interface/patient_file/front_payment.php

   1 <?php
   2  // Copyright (C) 2006 Rod Roark <rod@sunsetsystems.com>
   3  //
   4  // This program is free software; you can redistribute it and/or
   5  // modify it under the terms of the GNU General Public License
   6  // as published by the Free Software Foundation; either version 2
   7  // of the License, or (at your option) any later version.
   8
   9  include_once("../globals.php");
  10  include_once("$srcdir/patient.inc");
  11 ?>
  12 <html>
  13 <head>
  14 <link rel='stylesheet' href='<?php echo $css_header ?>' type='text/css'>
  15 <?php
  16  $payment_methods = array(
  17   xl('Cash'),
  18   xl('Check'),
  19   xl('MC'),
  20   xl('VISA'),
  21   xl('AMEX'),
  22   xl('DISC'),
  23   xl('Other'));
  24
  25  // $patdata = getPatientData($pid, 'fname,lname,pubpid');
  26
  27  $patdata = sqlQuery("SELECT " .
  28    "p.fname, p.mname, p.lname, p.pubpid, i.copay " .
  29    "FROM patient_data AS p " .
  30    "LEFT OUTER JOIN insurance_data AS i ON " .
  31    "i.pid = p.pid AND i.type = 'primary' " .
  32    "WHERE p.pid = '$pid' LIMIT 1");
  33
  34  $alertmsg = ''; // anything here pops up in an alert box
  35
  36  // If the Save button was clicked...
  37  if ($_POST['form_save']) {
  38   $form_pid = $_POST['form_pid'];
  39   $payid = $_REQUEST['payid'];
  40
  41   if ($payid) {
  42    sqlStatement("UPDATE payments SET " .
  43     "dtime = NOW(), " .
  44     "user = '"    . $_SESSION['authUser']  . "', " .
  45     "method = '"  . $_POST['form_method']  . "', " .
  46     "source = '"  . $_POST['form_source']  . "', " .
  47     "amount1 = '" . $_POST['form_amount1'] . "', " .
  48     "amount2 = '" . $_POST['form_amount2'] . "' " .
  49     "WHERE id = '$payid'");
  50   } else {
  51    $payid = sqlInsert("INSERT INTO payments ( " .
  52     "pid, dtime, user, method, source, amount1, amount2 " .
  53     ") VALUES ( " .
  54     "'$form_pid', " .
  55     "NOW(), " .
  56     "'" . $_SESSION['authUser']  . "', " .
  57     "'" . $_POST['form_method']  . "', " .
  58     "'" . $_POST['form_source']  . "', " .
  59     "'" . $_POST['form_amount1'] . "', " .
  60     "'" . $_POST['form_amount2'] . "' "  .
  61     ")");
  62   }
  63  }
  64 ?>
  65
  66 <?php
  67  if ($_POST['form_save'] || $_REQUEST['receipt']) {
  68
  69   // Get details for what we guess is the primary facility.
  70   $frow = sqlQuery("SELECT * FROM facility " .
  71     "ORDER BY billing_location DESC, accepts_assignment DESC, id LIMIT 1");
  72
  73   // Re-fetch info for this payment.
  74   $payrow = sqlQuery("SELECT * FROM payments WHERE id = '$payid'");
  75
  76   // Get the patient's name and chart number.
  77   $patdata = getPatientData($payrow['pid'], 'fname,mname,lname,pubpid');
  78
  79   // Now proceed with printing the receipt.
  80 ?>
  81
  82 <title><? xl('Receipt for Payment','e'); ?></title>
  83 <body bgcolor='#ffffff'>
  84 <center>
  85
  86 <p><h2><? xl('Receipt for Payment','e'); ?></h2>
  87
  88 <p><?php echo htmlentities($frow['name']) ?>
  89 <br><?php echo htmlentities($frow['street']) ?>
  90 <br><?php echo htmlentities($frow['city'] . ', ' . $frow['state']) . ' ' .
  91     $frow['postal_code'] ?>
  92 <br><?php echo htmlentities($frow['phone']) ?>
  93
  94 <p>
  95 <table border='0' cellspacing='8'>
  96  <tr>
  97   <td><? xl('Date','e'); ?>:</td>
  98   <td><?php echo date('Y-m-d', strtotime($payrow['dtime'])) ?></td>
  99  </tr>
 100  <tr>
 101   <td><? xl('Patient','e'); ?>:</td>
 102   <td><?php echo $patdata['fname'] . " " . $patdata['mname'] . " " .
 103        $patdata['lname'] . " (" . $patdata['pubpid'] . ")" ?></td>
 104  </tr>
 105  <tr>
 106   <td><? xl('Paid Via','e'); ?>:</td>
 107   <td><?php echo $payrow['method'] ?></td>
 108  </tr>
 109  <tr>
 110   <td><? xl('Check/Ref Number','e'); ?>:</td>
 111   <td><?php echo $payrow['source'] ?></td>
 112  </tr>
 113  <tr>
 114   <td><? xl('Amount for This Visit','e'); ?>:</td>
 115   <td><?php echo $payrow['amount1'] ?></td>
 116  </tr>
 117  <tr>
 118   <td><? xl('Amount for Past Balance','e'); ?>:</td>
 119   <td><?php echo $payrow['amount2'] ?></td>
 120  </tr>
 121  <tr>
 122   <td><? xl('Received By','e'); ?>:</td>
 123   <td><?php echo $payrow['user'] ?></td>
 124  </tr>
 125 </table>
 126
 127 </center>
 128
 129 <p>&nbsp;<br>
 130 <a href='' class='link_submit' onclick='window.print();return false;'><? xl('Print','e'); ?></a>
 131
 132 </body>
 133
 134 <?php
 135  } else {
 136
 137   // This is the case where we display the form for data entry.
 138
 139   $payrow = array('amount1' => $patdata['copay']);
 140   if ($_REQUEST['payid']) {
 141    $payrow = sqlQuery("SELECT * FROM payments WHERE id = '" .
 142     $_REQUEST['payid'] . "'");
 143   }
 144   // Continue with display of the data entry form.
 145 ?>
 146 <title><? xl('Record Payment','e'); ?></title>
 147
 148 <style>
 149 </style>
 150
 151 <script type="text/javascript" src="../../library/topdialog.js"></script>
 152 <script type="text/javascript" src="../../library/dialog.js"></script>
 153
 154 <script language="JavaScript">
 155 </script>
 156
 157 </head>
 158
 159 <body <?echo $top_bg_line;?> leftmargin='0' topmargin='0' marginwidth='0'
 160  marginheight='0' onunload='imclosing()'>
 161
 162 <form method='post' action='front_payment.php<?php if ($payid) echo "?payid=$payid"; ?>'>
 163 <input type='hidden' name='form_pid' value='<?php echo $pid ?>' />
 164
 165 <center>
 166 <p>
 167 <table border='0' cellspacing='8'>
 168
 169  <tr>
 170   <td colspan='2' align='center'>
 171    &nbsp;<br>
 172    <b><? xl('Accept Payment for ','e'); ?><?php echo $patdata['fname'] . " " .
 173     $patdata['lname'] . " (" . $patdata['pubpid'] . ")" ?></b>
 174     <br>&nbsp;
 175   </td>
 176  </tr>
 177
 178  <tr>
 179   <td>
 180    <? xl('Payment Method','e'); ?>:
 181   </td>
 182   <td>
 183    <select name='form_method'>
 184 <?
 185  foreach ($payment_methods as $value) {
 186   echo "    <option value='$value'";
 187   if ($value == $payrow['method']) echo " selected";
 188   echo ">$value</option>\n";
 189  }
 190 ?>
 191    </select>
 192   </td>
 193  </tr>
 194
 195  <tr>
 196   <td>
 197    <? xl('Check/Reference Number','e'); ?>:
 198   </td>
 199   <td>
 200    <input type='text' name='form_source' size='10' value='<?php echo $payrow['source'] ?>'>
 201   </td>
 202  </tr>
 203
 204  <tr>
 205   <td>
 206    <? xl('Amount for Todays Visit','e'); ?>:
 207   </td>
 208   <td>
 209    <input type='text' name='form_amount1' size='10' value='<?php echo $payrow['amount1'] ?>'>
 210   </td>
 211  </tr>
 212
 213  <tr>
 214   <td>
 215    <? xl('Amount for Prior Balance','e'); ?>:
 216   </td>
 217   <td>
 218    <input type='text' name='form_amount2' size='10' value='<?php echo $payrow['amount2'] ?>'>
 219   </td>
 220  </tr>
 221
 222  <tr>
 223   <td colspan='2' align='center'>
 224    &nbsp;<br>
 225    <input type='submit' name='form_save' value='<?php xl('Save','e'); ?>' /> &nbsp;
 226    <input type='button' value='<?php xl('Cancel','e'); ?>' onclick='window.close()' />
 227   </td>
 228  </tr>
 229
 230 </table>
 231 </center>
 232
 233 </form>
 234
 235 </body>
 236
 237 <?php
 238  }
 239 ?>
 240 </html>