interface/patient_file/encounter/copay.php

   1 <?php
   2 include_once("../../globals.php");
   3
   4 // This may be more appropriate to move to the library
   5 // later
   6 function getInsuranceCompanies($pid) {
   7   $res = sqlStatement("SELECT * FROM insurance_data WHERE pid = '$pid' " .
   8     "ORDER BY type ASC, date DESC");
   9   $prevtype = '';
  10   for($iter = 0; $row = sqlFetchArray($res); $iter++) {
  11     if (strcmp($row['type'], $prevtype) == 0) continue;
  12     $prevtype = $row['type'];
  13     $all[$iter] = $row;
  14   }
  15   return $all;
  16 }
  17
  18 //the number of rows to display before resetting and starting a new column:
  19 $N=10
  20 ?>
  21 <html>
  22 <head>
  23 <script type="text/javascript">
  24 function cleartext(atrib)
  25 {
  26 document.copay_form.code.value=document.copay_form.codeH.value;
  27 document.copay_form.codeH.value="";
  28 }
  29 </script>
  30
  31
  32 <?php html_header_show();?>
  33 <link rel="stylesheet" href="<?php echo $css_header;?>" type="text/css">
  34 </head>
  35 <body class="body_bottom">
  36
  37 <table border='0' cellspacing='0' cellpadding='0' height='100%'>
  38 <tr>
  39
  40 <td valign=top>
  41
  42 <dl>
  43
  44 <form method='post' name='copay_form' action="diagnosis.php?mode=add&type=COPAY&text=copay"
  45  target='Diagnosis' onsubmit='return top.restoreSession()'>
  46
  47 <dt><span class=title><?php xl('Copay','e'); ?></span></dt>
  48
  49 <br>
  50 <input type=hidden name=code>
  51 <span class='text'><?php xl('$','e'); ?> </span><input type='entry' name='codeH' value='' size='5' />
  52
  53 <input type="SUBMIT" value="<?php xl('Save','e');?>" onclick="cleartext('clear')"><br><br>
  54
  55
  56 <div<?php if ($GLOBALS['simplified_copay']) echo " style='display:none;'"; ?>>
  57 <input type="RADIO" name="payment_method" value="cash" checked><?php xl('cash','e'); ?>
  58 <input type="RADIO" name="payment_method" value="credit card"><?php xl('credit','e'); ?>
  59 <input type="RADIO" name="payment_method" value="check"><?php xl('check','e'); ?>
  60 <input type="RADIO" name="payment_method" value="other"><?php xl('other','e'); ?><br><br>
  61 <input type="RADIO" name="payment_method" value="insurance"><?php xl('insurance','e'); ?>
  62 <?php
  63 if ($ret=getInsuranceCompanies($pid)) {
  64         if (sizeof($ret)>0) {
  65                 echo "<select name=insurance_company>\n";
  66                 foreach($ret as $iter) {
  67                         $plan_name = trim($iter['plan_name']);
  68                         if ($plan_name != '') {
  69                                 echo "<option value='"
  70                                 .$plan_name
  71                                 ."'>".$plan_name ."\n";
  72                         }
  73                 }
  74                 echo "</select>\n";
  75         }
  76 }
  77 ?>
  78 <br><br>
  79 <input type="RADIO" name="payment_method" value="write off"><?php xl('write off','e'); ?>
  80
  81 </div>
  82
  83 </form>
  84
  85 </dl>
  86
  87 </td>
  88 </tr>
  89 </table>
  90
  91 </body>
  92 </html>