2 include_once("../globals.php");
3 include_once("$srcdir/md5.js");
4 include_once("$srcdir/sql.inc");
5 require_once("$srcdir/classes/POSRef.class.php");
7 if ($_POST["mode"] == "facility")
9 sqlStatement("update facility set
10 name='{$_POST['facility']}',
11 phone='{$_POST['phone']}',
12 fax='{$_POST['fax']}',
13 street='{$_POST['street']}',
14 city='{$_POST['city']}',
15 state='{$_POST['state']}',
16 postal_code='{$_POST['postal_code']}',
17 country_code='{$_POST['country_code']}',
18 federal_ein='{$_POST['federal_ein']}',
19 service_location='{$_POST['service_location']}',
20 billing_location='{$_POST['billing_location']}',
21 accepts_assignment='{$_POST['accepts_assignment']}',
22 pos_code='{$_POST['pos_code']}',
23 domain_identifier='{$_POST['domain_identifier']}',
24 facility_npi='{$_POST['facility_npi']}',
25 attn='{$_POST['attn']}'
26 where id='{$_POST['fid']}'");
29 if (isset($_GET["fid"])) {
30 $my_fid = $_GET["fid"];
33 if (isset($_POST["fid"])) {
34 $my_fid = $_POST["fid"];
41 <link rel
=stylesheet href
="<?echo $css_header;?>" type
="text/css">
44 <body
<?
echo $top_bg_line;?
> topmargin
=0 rightmargin
=0 leftmargin
=2 bottommargin
=0 marginwidth
=2 marginheight
=0>
46 <span
class="title"><?
xl('Edit Facility Information','e'); ?
></span
>
48 <form name
='facility' method
='post' action
="facility_admin.php">
49 <input type
=hidden name
=mode value
="facility">
50 <input type
=hidden name
=fid value
="<?echo $my_fid;?>">
51 <span
class=bold
><?
xl('Facility Information','e'); ?
>: </span
>
53 <?php
$facility = sqlQuery("select * from facility where id='$my_fid'"); ?
>
55 <table border
=0 cellpadding
=0 cellspacing
=0>
57 <td width
="24"><span
class=text
><?
xl('Name','e'); ?
>: </span
></td
><td width
="120"><input type
=entry name
=facility size
=20 value
="<?=$facility['name']?>"></td
><td rowspan
="10" width
="15"></d
>
58 <td width
="145"><span
class=text
><?
xl('Phone','e'); ?
> <?
xl('as','e'); ?
> (000) 000-0000:</span
></td
><td width
="210"><input type
=entry name
=phone size
=20 value
="<?=$facility['phone']?>"></td
>
61 <td
> 
;</td
><td
> 
;</td
>
62 <td
><span
class=text
><?
xl('Fax','e'); ?
> <?
xl('as','e'); ?
> (000) 000-0000:</span
></td
><td
><input type
=entry name
=f
63 ax size
=20 value
="<?=$facility['fax']?>"></td
>
66 <td
><span
class=text
><?
xl('Address','e'); ?
>: </span
></td
><td
><input type
=entry size
=20 name
=street value
="<?=$facility["street
"]?>"></td
>
67 <td
><span
class=text
><?
xl('City','e'); ?
>: </span
></td
><td
><input type
=entry size
=20 name
=city value
="<?echo $facility{"city
"}?>"></td
>
70 <td
><span
class=text
><?
xl('State','e'); ?
>: </span
></td
><td
><input type
=entry size
=20 name
=state value
="<?echo $facility{"state
"}?>"></td
>
71 <td
><span
class=text
><?
xl('Zip Code','e'); ?
>: </span
></td
><td
><input type
=entry size
=20 name
=postal_code value
="<?echo $facility{"postal_code
"}?>"></td
>
74 <td
><span
class=text
><?
xl('Country','e'); ?
>: </span
></td
><td
><input type
=entry size
=20 name
=country_code value
="<?echo $facility{"country_code
"}?>"></td
>
75 <td
><span
class=text
><?
xl('Federal EIN','e'); ?
>: </span
></td
><td
><input type
=entry size
=20 name
=federal_ein value
="<?echo $facility{"federal_ein
"}?>"></td
>
78 <td
> 
;</td
><td
> 
;</td
>
79 <td width
="21"><span
class=text
><?
xl('Facility NPI','e'); ?
>: </span
></td
><td
><input type
=entry size
=20 name
=facility_npi value
="<?echo $facility{"facility_npi
"}?>"></td
>
83 <td
><span
class='text'><?php
xl('Billing Location','e'); ?
>: </span
></td
>
84 <td
><input type
='checkbox' name
="billing_location" value
="1" <?php
if ($facility['billing_location'] == 1) echo "checked"?
>"></td>
85 <td rowspan='2'><span class='text'><?php xl('Accepts Assignment','e'); ?><br>(<?php xl('only if billing location','e'); ?>): </span></td>
86 <td><input type='checkbox' name="accepts_assignment
" value="1" <?php if ($facility['accepts_assignment'] == 1) echo "checked
"?>"></td
>
90 <td
><span
class='text'><?php
xl('Service Location','e'); ?
>: </span
></td
>
91 <td
><input type
='checkbox' name
="service_location" value
="1" <?php
if ($facility['service_location']) echo "checked"?
>"></td>
96 <td><span class=text><? xl('POS Code','e'); ?>: </span></td>
98 <select name="pos_code
">
102 foreach ($pc->get_pos_ref() as $pos) {
103 echo "<option value
=\"" . $pos["code
"] . "\"
";
104 if ($facility['pos_code'] == $pos['code']) {
107 echo ">" . $pos['code'] . ": ". $pos['title'];
116 <td><span class="text
"><? xl('Billing Attn','e'); ?>:</span></td>
117 <td colspan="4"><input type="text
" name="attn
" size="45" value="<?
=$facility['attn']?
>"></td>
120 <td><span class="text
"><? xl('CLIA Number','e'); ?>:</span></td>
121 <td colspan="4"><input type="text
" name="domain_identifier
" size="45" value="<?
=$facility['domain_identifier']?
>"></td>
124 <td> </td><td> </td>
125 <td> </td><td><br><br><input type="submit
" value=<? xl('Update Info','e'); ?>> <a href="usergroup_admin
.php
" class=link_submit>[<? xl('Back','e'); ?>]</font></a></td>