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(__DIR__ . "/../interface/globals.php");
  28 } else {
  29     OpenEMR\Common\Session\SessionUtil::portalSessionCookieDestroy();
  30     $ignoreAuth = false;
  31     require_once(__DIR__ . "/../interface/globals.php");
  32     if (!isset($_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 use OpenEMR\PaymentProcessing\Sphere\SpherePayment;
  50
  51 $cryptoGen = new CryptoGen();
  52
  53 $appsql = new ApplicationTable();
  54 $pid = isset($_REQUEST['pid']) ? $_REQUEST['pid'] : $pid;
  55 $pid = $_REQUEST['hidden_patient_code'] > 0 ? $_REQUEST['hidden_patient_code'] : $pid;
  56 $recid = isset($_REQUEST['recid']) ? (int) $_REQUEST['recid'] : 0;
  57 $adminUser = '';
  58 $portalPatient = '';
  59
  60 $query = "SELECT pao.portal_username as recip_id, Concat_Ws(' ', patient_data.fname, patient_data.lname) as username FROM patient_data " .
  61     "LEFT JOIN patient_access_onsite pao ON pao.pid = patient_data.pid " .
  62     "WHERE patient_data.pid = ? AND pao.portal_pwd_status = 1";
  63 $portalPatient = sqlQueryNoLog($query, $pid);
  64 if ($_SESSION['authUserID']) {
  65     $query = "SELECT users.username as recip_id, users.authorized as dash, CONCAT(users.fname,' ',users.lname) as username  " .
  66         "FROM users WHERE id = ?";
  67     $adminUser = sqlQueryNoLog($query, $_SESSION['authUserID']);
  68 }
  69
  70 if ($recid) {
  71     $edata = $appsql->getPortalAuditRec($recid);
  72 } else {
  73     $edata = $appsql->getPortalAudit($pid, 'review', 'payment');
  74 }
  75 $ccdata = array();
  76 $invdata = array();
  77 if ($edata) {
  78     $ccdata = json_decode($cryptoGen->decryptStandard($edata['checksum']), true);
  79     $invdata = json_decode($edata['table_args'], true);
  80     echo "<script>var jsondata='" . $edata['table_args'] . "';var ccdata='" . $edata['checksum'] . "'</script>";
  81 }
  82
  83 function bucks($amount)
  84 {
  85     if ($amount) {
  86         $amount = oeFormatMoney($amount);
  87         return $amount;
  88     }
  89
  90     return '';
  91 }
  92
  93 function rawbucks($amount)
  94 {
  95     if ($amount) {
  96         $amount = sprintf("%.2f", $amount);
  97         return $amount;
  98     }
  99
 100     return '';
 101 }
 102
 103 // Display a row of data for an encounter.
 104 //
 105 $var_index = 0;
 106 $sum_charges = $sum_ptpaid = $sum_inspaid = $sum_duept = $sum_copay = $sum_patcopay = $sum_balance = 0;
 107 function echoLine($iname, $date, $charges, $ptpaid, $inspaid, $duept, $encounter = 0, $copay = 0, $patcopay = 0)
 108 {
 109     global $sum_charges, $sum_ptpaid, $sum_inspaid, $sum_duept, $sum_copay, $sum_patcopay, $sum_balance;
 110     global $var_index;
 111     $var_index++;
 112     $balance = bucks($charges - $ptpaid - $inspaid);
 113     $balance = (round($duept, 2) != 0) ? 0 : $balance; // if balance is due from patient, then insurance balance is displayed as zero
 114     $encounter = $encounter ? $encounter : '';
 115     echo " <tr id='tr_" . attr($var_index) . "' >\n";
 116     echo "  <td class='detail'>" . text(oeFormatShortDate($date)) . "</td>\n";
 117     echo "  <td class='detail' id='" . attr($date) . "' align='left'>" . text($encounter) . "</td>\n";
 118     echo "  <td class='detail' align='center' id='td_charges_$var_index' >" . text(bucks($charges)) . "</td>\n";
 119     echo "  <td class='detail' align='center' id='td_inspaid_$var_index' >" . text(bucks($inspaid * -1)) . "</td>\n";
 120     echo "  <td class='detail' align='center' id='td_ptpaid_$var_index' >" . text(bucks($ptpaid * -1)) . "</td>\n";
 121     echo "  <td class='detail' align='center' id='td_patient_copay_$var_index' >" . text(bucks($patcopay)) . "</td>\n";
 122     echo "  <td class='detail' align='center' id='td_copay_$var_index' >" . text(bucks($copay)) . "</td>\n";
 123     echo "  <td class='detail' align='center' id='balance_$var_index'>" . text(bucks($balance)) . "</td>\n";
 124     echo "  <td class='detail' align='center' id='duept_$var_index'>" . text(bucks(round($duept, 2) * 1)) . "</td>\n";
 125     echo "  <td class='detail' align='center'><input class='form-control' name='" . attr($iname) . "'  id='paying_" . attr($var_index) .
 126         "' " . " value='" . '' . "' onchange='coloring();calctotal()'  autocomplete='off' " . "onkeyup='calctotal()'/></td>\n";
 127     echo " </tr>\n";
 128
 129     $sum_charges += (float)$charges * 1;
 130     $sum_ptpaid += (float)$ptpaid * -1;
 131     $sum_inspaid += (float)$inspaid * -1;
 132     $sum_duept += (float)$duept * 1;
 133     $sum_patcopay += (float)$patcopay * 1;
 134     $sum_copay += (float)$copay * 1;
 135     $sum_balance += (float)$balance * 1;
 136 }
 137
 138 // We use this to put dashes, colons, etc. back into a timestamp.
 139 //
 140 function decorateString($fmt, $str)
 141 {
 142     $res = '';
 143     while ($fmt) {
 144         $fc = substr($fmt, 0, 1);
 145         $fmt = substr($fmt, 1);
 146         if ($fc == '.') {
 147             $res .= substr($str, 0, 1);
 148             $str = substr($str, 1);
 149         } else {
 150             $res .= $fc;
 151         }
 152     }
 153
 154     return $res;
 155 }
 156
 157 // Compute taxes from a tax rate string and a possibly taxable amount.
 158 //
 159 function calcTaxes($row, $amount)
 160 {
 161     $total = 0;
 162     if (empty($row['taxrates'])) {
 163         return $total;
 164     }
 165
 166     $arates = explode(':', $row['taxrates']);
 167     if (empty($arates)) {
 168         return $total;
 169     }
 170
 171     foreach ($arates as $value) {
 172         if (empty($value)) {
 173             continue;
 174         }
 175
 176         $trow = sqlQuery("SELECT option_value FROM list_options WHERE " . "list_id = 'taxrate' AND option_id = ? LIMIT 1", array($value
 177         ));
 178         if (empty($trow['option_value'])) {
 179             echo "<!-- Missing tax rate '" . text($value) . "'! -->\n";
 180             continue;
 181         }
 182
 183         $tax = sprintf("%01.2f", $amount * $trow['option_value']);
 184 // echo "<!-- Rate = '$value', amount = '$amount', tax = '$tax' -->\n";
 185         $total += $tax;
 186     }
 187
 188     return $total;
 189 }
 190
 191 $now = time();
 192 $today = date('Y-m-d', $now);
 193 $timestamp = date('Y-m-d H:i:s', $now);
 194
 195 $patdata = sqlQuery("SELECT " . "p.fname, p.mname, p.lname, p.postal_code, p.pubpid,p.pid, i.copay " . "FROM patient_data AS p " . "LEFT OUTER JOIN insurance_data AS i ON " . "i.pid = p.pid AND i.type = 'primary' " . "WHERE p.pid = ? ORDER BY i.date DESC LIMIT 1", array($pid
 196 ));
 197
 198 $alertmsg = ''; // anything here pops up in an alert box
 199
 200 // If the Save button was clicked...
 201 if ($_POST['form_save']) {
 202     $form_pid = $_POST['form_pid'];
 203     $form_method = trim($_POST['form_method']);
 204     $form_source = trim($_POST['form_source']);
 205     $patdata = getPatientData($form_pid, 'fname,mname,lname,pubpid');
 206     $NameNew = $patdata['fname'] . " " . $patdata['lname'] . " " . $patdata['mname'];
 207
 208     if ($_REQUEST['radio_type_of_payment'] == 'pre_payment') {
 209         $payment_id = sqlInsert(
 210             "insert into ar_session set " .
 211             "payer_id = ?" .
 212             ", patient_id = ?" .
 213             ", user_id = ?" .
 214             ", closed = ?" .
 215             ", reference = ?" .
 216             ", check_date =  now() , deposit_date = now() " .
 217             ",  pay_total = ?" .
 218             ", payment_type = 'patient'" .
 219             ", description = ?" .
 220             ", adjustment_code = 'pre_payment'" .
 221             ", post_to_date = now() " .
 222             ", payment_method = ?",
 223             array(0, $form_pid, $_SESSION['authUserID'], 0, $form_source, $_REQUEST['form_prepayment'], $NameNew, $form_method)
 224         );
 225
 226         frontPayment($form_pid, 0, $form_method, $form_source, $_REQUEST['form_prepayment'], 0, $timestamp);//insertion to 'payments' table.
 227     }
 228
 229     if ($_POST['form_upay'] && $_REQUEST['radio_type_of_payment'] != 'pre_payment') {
 230         foreach ($_POST['form_upay'] as $enc => $payment) {
 231             if ($amount = (float)$payment) {
 232                 $zero_enc = $enc;
 233
 234                 //----------------------------------------------------------------------------------------------------
 235                 //Fetching the existing code and modifier
 236                 $ResultSearchNew = sqlStatement(
 237                     "SELECT * FROM billing LEFT JOIN code_types ON billing.code_type=code_types.ct_key " .
 238                     "WHERE code_types.ct_fee=1 AND billing.activity!=0 AND billing.pid =? AND encounter=? ORDER BY billing.code,billing.modifier",
 239                     array($form_pid, $enc)
 240                 );
 241                 if ($RowSearch = sqlFetchArray($ResultSearchNew)) {
 242                     $Codetype = $RowSearch['code_type'];
 243                     $Code = $RowSearch['code'];
 244                     $Modifier = $RowSearch['modifier'];
 245                 } else {
 246                     $Codetype = '';
 247                     $Code = '';
 248                     $Modifier = '';
 249                 }
 250
 251                 //----------------------------------------------------------------------------------------------------
 252                 if ($_REQUEST['radio_type_of_payment'] == 'copay') {//copay saving to ar_session and ar_activity tables
 253                     $session_id = sqlInsert(
 254                         "INSERT INTO ar_session (payer_id,user_id,reference,check_date,deposit_date,pay_total," .
 255                         " global_amount,payment_type,description,patient_id,payment_method,adjustment_code,post_to_date) " .
 256                         " VALUES ('0',?,?,now(),now(),?,'','patient','COPAY',?,?,'patient_payment',now())",
 257                         array($_SESSION['authUserID'], $form_source, $amount, $form_pid, $form_method)
 258                     );
 259
 260                     sqlBeginTrans();
 261                     $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM       ar_activity WHERE pid = ? AND encounter = ?", array($form_pid, $enc));
 262                     $insrt_id = sqlInsert(
 263                         "INSERT INTO ar_activity (pid,encounter,sequence_no,code_type,code,modifier,payer_type,post_time,post_user,session_id,pay_amount,account_code)" .
 264                         " VALUES (?,?,?,?,?,?,0,now(),?,?,?,'PCP')",
 265                         array($form_pid, $enc, $sequence_no['increment'], $Codetype, $Code, $Modifier, $_SESSION['authUserID'], $session_id, $amount)
 266                     );
 267                     sqlCommitTrans();
 268
 269                     frontPayment($form_pid, $enc, $form_method, $form_source, $amount, 0, $timestamp);//insertion to 'payments' table.
 270                 }
 271
 272                 if ($_REQUEST['radio_type_of_payment'] == 'invoice_balance' || $_REQUEST['radio_type_of_payment'] == 'cash') {                //Payment by patient after insurance paid, cash patients similar to do not bill insurance in feesheet.
 273                     if ($_REQUEST['radio_type_of_payment'] == 'cash') {
 274                         sqlStatement(
 275                             "update form_encounter set last_level_closed=? where encounter=? and pid=? ",
 276                             array(4, $enc, $form_pid)
 277                         );
 278                         sqlStatement(
 279                             "update billing set billed=? where encounter=? and pid=?",
 280                             array(1, $enc, $form_pid)
 281                         );
 282                     }
 283
 284                     $adjustment_code = 'patient_payment';
 285                     $payment_id = sqlInsert(
 286                         "insert into ar_session set " .
 287                         "payer_id = ?" .
 288                         ", patient_id = ?" .
 289                         ", user_id = ?" .
 290                         ", closed = ?" .
 291                         ", reference = ?"   .
 292                         ", check_date =  now() , deposit_date = now() " .
 293                         ",  pay_total = ?" .
 294                         ", payment_type = 'patient'" .
 295                         ", description = ?" .
 296                         ", adjustment_code = ?" .
 297                         ", post_to_date = now() " .
 298                         ", payment_method = ?",
 299                         array(0, $form_pid, $_SESSION['authUserID'], 0, $form_source, $amount, $NameNew, $adjustment_code, $form_method)
 300                     );
 301
 302                     //--------------------------------------------------------------------------------------------------------------------
 303
 304                     frontPayment($form_pid, $enc, $form_method, $form_source, 0, $amount, $timestamp);//insertion to 'payments' table.
 305
 306                     //--------------------------------------------------------------------------------------------------------------------
 307
 308                     $resMoneyGot = sqlStatement(
 309                         "SELECT sum(pay_amount) as PatientPay FROM ar_activity where deleted IS NULL AND pid =? and " .
 310                         "encounter =? and payer_type=0 and account_code='PCP'",
 311                         array($form_pid, $enc)
 312                     );//new fees screen copay gives account_code='PCP'
 313                     $rowMoneyGot = sqlFetchArray($resMoneyGot);
 314                     $Copay = $rowMoneyGot['PatientPay'];
 315
 316                     //--------------------------------------------------------------------------------------------------------------------
 317
 318                     //Looping the existing code and modifier
 319                     $ResultSearchNew = sqlStatement(
 320                         "SELECT * FROM billing LEFT JOIN code_types ON billing.code_type=code_types.ct_key WHERE code_types.ct_fee=1 " .
 321                         "AND billing.activity!=0 AND billing.pid =? AND encounter=? ORDER BY billing.code,billing.modifier",
 322                         array($form_pid, $enc)
 323                     );
 324                     while ($RowSearch = sqlFetchArray($ResultSearchNew)) {
 325                         $Codetype = $RowSearch['code_type'];
 326                         $Code = $RowSearch['code'];
 327                         $Modifier = $RowSearch['modifier'];
 328                         $Fee = $RowSearch['fee'];
 329
 330                         $resMoneyGot = sqlStatement(
 331                             "SELECT sum(pay_amount) as MoneyGot FROM ar_activity where deleted IS NULL AND pid = ? " .
 332                             "and code_type=? and code=? and modifier=? and encounter =? and !(payer_type=0 and account_code='PCP')",
 333                             array($form_pid, $Codetype, $Code, $Modifier, $enc)
 334                         );
 335                         //new fees screen copay gives account_code='PCP'
 336                         $rowMoneyGot = sqlFetchArray($resMoneyGot);
 337                         $MoneyGot = $rowMoneyGot['MoneyGot'];
 338
 339                         $resMoneyAdjusted = sqlStatement(
 340                             "SELECT sum(adj_amount) as MoneyAdjusted FROM ar_activity where deleted IS NULL AND " .
 341                             "pid =? and code_type=? and code=? and modifier=? and encounter =?",
 342                             array($form_pid, $Codetype, $Code, $Modifier, $enc)
 343                         );
 344                         $rowMoneyAdjusted = sqlFetchArray($resMoneyAdjusted);
 345                         $MoneyAdjusted = $rowMoneyAdjusted['MoneyAdjusted'];
 346
 347                         $Remainder = $Fee - $Copay - $MoneyGot - $MoneyAdjusted;
 348                         $Copay = 0;
 349                         if (round($Remainder, 2) != 0 && $amount != 0) {
 350                             if ($amount - $Remainder >= 0) {
 351                                 $insert_value = $Remainder;
 352                                 $amount = $amount - $Remainder;
 353                             } else {
 354                                 $insert_value = $amount;
 355                                 $amount = 0;
 356                             }
 357
 358                             sqlBeginTrans();
 359                             $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($form_pid, $enc));
 360                             sqlStatement(
 361                                 "insert into ar_activity set " .
 362                                 "pid = ?" .
 363                                 ", encounter = ?" .
 364                                 ", sequence_no = ?" .
 365                                 ", code_type = ?" .
 366                                 ", code = ?" .
 367                                 ", modifier = ?" .
 368                                 ", payer_type = ?" .
 369                                 ", post_time = now() " .
 370                                 ", post_user = ?" .
 371                                 ", session_id = ?" .
 372                                 ", pay_amount = ?" .
 373                                 ", adj_amount = ?" .
 374                                 ", account_code = 'PP'",
 375                                 array($form_pid, $enc, $sequence_no['increment'], $Codetype, $Code, $Modifier, 0, $_SESSION['authUserID'], $payment_id, $insert_value, 0)
 376                             );
 377                             sqlCommitTrans();
 378                         }//if
 379                     }//while
 380                     if ($amount != 0) {//if any excess is there.
 381                         sqlBeginTrans();
 382                         $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($form_pid, $enc));
 383                         sqlStatement(
 384                             "insert into ar_activity set " .
 385                             "pid = ?" .
 386                             ", encounter = ?" .
 387                             ", sequence_no = ?" .
 388                             ", code_type = ?" .
 389                             ", code = ?" .
 390                             ", modifier = ?" .
 391                             ", payer_type = ?" .
 392                             ", post_time = now() " .
 393                             ", post_user = ?" .
 394                             ", session_id = ?" .
 395                             ", pay_amount = ?" .
 396                             ", adj_amount = ?" .
 397                             ", account_code = 'PP'",
 398                             array($form_pid, $enc, $sequence_no['increment'], $Codetype, $Code, $Modifier, 0, $_SESSION['authUserID'], $payment_id, $amount, 0)
 399                         );
 400                         sqlCommitTrans();
 401                     }
 402
 403                     //--------------------------------------------------------------------------------------------------------------------
 404                 }//invoice_balance
 405             }//if ($amount = 0 + $payment)
 406         }//foreach
 407     }//if ($_POST['form_upay'])
 408 }//if ($_POST['form_save'])
 409
 410 if ($_POST['form_save'] || $_REQUEST['receipt']) {
 411     if ($_REQUEST['receipt']) {
 412         $form_pid = $_GET['patient'];
 413         $timestamp = decorateString('....-..-.. ..:..:..', $_GET['time']);
 414     }
 415
 416 // Get details for what we guess is the primary facility.
 417     $frow = sqlQuery("SELECT * FROM facility " . "ORDER BY billing_location DESC, accepts_assignment DESC, id LIMIT 1");
 418
 419 // Get the patient's name and chart number.
 420     $patdata = getPatientData($form_pid, 'fname,mname,lname,pubpid');
 421
 422 // Re-fetch payment info.
 423     $payrow = sqlQuery("SELECT " . "SUM(amount1) AS amount1, " . "SUM(amount2) AS amount2, " . "MAX(method) AS method, " . "MAX(source) AS source, " . "MAX(dtime) AS dtime, " .
 424 // "MAX(user) AS user " .
 425         "MAX(user) AS user, " . "MAX(encounter) as encounter " . "FROM payments WHERE " . "pid = ? AND dtime = ?", array($form_pid, $timestamp
 426     ));
 427
 428 // Create key for deleting, just in case.
 429     $ref_id = ($_REQUEST['radio_type_of_payment'] == 'copay') ? $session_id : $payment_id;
 430     $payment_key = $form_pid . '.' . preg_replace('/[^0-9]/', '', $timestamp) . '.' . $ref_id;
 431
 432 // get facility from encounter
 433     $tmprow = sqlQuery("SELECT facility_id FROM form_encounter WHERE encounter = ?", array($payrow['encounter']));
 434     $frow = sqlQuery("SELECT * FROM facility " . " WHERE id = ?", array($tmprow['facility_id']
 435     ));
 436
 437 // Now proceed with printing the receipt.
 438     ?>
 439
 440     <title><?php echo xlt('Receipt for Payment'); ?></title>
 441     <script src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery/dist/jquery.min.js"></script>
 442     <script>
 443
 444         function goHome() {
 445             window.location.replace("./patient/onsiteactivityviews");
 446         }
 447
 448         function notifyPatient() {
 449             let pid = <?php echo js_escape($pid); ?>;
 450             let note = $('#pop_receipt').html();
 451             let formURL = './messaging/handle_note.php';
 452             let owner = <?php echo js_escape($adminUser['recip_id']); ?>;
 453             let sn = <?php echo js_escape($adminUser['username']); ?>;
 454             let rid = <?php echo js_escape($portalPatient['recip_id']); ?>;
 455             let rn = <?php echo js_escape($portalPatient['username']); ?>;
 456             $.ajax({
 457                 url: formURL,
 458                 type: "POST",
 459                 data: {
 460                     'task': 'add',
 461                     'owner': owner,
 462                     'pid': pid,
 463                     'inputBody': note,
 464                     'title': 'Bill/Collect',
 465                     'recipient_name': rn,
 466                     'recipient_id': rid,
 467                     'sender_id': owner,
 468                     'sender_name': sn
 469                 },
 470                 success: function (data, textStatus, jqXHR) {
 471                     alert('Receipt sent to patient via Messages.')
 472                 },
 473                 error: function (jqXHR, status, error) {
 474                     console.log(status + ": " + error);
 475                 }
 476             });
 477         }
 478     </script>
 479     <?php
 480     ob_start();
 481     echo '<htlm><head></head><body style="text-align: center; margin: auto;">';
 482     ?>
 483     <div id='pop_receipt' style='display: block'>
 484         <p>
 485         <h2><?php echo xlt('Receipt for Payment'); ?></h2>
 486         <p><?php echo text($frow['name']) ?>
 487             <br /><?php echo text($frow['street']) ?>
 488             <br /><?php echo text($frow['city'] . ', ' . $frow['state']) . ' ' . text($frow['postal_code']) ?>
 489             <br /><?php echo text($frow['phone']) ?>
 490         <p>
 491         <div class="text-center" style="margin: auto;">
 492             <table border='0' cellspacing='8' class="text-center" style="margin: auto;">
 493                 <tr>
 494                     <td><?php echo xlt('Date'); ?>:</td>
 495                     <td><?php echo text(oeFormatSDFT(strtotime($payrow['dtime']))) ?></td>
 496                 </tr>
 497                 <tr>
 498                     <td><?php echo xlt('Patient'); ?>:</td>
 499                     <td><?php echo text($patdata['fname']) . " " . text($patdata['mname']) . " " . text($patdata['lname']) . " (" . text($patdata['pubpid']) . ")" ?></td>
 500                 </tr>
 501                 <tr>
 502                     <td><?php echo xlt('Paid Via'); ?>:</td>
 503                     <td><?php echo generate_display_field(array('data_type' => '1', 'list_id' => 'payment_method'), $payrow['method']); ?></td>
 504                 </tr>
 505                 <tr>
 506                     <td><?php echo xlt('Authorized Id'); ?>:</td>
 507                     <td><?php echo text($payrow['source']) ?></td>
 508                 </tr>
 509                 <tr>
 510                     <td><?php echo xlt('Amount for This Visit'); ?>:</td>
 511                     <td><?php echo text(oeFormatMoney($payrow['amount1'])) ?></td>
 512                 </tr>
 513                 <tr>
 514                     <td><?php echo xlt('Amount for Past Balance'); ?>:</td>
 515                     <td><?php echo text(oeFormatMoney($payrow['amount2'])) ?></td>
 516                 </tr>
 517                 <tr>
 518                     <td><?php echo xlt('Received By'); ?>:</td>
 519                     <td><?php echo text($payrow['user']) ?></td>
 520                 </tr>
 521             </table>
 522         </div>
 523     </div>
 524     <button class='btn btn-sm' type='button' onclick='goHome()' id='returnhome'><?php echo xla('Return Home'); ?></button>
 525     <button class='btn btn-sm' type='button' onclick="notifyPatient()"><?php echo xla('Notify Patient'); ?></button>
 526     </body></html>
 527     <?php
 528     ob_end_flush();
 529 } else {
 530 //
 531 // Here we display the form for data entry.
 532 //
 533     ?>
 534     <title><?php echo xlt('Record Payment'); ?></title>
 535     <style>
 536         .dehead {
 537             color: #000000;
 538             font-weight: bold
 539         }
 540         .detail {
 541             padding: 1px 1px;
 542             color: #000000;
 543             font-weight: normal
 544         }
 545     </style>
 546     <script src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-creditcardvalidator/jquery.creditCardValidator.js"></script>
 547     <script src="<?php echo $GLOBALS['webroot'] ?>/library/textformat.js?v=<?php echo $v_js_includes; ?>"></script>
 548     <script>
 549         var chargeMsg = <?php $amsg = xl('Payment was successfully authorized and your card is charged.') . "\n" .
 550                 xl("You will be notified when your payment is applied for this invoice.") . "\n" .
 551                 xl('Until then you will continue to see payment details here.') . "\n" . xl('Thank You.');
 552             echo json_encode($amsg);
 553         ?>;
 554         var publicKey = <?php echo json_encode($cryptoGen->decryptStandard($GLOBALS['gateway_public_key'])); ?>;
 555         var apiKey = <?php echo json_encode($cryptoGen->decryptStandard($GLOBALS['gateway_api_key'])); ?>;
 556
 557         function calctotal() {
 558             var flag = 0;
 559             var f = document.forms["invoiceForm"];
 560             var total = 0;
 561             for (var i = 0; i < f.elements.length; ++i) {
 562                 var elem = f.elements[i];
 563                 var ename = elem.name;
 564                 if (ename.indexOf('form_upay[') == 0 || ename.indexOf('form_bpay[') == 0) {
 565                     if (elem.value.length > 0) {
 566                         total += Number(elem.value);
 567                         if (total < 0) flag = 1;
 568                     }
 569                 }
 570             }
 571             f.form_paytotal.value = Number(total).toFixed(2);
 572             if (flag) {
 573                 $('#invoiceForm')[0].reset();
 574                 alert(<?php echo xlj('Negative payments not accepted'); ?>)
 575             }
 576             return true;
 577         }
 578
 579         function coloring() {
 580             for (var i = 1; ; ++i) {
 581                 if (document.getElementById('paying_' + i)) {
 582                     paying = document.getElementById('paying_' + i).value * 1;
 583                     patient_balance = document.getElementById('duept_' + i).innerHTML * 1;
 584                     if (patient_balance > 0 && paying > 0) {
 585                         if (paying > patient_balance) {
 586                             document.getElementById('paying_' + i).style.background = '#FF0000';
 587                         }
 588                         else if (paying < patient_balance) {
 589                             document.getElementById('paying_' + i).style.background = '#99CC00';
 590                         }
 591                         else if (paying == patient_balance) {
 592                             document.getElementById('paying_' + i).style.background = '#ffffff';
 593                         }
 594                     }
 595                     else {
 596                         document.getElementById('paying_' + i).style.background = '#ffffff';
 597                     }
 598                 }
 599                 else {
 600                     break;
 601                 }
 602             }
 603         }
 604
 605         function CheckVisible(MakeBlank) {//Displays and hides the check number text box.
 606             if (document.getElementById('form_method').options[document.getElementById('form_method').selectedIndex].value == 'check_payment' ||
 607                 document.getElementById('form_method').options[document.getElementById('form_method').selectedIndex].value == 'bank_draft') {
 608                 document.getElementById('check_number').disabled = false;
 609             }
 610             else {
 611                 document.getElementById('check_number').disabled = true;
 612             }
 613         }
 614
 615         function validate() {
 616             var f = document.forms["invoiceForm"];
 617             ok = -1;
 618 //no checks taken here....
 619             issue = 'no';
 620             if (document.getElementById('radio_type_of_payment_self1').checked == false &&
 621                 document.getElementById('radio_type_of_payment1').checked == false
 622                 && document.getElementById('radio_type_of_payment2').checked == false
 623                 && document.getElementById('radio_type_of_payment4').checked == false) {
 624                 alert("<?php //echo addslashes( xl('Please Select Type Of Payment.')) ?>");
 625                 return false;
 626             }
 627             if (document.getElementById('radio_type_of_payment_self1').checked == true || document.getElementById('radio_type_of_payment1').checked == true) {
 628                 for (var i = 0; i < f.elements.length; ++i) {
 629                     var elem = f.elements[i];
 630                     var ename = elem.name;
 631                     if (ename.indexOf('form_upay[0') == 0) //Today is this text box.
 632                     {
 633                         if (elem.value * 1 > 0) {//A warning message, if the amount is posted with out encounter.
 634                             if (confirm(<?php echo xlj('Are you sure to post for today?'); ?>)) {
 635                                 ok = 1;
 636                             }
 637                             else {
 638                                 elem.focus();
 639                                 return false;
 640                             }
 641                         }
 642                         break;
 643                     }
 644                 }
 645             }
 646             else if (document.getElementsByName('form_paytotal')[0].value <= 0)//total 0
 647             {
 648                 alert(<?php echo xlj('Invalid Total!'); ?>)
 649                 return false;
 650             }
 651             if (ok == -1) {
 652                 if (confirm(<?php echo xlj('Payment Validated: Save?'); ?>)) {
 653                     return true;
 654                 }
 655                 else {
 656                     return false;
 657                 }
 658             }
 659         }
 660
 661         function cursor_pointer() {//Point the cursor to the latest encounter(Today)
 662             var f = document.forms["invoiceForm"];
 663             var total = 0;
 664             for (var i = 0; i < f.elements.length; ++i) {
 665                 var elem = f.elements[i];
 666                 var ename = elem.name;
 667                 if (ename.indexOf('form_upay[') == 0) {
 668                     elem.focus();
 669                     break;
 670                 }
 671             }
 672         }
 673
 674         function make_it_hide_enc_pay() {
 675             document.getElementById('td_head_insurance_payment').style.display = "none";
 676             document.getElementById('td_head_patient_co_pay').style.display = "none";
 677             document.getElementById('td_head_co_pay').style.display = "none";
 678             document.getElementById('td_head_insurance_balance').style.display = "none";
 679             for (var i = 1; ; ++i) {
 680                 var td_inspaid_elem = document.getElementById('td_inspaid_' + i)
 681                 var td_patient_copay_elem = document.getElementById('td_patient_copay_' + i)
 682                 var td_copay_elem = document.getElementById('td_copay_' + i)
 683                 var balance_elem = document.getElementById('balance_' + i)
 684                 if (td_inspaid_elem) {
 685                     td_inspaid_elem.style.display = "none";
 686                     td_patient_copay_elem.style.display = "none";
 687                     td_copay_elem.style.display = "none";
 688                     balance_elem.style.display = "none";
 689                 }
 690                 else {
 691                     break;
 692                 }
 693             }
 694             document.getElementById('td_total_4').style.display = "none";
 695             document.getElementById('td_total_7').style.display = "none";
 696             document.getElementById('td_total_8').style.display = "none";
 697             document.getElementById('td_total_6').style.display = "none";
 698
 699             document.getElementById('table_display').width = "420px";
 700         }
 701
 702         function make_visible() {
 703             document.getElementById('td_head_rep_doc').style.display = "";
 704             document.getElementById('td_head_description').style.display = "";
 705             document.getElementById('td_head_total_charge').style.display = "none";
 706             document.getElementById('td_head_insurance_payment').style.display = "none";
 707             document.getElementById('td_head_patient_payment').style.display = "none";
 708             document.getElementById('td_head_patient_co_pay').style.display = "none";
 709             document.getElementById('td_head_co_pay').style.display = "none";
 710             document.getElementById('td_head_insurance_balance').style.display = "none";
 711             document.getElementById('td_head_patient_balance').style.display = "none";
 712             for (var i = 1; ; ++i) {
 713                 var td_charges_elem = document.getElementById('td_charges_' + i)
 714                 var td_inspaid_elem = document.getElementById('td_inspaid_' + i)
 715                 var td_ptpaid_elem = document.getElementById('td_ptpaid_' + i)
 716                 var td_patient_copay_elem = document.getElementById('td_patient_copay_' + i)
 717                 var td_copay_elem = document.getElementById('td_copay_' + i)
 718                 var balance_elem = document.getElementById('balance_' + i)
 719                 var duept_elem = document.getElementById('duept_' + i)
 720                 if (td_charges_elem) {
 721                     td_charges_elem.style.display = "none";
 722                     td_inspaid_elem.style.display = "none";
 723                     td_ptpaid_elem.style.display = "none";
 724                     td_patient_copay_elem.style.display = "none";
 725                     td_copay_elem.style.display = "none";
 726                     balance_elem.style.display = "none";
 727                     duept_elem.style.display = "none";
 728                 }
 729                 else {
 730                     break;
 731                 }
 732             }
 733             document.getElementById('td_total_7').style.display = "";
 734             document.getElementById('td_total_8').style.display = "";
 735             document.getElementById('td_total_1').style.display = "none";
 736             document.getElementById('td_total_2').style.display = "none";
 737             document.getElementById('td_total_3').style.display = "none";
 738             document.getElementById('td_total_4').style.display = "none";
 739             document.getElementById('td_total_5').style.display = "none";
 740             document.getElementById('td_total_6').style.display = "none";
 741
 742             document.getElementById('table_display').width = "505px";
 743         }
 744
 745         function make_it_hide() {
 746             document.getElementById('td_head_rep_doc').style.display = "none";
 747             document.getElementById('td_head_description').style.display = "none";
 748             document.getElementById('td_head_total_charge').style.display = "";
 749             document.getElementById('td_head_insurance_payment').style.display = "";
 750             document.getElementById('td_head_patient_payment').style.display = "";
 751             document.getElementById('td_head_patient_co_pay').style.display = "";
 752             document.getElementById('td_head_co_pay').style.display = "";
 753             document.getElementById('td_head_insurance_balance').style.display = "";
 754             document.getElementById('td_head_patient_balance').style.display = "";
 755             for (var i = 1; ; ++i) {
 756                 var td_charges_elem = document.getElementById('td_charges_' + i)
 757                 var td_inspaid_elem = document.getElementById('td_inspaid_' + i)
 758                 var td_ptpaid_elem = document.getElementById('td_ptpaid_' + i)
 759                 var td_patient_copay_elem = document.getElementById('td_patient_copay_' + i)
 760                 var td_copay_elem = document.getElementById('td_copay_' + i)
 761                 var balance_elem = document.getElementById('balance_' + i)
 762                 var duept_elem = document.getElementById('duept_' + i)
 763                 if (td_charges_elem) {
 764                     td_charges_elem.style.display = "";
 765                     td_inspaid_elem.style.display = "";
 766                     td_ptpaid_elem.style.display = "";
 767                     td_patient_copay_elem.style.display = "";
 768                     td_copay_elem.style.display = "";
 769                     balance_elem.style.display = "";
 770                     duept_elem.style.display = "";
 771                 }
 772                 else {
 773                     break;
 774                 }
 775             }
 776             document.getElementById('td_total_1').style.display = "";
 777             document.getElementById('td_total_2').style.display = "";
 778             document.getElementById('td_total_3').style.display = "";
 779             document.getElementById('td_total_4').style.display = "";
 780             document.getElementById('td_total_5').style.display = "";
 781             document.getElementById('td_total_6').style.display = "";
 782             document.getElementById('td_total_7').style.display = "";
 783             document.getElementById('td_total_8').style.display = "";
 784
 785             document.getElementById('table_display').width = "100%";
 786         }
 787
 788         function make_visible_radio() {
 789             document.getElementById('tr_radio1').style.display = "";
 790             document.getElementById('tr_radio2').style.display = "none";
 791         }
 792
 793         function make_hide_radio() {
 794             document.getElementById('tr_radio1').style.display = "none";
 795             document.getElementById('tr_radio2').style.display = "";
 796         }
 797
 798         function make_visible_row() {
 799             document.getElementById('table_display').style.display = "";
 800             document.getElementById('table_display_prepayment').style.display = "none";
 801         }
 802
 803         function make_hide_row() {
 804             document.getElementById('table_display').style.display = "none";
 805             document.getElementById('table_display_prepayment').style.display = "";
 806         }
 807
 808         function make_self() {
 809             make_visible_row();
 810             make_it_hide();
 811             make_it_hide_enc_pay();
 812             document.getElementById('radio_type_of_payment_self1').checked = true;
 813             cursor_pointer();
 814         }
 815
 816         function make_insurance() {
 817             make_visible_row();
 818             make_it_hide();
 819             cursor_pointer();
 820             document.getElementById('radio_type_of_payment1').checked = true;
 821         }
 822
 823         $('#paySubmit').click(function (e) {
 824             e.preventDefault();e.stopPropagation();
 825             $("#mode").val("portal-save");
 826             let inv_values = JSON.stringify(getFormObj('invoiceForm'));
 827             let extra_values = JSON.stringify(getFormObj('paymentForm'));
 828             let extra = "&inv_values=" + encodeURIComponent(inv_values) + "&extra_values=" + encodeURIComponent(extra_values);
 829             let flag = 0
 830             let liburl = './lib/paylib.php';
 831             $.ajax({
 832                 type: "POST",
 833                 url: liburl,
 834                 data: $("#invoiceForm").serialize() + extra,
 835                 beforeSend: function (xhr) {
 836                     if (validateCC() !== true) return false;
 837                     if ($('#cardCode').val() == "" || $('#cardHolderName').val() == "" || $('#expYear').val() == "" || $('#expMonth').val() == "") {
 838                         alert(<?php echo xlj('Invalid Credit Card Values: Please correct'); ?>)
 839                         return false;
 840                     }
 841                     if (validate() != true) {
 842                         flag = 1;
 843                         alert(<?php echo xlj('Validation error: Fix and resubmit. This popup info is preserved!'); ?>)
 844                         return false;
 845                     }
 846                     $("#openPayModal .close").click()
 847                 },
 848                 error: function (qXHR, textStatus, errorThrow) {
 849                     console.log("There was an error:" + errorThrow);
 850                 },
 851                 success: function (templateHtml, textStatus, jqXHR) {
 852                     let msg = <?php $amsg = xl('Payment successfully sent for review and posting to your account.') . "\n" .
 853                         xl("You will be notified when the payment transaction is confirmed.") . "\n" .
 854                         xl('Until then you will continue to see payment details here.') . "\n" . xl('Thank You.');
 855                         echo json_encode($amsg); // backward compatable 5.0.1
 856                     ?>;
 857                     alert(msg);
 858                     window.location.reload(false);
 859                 }
 860             });
 861             if (flag) {
 862                 $("#openPayModal .close").click();
 863             }
 864         });
 865
 866         $('#openPayModal').on('show.bs.modal', function () {
 867             let total = $("#form_paytotal").val();
 868             if(Number(total) < 1) {
 869                 let error = <?php echo json_encode("Please enter a payment amount"); ?>;
 870                 alert(error);
 871                 return false;
 872             }
 873             $("#payTotal").text(total);
 874             $("#paymentAmount").val(total);
 875         });
 876
 877         $("#invoiceForm").on('submit', function (e) {
 878             e.preventDefault();
 879             let thisform = this;
 880             $("#mode").val("review-save");
 881             let inv_values = JSON.stringify(getFormObj('invoiceForm'));
 882             let extra_values = JSON.stringify(getFormObj('paymentForm'));
 883             let extra = "&inv_values=" + inv_values + "&extra_values=" + extra_values;
 884
 885             let flag = 0
 886             let liburl = '<?php echo $GLOBALS["webroot"] ?>/portal/lib/paylib.php';
 887             $.ajax({
 888                 type: "POST",
 889                 url: liburl,
 890                 data: $("#invoiceForm").serialize() + extra,
 891                 beforeSend: function (xhr) {
 892                     if (validate() != true) {
 893                         flag = 1;
 894                         alert(<?php echo xlj('Validation error: Fix and resubmit.'); ?>)
 895                         return false;
 896                     }
 897                 },
 898                 error: function (xhr, textStatus, error) {
 899                     alert(<?php echo xlj('There is a Post error'); ?>)
 900                     console.log("There was an error:" + textStatus);
 901                     return false;
 902                 },
 903                 success: function (templateHtml, textStatus, jqXHR) {
 904                     thisform.submit();
 905                 }
 906             });
 907         });
 908
 909         function getFormObj(formId) {
 910             let formObj = {};
 911             let inputs = $('#' + formId).serializeArray();
 912             $.each(inputs, function (i, input) {
 913                 formObj[input.name] = input.value;
 914             });
 915             return formObj;
 916         }
 917
 918         function formRepopulate(jsondata) {
 919             let data = $.parseJSON(jsondata);
 920             $.each(data, function (name, val) {
 921                 let $el = $('[name="' + name + '"]'),
 922                     type = $el.attr('type');
 923                 switch (type) {
 924                     case 'checkbox':
 925                         $el.prop('checked', true);
 926                         break;
 927                     case 'radio':
 928                         $el.filter('[value="' + val + '"]').prop('checked', true);
 929                         break;
 930                     default:
 931                         $el.val(val);
 932                 }
 933             });
 934         }
 935
 936         function getAuth() {
 937             let authnum = document.getElementById("check_number").value;
 938             authnum = prompt(<?php echo xlj('Please enter card comfirmation authorization'); ?>, authnum);
 939             if (authnum != null) {
 940                 document.getElementById("check_number").value = authnum;
 941             }
 942         }
 943     </script>
 944
 945     <body class="skin-blue" onunload='imclosing()' onLoad="cursor_pointer();"
 946           style="text-align: center; margin: auto;">
 947
 948     <form id="invoiceForm" method='post' action='<?php echo $GLOBALS["webroot"] ?>/portal/portal_payment.php'>
 949         <input type='hidden' name='form_pid' value='<?php echo attr($pid) ?>'/>
 950         <input type='hidden' name='form_save' value='<?php echo xla('Invoice'); ?>'/>
 951         <table>
 952             <tr height="10">
 953                 <td colspan="3">&nbsp;</td>
 954             </tr>
 955             <tr>
 956                 <td colspan='3' align='center' class='text'>
 957                     <b><?php echo xlt('Accept Payment for'); ?>&nbsp;:&nbsp;&nbsp;<?php
 958                     echo text($patdata['fname']) . " " .
 959                         text($patdata['lname']) . " " .
 960                         text($patdata['mname']) . " (" .
 961                         text($patdata['pid']) . ")" ?></b>
 962                     <?php $NameNew = $patdata['fname'] . " " . $patdata['lname'] . " " . $patdata['mname']; ?>
 963                 </td>
 964             </tr>
 965             <tr height="15">
 966                 <td colspan='3'></td>
 967             </tr>
 968             <tr>
 969                 <td class='text'>
 970                     <?php echo xlt('Payment Method'); ?>:
 971                 </td>
 972                 <td colspan='2'><select name="form_method" id="form_method" class="form-control" onChange='CheckVisible("yes")'>
 973                         <?php
 974                         $query1112 = "SELECT * FROM list_options where list_id=?  ORDER BY seq, title ";
 975                         $bres1112 = sqlStatement($query1112, array('payment_method'));
 976                         while ($brow1112 = sqlFetchArray($bres1112)) {
 977                             if ($brow1112['option_id'] != 'credit_card' || $brow1112['option_id'] == 'debit' || $brow1112['option_id'] == 'bank_draft') {
 978                                 continue;
 979                             }
 980                             echo "<option value='" . attr($brow1112['option_id']) . "'>" .
 981                                 text(xl_list_label($brow1112['title'])) . "</option>";
 982                         }
 983                         ?>
 984                     </select></td>
 985             </tr>
 986             <?php if (isset($_SESSION['authUserID'])) { ?>
 987                 <tr height="5">
 988                     <td colspan='3'></td>
 989                 </tr>
 990                 <tr>
 991                     <td class='text'>
 992                         <?php echo xlt('Authorized'); ?>:
 993                     </td>
 994                     <td colspan='2'>
 995                         <?php if ($ccdata['authCode'] && empty($payrow['source'])) {
 996                             $payrow['source'] = $ccdata['authCode'] . " : " . $ccdata['transId'];
 997                         }
 998                         ?>
 999                         <input class="form-control form-control-sm" id='check_number' name='form_source' style='' value='<?php echo attr($payrow['source']) ?>' />
1000                     </td>
1001                 </tr>
1002             <?php } ?>
1003                 <?php if (isset($_SESSION['authUserID'])) {
1004                         $hide = '';
1005                         echo '<tr height="5"><td colspan="3"></td></tr><tr">';
1006                 } else {
1007                     $hide = 'hidden';
1008                     echo '<tr class="hidden">';
1009                 }
1010                 ?>
1011                 <td class='text' valign="middle">
1012                     <?php echo xlt('Patient Coverage'); ?>:
1013                 </td>
1014                 <td class='text' colspan="2">
1015                     <input type="radio" name="radio_type_of_coverage" id="radio_type_of_coverage1"
1016                            value="self" onClick="make_visible_radio();make_self();"/>
1017                     <?php echo xlt('Self'); ?>
1018                     <input type="radio" name="radio_type_of_coverage" id="radio_type_of_coverag2" value="insurance"
1019                            checked="checked"
1020                            onClick="make_hide_radio();make_insurance();"/>
1021                     <?php echo xlt('Insurance'); ?>
1022                 </td>
1023             </tr>
1024             <tr height="5">
1025                 <td colspan='3'></td>
1026             </tr>
1027             <tr id="tr_radio1" style="display: none">
1028                 <!-- For radio Insurance -->
1029                 <td class='text' valign="top">
1030                     <?php echo xlt('Payment against'); ?>:
1031                 </td>
1032                 <td class='text' colspan="2">
1033                     <input type="radio" name="radio_type_of_payment" id="radio_type_of_payment_self1"
1034                            value="cash" onClick="make_visible_row();make_it_hide_enc_pay();cursor_pointer();"/>
1035                     <?php echo xlt('Encounter Payment'); ?>
1036                 </td>
1037             </tr>
1038             <tr id="tr_radio2">
1039                 <!-- For radio self -->
1040                 <td class='text' valign="top"><?php echo xlt('Payment against'); ?>:</td>
1041                 <td class='text' colspan="2">
1042                     <input type="radio" name="radio_type_of_payment" id="radio_type_of_payment1" class="<?php echo $hide ? $hide : ''; ?>"
1043                            value="copay" onClick="make_visible_row();cursor_pointer();"/><?php echo !$hide ? xlt('Co Pay') : ''; ?>
1044                     <input type="radio" name="radio_type_of_payment" id="radio_type_of_payment2" checked="checked"
1045                            value="invoice_balance" onClick="make_visible_row();"/><?php echo xlt('Invoice Balance'); ?>
1046                     <input type="radio" name="radio_type_of_payment" id="radio_type_of_payment4" value="pre_payment"
1047                            onClick="make_hide_row();"/><?php echo xlt('Pre Pay'); ?>
1048                 </td>
1049             </tr>
1050             <tr height="15">
1051                 <td colspan='3'></td>
1052             </tr>
1053         </table>
1054         <table width="20%" border="0" cellspacing="0" cellpadding="0" id="table_display_prepayment" style="margin-bottom: 10px; display: none">
1055             <tr>
1056                 <td class='detail'><?php echo xlt('Pre Payment'); ?></td>
1057                 <td><input class="form-control" type='text' id= 'form_prepayment' name='form_prepayment' style=''/></td>
1058             </tr>
1059         </table>
1060         <table id="table_display" style="background: #eee;" class="table table-sm table-striped table-bordered w-100">
1061             <thead>
1062             </thead>
1063             <tbody>
1064             <tr bgcolor="#cccccc" id="tr_head">
1065                 <td class="dehead" width="60">
1066                     <?php echo xlt('DOS') ?>
1067                 </td>
1068                 <td class="dehead" width="120">
1069                     <?php echo xlt('Visit Reason') ?>
1070                 </td>
1071                 <td class="dehead" align="center" width="70" id="td_head_total_charge">
1072                     <?php echo xlt('Total Charge') ?>
1073                 </td>
1074                 <td class="dehead" align="center" width="70" id="td_head_rep_doc" style='display: none'>
1075                     <?php echo xlt('Report/ Form') ?>
1076                 </td>
1077                 <td class="dehead" align="center" width="200" id="td_head_description" style='display: none'>
1078                     <?php echo xlt('Description') ?>
1079                 </td>
1080                 <td class="dehead" align="center" width="70" id="td_head_insurance_payment">
1081                     <?php echo xlt('Insurance Payment') ?>
1082                 </td>
1083                 <td class="dehead" align="center" width="70" id="td_head_patient_payment">
1084                     <?php echo xlt('Patient Payment') ?>
1085                 </td>
1086                 <td class="dehead" align="center" width="55" id="td_head_patient_co_pay">
1087                     <?php echo xlt('Co Pay Paid') ?>
1088                 </td>
1089                 <td class="dehead" align="center" width="55" id="td_head_co_pay">
1090                     <?php echo xlt('Required Co Pay') ?>
1091                 </td>
1092                 <td class="dehead" align="center" width="70" id="td_head_insurance_balance">
1093                     <?php echo xlt('Insurance Balance') ?>
1094                 </td>
1095                 <td class="dehead" align="center" width="70" id="td_head_patient_balance">
1096                     <?php echo xlt('Patient Balance') ?>
1097                 </td>
1098                 <td class="dehead" align="center" width="50">
1099                     <?php echo xlt('Paying') ?>
1100                 </td>
1101             </tr>
1102             <?php
1103             $encs = array();
1104             // Get the unbilled service charges and payments by encounter for this patient.
1105             //
1106             $query = "SELECT fe.encounter, fe.reason, b.code_type, b.code, b.modifier, b.fee, " .
1107                 "LEFT(fe.date, 10) AS encdate ,fe.last_level_closed " . "FROM  form_encounter AS fe left join billing AS b  on " .
1108                 "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 " .
1109                 "where fe.pid = ? " . "ORDER BY b.encounter";
1110             $bres = sqlStatement($query, array($pid, $pid));
1111             //
1112             while ($brow = sqlFetchArray($bres)) {
1113                 $key = (int)$brow['encounter'];
1114                 if (empty($encs[$key])) {
1115                     $encs[$key] = array('encounter' => $brow['encounter'], 'date' => $brow['encdate'], 'last_level_closed' => $brow['last_level_closed'], 'charges' => 0, 'payments' => 0, 'reason' => $brow['reason']
1116                     );
1117                 }
1118
1119                 if ($brow['code_type'] === 'COPAY') {
1120                 // $encs[$key]['payments'] -= $brow['fee'];
1121                 } else {
1122                     $encs[$key]['charges'] += $brow['fee'];
1123                     // Add taxes.
1124                     $sql_array = array();
1125                     $query = "SELECT taxrates FROM codes WHERE " . "code_type = ? AND " . "code = ? AND ";
1126                     array_push($sql_array, $code_types[$brow['code_type']]['id'], $brow['code']);
1127                     if ($brow['modifier']) {
1128                         $query .= "modifier = ?";
1129                         array_push($sql_array, $brow['modifier']);
1130                     } else {
1131                         $query .= "(modifier IS NULL OR modifier = '')";
1132                     }
1133
1134                     $query .= " LIMIT 1";
1135                     $trow = sqlQuery($query, $sql_array);
1136                     $encs[$key]['charges'] += calcTaxes($trow, $brow['fee']);
1137                 }
1138             }
1139
1140             // Do the same for unbilled product sales.
1141             //
1142             $query = "SELECT fe.encounter, fe.reason, s.drug_id, s.fee, " .
1143                 "LEFT(fe.date, 10) AS encdate,fe.last_level_closed " .
1144                 "FROM form_encounter AS fe left join drug_sales AS s " .
1145                 "on s.pid = ? AND s.fee != 0 " .
1146                 "AND fe.pid = s.pid AND fe.encounter = s.encounter " .
1147                 "where fe.pid = ? " . "ORDER BY s.encounter";
1148
1149             $dres = sqlStatement($query, array($pid, $pid));
1150             //
1151             while ($drow = sqlFetchArray($dres)) {
1152                 $key = (int)$drow['encounter'];
1153                 if (empty($encs[$key])) {
1154                     $encs[$key] = array(
1155                         'encounter' => $drow['encounter'], 'date' => $drow['encdate'],
1156                         'last_level_closed' => $drow['last_level_closed'],
1157                         'charges' => 0, 'payments' => 0
1158                     );
1159                 }
1160
1161                 $encs[$key]['charges'] += $drow['fee'];
1162                 // Add taxes.
1163                 $trow = sqlQuery(
1164                     "SELECT taxrates FROM drug_templates WHERE drug_id = ? " .
1165                     "ORDER BY selector LIMIT 1",
1166                     array($drow['drug_id'])
1167                 );
1168                 $encs[$key]['charges'] += calcTaxes($trow, $drow['fee']);
1169             }
1170
1171             ksort($encs, SORT_NUMERIC);
1172
1173             foreach ($encs as $key => $value) {
1174                 $enc = $value['encounter'];
1175                 $reason = $value['reason'];
1176                 $dispdate = $value['date'];
1177
1178                 $inscopay = BillingUtilities::getCopay($pid, $dispdate);
1179                 $patcopay = BillingUtilities::getPatientCopay($pid, $enc);
1180                 // Insurance Payment
1181                 //
1182                 $drow = sqlQuery(
1183                     "SELECT  SUM(pay_amount) AS payments, " .
1184                     "SUM(adj_amount) AS adjustments FROM ar_activity WHERE " .
1185                     "deleted IS NULL AND pid = ? and encounter = ? AND " .
1186                     "payer_type != 0 AND account_code != 'PCP'",
1187                     array($pid, $enc)
1188                 );
1189                 $dpayment = $drow['payments'];
1190                 $dadjustment = $drow['adjustments'];
1191                 // Patient Payment
1192                 //
1193                 $drow = sqlQuery(
1194                     "SELECT  SUM(pay_amount) AS payments, SUM(adj_amount) AS adjustments " .
1195                     "FROM ar_activity WHERE deleted IS NULL AND pid = ? and encounter = ? and " .
1196                     "payer_type = 0 and account_code != 'PCP'",
1197                     array($pid, $enc)
1198                 );
1199                 $dpayment_pat = $drow['payments'];
1200
1201                 // NumberOfInsurance
1202                 //
1203                 $ResultNumberOfInsurance = sqlStatement(
1204                     "SELECT COUNT( DISTINCT TYPE ) NumberOfInsurance FROM insurance_data where pid = ? and provider>0 ",
1205                     array($pid)
1206                 );
1207                 $RowNumberOfInsurance = sqlFetchArray($ResultNumberOfInsurance);
1208                 $NumberOfInsurance = $RowNumberOfInsurance['NumberOfInsurance'] * 1;
1209                 $duept = 0;
1210                 if ((($NumberOfInsurance == 0 || $value['last_level_closed'] == 4 || $NumberOfInsurance == $value['last_level_closed']))) { // Patient balance
1211                     $brow = sqlQuery("SELECT SUM(fee) AS amount FROM billing WHERE " . "pid = ? and encounter = ? AND activity = 1", array($pid, $enc
1212                     ));
1213                     $srow = sqlQuery("SELECT SUM(fee) AS amount FROM drug_sales WHERE " . "pid = ? and encounter = ? ", array($pid, $enc
1214                     ));
1215                     $drow = sqlQuery(
1216                         "SELECT SUM(pay_amount) AS payments, SUM(adj_amount) AS adjustments " .
1217                         "FROM ar_activity WHERE deleted IS NULL AND pid = ? and encounter = ? ",
1218                         array($pid, $enc)
1219                     );
1220                     $duept = $brow['amount'] + $srow['amount'] - $drow['payments'] - $drow['adjustments'];
1221                 }
1222
1223                 echoLine("form_upay[$enc]", $dispdate, $value['charges'], $dpayment_pat, ($dpayment + $dadjustment), $duept, ($enc . ': ' . $reason), $inscopay, $patcopay);
1224             }
1225
1226             // Continue with display of the data entry form.
1227             ?>
1228             <tr>
1229                 <td class="dehead" align="center"><?php echo xlt('Total'); ?></td>
1230                 <td class="dehead" id='td_total_1' align="center"></td>
1231                 <td class="dehead" id='td_total_2' align="center"><?php echo text(bucks($sum_charges)) ?></td>
1232                 <td class="dehead" id='td_total_3' align="center"><?php echo text(bucks($sum_inspaid)) ?></td>
1233                 <td class="dehead" id='td_total_4' align="center"><?php echo text(bucks($sum_ptpaid)) ?></td>
1234                 <td class="dehead" id='td_total_5' align="center"><?php echo text(bucks($sum_patcopay)) ?></td>
1235                 <td class="dehead" id='td_total_6' align="center"><?php echo text(bucks($sum_copay)) ?></td>
1236                 <td class="dehead" id='td_total_7' align="center"><?php echo text(bucks($sum_balance)) ?></td>
1237                 <td class="dehead" id='td_total_8' align="center"><?php echo text(bucks($sum_duept)) ?></td>
1238                 <td class="dehead" align="center">
1239                     <input class="form-control" name='form_paytotal' id='form_paytotal' value='' style='color: #3b9204;' readonly />
1240                 </td>
1241             </tr>
1242         </table>
1243         <?php
1244         if (isset($ccdata["cardHolderName"])) {
1245             echo '<div class="col-5"><div class="card panel-default height">';
1246             if (!isset($_SESSION['authUserID'])) {
1247                 echo '<div class="card-heading">' . xlt("Payment Information") .
1248                     '<span style="color: #cc0000"><em> ' . xlt("Pending Auth since") . ': </em>' . text($edata["date"]) . '</span></div>';
1249             } else {
1250                 echo '<div class="card-heading">' . xlt("Audit Payment") .
1251                     '<span style="color: #cc0000"><em> ' . xlt("Pending since") . ': </em>' . text($edata["date"]) . '</span>' .
1252                     ' <button type="button" class="btn btn-warning btn-sm" onclick="getAuth()">' . xlt("Authorize") . '</button></div>';
1253             }
1254         } else {
1255             echo '<div style="display:none" class="col-6"><div class="card panel-default height">' .
1256                 '<div class="card-heading">' . xlt("Payment Information") . ' </div>';
1257         }
1258         ?>
1259         <div class="card-body">
1260             <span class="font-weight-bold"><?php echo xlt('Card Name'); ?>: </span><span id="cn"><?php echo text($ccdata["cc_type"]) ?></span><br />
1261             <span class="font-weight-bold"><?php echo xlt('Name on Card'); ?>: </span><span id="nc"><?php echo text($ccdata["cardHolderName"]) ?></span>
1262             <span class="font-weight-bold"><?php echo xlt('Card Holder Zip'); ?>: </span><span id="czip"><?php echo text($ccdata["zip"]) ?></span><br />
1263             <span class="font-weight-bold"><?php echo xlt('Card Number'); ?>: </span><span id="ccn">
1264         <?php
1265         if (isset($_SESSION['authUserID']) || isset($ccdata["transId"])) {
1266             echo text($ccdata["cardNumber"]) . "</span><br />";
1267         } else {
1268             echo "**********  " . text(substr($ccdata["cardNumber"], -4)) . "</span><br />";
1269         }
1270         ?>
1271         <?php
1272         if (!isset($ccdata["transId"])) { ?>
1273                 <span class="font-weight-bold"><?php echo xlt('Exp Date'); ?>:  </span><span id="ed"><?php echo text($ccdata["month"]) . "/" . text($ccdata["year"]) ?></span>
1274                 <span class="font-weight-bold"><?php echo xlt('CVV'); ?>:  </span><span id="cvvpin"><?php echo text($ccdata["cardCode"]) ?></span><br />
1275         <?php } else { ?>
1276                 <span class="font-weight-bold"><?php echo xlt('Transaction Id'); ?>:  </span><span id="ed"><?php echo text($ccdata["transId"]) . "/" . text($ccdata["year"]) ?></span>
1277                 <span class="font-weight-bold"><?php echo xlt('Authorization'); ?>:  </span><span id="cvvpin"><?php echo text($ccdata["authCode"]) ?></span><br />
1278         <?php } ?>
1279         <span class="font-weight-bold"><?php echo xlt('Charge Total'); ?>:  </span><span id="ct"><?php echo text($invdata["form_paytotal"]) ?></span><br />
1280         </div>
1281         </div>
1282         </div>
1283         <div>
1284         <?php
1285         if (!isset($_SESSION['authUserID'])) {
1286             if (!isset($ccdata["cardHolderName"])) {
1287                 if ($GLOBALS['payment_gateway'] == 'Sphere') {
1288                     echo SpherePayment::renderSphereHtml('patient');
1289                 } else {
1290                     echo '<button type="button" class="btn btn-primary" data-toggle="modal" data-target="#openPayModal">' . xlt("Pay Invoice") . '</button>';
1291                 }
1292             } else {
1293                 echo '<h4><span class="bg-danger">' . xlt("Locked Payment Pending") . '</span></h4>';
1294             }
1295         } else {
1296             echo "<button type='submit' class='btn btn-success' form='invoiceForm'>" . xlt('Post Payment') . "</button>";
1297         }
1298         ?>
1299         </div>
1300         <input type="hidden" name="hidden_patient_code" id="hidden_patient_code" value="<?php echo attr($pid); ?>"/>
1301         <input type='hidden' name='mode' id='mode' value=''/>
1302     </form>
1303
1304     <script>
1305         if (typeof jsondata !== 'undefined') {
1306             formRepopulate(jsondata);
1307         }
1308         calctotal();
1309     </script>
1310     <!-- credit payment modal -->
1311     <div id="openPayModal" class="modal fade" role="dialog">
1312         <div class="modal-dialog">
1313             <div class="modal-content">
1314                 <div class="modal-header">
1315                     <h4><?php echo xlt('Submit Payment for Authorization'); ?></h4>
1316                     <!--<button type="button" class="close" data-dismiss="modal">&times;</button>-->
1317                 </div>
1318                 <div class="modal-body">
1319                     <?php if ($GLOBALS['payment_gateway'] != 'Stripe' && $GLOBALS['payment_gateway'] != 'Sphere') { ?>
1320                     <form id='paymentForm' method='post' action='<?php echo $GLOBALS["webroot"] ?>/portal/lib/paylib.php'>
1321                         <fieldset>
1322                             <div class="form-group">
1323                                 <label label-default="label-default"
1324                                        class="control-label"><?php echo xlt('Name on Card'); ?></label>
1325                                 <div class="controls">
1326                                     <input name="cardHolderName" id="cardHolderName" type="text" class="form-control" pattern="\w+ \w+.*" title="<?php echo xla('Fill your first and last name'); ?>" value="<?php echo attr($patdata['fname']) . ' ' . attr($patdata['lname']) ?>" />
1327                                 </div>
1328                             </div>
1329                             <div class="form-group">
1330                                 <label class="control-label"><?php echo xlt('Card Number'); ?></label>
1331                                 <div class="controls">
1332                                     <div class="row">
1333                                         <div class="col-sm-12">
1334                                             <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;
1335                                             <h4 name="cardtype" id="cardtype" style="display: inline-block; color:#cc0000;"><?php echo xlt('Validating') ?></h4>
1336                                         </div>
1337                                     </div>
1338                                 </div>
1339                             </div>
1340                             <div class="form-group">
1341                                 <label label-default="label-default"><?php echo xlt('Card Expiry Date and Card Holders Zip'); ?></label>
1342                                 <div class="controls">
1343                                     <div class="row">
1344                                         <div class="col-md-4">
1345                                             <select name="month" id="expMonth" class="form-control">
1346                                                 <option value=""><?php echo xlt('Select Month'); ?></option>
1347                                                 <option value="01"><?php echo xlt('January'); ?></option>
1348                                                 <option value="02"><?php echo xlt('February'); ?></option>
1349                                                 <option value="03"><?php echo xlt('March'); ?></option>
1350                                                 <option value="04"><?php echo xlt('April'); ?></option>
1351                                                 <option value="05"><?php echo xlt('May'); ?></option>
1352                                                 <option value="06"><?php echo xlt('June'); ?></option>
1353                                                 <option value="07"><?php echo xlt('July'); ?></option>
1354                                                 <option value="08"><?php echo xlt('August'); ?></option>
1355                                                 <option value="09"><?php echo xlt('September'); ?></option>
1356                                                 <option value="10"><?php echo xlt('October'); ?></option>
1357                                                 <option value="11"><?php echo xlt('November'); ?></option>
1358                                                 <option value="12"><?php echo xlt('December'); ?></option>
1359                                             </select>
1360                                         </div>
1361                                         <div class="col-md-4">
1362                                             <select name="year" id="expYear" class="form-control">
1363                                                 <option value=""><?php echo xlt('Select Year'); ?></option>
1364                                                 <option value="2019">2019</option>
1365                                                 <option value="2020">2020</option>
1366                                                 <option value="2021">2021</option>
1367                                                 <option value="2022">2022</option>
1368                                                 <option value="2023">2023</option>
1369                                                 <option value="2024">2024</option>
1370                                                 <option value="2025">2025</option>
1371                                                 <option value="2026">2026</option>
1372                                                 <option value="2027">2027</option>
1373                                                 <option value="2028">2028</option>
1374                                             </select>
1375                                         </div>
1376                                         <div class="col-md-4">
1377                                             <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']) ?>"/>
1378                                         </div>
1379                                     </div>
1380                                 </div>
1381                             </div>
1382                             <div class="form-group">
1383                                 <label label-default="label-default" class="control-label"><?php echo xlt('Card CVV'); ?></label>
1384                                 <div class="controls">
1385                                     <div class="row">
1386                                         <div class="col-md-3">
1387                                             <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="" />
1388                                         </div>
1389                                         <div class="col-md-3">
1390                                             <img src='./images/img_cvc.png' style='height: 40px; width: auto' />
1391                                         </div>
1392                                         <div class="col-md-6">
1393                                             <h4 style="display: inline-block;"><?php echo xlt('Payment Amount'); ?>:&nbsp;
1394                                                 <span class="font-weight-bold"><span id="payTotal"></span></span></h4>
1395                                         </div>
1396                                     </div>
1397                                 </div>
1398                             </div>
1399                             <input type='hidden' name='pid' id='pid' value='<?php echo attr($pid) ?>'/>
1400                             <input type='hidden' name='mode' id='mode' value=''/>
1401                             <input type='hidden' name='cc_type' id='cc_type' value=''/>
1402                             <input type='hidden' name='payment' id='paymentAmount' value=''/>
1403                             <input type='hidden' name='invValues' id='invValues' value=''/>
1404                             <input type="hidden" name="dataValue" id="dataValue" />
1405                             <input type="hidden" name="dataDescriptor" id="dataDescriptor" />
1406                         </fieldset>
1407                     </form>
1408                     <?php } else { ?>
1409                         <form method="post" name="payment-form" id="payment-form">
1410                             <fieldset>
1411                                 <div class="form-group">
1412                                     <label label-default="label-default"><?php echo xlt('Name on Card'); ?></label>
1413                                     <div class="controls">
1414                                         <input name="cardHolderName" id="cardHolderName" type="text" class="form-control" pattern="\w+ \w+.*" title="<?php echo xla('Fill your first and last name'); ?>" value="<?php echo attr($patdata['fname']) . ' ' . attr($patdata['lname']) ?>" />
1415                                     </div>
1416                                 </div>
1417                                 <div class="form-group">
1418                                     <label for="card-element"><?php echo xlt('Credit or Debit Card') ?></label>
1419                                     <div class="form-group" id="card-element"></div>
1420                                     <div id="card-errors" role="alert"></div>
1421                                 </div>
1422                                 <div class="col-md-6">
1423                                     <h4 style="display: inline-block;"><?php echo xlt('Payment Amount'); ?>:&nbsp;
1424                                         <strong><span id="payTotal"></span></strong></h4>
1425                                 </div>
1426                                 <input type='hidden' name='mode' id='mode' value=''/>
1427                                 <input type='hidden' name='cc_type' id='cc_type' value=''/>
1428                                 <input type='hidden' name='payment' id='paymentAmount' value=''/>
1429                                 <input type='hidden' name='invValues' id='invValues' value=''/>
1430                             </fieldset>
1431                         </form>
1432                     <?php } ?>
1433                 </div>
1434                 <!-- Body  -->
1435                 <div class="modal-footer">
1436                     <div class="button-group">
1437                         <button type="button" class="btn btn-secondary" data-dismiss="modal"><?php echo xlt('Cancel'); ?></button>
1438                         <?php
1439                         if ($GLOBALS['payment_gateway'] == 'InHouse') { ?>
1440                             <button id="paySubmit" class="btn btn-primary"><?php echo xlt('Send Payment'); ?></button>
1441                         <?php } elseif ($GLOBALS['payment_gateway'] == 'AuthorizeNet') { ?>
1442                             <button id="payAurhorizeNet" class="btn btn-primary"
1443                                     onclick="sendPaymentDataToAnet(event)"><?php echo xlt('Pay Now'); ?></button>
1444                         <?php }
1445                         if ($GLOBALS['payment_gateway'] == 'Stripe') { ?>
1446                             <button id="stripeSubmit" class="btn btn-primary"><?php echo xlt('Pay Now'); ?></button>
1447                                                 <?php } ?>
1448                     </div>
1449                 </div>
1450             </div>
1451         </div>
1452     </div>
1453     <script>
1454         var ccerr = <?php echo xlj('Invalid Credit Card Number'); ?>
1455
1456         // In House CC number Validation
1457         /*$('#cardNumber').validateCreditCard(function (result) {
1458             var r = (result.card_type === null ? '' : result.card_type.name.toUpperCase())
1459             var v = (result.valid === true ? ' Valid Number' : ' Validating')
1460             if (result.valid === true) {
1461                 document.getElementById("cardtype").style.color = "#00aa00";
1462             } else {
1463                 document.getElementById("cardtype").style.color = "#aa0000";
1464             }
1465             $('#cardtype').text(r + v);
1466         });*/
1467
1468         // In House CC Validation
1469         function validateCC() {
1470             var result = $('#cardNumber').validateCreditCard();
1471             var r = (result.card_type == null ? '' : result.card_type.name.toUpperCase())
1472             var v = (result.valid == true ? ' Valid Card Number' : ' Invalid Card Number')
1473             if (result.valid === true) {
1474                 document.getElementById("cardtype").style.color = "#00aa00";
1475             } else {
1476                 document.getElementById("cardtype").style.color = "#aa0000";
1477             }
1478             $('#cardtype').text(r + v);
1479             $('#cc_type').val(r);
1480             if (!result.valid) {
1481                 alert(ccerr);
1482                 return false;
1483             }
1484             else {
1485                 return true;
1486             }
1487         }
1488     </script>
1489
1490     <?php if ($GLOBALS['payment_gateway'] == 'AuthorizeNet' && isset($_SESSION['patient_portal_onsite_two'])) {
1491         // Include Authorize.Net dependency to tokenize card.
1492         // Will return a token to use for payment request keeping
1493         // credit info off the server.
1494         ?>
1495         <script>
1496             function sendPaymentDataToAnet(e) {
1497                 e.preventDefault();
1498                 const authData = {};
1499                 authData.clientKey = publicKey;
1500                 authData.apiLoginID = apiKey;
1501
1502                 const cardData = {};
1503                 cardData.cardNumber = document.getElementById("cardNumber").value;
1504                 cardData.month = document.getElementById("expMonth").value;
1505                 cardData.year = document.getElementById("expYear").value;
1506                 cardData.cardCode = document.getElementById("cardCode").value;
1507                 cardData.fullName = document.getElementById("cardHolderName").value;
1508                 cardData.zip = document.getElementById("cczip").value;
1509
1510                 const secureData = {};
1511                 secureData.authData = authData;
1512                 secureData.cardData = cardData;
1513
1514                 Accept.dispatchData(secureData, acceptResponseHandler);
1515
1516                 function acceptResponseHandler(response) {
1517                     if (response.messages.resultCode === "Error") {
1518                         let i = 0;
1519                         let errorMsg = '';
1520                         while (i < response.messages.message.length) {
1521                             errorMsg = errorMsg + response.messages.message[i].code + ": " +response.messages.message[i].text;
1522                             console.log(errorMsg);
1523                             i = i + 1;
1524                         }
1525                         alert(errorMsg);
1526                     } else {
1527                         paymentFormUpdate(response.opaqueData);
1528                     }
1529                 }
1530             }
1531
1532             function paymentFormUpdate(opaqueData) {
1533                 // this is card tokenized
1534                 document.getElementById("dataDescriptor").value = opaqueData.dataDescriptor;
1535                 document.getElementById("dataValue").value = opaqueData.dataValue;
1536                 let oForm = document.forms['paymentForm'];
1537                 oForm.elements['mode'].value = "AuthorizeNet";
1538                 let inv_values = JSON.stringify(getFormObj('invoiceForm'));
1539                 document.getElementById("invValues").value = inv_values;
1540
1541                 // empty out the fields before submitting to server.
1542                 document.getElementById("cardNumber").value = "";
1543                 document.getElementById("expMonth").value = "";
1544                 document.getElementById("expYear").value = "";
1545                 document.getElementById("cardCode").value = "";
1546
1547                 // Submit payment to server
1548                 fetch('./lib/paylib.php', {
1549                     method: 'POST',
1550                     body: new FormData(oForm)
1551                 }).then(function(response) {
1552                     if (!response.ok) {
1553                         throw Error(response.statusText);
1554                     }
1555                     return response.text();
1556                 }).then(function(data) {
1557                     if(data !== 'ok') {
1558                         alert(data);
1559                         return;
1560                     }
1561                     alert(chargeMsg);
1562                     window.location.reload(false);
1563                 }).catch(function(error) {
1564                     alert(error)
1565                 });
1566             }
1567         </script>
1568     <?php }  // end authorize.net ?>
1569
1570     <?php if ($GLOBALS['payment_gateway'] == 'Stripe' && isset($_SESSION['patient_portal_onsite_two'])) { // Begin Include Stripe ?>
1571         <script>
1572             const stripe = Stripe(publicKey);
1573             const elements = stripe.elements();// Custom styling can be passed to options when creating an Element.
1574             const style = {
1575                 base: {
1576                     color: '#32325d',
1577                     lineHeight: '1.2rem',
1578                     fontSmoothing: 'antialiased',
1579                     fontSize: '16px',
1580                     '::placeholder': {
1581                         color: '#8e8e8e'
1582                     }
1583                 },
1584                 invalid: {
1585                     color: '#fa755a',
1586                     iconColor: '#fa755a'
1587                 }
1588
1589             };
1590             // Create an instance of the card Element.
1591             const card = elements.create('card', {style: style});
1592             // Add an instance of the card Element into the `card-element` <div>.
1593             card.mount('#card-element');
1594             // Handle real-time validation errors from the card Element.
1595             card.addEventListener('change', function (event) {
1596                 let displayError = document.getElementById('card-errors');
1597                 if (event.error) {
1598                     displayError.textContent = event.error.message;
1599                 } else {
1600                     displayError.textContent = '';
1601                 }
1602             });
1603             // Handle form submission.
1604             let form = document.getElementById('stripeSubmit');
1605             form.addEventListener('click', function (event) {
1606                 event.preventDefault();
1607                 stripe.createToken(card).then(function (result) {
1608                     if (result.error) {
1609                         // Inform the user if there was an error.
1610                         let errorElement = document.getElementById('card-errors');
1611                         errorElement.textContent = result.error.message;
1612                     } else {
1613                         // Send the token to server.
1614                         stripeTokenHandler(result.token);
1615                     }
1616                 });
1617             });
1618             // Submit the form with the token ID.
1619             function stripeTokenHandler(token) {
1620                 // Insert the token ID into the form so it gets submitted to the server
1621                 let oForm = document.forms['payment-form'];
1622                 oForm.elements['mode'].value = "Stripe";
1623
1624                 let inv_values = JSON.stringify(getFormObj('invoiceForm'));
1625                 document.getElementById("invValues").value = inv_values;
1626
1627                 let hiddenInput = document.createElement('input');
1628                 hiddenInput.setAttribute('type', 'hidden');
1629                 hiddenInput.setAttribute('name', 'stripeToken');
1630                 hiddenInput.setAttribute('value', token.id);
1631                 oForm.appendChild(hiddenInput);
1632
1633                 // Submit payment to server
1634                 fetch('./lib/paylib.php', {
1635                     method: 'POST',
1636                     body: new FormData(oForm)
1637                 }).then(function(response) {
1638                     if (!response.ok) {
1639                         throw Error(response.statusText);
1640                     }
1641                     return response.text();
1642                 }).then(function(data) {
1643                     if(data !== 'ok') {
1644                         alert(data);
1645                         return;
1646                     }
1647                     alert(chargeMsg);
1648                     window.location.reload(false);
1649                 }).catch(function(error) {
1650                     alert(error)
1651                 });
1652             }
1653         </script>
1654     <?php } ?>
1655
1656     <?php
1657     if ($GLOBALS['payment_gateway'] == 'Sphere' && isset($_SESSION['patient_portal_onsite_two'])) {
1658         echo (new SpherePayment('patient', $pid))->renderSphereJs();
1659     }
1660     ?>
1661
1662     </body>
1663     <?php } // end else display ?>