interface/billing/sl_eob_invoice.php

   1 <?php
   2
   3 /**
   4  * This provides for manual posting of EOBs.  It is invoked from
   5  * sl_eob_search.php.  For automated (X12 835) remittance posting
   6  * see sl_eob_process.php.
   7  *
   8  * @package   OpenEMR
   9  * @link      http://www.open-emr.org
  10  * @author    Rod Roark <rod@sunsetsystems.com>
  11  * @author    Roberto Vasquez <robertogagliotta@gmail.com>
  12  * @author    Terry Hill <terry@lillysystems.com>
  13  * @author    Jerry Padgett <sjpadgett@gmail.com>
  14  * @author    Stephen Waite <stephen.waite@cmsvt.com>
  15  * @author    Brady Miller <brady.g.miller@gmail.com>
  16  * @copyright Copyright (c) 2005-2016 Rod Roark <rod@sunsetsystems.com>
  17  * @copyright Copyright (c) 2018-2020 Stephen Waite <stephen.waite@cmsvt.com>
  18  * @copyright Copyright (c) 2019-2020 Brady Miller <brady.g.miller@gmail.com>
  19  * @license   https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  20  */
  21
  22 require_once("../globals.php");
  23 require_once("$srcdir/patient.inc");
  24 require_once("$srcdir/forms.inc");
  25 require_once("../../custom/code_types.inc.php");
  26 require_once "$srcdir/user.inc";
  27
  28 use OpenEMR\Billing\InvoiceSummary;
  29 use OpenEMR\Billing\SLEOB;
  30 use OpenEMR\Common\Csrf\CsrfUtils;
  31 use OpenEMR\Common\Logging\EventAuditLogger;
  32 use OpenEMR\Core\Header;
  33
  34 $debug = 0; // set to 1 for debugging mode
  35 $save_stay = $_REQUEST['form_save'] == '1' ? true : false;
  36 $from_posting = (0 + $_REQUEST['isPosting']) ? 1 : 0;
  37 $g_posting_adj_disable = $GLOBALS['posting_adj_disable'] ? 'checked' : '';
  38 if ($from_posting) {
  39     $posting_adj_disable = prevSetting('sl_eob_search.', 'posting_adj_disable', 'posting_adj_disable', $g_posting_adj_disable);
  40 } else {
  41     $posting_adj_disable = $g_posting_adj_disable;
  42 }
  43
  44 // If we permit deletion of transactions.  Might change this later.
  45 $ALLOW_DELETE = true;
  46
  47 $info_msg = "";
  48
  49 // Format money for display.
  50 //
  51 function bucks($amount)
  52 {
  53     if ($amount) {
  54         return sprintf("%.2f", $amount);
  55     }
  56 }
  57
  58 // Delete rows, with logging, for the specified table using the
  59 // specified WHERE clause.  Borrowed from deleter.php.
  60 //
  61 function row_delete($table, $where)
  62 {
  63     $tres = sqlStatement("SELECT * FROM " . escape_table_name($table) . " WHERE $where");
  64     $count = 0;
  65     while ($trow = sqlFetchArray($tres)) {
  66         $logstring = "";
  67         foreach ($trow as $key => $value) {
  68             if (!$value || $value == '0000-00-00 00:00:00') {
  69                 continue;
  70             }
  71
  72             if ($logstring) {
  73                 $logstring .= " ";
  74             }
  75
  76             $logstring .= $key . "='" . addslashes($value) . "'";
  77         }
  78
  79         EventAuditLogger::instance()->newEvent("delete", $_SESSION['authUser'], $_SESSION['authProvider'], 1, "$table: $logstring");
  80         ++$count;
  81     }
  82
  83     if ($count) { // Lets not echo the query for stay and save
  84         $query = "DELETE FROM " . escape_table_name($table) . " WHERE $where";
  85         sqlStatement($query);
  86     }
  87 }
  88
  89 ?>
  90 <html>
  91 <head>
  92     <?php Header::setupHeader(['datetime-picker', 'opener']); ?>
  93     <title><?php echo xlt('EOB Posting - Invoice') ?></title>
  94     <script>
  95
  96         const adjDisable = <?php echo js_escape($posting_adj_disable); ?>;
  97         // An insurance radio button is selected.
  98         function setins(istr) {
  99             return true;
 100         }
 101
 102         function goEncounterSummary(pid) {
 103             if(pid) {
 104                 if(typeof opener.toEncSummary  === 'function') {
 105                     opener.toEncSummary(pid);
 106                 }
 107             }
 108             doClose();
 109         }
 110
 111         function doClose() {
 112             window.close();
 113         }
 114
 115         // Compute an adjustment that writes off the balance:
 116         function writeoff(code) {
 117             const f = document.forms[0];
 118             const belement = f['form_line[' + code + '][bal]'];
 119             const pelement = f['form_line[' + code + '][pay]'];
 120             const aelement = f['form_line[' + code + '][adj]'];
 121             const relement = f['form_line[' + code + '][reason]'];
 122             const tmp = belement.value - pelement.value;
 123             aelement.value = Number(tmp).toFixed(2);
 124             if (aelement.value && !relement.value) {
 125                 relement.selectedIndex = 1;
 126             }
 127             return false;
 128         }
 129
 130         // Onsubmit handler.  A good excuse to write some JavaScript.
 131         function validate(f) {
 132             let delcount = 0;
 133             let allempty = true;
 134
 135             for (let i = 0; i < f.elements.length; ++i) {
 136                 let ename = f.elements[i].name;
 137                 // Count deletes.
 138                 if (ename.substring(0, 9) == 'form_del[') {
 139                     if (f.elements[i].checked) {
 140                         ++delcount;
 141                     }
 142                     continue;
 143                 }
 144                 let pfxlen = ename.indexOf('[pay]');
 145                 if (pfxlen < 0) {
 146                     continue
 147                 };
 148                 let pfx = ename.substring(0, pfxlen);
 149                 let code = pfx.substring(pfx.indexOf('[') + 1, pfxlen - 1);
 150                 let cPay = parseFloat(f[pfx + '[pay]'].value).toFixed(2);
 151                 let cAdjust = parseFloat(f[pfx + '[adj]'].value).toFixed(2);
 152
 153                 if ((cPay !== 0) || cAdjust !== 0) {
 154                     allempty = false;
 155                 }
 156                 if(adjDisable) {
 157                     if ((cAdjust == 0 && ins_done.value == 'changed')) {
 158                         allempty = false;
 159                     }
 160                 }
 161                 if ((cPay !== 0) && isNaN(parseFloat(f[pfx + '[pay]'].value))) {
 162                     let message = <?php echo xlj('Payment value for code') ?> + " " + code + " " + <?php echo xlj('is not a number') ?>;
 163                     (async (message, time) => {
 164                         await asyncAlertMsg(message, time, 'danger', 'lg');
 165                     })(message, 3000)
 166                     .then(res => { });
 167                     return false;
 168                 }
 169                 if ((cAdjust !== 0) && isNaN(parseFloat(f[pfx + '[adj]'].value))) {
 170                     let message = <?php echo xlj('Adjustment value for code') ?> + " " + code  + " " <?php echo xlj('is not a number') ?>;
 171                     (async (message, time) => {
 172                         await asyncAlertMsg(message, time, 'danger', 'lg');
 173                     })(message, 3000)
 174                     .then(res => { });
 175                     return false;
 176                 }
 177                 if ((cAdjust !== 0) && !f[pfx + '[reason]'].value && !adjDisable) {
 178                     let message = <?php echo xlj('Please select an adjustment reason for code') ?> + " " + code;
 179                     (async (message, time) => {
 180                         await asyncAlertMsg(message, time, 'danger', 'lg');
 181                     })(message, 3000)
 182                     .then(res => { });
 183                     return false;
 184                 }
 185             // TBD: validate the date format
 186             }
 187             // Check if save is clicked with nothing to post.
 188             if (allempty && delcount === 0) {
 189                 let message = <?php echo xlj('Nothing to Post! Please review entries or use Cancel to exit transaction') ?>;
 190                 (async (message, time) => {
 191                     await asyncAlertMsg(message, time, 'danger', 'lg');
 192                 })(message, 3000)
 193                 .then(res => { });
 194                 return false;
 195             }
 196             // Demand confirmation if deleting anything.
 197             if (delcount > 0) {
 198                 if (!confirm(<?php echo xlj('Really delete'); ?> + ' ' + delcount +
 199                     ' ' + <?php echo xlj('transactions'); ?> + '?' +
 200                     ' ' + <?php echo xlj('This action will be logged'); ?> + '!')
 201                 ) return false;
 202             }
 203             return true;
 204         }
 205
 206         // Get current date
 207         function getFormattedToday() {
 208             let today = new Date();
 209             let dd = today.getDate();
 210             let mm = today.getMonth() + 1; //January is 0!
 211             let yyyy = today.getFullYear();
 212             if (dd < 10) {
 213                 dd = '0' + dd;
 214             }
 215             if (mm < 10) {
 216                 mm = '0' + mm;
 217             }
 218             return (yyyy + '-' + mm + '-' + dd);
 219         }
 220
 221         // Update Payment Fields
 222         function updateFields(payField, adjField, balField, coPayField, isFirstProcCode) {
 223             let payAmount = 0.0;
 224             let adjAmount = 0.0;
 225             let balAmount = 0.0;
 226             let coPayAmount = 0.0;
 227
 228             // coPayFiled will be null if there is no co-pay entry in the fee sheet
 229             if (coPayField) {
 230                 coPayAmount = coPayField.value;
 231             }
 232
 233             // if balance field is 0.00, its value comes back as null, so check for nul-ness first
 234             if (balField) {
 235                 balAmount = (balField.value) ? balField.value : 0;
 236             }
 237
 238             if (payField) {
 239                 payAmount = (payField.value) ? payField.value : 0;
 240             }
 241
 242             // alert('balance = >' + balAmount +'<  payAmount = ' + payAmount + '  copay = ' + coPayAmount + '  isFirstProcCode = ' + isFirstProcCode);
 243
 244             // subtract the co-pay only from the first procedure code
 245             if (isFirstProcCode == 1) {
 246                 balAmount = parseFloat(balAmount) + parseFloat(coPayAmount);
 247             }
 248
 249             if (adjDisable) {
 250                 return;
 251             }
 252
 253             adjAmount = balAmount - payAmount;
 254             // Assign rounded adjustment value back to TextField
 255             adjField.value = adjAmount = Math.round(adjAmount * 100) / 100;
 256         }
 257
 258         $(function () {
 259             $('.datepicker').datetimepicker({
 260                 <?php $datetimepicker_timepicker = false; ?>
 261                 <?php $datetimepicker_showseconds = false; ?>
 262                 <?php $datetimepicker_formatInput = true; ?>
 263                 <?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
 264                 <?php // can add any additional javascript settings to datetimepicker here; need to prepend first setting with a comma ?>
 265             });
 266         });
 267
 268         $("#ins_done").on("change", function() {
 269             $("#ins_done").val('changed');
 270         });
 271
 272     </script>
 273     <style>
 274         @media only screen and (max-width: 768px) {
 275             [class*="col-"] {
 276                 width: 100%;
 277                 text-align: left !Important;
 278             }
 279         }
 280
 281         .table {
 282             margin: auto;
 283             width: 99%;
 284         }
 285
 286         .table > tbody > tr > td {
 287             border-top: none;
 288         }
 289
 290         .last_detail {
 291             border-bottom: 1px var(--black) solid;
 292             margin-top: 2px;
 293         }
 294
 295         @media (min-width: 992px) {
 296             .modal-lg {
 297                 width: 1000px !Important;
 298             }
 299         }
 300     </style>
 301 </head>
 302 <body>
 303 <?php
 304 $trans_id = 0 + $_GET['id'];
 305 if (!$trans_id) {
 306     die(xlt("You cannot access this page directly."));
 307 }
 308
 309 // A/R case, $trans_id matches form_encounter.id.
 310 $ferow = sqlQuery("SELECT e.*, p.fname, p.mname, p.lname FROM form_encounter AS e, patient_data AS p WHERE e.id = ? AND p.pid = e.pid", array($trans_id));
 311 if (empty($ferow)) {
 312     die("There is no encounter with form_encounter.id = '" . text($trans_id) . "'.");
 313 }
 314 $patient_id = 0 + $ferow['pid'];
 315 $encounter_id = 0 + $ferow['encounter'];
 316 $svcdate = substr($ferow['date'], 0, 10);
 317 $form_payer_id = ($_POST['$form_payer_id']) ? (0 + $_POST['form_payer_id']) : 0;
 318 $form_reference = $_POST['form_reference'];
 319 $form_check_date = ($_POST['form_check_date']) ? DateToYYYYMMDD($_POST['form_check_date']) : date('Y-m-d');
 320 $form_deposit_date = ($_POST['form_deposit_date']) ? DateToYYYYMMDD($_POST['form_deposit_date']) : date('Y-m-d');
 321 $form_pay_total = ($_POST['form_pay_total']) ? (0 + $_POST['form_pay_total']) : 0;
 322
 323
 324 $payer_type = 0;
 325 if (preg_match('/^Ins(\d)/i', $_POST['form_insurance'], $matches)) {
 326     $payer_type = $matches[1];
 327 }
 328
 329 if (($_POST['form_save'] || $_POST['form_cancel'])) {
 330     if ($_POST['form_save']) {
 331         if (!CsrfUtils::verifyCsrfToken($_POST["csrf_token_form"])) {
 332             CsrfUtils::csrfNotVerified();
 333         }
 334
 335         if ($debug) {
 336             echo "<p><b>" . xlt("This module is in test mode. The database will not be changed.") . "</b><p>\n";
 337         }
 338
 339         $session_id = SLEOB::arGetSession($form_payer_id, $form_reference, $form_check_date, $form_deposit_date, $form_pay_total);
 340 // The sl_eob_search page needs its invoice links modified to invoke
 341 // javascript to load form parms for all the above and submit.
 342 // At the same time that page would be modified to work off the
 343 // openemr database exclusively.
 344 // And back to the sl_eob_invoice page, I think we may want to move
 345 // the source input fields from row level to header level.
 346
 347 // Handle deletes. row_delete() is borrowed from deleter.php.
 348         if ($ALLOW_DELETE && !$debug) {
 349             if (is_array($_POST['form_del'])) {
 350                 foreach ($_POST['form_del'] as $arseq => $dummy) {
 351                     row_delete("ar_activity", "pid = '" . add_escape_custom($patient_id) . "' AND " . "encounter = '" . add_escape_custom($encounter_id) . "' AND sequence_no = '" . add_escape_custom($arseq) . "'");
 352                 }
 353             }
 354         }
 355
 356         $paytotal = 0;
 357         foreach ($_POST['form_line'] as $code => $cdata) {
 358             $thispay = trim($cdata['pay']);
 359             $thisadj = trim($cdata['adj']);
 360             $thisins = trim($cdata['ins']);
 361             $thiscodetype = trim($cdata['code_type']);
 362             $reason = $cdata['reason'];
 363
 364 // Get the adjustment reason type.  Possible values are:
 365 // 1 = Charge adjustment
 366 // 2 = Coinsurance
 367 // 3 = Deductible
 368 // 4 = Other pt resp
 369 // 5 = Comment
 370             $reason_type = '1';
 371             if ($reason) {
 372                 $tmp = sqlQuery("SELECT option_value FROM list_options WHERE list_id = 'adjreason' AND activity = 1 AND option_id = ?", array($reason));
 373                 if (empty($tmp['option_value'])) {
 374 // This should not happen but if it does, apply old logic.
 375                     if (preg_match("/To copay/", $reason)) {
 376                         $reason_type = 2;
 377                     } elseif (preg_match("/To ded'ble/", $reason)) {
 378                         $reason_type = 3;
 379                     }
 380                     $info_msg .= xl("No adjustment reason type found for") . " \"$reason\". ";
 381                 } else {
 382                     $reason_type = $tmp['option_value'];
 383                 }
 384             }
 385
 386             if (!$thisins) {
 387                 $thisins = 0;
 388             }
 389
 390             if (0.0 + $thispay) {
 391                 SLEOB::arPostPayment($patient_id, $encounter_id, $session_id, $thispay, $code, $payer_type, '', $debug, '', $thiscodetype);
 392                 $paytotal += $thispay;
 393             }
 394
 395 // Be sure to record adjustment reasons, even for zero adjustments if
 396 // they happen to be comments.
 397             if (
 398                 (0.0 + $thisadj) ||
 399                 ($reason && $reason_type == 5) ||
 400                 ($reason && ($reason_type > 1 && $reason_type < 6))
 401             ) {
 402 // "To copay" and "To ded'ble" need to become a comment in a zero
 403 // adjustment, formatted just like sl_eob_process.php.
 404                 if ($reason_type == '2') {
 405                     $reason = $_POST['form_insurance'] . " coins: $thisadj";
 406                     $thisadj = 0;
 407                 } elseif ($reason_type == '3') {
 408                     $reason = $_POST['form_insurance'] . " dedbl: $thisadj";
 409                     $thisadj = 0;
 410                 } elseif ($reason_type == '4') {
 411                     $reason = $_POST['form_insurance'] . " ptresp: $thisadj $reason";
 412                     $thisadj = 0;
 413                 } elseif ($reason_type == '5') {
 414                     $reason = $_POST['form_insurance'] . " note: $thisadj $reason";
 415                     $thisadj = 0;
 416                 } else {
 417 // An adjustment reason including "Ins" is assumed to be assigned by
 418 // insurance, and in that case we identify which one by appending
 419 // Ins1, Ins2 or Ins3.
 420                     if (strpos(strtolower($reason), 'ins') != false) {
 421                         $reason .= ' ' . $_POST['form_insurance'];
 422                     }
 423                 }
 424                 SLEOB::arPostAdjustment($patient_id, $encounter_id, $session_id, $thisadj, $code, $payer_type, $reason, $debug, '', $thiscodetype);
 425             }
 426         }
 427
 428 // Maintain which insurances are marked as finished.
 429
 430         $form_done = 0 + $_POST['form_done'];
 431         $form_stmt_count = 0 + $_POST['form_stmt_count'];
 432         sqlStatement("UPDATE form_encounter SET last_level_closed = ?, stmt_count = ? WHERE pid = ? AND encounter = ?", array($form_done, $form_stmt_count, $patient_id, $encounter_id));
 433
 434         if ($_POST['form_secondary']) {
 435             SLEOB::arSetupSecondary($patient_id, $encounter_id, $debug);
 436         }
 437         echo "<script>\n";
 438         echo " if (opener.document.forms[0] != undefined) {\n";
 439         echo "   if (opener.document.forms[0].form_amount) {\n";
 440         echo "     var tmp = opener.document.forms[0].form_amount.value - " . attr($paytotal) . ";\n";
 441         echo "     opener.document.forms[0].form_amount.value = Number(tmp).toFixed(2);\n";
 442         echo "   }\n";
 443         echo " }\n";
 444     } else {
 445         echo "<script>\n";
 446     }
 447     if ($info_msg) {
 448         echo " alert(" . js_escape($info_msg) . ");\n";
 449     }
 450     if (!$debug && !$save_stay) {
 451         echo "doClose();\n";
 452     }
 453     echo "</script></body></html>\n";
 454     if (!$save_stay) {
 455         exit();
 456     }
 457 }
 458
 459 // Get invoice charge details.
 460 $codes = InvoiceSummary::arGetInvoiceSummary($patient_id, $encounter_id, true);
 461 $pdrow = sqlQuery("select billing_note from patient_data where pid = ? limit 1", array($patient_id));
 462 ?>
 463
 464 <div class="container-fluid">
 465     <div class="row">
 466         <div class="page-header">
 467             <h2><?php echo xlt('EOB Invoice'); ?></h2>
 468         </div>
 469     </div>
 470     <div class="container-fluid">
 471         <form class="form" action='sl_eob_invoice.php?id=<?php echo attr_url($trans_id); ?>' method='post' onsubmit='return validate(this)'>
 472             <input type="hidden" name="csrf_token_form" value="<?php echo attr(CsrfUtils::collectCsrfToken()); ?>"/>
 473             <input type="hidden" name="isPosting" value="<?php echo attr($from_posting); ?>"/>
 474             <fieldset class="px-2">
 475                 <legend><?php echo xlt('Invoice Actions'); ?></legend>
 476                 <div class="form-row">
 477                     <div class="form-group col-lg">
 478                         <label class="col-form-label" for="form_name"><?php echo xlt('Patient'); ?>:</label>
 479                         <input type="text" class="form-control" id='form_name'
 480                                name='form_name'
 481                                value="<?php echo attr($ferow['fname']) . ' ' . attr($ferow['mname']) . ' ' . attr($ferow['lname']); ?>"
 482                                disabled>
 483                     </div>
 484                     <div class="form-group col-lg">
 485                         <label class="col-form-label" for="form_provider"><?php echo xlt('Provider'); ?>:</label>
 486                         <?php
 487                         $tmp = sqlQuery("SELECT fname, mname, lname " .
 488                             "FROM users WHERE id = ?", array($ferow['provider_id']));
 489                         $provider = text($tmp['fname']) . ' ' . text($tmp['mname']) . ' ' . text($tmp['lname']);
 490                         $tmp = sqlQuery("SELECT bill_date FROM billing WHERE " .
 491                             "pid = ? AND encounter = ? AND " .
 492                             "activity = 1 ORDER BY fee DESC, id ASC LIMIT 1", array($patient_id, $encounter_id));
 493                         $billdate = substr(($tmp['bill_date'] . "Not Billed"), 0, 10);
 494                         ?>
 495                         <input type="text" class="form-control" id='form_provider'
 496                                name='form_provider' value="<?php echo attr($provider); ?>" disabled>
 497                     </div>
 498                     <div class="form-group col-lg">
 499                         <label class="col-form-label" for="form_invoice"><?php echo xlt('Invoice'); ?>:</label>
 500                         <input type="text" class="form-control" id='form_provider'
 501                                name='form_provider' value='<?php echo attr($patient_id) . "." . attr($encounter_id); ?>'
 502                                disabled>
 503                     </div>
 504                     <div class="form-group col-lg">
 505                         <label class="col-form-label" for="svc_date"><?php echo xlt('Svc Date'); ?>:</label>
 506                         <input type="text" class="form-control" id='svc_date' name='form_provider'
 507                                value='<?php echo attr($svcdate); ?>' disabled>
 508                     </div>
 509                     <div class="card bg-light col-lg-4">
 510                         <div class="card-title mx-auto"><?php echo xlt('Insurance'); ?></div>
 511                         <?php
 512                         for ($i = 1; $i <= 3; ++$i) {
 513                             $payerid = SLEOB::arGetPayerID($patient_id, $svcdate, $i);
 514                             if ($payerid) {
 515                                 $tmp = sqlQuery("SELECT name FROM insurance_companies WHERE id = ?", array($payerid));
 516                                 echo "$i: " . $tmp['name'] . "<br />";
 517                             }
 518                         }
 519                         ?>
 520                     </div>
 521                 </div>
 522                 <div class="form-group mt-3">
 523                      <textarea name="insurance_name" id="insurance_name" class="form-control" cols="5" rows="2" readonly><?php echo attr($insurance); ?></textarea>
 524                 </div>
 525                 <div class="form-row">
 526                     <div class="form-group col-lg">
 527                         <label class="col-form-label" for="form_stmt_count"><?php echo xlt('Statements Sent'); ?>
 528                             :</label>
 529                         <input type='text' name='form_stmt_count' id='form_stmt_count' class="form-control" value='<?php echo attr((0 + $ferow['stmt_count'])); ?>'/>
 530                     </div>
 531                     <div class="form-group col-lg">
 532                         <label class="col-form-label" for="form_last_bill"><?php echo xlt('Last Bill Date'); ?>
 533                         :</label>
 534                         <input type='text' name="form_last_bill" id='form_last_bill' class="form-control"
 535                                value ='<?php echo attr($billdate); ?>' disabled/>
 536                     </div>
 537                     <div class="form-group col-lg">
 538                         <label class="col-form-label" for="form_reference"><?php echo xlt('Check/EOB No.'); ?>:</label>
 539                         <input type='text' name='form_reference' id='form_reference' class="form-control" value=''/>
 540                     </div>
 541                     <div class="form-group col-lg">
 542                         <label class="col-form-label" for="form_check_date"><?php echo xlt('Check/EOB Date'); ?>:</label>
 543                         <input type='text' name='form_check_date' id='form_check_date" class='form-control datepicker' value=''/>
 544                     </div>
 545                     <div class="form-group col-lg">
 546                         <label class="col-form-label" for="form_deposit_date"><?php echo xlt('Deposit Date'); ?>:</label>
 547                         <input type='text' name='form_deposit_date' id='form_deposit_date' class='form-control datepicker' value=''/>
 548                         <input type='hidden' name='form_payer_id' value=''/>
 549                         <input type='hidden' name='form_orig_reference' value=''/>
 550                         <input type='hidden' name='form_orig_check_date' value=''/>
 551                         <input type='hidden' name='form_orig_deposit_date' value=''/>
 552                         <input type='hidden' name='form_pay_total' value=''/>
 553                     </div>
 554                 </div>
 555                 <div class="form-row">
 556                     <div class="form-group col-lg">
 557                         <label class="col-form-label" for="type_code"><?php echo xlt('Now posting for'); ?>:</label>
 558                         <div style="padding-left: 15px">
 559                             <?php
 560                                 $last_level_closed = 0 + $ferow['last_level_closed'];
 561                             ?>
 562                             <label class="radio-inline">
 563                                 <input <?php echo $last_level_closed === 0 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Ins1")' type='radio'
 564                                        value='Ins1'><?php echo xlt('Ins1') ?>
 565                             </label>
 566                             <label class="radio-inline">
 567                                 <input <?php echo $last_level_closed === 1 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Ins2")' type='radio'
 568                                        value='Ins2'><?php echo xlt('Ins2') ?>
 569                             </label>
 570                             <label class="radio-inline">
 571                                 <input <?php echo $last_level_closed === 2 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Ins3")' type='radio'
 572                                        value='Ins3'><?php echo xlt('Ins3') ?>
 573                             </label>
 574                             <label class="radio-inline">
 575                                 <input <?php echo $last_level_closed === 3 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Pt")' type='radio'
 576                                        value='Pt'><?php echo xlt('Patient') ?>
 577                             </label>
 578                             <?php
 579                             // TBD: I think the following is unused and can be removed.
 580                             ?>
 581                             <input name='form_eobs' type='hidden' value='<?php echo attr($arrow['shipvia']) ?>'/>
 582                         </div>
 583                     </div>
 584                     <div class="form-group col-lg" id='ins_done'>
 585                         <label class="col-form-label" for=""><?php echo xlt('Done with'); ?>:</label>
 586                         <div style="padding-left:15px">
 587                             <?php
 588                             // Write a checkbox for each insurance.  It is to be checked when
 589                             // we no longer expect any payments from that company for the claim.
 590                             $last_level_closed = 0 + $ferow['last_level_closed'];
 591                             foreach (array(0 => 'None', 1 => 'Ins1', 2 => 'Ins2', 3 => 'Ins3') as $key => $value) {
 592                                 if ($key && !SLEOB::arGetPayerID($patient_id, $svcdate, $key)) {
 593                                     continue;
 594                                 }
 595                                 $checked = ($last_level_closed == $key) ? " checked" : "";
 596                                 echo "<label class='radio-inline'>";
 597                                 echo "<input type='radio' name='form_done' value='" . attr($key) . "'$checked />" . text($value);
 598                                 echo "</label>";
 599                             }
 600                             ?>
 601                         </div>
 602                     </div>
 603                     <div class="form-group col-lg">
 604                         <label class="col-form-label" for=""><?php echo xlt('Secondary billing'); ?>:</label>
 605                         <div style="padding-left:15px">
 606                             <label class="checkbox-inline">
 607                                 <input name="form_secondary" type="checkbox" value="1"><?php echo xlt('Needs secondary billing') ?>
 608                             </label>
 609                         </div>
 610                     </div>
 611                 </div>
 612
 613             </fieldset>
 614             <fieldset>
 615                 <legend><?php echo xlt('Invoice Details'); ?></legend>
 616                 <div class="table-responsive">
 617                     <table class="table table-sm">
 618                         <thead>
 619                         <tr>
 620                             <th><?php echo xlt('Code') ?></th>
 621                             <th class="text-right"><?php echo xlt('Charge') ?></th>
 622                             <th class="text-right"><?php echo xlt('Balance') ?>&nbsp;</th>
 623                             <th><?php echo xlt('By/Source') ?></th>
 624                             <th><?php echo xlt('Date') ?></th>
 625                             <th><?php echo xlt('Pay') ?></th>
 626                             <th><?php echo xlt('Adjust') ?></th>
 627                             <th>&nbsp;</th>
 628                             <th><?php echo xlt('Reason') ?></th>
 629                             <?php
 630                             if ($ALLOW_DELETE) { ?>
 631                                 <th><?php echo xlt('Del') ?></th>
 632                                 <?php
 633                             } ?>
 634                         </tr>
 635                         </thead>
 636                         <?php
 637                         $firstProcCodeIndex = -1;
 638                         $encount = 0;
 639                         foreach ($codes as $code => $cdata) {
 640                             ++$encount;
 641                             $dispcode = $code;
 642
 643                             // remember the index of the first entry whose code is not "CO-PAY", i.e. it's a legitimate proc code
 644                             if ($firstProcCodeIndex == -1 && strcmp($code, "CO-PAY") != 0) {
 645                                 $firstProcCodeIndex = $encount;
 646                             }
 647
 648                             // this sorts the details more or less chronologically:
 649                             ksort($cdata['dtl']);
 650                             foreach ($cdata['dtl'] as $dkey => $ddata) {
 651                                 $ddate = substr($dkey, 0, 10);
 652                                 if (preg_match('/^(\d\d\d\d)(\d\d)(\d\d)\s*$/', $ddate, $matches)) {
 653                                     $ddate = $matches[1] . '-' . $matches[2] . '-' . $matches[3];
 654                                 }
 655                                 $tmpchg = "";
 656                                 $tmpadj = "";
 657                                 if ($ddata['chg'] != 0) {
 658                                     if (isset($ddata['rsn'])) {
 659                                         $tmpadj = 0 - $ddata['chg'];
 660                                     } else {
 661                                         $tmpchg = $ddata['chg'];
 662                                     }
 663                                 }
 664                                 ?>
 665                                 <tr>
 666                                     <td class="detail" style="background:<?php echo $dispcode ? 'lightyellow' : ''; ?>"><?php echo text($dispcode); $dispcode = "" ?></td>
 667                                     <td class="detail"><?php echo text(bucks($tmpchg)); ?></td>
 668                                     <td class="detail">&nbsp;</td>
 669                                     <td class="detail">
 670                                         <?php
 671                                         if (isset($ddata['plv'])) {
 672                                             if (!$ddata['plv']) {
 673                                                 echo 'Pt/';
 674                                             } else {
 675                                                 echo 'Ins' . text($ddata['plv']) . '/';
 676                                             }
 677                                         }
 678                                         echo text($ddata['src']);
 679                                         ?>
 680                                     </td>
 681                                     <td class="detail"><?php echo text($ddate); ?></td>
 682                                     <td class="detail"><?php echo text(bucks($ddata['pmt'])); ?></td>
 683                                     <td class="detail"><?php echo text(bucks($tmpadj)); ?></td>
 684                                     <td class="detail">&nbsp;</td>
 685                                     <td class="detail"><?php echo text($ddata['rsn']); ?></td>
 686                                     <?php
 687                                     if ($ALLOW_DELETE) { ?>
 688                                         <td class="detail">
 689                                             <?php
 690                                             if (!empty($ddata['arseq'])) { ?>
 691                                                 <input name="form_del[<?php echo attr($ddata['arseq']); ?>]"
 692                                                        type="checkbox">
 693                                                 <?php
 694                                             } else {
 695                                                 ?> &nbsp;
 696                                                 <?php
 697                                             } ?>
 698                                         </td>
 699                                     <?php } ?>
 700                                 </tr>
 701                             <?php } // end of prior detail line ?>
 702                             <tr>
 703                                 <td class="last_detail"><?php echo text($dispcode);
 704                                     $dispcode = "" ?></td>
 705                                 <td class="last_detail">&nbsp;</td>
 706                                 <td class="last_detail">
 707                                     <input name="form_line[<?php echo attr($code); ?>][bal]" type="hidden"
 708                                            value="<?php echo attr(bucks($cdata['bal'])); ?>">
 709                                     <input name="form_line[<?php echo attr($code); ?>][ins]" type="hidden"
 710                                            value="<?php echo attr($cdata['ins']); ?>">
 711                                     <input name="form_line[<?php echo attr($code); ?>][code_type]" type="hidden"
 712                                            value="<?php echo attr($cdata['code_type']); ?>"> <?php echo text(sprintf("%.2f", $cdata['bal'])); ?>
 713                                     &nbsp;
 714                                 </td>
 715                                 <td class="last_detail"></td>
 716                                 <td class="last_detail"></td>
 717                                 <td class="last_detail">
 718                                     <input name="form_line[<?php echo attr($code); ?>][pay]"
 719                                            onkeyup="updateFields(document.forms[0]['form_line[<?php echo attr($code); ?>][pay]'], document.forms[0]['form_line[<?php echo attr($code); ?>][adj]'], document.forms[0]['form_line[<?php echo attr($code); ?>][bal]'], document.forms[0]['form_line[CO-PAY][bal]'], <?php echo ($firstProcCodeIndex == $encount) ? 1 : 0 ?>)"
 720                                            onfocus="this.select()" autofocus size="10" type="text" class="form-control"
 721                                            value="0.00"></td>
 722                                 <td class="last_detail">
 723                                     <input name="form_line[<?php echo attr($code); ?>][adj]" size="10" type="text"
 724                                            class="form-control"
 725                                            value='<?php echo attr($totalAdjAmount ? $totalAdjAmount : '0.00'); ?>'
 726                                            onclick="this.select()">
 727                                 </td>
 728                                 <td class="last_detail text-center">
 729                                     <a href="#" class="text-decoration-none" onclick="return writeoff(<?php echo attr_js($code); ?>)">WO</a>
 730                                 </td>
 731                                 <td class="last_detail">
 732                                     <select class="form-control" name="form_line[<?php echo attr($code); ?>][reason]">
 733                                         <?php
 734                                         // Adjustment reasons are now taken from the list_options table.
 735                                         echo "    <option value=''></option>\n";
 736                                         $ores = sqlStatement("SELECT option_id, title, is_default FROM list_options " .
 737                                             "WHERE list_id = 'adjreason' AND activity = 1 ORDER BY seq, title");
 738                                         while ($orow = sqlFetchArray($ores)) {
 739                                             echo "    <option value='" . attr($orow['option_id']) . "'";
 740                                             if ($orow['is_default']) {
 741                                                 echo " selected";
 742                                             }
 743                                             echo ">" . text($orow['title']) . "</option>\n";
 744                                         }
 745                                         ?>
 746                                     </select>
 747                                     <?php
 748                                     // TBD: Maybe a comment field would be good here, for appending
 749                                     // to the reason.
 750                                     ?>
 751                                 </td>
 752                                 <?php if ($ALLOW_DELETE) { ?>
 753                                     <td class="last_detail">&nbsp;</td>
 754                                 <?php } ?>
 755                             </tr>
 756                         <?php } // end of code ?>
 757                     </table>
 758                 </div>
 759             </fieldset>
 760         </div>
 761
 762             </div>
 763             <?php //can change position of buttons by creating a class 'position-override' and adding rule text-align:center or right as the case may be in individual stylesheets ?>
 764             <div class="form-group col-lg clearfix">
 765                 <div class="col-sm-12 text-left position-override" id="search-btn">
 766                     <div class="btn-group" role="group">
 767                         <button type='submit' class="btn btn-primary btn-save" name='form_save' id="btn-save-stay"
 768                             onclick="this.value='1';"><?php echo xlt("Save Current"); ?></button>
 769                         <button type='submit' class="btn btn-primary btn-save" name='form_save' id="btn-save"
 770                             onclick="this.value='2';"><?php echo xlt("Save & Exit"); ?></button>
 771                         <button type='button' class="btn btn-secondary btn-cancel btn-separate-left" name='form_cancel'
 772                             id="btn-cancel" onclick='doClose()'><?php echo xlt("Close"); ?></button>
 773                     </div>
 774                     <?php if ($from_posting) { ?>
 775                         <button type='button' class="btn btn-secondary btn-view float-right" name='form_goto' id="btn-goto"
 776                             onclick="goEncounterSummary(<?php echo attr_js($patient_id) ?>)"><?php echo xlt("Past Encounters"); ?></button>
 777                     <?php } ?>
 778                 </div>
 779             </div>
 780         </form>
 781     </div>
 782 </div><!--End of container div-->
 783 <?php if ($from_posting) { ?>
 784 <script>
 785     var f1 = opener.document.forms[0];
 786     var f2 = document.forms[0];
 787     if (f1.form_source) {
 788         <?php
 789         // These support creation and lookup of ar_session table entries:
 790         echo "  f2.form_reference.value         = f1.form_source.value;\n";
 791         echo "  f2.form_check_date.value        = f1.form_paydate.value;\n";
 792         echo "  //f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 793         echo "  if (f1.form_deposit_date.value != '')\n";
 794         echo "     f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 795         echo "  else\n";
 796         echo "     f2.form_deposit_date.value      = getFormattedToday();\n";
 797         echo "  f2.form_payer_id.value          = f1.form_payer_id.value;\n";
 798         echo "  f2.form_pay_total.value         = f1.form_amount.value;\n";
 799         echo "  f2.form_orig_reference.value    = f1.form_source.value;\n";
 800         echo "  f2.form_orig_check_date.value   = f1.form_paydate.value;\n";
 801         echo "  f2.form_orig_deposit_date.value = f1.form_deposit_date.value;\n";
 802
 803         // While I'm thinking about it, some notes about eob sessions.
 804         // If they do not have all of the session key fields in the search
 805         // page, then show a warning at the top of the invoice page.
 806         // Also when they go to save the invoice page and a session key
 807         // field has changed, alert them to that and allow a cancel.
 808
 809         // Another point... when posting EOBs, the incoming payer ID might
 810         // not match the payer ID for the patient's insurance.  This is
 811         // because the same payer might be entered more than once into the
 812         // insurance_companies table.  I don't think it matters much.
 813         ?>
 814     }
 815     setins("Ins1");
 816 </script>
 817 <?php } ?>
 818 </body>
 819 </html>