interface/billing/sl_eob_invoice.php

   1 <?php
   2 /**
   3  * This provides for manual posting of EOBs.  It is invoked from
   4  * sl_eob_search.php.  For automated (X12 835) remittance posting
   5  * see sl_eob_process.php.
   6  *
   7  * Copyright (C) 2005-2016 Rod Roark <rod@sunsetsystems.com>
   8  *
   9  * LICENSE: This program is free software; you can redistribute it and/or
  10  * modify it under the terms of the GNU General Public License
  11  * as published by the Free Software Foundation; either version 2
  12  * of the License, or (at your option) any later version.
  13  * This program is distributed in the hope that it will be useful,
  14  * but WITHOUT ANY WARRANTY; without even the implied warranty of
  15  * MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
  16  * GNU General Public License for more details.
  17  * You should have received a copy of the GNU General Public License
  18  * along with this program. If not, see <http://opensource.org/licenses/gpl-license.php>;.
  19  *
  20  * @package OpenEMR
  21  * @author  Rod Roark <rod@sunsetsystems.com>
  22  * @author  Roberto Vasquez <robertogagliotta@gmail.com>
  23  * @author  Terry Hill <terry@lillysystems.com>
  24  * @author  Jerry Padgett <sjpadgett@gmail.com>
  25  * @link    http://www.open-emr.org
  26  */
  27
  28
  29 require_once("../globals.php");
  30 require_once("$srcdir/log.inc");
  31 require_once("$srcdir/patient.inc");
  32 require_once("$srcdir/forms.inc");
  33 require_once("$srcdir/sl_eob.inc.php");
  34 require_once("$srcdir/invoice_summary.inc.php");
  35 require_once("../../custom/code_types.inc.php");
  36
  37 use OpenEMR\Core\Header;
  38
  39 $debug = 0; // set to 1 for debugging mode
  40 $save_stay = $_REQUEST['form_save'] == '1' ? true : false;
  41
  42 // If we permit deletion of transactions.  Might change this later.
  43 $ALLOW_DELETE = true;
  44
  45 $info_msg = "";
  46
  47 // Format money for display.
  48 //
  49 function bucks($amount)
  50 {
  51     if ($amount) {
  52         return sprintf("%.2f", $amount);
  53     }
  54 }
  55
  56 // Delete rows, with logging, for the specified table using the
  57 // specified WHERE clause.  Borrowed from deleter.php.
  58 //
  59 function row_delete($table, $where)
  60 {
  61     $tres = sqlStatement("SELECT * FROM $table WHERE $where");
  62     $count = 0;
  63     while ($trow = sqlFetchArray($tres)) {
  64         $logstring = "";
  65         foreach ($trow as $key => $value) {
  66             if (!$value || $value == '0000-00-00 00:00:00') {
  67                 continue;
  68             }
  69
  70             if ($logstring) {
  71                 $logstring .= " ";
  72             }
  73
  74             $logstring .= $key . "='" . addslashes($value) . "'";
  75         }
  76
  77         newEvent("delete", $_SESSION['authUser'], $_SESSION['authProvider'], 1, "$table: $logstring");
  78         ++$count;
  79     }
  80
  81     if ($count) { // Lets not echo the query for stay and save
  82         $query = "DELETE FROM $table WHERE $where";
  83         sqlStatement($query);
  84     }
  85 }
  86
  87 ?>
  88 <html>
  89 <head>
  90     <?php Header::setupHeader(['datetime-picker']); ?>
  91     <title><?php echo xlt('EOB Posting - Invoice') ?></title>
  92     <script language="JavaScript">
  93     var adjDisable = opener.document.forms[0].posting_adj_disable.checked;
  94
  95         // An insurance radio button is selected.
  96         function setins(istr) {
  97             return true;
  98         }
  99
 100         function goEncounterSummary (pid) {
 101             if(pid) {
 102                 opener.toEncSummary(pid);
 103             }
 104             window.close();
 105         }
 106
 107         // Compute an adjustment that writes off the balance:
 108         function writeoff(code) {
 109             var f = document.forms[0];
 110             var belement = f['form_line[' + code + '][bal]'];
 111             var pelement = f['form_line[' + code + '][pay]'];
 112             var aelement = f['form_line[' + code + '][adj]'];
 113             var relement = f['form_line[' + code + '][reason]'];
 114             var tmp = belement.value - pelement.value;
 115             aelement.value = Number(tmp).toFixed(2);
 116             if (aelement.value && !relement.value) relement.selectedIndex = 1;
 117             return false;
 118         }
 119
 120         // Onsubmit handler.  A good excuse to write some JavaScript.
 121         function validate(f) {
 122             let delcount = 0;
 123             let allempty = true;
 124             adjDisable = opener.document.forms[0].posting_adj_disable.checked;
 125
 126             for (var i = 0; i < f.elements.length; ++i) {
 127                 let ename = f.elements[i].name;
 128 // Count deletes.
 129                 if (ename.substring(0, 9) == 'form_del[') {
 130                     if (f.elements[i].checked) ++delcount;
 131                     continue;
 132                 }
 133                 let pfxlen = ename.indexOf('[pay]');
 134                 if (pfxlen < 0) continue;
 135                 let pfx = ename.substring(0, pfxlen);
 136                 let code = pfx.substring(pfx.indexOf('[') + 1, pfxlen - 1);
 137                 let cPay = parseFloat(f[pfx + '[pay]'].value).toFixed(2);
 138                 let cAdjust = parseFloat(f[pfx + '[adj]'].value).toFixed(2);
 139
 140                 if ((cPay != 0) || cAdjust != 0) {
 141                     allempty = false;
 142                 }
 143                 if(adjDisable) {
 144                     if ((cAdjust == 0 && f[pfx + '[reason]'].value)) {
 145                         allempty = false;
 146                     }
 147                 }
 148                 if ((cPay != 0) && isNaN(parseFloat(f[pfx + '[pay]'].value))) {
 149                     alert('<?php echo xls('Payment value for code ') ?>' + code + '<?php echo xls(' is not a number') ?>');
 150                     return false;
 151                 }
 152                 if ((cAdjust != 0) && isNaN(parseFloat(f[pfx + '[adj]'].value))) {
 153                     alert('<?php echo xls('Adjustment value for code ') ?>' + code + '<?php echo xls(' is not a number') ?>');
 154                     return false;
 155                 }
 156                 if ((cAdjust != 0) && !f[pfx + '[reason]'].value) {
 157                     alert('<?php echo xls('Please select an adjustment reason for code ') ?>' + code);
 158                     return false;
 159                 }
 160 // TBD: validate the date format
 161             }
 162 // Check if save is clicked with nothing to post.
 163             if (allempty && delcount === 0) {
 164                 alert('<?php echo xls('Nothing to Post! Please review entries or use Cancel to exit transaction')?>');
 165                 return false;
 166             }
 167 // Demand confirmation if deleting anything.
 168             if (delcount > 0) {
 169                 if (!confirm('<?php echo xls('Really delete'); ?> ' + delcount +
 170                     ' <?php echo xls('transactions'); ?>?' +
 171                     ' <?php echo xls('This action will be logged'); ?>!')
 172                 ) return false;
 173             }
 174             return true;
 175         }
 176
 177         <!-- Get current date -->
 178
 179         function getFormattedToday() {
 180             let today = new Date();
 181             let dd = today.getDate();
 182             let mm = today.getMonth() + 1; //January is 0!
 183             let yyyy = today.getFullYear();
 184             if (dd < 10) {
 185                 dd = '0' + dd
 186             }
 187             if (mm < 10) {
 188                 mm = '0' + mm
 189             }
 190
 191             return (yyyy + '-' + mm + '-' + dd);
 192         }
 193
 194         <!-- Update Payment Fields -->
 195
 196         function updateFields(payField, adjField, balField, coPayField, isFirstProcCode) {
 197             let payAmount = 0.0;
 198             let adjAmount = 0.0;
 199             let balAmount = 0.0;
 200             let coPayAmount = 0.0;
 201
 202 // coPayFiled will be null if there is no co-pay entry in the fee sheet
 203             if (coPayField)
 204                 coPayAmount = coPayField.value;
 205
 206 // if balance field is 0.00, its value comes back as null, so check for nul-ness first
 207             if (balField)
 208                 balAmount = (balField.value) ? balField.value : 0;
 209             if (payField)
 210                 payAmount = (payField.value) ? payField.value : 0;
 211
 212 //alert('balance = >' + balAmount +'<  payAmount = ' + payAmount + '  copay = ' + coPayAmount + '  isFirstProcCode = ' + isFirstProcCode);
 213
 214 // subtract the co-pay only from the first procedure code
 215             if (isFirstProcCode == 1)
 216                 balAmount = parseFloat(balAmount) + parseFloat(coPayAmount);
 217             let adjDisable = opener.document.forms[0].posting_adj_disable.checked;
 218             if (adjDisable) return;
 219
 220             adjAmount = balAmount - payAmount;
 221 // Assign rounded adjustment value back to TextField
 222             adjField.value = adjAmount = Math.round(adjAmount * 100) / 100;
 223         }
 224
 225         $(document).ready(function () {
 226             $('.datepicker').datetimepicker({
 227                 <?php $datetimepicker_timepicker = false; ?>
 228                 <?php $datetimepicker_showseconds = false; ?>
 229                 <?php $datetimepicker_formatInput = false; ?>
 230                 <?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
 231                 <?php // can add any additional javascript settings to datetimepicker here; need to prepend first setting with a comma ?>
 232             });
 233         });
 234
 235     </script>
 236     <style>
 237         @media only screen and (max-width: 768px) {
 238             [class*="col-"] {
 239                 width: 100%;
 240                 text-align: left !Important;
 241             }
 242         }
 243
 244         .table {
 245             margin: auto;
 246             width: 99%;
 247         }
 248
 249         .table > tbody > tr > td {
 250             border-top: none;
 251         }
 252
 253         .last_detail {
 254             border-bottom: 1px black solid;
 255             margin-top: 2px;
 256         }
 257
 258         @media (min-width: 992px) {
 259             .modal-lg {
 260                 width: 1000px !Important;
 261             }
 262         }
 263
 264         /*.modalclass {
 265         overflow-x: hidden !Important;
 266         }
 267         .oe-ckbox-label{
 268         padding-left: 30px;
 269         font-weight: 500;
 270         }*/
 271     </style>
 272 </head>
 273 <body>
 274 <?php
 275 $trans_id = 0 + $_GET['id'];
 276 if (!$trans_id) {
 277     die(xlt("You cannot access this page directly."));
 278 }
 279
 280 // A/R case, $trans_id matches form_encounter.id.
 281 $ferow = sqlQuery("SELECT e.*, p.fname, p.mname, p.lname FROM form_encounter AS e, patient_data AS p WHERE e.id = ? AND p.pid = e.pid", array($trans_id));
 282 if (empty($ferow)) {
 283     die("There is no encounter with form_encounter.id = '" . text($trans_id) . "'.");
 284 }
 285 $patient_id = 0 + $ferow['pid'];
 286 $encounter_id = 0 + $ferow['encounter'];
 287 $svcdate = substr($ferow['date'], 0, 10);
 288 $form_payer_id = 0 + $_POST['form_payer_id'];
 289 $form_reference = $_POST['form_reference'];
 290 $form_check_date = fixDate($_POST['form_check_date'], date('Y-m-d'));
 291 $form_deposit_date = fixDate($_POST['form_deposit_date'], $form_check_date);
 292 $form_pay_total = 0 + $_POST['form_pay_total'];
 293
 294 $payer_type = 0;
 295 if (preg_match('/^Ins(\d)/i', $_POST['form_insurance'], $matches)) {
 296     $payer_type = $matches[1];
 297 }
 298
 299 if (($_POST['form_save'] || $_POST['form_cancel'])) {
 300     if ($_POST['form_save']) {
 301         if (!verifyCsrfToken($_POST["csrf_token_form"])) {
 302             csrfNotVerified();
 303         }
 304
 305         if ($debug) {
 306             echo "<p><b>" . xlt("This module is in test mode. The database will not be changed.") . "</b><p>\n";
 307         }
 308
 309         $session_id = arGetSession($form_payer_id, $form_reference, $form_check_date, $form_deposit_date, $form_pay_total);
 310 // The sl_eob_search page needs its invoice links modified to invoke
 311 // javascript to load form parms for all the above and submit.
 312 // At the same time that page would be modified to work off the
 313 // openemr database exclusively.
 314 // And back to the sl_eob_invoice page, I think we may want to move
 315 // the source input fields from row level to header level.
 316
 317 // Handle deletes. row_delete() is borrowed from deleter.php.
 318         if ($ALLOW_DELETE && !$debug) {
 319             if (is_array($_POST['form_del'])) {
 320                 foreach ($_POST['form_del'] as $arseq => $dummy) {
 321                     row_delete("ar_activity", "pid = '" . add_escape_custom($patient_id) . "' AND " . "encounter = '" . add_escape_custom($encounter_id) . "' AND sequence_no = '" . add_escape_custom($arseq) . "'");
 322                 }
 323             }
 324         }
 325
 326         $paytotal = 0;
 327         foreach ($_POST['form_line'] as $code => $cdata) {
 328             $thispay = trim($cdata['pay']);
 329             $thisadj = trim($cdata['adj']);
 330             $thisins = trim($cdata['ins']);
 331             $thiscodetype = trim($cdata['code_type']);
 332             $reason = $cdata['reason'];
 333
 334 // Get the adjustment reason type.  Possible values are:
 335 // 1 = Charge adjustment
 336 // 2 = Coinsurance
 337 // 3 = Deductible
 338 // 4 = Other pt resp
 339 // 5 = Comment
 340             $reason_type = '1';
 341             if ($reason) {
 342                 $tmp = sqlQuery("SELECT option_value FROM list_options WHERE list_id = 'adjreason' AND activity = 1 AND option_id = ?", array($reason));
 343                 if (empty($tmp['option_value'])) {
 344 // This should not happen but if it does, apply old logic.
 345                     if (preg_match("/To copay/", $reason)) {
 346                         $reason_type = 2;
 347                     } elseif (preg_match("/To ded'ble/", $reason)) {
 348                         $reason_type = 3;
 349                     }
 350                     $info_msg .= xl("No adjustment reason type found for") . " \"$reason\". ";
 351                 } else {
 352                     $reason_type = $tmp['option_value'];
 353                 }
 354             }
 355
 356             if (!$thisins) {
 357                 $thisins = 0;
 358             }
 359
 360             if (0.0 + $thispay) {
 361                 arPostPayment($patient_id, $encounter_id, $session_id, $thispay, $code, $payer_type, '', $debug, '', $thiscodetype);
 362                 $paytotal += $thispay;
 363             }
 364
 365 // Be sure to record adjustment reasons, even for zero adjustments if
 366 // they happen to be comments.
 367             if ((0.0 + $thisadj) ||
 368                 ($reason && $reason_type == 5) ||
 369                 ($reason && ($reason_type > 1 && $reason_type < 6))) {
 370 // "To copay" and "To ded'ble" need to become a comment in a zero
 371 // adjustment, formatted just like sl_eob_process.php.
 372                 if ($reason_type == '2') {
 373                     $reason = $_POST['form_insurance'] . " coins: $thisadj";
 374                     $thisadj = 0;
 375                 } elseif ($reason_type == '3') {
 376                     $reason = $_POST['form_insurance'] . " dedbl: $thisadj";
 377                     $thisadj = 0;
 378                 } elseif ($reason_type == '4') {
 379                     $reason = $_POST['form_insurance'] . " ptresp: $thisadj $reason";
 380                     $thisadj = 0;
 381                 } elseif ($reason_type == '5') {
 382                     $reason = $_POST['form_insurance'] . " note: $thisadj $reason";
 383                     $thisadj = 0;
 384                 } else {
 385 // An adjustment reason including "Ins" is assumed to be assigned by
 386 // insurance, and in that case we identify which one by appending
 387 // Ins1, Ins2 or Ins3.
 388                     if (strpos(strtolower($reason), 'ins') != false) {
 389                         $reason .= ' ' . $_POST['form_insurance'];
 390                     }
 391                 }
 392                 arPostAdjustment($patient_id, $encounter_id, $session_id, $thisadj, $code, $payer_type, $reason, $debug, '', $thiscodetype);
 393             }
 394         }
 395
 396 // Maintain which insurances are marked as finished.
 397
 398         $form_done = 0 + $_POST['form_done'];
 399         $form_stmt_count = 0 + $_POST['form_stmt_count'];
 400         sqlStatement("UPDATE form_encounter SET last_level_closed = ?, stmt_count = ? WHERE pid = ? AND encounter = ?", array($form_done, $form_stmt_count, $patient_id, $encounter_id));
 401
 402         if ($_POST['form_secondary']) {
 403             arSetupSecondary($patient_id, $encounter_id, $debug);
 404         }
 405         echo "<script language='JavaScript'>\n";
 406         echo " if (opener.document.forms[0] != undefined) {\n";
 407         echo "   if (opener.document.forms[0].form_amount) {\n";
 408         echo "     var tmp = opener.document.forms[0].form_amount.value - " . attr($paytotal) . ";\n";
 409         echo "     opener.document.forms[0].form_amount.value = Number(tmp).toFixed(2);\n";
 410         echo "   }\n";
 411         echo " }\n";
 412     } else {
 413         echo "<script language='JavaScript'>\n";
 414     }
 415     if ($info_msg) {
 416         echo " alert('" . addslashes($info_msg) . "');\n";
 417     }
 418     echo "opener.$('#btn-inv-search').click();";
 419     if (!$debug && !$save_stay) {
 420         echo " window.close();\n";
 421     } else {
 422         $reload_url = "sl_eob_invoice.php?id=" . attr(urlencode($trans_id));
 423         echo "window.location.assign('" . $reload_url . "')";
 424     }
 425     echo "</script></body></html>\n";
 426     if (!$save_stay) {
 427         exit();
 428     }
 429 }
 430
 431 // Get invoice charge details.
 432 $codes = ar_get_invoice_summary($patient_id, $encounter_id, true);
 433 $pdrow = sqlQuery("select billing_note from patient_data where pid = ? limit 1", array($patient_id));
 434 ?>
 435
 436 <div class="container">
 437     <div class="row">
 438         <div class="page-header">
 439             <h2><?php echo xlt('EOB Invoice'); ?></h2>
 440         </div>
 441     </div>
 442     <div class="row">
 443         <form action='sl_eob_invoice.php?id=<?php echo attr(urlencode($trans_id)); ?>' method='post'
 444               onsubmit='return validate(this)'>
 445             <input type="hidden" name="csrf_token_form" value="<?php echo attr(collectCsrfToken()); ?>"/>
 446             <fieldset>
 447                 <legend><?php echo xlt('Invoice Actions'); ?></legend>
 448                 <div class="col-xs-12 oe-custom-line">
 449                     <div class="col-xs-3">
 450                         <label class="control-label" for="form_name"><?php echo xlt('Patient'); ?>:</label>
 451                         <input type="text" class="form-control" class="form-control" class="form-control" id='form_name'
 452                                name='form_name'
 453                                value="<?php echo attr($ferow['fname']) . ' ' . attr($ferow['mname']) . ' ' . attr($ferow['lname']); ?>"
 454                                disabled>
 455                     </div>
 456                     <div class="col-xs-3">
 457                         <label class="control-label" for="form_provider"><?php echo xlt('Provider'); ?>:</label>
 458                         <?php
 459                         $tmp = sqlQuery("SELECT fname, mname, lname " .
 460                             "FROM users WHERE id = ?", array($ferow['provider_id']));
 461                         $provider = text($tmp['fname']) . ' ' . text($tmp['mname']) . ' ' . text($tmp['lname']);
 462                         $tmp = sqlQuery("SELECT bill_date FROM billing WHERE " .
 463                             "pid = ? AND encounter = ? AND " .
 464                             "activity = 1 ORDER BY fee DESC, id ASC LIMIT 1", array($patient_id, $encounter_id));
 465                         $billdate = substr(($tmp['bill_date'] . "Not Billed"), 0, 10);
 466                         ?>
 467                         <input type="text" class="form-control" class="form-control" id='form_provider'
 468                                name='form_provider' value="<?php echo attr($provider); ?>" disabled>
 469                     </div>
 470                     <div class="col-xs-2">
 471                         <label class="control-label" for="form_invoice"><?php echo xlt('Invoice'); ?>:</label>
 472                         <input type="text" class="form-control" class="form-control" id='form_provider'
 473                                name='form_provider' value='<?php echo attr($patient_id) . "." . attr($encounter_id); ?>'
 474                                disabled>
 475                     </div>
 476                     <div class="col-xs-2">
 477                         <label class="control-label" for="svc_date"><?php echo xlt('Svc Date'); ?>:</label>
 478                         <input type="text" class="form-control" class="form-control" id='svc_date' name='form_provider'
 479                                value='<?php echo attr($svcdate); ?>' disabled>
 480                     </div>
 481                     <div class="col-xs-2">
 482                         <label class="control-label" for="insurance_name"><?php echo xlt('Insurance'); ?>:</label>
 483                         <?php
 484                         for ($i = 1; $i <= 3; ++$i) {
 485                             $payerid = arGetPayerID($patient_id, $svcdate, $i);
 486                             if ($payerid) {
 487                                 $tmp = sqlQuery("SELECT name FROM insurance_companies WHERE id = ?", array($payerid));
 488                                 $insurance .= "$i: " . $tmp['name'] . "\n";
 489                             }
 490                         }
 491                         ?>
 492                         <textarea name="insurance_name" id="insurance_name" class="form-control" cols="5" rows="2"
 493                                   readonly><?php echo attr($insurance); ?></textarea>
 494                     </div>
 495                 </div>
 496                 <div class="col-xs-12 oe-custom-line">
 497                     <div class="col-xs-3">
 498                         <label class="control-label" for="form_stmt_count"><?php echo xlt('Statements Sent'); ?>
 499                             :</label>
 500                         <input type='text' name='form_stmt_count' id='form_stmt_count' class="form-control"
 501                                value='<?php echo attr((0 + $ferow['stmt_count'])); ?>'/>
 502                     </div>
 503                     <div class="col-xs-3">
 504                         <label class="control-label" for="form_reference"><?php echo xlt('Check/EOB No.'); ?>:</label>
 505                         <input type='text' name='form_reference' id='form_reference' class="form-control" value=''/>
 506                     </div>
 507                     <div class="col-xs-2">
 508                         <label class="control-label" for="form_check_date"><?php echo xlt('Check/EOB Date'); ?>:</label>
 509                         <input type='text' name='form_check_date' class='form-control datepicker' value=''/>
 510                     </div>
 511                     <div class="col-xs-2">
 512                         <label class="control-label" for="form_deposit_date"><?php echo xlt('Deposit Date'); ?>:</label>
 513                         <input type='text' name='form_deposit_date' id='form_deposit_date'
 514                                class='form-control datepicker' value=''/>
 515                         <input type='hidden' name='form_payer_id' value=''/>
 516                         <input type='hidden' name='form_orig_reference' value=''/>
 517                         <input type='hidden' name='form_orig_check_date' value=''/>
 518                         <input type='hidden' name='form_orig_deposit_date' value=''/>
 519                         <input type='hidden' name='form_pay_total' value=''/>
 520                     </div>
 521                 </div>
 522                 <div class="col-xs-12 oe-custom-line">
 523                     <div class="col-xs-4">
 524                         <label class="control-label" for="type_code"><?php echo xlt('Now posting for'); ?>:</label>
 525                         <div style="padding-left:15px">
 526                             <?php
 527                                 $last_level_closed = 0 + $ferow['last_level_closed'];
 528                             ?>
 529                             <label class="radio-inline">
 530                                 <input <?php echo $last_level_closed === 0 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Ins1")' type='radio'
 531                                        value='Ins1'><?php echo xlt('Ins1') ?>
 532                             </label>
 533                             <label class="radio-inline">
 534                                 <input <?php echo $last_level_closed === 1 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Ins2")' type='radio'
 535                                        value='Ins2'><?php echo xlt('Ins2') ?>
 536                             </label>
 537                             <label class="radio-inline">
 538                                 <input <?php echo $last_level_closed === 2 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Ins3")' type='radio'
 539                                        value='Ins3'><?php echo xlt('Ins3') ?>
 540                             </label>
 541                             <label class="radio-inline">
 542                                 <input <?php echo $last_level_closed === 3 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Pt")' type='radio'
 543                                        value='Pt'><?php echo xlt('Patient') ?>
 544                             </label>
 545                             <?php
 546                             // TBD: I think the following is unused and can be removed.
 547                             ?>
 548                             <input name='form_eobs' type='hidden' value='<?php echo attr($arrow['shipvia']) ?>'/>
 549                         </div>
 550                     </div>
 551                     <div class="col-xs-4">
 552                         <label class="control-label" for=""><?php echo xlt('Done with'); ?>:</label>
 553                         <div style="padding-left:15px">
 554                             <?php
 555                             // Write a checkbox for each insurance.  It is to be checked when
 556                             // we no longer expect any payments from that company for the claim.
 557                             $last_level_closed = 0 + $ferow['last_level_closed'];
 558                             foreach (array(0 => 'None', 1 => 'Ins1', 2 => 'Ins2', 3 => 'Ins3') as $key => $value) {
 559                                 if ($key && !arGetPayerID($patient_id, $svcdate, $key)) {
 560                                     continue;
 561                                 }
 562                                 $checked = ($last_level_closed == $key) ? " checked" : "";
 563                                 echo "<label class='radio-inline'>";
 564                                 echo "<input type='radio' name='form_done' value='" . attr($key) . "'$checked />" . text($value);
 565                                 echo "</label>";
 566                             }
 567                             ?>
 568                         </div>
 569                     </div>
 570                     <div class="col-xs-4">
 571                         <label class="control-label" for=""><?php echo xlt('Secondary billing'); ?>:</label>
 572                         <div style="padding-left:15px">
 573                             <label class="checkbox-inline">
 574                                 <input name="form_secondary" type="checkbox"
 575                                        value="1"><?php echo xlt('Needs secondary billing') ?>
 576                             </label>
 577                         </div>
 578                     </div>
 579                 </div>
 580
 581             </fieldset>
 582             <fieldset>
 583                 <legend><?php echo xlt('Invoice Details'); ?></legend>
 584                 <div class="table-responsive">
 585                     <table class="table table-condensed">
 586                         <thead>
 587                         <tr>
 588                             <th><?php echo xlt('Code') ?></th>
 589                             <th align="right"><?php echo xlt('Charge') ?></th>
 590                             <th align="right"><?php echo xlt('Balance') ?>&nbsp;</th>
 591                             <th><?php echo xlt('By/Source') ?></th>
 592                             <th><?php echo xlt('Date') ?></th>
 593                             <th><?php echo xlt('Pay') ?></th>
 594                             <th><?php echo xlt('Adjust') ?></th>
 595                             <th>&nbsp;</th>
 596                             <th><?php echo xlt('Reason') ?></th>
 597                             <?php
 598                             if ($ALLOW_DELETE) { ?>
 599                                 <th><?php echo xlt('Del') ?></th>
 600                                 <?php
 601                             } ?>
 602                         </tr>
 603                         </thead>
 604                         <?php
 605                         $firstProcCodeIndex = -1;
 606                         $encount = 0;
 607                         foreach ($codes as $code => $cdata) {
 608                             ++$encount;
 609                             $dispcode = $code;
 610
 611                             // remember the index of the first entry whose code is not "CO-PAY", i.e. it's a legitimate proc code
 612                             if ($firstProcCodeIndex == -1 && strcmp($code, "CO-PAY") != 0) {
 613                                 $firstProcCodeIndex = $encount;
 614                             }
 615
 616                             // this sorts the details more or less chronologically:
 617                             ksort($cdata['dtl']);
 618                             foreach ($cdata['dtl'] as $dkey => $ddata) {
 619                                 $ddate = substr($dkey, 0, 10);
 620                                 if (preg_match('/^(\d\d\d\d)(\d\d)(\d\d)\s*$/', $ddate, $matches)) {
 621                                     $ddate = $matches[1] . '-' . $matches[2] . '-' . $matches[3];
 622                                 }
 623                                 $tmpchg = "";
 624                                 $tmpadj = "";
 625                                 if ($ddata['chg'] != 0) {
 626                                     if (isset($ddata['rsn'])) {
 627                                         $tmpadj = 0 - $ddata['chg'];
 628                                     } else {
 629                                         $tmpchg = $ddata['chg'];
 630                                     }
 631                                 }
 632                                 ?>
 633                                 <tr>
 634                                     <td class="detail"
 635                                         style="background:<?php echo $dispcode ? 'lightyellow' : ''; ?>"><?php echo text($dispcode);
 636                                         $dispcode = "" ?></td>
 637                                     <td class="detail" class="detail"><?php echo text(bucks($tmpchg)); ?></td>
 638                                     <td class="detail" class="detail">&nbsp;</td>
 639                                     <td class="detail">
 640                                         <?php
 641                                         if (isset($ddata['plv'])) {
 642                                             if (!$ddata['plv']) {
 643                                                 echo 'Pt/';
 644                                             } else {
 645                                                 echo 'Ins' . text($ddata['plv']) . '/';
 646                                             }
 647                                         }
 648                                         echo text($ddata['src']);
 649                                         ?>
 650                                     </td>
 651                                     <td class="detail"><?php echo text($ddate); ?></td>
 652                                     <td class="detail"><?php echo text(bucks($ddata['pmt'])); ?></td>
 653                                     <td class="detail"><?php echo text(bucks($tmpadj)); ?></td>
 654                                     <td class="detail">&nbsp;</td>
 655                                     <td class="detail"><?php echo text($ddata['rsn']); ?></td>
 656                                     <?php
 657                                     if ($ALLOW_DELETE) { ?>
 658                                         <td class="detail">
 659                                             <?php
 660                                             if (!empty($ddata['arseq'])) { ?>
 661                                                 <input name="form_del[<?php echo attr($ddata['arseq']); ?>]"
 662                                                        type="checkbox">
 663                                                 <?php
 664                                             } else {
 665                                                 ?> &nbsp;
 666                                                 <?php
 667                                             } ?>
 668                                         </td>
 669                                     <?php } ?>
 670                                 </tr>
 671                             <?php } // end of prior detail line ?>
 672                             <tr>
 673                                 <td class="last_detail"><?php echo text($dispcode);
 674                                     $dispcode = "" ?></td>
 675                                 <td class="last_detail">&nbsp;</td>
 676                                 <td class="last_detail">
 677                                     <input name="form_line[<?php echo attr($code); ?>][bal]" type="hidden"
 678                                            value="<?php echo attr(bucks($cdata['bal'])); ?>">
 679                                     <input name="form_line[<?php echo attr($code); ?>][ins]" type="hidden"
 680                                            value="<?php echo attr($cdata['ins']); ?>">
 681                                     <input name="form_line[<?php echo attr($code); ?>][code_type]" type="hidden"
 682                                            value="<?php echo attr($cdata['code_type']); ?>"> <?php echo text(sprintf("%.2f", $cdata['bal'])); ?>
 683                                     &nbsp;
 684                                 </td>
 685                                 <td class="last_detail"></td>
 686                                 <td class="last_detail"></td>
 687                                 <td class="last_detail">
 688                                     <input name="form_line[<?php echo attr($code); ?>][pay]"
 689                                            onkeyup="updateFields(document.forms[0]['form_line[<?php echo attr(addslashes($code)); ?>][pay]'], document.forms[0]['form_line[<?php echo attr(addslashes($code)); ?>][adj]'], document.forms[0]['form_line[<?php echo attr(addslashes($code)); ?>][bal]'], document.forms[0]['form_line[CO-PAY][bal]'], <?php echo ($firstProcCodeIndex == $encount) ? 1 : 0 ?>)"
 690                                            onclick="this.select()" autofocus size="10" type="text" class="form-control"
 691                                            value="0.00"></td>
 692                                 <td class="last_detail">
 693                                     <input name="form_line[<?php echo attr($code); ?>][adj]" size="10" type="text"
 694                                            class="form-control"
 695                                            value='<?php echo attr($totalAdjAmount ? $totalAdjAmount : '0.00'); ?>'
 696                                            onclick="this.select()">
 697                                 </td>
 698                                 <td class="last_detail" align="center"><a href=""
 699                                                                           onclick="return writeoff('<?php echo attr(addslashes($code)); ?>')">WO</a>
 700                                 </td>
 701                                 <td class="last_detail">
 702                                     <select class="form-control" name="form_line[<?php echo attr($code); ?>][reason]">
 703                                         <?php
 704                                         // Adjustment reasons are now taken from the list_options table.
 705                                         echo "    <option value=''></option>\n";
 706                                         $ores = sqlStatement("SELECT option_id, title, is_default FROM list_options " .
 707                                             "WHERE list_id = 'adjreason' AND activity = 1 ORDER BY seq, title");
 708                                         while ($orow = sqlFetchArray($ores)) {
 709                                             echo "    <option value='" . attr($orow['option_id']) . "'";
 710                                             if ($orow['is_default']) {
 711                                                 echo " selected";
 712                                             }
 713                                             echo ">" . text($orow['title']) . "</option>\n";
 714                                         }
 715                                         ?>
 716                                     </select>
 717                                     <?php
 718                                     // TBD: Maybe a comment field would be good here, for appending
 719                                     // to the reason.
 720                                     ?>
 721                                 </td>
 722                                 <?php if ($ALLOW_DELETE) { ?>
 723                                     <td class="last_detail">&nbsp;</td>
 724                                 <?php } ?>
 725                             </tr>
 726                         <?php } // end of code ?>
 727                     </table>
 728                 </div>
 729             </fieldset>
 730             <?php //can change position of buttons by creating a class 'position-override' and adding rule text-align:center or right as the case may be in individual stylesheets ?>
 731             <div class="form-group clearfix">
 732                 <div class="col-sm-12 text-left position-override" id="search-btn">
 733                     <div class="btn-group" role="group">
 734                         <button type='submit' class="btn btn-default btn-save" name='form_save' id="btn-save-stay"
 735                             onclick="this.value='1';"><?php echo xlt("Save Current"); ?></button>
 736                         <button type='submit' class="btn btn-default btn-save" name='form_save' id="btn-save"
 737                             onclick="this.value='2';"><?php echo xlt("Save & Exit"); ?></button>
 738                         <button type='button' class="btn btn-link btn-cancel btn-separate-left" name='form_cancel'
 739                             id="btn-cancel" onclick='window.close()'><?php echo xlt("Close"); ?></button>
 740                     </div>
 741                     <?php if ($GLOBALS['new_tabs_layout']) { ?>
 742                         <button type='button' class="btn btn-default btn-view pull-right" name='form_goto' id="btn-goto"
 743                             onclick="goEncounterSummary('<?php echo attr($patient_id) ?>')"><?php echo xlt("Encounter View"); ?></button>
 744                     <?php } ?>
 745                 </div>
 746             </div>
 747         </form>
 748     </div>
 749 </div><!--End of container div-->
 750 <script language="JavaScript">
 751     var f1 = opener.document.forms[0];
 752     var f2 = document.forms[0];
 753     if (f1.form_source) {
 754         <?php
 755         // These support creation and lookup of ar_session table entries:
 756         echo "  f2.form_reference.value         = f1.form_source.value;\n";
 757         echo "  f2.form_check_date.value        = f1.form_paydate.value;\n";
 758         echo "  //f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 759         echo "  if (f1.form_deposit_date.value != '')\n";
 760         echo "     f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 761         echo "  else\n";
 762         echo "     f2.form_deposit_date.value      = getFormattedToday();\n";
 763         echo "  f2.form_payer_id.value          = f1.form_payer_id.value;\n";
 764         echo "  f2.form_pay_total.value         = f1.form_amount.value;\n";
 765         echo "  f2.form_orig_reference.value    = f1.form_source.value;\n";
 766         echo "  f2.form_orig_check_date.value   = f1.form_paydate.value;\n";
 767         echo "  f2.form_orig_deposit_date.value = f1.form_deposit_date.value;\n";
 768
 769         // While I'm thinking about it, some notes about eob sessions.
 770         // If they do not have all of the session key fields in the search
 771         // page, then show a warning at the top of the invoice page.
 772         // Also when they go to save the invoice page and a session key
 773         // field has changed, alert them to that and allow a cancel.
 774
 775         // Another point... when posting EOBs, the incoming payer ID might
 776         // not match the payer ID for the patient's insurance.  This is
 777         // because the same payer might be entered more than once into the
 778         // insurance_companies table.  I don't think it matters much.
 779         ?>
 780     }
 781     setins("Ins1");
 782 </script>
 783 </body>
 784 </html>