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