interface/usergroup/facility_admin.php

   1 <?php
   2 include_once("../globals.php");
   3 include_once("$srcdir/md5.js");
   4 include_once("$srcdir/sql.inc");
   5 require_once("$srcdir/classes/POSRef.class.php");
   6
   7 if ($_POST["mode"] == "facility")
   8 {
   9         sqlStatement("update facility set
  10                 name='{$_POST['facility']}',
  11                 phone='{$_POST['phone']}',
  12                 fax='{$_POST['fax']}',
  13                 street='{$_POST['street']}',
  14                 city='{$_POST['city']}',
  15                 state='{$_POST['state']}',
  16                 postal_code='{$_POST['postal_code']}',
  17                 country_code='{$_POST['country_code']}',
  18                 federal_ein='{$_POST['federal_ein']}',
  19                 billing_location='{$_POST['billing_location']}',
  20                 accepts_assignment='{$_POST['accepts_assignment']}',
  21                 pos_code='{$_POST['pos_code']}',
  22                 domain_identifier='{$_POST['domain_identifier']}',
  23                 attn='{$_POST['attn']}'
  24         where id='{$_POST['fid']}'");
  25 }
  26
  27 if (isset($_GET["fid"])) {
  28         $my_fid = $_GET["fid"];
  29 }
  30
  31 if (isset($_POST["fid"])) {
  32         $my_fid = $_POST["fid"];
  33 }
  34
  35 ?>
  36 <html>
  37 <head>
  38
  39 <link rel=stylesheet href="<?php echo $css_header;?>" type="text/css">
  40
  41 </head>
  42 <body <?php echo $top_bg_line;?> topmargin=0 rightmargin=0 leftmargin=2 bottommargin=0 marginwidth=2 marginheight=0>
  43
  44 <span class="title"><?php  xl('Edit Facility Information','e'); ?></span>
  45
  46 <form name='facility' method='post' action="facility_admin.php">
  47 <input type=hidden name=mode value="facility">
  48 <input type=hidden name=fid value="<?php echo $my_fid;?>">
  49 <span class=bold><?php  xl('Facility Information','e'); ?>: </span>
  50 </td><td>
  51 <?php $facility = sqlQuery("select * from facility where id='$my_fid'"); ?>
  52 <br><br>
  53 <table border=0 cellpadding=0 cellspacing=0>
  54 <tr>
  55         <td><span class=text><?php  xl('Name','e'); ?>: </span></td><td><input type=entry name=facility size=20 value="<?php echo $facility['name']?>"></td><td rowspan="10" width="15"></d>
  56         <td><span class=text><?php  xl('Phone','e'); ?> <?php  xl('as','e'); ?> (000) 000-0000:</span></td><td><input type=entry name=phone size=20 value="<?php echo $facility['phone']?>"></td>
  57 </tr>
  58 <tr>
  59         <td>&nbsp;</td><td>&nbsp;</td>
  60         <td><span class=text><?php  xl('Fax','e'); ?> <?php  xl('as','e'); ?> (000) 000-0000:</span></td><td><input type=entry name=f
  61 ax size=20 value="<?php echo $facility['fax']?>"></td>
  62 </tr>
  63 <tr>
  64         <td><span class=text><?php  xl('Address','e'); ?>: </span></td><td><input type=entry size=20 name=street value="<?php echo $facility["street"]?>"></td>
  65         <td><span class=text><?php  xl('City','e'); ?>: </span></td><td><input type=entry size=20 name=city value="<?php echo $facility{"city"}?>"></td>
  66 </tr>
  67 <tr>
  68         <td><span class=text><?php  xl('State','e'); ?>: </span></td><td><input type=entry size=20 name=state value="<?php echo $facility{"state"}?>"></td>
  69         <td><span class=text><?php  xl('Zip Code','e'); ?>: </span></td><td><input type=entry size=20 name=postal_code value="<?php echo $facility{"postal_code"}?>"></td>
  70 </tr>
  71 <tr>
  72         <td><span class=text><?php  xl('Country','e'); ?>: </span></td><td><input type=entry size=20 name=country_code value="<?php echo $facility{"country_code"}?>"></td>
  73         <td><span class=text><?php  xl('Federal EIN','e'); ?>: </span></td><td><input type=entry size=20 name=federal_ein value="<?php echo $facility{"federal_ein"}?>"></td>
  74 </tr>
  75 <tr>
  76         <td><span class=text><?php  xl('Billing Location','e'); ?>: </span></td><td><input type=checkbox name="billing_location" value="1" <?php if ($facility['billing_location'] == 1) echo "checked"?>"></td>
  77         <td><span class=text><?php  xl('Accepts Assignment','e'); ?><br>(<?php  xl('only if billing location','e'); ?>): </span></td><td><input type=checkbox name="accepts_assignment" value="1" <?php if ($facility['accepts_assignment'] == 1) echo "checked"?>"></td>
  78 </tr>
  79 <tr>
  80         <td><span class=text><?php  xl('POS Code','e'); ?>: </span></td>
  81         <td colspan="6">
  82                 <select name="pos_code">
  83                 <?php
  84                 $pc = new POSRef();
  85
  86                 foreach ($pc->get_pos_ref() as $pos) {
  87                         echo "<option value=\"" . $pos["code"] . "\" ";
  88                         if ($facility['pos_code'] == $pos['code']) {
  89                                 echo "selected";
  90                         }
  91                         echo ">" . $pos['code']  . ": ". $pos['title'];
  92                         echo "</option>\n";
  93                 }
  94
  95                 ?>
  96                 </select>
  97         </td>
  98 </tr>
  99 <tr>
 100         <td><span class="text"><?php  xl('Billing Attn','e'); ?>:</span></td>
 101         <td colspan="4"><input type="text" name="attn" size="45" value="<?php echo $facility['attn']?>"></td>
 102 </tr>
 103 <tr>
 104         <td><span class="text"><?php  xl('CLIA Number','e'); ?>:</span></td>
 105         <td colspan="4"><input type="text" name="domain_identifier" size="45" value="<?php echo $facility['domain_identifier']?>"></td>
 106 </tr>
 107 <tr>
 108         <td>&nbsp;</td><td>&nbsp;</td>
 109         <td>&nbsp;</td><td><br><br><input type="submit" value="<?php xl('Update Info','e'); ?>">&nbsp;&nbsp;&nbsp;<a href="usergroup_admin.php" class=link_submit>[<?php xl('Back','e'); ?>]</font></a></td>
 110 </tr>
 111 </table>
 112 </form>
 113
 114 </body>
 115 </html>