templates/x12_partners/general_edit.html

   1 {literal}
   2 <script language="javascript">
   3 function add_x12()
   4 {
   5 if (document.x12_partner.name.value.length>0)
   6 {
   7 top.restoreSession();
   8 document.x12_partner.submit();
   9 }
  10 else
  11 {
  12 document.x12_partner.name.style.backgroundColor="red";
  13 document.x12_partner.name.focus();
  14 }
  15 }
  16
  17  function Waittoredirect(delaymsec) {
  18  var st = new Date();
  19  var et = null;
  20  do {
  21  et = new Date();
  22  } while ((et - st) < delaymsec);
  23
  24    }
  25 </script>
  26 {/literal}
  27
  28 <form name="x12_partner" method="post" action="{$FORM_ACTION}">
  29 <table width="400px" style="font-size:9pt;" CELLSPACING="0" CELLPADDING="3" border="0">
  30     <tr>
  31         <td colspan="2">{xl t='X12 Partner'}</td>
  32     </tr>
  33     <tr>
  34         <td ALIGN="LEFT" VALIGN="MIDDLE" >{xl t='Partner'}&nbsp;{xl t='Name'}</td>
  35         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" ><input type="text" size="20" name="name" value="{$partner->get_name()}" onKeyDown="PreventIt(event)" /></td>
  36     </tr>
  37     <tr>
  38         <td ALIGN="LEFT" VALIGN="MIDDLE" >{xl t='ID'}&nbsp;{xl t='Number'}&nbsp;({xl t='ETIN'})</td>
  39         <td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="20" name="id_number" value="{$partner->get_id_number()}" onKeyDown="PreventIt(event)" /></td>
  40     </tr>
  41     <tr>
  42         <td VALIGN="MIDDLE" >{xl t='User logon Required Indicator (ISA01~ use 00 or 03)'}</td>
  43         <td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="2" name="x12_isa01" value="{$partner->get_x12_isa01()}" onKeyDown="PreventIt(event)" /></td>
  44     </tr>
  45     <tr>
  46         <td VALIGN="MIDDLE" >{xl t='User Logon (If 03 above, else leave spaces) (ISA02)'}</td>
  47         <td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="20" name="x12_isa02" value="{$partner->get_x12_isa02()}" onKeyDown="PreventIt(event)" /></td>
  48     </tr>
  49     <tr>
  50         <td VALIGN="MIDDLE" >{xl t='User password required Indicator (ISA03~ use 00 or 01)'}</td>
  51         <td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="2" name="x12_isa03" value="{$partner->get_x12_isa03()}" onKeyDown="PreventIt(event)" /></td>
  52     </tr>
  53     <tr>
  54         <td VALIGN="MIDDLE" >{xl t='User Password (ISA04~ if 01 above, else leave spaces)'}</td>
  55         <td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="20" name="x12_isa04" value="{$partner->get_x12_isa04()}" onKeyDown="PreventIt(event)" /></td>
  56     </tr>
  57         <td VALIGN="MIDDLE" >{xl t='Sender ID Qualifier (ISA05)'}</td>
  58         <td COLSPAN="2" VALIGN="MIDDLE" >{html_options name="x12_isa05" options=$partner->get_idqual_array() selected=$partner->get_x12_isa05()}</td>
  59     </tr>
  60     <tr>
  61         <td VALIGN="MIDDLE" >{xl t='Sender ID (ISA06)'}</td>
  62         <td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="20" name="x12_sender_id" value="{$partner->get_x12_sender_id()}" onKeyDown="PreventIt(event)" /></td>
  63     </tr>
  64     <tr>
  65         <td VALIGN="MIDDLE" >{xl t='Receiver ID Qualifier (ISA07)'}</td>
  66         <td COLSPAN="2" VALIGN="MIDDLE" >{html_options name="x12_isa07" options=$partner->get_idqual_array() selected=$partner->get_x12_isa07()}</td>
  67     </tr>
  68     <tr>
  69         <td VALIGN="MIDDLE" >{xl t='Receiver ID (ISA08)'}</td>
  70         <td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="20" name="x12_receiver_id" value="{$partner->get_x12_receiver_id()}" onKeyDown="PreventIt(event)" /></td>
  71     </tr>
  72     <tr>
  73         <td VALIGN="MIDDLE" >{xl t='Acknowledgment Requested (ISA14)'}</td>
  74         <td COLSPAN="2" VALIGN="MIDDLE" >{html_options name="x12_isa14" options=$partner->get_x12_isa14_array() selected=$partner->get_x12_isa14()}</td>
  75     </tr>
  76     <tr>
  77         <td VALIGN="MIDDLE" >{xl t='Usage Indicator (ISA15)'}</td>
  78         <td COLSPAN="2" VALIGN="MIDDLE" >{html_options name="x12_isa15" options=$partner->get_x12_isa15_array() selected=$partner->get_x12_isa15()}</td>
  79     </tr>
  80     <tr>
  81         <td VALIGN="MIDDLE" >{xl t='Application Sender Code (GS02)'}</td>
  82         <td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="20" name="x12_gs02" value="{$partner->get_x12_gs02()}" onKeyDown="PreventIt(event)" /></td>
  83     </tr>
  84     <tr>
  85         <td VALIGN="MIDDLE" >{xl t='Submitter EDI Access Number (PER06)'}</td>
  86         <td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="20" name="x12_per06" value="{$partner->get_x12_per06()}" onKeyDown="PreventIt(event)" /></td>
  87     </tr>
  88     <tr>
  89         <td VALIGN="MIDDLE" >{xl t='Version'}</td>
  90         <td COLSPAN="2" VALIGN="MIDDLE" >{html_options name="x12_version" options=$partner->get_x12_version_array() selected=$partner->get_x12_version()}</td>
  91     </tr>
  92     <tr>
  93         <td VALIGN="MIDDLE" >{xl t='Processing'}&nbsp;{xl t='Format'}</td>
  94         <td COLSPAN="2" VALIGN="MIDDLE" >{html_options name="processing_format" options=$partner->get_processing_format_array() selected=$partner->get_processing_format()}</td>
  95     </tr>
  96     <tr>
  97         <td VALIGN="MIDDLE" >{xl t='Application Receiver Code (GS03 - If blank ISA08 will be used)'}</td>
  98         <td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="20" name="x12_gs03" value="{$partner->get_x12_gs03()}" onKeyDown="PreventIt(event)" maxlength="15"/></td>
  99     </tr>
 100 <tr height="25"><td colspan="2">&nbsp;</td></tr>
 101 <tr>
 102         <td colspan="2">
 103                 {if $partner->get_id() eq ""}
 104                         <a class="css_button" href="javascript:add_x12();"><span>{xl t='Save'}</span></a>
 105
 106                 {else}
 107                         <a class="css_button" href="javascript:add_x12();"><span>{xl t='Save'}</span></a>
 108                 {/if}
 109         <a href="controller.php?practice_settings&x12_partner&action=list"  {php} if (!$GLOBALS['concurrent_layout']) echo "target='Main'"; {/php} class="css_button" onclick="top.restoreSession()">
 110 <span>{xl t='Cancel'}</span></a></td>
 111 </tr>
 112 </table>
 113 <input type="hidden" name="id" value="{$partner->id}" />
 114 <input type="hidden" name="process" value="{$PROCESS}" />
 115 <input type="hidden" name="sub" value="no" />
 116 </form>