interface/usergroup/facility_admin.php

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