portal/portal_payment.php

   1 <?php
   2
   3 /**
   4  *
   5  * namespace OnsitePortal
   6  *
   7  * @package   OpenEMR
   8  * @link      http://www.open-emr.org
   9  * @author    Rod Roark <rod@sunsetsystems.com>
  10  * @author    Jerry Padgett <sjpadgett@gmail.com>
  11  * @author    Brady Miller <brady.g.miller@gmail.com>
  12  * @copyright Copyright (c) 2006-2020 Rod Roark <rod@sunsetsystems.com>
  13  * @copyright Copyright (c) 2016-2019 Jerry Padgett <sjpadgett@gmail.com>
  14  * @copyright Copyright (c) 2019 Brady Miller <brady.g.miller@gmail.com>
  15  * @license   https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  16  */
  17
  18 // Will start the (patient) portal OpenEMR session/cookie.
  19 require_once(__DIR__ . "/../src/Common/Session/SessionUtil.php");
  20 OpenEMR\Common\Session\SessionUtil::portalSessionStart();
  21
  22 $isPortal = false;
  23 if (isset($_SESSION['pid']) && isset($_SESSION['patient_portal_onsite_two'])) {
  24     $pid = $_SESSION['pid'];
  25     $ignoreAuth_onsite_portal = true;
  26     $isPortal = true;
  27     require_once(dirname(__FILE__) . "/../interface/globals.php");
  28 } else {
  29     OpenEMR\Common\Session\SessionUtil::portalSessionCookieDestroy();
  30     $ignoreAuth = false;
  31     require_once(dirname(__FILE__) . "/../interface/globals.php");
  32     if (!isset($_SESSION['authUserID'])) {
  33         $landingpage = "index.php";
  34         header('Location: ' . $landingpage);
  35         exit();
  36     }
  37 }
  38
  39 require_once(__DIR__ . "/lib/appsql.class.php");
  40 require_once("$srcdir/patient.inc");
  41 require_once("$srcdir/payment.inc.php");
  42 require_once("$srcdir/forms.inc");
  43 require_once("../custom/code_types.inc.php");
  44 require_once("$srcdir/options.inc.php");
  45 require_once("$srcdir/encounter_events.inc.php");
  46
  47 use OpenEMR\Billing\BillingUtilities;
  48 use OpenEMR\Common\Crypto\CryptoGen;
  49
  50 $cryptoGen = new CryptoGen();
  51
  52 $appsql = new ApplicationTable();
  53 $pid = isset($_REQUEST['pid']) ? $_REQUEST['pid'] : $pid;
  54 $pid = $_REQUEST['hidden_patient_code'] > 0 ? $_REQUEST['hidden_patient_code'] : $pid;
  55 $recid = isset($_REQUEST['recid']) ? (int) $_REQUEST['recid'] : 0;
  56 $adminUser = '';
  57 $portalPatient = '';
  58
  59 $query = "SELECT pao.portal_username as recip_id, Concat_Ws(' ', patient_data.fname, patient_data.lname) as username FROM patient_data " .
  60     "LEFT JOIN patient_access_onsite pao ON pao.pid = patient_data.pid " .
  61     "WHERE patient_data.pid = ? AND pao.portal_pwd_status = 1";
  62 $portalPatient = sqlQueryNoLog($query, $pid);
  63 if ($_SESSION['authUserID']) {
  64     $query = "SELECT users.username as recip_id, users.authorized as dash, CONCAT(users.fname,' ',users.lname) as username  " .
  65         "FROM users WHERE id = ?";
  66     $adminUser = sqlQueryNoLog($query, $_SESSION['authUserID']);
  67 }
  68
  69 if ($recid) {
  70     $edata = $appsql->getPortalAuditRec($recid);
  71 } else {
  72     $edata = $appsql->getPortalAudit($pid, 'review', 'payment');
  73 }
  74 $ccdata = array();
  75 $invdata = array();
  76 if ($edata) {
  77     $ccdata = json_decode($cryptoGen->decryptStandard($edata['checksum']), true);
  78     $invdata = json_decode($edata['table_args'], true);
  79     echo "<script>var jsondata='" . $edata['table_args'] . "';var ccdata='" . $edata['checksum'] . "'</script>";
  80 }
  81
  82 function bucks($amount)
  83 {
  84     if ($amount) {
  85         $amount = oeFormatMoney($amount);
  86         return $amount;
  87     }
  88
  89     return '';
  90 }
  91
  92 function rawbucks($amount)
  93 {
  94     if ($amount) {
  95         $amount = sprintf("%.2f", $amount);
  96         return $amount;
  97     }
  98
  99     return '';
 100 }
 101
 102 // Display a row of data for an encounter.
 103 //
 104 $var_index = 0;
 105 $sum_charges = $sum_ptpaid = $sum_inspaid = $sum_duept = $sum_copay = $sum_patcopay = $sum_balance = 0;
 106 function echoLine($iname, $date, $charges, $ptpaid, $inspaid, $duept, $encounter = 0, $copay = 0, $patcopay = 0)
 107 {
 108     global $sum_charges, $sum_ptpaid, $sum_inspaid, $sum_duept, $sum_copay, $sum_patcopay, $sum_balance;
 109     global $var_index;
 110     $var_index++;
 111     $balance = bucks($charges - $ptpaid - $inspaid);
 112     $balance = (round($duept, 2) != 0) ? 0 : $balance; // if balance is due from patient, then insurance balance is displayed as zero
 113     $encounter = $encounter ? $encounter : '';
 114     echo " <tr id='tr_" . attr($var_index) . "' >\n";
 115     echo "  <td class='detail'>" . text(oeFormatShortDate($date)) . "</td>\n";
 116     echo "  <td class='detail' id='" . attr($date) . "' align='left'>" . text($encounter) . "</td>\n";
 117     echo "  <td class='detail' align='center' id='td_charges_$var_index' >" . text(bucks($charges)) . "</td>\n";
 118     echo "  <td class='detail' align='center' id='td_inspaid_$var_index' >" . text(bucks($inspaid * -1)) . "</td>\n";
 119     echo "  <td class='detail' align='center' id='td_ptpaid_$var_index' >" . text(bucks($ptpaid * -1)) . "</td>\n";
 120     echo "  <td class='detail' align='center' id='td_patient_copay_$var_index' >" . text(bucks($patcopay)) . "</td>\n";
 121     echo "  <td class='detail' align='center' id='td_copay_$var_index' >" . text(bucks($copay)) . "</td>\n";
 122     echo "  <td class='detail' align='center' id='balance_$var_index'>" . text(bucks($balance)) . "</td>\n";
 123     echo "  <td class='detail' align='center' id='duept_$var_index'>" . text(bucks(round($duept, 2) * 1)) . "</td>\n";
 124     echo "  <td class='detail' align='center'><input class='form-control' name='" . attr($iname) . "'  id='paying_" . attr($var_index) .
 125         "' " . " value='" . '' . "' onchange='coloring();calctotal()'  autocomplete='off' " . "onkeyup='calctotal()'/></td>\n";
 126     echo " </tr>\n";
 127
 128     $sum_charges += $charges * 1;
 129     $sum_ptpaid += $ptpaid * -1;
 130     $sum_inspaid += $inspaid * -1;
 131     $sum_duept += $duept * 1;
 132     $sum_patcopay += $patcopay * 1;
 133     $sum_copay += $copay * 1;
 134     $sum_balance += $balance * 1;
 135 }
 136
 137 // We use this to put dashes, colons, etc. back into a timestamp.
 138 //
 139 function decorateString($fmt, $str)
 140 {
 141     $res = '';
 142     while ($fmt) {
 143         $fc = substr($fmt, 0, 1);
 144         $fmt = substr($fmt, 1);
 145         if ($fc == '.') {
 146             $res .= substr($str, 0, 1);
 147             $str = substr($str, 1);
 148         } else {
 149             $res .= $fc;
 150         }
 151     }
 152
 153     return $res;
 154 }
 155
 156 // Compute taxes from a tax rate string and a possibly taxable amount.
 157 //
 158 function calcTaxes($row, $amount)
 159 {
 160     $total = 0;
 161     if (empty($row['taxrates'])) {
 162         return $total;
 163     }
 164
 165     $arates = explode(':', $row['taxrates']);
 166     if (empty($arates)) {
 167         return $total;
 168     }
 169
 170     foreach ($arates as $value) {
 171         if (empty($value)) {
 172             continue;
 173         }
 174
 175         $trow = sqlQuery("SELECT option_value FROM list_options WHERE " . "list_id = 'taxrate' AND option_id = ? LIMIT 1", array($value
 176         ));
 177         if (empty($trow['option_value'])) {
 178             echo "<!-- Missing tax rate '" . text($value) . "'! -->\n";
 179             continue;
 180         }
 181
 182         $tax = sprintf("%01.2f", $amount * $trow['option_value']);
 183 // echo "<!-- Rate = '$value', amount = '$amount', tax = '$tax' -->\n";
 184         $total += $tax;
 185     }
 186
 187     return $total;
 188 }
 189
 190 $now = time();
 191 $today = date('Y-m-d', $now);
 192 $timestamp = date('Y-m-d H:i:s', $now);
 193
 194 $patdata = sqlQuery("SELECT " . "p.fname, p.mname, p.lname, p.postal_code, p.pubpid,p.pid, i.copay " . "FROM patient_data AS p " . "LEFT OUTER JOIN insurance_data AS i ON " . "i.pid = p.pid AND i.type = 'primary' " . "WHERE p.pid = ? ORDER BY i.date DESC LIMIT 1", array($pid
 195 ));
 196
 197 $alertmsg = ''; // anything here pops up in an alert box
 198
 199 // If the Save button was clicked...
 200 if ($_POST['form_save']) {
 201     $form_pid = $_POST['form_pid'];
 202     $form_method = trim($_POST['form_method']);
 203     $form_source = trim($_POST['form_source']);
 204     $patdata = getPatientData($form_pid, 'fname,mname,lname,pubpid');
 205     $NameNew = $patdata['fname'] . " " . $patdata['lname'] . " " . $patdata['mname'];
 206
 207     if ($_REQUEST['radio_type_of_payment'] == 'pre_payment') {
 208         $payment_id = sqlInsert(
 209             "insert into ar_session set " .
 210             "payer_id = ?" .
 211             ", patient_id = ?" .
 212             ", user_id = ?" .
 213             ", closed = ?" .
 214             ", reference = ?" .
 215             ", check_date =  now() , deposit_date = now() " .
 216             ",  pay_total = ?" .
 217             ", payment_type = 'patient'" .
 218             ", description = ?" .
 219             ", adjustment_code = 'pre_payment'" .
 220             ", post_to_date = now() " .
 221             ", payment_method = ?",
 222             array(0, $form_pid, $_SESSION['authUserID'], 0, $form_source, $_REQUEST['form_prepayment'], $NameNew, $form_method)
 223         );
 224
 225         frontPayment($form_pid, 0, $form_method, $form_source, $_REQUEST['form_prepayment'], 0, $timestamp);//insertion to 'payments' table.
 226     }
 227
 228     if ($_POST['form_upay'] && $_REQUEST['radio_type_of_payment'] != 'pre_payment') {
 229         foreach ($_POST['form_upay'] as $enc => $payment) {
 230             if ($amount = 0 + $payment) {
 231                 $zero_enc = $enc;
 232
 233                 //----------------------------------------------------------------------------------------------------
 234                 //Fetching the existing code and modifier
 235                 $ResultSearchNew = sqlStatement(
 236                     "SELECT * FROM billing LEFT JOIN code_types ON billing.code_type=code_types.ct_key " .
 237                     "WHERE code_types.ct_fee=1 AND billing.activity!=0 AND billing.pid =? AND encounter=? ORDER BY billing.code,billing.modifier",
 238                     array($form_pid, $enc)
 239                 );
 240                 if ($RowSearch = sqlFetchArray($ResultSearchNew)) {
 241                     $Codetype = $RowSearch['code_type'];
 242                     $Code = $RowSearch['code'];
 243                     $Modifier = $RowSearch['modifier'];
 244                 } else {
 245                     $Codetype = '';
 246                     $Code = '';
 247                     $Modifier = '';
 248                 }
 249
 250                 //----------------------------------------------------------------------------------------------------
 251                 if ($_REQUEST['radio_type_of_payment'] == 'copay') {//copay saving to ar_session and ar_activity tables
 252                     $session_id = sqlInsert(
 253                         "INSERT INTO ar_session (payer_id,user_id,reference,check_date,deposit_date,pay_total," .
 254                         " global_amount,payment_type,description,patient_id,payment_method,adjustment_code,post_to_date) " .
 255                         " VALUES ('0',?,?,now(),now(),?,'','patient','COPAY',?,?,'patient_payment',now())",
 256                         array($_SESSION['authUserID'], $form_source, $amount, $form_pid, $form_method)
 257                     );
 258
 259                     sqlBeginTrans();
 260                     $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM       ar_activity WHERE pid = ? AND encounter = ?", array($form_pid, $enc));
 261                     $insrt_id = sqlInsert(
 262                         "INSERT INTO ar_activity (pid,encounter,sequence_no,code_type,code,modifier,payer_type,post_time,post_user,session_id,pay_amount,account_code)" .
 263                         " VALUES (?,?,?,?,?,?,0,now(),?,?,?,'PCP')",
 264                         array($form_pid, $enc, $sequence_no['increment'], $Codetype, $Code, $Modifier, $_SESSION['authUserID'], $session_id, $amount)
 265                     );
 266                     sqlCommitTrans();
 267
 268                     frontPayment($form_pid, $enc, $form_method, $form_source, $amount, 0, $timestamp);//insertion to 'payments' table.
 269                 }
 270
 271                 if ($_REQUEST['radio_type_of_payment'] == 'invoice_balance' || $_REQUEST['radio_type_of_payment'] == 'cash') {                //Payment by patient after insurance paid, cash patients similar to do not bill insurance in feesheet.
 272                     if ($_REQUEST['radio_type_of_payment'] == 'cash') {
 273                         sqlStatement(
 274                             "update form_encounter set last_level_closed=? where encounter=? and pid=? ",
 275                             array(4, $enc, $form_pid)
 276                         );
 277                         sqlStatement(
 278                             "update billing set billed=? where encounter=? and pid=?",
 279                             array(1, $enc, $form_pid)
 280                         );
 281                     }
 282
 283                     $adjustment_code = 'patient_payment';
 284                     $payment_id = sqlInsert(
 285                         "insert into ar_session set " .
 286                         "payer_id = ?" .
 287                         ", patient_id = ?" .
 288                         ", user_id = ?" .
 289                         ", closed = ?" .
 290                         ", reference = ?"   .
 291                         ", check_date =  now() , deposit_date = now() " .
 292                         ",  pay_total = ?" .
 293                         ", payment_type = 'patient'" .
 294                         ", description = ?" .
 295                         ", adjustment_code = ?" .
 296                         ", post_to_date = now() " .
 297                         ", payment_method = ?",
 298                         array(0, $form_pid, $_SESSION['authUserID'], 0, $form_source, $amount, $NameNew, $adjustment_code, $form_method)
 299                     );
 300
 301                     //--------------------------------------------------------------------------------------------------------------------
 302
 303                     frontPayment($form_pid, $enc, $form_method, $form_source, 0, $amount, $timestamp);//insertion to 'payments' table.
 304
 305                     //--------------------------------------------------------------------------------------------------------------------
 306
 307                     $resMoneyGot = sqlStatement(
 308                         "SELECT sum(pay_amount) as PatientPay FROM ar_activity where deleted IS NULL AND pid =? and " .
 309                         "encounter =? and payer_type=0 and account_code='PCP'",
 310                         array($form_pid, $enc)
 311                     );//new fees screen copay gives account_code='PCP'
 312                     $rowMoneyGot = sqlFetchArray($resMoneyGot);
 313                     $Copay = $rowMoneyGot['PatientPay'];
 314
 315                     //--------------------------------------------------------------------------------------------------------------------
 316
 317                     //Looping the existing code and modifier
 318                     $ResultSearchNew = sqlStatement(
 319                         "SELECT * FROM billing LEFT JOIN code_types ON billing.code_type=code_types.ct_key WHERE code_types.ct_fee=1 " .
 320                         "AND billing.activity!=0 AND billing.pid =? AND encounter=? ORDER BY billing.code,billing.modifier",
 321                         array($form_pid, $enc)
 322                     );
 323                     while ($RowSearch = sqlFetchArray($ResultSearchNew)) {
 324                         $Codetype = $RowSearch['code_type'];
 325                         $Code = $RowSearch['code'];
 326                         $Modifier = $RowSearch['modifier'];
 327                         $Fee = $RowSearch['fee'];
 328
 329                         $resMoneyGot = sqlStatement(
 330                             "SELECT sum(pay_amount) as MoneyGot FROM ar_activity where deleted IS NULL AND pid = ? " .
 331                             "and code_type=? and code=? and modifier=? and encounter =? and !(payer_type=0 and account_code='PCP')",
 332                             array($form_pid, $Codetype, $Code, $Modifier, $enc)
 333                         );
 334                         //new fees screen copay gives account_code='PCP'
 335                         $rowMoneyGot = sqlFetchArray($resMoneyGot);
 336                         $MoneyGot = $rowMoneyGot['MoneyGot'];
 337
 338                         $resMoneyAdjusted = sqlStatement(
 339                             "SELECT sum(adj_amount) as MoneyAdjusted FROM ar_activity where deleted IS NULL AND " .
 340                             "pid =? and code_type=? and code=? and modifier=? and encounter =?",
 341                             array($form_pid, $Codetype, $Code, $Modifier, $enc)
 342                         );
 343                         $rowMoneyAdjusted = sqlFetchArray($resMoneyAdjusted);
 344                         $MoneyAdjusted = $rowMoneyAdjusted['MoneyAdjusted'];
 345
 346                         $Remainder = $Fee - $Copay - $MoneyGot - $MoneyAdjusted;
 347                         $Copay = 0;
 348                         if (round($Remainder, 2) != 0 && $amount != 0) {
 349                             if ($amount - $Remainder >= 0) {
 350                                 $insert_value = $Remainder;
 351                                 $amount = $amount - $Remainder;
 352                             } else {
 353                                 $insert_value = $amount;
 354                                 $amount = 0;
 355                             }
 356
 357                             sqlBeginTrans();
 358                             $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($form_pid, $enc));
 359                             sqlStatement(
 360                                 "insert into ar_activity set " .
 361                                 "pid = ?" .
 362                                 ", encounter = ?" .
 363                                 ", sequence_no = ?" .
 364                                 ", code_type = ?" .
 365                                 ", code = ?" .
 366                                 ", modifier = ?" .
 367                                 ", payer_type = ?" .
 368                                 ", post_time = now() " .
 369                                 ", post_user = ?" .
 370                                 ", session_id = ?" .
 371                                 ", pay_amount = ?" .
 372                                 ", adj_amount = ?" .
 373                                 ", account_code = 'PP'",
 374                                 array($form_pid, $enc, $sequence_no['increment'], $Codetype, $Code, $Modifier, 0, $_SESSION['authUserID'], $payment_id, $insert_value, 0)
 375                             );
 376                             sqlCommitTrans();
 377                         }//if
 378                     }//while
 379                     if ($amount != 0) {//if any excess is there.
 380                         sqlBeginTrans();
 381                         $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($form_pid, $enc));
 382                         sqlStatement(
 383                             "insert into ar_activity set " .
 384                             "pid = ?" .
 385                             ", encounter = ?" .
 386                             ", sequence_no = ?" .
 387                             ", code_type = ?" .
 388                             ", code = ?" .
 389                             ", modifier = ?" .
 390                             ", payer_type = ?" .
 391                             ", post_time = now() " .
 392                             ", post_user = ?" .
 393                             ", session_id = ?" .
 394                             ", pay_amount = ?" .
 395                             ", adj_amount = ?" .
 396                             ", account_code = 'PP'",
 397                             array($form_pid, $enc, $sequence_no['increment'], $Codetype, $Code, $Modifier, 0, $_SESSION['authUserID'], $payment_id, $amount, 0)
 398                         );
 399                         sqlCommitTrans();
 400                     }
 401
 402                     //--------------------------------------------------------------------------------------------------------------------
 403                 }//invoice_balance
 404             }//if ($amount = 0 + $payment)
 405         }//foreach
 406     }//if ($_POST['form_upay'])
 407 }//if ($_POST['form_save'])
 408
 409 if ($_POST['form_save'] || $_REQUEST['receipt']) {
 410     if ($_REQUEST['receipt']) {
 411         $form_pid = $_GET['patient'];
 412         $timestamp = decorateString('....-..-.. ..:..:..', $_GET['time']);
 413     }
 414
 415 // Get details for what we guess is the primary facility.
 416     $frow = sqlQuery("SELECT * FROM facility " . "ORDER BY billing_location DESC, accepts_assignment DESC, id LIMIT 1");
 417
 418 // Get the patient's name and chart number.
 419     $patdata = getPatientData($form_pid, 'fname,mname,lname,pubpid');
 420
 421 // Re-fetch payment info.
 422     $payrow = sqlQuery("SELECT " . "SUM(amount1) AS amount1, " . "SUM(amount2) AS amount2, " . "MAX(method) AS method, " . "MAX(source) AS source, " . "MAX(dtime) AS dtime, " .
 423 // "MAX(user) AS user " .
 424         "MAX(user) AS user, " . "MAX(encounter) as encounter " . "FROM payments WHERE " . "pid = ? AND dtime = ?", array($form_pid, $timestamp
 425     ));
 426
 427 // Create key for deleting, just in case.
 428     $ref_id = ($_REQUEST['radio_type_of_payment'] == 'copay') ? $session_id : $payment_id;
 429     $payment_key = $form_pid . '.' . preg_replace('/[^0-9]/', '', $timestamp) . '.' . $ref_id;
 430
 431 // get facility from encounter
 432     $tmprow = sqlQuery("SELECT facility_id FROM form_encounter WHERE encounter = ?", array($payrow['encounter']));
 433     $frow = sqlQuery("SELECT * FROM facility " . " WHERE id = ?", array($tmprow['facility_id']
 434     ));
 435
 436 // Now proceed with printing the receipt.
 437     ?>
 438
 439     <title><?php echo xlt('Receipt for Payment'); ?></title>
 440     <script src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery/dist/jquery.min.js"></script>
 441     <script>
 442
 443         function goHome() {
 444             window.location.replace("./patient/onsiteactivityviews");
 445         }
 446
 447         function notifyPatient() {
 448             let pid = <?php echo js_escape($pid); ?>;
 449             let note = $('#pop_receipt').html();
 450             let formURL = './messaging/handle_note.php';
 451             let owner = <?php echo js_escape($adminUser['recip_id']); ?>;
 452             let sn = <?php echo js_escape($adminUser['username']); ?>;
 453             let rid = <?php echo js_escape($portalPatient['recip_id']); ?>;
 454             let rn = <?php echo js_escape($portalPatient['username']); ?>;
 455             $.ajax({
 456                 url: formURL,
 457                 type: "POST",
 458                 data: {
 459                     'task': 'add',
 460                     'owner': owner,
 461                     'pid': pid,
 462                     'inputBody': note,
 463                     'title': 'Bill/Collect',
 464                     'recipient_name': rn,
 465                     'recipient_id': rid,
 466                     'sender_id': owner,
 467                     'sender_name': sn
 468                 },
 469                 success: function (data, textStatus, jqXHR) {
 470                     alert('Receipt sent to patient via Messages.')
 471                 },
 472                 error: function (jqXHR, status, error) {
 473                     console.log(status + ": " + error);
 474                 }
 475             });
 476         }
 477     </script>
 478     <?php
 479     ob_start();
 480     echo '<htlm><head></head><body style="text-align: center; margin: auto;">';
 481     ?>
 482     <div id='pop_receipt' style='display: block'>
 483         <p>
 484         <h2><?php echo xlt('Receipt for Payment'); ?></h2>
 485         <p><?php echo text($frow['name']) ?>
 486             <br /><?php echo text($frow['street']) ?>
 487             <br /><?php echo text($frow['city'] . ', ' . $frow['state']) . ' ' . text($frow['postal_code']) ?>
 488             <br /><?php echo text($frow['phone']) ?>
 489         <p>
 490         <div class="text-center" style="margin: auto;">
 491             <table border='0' cellspacing='8' class="text-center" style="margin: auto;">
 492                 <tr>
 493                     <td><?php echo xlt('Date'); ?>:</td>
 494                     <td><?php echo text(oeFormatSDFT(strtotime($payrow['dtime']))) ?></td>
 495                 </tr>
 496                 <tr>
 497                     <td><?php echo xlt('Patient'); ?>:</td>
 498                     <td><?php echo text($patdata['fname']) . " " . text($patdata['mname']) . " " . text($patdata['lname']) . " (" . text($patdata['pubpid']) . ")" ?></td>
 499                 </tr>
 500                 <tr>
 501                     <td><?php echo xlt('Paid Via'); ?>:</td>
 502                     <td><?php echo generate_display_field(array('data_type' => '1', 'list_id' => 'payment_method'), $payrow['method']); ?></td>
 503                 </tr>
 504                 <tr>
 505                     <td><?php echo xlt('Authorized Id'); ?>:</td>
 506                     <td><?php echo text($payrow['source']) ?></td>
 507                 </tr>
 508                 <tr>
 509                     <td><?php echo xlt('Amount for This Visit'); ?>:</td>
 510                     <td><?php echo text(oeFormatMoney($payrow['amount1'])) ?></td>
 511                 </tr>
 512                 <tr>
 513                     <td><?php echo xlt('Amount for Past Balance'); ?>:</td>
 514                     <td><?php echo text(oeFormatMoney($payrow['amount2'])) ?></td>
 515                 </tr>
 516                 <tr>
 517                     <td><?php echo xlt('Received By'); ?>:</td>
 518                     <td><?php echo text($payrow['user']) ?></td>
 519                 </tr>
 520             </table>
 521         </div>
 522     </div>
 523     <button class='btn btn-sm' type='button' onclick='goHome()' id='returnhome'><?php echo xla('Return Home'); ?></button>
 524     <button class='btn btn-sm' type='button' onclick="notifyPatient()"><?php echo xla('Notify Patient'); ?></button>
 525     </body></html>
 526     <?php
 527     ob_end_flush();
 528 } else {
 529 //
 530 // Here we display the form for data entry.
 531 //
 532     ?>
 533     <title><?php echo xlt('Record Payment'); ?></title>
 534     <style>
 535         .dehead {
 536             color: #000000;
 537             font-weight: bold
 538         }
 539         .detail {
 540             padding: 1px 1px;
 541             color: #000000;
 542             font-weight: normal
 543         }
 544     </style>
 545     <script src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-creditcardvalidator/jquery.creditCardValidator.js"></script>
 546     <script src="<?php echo $GLOBALS['webroot'] ?>/library/textformat.js?v=<?php echo $v_js_includes; ?>"></script>
 547     <script>
 548         var chargeMsg = <?php $amsg = xl('Payment was successfully authorized and your card is charged.') . "\n" .
 549                 xl("You will be notified when your payment is applied for this invoice.") . "\n" .
 550                 xl('Until then you will continue to see payment details here.') . "\n" . xl('Thank You.');
 551             echo json_encode($amsg);
 552         ?>;
 553         var publicKey = <?php echo json_encode($cryptoGen->decryptStandard($GLOBALS['gateway_public_key'])); ?>;
 554         var apiKey = <?php echo json_encode($cryptoGen->decryptStandard($GLOBALS['gateway_api_key'])); ?>;
 555
 556         function calctotal() {
 557             var flag = 0;
 558             var f = document.forms["invoiceForm"];
 559             var total = 0;
 560             for (var i = 0; i < f.elements.length; ++i) {
 561                 var elem = f.elements[i];
 562                 var ename = elem.name;
 563                 if (ename.indexOf('form_upay[') == 0 || ename.indexOf('form_bpay[') == 0) {
 564                     if (elem.value.length > 0) {
 565                         total += Number(elem.value);
 566                         if (total < 0) flag = 1;
 567                     }
 568                 }
 569             }
 570             f.form_paytotal.value = Number(total).toFixed(2);
 571             if (flag) {
 572                 $('#invoiceForm')[0].reset();
 573                 alert(<?php echo xlj('Negative payments not accepted'); ?>)
 574             }
 575             return true;
 576         }
 577
 578         function coloring() {
 579             for (var i = 1; ; ++i) {
 580                 if (document.getElementById('paying_' + i)) {
 581                     paying = document.getElementById('paying_' + i).value * 1;
 582                     patient_balance = document.getElementById('duept_' + i).innerHTML * 1;
 583                     if (patient_balance > 0 && paying > 0) {
 584                         if (paying > patient_balance) {
 585                             document.getElementById('paying_' + i).style.background = '#FF0000';
 586                         }
 587                         else if (paying < patient_balance) {
 588                             document.getElementById('paying_' + i).style.background = '#99CC00';
 589                         }
 590                         else if (paying == patient_balance) {
 591                             document.getElementById('paying_' + i).style.background = '#ffffff';
 592                         }
 593                     }
 594                     else {
 595                         document.getElementById('paying_' + i).style.background = '#ffffff';
 596                     }
 597                 }
 598                 else {
 599                     break;
 600                 }
 601             }
 602         }
 603
 604         function CheckVisible(MakeBlank) {//Displays and hides the check number text box.
 605             if (document.getElementById('form_method').options[document.getElementById('form_method').selectedIndex].value == 'check_payment' ||
 606                 document.getElementById('form_method').options[document.getElementById('form_method').selectedIndex].value == 'bank_draft') {
 607                 document.getElementById('check_number').disabled = false;
 608             }
 609             else {
 610                 document.getElementById('check_number').disabled = true;
 611             }
 612         }
 613
 614         function validate() {
 615             var f = document.forms["invoiceForm"];
 616             ok = -1;
 617 //no checks taken here....
 618             issue = 'no';
 619             if (document.getElementById('radio_type_of_payment_self1').checked == false &&
 620                 document.getElementById('radio_type_of_payment1').checked == false
 621                 && document.getElementById('radio_type_of_payment2').checked == false
 622                 && document.getElementById('radio_type_of_payment4').checked == false) {
 623                 alert("<?php //echo addslashes( xl('Please Select Type Of Payment.')) ?>");
 624                 return false;
 625             }
 626             if (document.getElementById('radio_type_of_payment_self1').checked == true || document.getElementById('radio_type_of_payment1').checked == true) {
 627                 for (var i = 0; i < f.elements.length; ++i) {
 628                     var elem = f.elements[i];
 629                     var ename = elem.name;
 630                     if (ename.indexOf('form_upay[0') == 0) //Today is this text box.
 631                     {
 632                         if (elem.value * 1 > 0) {//A warning message, if the amount is posted with out encounter.
 633                             if (confirm(<?php echo xlj('Are you sure to post for today?'); ?>)) {
 634                                 ok = 1;
 635                             }
 636                             else {
 637                                 elem.focus();
 638                                 return false;
 639                             }
 640                         }
 641                         break;
 642                     }
 643                 }
 644             }
 645             else if (document.getElementsByName('form_paytotal')[0].value <= 0)//total 0
 646             {
 647                 alert(<?php echo xlj('Invalid Total!'); ?>)
 648                 return false;
 649             }
 650             if (ok == -1) {
 651                 if (confirm(<?php echo xlj('Payment Validated: Save?'); ?>)) {
 652                     return true;
 653                 }
 654                 else {
 655                     return false;
 656                 }
 657             }
 658         }
 659
 660         function cursor_pointer() {//Point the cursor to the latest encounter(Today)
 661             var f = document.forms["invoiceForm"];
 662             var total = 0;
 663             for (var i = 0; i < f.elements.length; ++i) {
 664                 var elem = f.elements[i];
 665                 var ename = elem.name;
 666                 if (ename.indexOf('form_upay[') == 0) {
 667                     elem.focus();
 668                     break;
 669                 }
 670             }
 671         }
 672
 673         function make_it_hide_enc_pay() {
 674             document.getElementById('td_head_insurance_payment').style.display = "none";
 675             document.getElementById('td_head_patient_co_pay').style.display = "none";
 676             document.getElementById('td_head_co_pay').style.display = "none";
 677             document.getElementById('td_head_insurance_balance').style.display = "none";
 678             for (var i = 1; ; ++i) {
 679                 var td_inspaid_elem = document.getElementById('td_inspaid_' + i)
 680                 var td_patient_copay_elem = document.getElementById('td_patient_copay_' + i)
 681                 var td_copay_elem = document.getElementById('td_copay_' + i)
 682                 var balance_elem = document.getElementById('balance_' + i)
 683                 if (td_inspaid_elem) {
 684                     td_inspaid_elem.style.display = "none";
 685                     td_patient_copay_elem.style.display = "none";
 686                     td_copay_elem.style.display = "none";
 687                     balance_elem.style.display = "none";
 688                 }
 689                 else {
 690                     break;
 691                 }
 692             }
 693             document.getElementById('td_total_4').style.display = "none";
 694             document.getElementById('td_total_7').style.display = "none";
 695             document.getElementById('td_total_8').style.display = "none";
 696             document.getElementById('td_total_6').style.display = "none";
 697
 698             document.getElementById('table_display').width = "420px";
 699         }
 700
 701         function make_visible() {
 702             document.getElementById('td_head_rep_doc').style.display = "";
 703             document.getElementById('td_head_description').style.display = "";
 704             document.getElementById('td_head_total_charge').style.display = "none";
 705             document.getElementById('td_head_insurance_payment').style.display = "none";
 706             document.getElementById('td_head_patient_payment').style.display = "none";
 707             document.getElementById('td_head_patient_co_pay').style.display = "none";
 708             document.getElementById('td_head_co_pay').style.display = "none";
 709             document.getElementById('td_head_insurance_balance').style.display = "none";
 710             document.getElementById('td_head_patient_balance').style.display = "none";
 711             for (var i = 1; ; ++i) {
 712                 var td_charges_elem = document.getElementById('td_charges_' + i)
 713                 var td_inspaid_elem = document.getElementById('td_inspaid_' + i)
 714                 var td_ptpaid_elem = document.getElementById('td_ptpaid_' + i)
 715                 var td_patient_copay_elem = document.getElementById('td_patient_copay_' + i)
 716                 var td_copay_elem = document.getElementById('td_copay_' + i)
 717                 var balance_elem = document.getElementById('balance_' + i)
 718                 var duept_elem = document.getElementById('duept_' + i)
 719                 if (td_charges_elem) {
 720                     td_charges_elem.style.display = "none";
 721                     td_inspaid_elem.style.display = "none";
 722                     td_ptpaid_elem.style.display = "none";
 723                     td_patient_copay_elem.style.display = "none";
 724                     td_copay_elem.style.display = "none";
 725                     balance_elem.style.display = "none";
 726                     duept_elem.style.display = "none";
 727                 }
 728                 else {
 729                     break;
 730                 }
 731             }
 732             document.getElementById('td_total_7').style.display = "";
 733             document.getElementById('td_total_8').style.display = "";
 734             document.getElementById('td_total_1').style.display = "none";
 735             document.getElementById('td_total_2').style.display = "none";
 736             document.getElementById('td_total_3').style.display = "none";
 737             document.getElementById('td_total_4').style.display = "none";
 738             document.getElementById('td_total_5').style.display = "none";
 739             document.getElementById('td_total_6').style.display = "none";
 740
 741             document.getElementById('table_display').width = "505px";
 742         }
 743
 744         function make_it_hide() {
 745             document.getElementById('td_head_rep_doc').style.display = "none";
 746             document.getElementById('td_head_description').style.display = "none";
 747             document.getElementById('td_head_total_charge').style.display = "";
 748             document.getElementById('td_head_insurance_payment').style.display = "";
 749             document.getElementById('td_head_patient_payment').style.display = "";
 750             document.getElementById('td_head_patient_co_pay').style.display = "";
 751             document.getElementById('td_head_co_pay').style.display = "";
 752             document.getElementById('td_head_insurance_balance').style.display = "";
 753             document.getElementById('td_head_patient_balance').style.display = "";
 754             for (var i = 1; ; ++i) {
 755                 var td_charges_elem = document.getElementById('td_charges_' + i)
 756                 var td_inspaid_elem = document.getElementById('td_inspaid_' + i)
 757                 var td_ptpaid_elem = document.getElementById('td_ptpaid_' + i)
 758                 var td_patient_copay_elem = document.getElementById('td_patient_copay_' + i)
 759                 var td_copay_elem = document.getElementById('td_copay_' + i)
 760                 var balance_elem = document.getElementById('balance_' + i)
 761                 var duept_elem = document.getElementById('duept_' + i)
 762                 if (td_charges_elem) {
 763                     td_charges_elem.style.display = "";
 764                     td_inspaid_elem.style.display = "";
 765                     td_ptpaid_elem.style.display = "";
 766                     td_patient_copay_elem.style.display = "";
 767                     td_copay_elem.style.display = "";
 768                     balance_elem.style.display = "";
 769                     duept_elem.style.display = "";
 770                 }
 771                 else {
 772                     break;
 773                 }
 774             }
 775             document.getElementById('td_total_1').style.display = "";
 776             document.getElementById('td_total_2').style.display = "";
 777             document.getElementById('td_total_3').style.display = "";
 778             document.getElementById('td_total_4').style.display = "";
 779             document.getElementById('td_total_5').style.display = "";
 780             document.getElementById('td_total_6').style.display = "";
 781             document.getElementById('td_total_7').style.display = "";
 782             document.getElementById('td_total_8').style.display = "";
 783
 784             document.getElementById('table_display').width = "100%";
 785         }
 786
 787         function make_visible_radio() {
 788             document.getElementById('tr_radio1').style.display = "";
 789             document.getElementById('tr_radio2').style.display = "none";
 790         }
 791
 792         function make_hide_radio() {
 793             document.getElementById('tr_radio1').style.display = "none";
 794             document.getElementById('tr_radio2').style.display = "";
 795         }
 796
 797         function make_visible_row() {
 798             document.getElementById('table_display').style.display = "";
 799             document.getElementById('table_display_prepayment').style.display = "none";
 800         }
 801
 802         function make_hide_row() {
 803             document.getElementById('table_display').style.display = "none";
 804             document.getElementById('table_display_prepayment').style.display = "";
 805         }
 806
 807         function make_self() {
 808             make_visible_row();
 809             make_it_hide();
 810             make_it_hide_enc_pay();
 811             document.getElementById('radio_type_of_payment_self1').checked = true;
 812             cursor_pointer();
 813         }
 814
 815         function make_insurance() {
 816             make_visible_row();
 817             make_it_hide();
 818             cursor_pointer();
 819             document.getElementById('radio_type_of_payment1').checked = true;
 820         }
 821
 822         $('#paySubmit').click(function (e) {
 823             e.preventDefault();e.stopPropagation();
 824             $("#mode").val("portal-save");
 825             let inv_values = JSON.stringify(getFormObj('invoiceForm'));
 826             let extra_values = JSON.stringify(getFormObj('paymentForm'));
 827             let extra = "&inv_values=" + encodeURIComponent(inv_values) + "&extra_values=" + encodeURIComponent(extra_values);
 828             let flag = 0
 829             let liburl = './lib/paylib.php';
 830             $.ajax({
 831                 type: "POST",
 832                 url: liburl,
 833                 data: $("#invoiceForm").serialize() + extra,
 834                 beforeSend: function (xhr) {
 835                     if (validateCC() !== true) return false;
 836                     if ($('#cardCode').val() == "" || $('#cardHolderName').val() == "" || $('#expYear').val() == "" || $('#expMonth').val() == "") {
 837                         alert(<?php echo xlj('Invalid Credit Card Values: Please correct'); ?>)
 838                         return false;
 839                     }
 840                     if (validate() != true) {
 841                         flag = 1;
 842                         alert(<?php echo xlj('Validation error: Fix and resubmit. This popup info is preserved!'); ?>)
 843                         return false;
 844                     }
 845                     $("#openPayModal .close").click()
 846                 },
 847                 error: function (qXHR, textStatus, errorThrow) {
 848                     console.log("There was an error:" + errorThrow);
 849                 },
 850                 success: function (templateHtml, textStatus, jqXHR) {
 851                     let msg = <?php $amsg = xl('Payment successfully sent for review and posting to your account.') . "\n" .
 852                         xl("You will be notified when the payment transaction is confirmed.") . "\n" .
 853                         xl('Until then you will continue to see payment details here.') . "\n" . xl('Thank You.');
 854                         echo json_encode($amsg); // backward compatable 5.0.1
 855                     ?>;
 856                     alert(msg);
 857                     window.location.reload(false);
 858                 }
 859             });
 860             if (flag) {
 861                 $("#openPayModal .close").click();
 862             }
 863         });
 864
 865         $('#openPayModal').on('show.bs.modal', function () {
 866             let total = $("#form_paytotal").val();
 867             if(Number(total) < 1) {
 868                 let error = <?php echo json_encode("Please enter a payment amount"); ?>;
 869                 alert(error);
 870                 return false;
 871             }
 872             $("#payTotal").text(total);
 873             $("#paymentAmount").val(total);
 874         });
 875
 876         $("#invoiceForm").on('submit', function (e) {
 877             e.preventDefault();
 878             let thisform = this;
 879             $("#mode").val("review-save");
 880             let inv_values = JSON.stringify(getFormObj('invoiceForm'));
 881             let extra_values = JSON.stringify(getFormObj('paymentForm'));
 882             let extra = "&inv_values=" + inv_values + "&extra_values=" + extra_values;
 883
 884             let flag = 0
 885             let liburl = '<?php echo $GLOBALS["webroot"] ?>/portal/lib/paylib.php';
 886             $.ajax({
 887                 type: "POST",
 888                 url: liburl,
 889                 data: $("#invoiceForm").serialize() + extra,
 890                 beforeSend: function (xhr) {
 891                     if (validate() != true) {
 892                         flag = 1;
 893                         alert(<?php echo xlj('Validation error: Fix and resubmit.'); ?>)
 894                         return false;
 895                     }
 896                 },
 897                 error: function (xhr, textStatus, error) {
 898                     alert(<?php echo xlj('There is a Post error'); ?>)
 899                     console.log("There was an error:" + textStatus);
 900                     return false;
 901                 },
 902                 success: function (templateHtml, textStatus, jqXHR) {
 903                     thisform.submit();
 904                 }
 905             });
 906         });
 907
 908         function getFormObj(formId) {
 909             let formObj = {};
 910             let inputs = $('#' + formId).serializeArray();
 911             $.each(inputs, function (i, input) {
 912                 formObj[input.name] = input.value;
 913             });
 914             return formObj;
 915         }
 916
 917         function formRepopulate(jsondata) {
 918             let data = $.parseJSON(jsondata);
 919             $.each(data, function (name, val) {
 920                 let $el = $('[name="' + name + '"]'),
 921                     type = $el.attr('type');
 922                 switch (type) {
 923                     case 'checkbox':
 924                         $el.prop('checked', true);
 925                         break;
 926                     case 'radio':
 927                         $el.filter('[value="' + val + '"]').prop('checked', true);
 928                         break;
 929                     default:
 930                         $el.val(val);
 931                 }
 932             });
 933         }
 934
 935         function getAuth() {
 936             let authnum = document.getElementById("check_number").value;
 937             authnum = prompt(<?php echo xlj('Please enter card comfirmation authorization'); ?>, authnum);
 938             if (authnum != null) {
 939                 document.getElementById("check_number").value = authnum;
 940             }
 941         }
 942     </script>
 943
 944     <body class="skin-blue" onunload='imclosing()' onLoad="cursor_pointer();"
 945           style="text-align: center; margin: auto;">
 946
 947     <form id="invoiceForm" method='post' action='<?php echo $GLOBALS["webroot"] ?>/portal/portal_payment.php'>
 948         <input type='hidden' name='form_pid' value='<?php echo attr($pid) ?>'/>
 949         <input type='hidden' name='form_save' value='<?php echo xla('Invoice'); ?>'/>
 950         <table>
 951             <tr height="10">
 952                 <td colspan="3">&nbsp;</td>
 953             </tr>
 954             <tr>
 955                 <td colspan='3' align='center' class='text'>
 956                     <b><?php echo xlt('Accept Payment for'); ?>&nbsp;:&nbsp;&nbsp;<?php
 957                     echo text($patdata['fname']) . " " .
 958                         text($patdata['lname']) . " " .
 959                         text($patdata['mname']) . " (" .
 960                         text($patdata['pid']) . ")" ?></b>
 961                     <?php $NameNew = $patdata['fname'] . " " . $patdata['lname'] . " " . $patdata['mname']; ?>
 962                 </td>
 963             </tr>
 964             <tr height="15">
 965                 <td colspan='3'></td>
 966             </tr>
 967             <tr>
 968                 <td class='text'>
 969                     <?php echo xlt('Payment Method'); ?>:
 970                 </td>
 971                 <td colspan='2'><select name="form_method" id="form_method" class="form-control" onChange='CheckVisible("yes")'>
 972                         <?php
 973                         $query1112 = "SELECT * FROM list_options where list_id=?  ORDER BY seq, title ";
 974                         $bres1112 = sqlStatement($query1112, array('payment_method'));
 975                         while ($brow1112 = sqlFetchArray($bres1112)) {
 976                             if ($brow1112['option_id'] != 'credit_card' || $brow1112['option_id'] == 'debit' || $brow1112['option_id'] == 'bank_draft') {
 977                                 continue;
 978                             }
 979                             echo "<option value='" . attr($brow1112['option_id']) . "'>" .
 980                                 text(xl_list_label($brow1112['title'])) . "</option>";
 981                         }
 982                         ?>
 983                     </select></td>
 984             </tr>
 985             <?php if (isset($_SESSION['authUserID'])) { ?>
 986                 <tr height="5">
 987                     <td colspan='3'></td>
 988                 </tr>
 989                 <tr>
 990                     <td class='text'>
 991                         <?php echo xlt('Authorized'); ?>:
 992                     </td>
 993                     <td colspan='2'>
 994                         <?php if ($ccdata['authCode'] && empty($payrow['source'])) {
 995                             $payrow['source'] = $ccdata['authCode'] . " : " . $ccdata['transId'];
 996                         }
 997                         ?>
 998                         <input class="form-control form-control-sm" id='check_number' name='form_source' style='' value='<?php echo attr($payrow['source']) ?>' />
 999                     </td>
1000                 </tr>
1001             <?php } ?>
1002                 <?php if (isset($_SESSION['authUserID'])) {
1003                         $hide = '';
1004                         echo '<tr height="5"><td colspan="3"></td></tr><tr">';
1005                 } else {
1006                     $hide = 'hidden';
1007                     echo '<tr class="hidden">';
1008                 }
1009                 ?>
1010                 <td class='text' valign="middle">
1011                     <?php echo xlt('Patient Coverage'); ?>:
1012                 </td>
1013                 <td class='text' colspan="2">
1014                     <input type="radio" name="radio_type_of_coverage" id="radio_type_of_coverage1"
1015                            value="self" onClick="make_visible_radio();make_self();"/>
1016                     <?php echo xlt('Self'); ?>
1017                     <input type="radio" name="radio_type_of_coverage" id="radio_type_of_coverag2" value="insurance"
1018                            checked="checked"
1019                            onClick="make_hide_radio();make_insurance();"/>
1020                     <?php echo xlt('Insurance'); ?>
1021                 </td>
1022             </tr>
1023             <tr height="5">
1024                 <td colspan='3'></td>
1025             </tr>
1026             <tr id="tr_radio1" style="display: none">
1027                 <!-- For radio Insurance -->
1028                 <td class='text' valign="top">
1029                     <?php echo xlt('Payment against'); ?>:
1030                 </td>
1031                 <td class='text' colspan="2">
1032                     <input type="radio" name="radio_type_of_payment" id="radio_type_of_payment_self1"
1033                            value="cash" onClick="make_visible_row();make_it_hide_enc_pay();cursor_pointer();"/>
1034                     <?php echo xlt('Encounter Payment'); ?>
1035                 </td>
1036             </tr>
1037             <tr id="tr_radio2">
1038                 <!-- For radio self -->
1039                 <td class='text' valign="top"><?php echo xlt('Payment against'); ?>:</td>
1040                 <td class='text' colspan="2">
1041                     <input type="radio" name="radio_type_of_payment" id="radio_type_of_payment1" class="<?php echo $hide ? $hide : ''; ?>"
1042                            value="copay" onClick="make_visible_row();cursor_pointer();"/><?php echo !$hide ? xlt('Co Pay') : ''; ?>
1043                     <input type="radio" name="radio_type_of_payment" id="radio_type_of_payment2" checked="checked"
1044                            value="invoice_balance" onClick="make_visible_row();"/><?php echo xlt('Invoice Balance'); ?>
1045                     <input type="radio" name="radio_type_of_payment" id="radio_type_of_payment4" value="pre_payment"
1046                            onClick="make_hide_row();"/><?php echo xlt('Pre Pay'); ?>
1047                 </td>
1048             </tr>
1049             <tr height="15">
1050                 <td colspan='3'></td>
1051             </tr>
1052         </table>
1053         <table width="20%" border="0" cellspacing="0" cellpadding="0" id="table_display_prepayment" style="margin-bottom: 10px; display: none">
1054             <tr>
1055                 <td class='detail'><?php echo xlt('Pre Payment'); ?></td>
1056                 <td><input class="form-control" type='text' name='form_prepayment' style=''/></td>
1057             </tr>
1058         </table>
1059         <table id="table_display" style="background: #eee;" class="table table-sm table-striped table-bordered w-100">
1060             <thead>
1061             </thead>
1062             <tbody>
1063             <tr bgcolor="#cccccc" id="tr_head">
1064                 <td class="dehead" width="60">
1065                     <?php echo xlt('DOS') ?>
1066                 </td>
1067                 <td class="dehead" width="120">
1068                     <?php echo xlt('Visit Reason') ?>
1069                 </td>
1070                 <td class="dehead" align="center" width="70" id="td_head_total_charge">
1071                     <?php echo xlt('Total Charge') ?>
1072                 </td>
1073                 <td class="dehead" align="center" width="70" id="td_head_rep_doc" style='display: none'>
1074                     <?php echo xlt('Report/ Form') ?>
1075                 </td>
1076                 <td class="dehead" align="center" width="200" id="td_head_description" style='display: none'>
1077                     <?php echo xlt('Description') ?>
1078                 </td>
1079                 <td class="dehead" align="center" width="70" id="td_head_insurance_payment">
1080                     <?php echo xlt('Insurance Payment') ?>
1081                 </td>
1082                 <td class="dehead" align="center" width="70" id="td_head_patient_payment">
1083                     <?php echo xlt('Patient Payment') ?>
1084                 </td>
1085                 <td class="dehead" align="center" width="55" id="td_head_patient_co_pay">
1086                     <?php echo xlt('Co Pay Paid') ?>
1087                 </td>
1088                 <td class="dehead" align="center" width="55" id="td_head_co_pay">
1089                     <?php echo xlt('Required Co Pay') ?>
1090                 </td>
1091                 <td class="dehead" align="center" width="70" id="td_head_insurance_balance">
1092                     <?php echo xlt('Insurance Balance') ?>
1093                 </td>
1094                 <td class="dehead" align="center" width="70" id="td_head_patient_balance">
1095                     <?php echo xlt('Patient Balance') ?>
1096                 </td>
1097                 <td class="dehead" align="center" width="50">
1098                     <?php echo xlt('Paying') ?>
1099                 </td>
1100             </tr>
1101             <?php
1102             $encs = array();
1103             // Get the unbilled service charges and payments by encounter for this patient.
1104             //
1105             $query = "SELECT fe.encounter, fe.reason, b.code_type, b.code, b.modifier, b.fee, " .
1106                 "LEFT(fe.date, 10) AS encdate ,fe.last_level_closed " . "FROM  form_encounter AS fe left join billing AS b  on " .
1107                 "b.pid = ? AND b.activity = 1  AND " . "b.code_type != 'TAX' AND b.fee != 0 " . "AND fe.pid = b.pid AND fe.encounter = b.encounter " .
1108                 "where fe.pid = ? " . "ORDER BY b.encounter";
1109             $bres = sqlStatement($query, array($pid, $pid));
1110             //
1111             while ($brow = sqlFetchArray($bres)) {
1112                 $key = 0 + $brow['encounter'];
1113                 if (empty($encs[$key])) {
1114                     $encs[$key] = array('encounter' => $brow['encounter'], 'date' => $brow['encdate'], 'last_level_closed' => $brow['last_level_closed'], 'charges' => 0, 'payments' => 0, 'reason' => $brow['reason']
1115                     );
1116                 }
1117
1118                 if ($brow['code_type'] === 'COPAY') {
1119                 // $encs[$key]['payments'] -= $brow['fee'];
1120                 } else {
1121                     $encs[$key]['charges'] += $brow['fee'];
1122                     // Add taxes.
1123                     $sql_array = array();
1124                     $query = "SELECT taxrates FROM codes WHERE " . "code_type = ? AND " . "code = ? AND ";
1125                     array_push($sql_array, $code_types[$brow['code_type']]['id'], $brow['code']);
1126                     if ($brow['modifier']) {
1127                         $query .= "modifier = ?";
1128                         array_push($sql_array, $brow['modifier']);
1129                     } else {
1130                         $query .= "(modifier IS NULL OR modifier = '')";
1131                     }
1132
1133                     $query .= " LIMIT 1";
1134                     $trow = sqlQuery($query, $sql_array);
1135                     $encs[$key]['charges'] += calcTaxes($trow, $brow['fee']);
1136                 }
1137             }
1138
1139             // Do the same for unbilled product sales.
1140             //
1141             $query = "SELECT fe.encounter, fe.reason, s.drug_id, s.fee, " .
1142                 "LEFT(fe.date, 10) AS encdate,fe.last_level_closed " .
1143                 "FROM form_encounter AS fe left join drug_sales AS s " .
1144                 "on s.pid = ? AND s.fee != 0 " .
1145                 "AND fe.pid = s.pid AND fe.encounter = s.encounter " .
1146                 "where fe.pid = ? " . "ORDER BY s.encounter";
1147
1148             $dres = sqlStatement($query, array($pid, $pid));
1149             //
1150             while ($drow = sqlFetchArray($dres)) {
1151                 $key = 0 + $drow['encounter'];
1152                 if (empty($encs[$key])) {
1153                     $encs[$key] = array(
1154                         'encounter' => $drow['encounter'], 'date' => $drow['encdate'],
1155                         'last_level_closed' => $drow['last_level_closed'],
1156                         'charges' => 0, 'payments' => 0
1157                     );
1158                 }
1159
1160                 $encs[$key]['charges'] += $drow['fee'];
1161                 // Add taxes.
1162                 $trow = sqlQuery(
1163                     "SELECT taxrates FROM drug_templates WHERE drug_id = ? " .
1164                     "ORDER BY selector LIMIT 1",
1165                     array($drow['drug_id'])
1166                 );
1167                 $encs[$key]['charges'] += calcTaxes($trow, $drow['fee']);
1168             }
1169
1170             ksort($encs, SORT_NUMERIC);
1171
1172             foreach ($encs as $key => $value) {
1173                 $enc = $value['encounter'];
1174                 $reason = $value['reason'];
1175                 $dispdate = $value['date'];
1176
1177                 $inscopay = BillingUtilities::getCopay($pid, $dispdate);
1178                 $patcopay = BillingUtilities::getPatientCopay($pid, $enc);
1179                 // Insurance Payment
1180                 //
1181                 $drow = sqlQuery(
1182                     "SELECT  SUM(pay_amount) AS payments, " .
1183                     "SUM(adj_amount) AS adjustments FROM ar_activity WHERE " .
1184                     "deleted IS NULL AND pid = ? and encounter = ? AND " .
1185                     "payer_type != 0 AND account_code != 'PCP'",
1186                     array($pid, $enc)
1187                 );
1188                 $dpayment = $drow['payments'];
1189                 $dadjustment = $drow['adjustments'];
1190                 // Patient Payment
1191                 //
1192                 $drow = sqlQuery(
1193                     "SELECT  SUM(pay_amount) AS payments, SUM(adj_amount) AS adjustments " .
1194                     "FROM ar_activity WHERE deleted IS NULL AND pid = ? and encounter = ? and " .
1195                     "payer_type = 0 and account_code != 'PCP'",
1196                     array($pid, $enc)
1197                 );
1198                 $dpayment_pat = $drow['payments'];
1199
1200                 // NumberOfInsurance
1201                 //
1202                 $ResultNumberOfInsurance = sqlStatement(
1203                     "SELECT COUNT( DISTINCT TYPE ) NumberOfInsurance FROM insurance_data where pid = ? and provider>0 ",
1204                     array($pid)
1205                 );
1206                 $RowNumberOfInsurance = sqlFetchArray($ResultNumberOfInsurance);
1207                 $NumberOfInsurance = $RowNumberOfInsurance['NumberOfInsurance'] * 1;
1208                 $duept = 0;
1209                 if ((($NumberOfInsurance == 0 || $value['last_level_closed'] == 4 || $NumberOfInsurance == $value['last_level_closed']))) { // Patient balance
1210                     $brow = sqlQuery("SELECT SUM(fee) AS amount FROM billing WHERE " . "pid = ? and encounter = ? AND activity = 1", array($pid, $enc
1211                     ));
1212                     $srow = sqlQuery("SELECT SUM(fee) AS amount FROM drug_sales WHERE " . "pid = ? and encounter = ? ", array($pid, $enc
1213                     ));
1214                     $drow = sqlQuery(
1215                         "SELECT SUM(pay_amount) AS payments, SUM(adj_amount) AS adjustments " .
1216                         "FROM ar_activity WHERE deleted IS NULL AND pid = ? and encounter = ? ",
1217                         array($pid, $enc)
1218                     );
1219                     $duept = $brow['amount'] + $srow['amount'] - $drow['payments'] - $drow['adjustments'];
1220                 }
1221
1222                 echoLine("form_upay[$enc]", $dispdate, $value['charges'], $dpayment_pat, ($dpayment + $dadjustment), $duept, ($enc . ': ' . $reason), $inscopay, $patcopay);
1223             }
1224
1225             // Continue with display of the data entry form.
1226             ?>
1227             <tr>
1228                 <td class="dehead" align="center"><?php echo xlt('Total'); ?></td>
1229                 <td class="dehead" id='td_total_1' align="center"></td>
1230                 <td class="dehead" id='td_total_2' align="center"><?php echo text(bucks($sum_charges)) ?></td>
1231                 <td class="dehead" id='td_total_3' align="center"><?php echo text(bucks($sum_inspaid)) ?></td>
1232                 <td class="dehead" id='td_total_4' align="center"><?php echo text(bucks($sum_ptpaid)) ?></td>
1233                 <td class="dehead" id='td_total_5' align="center"><?php echo text(bucks($sum_patcopay)) ?></td>
1234                 <td class="dehead" id='td_total_6' align="center"><?php echo text(bucks($sum_copay)) ?></td>
1235                 <td class="dehead" id='td_total_7' align="center"><?php echo text(bucks($sum_balance)) ?></td>
1236                 <td class="dehead" id='td_total_8' align="center"><?php echo text(bucks($sum_duept)) ?></td>
1237                 <td class="dehead" align="center">
1238                     <input class="form-control" name='form_paytotal' id='form_paytotal' value='' style='color: #3b9204;' readonly />
1239                 </td>
1240             </tr>
1241         </table>
1242         <?php
1243         if (isset($ccdata["cardHolderName"])) {
1244             echo '<div class="col-5"><div class="card panel-default height">';
1245             if (!isset($_SESSION['authUserID'])) {
1246                 echo '<div class="card-heading">' . xlt("Payment Information") .
1247                     '<span style="color: #cc0000"><em> ' . xlt("Pending Auth since") . ': </em>' . text($edata["date"]) . '</span></div>';
1248             } else {
1249                 echo '<div class="card-heading">' . xlt("Audit Payment") .
1250                     '<span style="color: #cc0000"><em> ' . xlt("Pending since") . ': </em>' . text($edata["date"]) . '</span>' .
1251                     ' <button type="button" class="btn btn-warning btn-sm" onclick="getAuth()">' . xlt("Authorize") . '</button></div>';
1252             }
1253         } else {
1254             echo '<div style="display:none" class="col-6"><div class="card panel-default height">' .
1255                 '<div class="card-heading">' . xlt("Payment Information") . ' </div>';
1256         }
1257         ?>
1258         <div class="card-body">
1259             <span class="font-weight-bold"><?php echo xlt('Card Name'); ?>: </span><span id="cn"><?php echo text($ccdata["cc_type"]) ?></span><br />
1260             <span class="font-weight-bold"><?php echo xlt('Name on Card'); ?>: </span><span id="nc"><?php echo text($ccdata["cardHolderName"]) ?></span>
1261             <span class="font-weight-bold"><?php echo xlt('Card Holder Zip'); ?>: </span><span id="czip"><?php echo text($ccdata["zip"]) ?></span><br />
1262             <span class="font-weight-bold"><?php echo xlt('Card Number'); ?>: </span><span id="ccn">
1263         <?php
1264         if (isset($_SESSION['authUserID']) || isset($ccdata["transId"])) {
1265             echo text($ccdata["cardNumber"]) . "</span><br />";
1266         } else {
1267             echo "**********  " . text(substr($ccdata["cardNumber"], -4)) . "</span><br />";
1268         }
1269         ?>
1270         <?php
1271         if (!isset($ccdata["transId"])) { ?>
1272                 <span class="font-weight-bold"><?php echo xlt('Exp Date'); ?>:  </span><span id="ed"><?php echo text($ccdata["month"]) . "/" . text($ccdata["year"]) ?></span>
1273                 <span class="font-weight-bold"><?php echo xlt('CVV'); ?>:  </span><span id="cvvpin"><?php echo text($ccdata["cardCode"]) ?></span><br />
1274         <?php } else { ?>
1275                 <span class="font-weight-bold"><?php echo xlt('Transaction Id'); ?>:  </span><span id="ed"><?php echo text($ccdata["transId"]) . "/" . text($ccdata["year"]) ?></span>
1276                 <span class="font-weight-bold"><?php echo xlt('Authorization'); ?>:  </span><span id="cvvpin"><?php echo text($ccdata["authCode"]) ?></span><br />
1277         <?php } ?>
1278         <span class="font-weight-bold"><?php echo xlt('Charge Total'); ?>:  </span><span id="ct"><?php echo text($invdata["form_paytotal"]) ?></span><br />
1279         </div>
1280         </div>
1281         </div>
1282         <div>
1283         <?php
1284         if (!isset($_SESSION['authUserID'])) {
1285             if (!isset($ccdata["cardHolderName"])) {
1286                 echo '<button type="button" class="btn btn-primary" data-toggle="modal" data-target="#openPayModal">' . xlt("Pay Invoice") . '</button>';
1287             } else {
1288                 echo '<h4><span class="bg-danger">' . xlt("Locked Payment Pending") . '</span></h4>';
1289             }
1290         } else {
1291             echo "<button type='submit' class='btn btn-success' form='invoiceForm'>" . xlt('Post Payment') . "</button>";
1292         }
1293         ?>
1294         </div>
1295         <input type="hidden" name="hidden_patient_code" id="hidden_patient_code" value="<?php echo attr($pid); ?>"/>
1296         <input type='hidden' name='mode' id='mode' value=''/>
1297     </form>
1298
1299     <script>
1300         if (typeof jsondata !== 'undefined') {
1301             formRepopulate(jsondata);
1302         }
1303         calctotal();
1304     </script>
1305     <!-- credit payment modal -->
1306     <div id="openPayModal" class="modal fade" role="dialog">
1307         <div class="modal-dialog">
1308             <div class="modal-content">
1309                 <div class="modal-header">
1310                     <h4><?php echo xlt('Submit Payment for Authorization'); ?></h4>
1311                     <!--<button type="button" class="close" data-dismiss="modal">&times;</button>-->
1312                 </div>
1313                 <div class="modal-body">
1314                     <?php if ($GLOBALS['payment_gateway'] != 'Stripe') { ?>
1315                     <form id='paymentForm' method='post' action='<?php echo $GLOBALS["webroot"] ?>/portal/lib/paylib.php'>
1316                         <fieldset>
1317                             <div class="form-group">
1318                                 <label label-default="label-default"
1319                                        class="control-label"><?php echo xlt('Name on Card'); ?></label>
1320                                 <div class="controls">
1321                                     <input name="cardHolderName" id="cardHolderName" type="text" class="form-control" pattern="\w+ \w+.*" title="<?php echo xla('Fill your first and last name'); ?>" value="<?php echo attr($patdata['fname']) . ' ' . attr($patdata['lname']) ?>" />
1322                                 </div>
1323                             </div>
1324                             <div class="form-group">
1325                                 <label class="control-label"><?php echo xlt('Card Number'); ?></label>
1326                                 <div class="controls">
1327                                     <div class="row">
1328                                         <div class="col-sm-12">
1329                                             <input name="cardNumber" id="cardNumber" type="text" class="form-control inline col-sm-4" autocomplete="off" maxlength="19" pattern="\d" onchange="validateCC()" title="<?php echo xla('Card Number'); ?>" value="" />&nbsp;&nbsp;
1330                                             <h4 name="cardtype" id="cardtype" style="display: inline-block; color:#cc0000;"><?php echo xlt('Validating') ?></h4>
1331                                         </div>
1332                                     </div>
1333                                 </div>
1334                             </div>
1335                             <div class="form-group">
1336                                 <label label-default="label-default"><?php echo xlt('Card Expiry Date and Card Holders Zip'); ?></label>
1337                                 <div class="controls">
1338                                     <div class="row">
1339                                         <div class="col-md-4">
1340                                             <select name="month" id="expMonth" class="form-control">
1341                                                 <option value=""><?php echo xlt('Select Month'); ?></option>
1342                                                 <option value="01"><?php echo xlt('January'); ?></option>
1343                                                 <option value="02"><?php echo xlt('February'); ?></option>
1344                                                 <option value="03"><?php echo xlt('March'); ?></option>
1345                                                 <option value="04"><?php echo xlt('April'); ?></option>
1346                                                 <option value="05"><?php echo xlt('May'); ?></option>
1347                                                 <option value="06"><?php echo xlt('June'); ?></option>
1348                                                 <option value="07"><?php echo xlt('July'); ?></option>
1349                                                 <option value="08"><?php echo xlt('August'); ?></option>
1350                                                 <option value="09"><?php echo xlt('September'); ?></option>
1351                                                 <option value="10"><?php echo xlt('October'); ?></option>
1352                                                 <option value="11"><?php echo xlt('November'); ?></option>
1353                                                 <option value="12"><?php echo xlt('December'); ?></option>
1354                                             </select>
1355                                         </div>
1356                                         <div class="col-md-4">
1357                                             <select name="year" id="expYear" class="form-control">
1358                                                 <option value=""><?php echo xlt('Select Year'); ?></option>
1359                                                 <option value="2019">2019</option>
1360                                                 <option value="2020">2020</option>
1361                                                 <option value="2021">2021</option>
1362                                                 <option value="2022">2022</option>
1363                                                 <option value="2023">2023</option>
1364                                                 <option value="2024">2024</option>
1365                                                 <option value="2025">2025</option>
1366                                                 <option value="2026">2026</option>
1367                                                 <option value="2027">2027</option>
1368                                                 <option value="2028">2028</option>
1369                                             </select>
1370                                         </div>
1371                                         <div class="col-md-4">
1372                                             <input name="zip" id="cczip" type="text" class="form-control" pattern="\d" title="<?php echo xla('Enter Your Zip'); ?>" placeholder="<?php echo xla('Card Holder Zip'); ?>" value="<?php echo attr($patdata['postal_code']) ?>"/>
1373                                         </div>
1374                                     </div>
1375                                 </div>
1376                             </div>
1377                             <div class="form-group">
1378                                 <label label-default="label-default" class="control-label"><?php echo xlt('Card CVV'); ?></label>
1379                                 <div class="controls">
1380                                     <div class="row">
1381                                         <div class="col-md-3">
1382                                             <input name="cardCode" id="cardCode" type="text" class="form-control" autocomplete="off" maxlength="4" onfocus="validateCC()" title="<?php echo xla('Three or four digits at back of your card'); ?>" value="" />
1383                                         </div>
1384                                         <div class="col-md-3">
1385                                             <img src='./images/img_cvc.png' style='height: 40px; width: auto' />
1386                                         </div>
1387                                         <div class="col-md-6">
1388                                             <h4 style="display: inline-block;"><?php echo xlt('Payment Amount'); ?>:&nbsp;
1389                                                 <span class="font-weight-bold"><span id="payTotal"></span></span></h4>
1390                                         </div>
1391                                     </div>
1392                                 </div>
1393                             </div>
1394                             <input type='hidden' name='pid' id='pid' value='<?php echo attr($pid) ?>'/>
1395                             <input type='hidden' name='mode' id='mode' value=''/>
1396                             <input type='hidden' name='cc_type' id='cc_type' value=''/>
1397                             <input type='hidden' name='payment' id='paymentAmount' value=''/>
1398                             <input type='hidden' name='invValues' id='invValues' value=''/>
1399                             <input type="hidden" name="dataValue" id="dataValue" />
1400                             <input type="hidden" name="dataDescriptor" id="dataDescriptor" />
1401                         </fieldset>
1402                     </form>
1403                     <?php } else { ?>
1404                         <form method="post" name="payment-form" id="payment-form">
1405                             <fieldset>
1406                                 <div class="form-group">
1407                                     <label label-default="label-default"><?php echo xlt('Name on Card'); ?></label>
1408                                     <div class="controls">
1409                                         <input name="cardHolderName" id="cardHolderName" type="text" class="form-control" pattern="\w+ \w+.*" title="<?php echo xla('Fill your first and last name'); ?>" value="<?php echo attr($patdata['fname']) . ' ' . attr($patdata['lname']) ?>" />
1410                                     </div>
1411                                 </div>
1412                                 <div class="form-group">
1413                                     <label for="card-element"><?php echo xlt('Credit or Debit Card') ?></label>
1414                                     <div class="form-group" id="card-element"></div>
1415                                     <div id="card-errors" role="alert"></div>
1416                                 </div>
1417                                 <div class="col-md-6">
1418                                     <h4 style="display: inline-block;"><?php echo xlt('Payment Amount'); ?>:&nbsp;
1419                                         <strong><span id="payTotal"></span></strong></h4>
1420                                 </div>
1421                                 <input type='hidden' name='mode' id='mode' value=''/>
1422                                 <input type='hidden' name='cc_type' id='cc_type' value=''/>
1423                                 <input type='hidden' name='payment' id='paymentAmount' value=''/>
1424                                 <input type='hidden' name='invValues' id='invValues' value=''/>
1425                             </fieldset>
1426                         </form>
1427                     <?php } ?>
1428                 </div>
1429                 <!-- Body  -->
1430                 <div class="modal-footer">
1431                     <div class="button-group">
1432                         <button type="button" class="btn btn-secondary" data-dismiss="modal"><?php echo xlt('Cancel'); ?></button>
1433                         <?php
1434                         if ($GLOBALS['payment_gateway'] == 'InHouse') { ?>
1435                             <button id="paySubmit" class="btn btn-primary"><?php echo xlt('Send Payment'); ?></button>
1436                         <?php } elseif ($GLOBALS['payment_gateway'] == 'AuthorizeNet') { ?>
1437                             <button id="payAurhorizeNet" class="btn btn-primary"
1438                                     onclick="sendPaymentDataToAnet(event)"><?php echo xlt('Pay Now'); ?></button>
1439                         <?php }
1440                         if ($GLOBALS['payment_gateway'] == 'Stripe') { ?>
1441                             <button id="stripeSubmit" class="btn btn-primary"><?php echo xlt('Pay Now'); ?></button>
1442                                                 <?php } ?>
1443                     </div>
1444                 </div>
1445             </div>
1446         </div>
1447     </div>
1448     <script>
1449         var ccerr = <?php echo xlj('Invalid Credit Card Number'); ?>
1450
1451         // In House CC number Validation
1452         /*$('#cardNumber').validateCreditCard(function (result) {
1453             var r = (result.card_type === null ? '' : result.card_type.name.toUpperCase())
1454             var v = (result.valid === true ? ' Valid Number' : ' Validating')
1455             if (result.valid === true) {
1456                 document.getElementById("cardtype").style.color = "#00aa00";
1457             } else {
1458                 document.getElementById("cardtype").style.color = "#aa0000";
1459             }
1460             $('#cardtype').text(r + v);
1461         });*/
1462
1463         // In House CC Validation
1464         function validateCC() {
1465             var result = $('#cardNumber').validateCreditCard();
1466             var r = (result.card_type == null ? '' : result.card_type.name.toUpperCase())
1467             var v = (result.valid == true ? ' Valid Card Number' : ' Invalid Card Number')
1468             if (result.valid === true) {
1469                 document.getElementById("cardtype").style.color = "#00aa00";
1470             } else {
1471                 document.getElementById("cardtype").style.color = "#aa0000";
1472             }
1473             $('#cardtype').text(r + v);
1474             $('#cc_type').val(r);
1475             if (!result.valid) {
1476                 alert(ccerr);
1477                 return false;
1478             }
1479             else {
1480                 return true;
1481             }
1482         }
1483     </script>
1484
1485     <?php if ($GLOBALS['payment_gateway'] == 'AuthorizeNet' && isset($_SESSION['patient_portal_onsite_two'])) {
1486         // Include Authorize.Net dependency to tokenize card.
1487         // Will return a token to use for payment request keeping
1488         // credit info off the server.
1489         ?>
1490         <script>
1491             function sendPaymentDataToAnet(e) {
1492                 e.preventDefault();
1493                 const authData = {};
1494                 authData.clientKey = publicKey;
1495                 authData.apiLoginID = apiKey;
1496
1497                 const cardData = {};
1498                 cardData.cardNumber = document.getElementById("cardNumber").value;
1499                 cardData.month = document.getElementById("expMonth").value;
1500                 cardData.year = document.getElementById("expYear").value;
1501                 cardData.cardCode = document.getElementById("cardCode").value;
1502                 cardData.fullName = document.getElementById("cardHolderName").value;
1503                 cardData.zip = document.getElementById("cczip").value;
1504
1505                 const secureData = {};
1506                 secureData.authData = authData;
1507                 secureData.cardData = cardData;
1508
1509                 Accept.dispatchData(secureData, acceptResponseHandler);
1510
1511                 function acceptResponseHandler(response) {
1512                     if (response.messages.resultCode === "Error") {
1513                         let i = 0;
1514                         let errorMsg = '';
1515                         while (i < response.messages.message.length) {
1516                             errorMsg = errorMsg + response.messages.message[i].code + ": " +response.messages.message[i].text;
1517                             console.log(errorMsg);
1518                             i = i + 1;
1519                         }
1520                         alert(errorMsg);
1521                     } else {
1522                         paymentFormUpdate(response.opaqueData);
1523                     }
1524                 }
1525             }
1526
1527             function paymentFormUpdate(opaqueData) {
1528                 // this is card tokenized
1529                 document.getElementById("dataDescriptor").value = opaqueData.dataDescriptor;
1530                 document.getElementById("dataValue").value = opaqueData.dataValue;
1531                 let oForm = document.forms['paymentForm'];
1532                 oForm.elements['mode'].value = "AuthorizeNet";
1533                 let inv_values = JSON.stringify(getFormObj('invoiceForm'));
1534                 document.getElementById("invValues").value = inv_values;
1535
1536                 // empty out the fields before submitting to server.
1537                 document.getElementById("cardNumber").value = "";
1538                 document.getElementById("expMonth").value = "";
1539                 document.getElementById("expYear").value = "";
1540                 document.getElementById("cardCode").value = "";
1541
1542                 // Submit payment to server
1543                 fetch('./lib/paylib.php', {
1544                     method: 'POST',
1545                     body: new FormData(oForm)
1546                 }).then(function(response) {
1547                     if (!response.ok) {
1548                         throw Error(response.statusText);
1549                     }
1550                     return response.text();
1551                 }).then(function(data) {
1552                     if(data !== 'ok') {
1553                         alert(data);
1554                         return;
1555                     }
1556                     alert(chargeMsg);
1557                     window.location.reload(false);
1558                 }).catch(function(error) {
1559                     alert(error)
1560                 });
1561             }
1562         </script>
1563     <?php }  // end authorize.net ?>
1564
1565     <?php if ($GLOBALS['payment_gateway'] == 'Stripe' && isset($_SESSION['patient_portal_onsite_two'])) { // Begin Include Stripe ?>
1566         <script>
1567             const stripe = Stripe(publicKey);
1568             const elements = stripe.elements();// Custom styling can be passed to options when creating an Element.
1569             const style = {
1570                 base: {
1571                     color: '#32325d',
1572                     lineHeight: '1.2rem',
1573                     fontSmoothing: 'antialiased',
1574                     fontSize: '16px',
1575                     '::placeholder': {
1576                         color: '#8e8e8e'
1577                     }
1578                 },
1579                 invalid: {
1580                     color: '#fa755a',
1581                     iconColor: '#fa755a'
1582                 }
1583
1584             };
1585             // Create an instance of the card Element.
1586             const card = elements.create('card', {style: style});
1587             // Add an instance of the card Element into the `card-element` <div>.
1588             card.mount('#card-element');
1589             // Handle real-time validation errors from the card Element.
1590             card.addEventListener('change', function (event) {
1591                 let displayError = document.getElementById('card-errors');
1592                 if (event.error) {
1593                     displayError.textContent = event.error.message;
1594                 } else {
1595                     displayError.textContent = '';
1596                 }
1597             });
1598             // Handle form submission.
1599             let form = document.getElementById('stripeSubmit');
1600             form.addEventListener('click', function (event) {
1601                 event.preventDefault();
1602                 stripe.createToken(card).then(function (result) {
1603                     if (result.error) {
1604                         // Inform the user if there was an error.
1605                         let errorElement = document.getElementById('card-errors');
1606                         errorElement.textContent = result.error.message;
1607                     } else {
1608                         // Send the token to server.
1609                         stripeTokenHandler(result.token);
1610                     }
1611                 });
1612             });
1613             // Submit the form with the token ID.
1614             function stripeTokenHandler(token) {
1615                 // Insert the token ID into the form so it gets submitted to the server
1616                 let oForm = document.forms['payment-form'];
1617                 oForm.elements['mode'].value = "Stripe";
1618
1619                 let inv_values = JSON.stringify(getFormObj('invoiceForm'));
1620                 document.getElementById("invValues").value = inv_values;
1621
1622                 let hiddenInput = document.createElement('input');
1623                 hiddenInput.setAttribute('type', 'hidden');
1624                 hiddenInput.setAttribute('name', 'stripeToken');
1625                 hiddenInput.setAttribute('value', token.id);
1626                 oForm.appendChild(hiddenInput);
1627
1628                 // Submit payment to server
1629                 fetch('./lib/paylib.php', {
1630                     method: 'POST',
1631                     body: new FormData(oForm)
1632                 }).then(function(response) {
1633                     if (!response.ok) {
1634                         throw Error(response.statusText);
1635                     }
1636                     return response.text();
1637                 }).then(function(data) {
1638                     if(data !== 'ok') {
1639                         alert(data);
1640                         return;
1641                     }
1642                     alert(chargeMsg);
1643                     window.location.reload(false);
1644                 }).catch(function(error) {
1645                     alert(error)
1646                 });
1647             }
1648         </script>
1649     <?php } ?>
1650
1651     </body>
1652     <?php } // end else display ?>