interface/billing/sl_eob_invoice.php

   1 <?php
   2 /**
   3  * This provides for manual posting of EOBs.  It is invoked from
   4  * sl_eob_search.php.  For automated (X12 835) remittance posting
   5  * see sl_eob_process.php.
   6  *
   7  * Copyright (C) 2005-2016 Rod Roark <rod@sunsetsystems.com>
   8  *
   9  * LICENSE: This program is free software; you can redistribute it and/or
  10  * modify it under the terms of the GNU General Public License
  11  * as published by the Free Software Foundation; either version 2
  12  * of the License, or (at your option) any later version.
  13  * This program is distributed in the hope that it will be useful,
  14  * but WITHOUT ANY WARRANTY; without even the implied warranty of
  15  * MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
  16  * GNU General Public License for more details.
  17  * You should have received a copy of the GNU General Public License
  18  * along with this program. If not, see <http://opensource.org/licenses/gpl-license.php>;.
  19  *
  20  * @package OpenEMR
  21  * @author  Rod Roark <rod@sunsetsystems.com>
  22  * @author  Roberto Vasquez <robertogagliotta@gmail.com>
  23  * @author  Terry Hill <terry@lillysystems.com>
  24  * @link    http://www.open-emr.org
  25  */
  26
  27   require_once("../globals.php");
  28   require_once("$srcdir/log.inc");
  29   require_once("$srcdir/patient.inc");
  30   require_once("$srcdir/forms.inc");
  31   require_once("$srcdir/sl_eob.inc.php");
  32   require_once("$srcdir/invoice_summary.inc.php");
  33   require_once("../../custom/code_types.inc.php");
  34   require_once("$srcdir/formdata.inc.php");
  35
  36   $debug = 0; // set to 1 for debugging mode
  37
  38
  39   // If we permit deletion of transactions.  Might change this later.
  40   $ALLOW_DELETE = true;
  41
  42   $info_msg = "";
  43
  44   // Format money for display.
  45   //
  46   function bucks($amount) {
  47     if ($amount)
  48       printf("%.2f", $amount);
  49   }
  50
  51   // Delete rows, with logging, for the specified table using the
  52   // specified WHERE clause.  Borrowed from deleter.php.
  53   //
  54   function row_delete($table, $where) {
  55     $tres = sqlStatement("SELECT * FROM $table WHERE $where");
  56     $count = 0;
  57     while ($trow = sqlFetchArray($tres)) {
  58       $logstring = "";
  59       foreach ($trow as $key => $value) {
  60         if (! $value || $value == '0000-00-00 00:00:00') continue;
  61         if ($logstring) $logstring .= " ";
  62         $logstring .= $key . "='" . addslashes($value) . "'";
  63       }
  64       newEvent("delete", $_SESSION['authUser'], $_SESSION['authProvider'], 1, "$table: $logstring");
  65       ++$count;
  66     }
  67     if ($count) {
  68       $query = "DELETE FROM $table WHERE $where";
  69       echo $query . "<br>\n";
  70       sqlStatement($query);
  71     }
  72   }
  73 ?>
  74 <html>
  75 <head>
  76 <?php html_header_show(); ?>
  77 <link rel=stylesheet href="<?php echo $css_header;?>" type="text/css">
  78 <title><?php xl('EOB Posting - Invoice','e')?></title>
  79 <script language="JavaScript">
  80
  81 // An insurance radio button is selected.
  82 function setins(istr) {
  83  return true;
  84 }
  85
  86 // Compute an adjustment that writes off the balance:
  87 function writeoff(code) {
  88  var f = document.forms[0];
  89  var belement = f['form_line[' + code + '][bal]'];
  90  var pelement = f['form_line[' + code + '][pay]'];
  91  var aelement = f['form_line[' + code + '][adj]'];
  92  var relement = f['form_line[' + code + '][reason]'];
  93  var tmp = belement.value - pelement.value;
  94  aelement.value = Number(tmp).toFixed(2);
  95  if (aelement.value && ! relement.value) relement.selectedIndex = 1;
  96  return false;
  97 }
  98
  99 // Onsubmit handler.  A good excuse to write some JavaScript.
 100 function validate(f) {
 101  var delcount = 0;
 102  for (var i = 0; i < f.elements.length; ++i) {
 103   var ename = f.elements[i].name;
 104   // Count deletes.
 105   if (ename.substring(0, 9) == 'form_del[') {
 106    if (f.elements[i].checked) ++delcount;
 107    continue;
 108   }
 109   var pfxlen = ename.indexOf('[pay]');
 110   if (pfxlen < 0) continue;
 111   var pfx = ename.substring(0, pfxlen);
 112   var code = pfx.substring(pfx.indexOf('[')+1, pfxlen-1);
 113   if (f[pfx+'[pay]'].value || f[pfx+'[adj]'].value) {
 114    if (! f[pfx+'[date]'].value) {
 115     alert('<?php xl('Date is missing for code ','e')?>' + code);
 116     return false;
 117    }
 118   }
 119   if (f[pfx+'[pay]'].value && isNaN(parseFloat(f[pfx+'[pay]'].value))) {
 120    alert('<?php xl('Payment value for code ','e') ?>' + code + '<?php xl(' is not a number','e') ?>');
 121    return false;
 122   }
 123   if (f[pfx+'[adj]'].value && isNaN(parseFloat(f[pfx+'[adj]'].value))) {
 124    alert('<?php xl('Adjustment value for code ','e') ?>' + code + '<?php xl(' is not a number','e') ?>');
 125    return false;
 126   }
 127   if (f[pfx+'[adj]'].value && ! f[pfx+'[reason]'].value) {
 128    alert('<?php xl('Please select an adjustment reason for code ','e') ?>' + code);
 129    return false;
 130   }
 131   // TBD: validate the date format
 132  }
 133  // Demand confirmation if deleting anything.
 134  if (delcount > 0) {
 135   if (!confirm('<?php echo xl('Really delete'); ?> ' + delcount +
 136    ' <?php echo xl('transactions'); ?>?' +
 137    ' <?php echo xl('This action will be logged'); ?>!')
 138   ) return false;
 139  }
 140  return true;
 141 }
 142
 143 <!-- Get current date -->
 144
 145 function getFormattedToday()
 146 {
 147    var today = new Date();
 148    var dd = today.getDate();
 149    var mm = today.getMonth()+1; //January is 0!
 150    var yyyy = today.getFullYear();
 151    if(dd<10){dd='0'+dd}
 152    if(mm<10){mm='0'+mm}
 153
 154    return (yyyy + '-' + mm + '-' + dd);
 155 }
 156
 157 <!-- Update Payment Fields -->
 158
 159 function updateFields(payField, adjField, balField, coPayField, isFirstProcCode)
 160 {
 161    var payAmount = 0.0;
 162    var adjAmount = 0.0;
 163    var balAmount = 0.0;
 164    var coPayAmount = 0.0;
 165
 166    // coPayFiled will be null if there is no co-pay entry in the fee sheet
 167    if (coPayField)
 168       coPayAmount = coPayField.value;
 169
 170    // if balance field is 0.00, its value comes back as null, so check for nul-ness first
 171    if (balField)
 172       balAmount = (balField.value) ? balField.value : 0;
 173    if (payField)
 174       payAmount = (payField.value) ? payField.value : 0;
 175
 176    //alert('balance = >' + balAmount +'<  payAmount = ' + payAmount + '  copay = ' + coPayAmount + '  isFirstProcCode = ' + isFirstProcCode);
 177
 178    // subtract the co-pay only from the first procedure code
 179    if (isFirstProcCode == 1)
 180       balAmount = parseFloat(balAmount) + parseFloat(coPayAmount);
 181
 182    adjAmount = balAmount - payAmount;
 183
 184    // Assign rounded adjustment value back to TextField
 185    adjField.value = adjAmount = Math.round(adjAmount*100)/100;
 186 }
 187
 188 </script>
 189 </head>
 190 <body leftmargin='0' topmargin='0' marginwidth='0' marginheight='0'>
 191 <?php
 192   $trans_id = 0 + $_GET['id'];
 193   if (! $trans_id) die(xl("You cannot access this page directly."));
 194
 195     // A/R case, $trans_id matches form_encounter.id.
 196     $ferow = sqlQuery("SELECT e.*, p.fname, p.mname, p.lname " .
 197       "FROM form_encounter AS e, patient_data AS p WHERE " .
 198       "e.id = '$trans_id' AND p.pid = e.pid");
 199     if (empty($ferow)) die("There is no encounter with form_encounter.id = '$trans_id'.");
 200     $patient_id        = 0 + $ferow['pid'];
 201     $encounter_id      = 0 + $ferow['encounter'];
 202     $svcdate           = substr($ferow['date'], 0, 10);
 203     $form_payer_id     = 0 + $_POST['form_payer_id'];
 204     $form_reference    = $_POST['form_reference'];
 205     $form_check_date   = fixDate($_POST['form_check_date'], date('Y-m-d'));
 206     $form_deposit_date = fixDate($_POST['form_deposit_date'], $form_check_date);
 207     $form_pay_total    = 0 + $_POST['form_pay_total'];
 208
 209   $payer_type = 0;
 210   if (preg_match('/^Ins(\d)/i', $_POST['form_insurance'], $matches)) {
 211     $payer_type = $matches[1];
 212   }
 213
 214   if ($_POST['form_save'] || $_POST['form_cancel']) {
 215     if ($_POST['form_save']) {
 216       if ($debug) {
 217         echo xl("This module is in test mode. The database will not be changed.",'','<p><b>',"</b><p>\n");
 218       }
 219
 220         $session_id = arGetSession($form_payer_id, $form_reference,
 221           $form_check_date, $form_deposit_date, $form_pay_total);
 222         // The sl_eob_search page needs its invoice links modified to invoke
 223         // javascript to load form parms for all the above and submit.
 224         // At the same time that page would be modified to work off the
 225         // openemr database exclusively.
 226         // And back to the sl_eob_invoice page, I think we may want to move
 227         // the source input fields from row level to header level.
 228
 229         // Handle deletes. row_delete() is borrowed from deleter.php.
 230         if ($ALLOW_DELETE && !$debug) {
 231           foreach ($_POST['form_del'] as $arseq => $dummy) {
 232             row_delete("ar_activity", "pid = '$patient_id' AND " .
 233               "encounter = '$encounter_id' AND sequence_no = '$arseq'");
 234           }
 235         }
 236
 237       $paytotal = 0;
 238       foreach ($_POST['form_line'] as $code => $cdata) {
 239         $thispay  = trim($cdata['pay']);
 240         $thisadj  = trim($cdata['adj']);
 241         $thisins  = trim($cdata['ins']);
 242         $thiscodetype = trim($cdata['code_type']);
 243         $reason   = strip_escape_custom($cdata['reason']);
 244
 245         // Get the adjustment reason type.  Possible values are:
 246         // 1 = Charge adjustment
 247         // 2 = Coinsurance
 248         // 3 = Deductible
 249         // 4 = Other pt resp
 250         // 5 = Comment
 251         $reason_type = '1';
 252         if ($reason) {
 253           $tmp = sqlQuery("SELECT option_value FROM list_options WHERE " .
 254             "list_id = 'adjreason' AND activity = 1 AND " .
 255             "option_id = '" . add_escape_custom($reason) . "'");
 256           if (empty($tmp['option_value'])) {
 257             // This should not happen but if it does, apply old logic.
 258             if (preg_match("/To copay/", $reason)) {
 259               $reason_type = 2;
 260             }
 261             else if (preg_match("/To ded'ble/", $reason)) {
 262               $reason_type = 3;
 263             }
 264             $info_msg .= xl("No adjustment reason type found for") . " \"$reason\". ";
 265           }
 266           else {
 267             $reason_type = $tmp['option_value'];
 268           }
 269         }
 270
 271         if (! $thisins) $thisins = 0;
 272
 273         if ($thispay) {
 274             arPostPayment($patient_id, $encounter_id, $session_id,
 275               $thispay, $code, $payer_type, '', $debug, '', $thiscodetype);
 276           $paytotal += $thispay;
 277         }
 278
 279         // Be sure to record adjustment reasons, even for zero adjustments if
 280         // they happen to be comments.
 281         if ($thisadj || ($reason && $reason_type == 5)) {
 282           // "To copay" and "To ded'ble" need to become a comment in a zero
 283           // adjustment, formatted just like sl_eob_process.php.
 284           if ($reason_type == '2') {
 285             $reason = $_POST['form_insurance'] . " coins: $thisadj";
 286             $thisadj = 0;
 287           }
 288           else if ($reason_type == '3') {
 289             $reason = $_POST['form_insurance'] . " dedbl: $thisadj";
 290             $thisadj = 0;
 291           }
 292           else if ($reason_type == '4') {
 293             $reason = $_POST['form_insurance'] . " ptresp: $thisadj $reason";
 294             $thisadj = 0;
 295           }
 296           else if ($reason_type == '5') {
 297             $reason = $_POST['form_insurance'] . " note: $thisadj $reason";
 298             $thisadj = 0;
 299           }
 300           else {
 301             // An adjustment reason including "Ins" is assumed to be assigned by
 302             // insurance, and in that case we identify which one by appending
 303             // Ins1, Ins2 or Ins3.
 304             if (strpos(strtolower($reason), 'ins') !== false)
 305               $reason .= ' ' . $_POST['form_insurance'];
 306           }
 307             arPostAdjustment($patient_id, $encounter_id, $session_id,
 308               $thisadj, $code, $payer_type, $reason, $debug, '', $thiscodetype);
 309         }
 310       }
 311
 312       // Maintain which insurances are marked as finished.
 313
 314         $form_done = 0 + $_POST['form_done'];
 315         $form_stmt_count = 0 + $_POST['form_stmt_count'];
 316         sqlStatement("UPDATE form_encounter " .
 317           "SET last_level_closed = $form_done, " .
 318           "stmt_count = $form_stmt_count WHERE " .
 319           "pid = '$patient_id' AND encounter = '$encounter_id'");
 320
 321       if ($_POST['form_secondary']) {
 322           arSetupSecondary($patient_id, $encounter_id, $debug);
 323         }
 324
 325       echo "<script language='JavaScript'>\n";
 326       echo " if (opener.document.forms[0].form_amount) {\n";
 327       echo "  var tmp = opener.document.forms[0].form_amount.value - $paytotal;\n";
 328       echo "  opener.document.forms[0].form_amount.value = Number(tmp).toFixed(2);\n";
 329       echo " }\n";
 330     } else {
 331       echo "<script language='JavaScript'>\n";
 332     }
 333     if ($info_msg) echo " alert('" . addslashes($info_msg) . "');\n";
 334     if (! $debug) echo " window.close();\n";
 335     echo "</script></body></html>\n";
 336     exit();
 337   }
 338
 339     // Get invoice charge details.
 340     $codes = ar_get_invoice_summary($patient_id, $encounter_id, true);
 341
 342   $pdrow = sqlQuery("select billing_note " .
 343     "from patient_data where pid = '$patient_id' limit 1");
 344 ?>
 345 <center>
 346
 347 <form method='post' action='sl_eob_invoice.php?id=<?php echo $trans_id ?>'
 348  onsubmit='return validate(this)'>
 349
 350 <table border='0' cellpadding='3'>
 351  <tr>
 352   <td>
 353    <?php xl('Patient:','e')?>
 354   </td>
 355   <td>
 356 <?php
 357     echo $ferow['fname'] . ' ' . $ferow['mname'] . ' ' . $ferow['lname'];
 358 ?>
 359   </td>
 360   <td colspan="2" rowspan="3">
 361 <?php
 362     for ($i = 1; $i <= 3; ++$i) {
 363       $payerid = arGetPayerID($patient_id, $svcdate, $i);
 364       if ($payerid) {
 365         $tmp = sqlQuery("SELECT name FROM insurance_companies WHERE id = $payerid");
 366         echo "Ins$i: " . $tmp['name'] . "<br />";
 367       }
 368     }
 369 ?>
 370   </td>
 371 <?php
 372     echo "<td rowspan='3' valign='bottom'>\n";
 373     echo xl('Statements Sent:');
 374     echo "</td>\n";
 375     echo "<td rowspan='3' valign='bottom'>\n";
 376     echo "<input type='text' name='form_stmt_count' size='10' value='" .
 377       (0 + $ferow['stmt_count']) . "' />\n";
 378     echo "</td>\n";
 379 ?>
 380  </tr>
 381  <tr>
 382   <td>
 383    <?php xl('Provider:','e')?>
 384   </td>
 385   <td>
 386    <?php
 387     $tmp = sqlQuery("SELECT fname, mname, lname " .
 388       "FROM users WHERE id = " . $ferow['provider_id']);
 389     echo text($tmp['fname']) . ' ' . text($tmp['mname']) . ' ' . text($tmp['lname']);
 390     $tmp = sqlQuery("SELECT bill_date FROM billing WHERE " .
 391       "pid = '$patient_id' AND encounter = '$encounter_id' AND " .
 392       "activity = 1 ORDER BY fee DESC, id ASC LIMIT 1");
 393     $billdate = substr(($tmp['bill_date'] . "Not Billed"), 0, 10);
 394 ?>
 395   </td>
 396  </tr>
 397  <tr>
 398   <td>
 399    <?php xl('Invoice:','e')?>
 400   </td>
 401   <td>
 402 <?php
 403     echo "$patient_id.$encounter_id";
 404 ?>
 405   </td>
 406  </tr>
 407
 408  <tr>
 409   <td>
 410 <?php xl('Svc Date:','e'); ?>
 411   </td>
 412   <td>
 413 <?php
 414     echo $svcdate;
 415 ?>
 416   </td>
 417   <td colspan="2">
 418    <?php xl('Done with:','e','',"&nbsp")?>;
 419 <?php
 420   // Write a checkbox for each insurance.  It is to be checked when
 421   // we no longer expect any payments from that company for the claim.
 422     $last_level_closed = 0 + $ferow['last_level_closed'];
 423     foreach (array(0 => 'None', 1 => 'Ins1', 2 => 'Ins2', 3 => 'Ins3') as $key => $value) {
 424       if ($key && !arGetPayerID($patient_id, $svcdate, $key)) continue;
 425       $checked = ($last_level_closed == $key) ? " checked" : "";
 426       echo "   <input type='radio' name='form_done' value='$key'$checked />$value&nbsp;\n";
 427     }
 428 ?>
 429   </td>
 430 <?php
 431     echo "<td>\n";
 432     echo xl('Check/EOB No.:');
 433     echo "</td>\n";
 434     echo "<td>\n";
 435     echo "<input type='text' name='form_reference' size='10' value='' />\n";
 436     echo "</td>\n";
 437 ?>
 438  </tr>
 439
 440  <tr>
 441   <td>
 442    <?php xl('Last Bill Date:','e') ?>
 443   </td>
 444   <td>
 445    <?php
 446     echo $billdate;
 447 ?>
 448   </td>
 449   <td colspan="2">
 450    <?php xl('Now posting for:','e','',"&nbsp")?>;
 451
 452 <?php
 453   // TBD: check the first not-done-with insurance, not always Ins1!
 454 ?>
 455    <input type='radio' name='form_insurance' value='Ins1' onclick='setins("Ins1")' checked /><?php xl('Ins1','e')?>&nbsp;
 456    <input type='radio' name='form_insurance' value='Ins2' onclick='setins("Ins2")' /><?php xl('Ins2','e')?>&nbsp;
 457    <input type='radio' name='form_insurance' value='Ins3' onclick='setins("Ins3")' /><?php xl('Ins3','e')?>&nbsp;
 458    <input type='radio' name='form_insurance' value='Pt'   onclick='setins("Pt")'   /><?php xl('Patient','e')?>
 459
 460 <?php
 461   // TBD: I think the following is unused and can be removed.
 462 ?>
 463    <input type='hidden' name='form_eobs' value='<?php echo addslashes($arrow['shipvia']) ?>' />
 464
 465   </td>
 466 <?php
 467     echo "<td>\n";
 468     echo xl('Check/EOB Date:');
 469     echo "</td>\n";
 470     echo "<td>\n";
 471     echo "<input type='text' name='form_check_date' size='10' value='' />\n";
 472     echo "</td>\n";
 473 ?>
 474  </tr>
 475  <tr>
 476   <td>
 477   </td>
 478   <td>
 479   </td>
 480   <td colspan="2">
 481    <input type="checkbox" name="form_secondary" value="1"> <?php xl('Needs secondary billing','e')?>
 482    &nbsp;&nbsp;
 483    <input type='submit' name='form_save' value='<?php xl('Save','e')?>'>
 484    &nbsp;
 485    <input type='button' value='<?php xl('Cancel','e')?>' onclick='window.close()'>
 486   </td>
 487 <?php
 488     echo "<td>\n";
 489     echo xl('Deposit Date:');
 490     echo "</td>\n";
 491     echo "<td>\n";
 492     echo "<input type='text' name='form_deposit_date' size='10' value='' />\n";
 493     echo "<input type='hidden' name='form_payer_id' value='' />\n";
 494     echo "<input type='hidden' name='form_orig_reference' value='' />\n";
 495     echo "<input type='hidden' name='form_orig_check_date' value='' />\n";
 496     echo "<input type='hidden' name='form_orig_deposit_date' value='' />\n";
 497     echo "<input type='hidden' name='form_pay_total' value='' />\n";
 498     echo "</td>\n";
 499 ?>
 500  </tr>
 501 <?php if (!empty($pdrow['billing_note'])) { ?>
 502  <tr>
 503   <td>
 504    <?php xl('Billing Note:','e')?>
 505   </td>
 506   <td colspan='3' style='color:red'>
 507    <?php echo $pdrow['billing_note'] ?>
 508   </td>
 509  </tr>
 510 <?php } ?>
 511  <tr>
 512   <td height="1">
 513   </td>
 514  </tr>
 515 </table>
 516
 517 <table border='0' cellpadding='2' cellspacing='0' width='98%'>
 518
 519  <tr bgcolor="#cccccc">
 520   <td class="dehead">
 521    <?php xl('Code','e')?>
 522   </td>
 523   <td class="dehead" align="right">
 524    <?php xl('Charge','e')?>
 525   </td>
 526   <td class="dehead" align="right">
 527    <?php xl('Balance','e')?>&nbsp;
 528   </td>
 529   <td class="dehead">
 530    <?php xl('By/Source','e')?>
 531   </td>
 532   <td class="dehead">
 533    <?php xl('Date','e')?>
 534   </td>
 535   <td class="dehead">
 536    <?php xl('Pay','e')?>
 537   </td>
 538   <td class="dehead">
 539    <?php xl('Adjust','e')?>
 540   </td>
 541   <td class="dehead">
 542    <?php xl('Reason','e')?>
 543   </td>
 544 <?php if ($ALLOW_DELETE) { ?>
 545   <td class="dehead">
 546    <?php xl('Del','e')?>
 547   </td>
 548 <?php } ?>
 549  </tr>
 550 <?php
 551   $firstProcCodeIndex = -1;
 552   $encount = 0;
 553   foreach ($codes as $code => $cdata) {
 554    ++$encount;
 555    $bgcolor = "#" . (($encount & 1) ? "ddddff" : "ffdddd");
 556    $dispcode = $code;
 557
 558    // remember the index of the first entry whose code is not "CO-PAY", i.e. it's a legitimate proc code
 559    if ($firstProcCodeIndex == -1 && strcmp($code, "CO-PAY") !=0)
 560     $firstProcCodeIndex = $encount;
 561
 562    // this sorts the details more or less chronologically:
 563    ksort($cdata['dtl']);
 564    foreach ($cdata['dtl'] as $dkey => $ddata) {
 565     $ddate = substr($dkey, 0, 10);
 566     if (preg_match('/^(\d\d\d\d)(\d\d)(\d\d)\s*$/', $ddate, $matches)) {
 567      $ddate = $matches[1] . '-' . $matches[2] . '-' . $matches[3];
 568     }
 569     $tmpchg = "";
 570     $tmpadj = "";
 571     /*****************************************************************
 572     if ($ddata['chg'] > 0)
 573      $tmpchg = $ddata['chg'];
 574     else if ($ddata['chg'] < 0)
 575      $tmpadj = 0 - $ddata['chg'];
 576     *****************************************************************/
 577     if ($ddata['chg'] != 0) {
 578       if (isset($ddata['rsn'])) $tmpadj = 0 - $ddata['chg'];
 579       else $tmpchg = $ddata['chg'];
 580     }
 581 ?>
 582  <tr bgcolor='<?php echo $bgcolor ?>'>
 583   <td class="detail">
 584    <?php echo $dispcode; $dispcode = "" ?>
 585   </td>
 586   <td class="detail" align="right">
 587    <?php bucks($tmpchg) ?>
 588   </td>
 589   <td class="detail" align="right">
 590    &nbsp;
 591   </td>
 592   <td class="detail">
 593    <?php
 594     if (isset($ddata['plv'])) {
 595       if (!$ddata['plv']) echo 'Pt/';
 596       else echo 'Ins' . $ddata['plv'] . '/';
 597     }
 598     echo $ddata['src'];
 599    ?>
 600   </td>
 601   <td class="detail">
 602    <?php echo $ddate ?>
 603   </td>
 604   <td class="detail">
 605    <?php bucks($ddata['pmt']) ?>
 606   </td>
 607   <td class="detail">
 608    <?php bucks($tmpadj) ?>
 609   </td>
 610   <td class="detail">
 611    <?php echo $ddata['rsn'] ?>
 612   </td>
 613 <?php if ($ALLOW_DELETE) { ?>
 614   <td class="detail">
 615 <?php if (!empty($ddata['arseq'])) { ?>
 616    <input type="checkbox" name="form_del[<?php echo $ddata['arseq']; ?>]" />
 617 <?php } else { ?>
 618    &nbsp;
 619 <?php } ?>
 620   </td>
 621 <?php } ?>
 622  </tr>
 623 <?php
 624    } // end of prior detail line
 625 ?>
 626  <tr bgcolor='<?php echo $bgcolor ?>'>
 627   <td class="detail">
 628    <?php echo $dispcode; $dispcode = "" ?>
 629   </td>
 630   <td class="detail" align="right">
 631    &nbsp;
 632   </td>
 633   <td class="detail" align="right">
 634    <input type="hidden" name="form_line[<?php echo $code ?>][bal]" value="<?php bucks($cdata['bal']) ?>">
 635    <input type="hidden" name="form_line[<?php echo $code ?>][ins]" value="<?php echo $cdata['ins'] ?>">
 636    <input type="hidden" name="form_line[<?php echo $code ?>][code_type]" value="<?php echo $cdata['code_type'] ?>">
 637    <?php printf("%.2f", $cdata['bal']) ?>&nbsp;
 638   </td>
 639   <td class="detail">
 640
 641
 642   </td>
 643   <td class="detail">
 644
 645
 646   </td>
 647   <td class="detail">
 648    <input type="text" name="form_line[<?php echo $code ?>][pay]" size="10"
 649     style="background-color:<?php echo $bgcolor ?>"
 650     onKeyUp="updateFields(document.forms[0]['form_line[<?php echo $code ?>][pay]'],
 651                           document.forms[0]['form_line[<?php echo $code ?>][adj]'],
 652                           document.forms[0]['form_line[<?php echo $code ?>][bal]'],
 653                           document.forms[0]['form_line[CO-PAY][bal]'],
 654                           <?php echo ($firstProcCodeIndex == $encount) ? 1 : 0 ?>)"/>
 655   </td>
 656   <td class="detail">
 657    <input type="text" name="form_line[<?php echo $code ?>][adj]" size="10"
 658     value='<?php echo $totalAdjAmount ?>'
 659     style="background-color:<?php echo $bgcolor ?>" />
 660    &nbsp; <a href="" onclick="return writeoff('<?php echo $code ?>')">W</a>
 661   </td>
 662   <td class="detail">
 663    <select name="form_line[<?php echo $code ?>][reason]"
 664     style="background-color:<?php echo $bgcolor ?>">
 665 <?php
 666 // Adjustment reasons are now taken from the list_options table.
 667 echo "    <option value=''></option>\n";
 668 $ores = sqlStatement("SELECT option_id, title, is_default FROM list_options " .
 669   "WHERE list_id = 'adjreason' AND activity = 1 ORDER BY seq, title");
 670 while ($orow = sqlFetchArray($ores)) {
 671   echo "    <option value='" . htmlspecialchars($orow['option_id'], ENT_QUOTES) . "'";
 672   if ($orow['is_default']) echo " selected";
 673   echo ">" . htmlspecialchars($orow['title']) . "</option>\n";
 674 }
 675 ?>
 676
 677    </select>
 678 <?php
 679     // TBD: Maybe a comment field would be good here, for appending
 680     // to the reason.
 681 ?>
 682   </td>
 683
 684 <?php if ($ALLOW_DELETE) { ?>
 685   <td class="detail">
 686    &nbsp;
 687   </td>
 688 <?php } ?>
 689
 690  </tr>
 691 <?php
 692   } // end of code
 693 ?>
 694
 695 </table>
 696 </form>
 697 </center>
 698 <script language="JavaScript">
 699  var f1 = opener.document.forms[0];
 700  var f2 = document.forms[0];
 701  if (f1.form_source) {
 702 <?php
 703     // These support creation and lookup of ar_session table entries:
 704     echo "  f2.form_reference.value         = f1.form_source.value;\n";
 705     echo "  f2.form_check_date.value        = f1.form_paydate.value;\n";
 706     echo "  //f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 707     echo "  if (f1.form_deposit_date.value != '')\n";
 708     echo "     f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 709     echo "  else\n";
 710     echo "     f2.form_deposit_date.value      = getFormattedToday();\n";
 711     echo "  f2.form_payer_id.value          = f1.form_payer_id.value;\n";
 712     echo "  f2.form_pay_total.value         = f1.form_amount.value;\n";
 713     echo "  f2.form_orig_reference.value    = f1.form_source.value;\n";
 714     echo "  f2.form_orig_check_date.value   = f1.form_paydate.value;\n";
 715     echo "  f2.form_orig_deposit_date.value = f1.form_deposit_date.value;\n";
 716
 717     // While I'm thinking about it, some notes about eob sessions.
 718     // If they do not have all of the session key fields in the search
 719     // page, then show a warning at the top of the invoice page.
 720     // Also when they go to save the invoice page and a session key
 721     // field has changed, alert them to that and allow a cancel.
 722
 723     // Another point... when posting EOBs, the incoming payer ID might
 724     // not match the payer ID for the patient's insurance.  This is
 725     // because the same payer might be entered more than once into the
 726     // insurance_companies table.  I don't think it matters much.
 727 ?>
 728  }
 729  setins("Ins1");
 730 </script>
 731 </body>
 732 </html>