interface/usergroup/facility_admin.php

   1 <?
   2 include_once("../globals.php");
   3
   4
   5 include_once("$srcdir/md5.js");
   6 include_once("$srcdir/sql.inc");
   7 require_once("$srcdir/classes/POSRef.class.php");
   8
   9
  10 if ($_POST["mode"] == "facility")
  11 {
  12          sqlStatement("update facility set
  13                 name='{$_POST['facility']}',
  14                 phone='{$_POST['phone']}',
  15                 street='{$_POST['street']}',
  16                 city='{$_POST['city']}',
  17                 state='{$_POST['state']}',
  18                 postal_code='{$_POST['postal_code']}',
  19                 country_code='{$_POST['country_code']}',
  20                 federal_ein='{$_POST['federal_ein']}',
  21                 billing_location='{$_POST['billing_location']}',
  22                 accepts_assignment='{$_POST['accepts_assignment']}',
  23                 pos_code='{$_POST['pos_code']}',
  24                 x12_sender_id='{$_POST['x12_sender_id']}',
  25                 attn='{$_POST['attn']}'
  26         where id='{$_POST['fid']}'");
  27 }
  28
  29 if (isset($_GET["fid"])) {
  30         $my_fid = $_GET["fid"];
  31 }
  32
  33 if (isset($_POST["fid"])) {
  34         $my_fid = $_POST["fid"];
  35 }
  36
  37
  38
  39 ?>
  40
  41 <html>
  42 <head>
  43
  44 <link rel=stylesheet href="<?echo $css_header;?>" type="text/css">
  45
  46 </head>
  47 <body <?echo $top_bg_line;?> topmargin=0 rightmargin=0 leftmargin=2 bottommargin=0 marginwidth=2 marginheight=0>
  48
  49 <span class="title">Edit Facility Information</span>
  50
  51 <form name='facility' method='post' action="facility_admin.php">
  52 <input type=hidden name=mode value="facility">
  53 <input type=hidden name=fid value="<?echo $my_fid;?>">
  54 <span class=bold>Facility Information: </span>
  55 </td><td>
  56 <?php $facility = sqlQuery("select * from facility where id='$my_fid'"); ?>
  57 <br><br>
  58 <table border=0 cellpadding=0 cellspacing=0>
  59 <tr>
  60         <td><span class=text>Name: </span></td><td><input type=entry name=facility size=20 value="<?=$facility['name']?>"></td><td rowspan="10" width="15"></d>
  61         <td><span class=text>Phone as (000) 000-0000:</span></td><td><input type=entry name=phone size=20 value="<?=$facility['phone']?>"></td>
  62 </tr>
  63 <tr>
  64         <td><span class=text>Address: </span></td><td><input type=entry size=20 name=street value="<?=$facility["street"]?>"></td>
  65         <td><span class=text>City: </span></td><td><input type=entry size=20 name=city value="<?echo $facility{"city"}?>"></td>
  66 </tr>
  67 <tr>
  68         <td><span class=text>State: </span></td><td><input type=entry size=20 name=state value="<?echo $facility{"state"}?>"></td>
  69         <td><span class=text>Zip Code: </span></td><td><input type=entry size=20 name=postal_code value="<?echo $facility{"postal_code"}?>"></td>
  70 </tr>
  71 <tr>
  72         <td><span class=text>Country: </span></td><td><input type=entry size=20 name=country_code value="<?echo $facility{"country_code"}?>"></td>
  73         <td><span class=text>Federal EIN: </span></td><td><input type=entry size=20 name=federal_ein value="<?echo $facility{"federal_ein"}?>"></td>
  74 </tr>
  75 <tr>
  76         <td><span class=text>Billing Location: </span></td><td><input type=checkbox name="billing_location" value="1" <?if ($facility['billing_location'] == 1) echo "checked"?>"></td>
  77         <td><span class=text>Accepts Assignment<br>(only if billing location): </span></td><td><input type=checkbox name="accepts_assignment" value="1" <?if ($facility['accepts_assignment'] == 1) echo "checked"?>"></td>
  78 </tr>
  79 <tr>
  80         <td><span class=text>POS Code: </span></td>
  81         <td colspan="6">
  82                 <select name="pos_code">
  83                 <?php
  84                 $pc = new POSRef();
  85
  86                 foreach ($pc->get_pos_ref() as $pos) {
  87                         echo "<option value=\"" . $pos["code"] . "\" ";
  88                         if ($facility['pos_code'] == $pos['code']) {
  89                                 echo "selected";
  90                         }
  91                         echo ">" . $pos['code']  . ": ". $pos['title'];
  92                         echo "</option>\n";
  93                 }
  94
  95                 ?>
  96                 </select>
  97         </td>
  98 </tr>
  99 <tr>
 100         <td><span class="text">Billing Attn:</span></td>
 101         <td colspan="4"><input type="text" name="attn" size="45" value="<?=$facility['attn']?>"></td>
 102 </tr>
 103 <!--
 104 This is now deprecated use the newer X12 partner management in practice settings
 105 <tr>
 106         <td><span class="text">X12 Sender ID: </span></td>
 107         <td><input type="text" name="x12_sender_id" size="15" value="<?=$facility['x12_sender_id']?>"></td>
 108 </tr>
 109 -->
 110 <tr>
 111         <td>&nbsp;</td><td>&nbsp;</td>
 112         <td>&nbsp;</td><td><br><br><input type="submit" value="Update Info">&nbsp;&nbsp;&nbsp;<a href="usergroup_admin.php" class=link_submit>[Back]</font></a></td>
 113 </tr>
 114 </table>
 115 </form>
 116
 117
 118
 119
 120
 121
 122
 123
 124
 125
 126
 127
 128
 129
 130
 131
 132 </body>
 133 </html>
 134