').val(authnum);
 860     }
 861 }
 862 </script>
 863
 864 <body class="body_top" onunload='imclosing()' onLoad="cursor_pointer();"
 865     style="text-align: center; margin: auto;">
 866
 867     <form id="payfrm" method='post'
 868         action='<?php echo $GLOBALS["webroot"] ?>/portal/portal_payment.php'>
 869         <input type='hidden' name='form_pid' value='<?php echo attr($pid) ?>' />
 870         <input type='hidden' name='form_save'
 871             value='<?php echo xlt('Invoice');?>' />
 872
 873         <table>
 874             <tr height="10">
 875                 <td colspan="3">&nbsp;</td>
 876             </tr>
 877
 878             <tr>
 879                 <td colspan='3' align='center' class='text'><b><?php echo xlt('Accept Payment for'); ?>&nbsp;:&nbsp;&nbsp;<?php
 880
 881 echo htmlspecialchars( $patdata['fname'], ENT_QUOTES ) . " " . htmlspecialchars( $patdata['lname'], ENT_QUOTES ) . " " . htmlspecialchars( $patdata['mname'], ENT_QUOTES ) . " (" . htmlspecialchars( $patdata['pid'], ENT_QUOTES ) . ")"?></b>
 882     <?php $NameNew=$patdata['fname'] . " " .$patdata['lname']. " " .$patdata['mname'];?>
 883   </td>
 884             </tr>
 885             <tr height="15">
 886                 <td colspan='3'></td>
 887             </tr>
 888             <tr>
 889                 <td class='text'>
 890    <?php echo xlt('Payment Method'); ?>:
 891   </td>
 892                 <td colspan='2'><select name="form_method" id="form_method"
 893                     class="text" onChange='CheckVisible("yes")'>
 894   <?php
 895     $query1112 = "SELECT * FROM list_options where list_id=?  ORDER BY seq, title ";
 896     $bres1112 = sqlStatement( $query1112, array ('payment_method') );
 897     while( $brow1112 = sqlFetchArray( $bres1112 ) ){
 898         if( $brow1112['option_id'] != 'credit_card' || $brow1112['option_id'] == 'electronic' || $brow1112['option_id'] == 'bank_draft' ) continue;
 899         echo "<option value='" . htmlspecialchars( $brow1112['option_id'], ENT_QUOTES ) . "'>" . htmlspecialchars( xl_list_label( $brow1112['title'] ), ENT_QUOTES ) . "</option>";
 900     }
 901     ?>
 902   </select></td>
 903             </tr>
 904
 905             <tr height="5">
 906                 <td colspan='3'></td>
 907             </tr>
 908
 909             <tr>
 910                 <td class='text'>
 911    <?php echo xla('Authorized'); ?>:
 912   </td>
 913                 <td colspan='2'>
 914   <?php
 915     if( isset( $_SESSION['authUserID'] ) )
 916         echo "<input type='text'  id='check_number' name='form_source' style='width:120px;' value='" . htmlspecialchars( $payrow['source'], ENT_QUOTES ) . "'>";
 917     ?>
 918   </td>
 919             </tr>
 920             <tr height="5">
 921                 <td colspan='3'></td>
 922             </tr>
 923             <tr>
 924                 <td class='text' valign="middle">
 925    <?php echo xlt('Patient Coverage'); ?>:
 926   </td>
 927                 <td class='text' colspan="2">
 928                     <input type="radio"    name="radio_type_of_coverage" id="radio_type_of_coverage1"
 929                     value="self" onClick="make_visible_radio();make_self();" />
 930                     <?php echo xlt('Self'); ?>
 931                       <input type="radio" name="radio_type_of_coverage"    id="radio_type_of_coverag2" value="insurance" checked="checked"
 932                     onClick="make_hide_radio();make_insurance();" />
 933                     <?php echo xlt('Insurance'); ?>
 934                 </td>
 935             </tr>
 936             <tr height="5">
 937                 <td colspan='3'></td>
 938             </tr>
 939             <tr id="tr_radio1" style="display: none">
 940                 <!-- For radio Insurance -->
 941                 <td class='text' valign="top">
 942    <?php echo xlt('Payment against'); ?>:
 943   </td>
 944                 <td class='text' colspan="2">
 945                     <input type="radio"    name="radio_type_of_payment" id="radio_type_of_payment_self1"
 946                     value="cash" onClick="make_visible_row();make_it_hide_enc_pay();cursor_pointer();" />
 947                     <?php echo xlt('Encounter Payment'); ?>
 948                 </td>
 949             </tr>
 950             <tr id="tr_radio2">
 951                 <!-- For radio self -->
 952                 <td class='text' valign="top"><?php echo xlt('Payment against'); ?>:
 953   </td>
 954                 <td class='text' colspan="2"><input type="radio"    name="radio_type_of_payment" id="radio_type_of_payment1" checked="checked"
 955                     value="copay" onClick="make_visible_row();cursor_pointer();" /><?php echo xlt('Co Pay'); ?>
 956           <input type="radio" name="radio_type_of_payment" id="radio_type_of_payment2"
 957                     value="invoice_balance" onClick="make_visible_row();" /><?php echo xlt('Invoice Balance'); ?><br />
 958         <input type="radio" name="radio_type_of_payment"    id="radio_type_of_payment4" value="pre_payment"
 959                     onClick="make_hide_row();" /><?php echo xlt('Pre Pay'); ?></td>
 960             </tr>
 961             <tr height="15">
 962                 <td colspan='3'></td>
 963             </tr>
 964         </table>
 965         <table width="35%" border="0" cellspacing="0" cellpadding="0" id="table_display_prepayment" style="display: none">
 966             <tr>
 967                 <td class='detail'><?php echo xlt('Pre Payment'); ?></td>
 968                 <td><input class="form-control" type='text' name='form_prepayment' style='width: 100px' /></td>
 969             </tr>
 970         </table>
 971         <table id="table_display" style="width: 100%; background: #eee;" class="table table-striped table-responsive">
 972             <thead>
 973             </thead>
 974             <tbody>
 975                 <!-- <table border='0' id="table_display" cellpadding='0' cellspacing='0' width='100%'> -->
 976     <tr bgcolor="#cccccc" id="tr_head">
 977     <td class="dehead" width="60">
 978    <?php echo xlt('DOS')?>
 979   </td>
 980                     <td class="dehead" width="120">
 981    <?php echo xlt('Visit Reason')?>
 982   </td>
 983                     <td class="dehead" align="center" width="70" id="td_head_total_charge">
 984    <?php echo xlt('Total Charge')?>
 985   </td>
 986                     <td class="dehead" align="center" width="70" id="td_head_rep_doc" style='display: none'>
 987    <?php echo xlt('Report/ Form')?>
 988   </td>
 989                     <td class="dehead" align="center" width="200"    id="td_head_description" style='display: none'>
 990    <?php echo xlt('Description')?>
 991   </td>
 992                     <td class="dehead" align="center" width="70" id="td_head_insurance_payment">
 993    <?php echo xlt('Insurance Payment')?>
 994   </td>
 995                     <td class="dehead" align="center" width="70" id="td_head_patient_payment">
 996    <?php echo xlt('Patient Payment')?>
 997   </td>
 998                     <td class="dehead" align="center" width="55" id="td_head_patient_co_pay">
 999    <?php echo xlt('Co Pay Paid')?>
1000   </td>
1001                     <td class="dehead" align="center" width="55" id="td_head_co_pay">
1002    <?php echo xlt('Required Co Pay')?>
1003   </td>
1004                     <td class="dehead" align="center" width="70" id="td_head_insurance_balance">
1005    <?php echo xlt('Insurance Balance')?>
1006   </td>
1007                     <td class="dehead" align="center" width="70" id="td_head_patient_balance">
1008    <?php echo xlt('Patient Balance')?>
1009   </td>
1010                     <td class="dehead" align="center" width="50">
1011    <?php echo xlt('Paying')?>
1012   </td>
1013                 </tr>
1014 <?php
1015     $encs = array ();
1016     // Get the unbilled service charges and payments by encounter for this patient.
1017     //
1018     $query = "SELECT fe.encounter, fe.reason, b.code_type, b.code, b.modifier, b.fee, " . "LEFT(fe.date, 10) AS encdate ,fe.last_level_closed " . "FROM  form_encounter AS fe left join billing AS b  on " . "b.pid = ? AND b.activity = 1  AND " . // AND b.billed = 0
1019 "b.code_type != 'TAX' AND b.fee != 0 " . "AND fe.pid = b.pid AND fe.encounter = b.encounter " . "where fe.pid = ? " . "ORDER BY b.encounter";
1020     $bres = sqlStatement( $query, array ($pid,$pid) );
1021     //
1022     while( $brow = sqlFetchArray( $bres ) ){
1023         $key = 0 + $brow['encounter'];
1024         if( empty( $encs[$key] ) ){
1025             $encs[$key] = array ('encounter' => $brow['encounter'],'date' => $brow['encdate'],'last_level_closed' => $brow['last_level_closed'],'charges' => 0,'payments' => 0,'reason'=>$brow['reason']
1026             );
1027         }
1028         if( $brow['code_type'] === 'COPAY' ){
1029             // $encs[$key]['payments'] -= $brow['fee'];
1030         } else{
1031             $encs[$key]['charges'] += $brow['fee'];
1032             // Add taxes.
1033             $sql_array = array ();
1034             $query = "SELECT taxrates FROM codes WHERE " . "code_type = ? AND " . "code = ? AND ";
1035             array_push( $sql_array, $code_types[$brow['code_type']]['id'], $brow['code'] );
1036             if( $brow['modifier'] ){
1037                 $query .= "modifier = ?";
1038                 array_push( $sql_array, $brow['modifier'] );
1039             } else{
1040                 $query .= "(modifier IS NULL OR modifier = '')";
1041             }
1042             $query .= " LIMIT 1";
1043             $trow = sqlQuery( $query, $sql_array );
1044             $encs[$key]['charges'] += calcTaxes( $trow, $brow['fee'] );
1045         }
1046     }
1047     // Do the same for unbilled product sales.
1048     //
1049     $query = "SELECT fe.encounter, fe.reason, s.drug_id, s.fee, " . "LEFT(fe.date, 10) AS encdate,fe.last_level_closed " . "FROM form_encounter AS fe left join drug_sales AS s " . "on s.pid = ? AND s.fee != 0 " . // AND s.billed = 0
1050 "AND fe.pid = s.pid AND fe.encounter = s.encounter " . "where fe.pid = ? " . "ORDER BY s.encounter";
1051
1052     $dres = sqlStatement( $query, array ($pid,$pid) );
1053     //
1054     while( $drow = sqlFetchArray( $dres ) ){
1055         $key = 0 + $drow['encounter'];
1056         if( empty( $encs[$key] ) ){
1057             $encs[$key] = array ('encounter' => $drow['encounter'],'date' => $drow['encdate'],'last_level_closed' => $drow['last_level_closed'],'charges' => 0,'payments' => 0
1058             );
1059         }
1060         $encs[$key]['charges'] += $drow['fee'];
1061         // Add taxes.
1062         $trow = sqlQuery( "SELECT taxrates FROM drug_templates WHERE drug_id = ? " . "ORDER BY selector LIMIT 1", array ($drow['drug_id']
1063         ) );
1064         $encs[$key]['charges'] += calcTaxes( $trow, $drow['fee'] );
1065     }
1066
1067     ksort( $encs, SORT_NUMERIC );
1068     $gottoday = false;
1069     // Bringing on top the Today always
1070     foreach( $encs as $key => $value ){
1071         $dispdate = $value['date'];
1072         if( strcmp( $dispdate, $today ) == 0 && ! $gottoday ){
1073             $gottoday = true;
1074             break;
1075         }
1076     }
1077
1078     // If no billing was entered yet for today, then generate a line for
1079     // entering today's co-pay.
1080     //
1081     if( ! $gottoday ){
1082         // echoLine("form_upay[0]", date("Y-m-d"), 0, 0, 0, 0 /*$duept*/);//No encounter yet defined.
1083     }
1084     $gottoday = false;
1085     foreach( $encs as $key => $value ){
1086         $enc = $value['encounter'];
1087         $reason = $value['reason'];
1088         $dispdate = $value['date'];
1089         if( strcmp( $dispdate, $today ) == 0 && ! $gottoday ){
1090             $dispdate = date( "Y-m-d" );
1091             $gottoday = true;
1092         }
1093         // ------------------------------------------------------------------------------------
1094         $inscopay = getCopay( $pid, $dispdate );
1095         $patcopay = getPatientCopay( $pid, $enc );
1096         // Insurance Payment
1097         // -----------------
1098         $drow = sqlQuery( "SELECT  SUM(pay_amount) AS payments, " . "SUM(adj_amount) AS adjustments  FROM ar_activity WHERE " . "pid = ? and encounter = ? and " . "payer_type != 0 and account_code!='PCP' ", array ($pid,$enc
1099         ) );
1100         $dpayment = $drow['payments'];
1101         $dadjustment = $drow['adjustments'];
1102         // Patient Payment
1103         // ---------------
1104         $drow = sqlQuery( "SELECT  SUM(pay_amount) AS payments, " . "SUM(adj_amount) AS adjustments  FROM ar_activity WHERE " . "pid = ? and encounter = ? and " . "payer_type = 0 and account_code!='PCP' ", array ($pid,$enc
1105         ) );
1106         $dpayment_pat = $drow['payments'];
1107
1108         // ------------------------------------------------------------------------------------
1109         // NumberOfInsurance
1110         $ResultNumberOfInsurance = sqlStatement( "SELECT COUNT( DISTINCT TYPE ) NumberOfInsurance FROM insurance_data
1111             where pid = ? and provider>0 ", array ($pid
1112         ) );
1113         $RowNumberOfInsurance = sqlFetchArray( $ResultNumberOfInsurance );
1114         $NumberOfInsurance = $RowNumberOfInsurance['NumberOfInsurance'] * 1;
1115         // ------------------------------------------------------------------------------------
1116         $duept = 0;
1117         if( ( ( $NumberOfInsurance == 0 || $value['last_level_closed'] == 4 || $NumberOfInsurance == $value['last_level_closed'] ) ) ){ // Patient balance
1118             $brow = sqlQuery( "SELECT SUM(fee) AS amount FROM billing WHERE " . "pid = ? and encounter = ? AND activity = 1", array ($pid,$enc
1119             ) );
1120             $srow = sqlQuery( "SELECT SUM(fee) AS amount FROM drug_sales WHERE " . "pid = ? and encounter = ? ", array ($pid,$enc
1121             ) );
1122             $drow = sqlQuery( "SELECT SUM(pay_amount) AS payments, " . "SUM(adj_amount) AS adjustments FROM ar_activity WHERE " . "pid = ? and encounter = ? ", array ($pid,$enc
1123             ) );
1124             $duept = $brow['amount'] + $srow['amount'] - $drow['payments'] - $drow['adjustments'];
1125         }
1126         echoLine( "form_upay[$enc]", $dispdate, $value['charges'], $dpayment_pat, ( $dpayment + $dadjustment ), $duept, ($enc.':'.$reason), $inscopay, $patcopay );
1127     }
1128
1129     // Continue with display of the data entry form.
1130     ?>
1131 <tr>
1132                     <td class="dehead" id='td_total_1'></td>
1133                     <td class="dehead" id='td_total_2'></td>
1134                     <td class="dehead" id='td_total_3'></td>
1135                     <td class="dehead" id='td_total_4'></td>
1136                     <td class="dehead" id='td_total_5'></td>
1137                     <td class="dehead" id='td_total_6'></td>
1138                     <td class="dehead" id='td_total_7'></td>
1139                     <td class="dehead" id='td_total_8'></td>
1140                     <td class="dehead" align="right"><?php echo xlt('Total');?></td>
1141                     <td class="dehead" align="right"><input class="form-control" type='text' name='form_paytotal'
1142                     value='' style='color: #00aa00; width: 65px; padding: 1px 1px;' readonly />
1143                     </td>
1144                 </tr>
1145         </table>
1146 <?php
1147     if( isset( $ccdata["name"] ) ){
1148         echo '<div class="col-xs-12 col-md-4 col-lg-4">
1149         <div class="panel panel-default height">';
1150         if( ! isset( $_SESSION['authUserID'] ) )
1151             echo '<div class="panel-heading">'.xlt("Payment Information").'<span style="color:#cc0000"><em> '.xlt("Pending Auth since").': </em>'.text($edata["date"]).'</span></div>';
1152         else
1153             echo '<div class="panel-heading">'.xlt("Payment Information").' <button type="button" class="btn btn-danger btn-sm" onclick="getAuth()">'.xlt("Authorize").'</button></div>';
1154     }
1155     else{
1156         echo '<div style="display:none" class="col-xs-12 col-md-6 col-lg-6"><div class="panel panel-default height"><div class="panel-heading">'.xlt("Payment Information").' </div>';
1157     }
1158     ?>
1159                      <div class="panel-body">
1160                              <strong><?php echo xlt('Card Name');?>:  </strong><span id="cn"><?php echo attr($ccdata["cc_type"])?></span><br>
1161                             <strong><?php echo xlt('Name On Card');?>:  </strong><span id="nc"><?php echo attr($ccdata["name"])?></span><br>
1162                             <strong><?php echo xlt('Card Number');?>:  </strong><span id="ccn"><?php
1163                             if( isset( $_SESSION['authUserID'] ) )
1164                                 echo $ccdata["cc_number"] . "</span><br>";
1165                                 else
1166                                     echo "**********  ".substr($ccdata["cc_number"],-4) . "</span><br>";
1167                                     ?>
1168                             <strong><?php echo xlt('Exp Date');?>:  </strong><span id="ed"><?php echo attr($ccdata["month"])."/".attr($ccdata["year"])?></span><br>
1169                             <strong><?php echo xlt('Charge Total');?>:  </strong><span id="ct"><?php echo attr($invdata["form_paytotal"])?></span><br>
1170                       </div>
1171                   </div>
1172              </div>
1173     <p>
1174 <?php
1175     if( ! isset( $_SESSION['authUserID'] ) )
1176         echo '<button type="button" class="btn btn-primary" data-toggle="modal" data-target="#openPayModal">' . xlt("Pay Invoice") . '</button>';
1177     else
1178         echo "<button type='submit' class='btn btn-danger' form='payfrm'>" . xlt('Post Payment') . "</button>";
1179     ?>
1180  &nbsp;
1181     </p>
1182         <input type="hidden" name="hidden_patient_code" id="hidden_patient_code" value="<?php echo attr($pid);?>" />
1183         <input type='hidden' name='mode' id='mode' value='' />
1184     </form>
1185
1186 <script type="text/javascript">
1187 if (typeof jsondata !== 'undefined') {
1188      formRepopulate(jsondata);
1189 }
1190  calctotal();
1191 </script>
1192     <!-- credit payment modal -->
1193     <div id="openPayModal" class="modal fade" role="dialog">
1194         <div class="modal-dialog">
1195             <div class="modal-content">
1196                 <div class="modal-header">
1197                     <h3><?php echo xlt('Submit Payment for Authorization');?></h3>
1198                     <button type="button" class="close" data-dismiss="modal">&times;</button>
1199                 </div>
1200                 <div class="modal-body container">
1201                     <form id='paycredit' class="form-horizontal col-xs-12 col-sm-6 col-md-6">
1202                         <fieldset>
1203                             <div class="control-group">
1204                                 <label label-default="label-default" class="control-label"><?php echo xlt('Name on Card');?></label>
1205                                 <div class="controls">
1206                                     <input name="name" id="ccname" type="text" class="form-control"
1207                                         pattern="\w+ \w+.*" title="<?php echo xla('Fill your first and last name'); ?>"
1208                                         required value="" />
1209                                 </div>
1210                             </div>
1211                             <div class="control-group">
1212                                 <label class="control-label"><?php echo xlt('Card Number');?></label>
1213                                 <div class="controls">
1214                                     <div class="row">
1215                                     <div class="col-sm-12">
1216                                             <input name="cc_number" id="cc_number" type="text" class="form-control inline col-sm-3"
1217                                                 autocomplete="off" maxlength="19" pattern="\d" onchange="validateCC()"
1218                                                 title="<?php echo xla('Card Number'); ?>" required value="" />
1219                                             <input disabled name="cardtype" id="cardtype" type="text" class="form-control inline" title="<?php echo xla('Card Type'); ?>" style="max-width:160px;font-weight:bold;color:red;" value="" />
1220                                         </div>
1221                                     </div>
1222                                 </div>
1223                             </div>
1224                             <div class="control-group">
1225                                 <label label-default="label-default" class="control-label"><?php echo xlt('Card Expiry Date');?></label>
1226                                 <div class="controls">
1227                                     <div class="row">
1228                                         <div class="col-md-4">
1229                                             <select name="month" id="ccmonth" class="form-control">
1230                                                 <option value=""><?php echo xlt('Select Month'); ?></option>
1231                                                 <option value="01"><?php echo xlt('January'); ?></option>
1232                                                 <option value="02"><?php echo xlt('February'); ?></option>
1233                                                 <option value="03"><?php echo xlt('March'); ?></option>
1234                                                 <option value="04"><?php echo xlt('April'); ?></option>
1235                                                 <option value="05"><?php echo xlt('May'); ?></option>
1236                                                 <option value="06"><?php echo xlt('June'); ?></option>
1237                                                 <option value="07"><?php echo xlt('July'); ?></option>
1238                                                 <option value="08"><?php echo xlt('August'); ?></option>
1239                                                 <option value="09"><?php echo xlt('September'); ?></option>
1240                                                 <option value="10"><?php echo xlt('October'); ?></option>
1241                                                 <option value="11"><?php echo xlt('November'); ?></option>
1242                                                 <option value="12"><?php echo xlt('December'); ?></option>
1243                                             </select>
1244                                         </div>
1245                                         <div class="col-md-3">
1246                                             <select name="year" id="ccyear" class="form-control">
1247                                                 <option value=""><?php echo xlt('Select Year'); ?></option>
1248                                                 <option value="2017">2017</option>
1249                                                 <option value="2018">2018</option>
1250                                                 <option value="2019">2019</option>
1251                                                 <option value="2020">2020</option>
1252                                                 <option value="2021">2021</option>
1253                                                 <option value="2022">2022</option>
1254                                                 <option value="2023">2023</option>
1255                                                 <option value="2024">2024</option>
1256                                             </select>
1257                                         </div>
1258                                     </div>
1259                                 </div>
1260                             </div>
1261                             <div class="control-group">
1262                                 <label label-default="label-default" class="control-label"><?php echo xlt('Card CVV');?></label>
1263                                 <div class="controls">
1264                                     <div class="row">
1265                                         <div class="col-md-3">
1266                                             <input name="pin" id="pin" type="text" class="form-control"
1267                                                 autocomplete="off" maxlength="4" pattern="\d{3}" onfocus="validateCC()"
1268                                                 title="<?php echo xlt('Three or four digits at back of your card'); ?>" required value="" />
1269                                         </div>
1270                                         <div class="col-md-3">
1271                                             <img src='./images/img_cvc.png' style='height: 58px; width: auto'>
1272                                         </div>
1273                                     </div>
1274                                 </div>
1275                             </div>
1276                             <div class="form-actions">
1277                                 <button id="paySubmit" class="btn btn-danger"><?php echo xlt('Submit');?></button>
1278                                 <button type="button" class="btn btn-default" data-dismiss="modal"><?php echo xlt('Cancel');?></button>
1279                             </div>
1280                         </fieldset>
1281                         <input type='hidden' name='cc_type' id='cc_type' value='' />
1282                     </form>
1283                 </div>
1284                 <!-- Body  -->
1285                 <div class="modal-footer">
1286                     <button type="button" class="btn btn-default" data-dismiss="modal"><?php echo xlt('Close');?></button>
1287                 </div>
1288             </div>
1289         </div>
1290     </div>
1291 <?php echo "<script>var ccerr='". xlt('Invalid Credit Card Number') . "';</script>";?>
1292 <script type="text/javascript">
1293 $('#cc_number').validateCreditCard(function(result){
1294     var r = (result.card_type == null ? '' : result.card_type.name.toUpperCase())
1295     var v = (result.valid== true ? ' Valid #' : ' Invalid #')
1296     $('#cardtype').val(r+v);
1297  });
1298 function validateCC() {
1299     var result = $('#cc_number').validateCreditCard();
1300     var r = (result.card_type == null ? '' : result.card_type.name.toUpperCase())
1301     var v = (result.valid == true ? ' Okay' : ' Invalid #')
1302     $('#cardtype').val(r+v);
1303     $('#cc_type').val(r);
1304     if(!result.valid){
1305          alert(ccerr)
1306          return false;
1307     }
1308     else{
1309                 return true;
1310     }
1311 }
1312 </script>
1313 </body>
1314 <?php
1315 }
1316 ?>