interface/orders/procedure_provider_edit.php

   1 <?php
   2
   3 /**
   4  * Maintenance for the list of procedure providers.
   5  *
   6  * @package   OpenEMR
   7  * @link      http://www.open-emr.org
   8  * @author    Rod Roark <rod@sunsetsystems.com>
   9  * @author    Brady Miller <brady.g.miller@gmail.com>
  10  * @copyright Copyright (c) 2012-2014 Rod Roark <rod@sunsetsystems.com>
  11  * @copyright Copyright (c) 2019 Brady Miller <brady.g.miller@gmail.com>
  12  * @license   https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  13  */
  14
  15 require_once("../globals.php");
  16 require_once("$srcdir/options.inc.php");
  17
  18 use OpenEMR\Common\Acl\AclMain;
  19 use OpenEMR\Common\Csrf\CsrfUtils;
  20 use OpenEMR\Common\Twig\TwigContainer;
  21 use OpenEMR\Core\Header;
  22
  23 if (!empty($_GET)) {
  24     if (!CsrfUtils::verifyCsrfToken($_GET["csrf_token_form"])) {
  25         CsrfUtils::csrfNotVerified();
  26     }
  27 }
  28
  29 if (!empty($_POST)) {
  30     if (!CsrfUtils::verifyCsrfToken($_POST["csrf_token_form"])) {
  31         CsrfUtils::csrfNotVerified();
  32     }
  33 }
  34
  35 if (!AclMain::aclCheckCore('admin', 'users')) {
  36     echo (new TwigContainer(null, $GLOBALS['kernel']))->getTwig()->render('core/unauthorized.html.twig', ['pageTitle' => xl("Edit/Add Procedure Provider")]);
  37     exit;
  38 }
  39
  40 // Collect user id if editing entry
  41 $ppid = $_REQUEST['ppid'];
  42
  43 $info_msg = "";
  44
  45 function invalue($name)
  46 {
  47     $fld = add_escape_custom(trim($_POST[$name]));
  48     return "'$fld'";
  49 }
  50
  51 function onvalue($name)
  52 {
  53     $fld = ($_POST[$name] == 'on') ? '1' : '0';
  54     return "'$fld'";
  55 }
  56
  57 ?>
  58 <html>
  59 <head>
  60 <?php Header::setupHeader(['opener']);?>
  61 <title><?php echo $ppid ? xlt('Edit') : xlt('Add New{{Provider}}') ?> <?php echo xlt('Procedure Provider'); ?></title>
  62 <style>
  63     td {
  64         font-size: 0.8125rem;
  65     }
  66
  67     .inputtext {
  68      padding-left:2px;
  69      padding-right:2px;
  70     }
  71
  72     .button {
  73      font-family:sans-serif;
  74         font-size: 0.75rem;
  75      font-weight:bold;
  76     }
  77
  78
  79     .label-div > a {
  80         display:none;
  81     }
  82     .label-div:hover > a {
  83        display:inline-block;
  84     }
  85     /* This is overridden on any theme */
  86     div[id$="_info"] {
  87         background: #F7FAB3;
  88         color: #000;
  89         padding: 20px;
  90         margin: 10px 15px 0 15px;
  91     }
  92     div[id$="_info"] > a {
  93         margin-left:10px;
  94     }
  95 </style>
  96
  97 </head>
  98
  99 <body>
 100 <div class="container-fluid">
 101     <?php
 102     // If we are saving, then save and close the window.
 103     // lab_director is the id of the organization in the users table
 104     //
 105     if (!empty($_POST['form_save'])) {
 106         $org_qry = "SELECT organization FROM users WHERE id = ?";
 107         $org_res = sqlQuery($org_qry, array($_POST['form_name']));
 108         $org_name = $org_res['organization'];
 109         $sets =
 110             "name = '" . add_escape_custom($org_name) . "', " .
 111             "lab_director = " . invalue('form_name') . ", " .
 112             "npi = " . invalue('form_npi') . ", " .
 113             "send_app_id = " . invalue('form_send_app_id') . ", " .
 114             "send_fac_id = " . invalue('form_send_fac_id') . ", " .
 115             "recv_app_id = " . invalue('form_recv_app_id') . ", " .
 116             "recv_fac_id = " . invalue('form_recv_fac_id') . ", " .
 117             "DorP = " . invalue('form_DorP') . ", " .
 118             "direction = " . invalue('form_direction') . ", " .
 119             "protocol = " . invalue('form_protocol') . ", " .
 120             "remote_host = " . invalue('form_remote_host') . ", " .
 121             "login = " . invalue('form_login') . ", " .
 122             "password = " . invalue('form_password') . ", " .
 123             "orders_path = " . invalue('form_orders_path') . ", " .
 124             "results_path = " . invalue('form_results_path') . ", " .
 125             "notes = " . invalue('form_notes') . ", " .
 126             "active = " . onvalue('form_active');
 127
 128         if ($ppid) {
 129             $query = "UPDATE procedure_providers SET $sets " .
 130                 "WHERE ppid = '" . add_escape_custom($ppid) . "'";
 131             sqlStatement($query);
 132         } else {
 133             $ppid = sqlInsert("INSERT INTO `procedure_providers` SET $sets");
 134         }
 135     } elseif (!empty($_POST['form_delete'])) {
 136         if ($ppid) {
 137             sqlStatement("DELETE FROM procedure_providers WHERE ppid = ?", array($ppid));
 138         }
 139     }
 140
 141     if (!empty($_POST['form_save']) || !empty($_POST['form_delete'])) {
 142         // Close this window and redisplay the updated list.
 143         echo "<script>\n";
 144         if ($info_msg) {
 145             echo " alert(" . js_escape($info_msg) . ");\n";
 146         }
 147
 148         echo " window.close();\n";
 149         echo " if (opener.refreshme) opener.refreshme();\n";
 150         echo "</script></body></html>\n";
 151         exit();
 152     }
 153
 154     if ($ppid) {
 155         $row = sqlQuery("SELECT * FROM procedure_providers WHERE ppid = ?", array($ppid));
 156     }
 157
 158     $ppid_active = $row['active'] ?? null;
 159
 160     $org_query = "SELECT id, organization FROM users WHERE abook_type LIKE 'ord_%'";
 161     $org_res = sqlStatement($org_query);
 162     $optionsStr = '';
 163     while ($org_row = sqlFetchArray($org_res)) {
 164         $org_name = $org_row['organization'];
 165         $selected = '';
 166         if ($ppid) {
 167             if ($row['lab_director'] == $org_row['id']) {
 168                 $selected = "selected";
 169                 $optionsStr .= "<option value='" . attr($org_row['id']) . "' $selected>" . text($org_name) . "</option>";
 170             }
 171         } else {
 172             $checkName = sqlQuery("SELECT `name` FROM `procedure_providers` WHERE `name` = ?", [$org_name]);
 173             if (empty($checkName['name'])) {
 174                 $optionsStr .= "<option value='" . attr($org_row['id']) . "' $selected>" . text($org_name) . "</option>";
 175             }
 176         }
 177     }
 178     ?>
 179     <div class="page-header" name="form_legend" id="form_legend">
 180         <h4><?php echo xlt('Enter Provider Details'); ?><i id="enter-details-tooltip" class="fa fa-info-circle oe-text-black oe-superscript ml-2" aria-hidden="true"></i></h4>
 181     </div>
 182     <div class="row">
 183         <div class="col-sm-12">
 184             <form method='post' name='theform' action="procedure_provider_edit.php?ppid=<?php echo attr_url($ppid); ?>&csrf_token_form=<?php echo attr_url(CsrfUtils::collectCsrfToken()); ?>">
 185                 <input type="hidden" name="csrf_token_form" value="<?php echo attr(CsrfUtils::collectCsrfToken()); ?>" />
 186                 <div class="form-check-inline">
 187                     <label class='form-check-label mr-2' for="form_active"><?php echo xlt('Active'); ?></label>
 188                     <input type='checkbox' class='form-check-input' name='form_active' id='form_active'
 189                         <?php if ($ppid) {
 190                             echo !empty($ppid_active) ? " checked" : "";
 191                         } else {
 192                             echo " checked";
 193                         } ?> />
 194                 </div>
 195                 <div class="row mt-3">
 196                     <div class="col-12">
 197                         <div class="col-sm-6">
 198                             <div class="clearfix">
 199                                 <div class="label-div">
 200                                     <label for="form_name"><?php echo xlt('Name'); ?>:</label><a href="#name_info" class="info-anchor icon-tooltip" data-toggle="collapse"><i class="fa fa-question-circle" aria-hidden="true"></i></a>
 201                                 </div>
 202                                 <select name='form_name' id='form_name' class='form-control'>
 203                                     <?php echo $optionsStr ?? ''; ?>
 204                                 </select>
 205                             </div>
 206                             <div id="name_info" class="collapse">
 207                                 <a href="#name_info" data-toggle="collapse" class="oe-pull-away"><i class="fa fa-times oe-help-x" aria-hidden="true"></i></a>
 208                                 <p><?php echo xlt("Name - Select a provider name from the drop-down list"); ?></p>
 209                                 <p><?php echo xlt("For the name to appear on the drop-down list it must be first entered in Administration > Address Book "); ?></p>
 210                                 <p><?php echo xlt("Select Lab Service in the Type drop-down box and enter a name under organization"); ?></p>
 211                                 <p><?php echo xlt("For detailed instructions close the 'Enter Provider Details' popup and click on the Help icon on the main form. "); ?><i class="fa fa-question-circle" aria-hidden="true"></i></p>
 212                             </div>
 213                         </div>
 214                         <div class="col-sm-6">
 215                             <div class="clearfix">
 216                                 <div class="label-div">
 217                                     <label class="col-form-label" for="form_npi"><?php echo xlt('NPI'); ?>:</label> <a href="#npi_info" class="info-anchor icon-tooltip" data-toggle="collapse"><i class="fa fa-question-circle" aria-hidden="true"></i></a>
 218                                 </div>
 219                                 <input type='text' name='form_npi' id='form_npi' maxlength='10' value='<?php echo attr($row['npi'] ?? ''); ?>' class='form-control' />
 220                             </div>
 221                             <div id="npi_info" class="collapse">
 222                                 <a href="#npi_info" data-toggle="collapse" class="oe-pull-away"><i class="fa fa-times oe-help-x" aria-hidden="true"></i></a>
 223                                 <p><?php echo xlt("NPI - Enter the Provider's unique 10-digit National Provider Identifier or NPI identification number"); ?></p>
 224                                 <p><?php echo xlt("It is issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS)"); ?></p>
 225                                 <p><?php echo xlt("This has to entered once in this form"); ?></p>
 226                                 <p><?php echo xlt("IMPORTANT: The NPI number also exists in the Address Book entry for the provider, take care to enter the correct NPI number"); ?></p>
 227                             </div>
 228                         </div>
 229                     </div>
 230                 </div>
 231                 <div class="row mt-3">
 232                     <div class="col-12">
 233                         <div class="clearfix">
 234                             <div class="col-sm-12 label-div">
 235                                 <label class="col-form-label" for="form_DorP"><?php echo xlt('Usage'); ?>:</label> <a href="#usage_info" class="info-anchor icon-tooltip" data-toggle="collapse"><i class="fa fa-question-circle" aria-hidden="true"></i></a>
 236                             </div>
 237                             <div class="col-sm-6">
 238                                 <select name='form_DorP' id='form_DorP' class='form-control' title='<?php echo xla('HL7 - MSH-11 - Processing ID'); ?>'>
 239                                     <?php
 240                                     foreach (
 241                                         array(
 242                                         'D' => xl('Debugging'),
 243                                         'P' => xl('Production'),
 244                                         'T' => xl('Quest Cert Testing'),
 245                                         'Q' => xl('Quest Cert Debug'),
 246                                         ) as $key => $value
 247                                     ) {
 248                                         echo "    <option value='" . attr($key) . "'";
 249                                         if (!empty($row['DorP']) && ($key == $row['DorP'])) {
 250                                             echo " selected";
 251                                         }
 252                                         echo ">" . text($value) . "</option>\n";
 253                                     }
 254                                     ?>
 255                                 </select>
 256                             </div>
 257                         </div>
 258                         <div id="usage_info" class="collapse">
 259                             <a href="#usage_info" data-toggle="collapse" class="oe-pull-away"><i class="fa fa-times oe-help-x" aria-hidden="true"></i></a>
 260                             <p><?php echo xlt("Usage - is only required if you are submitting an electronic order to an external facility"); ?></p>
 261                             <p><?php echo xlt("It is a field in the HL7 Message header known as Processing ID"); ?></p>
 262                             <p><?php echo xlt("Health Level-7 or HL7 refers to a set of international standards for transfer of clinical and administrative data between software applications used by various healthcare providers"); ?></p>
 263                             <p><?php echo xlt("This field is used to decide whether to process the message as defined in HL7 Application (level 7) Processing rules"); ?></p>
 264                             <p><?php echo xlt("Select the appropriate choice - Debugging or Production"); ?></p>
 265                         </div>
 266                     </div>
 267                 </div>
 268                 <div class="row mt-3">
 269                     <div class="col-12">
 270                         <div class="clearfix">
 271                             <div class="col-sm-12 label-div">
 272                                 <label class="col-form-label" for="form_send_app_id"><?php echo xlt('Sender IDs'); ?>:</label>
 273                                 <a href="#sender_id_info" class="info-anchor icon-tooltip" data-toggle="collapse"><i class="fa fa-question-circle" aria-hidden="true"></i></a>
 274                             </div>
 275                             <div class="row col-12">
 276                                 <div class="col-sm-6">
 277                                     <input type='text' name='form_send_app_id' id='form_send_app_id' maxlength='100'
 278                                         value='<?php echo attr($row['send_app_id'] ?? ''); ?>'
 279                                         title='<?php echo xla('HL7 - MSH-3.1 - Sending application'); ?>'
 280                                         placeholder='<?php echo xla('Enter Application Name'); ?>'
 281                                         class='form-control' />
 282                                 </div>
 283                                 <div class="col-sm-6">
 284                                     <input type='text' name='form_send_fac_id' id='form_send_fac_id' maxlength='100'
 285                                         value='<?php echo attr($row['send_fac_id'] ?? ''); ?>'
 286                                         title='<?php echo xla('HL7 - MSH-4.1 - Sending facility'); ?>'
 287                                         placeholder='<?php echo xla('Enter Facility Name'); ?>'
 288                                         class='form-control' />
 289                                 </div>
 290                             </div>
 291                         </div>
 292                         <div id="sender_id_info" class="collapse">
 293                             <a href="#sender_id_info" data-toggle="collapse" class="oe-pull-away"><i class="fa fa-times oe-help-x" aria-hidden="true"></i></a>
 294                             <p><?php echo xlt("Sender IDs - is only required if you are submitting an electronic order to an external facility"); ?></p>
 295                             <p><?php echo xlt("It consists of two parts - the Sending application and Sending facility"); ?></p>
 296                             <p><?php echo xlt("These are used to populate fields 3 and 4 in the HL7 MSH - message header"); ?></p>
 297                             <p><?php echo xlt("Sending application name will be provided by the facility that you will be connecting to"); ?></p>
 298                             <p><?php echo xlt("Sending facility name is user defined"); ?></p>
 299                         </div>
 300                     </div>
 301                 </div>
 302                 <div class="row mt-3">
 303                     <div class="col-12">
 304                         <div class="clearfix">
 305                             <div class="col-sm-12 label-div">
 306                                 <label class="col-form-label" for="form_recv_app_id"><?php echo xlt('Receiver IDs'); ?>:</label>
 307                                 <a href="#receiver_id_info" class="info-anchor icon-tooltip" data-toggle="collapse"><i class="fa fa-question-circle" aria-hidden="true"></i></a>
 308                             </div>
 309                             <div class="row col-12">
 310                                 <div class="col-sm-6">
 311                                     <input type='text' name='form_recv_app_id' id='form_recv_app_id' maxlength='100' value='<?php echo attr($row['recv_app_id'] ?? ''); ?>' title='<?php echo xla('HL7 - MSH-5.1 - Receiving application'); ?>' placeholder='<?php echo xla('Enter Application Name'); ?>' class='form-control' />
 312                                 </div>
 313                                 <div class="col-sm-6">
 314                                     <input type='text' name='form_recv_fac_id' id='form_recv_fac_id' maxlength='100' value='<?php echo attr($row['recv_fac_id'] ?? ''); ?>' title='<?php echo xla('HL7 - MSH-6.1 - Receiving facility'); ?>' placeholder='<?php echo xla('Enter Facility Name'); ?>' class='form-control' />
 315                                 </div>
 316                             </div>
 317                         </div>
 318                         <div id="receiver_id_info" class="collapse">
 319                             <a href="#receiver_id_info" data-toggle="collapse" class="oe-pull-away"><i class="fa fa-times oe-help-x" aria-hidden="true"></i></a>
 320                             <p><?php echo xlt("Receiver IDs - is only required if you are submitting an electronic order to an external facility"); ?></p>
 321                             <p><?php echo xlt("It consists of two parts - the Receiving application and Receiving facility"); ?></p>
 322                             <p><?php echo xlt("These are used to populate fields 5 and 6 in the HL7 MSH - message header"); ?></p>
 323                             <p><?php echo xlt("They will be provided by the facility that you will be connecting to"); ?></p>
 324                         </div>
 325                     </div>
 326                 </div>
 327                 <div class="row mt-3">
 328                     <div class="col-12">
 329                         <div class="clearfix">
 330                             <div class="col-sm-12 label-div">
 331                                 <label for="form_protocol"><?php echo xlt('Protocol'); ?>:</label> <a href="#protocol_info" class="info-anchor icon-tooltip" data-toggle="collapse"><i class="fa fa-question-circle" aria-hidden="true"></i></a>
 332                             </div>
 333                             <div class="row col-12">
 334                                 <div class="col-sm-6">
 335                                     <select name='form_protocol' id='form_protocol' class='form-control'>
 336                                         <?php
 337                                         foreach (
 338                                             array(
 339                                             // Add to this list as more protocols are supported.
 340                                             'DL' => xl('Download'),
 341                                             'SFTP' => xl('SFTP'),
 342                                             'FS' => xl('Local Filesystem'),
 343                                             'WS' => xl('Web Service'),
 344                                             ) as $key => $value
 345                                         ) {
 346                                             echo "    <option value='" . attr($key) . "'";
 347                                             if (!empty($row['protocol']) && ($key == $row['protocol'])) {
 348                                                 echo " selected";
 349                                             }
 350                                             echo ">" . text($value) . "</option>\n";
 351                                         }
 352                                         ?>
 353                                     </select>
 354                                 </div>
 355                                 <div class="col-sm-6">
 356                                     <select name='form_direction' id='form_direction' class='form-control'>
 357                                         <?php
 358                                         foreach (
 359                                             array(
 360                                             'B' => xl('Bidirectional'),
 361                                             'R' => xl('Results Only'),
 362                                             ) as $key => $value
 363                                         ) {
 364                                             echo "    <option value='" . attr($key) . "'";
 365                                             if (!empty($row['direction']) && ($key == $row['direction'])) {
 366                                                 echo " selected";
 367                                             }
 368
 369                                             echo ">" . text($value) . "</option>\n";
 370                                         }
 371                                         ?>
 372                                     </select>
 373                                 </div>
 374                             </div>
 375                         </div>
 376                         <div id="protocol_info" class="collapse">
 377                             <a href="#protocol_info" data-toggle="collapse" class="oe-pull-away"><i class="fa fa-times oe-help-x" aria-hidden="true"></i></a>
 378                             <p><?php echo xlt("Protocol - consists of two parts - the method used to send orders and receive results and whether it is used to receive results only or is used to send orders and receive result i.e. bidirectional"); ?></p>
 379                             <p><?php echo xlt("If you do not submit orders electronically or receive result electronically leave it as the default value, Download"); ?></p>
 380                             <p><?php echo xlt("Download will download a text file containing the order in the HL7v2.3 message format to the downloads directory of your computer"); ?></p>
 381                             <p><?php echo xlt("SFTP will send the order as a HL7v2.3 message to the receiving lab using the SFTP protocol"); ?></p>
 382                             <p><?php echo xlt("Secure File Transfer Protocol, or SFTP is a network protocol that provides file access, file transfer, and file management over a secure connection"); ?></p>
 383                             <p><?php echo xlt("Local Filesystem will store the order as a HL7v2.3 message in a predefined location in the local server hosting openEMR"); ?></p>
 384                             <p><?php echo xlt("Select Bidirectional or Results Only as appropriate, again only used for electronic orders"); ?></p>
 385                         </div>
 386                     </div>
 387                 </div>
 388                 <div class="row mt-3">
 389                     <div class="col-12">
 390                         <div class="clearfix">
 391                             <div class="col-sm-12 label-div">
 392                                 <label for="form_login"><?php echo xlt('Login'); ?>:</label> <a href="#login_info" class="info-anchor icon-tooltip" data-toggle="collapse"><i class="fa fa-question-circle" aria-hidden="true"></i></a>
 393                             </div>
 394                             <div class="row col-12">
 395                                 <div class="col-sm-6">
 396                                     <input type='text' name='form_login' id='form_login' maxlength='255' value='<?php echo attr($row['login'] ?? ''); ?>' placeholder='<?php echo xla('Enter User Login ID'); ?>' class='form-control' />
 397                                 </div>
 398                                 <div class="col-sm-6">
 399                                     <input type='text' name='form_password' id='form_password' maxlength='255' value='<?php echo attr($row['password'] ?? ''); ?>' placeholder='<?php echo xla('Enter Password'); ?>' class='form-control' />
 400                                 </div>
 401                             </div>
 402                         </div>
 403                         <div id="login_info" class="collapse">
 404                             <a href="#login_info" data-toggle="collapse" class="oe-pull-away"><i class="fa fa-times oe-help-x" aria-hidden="true"></i></a>
 405                             <p><?php echo xlt("Login - details are only required if you are connecting to a facility using the SFTP protocol "); ?></p>
 406                             <p><?php echo xlt("Type in the username and password provided by the facility"); ?></p>
 407                         </div>
 408                     </div>
 409                 </div>
 410                 <div class="row mt-3">
 411                     <div class="col-12">
 412                         <div class="clearfix">
 413                             <div class="col-sm-12 label-div">
 414                                 <label class="col-form-label" for="form_remote_host"><?php echo xlt('Remote Host'); ?>:</label> <a href="#remote_host_info" class="info-anchor icon-tooltip" data-toggle="collapse"><i class="fa fa-question-circle" aria-hidden="true"></i></a>
 415                             </div>
 416                             <div class="col-sm-12">
 417                                 <input type='text' name='form_remote_host' id='form_remote_host' maxlength='255' value='<?php echo attr($row['remote_host'] ?? ''); ?>' class='form-control' />
 418                             </div>
 419                         </div>
 420                         <div id="remote_host_info" class="collapse">
 421                             <a href="#remote_host_info" data-toggle="collapse" class="oe-pull-away"><i class="fa fa-times oe-help-x" aria-hidden="true"></i></a>
 422                             <p><?php echo xlt("Remote Host - is only required if you are submitting an electronic order to an external facility or just receiving results from it"); ?></p>
 423                             <p><?php echo xlt("Type in the URL of the external facility to which the order will be sent, this will be provided by the facility"); ?></p>
 424                         </div>
 425                     </div>
 426                 </div>
 427                 <div class="row mt-3">
 428                     <div class="col-12">
 429                         <div class="clearfix">
 430                             <div class="col-sm-12 label-div">
 431                                 <label class="col-form-label" for="form_orders_path"><?php echo xlt('Orders Path'); ?>:</label> <a href="#orders_path_info" class="info-anchor icon-tooltip" data-toggle="collapse"><i class="fa fa-question-circle" aria-hidden="true"></i></a>
 432                             </div>
 433                             <div class="col-sm-12">
 434                                 <input type='text' name='form_orders_path' id='form_orders_path' maxlength='255'
 435                                     value='<?php echo attr($row['orders_path'] ?? ''); ?>' class='form-control' />
 436                             </div>
 437                         </div>
 438                         <div id="orders_path_info" class="collapse">
 439                             <a href="#orders_path_info" data-toggle="collapse" class="oe-pull-away"><i class="fa fa-times oe-help-x" aria-hidden="true"></i></a>
 440                             <p><?php echo xlt("Orders Path - is only required if you are submitting an electronic order to an external facility"); ?></p>
 441                             <p><?php echo xlt("Type in the location of the directory or folder in which the created orders (HL7 messages) will be stored"); ?></p>
 442                         </div>
 443                     </div>
 444                 </div>
 445                 <div class="row mt-3">
 446                     <div class="col-12">
 447                         <div class="clearfix">
 448                             <div class="col-sm-12 label-div">
 449                                 <label class="col-form-label" for="form_results_path"><?php echo xlt('Results Path'); ?>:</label>
 450                                 <a href="#results_path_info" class="info-anchor icon-tooltip" data-toggle="collapse"><i class="fa fa-question-circle" aria-hidden="true"></i></a>
 451                             </div>
 452                             <div class="col-sm-12">
 453                                 <input type='text' name='form_results_path' id='form_results_path' maxlength='255'
 454                                     value='<?php echo attr($row['results_path'] ?? ''); ?>' class='form-control' />
 455                             </div>
 456                         </div>
 457                         <div id="results_path_info" class="collapse">
 458                             <a href="#results_path_info" data-toggle="collapse" class="oe-pull-away"><i class="fa fa-times oe-help-x" aria-hidden="true"></i></a>
 459                             <p><?php echo xlt("Results Path - is only required if you are submitting an electronic order to an external facility or just receiving results from it"); ?></p>
 460                             <p><?php echo xlt("Type in the location of the directory or folder in which the returned results (HL7 messages) will be stored"); ?></p>
 461                         </div>
 462                     </div>
 463                 </div>
 464                 <div class="row mt-3">
 465                     <div class="col-12">
 466                         <div class="clearfix">
 467                             <div class="col-sm-12 label-div">
 468                                 <label class="col-form-label" for="form_notes"><?php echo xlt('Notes'); ?>:</label> <a href="#notes_info" class="info-anchor icon-tooltip" data-toggle="collapse"><i class="fa fa-question-circle" aria-hidden="true"></i></a>
 469                             </div>
 470                             <div class="col-sm-12">
 471                                 <textarea rows='3' name='form_notes' id='form_notes' wrap='virtual' class='form-control'><?php echo text($row['notes'] ?? ''); ?></textarea>
 472                             </div>
 473                         </div>
 474                         <div id="notes_info" class="collapse">
 475                             <a href="#notes_info" data-toggle="collapse" class="oe-pull-away"><i class="fa fa-times oe-help-x" aria-hidden="true"></i></a>
 476                             <p><?php echo xlt("Any additional information pertaining to this provider"); ?></p>
 477                         </div>
 478                     </div>
 479                 </div>
 480                 <div class="row mt-3">
 481                     <div class="form-group clearfix" id="button-container">
 482                         <div class="col-sm-12 text-left position-override">
 483                             <div class="btn-group" role="group">
 484                                 <button type='submit' name='form_save' class="btn btn-primary btn-save" value='<?php echo xla('Save'); ?>'><?php echo xlt('Save'); ?></button>
 485                                 <button type="button" class="btn btn-secondary btn-cancel" onclick='window.close()' ;><?php echo xlt('Cancel'); ?></button>
 486                                 <?php if ($ppid) { ?>
 487                                 <button type='submit' name='form_delete' class="btn btn-danger btn-cancel btn-delete" value='<?php echo xla('Delete'); ?>'><?php echo xlt('Delete'); ?></button>
 488                                 <?php } ?>
 489                             </div>
 490                         </div>
 491                     </div>
 492                 </div>
 493             </form>
 494         </div>
 495     </div>
 496 </div><!--end of container div-->
 497 <script>
 498     //jqury-ui tooltip
 499     $(function () {
 500         $('.icon-tooltip i').attr({"title": <?php echo xlj('Click to see more information'); ?>, "data-toggle": "tooltip", "data-placement": "bottom"}).tooltip({
 501             show: {
 502                 delay: 700,
 503                 duration: 0
 504             }
 505         });
 506         $('#enter-details-tooltip').attr({"title": <?php echo xlj('Additional help to fill out this form is available by hovering over labels of each box and clicking on the dark blue help ? icon that is revealed. On mobile devices tap once on the label to reveal the help icon and tap on the icon to show the help section'); ?>, "data-toggle": "tooltip", "data-placement": "bottom"}).tooltip();
 507     });
 508 </script>
 509 </body>
 510 </html>