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.php");
  41 require_once("$srcdir/payment.inc.php");
  42 require_once("$srcdir/forms.inc.php");
  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\Common\Csrf\CsrfUtils;
  50 use OpenEMR\PaymentProcessing\Sphere\SpherePayment;
  51
  52 $cryptoGen = new CryptoGen();
  53
  54 $appsql = new ApplicationTable();
  55 $pid = isset($_REQUEST['pid']) ? $_REQUEST['pid'] : $pid;
  56 $pid = $_REQUEST['hidden_patient_code'] > 0 ? $_REQUEST['hidden_patient_code'] : $pid;
  57 $recid = isset($_REQUEST['recid']) ? (int) $_REQUEST['recid'] : 0;
  58 $adminUser = '';
  59 $portalPatient = '';
  60
  61 $query = "SELECT pao.portal_username as recip_id, Concat_Ws(' ', patient_data.fname, patient_data.lname) as username FROM patient_data " .
  62     "LEFT JOIN patient_access_onsite pao ON pao.pid = patient_data.pid " .
  63     "WHERE patient_data.pid = ? AND pao.portal_pwd_status = 1";
  64 $portalPatient = sqlQueryNoLog($query, $pid);
  65 if ($_SESSION['authUserID']) {
  66     $query = "SELECT users.username as recip_id, users.authorized as dash, CONCAT(users.fname,' ',users.lname) as username  " .
  67         "FROM users WHERE id = ?";
  68     $adminUser = sqlQueryNoLog($query, $_SESSION['authUserID']);
  69 }
  70
  71 if ($recid) {
  72     $edata = $appsql->getPortalAuditRec($recid);
  73 } else {
  74     $edata = $appsql->getPortalAudit($pid, 'review', 'payment');
  75 }
  76 $ccdata = array();
  77 $invdata = array();
  78 if ($edata) {
  79     $ccdata = json_decode($cryptoGen->decryptStandard($edata['checksum']), true);
  80     $invdata = json_decode($edata['table_args'], true);
  81     echo "<script>var jsondata='" . $edata['table_args'] . "';var ccdata='" . $edata['checksum'] . "'</script>";
  82 }
  83
  84 function bucks($amount)
  85 {
  86     if ($amount) {
  87         $amount = oeFormatMoney($amount);
  88         return $amount;
  89     }
  90
  91     return '';
  92 }
  93
  94 function rawbucks($amount)
  95 {
  96     if ($amount) {
  97         $amount = sprintf("%.2f", $amount);
  98         return $amount;
  99     }
 100
 101     return '';
 102 }
 103
 104 // Display a row of data for an encounter.
 105 //
 106 $var_index = 0;
 107 $sum_charges = $sum_ptpaid = $sum_inspaid = $sum_duept = $sum_copay = $sum_patcopay = $sum_balance = 0;
 108 function echoLine($iname, $date, $charges, $ptpaid, $inspaid, $duept, $encounter = 0, $copay = 0, $patcopay = 0)
 109 {
 110     global $sum_charges, $sum_ptpaid, $sum_inspaid, $sum_duept, $sum_copay, $sum_patcopay, $sum_balance;
 111     global $var_index;
 112     $var_index++;
 113     $balance = bucks($charges - $ptpaid - $inspaid);
 114     $balance = (round($duept, 2) != 0) ? 0 : $balance; // if balance is due from patient, then insurance balance is displayed as zero
 115     $encounter = $encounter ? $encounter : '';
 116     echo " <tr id='tr_" . attr($var_index) . "' >\n";
 117     echo "  <td class='detail'>" . text(oeFormatShortDate($date)) . "</td>\n";
 118     echo "  <td class='detail' id='" . attr($date) . "' align='left'>" . text($encounter) . "</td>\n";
 119     echo "  <td class='detail' align='center' id='td_charges_$var_index' >" . text(bucks($charges)) . "</td>\n";
 120     echo "  <td class='detail' align='center' id='td_inspaid_$var_index' >" . text(bucks($inspaid * -1)) . "</td>\n";
 121     echo "  <td class='detail' align='center' id='td_ptpaid_$var_index' >" . text(bucks($ptpaid * -1)) . "</td>\n";
 122     echo "  <td class='detail' align='center' id='td_patient_copay_$var_index' >" . text(bucks($patcopay)) . "</td>\n";
 123     echo "  <td class='detail' align='center' id='td_copay_$var_index' >" . text(bucks($copay)) . "</td>\n";
 124     echo "  <td class='detail' align='center' id='balance_$var_index'>" . text(bucks($balance)) . "</td>\n";
 125     echo "  <td class='detail' align='center' id='duept_$var_index'>" . text(bucks(round($duept, 2) * 1)) . "</td>\n";
 126     echo "  <td class='detail' align='center'><input class='form-control' name='" . attr($iname) . "'  id='paying_" . attr($var_index) .
 127         "' " . " value='" . '' . "' onchange='coloring();calctotal()'  autocomplete='off' " . "onkeyup='calctotal()'/></td>\n";
 128     echo " </tr>\n";
 129
 130     $sum_charges += (float)$charges * 1;
 131     $sum_ptpaid += (float)$ptpaid * -1;
 132     $sum_inspaid += (float)$inspaid * -1;
 133     $sum_duept += (float)$duept * 1;
 134     $sum_patcopay += (float)$patcopay * 1;
 135     $sum_copay += (float)$copay * 1;
 136     $sum_balance += (float)$balance * 1;
 137 }
 138
 139 // We use this to put dashes, colons, etc. back into a timestamp.
 140 //
 141 function decorateString($fmt, $str)
 142 {
 143     $res = '';
 144     while ($fmt) {
 145         $fc = substr($fmt, 0, 1);
 146         $fmt = substr($fmt, 1);
 147         if ($fc == '.') {
 148             $res .= substr($str, 0, 1);
 149             $str = substr($str, 1);
 150         } else {
 151             $res .= $fc;
 152         }
 153     }
 154
 155     return $res;
 156 }
 157
 158 // Compute taxes from a tax rate string and a possibly taxable amount.
 159 //
 160 function calcTaxes($row, $amount)
 161 {
 162     $total = 0;
 163     if (empty($row['taxrates'])) {
 164         return $total;
 165     }
 166
 167     $arates = explode(':', $row['taxrates']);
 168     if (empty($arates)) {
 169         return $total;
 170     }
 171
 172     foreach ($arates as $value) {
 173         if (empty($value)) {
 174             continue;
 175         }
 176
 177         $trow = sqlQuery("SELECT option_value FROM list_options WHERE " . "list_id = 'taxrate' AND option_id = ? LIMIT 1", array($value
 178         ));
 179         if (empty($trow['option_value'])) {
 180             echo "<!-- Missing tax rate '" . text($value) . "'! -->\n";
 181             continue;
 182         }
 183
 184         $tax = sprintf("%01.2f", $amount * $trow['option_value']);
 185 // echo "<!-- Rate = '$value', amount = '$amount', tax = '$tax' -->\n";
 186         $total += $tax;
 187     }
 188
 189     return $total;
 190 }
 191
 192 $now = time();
 193 $today = date('Y-m-d', $now);
 194 $timestamp = date('Y-m-d H:i:s', $now);
 195
 196 $patdata = sqlQuery("SELECT " . "p.fname, p.mname, p.lname, p.postal_code, p.pubpid,p.pid, i.copay " . "FROM patient_data AS p " . "LEFT OUTER JOIN insurance_data AS i ON " . "i.pid = p.pid AND i.type = 'primary' " . "WHERE p.pid = ? ORDER BY i.date DESC LIMIT 1", array($pid
 197 ));
 198
 199 $alertmsg = ''; // anything here pops up in an alert box
 200
 201 // If the Save button was clicked...
 202 if ($_POST['form_save']) {
 203     $form_pid = $_POST['form_pid'];
 204     $form_method = trim($_POST['form_method']);
 205     $form_source = trim($_POST['form_source']);
 206     $patdata = getPatientData($form_pid, 'fname,mname,lname,pubpid');
 207     $NameNew = $patdata['fname'] . " " . $patdata['lname'] . " " . $patdata['mname'];
 208
 209     if ($_REQUEST['radio_type_of_payment'] == 'pre_payment') {
 210         $payment_id = sqlInsert(
 211             "insert into ar_session set " .
 212             "payer_id = ?" .
 213             ", patient_id = ?" .
 214             ", user_id = ?" .
 215             ", closed = ?" .
 216             ", reference = ?" .
 217             ", check_date =  now() , deposit_date = now() " .
 218             ",  pay_total = ?" .
 219             ", payment_type = 'patient'" .
 220             ", description = ?" .
 221             ", adjustment_code = 'pre_payment'" .
 222             ", post_to_date = now() " .
 223             ", payment_method = ?",
 224             array(0, $form_pid, $_SESSION['authUserID'], 0, $form_source, $_REQUEST['form_prepayment'], $NameNew, $form_method)
 225         );
 226
 227         frontPayment($form_pid, 0, $form_method, $form_source, $_REQUEST['form_prepayment'], 0, $timestamp);//insertion to 'payments' table.
 228     }
 229
 230     if ($_POST['form_upay'] && $_REQUEST['radio_type_of_payment'] != 'pre_payment') {
 231         foreach ($_POST['form_upay'] as $enc => $payment) {
 232             if ($amount = (float)$payment) {
 233                 $zero_enc = $enc;
 234
 235                 //----------------------------------------------------------------------------------------------------
 236                 //Fetching the existing code and modifier
 237                 $ResultSearchNew = sqlStatement(
 238                     "SELECT * FROM billing LEFT JOIN code_types ON billing.code_type=code_types.ct_key " .
 239                     "WHERE code_types.ct_fee=1 AND billing.activity!=0 AND billing.pid =? AND encounter=? ORDER BY billing.code,billing.modifier",
 240                     array($form_pid, $enc)
 241                 );
 242                 if ($RowSearch = sqlFetchArray($ResultSearchNew)) {
 243                     $Codetype = $RowSearch['code_type'];
 244                     $Code = $RowSearch['code'];
 245                     $Modifier = $RowSearch['modifier'];
 246                 } else {
 247                     $Codetype = '';
 248                     $Code = '';
 249                     $Modifier = '';
 250                 }
 251
 252                 //----------------------------------------------------------------------------------------------------
 253                 if ($_REQUEST['radio_type_of_payment'] == 'copay') {//copay saving to ar_session and ar_activity tables
 254                     $session_id = sqlInsert(
 255                         "INSERT INTO ar_session (payer_id,user_id,reference,check_date,deposit_date,pay_total," .
 256                         " global_amount,payment_type,description,patient_id,payment_method,adjustment_code,post_to_date) " .
 257                         " VALUES ('0',?,?,now(),now(),?,'','patient','COPAY',?,?,'patient_payment',now())",
 258                         array($_SESSION['authUserID'], $form_source, $amount, $form_pid, $form_method)
 259                     );
 260
 261                     sqlBeginTrans();
 262                     $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM       ar_activity WHERE pid = ? AND encounter = ?", array($form_pid, $enc));
 263                     $insrt_id = sqlInsert(
 264                         "INSERT INTO ar_activity (pid,encounter,sequence_no,code_type,code,modifier,payer_type,post_time,post_user,session_id,pay_amount,account_code)" .
 265                         " VALUES (?,?,?,?,?,?,0,now(),?,?,?,'PCP')",
 266                         array($form_pid, $enc, $sequence_no['increment'], $Codetype, $Code, $Modifier, $_SESSION['authUserID'], $session_id, $amount)
 267                     );
 268                     sqlCommitTrans();
 269
 270                     frontPayment($form_pid, $enc, $form_method, $form_source, $amount, 0, $timestamp);//insertion to 'payments' table.
 271                 }
 272
 273                 if ($_REQUEST['radio_type_of_payment'] == 'invoice_balance' || $_REQUEST['radio_type_of_payment'] == 'cash') {                //Payment by patient after insurance paid, cash patients similar to do not bill insurance in feesheet.
 274                     if ($_REQUEST['radio_type_of_payment'] == 'cash') {
 275                         sqlStatement(
 276                             "update form_encounter set last_level_closed=? where encounter=? and pid=? ",
 277                             array(4, $enc, $form_pid)
 278                         );
 279                         sqlStatement(
 280                             "update billing set billed=? where encounter=? and pid=?",
 281                             array(1, $enc, $form_pid)
 282                         );
 283                     }
 284
 285                     $adjustment_code = 'patient_payment';
 286                     $payment_id = sqlInsert(
 287                         "insert into ar_session set " .
 288                         "payer_id = ?" .
 289                         ", patient_id = ?" .
 290                         ", user_id = ?" .
 291                         ", closed = ?" .
 292                         ", reference = ?"   .
 293                         ", check_date =  now() , deposit_date = now() " .
 294                         ",  pay_total = ?" .
 295                         ", payment_type = 'patient'" .
 296                         ", description = ?" .
 297                         ", adjustment_code = ?" .
 298                         ", post_to_date = now() " .
 299                         ", payment_method = ?",
 300                         array(0, $form_pid, $_SESSION['authUserID'], 0, $form_source, $amount, $NameNew, $adjustment_code, $form_method)
 301                     );
 302
 303                     //--------------------------------------------------------------------------------------------------------------------
 304
 305                     frontPayment($form_pid, $enc, $form_method, $form_source, 0, $amount, $timestamp);//insertion to 'payments' table.
 306
 307                     //--------------------------------------------------------------------------------------------------------------------
 308
 309                     $resMoneyGot = sqlStatement(
 310                         "SELECT sum(pay_amount) as PatientPay FROM ar_activity where deleted IS NULL AND pid =? and " .
 311                         "encounter =? and payer_type=0 and account_code='PCP'",
 312                         array($form_pid, $enc)
 313                     );//new fees screen copay gives account_code='PCP'
 314                     $rowMoneyGot = sqlFetchArray($resMoneyGot);
 315                     $Copay = $rowMoneyGot['PatientPay'];
 316
 317                     //--------------------------------------------------------------------------------------------------------------------
 318
 319                     //Looping the existing code and modifier
 320                     $ResultSearchNew = sqlStatement(
 321                         "SELECT * FROM billing LEFT JOIN code_types ON billing.code_type=code_types.ct_key WHERE code_types.ct_fee=1 " .
 322                         "AND billing.activity!=0 AND billing.pid =? AND encounter=? ORDER BY billing.code,billing.modifier",
 323                         array($form_pid, $enc)
 324                     );
 325                     while ($RowSearch = sqlFetchArray($ResultSearchNew)) {
 326                         $Codetype = $RowSearch['code_type'];
 327                         $Code = $RowSearch['code'];
 328                         $Modifier = $RowSearch['modifier'];
 329                         $Fee = $RowSearch['fee'];
 330
 331                         $resMoneyGot = sqlStatement(
 332                             "SELECT sum(pay_amount) as MoneyGot FROM ar_activity where deleted IS NULL AND pid = ? " .
 333                             "and code_type=? and code=? and modifier=? and encounter =? and !(payer_type=0 and account_code='PCP')",
 334                             array($form_pid, $Codetype, $Code, $Modifier, $enc)
 335                         );
 336                         //new fees screen copay gives account_code='PCP'
 337                         $rowMoneyGot = sqlFetchArray($resMoneyGot);
 338                         $MoneyGot = $rowMoneyGot['MoneyGot'];
 339
 340                         $resMoneyAdjusted = sqlStatement(
 341                             "SELECT sum(adj_amount) as MoneyAdjusted FROM ar_activity where deleted IS NULL AND " .
 342                             "pid =? and code_type=? and code=? and modifier=? and encounter =?",
 343                             array($form_pid, $Codetype, $Code, $Modifier, $enc)
 344                         );
 345                         $rowMoneyAdjusted = sqlFetchArray($resMoneyAdjusted);
 346                         $MoneyAdjusted = $rowMoneyAdjusted['MoneyAdjusted'];
 347
 348                         $Remainder = $Fee - $Copay - $MoneyGot - $MoneyAdjusted;
 349                         $Copay = 0;
 350                         if (round($Remainder, 2) != 0 && $amount != 0) {
 351                             if ($amount - $Remainder >= 0) {
 352                                 $insert_value = $Remainder;
 353                                 $amount = $amount - $Remainder;
 354                             } else {
 355                                 $insert_value = $amount;
 356                                 $amount = 0;
 357                             }
 358
 359                             sqlBeginTrans();
 360                             $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($form_pid, $enc));
 361                             sqlStatement(
 362                                 "insert into ar_activity set " .
 363                                 "pid = ?" .
 364                                 ", encounter = ?" .
 365                                 ", sequence_no = ?" .
 366                                 ", code_type = ?" .
 367                                 ", code = ?" .
 368                                 ", modifier = ?" .
 369                                 ", payer_type = ?" .
 370                                 ", post_time = now() " .
 371                                 ", post_user = ?" .
 372                                 ", session_id = ?" .
 373                                 ", pay_amount = ?" .
 374                                 ", adj_amount = ?" .
 375                                 ", account_code = 'PP'",
 376                                 array($form_pid, $enc, $sequence_no['increment'], $Codetype, $Code, $Modifier, 0, $_SESSION['authUserID'], $payment_id, $insert_value, 0)
 377                             );
 378                             sqlCommitTrans();
 379                         }//if
 380                     }//while
 381                     if ($amount != 0) {//if any excess is there.
 382                         sqlBeginTrans();
 383                         $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($form_pid, $enc));
 384                         sqlStatement(
 385                             "insert into ar_activity set " .
 386                             "pid = ?" .
 387                             ", encounter = ?" .
 388                             ", sequence_no = ?" .
 389                             ", code_type = ?" .
 390                             ", code = ?" .
 391                             ", modifier = ?" .
 392                             ", payer_type = ?" .
 393                             ", post_time = now() " .
 394                             ", post_user = ?" .
 395                             ", session_id = ?" .
 396                             ", pay_amount = ?" .
 397                             ", adj_amount = ?" .
 398                             ", account_code = 'PP'",
 399                             array($form_pid, $enc, $sequence_no['increment'], $Codetype, $Code, $Modifier, 0, $_SESSION['authUserID'], $payment_id, $amount, 0)
 400                         );
 401                         sqlCommitTrans();
 402                     }
 403
 404                     //--------------------------------------------------------------------------------------------------------------------
 405                 }//invoice_balance
 406             }//if ($amount = 0 + $payment)
 407         }//foreach
 408     }//if ($_POST['form_upay'])
 409 }//if ($_POST['form_save'])
 410
 411 if ($_POST['form_save'] || $_REQUEST['receipt']) {
 412     if ($_REQUEST['receipt']) {
 413         $form_pid = $_GET['patient'];
 414         $timestamp = decorateString('....-..-.. ..:..:..', $_GET['time']);
 415     }
 416
 417 // Get details for what we guess is the primary facility.
 418     $frow = sqlQuery("SELECT * FROM facility " . "ORDER BY billing_location DESC, accepts_assignment DESC, id LIMIT 1");
 419
 420 // Get the patient's name and chart number.
 421     $patdata = getPatientData($form_pid, 'fname,mname,lname,pubpid');
 422
 423 // Re-fetch payment info.
 424     $payrow = sqlQuery("SELECT " . "SUM(amount1) AS amount1, " . "SUM(amount2) AS amount2, " . "MAX(method) AS method, " . "MAX(source) AS source, " . "MAX(dtime) AS dtime, " .
 425 // "MAX(user) AS user " .
 426         "MAX(user) AS user, " . "MAX(encounter) as encounter " . "FROM payments WHERE " . "pid = ? AND dtime = ?", array($form_pid, $timestamp
 427     ));
 428
 429 // Create key for deleting, just in case.
 430     $ref_id = ($_REQUEST['radio_type_of_payment'] == 'copay') ? $session_id : $payment_id;
 431     $payment_key = $form_pid . '.' . preg_replace('/[^0-9]/', '', $timestamp) . '.' . $ref_id;
 432
 433 // get facility from encounter
 434     $tmprow = sqlQuery("SELECT facility_id FROM form_encounter WHERE encounter = ?", array($payrow['encounter']));
 435     $frow = sqlQuery("SELECT * FROM facility " . " WHERE id = ?", array($tmprow['facility_id']
 436     ));
 437
 438 // Now proceed with printing the receipt.
 439     ?>
 440
 441     <title><?php echo xlt('Receipt for Payment'); ?></title>
 442     <script src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery/dist/jquery.min.js"></script>
 443     <script>
 444
 445         function goHome() {
 446             window.location.replace("./patient/onsiteactivityviews");
 447         }
 448
 449         function notifyPatient() {
 450             let pid = <?php echo js_escape($pid); ?>;
 451             let note = $('#pop_receipt').html();
 452             let formURL = './messaging/handle_note.php';
 453             let owner = <?php echo js_escape($adminUser['recip_id']); ?>;
 454             let sn = <?php echo js_escape($adminUser['username']); ?>;
 455             let rid = <?php echo js_escape($portalPatient['recip_id']); ?>;
 456             let rn = <?php echo js_escape($portalPatient['username']); ?>;
 457             $.ajax({
 458                 url: formURL,
 459                 type: "POST",
 460                 data: {
 461                     'csrf_token_form': <?php echo js_escape(CsrfUtils::collectCsrfToken('messages-portal')); ?>,
 462                     'task': 'add',
 463                     'pid': pid,
 464                     'inputBody': note,
 465                     'title': 'Bill/Collect',
 466                     'recipient_name': rn,
 467                     'recipient_id': rid,
 468                     'sender_id': owner,
 469                     'sender_name': sn
 470                 },
 471                 success: function (data, textStatus, jqXHR) {
 472                     alert('Receipt sent to patient via Messages.')
 473                 },
 474                 error: function (jqXHR, status, error) {
 475                     console.log(status + ": " + error);
 476                 }
 477             });
 478         }
 479     </script>
 480     <?php
 481     ob_start();
 482     echo '<htlm><head></head><body style="text-align: center; margin: auto;">';
 483     ?>
 484     <div id='pop_receipt' style='display: block'>
 485         <p>
 486         <h2><?php echo xlt('Receipt for Payment'); ?></h2>
 487         <p><?php echo text($frow['name']) ?>
 488             <br /><?php echo text($frow['street']) ?>
 489             <br /><?php echo text($frow['city'] . ', ' . $frow['state']) . ' ' . text($frow['postal_code']) ?>
 490             <br /><?php echo text($frow['phone']) ?>
 491         <p>
 492         <div class="text-center" style="margin: auto;">
 493             <table border='0' cellspacing='8' class="text-center" style="margin: auto;">
 494                 <tr>
 495                     <td><?php echo xlt('Date'); ?>:</td>
 496                     <td><?php echo text(oeFormatSDFT(strtotime($payrow['dtime']))) ?></td>
 497                 </tr>
 498                 <tr>
 499                     <td><?php echo xlt('Patient'); ?>:</td>
 500                     <td><?php echo text($patdata['fname']) . " " . text($patdata['mname']) . " " . text($patdata['lname']) . " (" . text($patdata['pubpid']) . ")" ?></td>
 501                 </tr>
 502                 <tr>
 503                     <td><?php echo xlt('Paid Via'); ?>:</td>
 504                     <td><?php echo generate_display_field(array('data_type' => '1', 'list_id' => 'payment_method'), $payrow['method']); ?></td>
 505                 </tr>
 506                 <tr>
 507                     <td><?php echo xlt('Authorized Id'); ?>:</td>
 508                     <td><?php echo text($payrow['source']) ?></td>
 509                 </tr>
 510                 <tr>
 511                     <td><?php echo xlt('Amount for This Visit'); ?>:</td>
 512                     <td><?php echo text(oeFormatMoney($payrow['amount1'])) ?></td>
 513                 </tr>
 514                 <tr>
 515                     <td><?php echo xlt('Amount for Past Balance'); ?>:</td>
 516                     <td><?php echo text(oeFormatMoney($payrow['amount2'])) ?></td>
 517                 </tr>
 518                 <tr>
 519                     <td><?php echo xlt('Received By'); ?>:</td>
 520                     <td><?php echo text($payrow['user']) ?></td>
 521                 </tr>
 522             </table>
 523         </div>
 524     </div>
 525     <button class='btn btn-sm' type='button' onclick='goHome()' id='returnhome'><?php echo xla('Return Home'); ?></button>
 526     <button class='btn btn-sm' type='button' onclick="notifyPatient()"><?php echo xla('Notify Patient'); ?></button>
 527     </body></html>
 528     <?php
 529     ob_end_flush();
 530 } else {
 531 //
 532 // Here we display the form for data entry.
 533 //
 534     ?>
 535     <title><?php echo xlt('Record Payment'); ?></title>
 536     <style>
 537         .dehead {
 538             color: #000000;
 539             font-weight: bold
 540         }
 541         .detail {
 542             padding: 1px 1px;
 543             color: #000000;
 544             font-weight: normal
 545         }
 546     </style>
 547     <script src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-creditcardvalidator/jquery.creditCardValidator.js"></script>
 548     <script src="<?php echo $GLOBALS['webroot'] ?>/library/textformat.js?v=<?php echo $v_js_includes; ?>"></script>
 549     <script>
 550         var chargeMsg = <?php $amsg = xl('Payment was successfully authorized and your card is charged.') . "\n" .
 551                 xl("You will be notified when your payment is applied for this invoice.") . "\n" .
 552                 xl('Until then you will continue to see payment details here.') . "\n" . xl('Thank You.');
 553             echo json_encode($amsg);
 554         ?>;
 555         var publicKey = <?php echo json_encode($cryptoGen->decryptStandard($GLOBALS['gateway_public_key'])); ?>;
 556         var apiKey = <?php echo json_encode($cryptoGen->decryptStandard($GLOBALS['gateway_api_key'])); ?>;
 557
 558         function calctotal() {
 559             var flag = 0;
 560             var f = document.forms["invoiceForm"];
 561             var total = 0;
 562             for (var i = 0; i < f.elements.length; ++i) {
 563                 var elem = f.elements[i];
 564                 var ename = elem.name;
 565                 if (ename.indexOf('form_upay[') == 0 || ename.indexOf('form_bpay[') == 0) {
 566                     if (elem.value.length > 0) {
 567                         total += Number(elem.value);
 568                         if (total < 0) flag = 1;
 569                     }
 570                 }
 571             }
 572             f.form_paytotal.value = Number(total).toFixed(2);
 573             if (flag) {
 574                 $('#invoiceForm')[0].reset();
 575                 alert(<?php echo xlj('Negative payments not accepted'); ?>)
 576             }
 577             return true;
 578         }
 579
 580         function coloring() {
 581             for (var i = 1; ; ++i) {
 582                 if (document.getElementById('paying_' + i)) {
 583                     paying = document.getElementById('paying_' + i).value * 1;
 584                     patient_balance = document.getElementById('duept_' + i).innerHTML * 1;
 585                     if (patient_balance > 0 && paying > 0) {
 586                         if (paying > patient_balance) {
 587                             document.getElementById('paying_' + i).style.background = '#FF0000';
 588                         }
 589                         else if (paying < patient_balance) {
 590                             document.getElementById('paying_' + i).style.background = '#99CC00';
 591                         }
 592                         else if (paying == patient_balance) {
 593                             document.getElementById('paying_' + i).style.background = '#ffffff';
 594                         }
 595                     }
 596                     else {
 597                         document.getElementById('paying_' + i).style.background = '#ffffff';
 598                     }
 599                 }
 600                 else {
 601                     break;
 602                 }
 603             }
 604         }
 605
 606         function CheckVisible(MakeBlank) {//Displays and hides the check number text box.
 607             if (document.getElementById('form_method').options[document.getElementById('form_method').selectedIndex].value == 'check_payment' ||
 608                 document.getElementById('form_method').options[document.getElementById('form_method').selectedIndex].value == 'bank_draft') {
 609                 document.getElementById('check_number').disabled = false;
 610             }
 611             else {
 612                 document.getElementById('check_number').disabled = true;
 613             }
 614         }
 615
 616         function validate() {
 617             var f = document.forms["invoiceForm"];
 618             ok = -1;
 619 //no checks taken here....
 620             issue = 'no';
 621             if (document.getElementById('radio_type_of_payment_self1').checked == false &&
 622                 document.getElementById('radio_type_of_payment1').checked == false
 623                 && document.getElementById('radio_type_of_payment2').checked == false
 624                 && document.getElementById('radio_type_of_payment4').checked == false) {
 625                 alert("<?php //echo addslashes( xl('Please Select Type Of Payment.')) ?>");
 626                 return false;
 627             }
 628             if (document.getElementById('radio_type_of_payment_self1').checked == true || document.getElementById('radio_type_of_payment1').checked == true) {
 629                 for (var i = 0; i < f.elements.length; ++i) {
 630                     var elem = f.elements[i];
 631                     var ename = elem.name;
 632                     if (ename.indexOf('form_upay[0') == 0) //Today is this text box.
 633                     {
 634                         if (elem.value * 1 > 0) {//A warning message, if the amount is posted with out encounter.
 635                             if (confirm(<?php echo xlj('Are you sure to post for today?'); ?>)) {
 636                                 ok = 1;
 637                             }
 638                             else {
 639                                 elem.focus();
 640                                 return false;
 641                             }
 642                         }
 643                         break;
 644                     }
 645                 }
 646             }
 647             else if (document.getElementsByName('form_paytotal')[0].value <= 0)//total 0
 648             {
 649                 alert(<?php echo xlj('Invalid Total!'); ?>)
 650                 return false;
 651             }
 652             if (ok == -1) {
 653                 if (confirm(<?php echo xlj('Payment Validated: Save?'); ?>)) {
 654                     return true;
 655                 }
 656                 else {
 657                     return false;
 658                 }
 659             }
 660         }
 661
 662         function cursor_pointer() {//Point the cursor to the latest encounter(Today)
 663             var f = document.forms["invoiceForm"];
 664             var total = 0;
 665             for (var i = 0; i < f.elements.length; ++i) {
 666                 var elem = f.elements[i];
 667                 var ename = elem.name;
 668                 if (ename.indexOf('form_upay[') == 0) {
 669                     elem.focus();
 670                     break;
 671                 }
 672             }
 673         }
 674
 675         function make_it_hide_enc_pay() {
 676             document.getElementById('td_head_insurance_payment').style.display = "none";
 677             document.getElementById('td_head_patient_co_pay').style.display = "none";
 678             document.getElementById('td_head_co_pay').style.display = "none";
 679             document.getElementById('td_head_insurance_balance').style.display = "none";
 680             for (var i = 1; ; ++i) {
 681                 var td_inspaid_elem = document.getElementById('td_inspaid_' + i)
 682                 var td_patient_copay_elem = document.getElementById('td_patient_copay_' + i)
 683                 var td_copay_elem = document.getElementById('td_copay_' + i)
 684                 var balance_elem = document.getElementById('balance_' + i)
 685                 if (td_inspaid_elem) {
 686                     td_inspaid_elem.style.display = "none";
 687                     td_patient_copay_elem.style.display = "none";
 688                     td_copay_elem.style.display = "none";
 689                     balance_elem.style.display = "none";
 690                 }
 691                 else {
 692                     break;
 693                 }
 694             }
 695             document.getElementById('td_total_4').style.display = "none";
 696             document.getElementById('td_total_7').style.display = "none";
 697             document.getElementById('td_total_8').style.display = "none";
 698             document.getElementById('td_total_6').style.display = "none";
 699
 700             document.getElementById('table_display').width = "420px";
 701         }
 702
 703         function make_visible() {
 704             document.getElementById('td_head_rep_doc').style.display = "";
 705             document.getElementById('td_head_description').style.display = "";
 706             document.getElementById('td_head_total_charge').style.display = "none";
 707             document.getElementById('td_head_insurance_payment').style.display = "none";
 708             document.getElementById('td_head_patient_payment').style.display = "none";
 709             document.getElementById('td_head_patient_co_pay').style.display = "none";
 710             document.getElementById('td_head_co_pay').style.display = "none";
 711             document.getElementById('td_head_insurance_balance').style.display = "none";
 712             document.getElementById('td_head_patient_balance').style.display = "none";
 713             for (var i = 1; ; ++i) {
 714                 var td_charges_elem = document.getElementById('td_charges_' + i)
 715                 var td_inspaid_elem = document.getElementById('td_inspaid_' + i)
 716                 var td_ptpaid_elem = document.getElementById('td_ptpaid_' + i)
 717                 var td_patient_copay_elem = document.getElementById('td_patient_copay_' + i)
 718                 var td_copay_elem = document.getElementById('td_copay_' + i)
 719                 var balance_elem = document.getElementById('balance_' + i)
 720                 var duept_elem = document.getElementById('duept_' + i)
 721                 if (td_charges_elem) {
 722                     td_charges_elem.style.display = "none";
 723                     td_inspaid_elem.style.display = "none";
 724                     td_ptpaid_elem.style.display = "none";
 725                     td_patient_copay_elem.style.display = "none";
 726                     td_copay_elem.style.display = "none";
 727                     balance_elem.style.display = "none";
 728                     duept_elem.style.display = "none";
 729                 }
 730                 else {
 731                     break;
 732                 }
 733             }
 734             document.getElementById('td_total_7').style.display = "";
 735             document.getElementById('td_total_8').style.display = "";
 736             document.getElementById('td_total_1').style.display = "none";
 737             document.getElementById('td_total_2').style.display = "none";
 738             document.getElementById('td_total_3').style.display = "none";
 739             document.getElementById('td_total_4').style.display = "none";
 740             document.getElementById('td_total_5').style.display = "none";
 741             document.getElementById('td_total_6').style.display = "none";
 742
 743             document.getElementById('table_display').width = "505px";
 744         }
 745
 746         function make_it_hide() {
 747             document.getElementById('td_head_rep_doc').style.display = "none";
 748             document.getElementById('td_head_description').style.display = "none";
 749             document.getElementById('td_head_total_charge').style.display = "";
 750             document.getElementById('td_head_insurance_payment').style.display = "";
 751             document.getElementById('td_head_patient_payment').style.display = "";
 752             document.getElementById('td_head_patient_co_pay').style.display = "";
 753             document.getElementById('td_head_co_pay').style.display = "";
 754             document.getElementById('td_head_insurance_balance').style.display = "";
 755             document.getElementById('td_head_patient_balance').style.display = "";
 756             for (var i = 1; ; ++i) {
 757                 var td_charges_elem = document.getElementById('td_charges_' + i)
 758                 var td_inspaid_elem = document.getElementById('td_inspaid_' + i)
 759                 var td_ptpaid_elem = document.getElementById('td_ptpaid_' + i)
 760                 var td_patient_copay_elem = document.getElementById('td_patient_copay_' + i)
 761                 var td_copay_elem = document.getElementById('td_copay_' + i)
 762                 var balance_elem = document.getElementById('balance_' + i)
 763                 var duept_elem = document.getElementById('duept_' + i)
 764                 if (td_charges_elem) {
 765                     td_charges_elem.style.display = "";
 766                     td_inspaid_elem.style.display = "";
 767                     td_ptpaid_elem.style.display = "";
 768                     td_patient_copay_elem.style.display = "";
 769                     td_copay_elem.style.display = "";
 770                     balance_elem.style.display = "";
 771                     duept_elem.style.display = "";
 772                 }
 773                 else {
 774                     break;
 775                 }
 776             }
 777             document.getElementById('td_total_1').style.display = "";
 778             document.getElementById('td_total_2').style.display = "";
 779             document.getElementById('td_total_3').style.display = "";
 780             document.getElementById('td_total_4').style.display = "";
 781             document.getElementById('td_total_5').style.display = "";
 782             document.getElementById('td_total_6').style.display = "";
 783             document.getElementById('td_total_7').style.display = "";
 784             document.getElementById('td_total_8').style.display = "";
 785
 786             document.getElementById('table_display').width = "100%";
 787         }
 788
 789         function make_visible_radio() {
 790             document.getElementById('tr_radio1').style.display = "";
 791             document.getElementById('tr_radio2').style.display = "none";
 792         }
 793
 794         function make_hide_radio() {
 795             document.getElementById('tr_radio1').style.display = "none";
 796             document.getElementById('tr_radio2').style.display = "";
 797         }
 798
 799         function make_visible_row() {
 800             document.getElementById('table_display').style.display = "";
 801             document.getElementById('table_display_prepayment').style.display = "none";
 802         }
 803
 804         function make_hide_row() {
 805             document.getElementById('table_display').style.display = "none";
 806             document.getElementById('table_display_prepayment').style.display = "";
 807         }
 808
 809         function make_self() {
 810             make_visible_row();
 811             make_it_hide();
 812             make_it_hide_enc_pay();
 813             document.getElementById('radio_type_of_payment_self1').checked = true;
 814             cursor_pointer();
 815         }
 816
 817         function make_insurance() {
 818             make_visible_row();
 819             make_it_hide();
 820             cursor_pointer();
 821             document.getElementById('radio_type_of_payment1').checked = true;
 822         }
 823
 824         $('#paySubmit').click(function (e) {
 825             e.preventDefault();e.stopPropagation();
 826             $("#mode").val("portal-save");
 827             let inv_values = JSON.stringify(getFormObj('invoiceForm'));
 828             let extra_values = JSON.stringify(getFormObj('paymentForm'));
 829             let extra = "&inv_values=" + encodeURIComponent(inv_values) + "&extra_values=" + encodeURIComponent(extra_values);
 830             let flag = 0
 831             let liburl = './lib/paylib.php';
 832             $.ajax({
 833                 type: "POST",
 834                 url: liburl,
 835                 data: $("#invoiceForm").serialize() + extra,
 836                 beforeSend: function (xhr) {
 837                     if (validateCC() !== true) return false;
 838                     if ($('#cardCode').val() == "" || $('#cardHolderName').val() == "" || $('#expYear').val() == "" || $('#expMonth').val() == "") {
 839                         alert(<?php echo xlj('Invalid Credit Card Values: Please correct'); ?>)
 840                         return false;
 841                     }
 842                     if (validate() != true) {
 843                         flag = 1;
 844                         alert(<?php echo xlj('Validation error: Fix and resubmit. This popup info is preserved!'); ?>)
 845                         return false;
 846                     }
 847                     $("#openPayModal .close").click()
 848                 },
 849                 error: function (qXHR, textStatus, errorThrow) {
 850                     console.log("There was an error:" + errorThrow);
 851                 },
 852                 success: function (templateHtml, textStatus, jqXHR) {
 853                     let msg = <?php $amsg = xl('Payment successfully sent for review and posting to your account.') . "\n" .
 854                         xl("You will be notified when the payment transaction is confirmed.") . "\n" .
 855                         xl('Until then you will continue to see payment details here.') . "\n" . xl('Thank You.');
 856                         echo json_encode($amsg); // backward compatable 5.0.1
 857                     ?>;
 858                     alert(msg);
 859                     window.location.reload(false);
 860                 }
 861             });
 862             if (flag) {
 863                 $("#openPayModal .close").click();
 864             }
 865         });
 866
 867         $('#openPayModal').on('show.bs.modal', function () {
 868             let total = $("#form_paytotal").val();
 869             if(Number(total) < 1) {
 870                 let error = <?php echo json_encode("Please enter a payment amount"); ?>;
 871                 alert(error);
 872                 return false;
 873             }
 874             $("#payTotal").text(total);
 875             $("#paymentAmount").val(total);
 876         });
 877
 878         $("#invoiceForm").on('submit', function (e) {
 879             e.preventDefault();
 880             let thisform = this;
 881             $("#mode").val("review-save");
 882             let inv_values = JSON.stringify(getFormObj('invoiceForm'));
 883             let extra_values = JSON.stringify(getFormObj('paymentForm'));
 884             let extra = "&inv_values=" + inv_values + "&extra_values=" + extra_values;
 885
 886             let flag = 0
 887             let liburl = '<?php echo $GLOBALS["webroot"] ?>/portal/lib/paylib.php';
 888             $.ajax({
 889                 type: "POST",
 890                 url: liburl,
 891                 data: $("#invoiceForm").serialize() + extra,
 892                 beforeSend: function (xhr) {
 893                     if (validate() != true) {
 894                         flag = 1;
 895                         alert(<?php echo xlj('Validation error: Fix and resubmit.'); ?>)
 896                         return false;
 897                     }
 898                 },
 899                 error: function (xhr, textStatus, error) {
 900                     alert(<?php echo xlj('There is a Post error'); ?>)
 901                     console.log("There was an error:" + textStatus);
 902                     return false;
 903                 },
 904                 success: function (templateHtml, textStatus, jqXHR) {
 905                     thisform.submit();
 906                 }
 907             });
 908         });
 909
 910         function getFormObj(formId) {
 911             let formObj = {};
 912             let inputs = $('#' + formId).serializeArray();
 913             $.each(inputs, function (i, input) {
 914                 formObj[input.name] = input.value;
 915             });
 916             return formObj;
 917         }
 918
 919         function formRepopulate(jsondata) {
 920             let data = $.parseJSON(jsondata);
 921             $.each(data, function (name, val) {
 922                 let $el = $('[name="' + name + '"]'),
 923                     type = $el.attr('type');
 924                 switch (type) {
 925                     case 'checkbox':
 926                         $el.prop('checked', true);
 927                         break;
 928                     case 'radio':
 929                         $el.filter('[value="' + val + '"]').prop('checked', true);
 930                         break;
 931                     default:
 932                         $el.val(val);
 933                 }
 934             });
 935         }
 936
 937         function getAuth() {
 938             let authnum = document.getElementById("check_number").value;
 939             authnum = prompt(<?php echo xlj('Please enter card comfirmation authorization'); ?>, authnum);
 940             if (authnum != null) {
 941                 document.getElementById("check_number").value = authnum;
 942             }
 943         }
 944     </script>
 945
 946     <body class="skin-blue" onunload='imclosing()' onLoad="cursor_pointer();"
 947           style="text-align: center; margin: auto;">
 948
 949     <form id="invoiceForm" method='post' action='<?php echo $GLOBALS["webroot"] ?>/portal/portal_payment.php'>
 950         <input type='hidden' name='form_pid' value='<?php echo attr($pid) ?>'/>
 951         <input type='hidden' name='form_save' value='<?php echo xla('Invoice'); ?>'/>
 952         <table>
 953             <tr height="10">
 954                 <td colspan="3">&nbsp;</td>
 955             </tr>
 956             <tr>
 957                 <td colspan='3' align='center' class='text'>
 958                     <b><?php echo xlt('Accept Payment for'); ?>&nbsp;:&nbsp;&nbsp;<?php
 959                     echo text($patdata['fname']) . " " .
 960                         text($patdata['lname']) . " " .
 961                         text($patdata['mname']) . " (" .
 962                         text($patdata['pid']) . ")" ?></b>
 963                     <?php $NameNew = $patdata['fname'] . " " . $patdata['lname'] . " " . $patdata['mname']; ?>
 964                 </td>
 965             </tr>
 966             <tr height="15">
 967                 <td colspan='3'></td>
 968             </tr>
 969             <tr>
 970                 <td class='text'>
 971                     <?php echo xlt('Payment Method'); ?>:
 972                 </td>
 973                 <td colspan='2'><select name="form_method" id="form_method" class="form-control" onChange='CheckVisible("yes")'>
 974                         <?php
 975                         $query1112 = "SELECT * FROM list_options where list_id=?  ORDER BY seq, title ";
 976                         $bres1112 = sqlStatement($query1112, array('payment_method'));
 977                         while ($brow1112 = sqlFetchArray($bres1112)) {
 978                             if ($brow1112['option_id'] != 'credit_card' || $brow1112['option_id'] == 'debit' || $brow1112['option_id'] == 'bank_draft') {
 979                                 continue;
 980                             }
 981                             echo "<option value='" . attr($brow1112['option_id']) . "'>" .
 982                                 text(xl_list_label($brow1112['title'])) . "</option>";
 983                         }
 984                         ?>
 985                     </select></td>
 986             </tr>
 987             <?php if (isset($_SESSION['authUserID'])) { ?>
 988                 <tr height="5">
 989                     <td colspan='3'></td>
 990                 </tr>
 991                 <tr>
 992                     <td class='text'>
 993                         <?php echo xlt('Authorized'); ?>:
 994                     </td>
 995                     <td colspan='2'>
 996                         <?php if ($ccdata['authCode'] && empty($payrow['source'])) {
 997                             $payrow['source'] = $ccdata['authCode'] . " : " . $ccdata['transId'];
 998                         }
 999                         ?>
1000                         <input class="form-control form-control-sm" id='check_number' name='form_source' style='' value='<?php echo attr($payrow['source']) ?>' />
1001                     </td>
1002                 </tr>
1003             <?php } ?>
1004                 <?php if (isset($_SESSION['authUserID'])) {
1005                         $hide = '';
1006                         echo '<tr height="5"><td colspan="3"></td></tr><tr">';
1007                 } else {
1008                     $hide = 'hidden';
1009                     echo '<tr class="hidden">';
1010                 }
1011                 ?>
1012                 <td class='text' valign="middle">
1013                     <?php echo xlt('Patient Coverage'); ?>:
1014                 </td>
1015                 <td class='text' colspan="2">
1016                     <input type="radio" name="radio_type_of_coverage" id="radio_type_of_coverage1"
1017                            value="self" onClick="make_visible_radio();make_self();"/>
1018                     <?php echo xlt('Self'); ?>
1019                     <input type="radio" name="radio_type_of_coverage" id="radio_type_of_coverag2" value="insurance"
1020                            checked="checked"
1021                            onClick="make_hide_radio();make_insurance();"/>
1022                     <?php echo xlt('Insurance'); ?>
1023                 </td>
1024             </tr>
1025             <tr height="5">
1026                 <td colspan='3'></td>
1027             </tr>
1028             <tr id="tr_radio1" style="display: none">
1029                 <!-- For radio Insurance -->
1030                 <td class='text' valign="top">
1031                     <?php echo xlt('Payment against'); ?>:
1032                 </td>
1033                 <td class='text' colspan="2">
1034                     <input type="radio" name="radio_type_of_payment" id="radio_type_of_payment_self1"
1035                            value="cash" onClick="make_visible_row();make_it_hide_enc_pay();cursor_pointer();"/>
1036                     <?php echo xlt('Encounter Payment'); ?>
1037                 </td>
1038             </tr>
1039             <tr id="tr_radio2">
1040                 <!-- For radio self -->
1041                 <td class='text' valign="top"><?php echo xlt('Payment against'); ?>:</td>
1042                 <td class='text' colspan="2">
1043                     <input type="radio" name="radio_type_of_payment" id="radio_type_of_payment1" class="<?php echo $hide ? $hide : ''; ?>"
1044                            value="copay" onClick="make_visible_row();cursor_pointer();"/><?php echo !$hide ? xlt('Co Pay') : ''; ?>
1045                     <input type="radio" name="radio_type_of_payment" id="radio_type_of_payment2" checked="checked"
1046                            value="invoice_balance" onClick="make_visible_row();"/><?php echo xlt('Invoice Balance'); ?>
1047                     <input type="radio" name="radio_type_of_payment" id="radio_type_of_payment4" value="pre_payment"
1048                            onClick="make_hide_row();"/><?php echo xlt('Pre Pay'); ?>
1049                 </td>
1050             </tr>
1051             <tr height="15">
1052                 <td colspan='3'></td>
1053             </tr>
1054         </table>
1055         <table width="20%" border="0" cellspacing="0" cellpadding="0" id="table_display_prepayment" style="margin-bottom: 10px; display: none">
1056             <tr>
1057                 <td class='detail'><?php echo xlt('Pre Payment'); ?></td>
1058                 <td><input class="form-control" type='text' id= 'form_prepayment' name='form_prepayment' style=''/></td>
1059             </tr>
1060         </table>
1061         <table id="table_display" style="background: #eee;" class="table table-sm table-striped table-bordered w-100">
1062             <thead>
1063             </thead>
1064             <tbody>
1065             <tr bgcolor="#cccccc" id="tr_head">
1066                 <td class="dehead" width="60">
1067                     <?php echo xlt('DOS') ?>
1068                 </td>
1069                 <td class="dehead" width="120">
1070                     <?php echo xlt('Visit Reason') ?>
1071                 </td>
1072                 <td class="dehead" align="center" width="70" id="td_head_total_charge">
1073                     <?php echo xlt('Total Charge') ?>
1074                 </td>
1075                 <td class="dehead" align="center" width="70" id="td_head_rep_doc" style='display: none'>
1076                     <?php echo xlt('Report/ Form') ?>
1077                 </td>
1078                 <td class="dehead" align="center" width="200" id="td_head_description" style='display: none'>
1079                     <?php echo xlt('Description') ?>
1080                 </td>
1081                 <td class="dehead" align="center" width="70" id="td_head_insurance_payment">
1082                     <?php echo xlt('Insurance Payment') ?>
1083                 </td>
1084                 <td class="dehead" align="center" width="70" id="td_head_patient_payment">
1085                     <?php echo xlt('Patient Payment') ?>
1086                 </td>
1087                 <td class="dehead" align="center" width="55" id="td_head_patient_co_pay">
1088                     <?php echo xlt('Co Pay Paid') ?>
1089                 </td>
1090                 <td class="dehead" align="center" width="55" id="td_head_co_pay">
1091                     <?php echo xlt('Required Co Pay') ?>
1092                 </td>
1093                 <td class="dehead" align="center" width="70" id="td_head_insurance_balance">
1094                     <?php echo xlt('Insurance Balance') ?>
1095                 </td>
1096                 <td class="dehead" align="center" width="70" id="td_head_patient_balance">
1097                     <?php echo xlt('Patient Balance') ?>
1098                 </td>
1099                 <td class="dehead" align="center" width="50">
1100                     <?php echo xlt('Paying') ?>
1101                 </td>
1102             </tr>
1103             <?php
1104             $encs = array();
1105             // Get the unbilled service charges and payments by encounter for this patient.
1106             //
1107             $query = "SELECT fe.encounter, fe.reason, b.code_type, b.code, b.modifier, b.fee, " .
1108                 "LEFT(fe.date, 10) AS encdate ,fe.last_level_closed " . "FROM  form_encounter AS fe left join billing AS b  on " .
1109                 "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 " .
1110                 "where fe.pid = ? " . "ORDER BY b.encounter";
1111             $bres = sqlStatement($query, array($pid, $pid));
1112             //
1113             while ($brow = sqlFetchArray($bres)) {
1114                 $key = (int)$brow['encounter'];
1115                 if (empty($encs[$key])) {
1116                     $encs[$key] = array('encounter' => $brow['encounter'], 'date' => $brow['encdate'], 'last_level_closed' => $brow['last_level_closed'], 'charges' => 0, 'payments' => 0, 'reason' => $brow['reason']
1117                     );
1118                 }
1119
1120                 if ($brow['code_type'] === 'COPAY') {
1121                 // $encs[$key]['payments'] -= $brow['fee'];
1122                 } else {
1123                     $encs[$key]['charges'] += $brow['fee'];
1124                     // Add taxes.
1125                     $sql_array = array();
1126                     $query = "SELECT taxrates FROM codes WHERE " . "code_type = ? AND " . "code = ? AND ";
1127                     array_push($sql_array, $code_types[$brow['code_type']]['id'], $brow['code']);
1128                     if ($brow['modifier']) {
1129                         $query .= "modifier = ?";
1130                         array_push($sql_array, $brow['modifier']);
1131                     } else {
1132                         $query .= "(modifier IS NULL OR modifier = '')";
1133                     }
1134
1135                     $query .= " LIMIT 1";
1136                     $trow = sqlQuery($query, $sql_array);
1137                     $encs[$key]['charges'] += calcTaxes($trow, $brow['fee']);
1138                 }
1139             }
1140
1141             // Do the same for unbilled product sales.
1142             //
1143             $query = "SELECT fe.encounter, fe.reason, s.drug_id, s.fee, " .
1144                 "LEFT(fe.date, 10) AS encdate,fe.last_level_closed " .
1145                 "FROM form_encounter AS fe left join drug_sales AS s " .
1146                 "on s.pid = ? AND s.fee != 0 " .
1147                 "AND fe.pid = s.pid AND fe.encounter = s.encounter " .
1148                 "where fe.pid = ? " . "ORDER BY s.encounter";
1149
1150             $dres = sqlStatement($query, array($pid, $pid));
1151             //
1152             while ($drow = sqlFetchArray($dres)) {
1153                 $key = (int)$drow['encounter'];
1154                 if (empty($encs[$key])) {
1155                     $encs[$key] = array(
1156                         'encounter' => $drow['encounter'], 'date' => $drow['encdate'],
1157                         'last_level_closed' => $drow['last_level_closed'],
1158                         'charges' => 0, 'payments' => 0
1159                     );
1160                 }
1161
1162                 $encs[$key]['charges'] += $drow['fee'];
1163                 // Add taxes.
1164                 $trow = sqlQuery(
1165                     "SELECT taxrates FROM drug_templates WHERE drug_id = ? " .
1166                     "ORDER BY selector LIMIT 1",
1167                     array($drow['drug_id'])
1168                 );
1169                 $encs[$key]['charges'] += calcTaxes($trow, $drow['fee']);
1170             }
1171
1172             ksort($encs, SORT_NUMERIC);
1173
1174             foreach ($encs as $key => $value) {
1175                 $enc = $value['encounter'];
1176                 $reason = $value['reason'];
1177                 $dispdate = $value['date'];
1178
1179                 $inscopay = BillingUtilities::getCopay($pid, $dispdate);
1180                 $patcopay = BillingUtilities::getPatientCopay($pid, $enc);
1181                 // Insurance Payment
1182                 //
1183                 $drow = sqlQuery(
1184                     "SELECT  SUM(pay_amount) AS payments, " .
1185                     "SUM(adj_amount) AS adjustments FROM ar_activity WHERE " .
1186                     "deleted IS NULL AND pid = ? and encounter = ? AND " .
1187                     "payer_type != 0 AND account_code != 'PCP'",
1188                     array($pid, $enc)
1189                 );
1190                 $dpayment = $drow['payments'];
1191                 $dadjustment = $drow['adjustments'];
1192                 // Patient Payment
1193                 //
1194                 $drow = sqlQuery(
1195                     "SELECT  SUM(pay_amount) AS payments, SUM(adj_amount) AS adjustments " .
1196                     "FROM ar_activity WHERE deleted IS NULL AND pid = ? and encounter = ? and " .
1197                     "payer_type = 0 and account_code != 'PCP'",
1198                     array($pid, $enc)
1199                 );
1200                 $dpayment_pat = $drow['payments'];
1201
1202                 // NumberOfInsurance
1203                 //
1204                 $ResultNumberOfInsurance = sqlStatement(
1205                     "SELECT COUNT( DISTINCT TYPE ) NumberOfInsurance FROM insurance_data where pid = ? and provider>0 ",
1206                     array($pid)
1207                 );
1208                 $RowNumberOfInsurance = sqlFetchArray($ResultNumberOfInsurance);
1209                 $NumberOfInsurance = $RowNumberOfInsurance['NumberOfInsurance'] * 1;
1210                 $duept = 0;
1211                 if ((($NumberOfInsurance == 0 || $value['last_level_closed'] == 4 || $NumberOfInsurance == $value['last_level_closed']))) { // Patient balance
1212                     $brow = sqlQuery("SELECT SUM(fee) AS amount FROM billing WHERE " . "pid = ? and encounter = ? AND activity = 1", array($pid, $enc
1213                     ));
1214                     $srow = sqlQuery("SELECT SUM(fee) AS amount FROM drug_sales WHERE " . "pid = ? and encounter = ? ", array($pid, $enc
1215                     ));
1216                     $drow = sqlQuery(
1217                         "SELECT SUM(pay_amount) AS payments, SUM(adj_amount) AS adjustments " .
1218                         "FROM ar_activity WHERE deleted IS NULL AND pid = ? and encounter = ? ",
1219                         array($pid, $enc)
1220                     );
1221                     $duept = $brow['amount'] + $srow['amount'] - $drow['payments'] - $drow['adjustments'];
1222                 }
1223
1224                 echoLine("form_upay[$enc]", $dispdate, $value['charges'], $dpayment_pat, ($dpayment + $dadjustment), $duept, ($enc . ': ' . $reason), $inscopay, $patcopay);
1225             }
1226
1227             // Continue with display of the data entry form.
1228             ?>
1229             <tr>
1230                 <td class="dehead" align="center"><?php echo xlt('Total'); ?></td>
1231                 <td class="dehead" id='td_total_1' align="center"></td>
1232                 <td class="dehead" id='td_total_2' align="center"><?php echo text(bucks($sum_charges)) ?></td>
1233                 <td class="dehead" id='td_total_3' align="center"><?php echo text(bucks($sum_inspaid)) ?></td>
1234                 <td class="dehead" id='td_total_4' align="center"><?php echo text(bucks($sum_ptpaid)) ?></td>
1235                 <td class="dehead" id='td_total_5' align="center"><?php echo text(bucks($sum_patcopay)) ?></td>
1236                 <td class="dehead" id='td_total_6' align="center"><?php echo text(bucks($sum_copay)) ?></td>
1237                 <td class="dehead" id='td_total_7' align="center"><?php echo text(bucks($sum_balance)) ?></td>
1238                 <td class="dehead" id='td_total_8' align="center"><?php echo text(bucks($sum_duept)) ?></td>
1239                 <td class="dehead" align="center">
1240                     <input class="form-control" name='form_paytotal' id='form_paytotal' value='' style='color: #3b9204;' readonly />
1241                 </td>
1242             </tr>
1243         </table>
1244         <?php
1245         if (isset($ccdata["cardHolderName"])) {
1246             echo '<div class="col-5"><div class="card panel-default height">';
1247             if (!isset($_SESSION['authUserID'])) {
1248                 echo '<div class="card-heading">' . xlt("Payment Information") .
1249                     '<span style="color: #cc0000"><em> ' . xlt("Pending Auth since") . ': </em>' . text($edata["date"]) . '</span></div>';
1250             } else {
1251                 echo '<div class="card-heading">' . xlt("Audit Payment") .
1252                     '<span style="color: #cc0000"><em> ' . xlt("Pending since") . ': </em>' . text($edata["date"]) . '</span>' .
1253                     ' <button type="button" class="btn btn-warning btn-sm" onclick="getAuth()">' . xlt("Authorize") . '</button></div>';
1254             }
1255         } else {
1256             echo '<div style="display:none" class="col-6"><div class="card panel-default height">' .
1257                 '<div class="card-heading">' . xlt("Payment Information") . ' </div>';
1258         }
1259         ?>
1260         <div class="card-body">
1261             <span class="font-weight-bold"><?php echo xlt('Card Name'); ?>: </span><span id="cn"><?php echo text($ccdata["cc_type"]) ?></span><br />
1262             <span class="font-weight-bold"><?php echo xlt('Name on Card'); ?>: </span><span id="nc"><?php echo text($ccdata["cardHolderName"]) ?></span>
1263             <span class="font-weight-bold"><?php echo xlt('Card Holder Zip'); ?>: </span><span id="czip"><?php echo text($ccdata["zip"]) ?></span><br />
1264             <span class="font-weight-bold"><?php echo xlt('Card Number'); ?>: </span><span id="ccn">
1265         <?php
1266         if (isset($_SESSION['authUserID']) || isset($ccdata["transId"])) {
1267             echo text($ccdata["cardNumber"]) . "</span><br />";
1268         } else {
1269             echo "**********  " . text(substr($ccdata["cardNumber"], -4)) . "</span><br />";
1270         }
1271         ?>
1272         <?php
1273         if (!isset($ccdata["transId"])) { ?>
1274                 <span class="font-weight-bold"><?php echo xlt('Exp Date'); ?>:  </span><span id="ed"><?php echo text($ccdata["month"]) . "/" . text($ccdata["year"]) ?></span>
1275                 <span class="font-weight-bold"><?php echo xlt('CVV'); ?>:  </span><span id="cvvpin"><?php echo text($ccdata["cardCode"]) ?></span><br />
1276         <?php } else { ?>
1277                 <span class="font-weight-bold"><?php echo xlt('Transaction Id'); ?>:  </span><span id="ed"><?php echo text($ccdata["transId"]) . "/" . text($ccdata["year"]) ?></span>
1278                 <span class="font-weight-bold"><?php echo xlt('Authorization'); ?>:  </span><span id="cvvpin"><?php echo text($ccdata["authCode"]) ?></span><br />
1279         <?php } ?>
1280         <span class="font-weight-bold"><?php echo xlt('Charge Total'); ?>:  </span><span id="ct"><?php echo text($invdata["form_paytotal"]) ?></span><br />
1281         </div>
1282         </div>
1283         </div>
1284         <div>
1285         <?php
1286         if (!isset($_SESSION['authUserID'])) {
1287             if (!isset($ccdata["cardHolderName"])) {
1288                 if ($GLOBALS['payment_gateway'] == 'Sphere') {
1289                     echo SpherePayment::renderSphereHtml('patient');
1290                 } else {
1291                     echo '<button type="button" class="btn btn-primary" data-toggle="modal" data-target="#openPayModal">' . xlt("Pay Invoice") . '</button>';
1292                 }
1293             } else {
1294                 echo '<h4><span class="bg-danger">' . xlt("Locked Payment Pending") . '</span></h4>';
1295             }
1296         } else {
1297             echo "<button type='submit' class='btn btn-success' form='invoiceForm'>" . xlt('Post Payment') . "</button>";
1298         }
1299         ?>
1300         </div>
1301         <input type="hidden" name="hidden_patient_code" id="hidden_patient_code" value="<?php echo attr($pid); ?>"/>
1302         <input type='hidden' name='mode' id='mode' value=''/>
1303     </form>
1304
1305     <script>
1306         if (typeof jsondata !== 'undefined') {
1307             formRepopulate(jsondata);
1308         }
1309         calctotal();
1310     </script>
1311     <!-- credit payment modal -->
1312     <div id="openPayModal" class="modal fade" role="dialog">
1313         <div class="modal-dialog">
1314             <div class="modal-content">
1315                 <div class="modal-header">
1316                     <h4><?php echo xlt('Submit Payment for Authorization'); ?></h4>
1317                     <!--<button type="button" class="close" data-dismiss="modal">&times;</button>-->
1318                 </div>
1319                 <div class="modal-body">
1320                     <?php if ($GLOBALS['payment_gateway'] != 'Stripe' && $GLOBALS['payment_gateway'] != 'Sphere') { ?>
1321                     <form id='paymentForm' method='post' action='<?php echo $GLOBALS["webroot"] ?>/portal/lib/paylib.php'>
1322                         <fieldset>
1323                             <div class="form-group">
1324                                 <label label-default="label-default"
1325                                        class="control-label"><?php echo xlt('Name on Card'); ?></label>
1326                                 <div class="controls">
1327                                     <input name="cardHolderName" id="cardHolderName" type="text" class="form-control" pattern="\w+ \w+.*" title="<?php echo xla('Fill your first and last name'); ?>" value="<?php echo attr($patdata['fname']) . ' ' . attr($patdata['lname']) ?>" />
1328                                 </div>
1329                             </div>
1330                             <div class="form-group">
1331                                 <label class="control-label"><?php echo xlt('Card Number'); ?></label>
1332                                 <div class="controls">
1333                                     <div class="row">
1334                                         <div class="col-sm-12">
1335                                             <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;
1336                                             <h4 name="cardtype" id="cardtype" style="display: inline-block; color:#cc0000;"><?php echo xlt('Validating') ?></h4>
1337                                         </div>
1338                                     </div>
1339                                 </div>
1340                             </div>
1341                             <div class="form-group">
1342                                 <label label-default="label-default"><?php echo xlt('Card Expiry Date and Card Holders Zip'); ?></label>
1343                                 <div class="controls">
1344                                     <div class="row">
1345                                         <div class="col-md-4">
1346                                             <select name="month" id="expMonth" class="form-control">
1347                                                 <option value=""><?php echo xlt('Select Month'); ?></option>
1348                                                 <option value="01"><?php echo xlt('January'); ?></option>
1349                                                 <option value="02"><?php echo xlt('February'); ?></option>
1350                                                 <option value="03"><?php echo xlt('March'); ?></option>
1351                                                 <option value="04"><?php echo xlt('April'); ?></option>
1352                                                 <option value="05"><?php echo xlt('May'); ?></option>
1353                                                 <option value="06"><?php echo xlt('June'); ?></option>
1354                                                 <option value="07"><?php echo xlt('July'); ?></option>
1355                                                 <option value="08"><?php echo xlt('August'); ?></option>
1356                                                 <option value="09"><?php echo xlt('September'); ?></option>
1357                                                 <option value="10"><?php echo xlt('October'); ?></option>
1358                                                 <option value="11"><?php echo xlt('November'); ?></option>
1359                                                 <option value="12"><?php echo xlt('December'); ?></option>
1360                                             </select>
1361                                         </div>
1362                                         <div class="col-md-4">
1363                                             <select name="year" id="expYear" class="form-control">
1364                                                 <option value=""><?php echo xlt('Select Year'); ?></option>
1365                                                 <option value="2019">2019</option>
1366                                                 <option value="2020">2020</option>
1367                                                 <option value="2021">2021</option>
1368                                                 <option value="2022">2022</option>
1369                                                 <option value="2023">2023</option>
1370                                                 <option value="2024">2024</option>
1371                                                 <option value="2025">2025</option>
1372                                                 <option value="2026">2026</option>
1373                                                 <option value="2027">2027</option>
1374                                                 <option value="2028">2028</option>
1375                                             </select>
1376                                         </div>
1377                                         <div class="col-md-4">
1378                                             <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']) ?>"/>
1379                                         </div>
1380                                     </div>
1381                                 </div>
1382                             </div>
1383                             <div class="form-group">
1384                                 <label label-default="label-default" class="control-label"><?php echo xlt('Card CVV'); ?></label>
1385                                 <div class="controls">
1386                                     <div class="row">
1387                                         <div class="col-md-3">
1388                                             <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="" />
1389                                         </div>
1390                                         <div class="col-md-3">
1391                                             <img src='./images/img_cvc.png' style='height: 40px; width: auto' />
1392                                         </div>
1393                                         <div class="col-md-6">
1394                                             <h4 style="display: inline-block;"><?php echo xlt('Payment Amount'); ?>:&nbsp;
1395                                                 <span class="font-weight-bold"><span id="payTotal"></span></span></h4>
1396                                         </div>
1397                                     </div>
1398                                 </div>
1399                             </div>
1400                             <input type='hidden' name='pid' id='pid' value='<?php echo attr($pid) ?>'/>
1401                             <input type='hidden' name='mode' id='mode' value=''/>
1402                             <input type='hidden' name='cc_type' id='cc_type' value=''/>
1403                             <input type='hidden' name='payment' id='paymentAmount' value=''/>
1404                             <input type='hidden' name='invValues' id='invValues' value=''/>
1405                             <input type="hidden" name="dataValue" id="dataValue" />
1406                             <input type="hidden" name="dataDescriptor" id="dataDescriptor" />
1407                         </fieldset>
1408                     </form>
1409                     <?php } else { ?>
1410                         <form method="post" name="payment-form" id="payment-form">
1411                             <fieldset>
1412                                 <div class="form-group">
1413                                     <label label-default="label-default"><?php echo xlt('Name on Card'); ?></label>
1414                                     <div class="controls">
1415                                         <input name="cardHolderName" id="cardHolderName" type="text" class="form-control" pattern="\w+ \w+.*" title="<?php echo xla('Fill your first and last name'); ?>" value="<?php echo attr($patdata['fname']) . ' ' . attr($patdata['lname']) ?>" />
1416                                     </div>
1417                                 </div>
1418                                 <div class="form-group">
1419                                     <label for="card-element"><?php echo xlt('Credit or Debit Card') ?></label>
1420                                     <div class="form-group" id="card-element"></div>
1421                                     <div id="card-errors" role="alert"></div>
1422                                 </div>
1423                                 <div class="col-md-6">
1424                                     <h4 style="display: inline-block;"><?php echo xlt('Payment Amount'); ?>:&nbsp;
1425                                         <strong><span id="payTotal"></span></strong></h4>
1426                                 </div>
1427                                 <input type='hidden' name='mode' id='mode' value=''/>
1428                                 <input type='hidden' name='cc_type' id='cc_type' value=''/>
1429                                 <input type='hidden' name='payment' id='paymentAmount' value=''/>
1430                                 <input type='hidden' name='invValues' id='invValues' value=''/>
1431                             </fieldset>
1432                         </form>
1433                     <?php } ?>
1434                 </div>
1435                 <!-- Body  -->
1436                 <div class="modal-footer">
1437                     <div class="button-group">
1438                         <button type="button" class="btn btn-secondary" data-dismiss="modal"><?php echo xlt('Cancel'); ?></button>
1439                         <?php
1440                         if ($GLOBALS['payment_gateway'] == 'InHouse') { ?>
1441                             <button id="paySubmit" class="btn btn-primary"><?php echo xlt('Send Payment'); ?></button>
1442                         <?php } elseif ($GLOBALS['payment_gateway'] == 'AuthorizeNet') { ?>
1443                             <button id="payAurhorizeNet" class="btn btn-primary"
1444                                     onclick="sendPaymentDataToAnet(event)"><?php echo xlt('Pay Now'); ?></button>
1445                         <?php }
1446                         if ($GLOBALS['payment_gateway'] == 'Stripe') { ?>
1447                             <button id="stripeSubmit" class="btn btn-primary"><?php echo xlt('Pay Now'); ?></button>
1448                                                 <?php } ?>
1449                     </div>
1450                 </div>
1451             </div>
1452         </div>
1453     </div>
1454     <script>
1455         var ccerr = <?php echo xlj('Invalid Credit Card Number'); ?>
1456
1457         // In House CC number Validation
1458         /*$('#cardNumber').validateCreditCard(function (result) {
1459             var r = (result.card_type === null ? '' : result.card_type.name.toUpperCase())
1460             var v = (result.valid === true ? ' Valid Number' : ' Validating')
1461             if (result.valid === true) {
1462                 document.getElementById("cardtype").style.color = "#00aa00";
1463             } else {
1464                 document.getElementById("cardtype").style.color = "#aa0000";
1465             }
1466             $('#cardtype').text(r + v);
1467         });*/
1468
1469         // In House CC Validation
1470         function validateCC() {
1471             var result = $('#cardNumber').validateCreditCard();
1472             var r = (result.card_type == null ? '' : result.card_type.name.toUpperCase())
1473             var v = (result.valid == true ? ' Valid Card Number' : ' Invalid Card Number')
1474             if (result.valid === true) {
1475                 document.getElementById("cardtype").style.color = "#00aa00";
1476             } else {
1477                 document.getElementById("cardtype").style.color = "#aa0000";
1478             }
1479             $('#cardtype').text(r + v);
1480             $('#cc_type').val(r);
1481             if (!result.valid) {
1482                 alert(ccerr);
1483                 return false;
1484             }
1485             else {
1486                 return true;
1487             }
1488         }
1489     </script>
1490
1491     <?php if ($GLOBALS['payment_gateway'] == 'AuthorizeNet' && isset($_SESSION['patient_portal_onsite_two'])) {
1492         // Include Authorize.Net dependency to tokenize card.
1493         // Will return a token to use for payment request keeping
1494         // credit info off the server.
1495         ?>
1496         <script>
1497             function sendPaymentDataToAnet(e) {
1498                 e.preventDefault();
1499                 const authData = {};
1500                 authData.clientKey = publicKey;
1501                 authData.apiLoginID = apiKey;
1502
1503                 const cardData = {};
1504                 cardData.cardNumber = document.getElementById("cardNumber").value;
1505                 cardData.month = document.getElementById("expMonth").value;
1506                 cardData.year = document.getElementById("expYear").value;
1507                 cardData.cardCode = document.getElementById("cardCode").value;
1508                 cardData.fullName = document.getElementById("cardHolderName").value;
1509                 cardData.zip = document.getElementById("cczip").value;
1510
1511                 const secureData = {};
1512                 secureData.authData = authData;
1513                 secureData.cardData = cardData;
1514
1515                 Accept.dispatchData(secureData, acceptResponseHandler);
1516
1517                 function acceptResponseHandler(response) {
1518                     if (response.messages.resultCode === "Error") {
1519                         let i = 0;
1520                         let errorMsg = '';
1521                         while (i < response.messages.message.length) {
1522                             errorMsg = errorMsg + response.messages.message[i].code + ": " +response.messages.message[i].text;
1523                             console.log(errorMsg);
1524                             i = i + 1;
1525                         }
1526                         alert(errorMsg);
1527                     } else {
1528                         paymentFormUpdate(response.opaqueData);
1529                     }
1530                 }
1531             }
1532
1533             function paymentFormUpdate(opaqueData) {
1534                 // this is card tokenized
1535                 document.getElementById("dataDescriptor").value = opaqueData.dataDescriptor;
1536                 document.getElementById("dataValue").value = opaqueData.dataValue;
1537                 let oForm = document.forms['paymentForm'];
1538                 oForm.elements['mode'].value = "AuthorizeNet";
1539                 let inv_values = JSON.stringify(getFormObj('invoiceForm'));
1540                 document.getElementById("invValues").value = inv_values;
1541
1542                 // empty out the fields before submitting to server.
1543                 document.getElementById("cardNumber").value = "";
1544                 document.getElementById("expMonth").value = "";
1545                 document.getElementById("expYear").value = "";
1546                 document.getElementById("cardCode").value = "";
1547
1548                 // Submit payment to server
1549                 fetch('./lib/paylib.php', {
1550                     method: 'POST',
1551                     body: new FormData(oForm)
1552                 }).then(function(response) {
1553                     if (!response.ok) {
1554                         throw Error(response.statusText);
1555                     }
1556                     return response.text();
1557                 }).then(function(data) {
1558                     if(data !== 'ok') {
1559                         alert(data);
1560                         return;
1561                     }
1562                     alert(chargeMsg);
1563                     window.location.reload(false);
1564                 }).catch(function(error) {
1565                     alert(error)
1566                 });
1567             }
1568         </script>
1569     <?php }  // end authorize.net ?>
1570
1571     <?php if ($GLOBALS['payment_gateway'] == 'Stripe' && isset($_SESSION['patient_portal_onsite_two'])) { // Begin Include Stripe ?>
1572         <script>
1573             const stripe = Stripe(publicKey);
1574             const elements = stripe.elements();// Custom styling can be passed to options when creating an Element.
1575             const style = {
1576                 base: {
1577                     color: '#32325d',
1578                     lineHeight: '1.2rem',
1579                     fontSmoothing: 'antialiased',
1580                     fontSize: '16px',
1581                     '::placeholder': {
1582                         color: '#8e8e8e'
1583                     }
1584                 },
1585                 invalid: {
1586                     color: '#fa755a',
1587                     iconColor: '#fa755a'
1588                 }
1589
1590             };
1591             // Create an instance of the card Element.
1592             const card = elements.create('card', {style: style});
1593             // Add an instance of the card Element into the `card-element` <div>.
1594             card.mount('#card-element');
1595             // Handle real-time validation errors from the card Element.
1596             card.addEventListener('change', function (event) {
1597                 let displayError = document.getElementById('card-errors');
1598                 if (event.error) {
1599                     displayError.textContent = event.error.message;
1600                 } else {
1601                     displayError.textContent = '';
1602                 }
1603             });
1604             // Handle form submission.
1605             let form = document.getElementById('stripeSubmit');
1606             form.addEventListener('click', function (event) {
1607                 event.preventDefault();
1608                 stripe.createToken(card).then(function (result) {
1609                     if (result.error) {
1610                         // Inform the user if there was an error.
1611                         let errorElement = document.getElementById('card-errors');
1612                         errorElement.textContent = result.error.message;
1613                     } else {
1614                         // Send the token to server.
1615                         stripeTokenHandler(result.token);
1616                     }
1617                 });
1618             });
1619             // Submit the form with the token ID.
1620             function stripeTokenHandler(token) {
1621                 // Insert the token ID into the form so it gets submitted to the server
1622                 let oForm = document.forms['payment-form'];
1623                 oForm.elements['mode'].value = "Stripe";
1624
1625                 let inv_values = JSON.stringify(getFormObj('invoiceForm'));
1626                 document.getElementById("invValues").value = inv_values;
1627
1628                 let hiddenInput = document.createElement('input');
1629                 hiddenInput.setAttribute('type', 'hidden');
1630                 hiddenInput.setAttribute('name', 'stripeToken');
1631                 hiddenInput.setAttribute('value', token.id);
1632                 oForm.appendChild(hiddenInput);
1633
1634                 // Submit payment to server
1635                 fetch('./lib/paylib.php', {
1636                     method: 'POST',
1637                     body: new FormData(oForm)
1638                 }).then(function(response) {
1639                     if (!response.ok) {
1640                         throw Error(response.statusText);
1641                     }
1642                     return response.text();
1643                 }).then(function(data) {
1644                     if(data !== 'ok') {
1645                         alert(data);
1646                         return;
1647                     }
1648                     alert(chargeMsg);
1649                     window.location.reload(false);
1650                 }).catch(function(error) {
1651                     alert(error)
1652                 });
1653             }
1654         </script>
1655     <?php } ?>
1656
1657     <?php
1658     if ($GLOBALS['payment_gateway'] == 'Sphere' && isset($_SESSION['patient_portal_onsite_two'])) {
1659         echo (new SpherePayment('patient', $pid))->renderSphereJs();
1660     }
1661     ?>
1662
1663     </body>
1664     <?php } // end else display ?>