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1665 lines
82 KiB
1665 lines
82 KiB
2 years ago
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<?php
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/**
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*
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* namespace OnsitePortal
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*
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* @package OpenEMR
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* @link http://www.open-emr.org
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* @author Rod Roark <rod@sunsetsystems.com>
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* @author Jerry Padgett <sjpadgett@gmail.com>
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* @author Brady Miller <brady.g.miller@gmail.com>
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* @copyright Copyright (c) 2006-2020 Rod Roark <rod@sunsetsystems.com>
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* @copyright Copyright (c) 2016-2019 Jerry Padgett <sjpadgett@gmail.com>
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* @copyright Copyright (c) 2019 Brady Miller <brady.g.miller@gmail.com>
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* @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
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*/
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// Will start the (patient) portal OpenEMR session/cookie.
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require_once(__DIR__ . "/../src/Common/Session/SessionUtil.php");
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OpenEMR\Common\Session\SessionUtil::portalSessionStart();
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$isPortal = false;
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if (isset($_SESSION['pid']) && isset($_SESSION['patient_portal_onsite_two'])) {
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$pid = $_SESSION['pid'];
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$ignoreAuth_onsite_portal = true;
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$isPortal = true;
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require_once(__DIR__ . "/../interface/globals.php");
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} else {
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OpenEMR\Common\Session\SessionUtil::portalSessionCookieDestroy();
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$ignoreAuth = false;
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require_once(__DIR__ . "/../interface/globals.php");
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if (!isset($_SESSION['authUserID'])) {
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$landingpage = "index.php";
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header('Location: ' . $landingpage);
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exit();
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}
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}
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require_once(__DIR__ . "/lib/appsql.class.php");
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require_once("$srcdir/patient.inc");
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require_once("$srcdir/payment.inc.php");
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require_once("$srcdir/forms.inc");
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require_once("../custom/code_types.inc.php");
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require_once("$srcdir/options.inc.php");
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require_once("$srcdir/encounter_events.inc.php");
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use OpenEMR\Billing\BillingUtilities;
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use OpenEMR\Common\Crypto\CryptoGen;
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use OpenEMR\Common\Csrf\CsrfUtils;
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use OpenEMR\PaymentProcessing\Sphere\SpherePayment;
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$cryptoGen = new CryptoGen();
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$appsql = new ApplicationTable();
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$pid = isset($_REQUEST['pid']) ? $_REQUEST['pid'] : $pid;
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$pid = $_REQUEST['hidden_patient_code'] > 0 ? $_REQUEST['hidden_patient_code'] : $pid;
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$recid = isset($_REQUEST['recid']) ? (int) $_REQUEST['recid'] : 0;
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$adminUser = '';
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$portalPatient = '';
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$query = "SELECT pao.portal_username as recip_id, Concat_Ws(' ', patient_data.fname, patient_data.lname) as username FROM patient_data " .
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"LEFT JOIN patient_access_onsite pao ON pao.pid = patient_data.pid " .
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"WHERE patient_data.pid = ? AND pao.portal_pwd_status = 1";
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$portalPatient = sqlQueryNoLog($query, $pid);
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if ($_SESSION['authUserID']) {
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$query = "SELECT users.username as recip_id, users.authorized as dash, CONCAT(users.fname,' ',users.lname) as username " .
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"FROM users WHERE id = ?";
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$adminUser = sqlQueryNoLog($query, $_SESSION['authUserID']);
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}
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if ($recid) {
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$edata = $appsql->getPortalAuditRec($recid);
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} else {
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$edata = $appsql->getPortalAudit($pid, 'review', 'payment');
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}
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$ccdata = array();
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$invdata = array();
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if ($edata) {
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$ccdata = json_decode($cryptoGen->decryptStandard($edata['checksum']), true);
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$invdata = json_decode($edata['table_args'], true);
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echo "<script>var jsondata='" . $edata['table_args'] . "';var ccdata='" . $edata['checksum'] . "'</script>";
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}
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function bucks($amount)
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{
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if ($amount) {
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$amount = oeFormatMoney($amount);
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return $amount;
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}
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return '';
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}
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function rawbucks($amount)
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{
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if ($amount) {
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$amount = sprintf("%.2f", $amount);
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return $amount;
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}
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return '';
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}
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// Display a row of data for an encounter.
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//
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$var_index = 0;
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$sum_charges = $sum_ptpaid = $sum_inspaid = $sum_duept = $sum_copay = $sum_patcopay = $sum_balance = 0;
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function echoLine($iname, $date, $charges, $ptpaid, $inspaid, $duept, $encounter = 0, $copay = 0, $patcopay = 0)
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{
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global $sum_charges, $sum_ptpaid, $sum_inspaid, $sum_duept, $sum_copay, $sum_patcopay, $sum_balance;
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global $var_index;
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$var_index++;
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$balance = bucks($charges - $ptpaid - $inspaid);
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$balance = (round($duept, 2) != 0) ? 0 : $balance; // if balance is due from patient, then insurance balance is displayed as zero
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$encounter = $encounter ? $encounter : '';
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echo " <tr id='tr_" . attr($var_index) . "' >\n";
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echo " <td class='detail'>" . text(oeFormatShortDate($date)) . "</td>\n";
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echo " <td class='detail' id='" . attr($date) . "' align='left'>" . text($encounter) . "</td>\n";
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echo " <td class='detail' align='center' id='td_charges_$var_index' >" . text(bucks($charges)) . "</td>\n";
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echo " <td class='detail' align='center' id='td_inspaid_$var_index' >" . text(bucks($inspaid * -1)) . "</td>\n";
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echo " <td class='detail' align='center' id='td_ptpaid_$var_index' >" . text(bucks($ptpaid * -1)) . "</td>\n";
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echo " <td class='detail' align='center' id='td_patient_copay_$var_index' >" . text(bucks($patcopay)) . "</td>\n";
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echo " <td class='detail' align='center' id='td_copay_$var_index' >" . text(bucks($copay)) . "</td>\n";
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echo " <td class='detail' align='center' id='balance_$var_index'>" . text(bucks($balance)) . "</td>\n";
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echo " <td class='detail' align='center' id='duept_$var_index'>" . text(bucks(round($duept, 2) * 1)) . "</td>\n";
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echo " <td class='detail' align='center'><input class='form-control' name='" . attr($iname) . "' id='paying_" . attr($var_index) .
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"' " . " value='" . '' . "' onchange='coloring();calctotal()' autocomplete='off' " . "onkeyup='calctotal()'/></td>\n";
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echo " </tr>\n";
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$sum_charges += (float)$charges * 1;
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$sum_ptpaid += (float)$ptpaid * -1;
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$sum_inspaid += (float)$inspaid * -1;
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$sum_duept += (float)$duept * 1;
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$sum_patcopay += (float)$patcopay * 1;
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$sum_copay += (float)$copay * 1;
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$sum_balance += (float)$balance * 1;
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}
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// We use this to put dashes, colons, etc. back into a timestamp.
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//
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function decorateString($fmt, $str)
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{
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$res = '';
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while ($fmt) {
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$fc = substr($fmt, 0, 1);
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$fmt = substr($fmt, 1);
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if ($fc == '.') {
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$res .= substr($str, 0, 1);
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$str = substr($str, 1);
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} else {
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$res .= $fc;
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}
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}
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return $res;
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}
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// Compute taxes from a tax rate string and a possibly taxable amount.
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//
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function calcTaxes($row, $amount)
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{
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$total = 0;
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if (empty($row['taxrates'])) {
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return $total;
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}
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$arates = explode(':', $row['taxrates']);
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if (empty($arates)) {
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return $total;
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}
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foreach ($arates as $value) {
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if (empty($value)) {
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continue;
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}
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$trow = sqlQuery("SELECT option_value FROM list_options WHERE " . "list_id = 'taxrate' AND option_id = ? LIMIT 1", array($value
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));
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if (empty($trow['option_value'])) {
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echo "<!-- Missing tax rate '" . text($value) . "'! -->\n";
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continue;
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}
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$tax = sprintf("%01.2f", $amount * $trow['option_value']);
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// echo "<!-- Rate = '$value', amount = '$amount', tax = '$tax' -->\n";
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$total += $tax;
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}
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return $total;
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}
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$now = time();
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$today = date('Y-m-d', $now);
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$timestamp = date('Y-m-d H:i:s', $now);
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$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($pid
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));
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$alertmsg = ''; // anything here pops up in an alert box
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// If the Save button was clicked...
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if ($_POST['form_save']) {
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$form_pid = $_POST['form_pid'];
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$form_method = trim($_POST['form_method']);
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$form_source = trim($_POST['form_source']);
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$patdata = getPatientData($form_pid, 'fname,mname,lname,pubpid');
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$NameNew = $patdata['fname'] . " " . $patdata['lname'] . " " . $patdata['mname'];
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if ($_REQUEST['radio_type_of_payment'] == 'pre_payment') {
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$payment_id = sqlInsert(
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"insert into ar_session set " .
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"payer_id = ?" .
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", patient_id = ?" .
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", user_id = ?" .
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", closed = ?" .
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", reference = ?" .
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", check_date = now() , deposit_date = now() " .
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", pay_total = ?" .
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", payment_type = 'patient'" .
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", description = ?" .
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", adjustment_code = 'pre_payment'" .
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", post_to_date = now() " .
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", payment_method = ?",
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array(0, $form_pid, $_SESSION['authUserID'], 0, $form_source, $_REQUEST['form_prepayment'], $NameNew, $form_method)
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);
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frontPayment($form_pid, 0, $form_method, $form_source, $_REQUEST['form_prepayment'], 0, $timestamp);//insertion to 'payments' table.
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}
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if ($_POST['form_upay'] && $_REQUEST['radio_type_of_payment'] != 'pre_payment') {
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foreach ($_POST['form_upay'] as $enc => $payment) {
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if ($amount = (float)$payment) {
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$zero_enc = $enc;
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//----------------------------------------------------------------------------------------------------
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//Fetching the existing code and modifier
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$ResultSearchNew = sqlStatement(
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"SELECT * FROM billing LEFT JOIN code_types ON billing.code_type=code_types.ct_key " .
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"WHERE code_types.ct_fee=1 AND billing.activity!=0 AND billing.pid =? AND encounter=? ORDER BY billing.code,billing.modifier",
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array($form_pid, $enc)
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);
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if ($RowSearch = sqlFetchArray($ResultSearchNew)) {
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$Codetype = $RowSearch['code_type'];
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$Code = $RowSearch['code'];
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$Modifier = $RowSearch['modifier'];
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} else {
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$Codetype = '';
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$Code = '';
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$Modifier = '';
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}
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//----------------------------------------------------------------------------------------------------
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if ($_REQUEST['radio_type_of_payment'] == 'copay') {//copay saving to ar_session and ar_activity tables
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$session_id = sqlInsert(
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"INSERT INTO ar_session (payer_id,user_id,reference,check_date,deposit_date,pay_total," .
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" global_amount,payment_type,description,patient_id,payment_method,adjustment_code,post_to_date) " .
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" VALUES ('0',?,?,now(),now(),?,'','patient','COPAY',?,?,'patient_payment',now())",
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array($_SESSION['authUserID'], $form_source, $amount, $form_pid, $form_method)
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);
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sqlBeginTrans();
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$sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($form_pid, $enc));
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$insrt_id = sqlInsert(
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"INSERT INTO ar_activity (pid,encounter,sequence_no,code_type,code,modifier,payer_type,post_time,post_user,session_id,pay_amount,account_code)" .
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" VALUES (?,?,?,?,?,?,0,now(),?,?,?,'PCP')",
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array($form_pid, $enc, $sequence_no['increment'], $Codetype, $Code, $Modifier, $_SESSION['authUserID'], $session_id, $amount)
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);
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sqlCommitTrans();
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frontPayment($form_pid, $enc, $form_method, $form_source, $amount, 0, $timestamp);//insertion to 'payments' table.
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}
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if ($_REQUEST['radio_type_of_payment'] == 'invoice_balance' || $_REQUEST['radio_type_of_payment'] == 'cash') { //Payment by patient after insurance paid, cash patients similar to do not bill insurance in feesheet.
|
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if ($_REQUEST['radio_type_of_payment'] == 'cash') {
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sqlStatement(
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"update form_encounter set last_level_closed=? where encounter=? and pid=? ",
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array(4, $enc, $form_pid)
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);
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sqlStatement(
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"update billing set billed=? where encounter=? and pid=?",
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array(1, $enc, $form_pid)
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);
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}
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$adjustment_code = 'patient_payment';
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$payment_id = sqlInsert(
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"insert into ar_session set " .
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"payer_id = ?" .
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", patient_id = ?" .
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", user_id = ?" .
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", closed = ?" .
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", reference = ?" .
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", check_date = now() , deposit_date = now() " .
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", pay_total = ?" .
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", payment_type = 'patient'" .
|
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", description = ?" .
|
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", adjustment_code = ?" .
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", post_to_date = now() " .
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", payment_method = ?",
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array(0, $form_pid, $_SESSION['authUserID'], 0, $form_source, $amount, $NameNew, $adjustment_code, $form_method)
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);
|
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//--------------------------------------------------------------------------------------------------------------------
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frontPayment($form_pid, $enc, $form_method, $form_source, 0, $amount, $timestamp);//insertion to 'payments' table.
|
||
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|
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//--------------------------------------------------------------------------------------------------------------------
|
||
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$resMoneyGot = sqlStatement(
|
||
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"SELECT sum(pay_amount) as PatientPay FROM ar_activity where deleted IS NULL AND pid =? and " .
|
||
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"encounter =? and payer_type=0 and account_code='PCP'",
|
||
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array($form_pid, $enc)
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);//new fees screen copay gives account_code='PCP'
|
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$rowMoneyGot = sqlFetchArray($resMoneyGot);
|
||
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$Copay = $rowMoneyGot['PatientPay'];
|
||
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//--------------------------------------------------------------------------------------------------------------------
|
||
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|
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//Looping the existing code and modifier
|
||
|
|
$ResultSearchNew = sqlStatement(
|
||
|
|
"SELECT * FROM billing LEFT JOIN code_types ON billing.code_type=code_types.ct_key WHERE code_types.ct_fee=1 " .
|
||
|
|
"AND billing.activity!=0 AND billing.pid =? AND encounter=? ORDER BY billing.code,billing.modifier",
|
||
|
|
array($form_pid, $enc)
|
||
|
|
);
|
||
|
|
while ($RowSearch = sqlFetchArray($ResultSearchNew)) {
|
||
|
|
$Codetype = $RowSearch['code_type'];
|
||
|
|
$Code = $RowSearch['code'];
|
||
|
|
$Modifier = $RowSearch['modifier'];
|
||
|
|
$Fee = $RowSearch['fee'];
|
||
|
|
|
||
|
|
$resMoneyGot = sqlStatement(
|
||
|
|
"SELECT sum(pay_amount) as MoneyGot FROM ar_activity where deleted IS NULL AND pid = ? " .
|
||
|
|
"and code_type=? and code=? and modifier=? and encounter =? and !(payer_type=0 and account_code='PCP')",
|
||
|
|
array($form_pid, $Codetype, $Code, $Modifier, $enc)
|
||
|
|
);
|
||
|
|
//new fees screen copay gives account_code='PCP'
|
||
|
|
$rowMoneyGot = sqlFetchArray($resMoneyGot);
|
||
|
|
$MoneyGot = $rowMoneyGot['MoneyGot'];
|
||
|
|
|
||
|
|
$resMoneyAdjusted = sqlStatement(
|
||
|
|
"SELECT sum(adj_amount) as MoneyAdjusted FROM ar_activity where deleted IS NULL AND " .
|
||
|
|
"pid =? and code_type=? and code=? and modifier=? and encounter =?",
|
||
|
|
array($form_pid, $Codetype, $Code, $Modifier, $enc)
|
||
|
|
);
|
||
|
|
$rowMoneyAdjusted = sqlFetchArray($resMoneyAdjusted);
|
||
|
|
$MoneyAdjusted = $rowMoneyAdjusted['MoneyAdjusted'];
|
||
|
|
|
||
|
|
$Remainder = $Fee - $Copay - $MoneyGot - $MoneyAdjusted;
|
||
|
|
$Copay = 0;
|
||
|
|
if (round($Remainder, 2) != 0 && $amount != 0) {
|
||
|
|
if ($amount - $Remainder >= 0) {
|
||
|
|
$insert_value = $Remainder;
|
||
|
|
$amount = $amount - $Remainder;
|
||
|
|
} else {
|
||
|
|
$insert_value = $amount;
|
||
|
|
$amount = 0;
|
||
|
|
}
|
||
|
|
|
||
|
|
sqlBeginTrans();
|
||
|
|
$sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($form_pid, $enc));
|
||
|
|
sqlStatement(
|
||
|
|
"insert into ar_activity set " .
|
||
|
|
"pid = ?" .
|
||
|
|
", encounter = ?" .
|
||
|
|
", sequence_no = ?" .
|
||
|
|
", code_type = ?" .
|
||
|
|
", code = ?" .
|
||
|
|
", modifier = ?" .
|
||
|
|
", payer_type = ?" .
|
||
|
|
", post_time = now() " .
|
||
|
|
", post_user = ?" .
|
||
|
|
", session_id = ?" .
|
||
|
|
", pay_amount = ?" .
|
||
|
|
", adj_amount = ?" .
|
||
|
|
", account_code = 'PP'",
|
||
|
|
array($form_pid, $enc, $sequence_no['increment'], $Codetype, $Code, $Modifier, 0, $_SESSION['authUserID'], $payment_id, $insert_value, 0)
|
||
|
|
);
|
||
|
|
sqlCommitTrans();
|
||
|
|
}//if
|
||
|
|
}//while
|
||
|
|
if ($amount != 0) {//if any excess is there.
|
||
|
|
sqlBeginTrans();
|
||
|
|
$sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($form_pid, $enc));
|
||
|
|
sqlStatement(
|
||
|
|
"insert into ar_activity set " .
|
||
|
|
"pid = ?" .
|
||
|
|
", encounter = ?" .
|
||
|
|
", sequence_no = ?" .
|
||
|
|
", code_type = ?" .
|
||
|
|
", code = ?" .
|
||
|
|
", modifier = ?" .
|
||
|
|
", payer_type = ?" .
|
||
|
|
", post_time = now() " .
|
||
|
|
", post_user = ?" .
|
||
|
|
", session_id = ?" .
|
||
|
|
", pay_amount = ?" .
|
||
|
|
", adj_amount = ?" .
|
||
|
|
", account_code = 'PP'",
|
||
|
|
array($form_pid, $enc, $sequence_no['increment'], $Codetype, $Code, $Modifier, 0, $_SESSION['authUserID'], $payment_id, $amount, 0)
|
||
|
|
);
|
||
|
|
sqlCommitTrans();
|
||
|
|
}
|
||
|
|
|
||
|
|
//--------------------------------------------------------------------------------------------------------------------
|
||
|
|
}//invoice_balance
|
||
|
|
}//if ($amount = 0 + $payment)
|
||
|
|
}//foreach
|
||
|
|
}//if ($_POST['form_upay'])
|
||
|
|
}//if ($_POST['form_save'])
|
||
|
|
|
||
|
|
if ($_POST['form_save'] || $_REQUEST['receipt']) {
|
||
|
|
if ($_REQUEST['receipt']) {
|
||
|
|
$form_pid = $_GET['patient'];
|
||
|
|
$timestamp = decorateString('....-..-.. ..:..:..', $_GET['time']);
|
||
|
|
}
|
||
|
|
|
||
|
|
// Get details for what we guess is the primary facility.
|
||
|
|
$frow = sqlQuery("SELECT * FROM facility " . "ORDER BY billing_location DESC, accepts_assignment DESC, id LIMIT 1");
|
||
|
|
|
||
|
|
// Get the patient's name and chart number.
|
||
|
|
$patdata = getPatientData($form_pid, 'fname,mname,lname,pubpid');
|
||
|
|
|
||
|
|
// Re-fetch payment info.
|
||
|
|
$payrow = sqlQuery("SELECT " . "SUM(amount1) AS amount1, " . "SUM(amount2) AS amount2, " . "MAX(method) AS method, " . "MAX(source) AS source, " . "MAX(dtime) AS dtime, " .
|
||
|
|
// "MAX(user) AS user " .
|
||
|
|
"MAX(user) AS user, " . "MAX(encounter) as encounter " . "FROM payments WHERE " . "pid = ? AND dtime = ?", array($form_pid, $timestamp
|
||
|
|
));
|
||
|
|
|
||
|
|
// Create key for deleting, just in case.
|
||
|
|
$ref_id = ($_REQUEST['radio_type_of_payment'] == 'copay') ? $session_id : $payment_id;
|
||
|
|
$payment_key = $form_pid . '.' . preg_replace('/[^0-9]/', '', $timestamp) . '.' . $ref_id;
|
||
|
|
|
||
|
|
// get facility from encounter
|
||
|
|
$tmprow = sqlQuery("SELECT facility_id FROM form_encounter WHERE encounter = ?", array($payrow['encounter']));
|
||
|
|
$frow = sqlQuery("SELECT * FROM facility " . " WHERE id = ?", array($tmprow['facility_id']
|
||
|
|
));
|
||
|
|
|
||
|
|
// Now proceed with printing the receipt.
|
||
|
|
?>
|
||
|
|
|
||
|
|
<title><?php echo xlt('Receipt for Payment'); ?></title>
|
||
|
|
<script src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery/dist/jquery.min.js"></script>
|
||
|
|
<script>
|
||
|
|
|
||
|
|
function goHome() {
|
||
|
|
window.location.replace("./patient/onsiteactivityviews");
|
||
|
|
}
|
||
|
|
|
||
|
|
function notifyPatient() {
|
||
|
|
let pid = <?php echo js_escape($pid); ?>;
|
||
|
|
let note = $('#pop_receipt').html();
|
||
|
|
let formURL = './messaging/handle_note.php';
|
||
|
|
let owner = <?php echo js_escape($adminUser['recip_id']); ?>;
|
||
|
|
let sn = <?php echo js_escape($adminUser['username']); ?>;
|
||
|
|
let rid = <?php echo js_escape($portalPatient['recip_id']); ?>;
|
||
|
|
let rn = <?php echo js_escape($portalPatient['username']); ?>;
|
||
|
|
$.ajax({
|
||
|
|
url: formURL,
|
||
|
|
type: "POST",
|
||
|
|
data: {
|
||
|
|
'csrf_token_form': <?php echo js_escape(CsrfUtils::collectCsrfToken('messages-portal')); ?>,
|
||
|
|
'task': 'add',
|
||
|
|
'pid': pid,
|
||
|
|
'inputBody': note,
|
||
|
|
'title': 'Bill/Collect',
|
||
|
|
'recipient_name': rn,
|
||
|
|
'recipient_id': rid,
|
||
|
|
'sender_id': owner,
|
||
|
|
'sender_name': sn
|
||
|
|
},
|
||
|
|
success: function (data, textStatus, jqXHR) {
|
||
|
|
alert('Receipt sent to patient via Messages.')
|
||
|
|
},
|
||
|
|
error: function (jqXHR, status, error) {
|
||
|
|
console.log(status + ": " + error);
|
||
|
|
}
|
||
|
|
});
|
||
|
|
}
|
||
|
|
</script>
|
||
|
|
<?php
|
||
|
|
ob_start();
|
||
|
|
echo '<htlm><head></head><body style="text-align: center; margin: auto;">';
|
||
|
|
?>
|
||
|
|
<div id='pop_receipt' style='display: block'>
|
||
|
|
<p>
|
||
|
|
<h2><?php echo xlt('Receipt for Payment'); ?></h2>
|
||
|
|
<p><?php echo text($frow['name']) ?>
|
||
|
|
<br /><?php echo text($frow['street']) ?>
|
||
|
|
<br /><?php echo text($frow['city'] . ', ' . $frow['state']) . ' ' . text($frow['postal_code']) ?>
|
||
|
|
<br /><?php echo text($frow['phone']) ?>
|
||
|
|
<p>
|
||
|
|
<div class="text-center" style="margin: auto;">
|
||
|
|
<table border='0' cellspacing='8' class="text-center" style="margin: auto;">
|
||
|
|
<tr>
|
||
|
|
<td><?php echo xlt('Date'); ?>:</td>
|
||
|
|
<td><?php echo text(oeFormatSDFT(strtotime($payrow['dtime']))) ?></td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td><?php echo xlt('Patient'); ?>:</td>
|
||
|
|
<td><?php echo text($patdata['fname']) . " " . text($patdata['mname']) . " " . text($patdata['lname']) . " (" . text($patdata['pubpid']) . ")" ?></td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td><?php echo xlt('Paid Via'); ?>:</td>
|
||
|
|
<td><?php echo generate_display_field(array('data_type' => '1', 'list_id' => 'payment_method'), $payrow['method']); ?></td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td><?php echo xlt('Authorized Id'); ?>:</td>
|
||
|
|
<td><?php echo text($payrow['source']) ?></td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td><?php echo xlt('Amount for This Visit'); ?>:</td>
|
||
|
|
<td><?php echo text(oeFormatMoney($payrow['amount1'])) ?></td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td><?php echo xlt('Amount for Past Balance'); ?>:</td>
|
||
|
|
<td><?php echo text(oeFormatMoney($payrow['amount2'])) ?></td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td><?php echo xlt('Received By'); ?>:</td>
|
||
|
|
<td><?php echo text($payrow['user']) ?></td>
|
||
|
|
</tr>
|
||
|
|
</table>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<button class='btn btn-sm' type='button' onclick='goHome()' id='returnhome'><?php echo xla('Return Home'); ?></button>
|
||
|
|
<button class='btn btn-sm' type='button' onclick="notifyPatient()"><?php echo xla('Notify Patient'); ?></button>
|
||
|
|
</body></html>
|
||
|
|
<?php
|
||
|
|
ob_end_flush();
|
||
|
|
} else {
|
||
|
|
//
|
||
|
|
// Here we display the form for data entry.
|
||
|
|
//
|
||
|
|
?>
|
||
|
|
<title><?php echo xlt('Record Payment'); ?></title>
|
||
|
|
<style>
|
||
|
|
.dehead {
|
||
|
|
color: #000000;
|
||
|
|
font-weight: bold
|
||
|
|
}
|
||
|
|
.detail {
|
||
|
|
padding: 1px 1px;
|
||
|
|
color: #000000;
|
||
|
|
font-weight: normal
|
||
|
|
}
|
||
|
|
</style>
|
||
|
|
<script src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-creditcardvalidator/jquery.creditCardValidator.js"></script>
|
||
|
|
<script src="<?php echo $GLOBALS['webroot'] ?>/library/textformat.js?v=<?php echo $v_js_includes; ?>"></script>
|
||
|
|
<script>
|
||
|
|
var chargeMsg = <?php $amsg = xl('Payment was successfully authorized and your card is charged.') . "\n" .
|
||
|
|
xl("You will be notified when your payment is applied for this invoice.") . "\n" .
|
||
|
|
xl('Until then you will continue to see payment details here.') . "\n" . xl('Thank You.');
|
||
|
|
echo json_encode($amsg);
|
||
|
|
?>;
|
||
|
|
var publicKey = <?php echo json_encode($cryptoGen->decryptStandard($GLOBALS['gateway_public_key'])); ?>;
|
||
|
|
var apiKey = <?php echo json_encode($cryptoGen->decryptStandard($GLOBALS['gateway_api_key'])); ?>;
|
||
|
|
|
||
|
|
function calctotal() {
|
||
|
|
var flag = 0;
|
||
|
|
var f = document.forms["invoiceForm"];
|
||
|
|
var total = 0;
|
||
|
|
for (var i = 0; i < f.elements.length; ++i) {
|
||
|
|
var elem = f.elements[i];
|
||
|
|
var ename = elem.name;
|
||
|
|
if (ename.indexOf('form_upay[') == 0 || ename.indexOf('form_bpay[') == 0) {
|
||
|
|
if (elem.value.length > 0) {
|
||
|
|
total += Number(elem.value);
|
||
|
|
if (total < 0) flag = 1;
|
||
|
|
}
|
||
|
|
}
|
||
|
|
}
|
||
|
|
f.form_paytotal.value = Number(total).toFixed(2);
|
||
|
|
if (flag) {
|
||
|
|
$('#invoiceForm')[0].reset();
|
||
|
|
alert(<?php echo xlj('Negative payments not accepted'); ?>)
|
||
|
|
}
|
||
|
|
return true;
|
||
|
|
}
|
||
|
|
|
||
|
|
function coloring() {
|
||
|
|
for (var i = 1; ; ++i) {
|
||
|
|
if (document.getElementById('paying_' + i)) {
|
||
|
|
paying = document.getElementById('paying_' + i).value * 1;
|
||
|
|
patient_balance = document.getElementById('duept_' + i).innerHTML * 1;
|
||
|
|
if (patient_balance > 0 && paying > 0) {
|
||
|
|
if (paying > patient_balance) {
|
||
|
|
document.getElementById('paying_' + i).style.background = '#FF0000';
|
||
|
|
}
|
||
|
|
else if (paying < patient_balance) {
|
||
|
|
document.getElementById('paying_' + i).style.background = '#99CC00';
|
||
|
|
}
|
||
|
|
else if (paying == patient_balance) {
|
||
|
|
document.getElementById('paying_' + i).style.background = '#ffffff';
|
||
|
|
}
|
||
|
|
}
|
||
|
|
else {
|
||
|
|
document.getElementById('paying_' + i).style.background = '#ffffff';
|
||
|
|
}
|
||
|
|
}
|
||
|
|
else {
|
||
|
|
break;
|
||
|
|
}
|
||
|
|
}
|
||
|
|
}
|
||
|
|
|
||
|
|
function CheckVisible(MakeBlank) {//Displays and hides the check number text box.
|
||
|
|
if (document.getElementById('form_method').options[document.getElementById('form_method').selectedIndex].value == 'check_payment' ||
|
||
|
|
document.getElementById('form_method').options[document.getElementById('form_method').selectedIndex].value == 'bank_draft') {
|
||
|
|
document.getElementById('check_number').disabled = false;
|
||
|
|
}
|
||
|
|
else {
|
||
|
|
document.getElementById('check_number').disabled = true;
|
||
|
|
}
|
||
|
|
}
|
||
|
|
|
||
|
|
function validate() {
|
||
|
|
var f = document.forms["invoiceForm"];
|
||
|
|
ok = -1;
|
||
|
|
//no checks taken here....
|
||
|
|
issue = 'no';
|
||
|
|
if (document.getElementById('radio_type_of_payment_self1').checked == false &&
|
||
|
|
document.getElementById('radio_type_of_payment1').checked == false
|
||
|
|
&& document.getElementById('radio_type_of_payment2').checked == false
|
||
|
|
&& document.getElementById('radio_type_of_payment4').checked == false) {
|
||
|
|
alert("<?php //echo addslashes( xl('Please Select Type Of Payment.')) ?>");
|
||
|
|
return false;
|
||
|
|
}
|
||
|
|
if (document.getElementById('radio_type_of_payment_self1').checked == true || document.getElementById('radio_type_of_payment1').checked == true) {
|
||
|
|
for (var i = 0; i < f.elements.length; ++i) {
|
||
|
|
var elem = f.elements[i];
|
||
|
|
var ename = elem.name;
|
||
|
|
if (ename.indexOf('form_upay[0') == 0) //Today is this text box.
|
||
|
|
{
|
||
|
|
if (elem.value * 1 > 0) {//A warning message, if the amount is posted with out encounter.
|
||
|
|
if (confirm(<?php echo xlj('Are you sure to post for today?'); ?>)) {
|
||
|
|
ok = 1;
|
||
|
|
}
|
||
|
|
else {
|
||
|
|
elem.focus();
|
||
|
|
return false;
|
||
|
|
}
|
||
|
|
}
|
||
|
|
break;
|
||
|
|
}
|
||
|
|
}
|
||
|
|
}
|
||
|
|
else if (document.getElementsByName('form_paytotal')[0].value <= 0)//total 0
|
||
|
|
{
|
||
|
|
alert(<?php echo xlj('Invalid Total!'); ?>)
|
||
|
|
return false;
|
||
|
|
}
|
||
|
|
if (ok == -1) {
|
||
|
|
if (confirm(<?php echo xlj('Payment Validated: Save?'); ?>)) {
|
||
|
|
return true;
|
||
|
|
}
|
||
|
|
else {
|
||
|
|
return false;
|
||
|
|
}
|
||
|
|
}
|
||
|
|
}
|
||
|
|
|
||
|
|
function cursor_pointer() {//Point the cursor to the latest encounter(Today)
|
||
|
|
var f = document.forms["invoiceForm"];
|
||
|
|
var total = 0;
|
||
|
|
for (var i = 0; i < f.elements.length; ++i) {
|
||
|
|
var elem = f.elements[i];
|
||
|
|
var ename = elem.name;
|
||
|
|
if (ename.indexOf('form_upay[') == 0) {
|
||
|
|
elem.focus();
|
||
|
|
break;
|
||
|
|
}
|
||
|
|
}
|
||
|
|
}
|
||
|
|
|
||
|
|
function make_it_hide_enc_pay() {
|
||
|
|
document.getElementById('td_head_insurance_payment').style.display = "none";
|
||
|
|
document.getElementById('td_head_patient_co_pay').style.display = "none";
|
||
|
|
document.getElementById('td_head_co_pay').style.display = "none";
|
||
|
|
document.getElementById('td_head_insurance_balance').style.display = "none";
|
||
|
|
for (var i = 1; ; ++i) {
|
||
|
|
var td_inspaid_elem = document.getElementById('td_inspaid_' + i)
|
||
|
|
var td_patient_copay_elem = document.getElementById('td_patient_copay_' + i)
|
||
|
|
var td_copay_elem = document.getElementById('td_copay_' + i)
|
||
|
|
var balance_elem = document.getElementById('balance_' + i)
|
||
|
|
if (td_inspaid_elem) {
|
||
|
|
td_inspaid_elem.style.display = "none";
|
||
|
|
td_patient_copay_elem.style.display = "none";
|
||
|
|
td_copay_elem.style.display = "none";
|
||
|
|
balance_elem.style.display = "none";
|
||
|
|
}
|
||
|
|
else {
|
||
|
|
break;
|
||
|
|
}
|
||
|
|
}
|
||
|
|
document.getElementById('td_total_4').style.display = "none";
|
||
|
|
document.getElementById('td_total_7').style.display = "none";
|
||
|
|
document.getElementById('td_total_8').style.display = "none";
|
||
|
|
document.getElementById('td_total_6').style.display = "none";
|
||
|
|
|
||
|
|
document.getElementById('table_display').width = "420px";
|
||
|
|
}
|
||
|
|
|
||
|
|
function make_visible() {
|
||
|
|
document.getElementById('td_head_rep_doc').style.display = "";
|
||
|
|
document.getElementById('td_head_description').style.display = "";
|
||
|
|
document.getElementById('td_head_total_charge').style.display = "none";
|
||
|
|
document.getElementById('td_head_insurance_payment').style.display = "none";
|
||
|
|
document.getElementById('td_head_patient_payment').style.display = "none";
|
||
|
|
document.getElementById('td_head_patient_co_pay').style.display = "none";
|
||
|
|
document.getElementById('td_head_co_pay').style.display = "none";
|
||
|
|
document.getElementById('td_head_insurance_balance').style.display = "none";
|
||
|
|
document.getElementById('td_head_patient_balance').style.display = "none";
|
||
|
|
for (var i = 1; ; ++i) {
|
||
|
|
var td_charges_elem = document.getElementById('td_charges_' + i)
|
||
|
|
var td_inspaid_elem = document.getElementById('td_inspaid_' + i)
|
||
|
|
var td_ptpaid_elem = document.getElementById('td_ptpaid_' + i)
|
||
|
|
var td_patient_copay_elem = document.getElementById('td_patient_copay_' + i)
|
||
|
|
var td_copay_elem = document.getElementById('td_copay_' + i)
|
||
|
|
var balance_elem = document.getElementById('balance_' + i)
|
||
|
|
var duept_elem = document.getElementById('duept_' + i)
|
||
|
|
if (td_charges_elem) {
|
||
|
|
td_charges_elem.style.display = "none";
|
||
|
|
td_inspaid_elem.style.display = "none";
|
||
|
|
td_ptpaid_elem.style.display = "none";
|
||
|
|
td_patient_copay_elem.style.display = "none";
|
||
|
|
td_copay_elem.style.display = "none";
|
||
|
|
balance_elem.style.display = "none";
|
||
|
|
duept_elem.style.display = "none";
|
||
|
|
}
|
||
|
|
else {
|
||
|
|
break;
|
||
|
|
}
|
||
|
|
}
|
||
|
|
document.getElementById('td_total_7').style.display = "";
|
||
|
|
document.getElementById('td_total_8').style.display = "";
|
||
|
|
document.getElementById('td_total_1').style.display = "none";
|
||
|
|
document.getElementById('td_total_2').style.display = "none";
|
||
|
|
document.getElementById('td_total_3').style.display = "none";
|
||
|
|
document.getElementById('td_total_4').style.display = "none";
|
||
|
|
document.getElementById('td_total_5').style.display = "none";
|
||
|
|
document.getElementById('td_total_6').style.display = "none";
|
||
|
|
|
||
|
|
document.getElementById('table_display').width = "505px";
|
||
|
|
}
|
||
|
|
|
||
|
|
function make_it_hide() {
|
||
|
|
document.getElementById('td_head_rep_doc').style.display = "none";
|
||
|
|
document.getElementById('td_head_description').style.display = "none";
|
||
|
|
document.getElementById('td_head_total_charge').style.display = "";
|
||
|
|
document.getElementById('td_head_insurance_payment').style.display = "";
|
||
|
|
document.getElementById('td_head_patient_payment').style.display = "";
|
||
|
|
document.getElementById('td_head_patient_co_pay').style.display = "";
|
||
|
|
document.getElementById('td_head_co_pay').style.display = "";
|
||
|
|
document.getElementById('td_head_insurance_balance').style.display = "";
|
||
|
|
document.getElementById('td_head_patient_balance').style.display = "";
|
||
|
|
for (var i = 1; ; ++i) {
|
||
|
|
var td_charges_elem = document.getElementById('td_charges_' + i)
|
||
|
|
var td_inspaid_elem = document.getElementById('td_inspaid_' + i)
|
||
|
|
var td_ptpaid_elem = document.getElementById('td_ptpaid_' + i)
|
||
|
|
var td_patient_copay_elem = document.getElementById('td_patient_copay_' + i)
|
||
|
|
var td_copay_elem = document.getElementById('td_copay_' + i)
|
||
|
|
var balance_elem = document.getElementById('balance_' + i)
|
||
|
|
var duept_elem = document.getElementById('duept_' + i)
|
||
|
|
if (td_charges_elem) {
|
||
|
|
td_charges_elem.style.display = "";
|
||
|
|
td_inspaid_elem.style.display = "";
|
||
|
|
td_ptpaid_elem.style.display = "";
|
||
|
|
td_patient_copay_elem.style.display = "";
|
||
|
|
td_copay_elem.style.display = "";
|
||
|
|
balance_elem.style.display = "";
|
||
|
|
duept_elem.style.display = "";
|
||
|
|
}
|
||
|
|
else {
|
||
|
|
break;
|
||
|
|
}
|
||
|
|
}
|
||
|
|
document.getElementById('td_total_1').style.display = "";
|
||
|
|
document.getElementById('td_total_2').style.display = "";
|
||
|
|
document.getElementById('td_total_3').style.display = "";
|
||
|
|
document.getElementById('td_total_4').style.display = "";
|
||
|
|
document.getElementById('td_total_5').style.display = "";
|
||
|
|
document.getElementById('td_total_6').style.display = "";
|
||
|
|
document.getElementById('td_total_7').style.display = "";
|
||
|
|
document.getElementById('td_total_8').style.display = "";
|
||
|
|
|
||
|
|
document.getElementById('table_display').width = "100%";
|
||
|
|
}
|
||
|
|
|
||
|
|
function make_visible_radio() {
|
||
|
|
document.getElementById('tr_radio1').style.display = "";
|
||
|
|
document.getElementById('tr_radio2').style.display = "none";
|
||
|
|
}
|
||
|
|
|
||
|
|
function make_hide_radio() {
|
||
|
|
document.getElementById('tr_radio1').style.display = "none";
|
||
|
|
document.getElementById('tr_radio2').style.display = "";
|
||
|
|
}
|
||
|
|
|
||
|
|
function make_visible_row() {
|
||
|
|
document.getElementById('table_display').style.display = "";
|
||
|
|
document.getElementById('table_display_prepayment').style.display = "none";
|
||
|
|
}
|
||
|
|
|
||
|
|
function make_hide_row() {
|
||
|
|
document.getElementById('table_display').style.display = "none";
|
||
|
|
document.getElementById('table_display_prepayment').style.display = "";
|
||
|
|
}
|
||
|
|
|
||
|
|
function make_self() {
|
||
|
|
make_visible_row();
|
||
|
|
make_it_hide();
|
||
|
|
make_it_hide_enc_pay();
|
||
|
|
document.getElementById('radio_type_of_payment_self1').checked = true;
|
||
|
|
cursor_pointer();
|
||
|
|
}
|
||
|
|
|
||
|
|
function make_insurance() {
|
||
|
|
make_visible_row();
|
||
|
|
make_it_hide();
|
||
|
|
cursor_pointer();
|
||
|
|
document.getElementById('radio_type_of_payment1').checked = true;
|
||
|
|
}
|
||
|
|
|
||
|
|
$('#paySubmit').click(function (e) {
|
||
|
|
e.preventDefault();e.stopPropagation();
|
||
|
|
$("#mode").val("portal-save");
|
||
|
|
let inv_values = JSON.stringify(getFormObj('invoiceForm'));
|
||
|
|
let extra_values = JSON.stringify(getFormObj('paymentForm'));
|
||
|
|
let extra = "&inv_values=" + encodeURIComponent(inv_values) + "&extra_values=" + encodeURIComponent(extra_values);
|
||
|
|
let flag = 0
|
||
|
|
let liburl = './lib/paylib.php';
|
||
|
|
$.ajax({
|
||
|
|
type: "POST",
|
||
|
|
url: liburl,
|
||
|
|
data: $("#invoiceForm").serialize() + extra,
|
||
|
|
beforeSend: function (xhr) {
|
||
|
|
if (validateCC() !== true) return false;
|
||
|
|
if ($('#cardCode').val() == "" || $('#cardHolderName').val() == "" || $('#expYear').val() == "" || $('#expMonth').val() == "") {
|
||
|
|
alert(<?php echo xlj('Invalid Credit Card Values: Please correct'); ?>)
|
||
|
|
return false;
|
||
|
|
}
|
||
|
|
if (validate() != true) {
|
||
|
|
flag = 1;
|
||
|
|
alert(<?php echo xlj('Validation error: Fix and resubmit. This popup info is preserved!'); ?>)
|
||
|
|
return false;
|
||
|
|
}
|
||
|
|
$("#openPayModal .close").click()
|
||
|
|
},
|
||
|
|
error: function (qXHR, textStatus, errorThrow) {
|
||
|
|
console.log("There was an error:" + errorThrow);
|
||
|
|
},
|
||
|
|
success: function (templateHtml, textStatus, jqXHR) {
|
||
|
|
let msg = <?php $amsg = xl('Payment successfully sent for review and posting to your account.') . "\n" .
|
||
|
|
xl("You will be notified when the payment transaction is confirmed.") . "\n" .
|
||
|
|
xl('Until then you will continue to see payment details here.') . "\n" . xl('Thank You.');
|
||
|
|
echo json_encode($amsg); // backward compatable 5.0.1
|
||
|
|
?>;
|
||
|
|
alert(msg);
|
||
|
|
window.location.reload(false);
|
||
|
|
}
|
||
|
|
});
|
||
|
|
if (flag) {
|
||
|
|
$("#openPayModal .close").click();
|
||
|
|
}
|
||
|
|
});
|
||
|
|
|
||
|
|
$('#openPayModal').on('show.bs.modal', function () {
|
||
|
|
let total = $("#form_paytotal").val();
|
||
|
|
if(Number(total) < 1) {
|
||
|
|
let error = <?php echo json_encode("Please enter a payment amount"); ?>;
|
||
|
|
alert(error);
|
||
|
|
return false;
|
||
|
|
}
|
||
|
|
$("#payTotal").text(total);
|
||
|
|
$("#paymentAmount").val(total);
|
||
|
|
});
|
||
|
|
|
||
|
|
$("#invoiceForm").on('submit', function (e) {
|
||
|
|
e.preventDefault();
|
||
|
|
let thisform = this;
|
||
|
|
$("#mode").val("review-save");
|
||
|
|
let inv_values = JSON.stringify(getFormObj('invoiceForm'));
|
||
|
|
let extra_values = JSON.stringify(getFormObj('paymentForm'));
|
||
|
|
let extra = "&inv_values=" + inv_values + "&extra_values=" + extra_values;
|
||
|
|
|
||
|
|
let flag = 0
|
||
|
|
let liburl = '<?php echo $GLOBALS["webroot"] ?>/portal/lib/paylib.php';
|
||
|
|
$.ajax({
|
||
|
|
type: "POST",
|
||
|
|
url: liburl,
|
||
|
|
data: $("#invoiceForm").serialize() + extra,
|
||
|
|
beforeSend: function (xhr) {
|
||
|
|
if (validate() != true) {
|
||
|
|
flag = 1;
|
||
|
|
alert(<?php echo xlj('Validation error: Fix and resubmit.'); ?>)
|
||
|
|
return false;
|
||
|
|
}
|
||
|
|
},
|
||
|
|
error: function (xhr, textStatus, error) {
|
||
|
|
alert(<?php echo xlj('There is a Post error'); ?>)
|
||
|
|
console.log("There was an error:" + textStatus);
|
||
|
|
return false;
|
||
|
|
},
|
||
|
|
success: function (templateHtml, textStatus, jqXHR) {
|
||
|
|
thisform.submit();
|
||
|
|
}
|
||
|
|
});
|
||
|
|
});
|
||
|
|
|
||
|
|
function getFormObj(formId) {
|
||
|
|
let formObj = {};
|
||
|
|
let inputs = $('#' + formId).serializeArray();
|
||
|
|
$.each(inputs, function (i, input) {
|
||
|
|
formObj[input.name] = input.value;
|
||
|
|
});
|
||
|
|
return formObj;
|
||
|
|
}
|
||
|
|
|
||
|
|
function formRepopulate(jsondata) {
|
||
|
|
let data = $.parseJSON(jsondata);
|
||
|
|
$.each(data, function (name, val) {
|
||
|
|
let $el = $('[name="' + name + '"]'),
|
||
|
|
type = $el.attr('type');
|
||
|
|
switch (type) {
|
||
|
|
case 'checkbox':
|
||
|
|
$el.prop('checked', true);
|
||
|
|
break;
|
||
|
|
case 'radio':
|
||
|
|
$el.filter('[value="' + val + '"]').prop('checked', true);
|
||
|
|
break;
|
||
|
|
default:
|
||
|
|
$el.val(val);
|
||
|
|
}
|
||
|
|
});
|
||
|
|
}
|
||
|
|
|
||
|
|
function getAuth() {
|
||
|
|
let authnum = document.getElementById("check_number").value;
|
||
|
|
authnum = prompt(<?php echo xlj('Please enter card comfirmation authorization'); ?>, authnum);
|
||
|
|
if (authnum != null) {
|
||
|
|
document.getElementById("check_number").value = authnum;
|
||
|
|
}
|
||
|
|
}
|
||
|
|
</script>
|
||
|
|
|
||
|
|
<body class="skin-blue" onunload='imclosing()' onLoad="cursor_pointer();"
|
||
|
|
style="text-align: center; margin: auto;">
|
||
|
|
|
||
|
|
<form id="invoiceForm" method='post' action='<?php echo $GLOBALS["webroot"] ?>/portal/portal_payment.php'>
|
||
|
|
<input type='hidden' name='form_pid' value='<?php echo attr($pid) ?>'/>
|
||
|
|
<input type='hidden' name='form_save' value='<?php echo xla('Invoice'); ?>'/>
|
||
|
|
<table>
|
||
|
|
<tr height="10">
|
||
|
|
<td colspan="3"> </td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td colspan='3' align='center' class='text'>
|
||
|
|
<b><?php echo xlt('Accept Payment for'); ?> : <?php
|
||
|
|
echo text($patdata['fname']) . " " .
|
||
|
|
text($patdata['lname']) . " " .
|
||
|
|
text($patdata['mname']) . " (" .
|
||
|
|
text($patdata['pid']) . ")" ?></b>
|
||
|
|
<?php $NameNew = $patdata['fname'] . " " . $patdata['lname'] . " " . $patdata['mname']; ?>
|
||
|
|
</td>
|
||
|
|
</tr>
|
||
|
|
<tr height="15">
|
||
|
|
<td colspan='3'></td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td class='text'>
|
||
|
|
<?php echo xlt('Payment Method'); ?>:
|
||
|
|
</td>
|
||
|
|
<td colspan='2'><select name="form_method" id="form_method" class="form-control" onChange='CheckVisible("yes")'>
|
||
|
|
<?php
|
||
|
|
$query1112 = "SELECT * FROM list_options where list_id=? ORDER BY seq, title ";
|
||
|
|
$bres1112 = sqlStatement($query1112, array('payment_method'));
|
||
|
|
while ($brow1112 = sqlFetchArray($bres1112)) {
|
||
|
|
if ($brow1112['option_id'] != 'credit_card' || $brow1112['option_id'] == 'debit' || $brow1112['option_id'] == 'bank_draft') {
|
||
|
|
continue;
|
||
|
|
}
|
||
|
|
echo "<option value='" . attr($brow1112['option_id']) . "'>" .
|
||
|
|
text(xl_list_label($brow1112['title'])) . "</option>";
|
||
|
|
}
|
||
|
|
?>
|
||
|
|
</select></td>
|
||
|
|
</tr>
|
||
|
|
<?php if (isset($_SESSION['authUserID'])) { ?>
|
||
|
|
<tr height="5">
|
||
|
|
<td colspan='3'></td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td class='text'>
|
||
|
|
<?php echo xlt('Authorized'); ?>:
|
||
|
|
</td>
|
||
|
|
<td colspan='2'>
|
||
|
|
<?php if ($ccdata['authCode'] && empty($payrow['source'])) {
|
||
|
|
$payrow['source'] = $ccdata['authCode'] . " : " . $ccdata['transId'];
|
||
|
|
}
|
||
|
|
?>
|
||
|
|
<input class="form-control form-control-sm" id='check_number' name='form_source' style='' value='<?php echo attr($payrow['source']) ?>' />
|
||
|
|
</td>
|
||
|
|
</tr>
|
||
|
|
<?php } ?>
|
||
|
|
<?php if (isset($_SESSION['authUserID'])) {
|
||
|
|
$hide = '';
|
||
|
|
echo '<tr height="5"><td colspan="3"></td></tr><tr">';
|
||
|
|
} else {
|
||
|
|
$hide = 'hidden';
|
||
|
|
echo '<tr class="hidden">';
|
||
|
|
}
|
||
|
|
?>
|
||
|
|
<td class='text' valign="middle">
|
||
|
|
<?php echo xlt('Patient Coverage'); ?>:
|
||
|
|
</td>
|
||
|
|
<td class='text' colspan="2">
|
||
|
|
<input type="radio" name="radio_type_of_coverage" id="radio_type_of_coverage1"
|
||
|
|
value="self" onClick="make_visible_radio();make_self();"/>
|
||
|
|
<?php echo xlt('Self'); ?>
|
||
|
|
<input type="radio" name="radio_type_of_coverage" id="radio_type_of_coverag2" value="insurance"
|
||
|
|
checked="checked"
|
||
|
|
onClick="make_hide_radio();make_insurance();"/>
|
||
|
|
<?php echo xlt('Insurance'); ?>
|
||
|
|
</td>
|
||
|
|
</tr>
|
||
|
|
<tr height="5">
|
||
|
|
<td colspan='3'></td>
|
||
|
|
</tr>
|
||
|
|
<tr id="tr_radio1" style="display: none">
|
||
|
|
<!-- For radio Insurance -->
|
||
|
|
<td class='text' valign="top">
|
||
|
|
<?php echo xlt('Payment against'); ?>:
|
||
|
|
</td>
|
||
|
|
<td class='text' colspan="2">
|
||
|
|
<input type="radio" name="radio_type_of_payment" id="radio_type_of_payment_self1"
|
||
|
|
value="cash" onClick="make_visible_row();make_it_hide_enc_pay();cursor_pointer();"/>
|
||
|
|
<?php echo xlt('Encounter Payment'); ?>
|
||
|
|
</td>
|
||
|
|
</tr>
|
||
|
|
<tr id="tr_radio2">
|
||
|
|
<!-- For radio self -->
|
||
|
|
<td class='text' valign="top"><?php echo xlt('Payment against'); ?>:</td>
|
||
|
|
<td class='text' colspan="2">
|
||
|
|
<input type="radio" name="radio_type_of_payment" id="radio_type_of_payment1" class="<?php echo $hide ? $hide : ''; ?>"
|
||
|
|
value="copay" onClick="make_visible_row();cursor_pointer();"/><?php echo !$hide ? xlt('Co Pay') : ''; ?>
|
||
|
|
<input type="radio" name="radio_type_of_payment" id="radio_type_of_payment2" checked="checked"
|
||
|
|
value="invoice_balance" onClick="make_visible_row();"/><?php echo xlt('Invoice Balance'); ?>
|
||
|
|
<input type="radio" name="radio_type_of_payment" id="radio_type_of_payment4" value="pre_payment"
|
||
|
|
onClick="make_hide_row();"/><?php echo xlt('Pre Pay'); ?>
|
||
|
|
</td>
|
||
|
|
</tr>
|
||
|
|
<tr height="15">
|
||
|
|
<td colspan='3'></td>
|
||
|
|
</tr>
|
||
|
|
</table>
|
||
|
|
<table width="20%" border="0" cellspacing="0" cellpadding="0" id="table_display_prepayment" style="margin-bottom: 10px; display: none">
|
||
|
|
<tr>
|
||
|
|
<td class='detail'><?php echo xlt('Pre Payment'); ?></td>
|
||
|
|
<td><input class="form-control" type='text' id= 'form_prepayment' name='form_prepayment' style=''/></td>
|
||
|
|
</tr>
|
||
|
|
</table>
|
||
|
|
<table id="table_display" style="background: #eee;" class="table table-sm table-striped table-bordered w-100">
|
||
|
|
<thead>
|
||
|
|
</thead>
|
||
|
|
<tbody>
|
||
|
|
<tr bgcolor="#cccccc" id="tr_head">
|
||
|
|
<td class="dehead" width="60">
|
||
|
|
<?php echo xlt('DOS') ?>
|
||
|
|
</td>
|
||
|
|
<td class="dehead" width="120">
|
||
|
|
<?php echo xlt('Visit Reason') ?>
|
||
|
|
</td>
|
||
|
|
<td class="dehead" align="center" width="70" id="td_head_total_charge">
|
||
|
|
<?php echo xlt('Total Charge') ?>
|
||
|
|
</td>
|
||
|
|
<td class="dehead" align="center" width="70" id="td_head_rep_doc" style='display: none'>
|
||
|
|
<?php echo xlt('Report/ Form') ?>
|
||
|
|
</td>
|
||
|
|
<td class="dehead" align="center" width="200" id="td_head_description" style='display: none'>
|
||
|
|
<?php echo xlt('Description') ?>
|
||
|
|
</td>
|
||
|
|
<td class="dehead" align="center" width="70" id="td_head_insurance_payment">
|
||
|
|
<?php echo xlt('Insurance Payment') ?>
|
||
|
|
</td>
|
||
|
|
<td class="dehead" align="center" width="70" id="td_head_patient_payment">
|
||
|
|
<?php echo xlt('Patient Payment') ?>
|
||
|
|
</td>
|
||
|
|
<td class="dehead" align="center" width="55" id="td_head_patient_co_pay">
|
||
|
|
<?php echo xlt('Co Pay Paid') ?>
|
||
|
|
</td>
|
||
|
|
<td class="dehead" align="center" width="55" id="td_head_co_pay">
|
||
|
|
<?php echo xlt('Required Co Pay') ?>
|
||
|
|
</td>
|
||
|
|
<td class="dehead" align="center" width="70" id="td_head_insurance_balance">
|
||
|
|
<?php echo xlt('Insurance Balance') ?>
|
||
|
|
</td>
|
||
|
|
<td class="dehead" align="center" width="70" id="td_head_patient_balance">
|
||
|
|
<?php echo xlt('Patient Balance') ?>
|
||
|
|
</td>
|
||
|
|
<td class="dehead" align="center" width="50">
|
||
|
|
<?php echo xlt('Paying') ?>
|
||
|
|
</td>
|
||
|
|
</tr>
|
||
|
|
<?php
|
||
|
|
$encs = array();
|
||
|
|
// Get the unbilled service charges and payments by encounter for this patient.
|
||
|
|
//
|
||
|
|
$query = "SELECT fe.encounter, fe.reason, b.code_type, b.code, b.modifier, b.fee, " .
|
||
|
|
"LEFT(fe.date, 10) AS encdate ,fe.last_level_closed " . "FROM form_encounter AS fe left join billing AS b on " .
|
||
|
|
"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 " .
|
||
|
|
"where fe.pid = ? " . "ORDER BY b.encounter";
|
||
|
|
$bres = sqlStatement($query, array($pid, $pid));
|
||
|
|
//
|
||
|
|
while ($brow = sqlFetchArray($bres)) {
|
||
|
|
$key = (int)$brow['encounter'];
|
||
|
|
if (empty($encs[$key])) {
|
||
|
|
$encs[$key] = array('encounter' => $brow['encounter'], 'date' => $brow['encdate'], 'last_level_closed' => $brow['last_level_closed'], 'charges' => 0, 'payments' => 0, 'reason' => $brow['reason']
|
||
|
|
);
|
||
|
|
}
|
||
|
|
|
||
|
|
if ($brow['code_type'] === 'COPAY') {
|
||
|
|
// $encs[$key]['payments'] -= $brow['fee'];
|
||
|
|
} else {
|
||
|
|
$encs[$key]['charges'] += $brow['fee'];
|
||
|
|
// Add taxes.
|
||
|
|
$sql_array = array();
|
||
|
|
$query = "SELECT taxrates FROM codes WHERE " . "code_type = ? AND " . "code = ? AND ";
|
||
|
|
array_push($sql_array, $code_types[$brow['code_type']]['id'], $brow['code']);
|
||
|
|
if ($brow['modifier']) {
|
||
|
|
$query .= "modifier = ?";
|
||
|
|
array_push($sql_array, $brow['modifier']);
|
||
|
|
} else {
|
||
|
|
$query .= "(modifier IS NULL OR modifier = '')";
|
||
|
|
}
|
||
|
|
|
||
|
|
$query .= " LIMIT 1";
|
||
|
|
$trow = sqlQuery($query, $sql_array);
|
||
|
|
$encs[$key]['charges'] += calcTaxes($trow, $brow['fee']);
|
||
|
|
}
|
||
|
|
}
|
||
|
|
|
||
|
|
// Do the same for unbilled product sales.
|
||
|
|
//
|
||
|
|
$query = "SELECT fe.encounter, fe.reason, s.drug_id, s.fee, " .
|
||
|
|
"LEFT(fe.date, 10) AS encdate,fe.last_level_closed " .
|
||
|
|
"FROM form_encounter AS fe left join drug_sales AS s " .
|
||
|
|
"on s.pid = ? AND s.fee != 0 " .
|
||
|
|
"AND fe.pid = s.pid AND fe.encounter = s.encounter " .
|
||
|
|
"where fe.pid = ? " . "ORDER BY s.encounter";
|
||
|
|
|
||
|
|
$dres = sqlStatement($query, array($pid, $pid));
|
||
|
|
//
|
||
|
|
while ($drow = sqlFetchArray($dres)) {
|
||
|
|
$key = (int)$drow['encounter'];
|
||
|
|
if (empty($encs[$key])) {
|
||
|
|
$encs[$key] = array(
|
||
|
|
'encounter' => $drow['encounter'], 'date' => $drow['encdate'],
|
||
|
|
'last_level_closed' => $drow['last_level_closed'],
|
||
|
|
'charges' => 0, 'payments' => 0
|
||
|
|
);
|
||
|
|
}
|
||
|
|
|
||
|
|
$encs[$key]['charges'] += $drow['fee'];
|
||
|
|
// Add taxes.
|
||
|
|
$trow = sqlQuery(
|
||
|
|
"SELECT taxrates FROM drug_templates WHERE drug_id = ? " .
|
||
|
|
"ORDER BY selector LIMIT 1",
|
||
|
|
array($drow['drug_id'])
|
||
|
|
);
|
||
|
|
$encs[$key]['charges'] += calcTaxes($trow, $drow['fee']);
|
||
|
|
}
|
||
|
|
|
||
|
|
ksort($encs, SORT_NUMERIC);
|
||
|
|
|
||
|
|
foreach ($encs as $key => $value) {
|
||
|
|
$enc = $value['encounter'];
|
||
|
|
$reason = $value['reason'];
|
||
|
|
$dispdate = $value['date'];
|
||
|
|
|
||
|
|
$inscopay = BillingUtilities::getCopay($pid, $dispdate);
|
||
|
|
$patcopay = BillingUtilities::getPatientCopay($pid, $enc);
|
||
|
|
// Insurance Payment
|
||
|
|
//
|
||
|
|
$drow = sqlQuery(
|
||
|
|
"SELECT SUM(pay_amount) AS payments, " .
|
||
|
|
"SUM(adj_amount) AS adjustments FROM ar_activity WHERE " .
|
||
|
|
"deleted IS NULL AND pid = ? and encounter = ? AND " .
|
||
|
|
"payer_type != 0 AND account_code != 'PCP'",
|
||
|
|
array($pid, $enc)
|
||
|
|
);
|
||
|
|
$dpayment = $drow['payments'];
|
||
|
|
$dadjustment = $drow['adjustments'];
|
||
|
|
// Patient Payment
|
||
|
|
//
|
||
|
|
$drow = sqlQuery(
|
||
|
|
"SELECT SUM(pay_amount) AS payments, SUM(adj_amount) AS adjustments " .
|
||
|
|
"FROM ar_activity WHERE deleted IS NULL AND pid = ? and encounter = ? and " .
|
||
|
|
"payer_type = 0 and account_code != 'PCP'",
|
||
|
|
array($pid, $enc)
|
||
|
|
);
|
||
|
|
$dpayment_pat = $drow['payments'];
|
||
|
|
|
||
|
|
// NumberOfInsurance
|
||
|
|
//
|
||
|
|
$ResultNumberOfInsurance = sqlStatement(
|
||
|
|
"SELECT COUNT( DISTINCT TYPE ) NumberOfInsurance FROM insurance_data where pid = ? and provider>0 ",
|
||
|
|
array($pid)
|
||
|
|
);
|
||
|
|
$RowNumberOfInsurance = sqlFetchArray($ResultNumberOfInsurance);
|
||
|
|
$NumberOfInsurance = $RowNumberOfInsurance['NumberOfInsurance'] * 1;
|
||
|
|
$duept = 0;
|
||
|
|
if ((($NumberOfInsurance == 0 || $value['last_level_closed'] == 4 || $NumberOfInsurance == $value['last_level_closed']))) { // Patient balance
|
||
|
|
$brow = sqlQuery("SELECT SUM(fee) AS amount FROM billing WHERE " . "pid = ? and encounter = ? AND activity = 1", array($pid, $enc
|
||
|
|
));
|
||
|
|
$srow = sqlQuery("SELECT SUM(fee) AS amount FROM drug_sales WHERE " . "pid = ? and encounter = ? ", array($pid, $enc
|
||
|
|
));
|
||
|
|
$drow = sqlQuery(
|
||
|
|
"SELECT SUM(pay_amount) AS payments, SUM(adj_amount) AS adjustments " .
|
||
|
|
"FROM ar_activity WHERE deleted IS NULL AND pid = ? and encounter = ? ",
|
||
|
|
array($pid, $enc)
|
||
|
|
);
|
||
|
|
$duept = $brow['amount'] + $srow['amount'] - $drow['payments'] - $drow['adjustments'];
|
||
|
|
}
|
||
|
|
|
||
|
|
echoLine("form_upay[$enc]", $dispdate, $value['charges'], $dpayment_pat, ($dpayment + $dadjustment), $duept, ($enc . ': ' . $reason), $inscopay, $patcopay);
|
||
|
|
}
|
||
|
|
|
||
|
|
// Continue with display of the data entry form.
|
||
|
|
?>
|
||
|
|
<tr>
|
||
|
|
<td class="dehead" align="center"><?php echo xlt('Total'); ?></td>
|
||
|
|
<td class="dehead" id='td_total_1' align="center"></td>
|
||
|
|
<td class="dehead" id='td_total_2' align="center"><?php echo text(bucks($sum_charges)) ?></td>
|
||
|
|
<td class="dehead" id='td_total_3' align="center"><?php echo text(bucks($sum_inspaid)) ?></td>
|
||
|
|
<td class="dehead" id='td_total_4' align="center"><?php echo text(bucks($sum_ptpaid)) ?></td>
|
||
|
|
<td class="dehead" id='td_total_5' align="center"><?php echo text(bucks($sum_patcopay)) ?></td>
|
||
|
|
<td class="dehead" id='td_total_6' align="center"><?php echo text(bucks($sum_copay)) ?></td>
|
||
|
|
<td class="dehead" id='td_total_7' align="center"><?php echo text(bucks($sum_balance)) ?></td>
|
||
|
|
<td class="dehead" id='td_total_8' align="center"><?php echo text(bucks($sum_duept)) ?></td>
|
||
|
|
<td class="dehead" align="center">
|
||
|
|
<input class="form-control" name='form_paytotal' id='form_paytotal' value='' style='color: #3b9204;' readonly />
|
||
|
|
</td>
|
||
|
|
</tr>
|
||
|
|
</table>
|
||
|
|
<?php
|
||
|
|
if (isset($ccdata["cardHolderName"])) {
|
||
|
|
echo '<div class="col-5"><div class="card panel-default height">';
|
||
|
|
if (!isset($_SESSION['authUserID'])) {
|
||
|
|
echo '<div class="card-heading">' . xlt("Payment Information") .
|
||
|
|
'<span style="color: #cc0000"><em> ' . xlt("Pending Auth since") . ': </em>' . text($edata["date"]) . '</span></div>';
|
||
|
|
} else {
|
||
|
|
echo '<div class="card-heading">' . xlt("Audit Payment") .
|
||
|
|
'<span style="color: #cc0000"><em> ' . xlt("Pending since") . ': </em>' . text($edata["date"]) . '</span>' .
|
||
|
|
' <button type="button" class="btn btn-warning btn-sm" onclick="getAuth()">' . xlt("Authorize") . '</button></div>';
|
||
|
|
}
|
||
|
|
} else {
|
||
|
|
echo '<div style="display:none" class="col-6"><div class="card panel-default height">' .
|
||
|
|
'<div class="card-heading">' . xlt("Payment Information") . ' </div>';
|
||
|
|
}
|
||
|
|
?>
|
||
|
|
<div class="card-body">
|
||
|
|
<span class="font-weight-bold"><?php echo xlt('Card Name'); ?>: </span><span id="cn"><?php echo text($ccdata["cc_type"]) ?></span><br />
|
||
|
|
<span class="font-weight-bold"><?php echo xlt('Name on Card'); ?>: </span><span id="nc"><?php echo text($ccdata["cardHolderName"]) ?></span>
|
||
|
|
<span class="font-weight-bold"><?php echo xlt('Card Holder Zip'); ?>: </span><span id="czip"><?php echo text($ccdata["zip"]) ?></span><br />
|
||
|
|
<span class="font-weight-bold"><?php echo xlt('Card Number'); ?>: </span><span id="ccn">
|
||
|
|
<?php
|
||
|
|
if (isset($_SESSION['authUserID']) || isset($ccdata["transId"])) {
|
||
|
|
echo text($ccdata["cardNumber"]) . "</span><br />";
|
||
|
|
} else {
|
||
|
|
echo "********** " . text(substr($ccdata["cardNumber"], -4)) . "</span><br />";
|
||
|
|
}
|
||
|
|
?>
|
||
|
|
<?php
|
||
|
|
if (!isset($ccdata["transId"])) { ?>
|
||
|
|
<span class="font-weight-bold"><?php echo xlt('Exp Date'); ?>: </span><span id="ed"><?php echo text($ccdata["month"]) . "/" . text($ccdata["year"]) ?></span>
|
||
|
|
<span class="font-weight-bold"><?php echo xlt('CVV'); ?>: </span><span id="cvvpin"><?php echo text($ccdata["cardCode"]) ?></span><br />
|
||
|
|
<?php } else { ?>
|
||
|
|
<span class="font-weight-bold"><?php echo xlt('Transaction Id'); ?>: </span><span id="ed"><?php echo text($ccdata["transId"]) . "/" . text($ccdata["year"]) ?></span>
|
||
|
|
<span class="font-weight-bold"><?php echo xlt('Authorization'); ?>: </span><span id="cvvpin"><?php echo text($ccdata["authCode"]) ?></span><br />
|
||
|
|
<?php } ?>
|
||
|
|
<span class="font-weight-bold"><?php echo xlt('Charge Total'); ?>: </span><span id="ct"><?php echo text($invdata["form_paytotal"]) ?></span><br />
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<div>
|
||
|
|
<?php
|
||
|
|
if (!isset($_SESSION['authUserID'])) {
|
||
|
|
if (!isset($ccdata["cardHolderName"])) {
|
||
|
|
if ($GLOBALS['payment_gateway'] == 'Sphere') {
|
||
|
|
echo SpherePayment::renderSphereHtml('patient');
|
||
|
|
} else {
|
||
|
|
echo '<button type="button" class="btn btn-primary" data-toggle="modal" data-target="#openPayModal">' . xlt("Pay Invoice") . '</button>';
|
||
|
|
}
|
||
|
|
} else {
|
||
|
|
echo '<h4><span class="bg-danger">' . xlt("Locked Payment Pending") . '</span></h4>';
|
||
|
|
}
|
||
|
|
} else {
|
||
|
|
echo "<button type='submit' class='btn btn-success' form='invoiceForm'>" . xlt('Post Payment') . "</button>";
|
||
|
|
}
|
||
|
|
?>
|
||
|
|
</div>
|
||
|
|
<input type="hidden" name="hidden_patient_code" id="hidden_patient_code" value="<?php echo attr($pid); ?>"/>
|
||
|
|
<input type='hidden' name='mode' id='mode' value=''/>
|
||
|
|
</form>
|
||
|
|
|
||
|
|
<script>
|
||
|
|
if (typeof jsondata !== 'undefined') {
|
||
|
|
formRepopulate(jsondata);
|
||
|
|
}
|
||
|
|
calctotal();
|
||
|
|
</script>
|
||
|
|
<!-- credit payment modal -->
|
||
|
|
<div id="openPayModal" class="modal fade" role="dialog">
|
||
|
|
<div class="modal-dialog">
|
||
|
|
<div class="modal-content">
|
||
|
|
<div class="modal-header">
|
||
|
|
<h4><?php echo xlt('Submit Payment for Authorization'); ?></h4>
|
||
|
|
<!--<button type="button" class="close" data-dismiss="modal">×</button>-->
|
||
|
|
</div>
|
||
|
|
<div class="modal-body">
|
||
|
|
<?php if ($GLOBALS['payment_gateway'] != 'Stripe' && $GLOBALS['payment_gateway'] != 'Sphere') { ?>
|
||
|
|
<form id='paymentForm' method='post' action='<?php echo $GLOBALS["webroot"] ?>/portal/lib/paylib.php'>
|
||
|
|
<fieldset>
|
||
|
|
<div class="form-group">
|
||
|
|
<label label-default="label-default"
|
||
|
|
class="control-label"><?php echo xlt('Name on Card'); ?></label>
|
||
|
|
<div class="controls">
|
||
|
|
<input name="cardHolderName" id="cardHolderName" type="text" class="form-control" pattern="\w+ \w+.*" title="<?php echo xla('Fill your first and last name'); ?>" value="<?php echo attr($patdata['fname']) . ' ' . attr($patdata['lname']) ?>" />
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<div class="form-group">
|
||
|
|
<label class="control-label"><?php echo xlt('Card Number'); ?></label>
|
||
|
|
<div class="controls">
|
||
|
|
<div class="row">
|
||
|
|
<div class="col-sm-12">
|
||
|
|
<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="" />
|
||
|
|
<h4 name="cardtype" id="cardtype" style="display: inline-block; color:#cc0000;"><?php echo xlt('Validating') ?></h4>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<div class="form-group">
|
||
|
|
<label label-default="label-default"><?php echo xlt('Card Expiry Date and Card Holders Zip'); ?></label>
|
||
|
|
<div class="controls">
|
||
|
|
<div class="row">
|
||
|
|
<div class="col-md-4">
|
||
|
|
<select name="month" id="expMonth" class="form-control">
|
||
|
|
<option value=""><?php echo xlt('Select Month'); ?></option>
|
||
|
|
<option value="01"><?php echo xlt('January'); ?></option>
|
||
|
|
<option value="02"><?php echo xlt('February'); ?></option>
|
||
|
|
<option value="03"><?php echo xlt('March'); ?></option>
|
||
|
|
<option value="04"><?php echo xlt('April'); ?></option>
|
||
|
|
<option value="05"><?php echo xlt('May'); ?></option>
|
||
|
|
<option value="06"><?php echo xlt('June'); ?></option>
|
||
|
|
<option value="07"><?php echo xlt('July'); ?></option>
|
||
|
|
<option value="08"><?php echo xlt('August'); ?></option>
|
||
|
|
<option value="09"><?php echo xlt('September'); ?></option>
|
||
|
|
<option value="10"><?php echo xlt('October'); ?></option>
|
||
|
|
<option value="11"><?php echo xlt('November'); ?></option>
|
||
|
|
<option value="12"><?php echo xlt('December'); ?></option>
|
||
|
|
</select>
|
||
|
|
</div>
|
||
|
|
<div class="col-md-4">
|
||
|
|
<select name="year" id="expYear" class="form-control">
|
||
|
|
<option value=""><?php echo xlt('Select Year'); ?></option>
|
||
|
|
<option value="2019">2019</option>
|
||
|
|
<option value="2020">2020</option>
|
||
|
|
<option value="2021">2021</option>
|
||
|
|
<option value="2022">2022</option>
|
||
|
|
<option value="2023">2023</option>
|
||
|
|
<option value="2024">2024</option>
|
||
|
|
<option value="2025">2025</option>
|
||
|
|
<option value="2026">2026</option>
|
||
|
|
<option value="2027">2027</option>
|
||
|
|
<option value="2028">2028</option>
|
||
|
|
</select>
|
||
|
|
</div>
|
||
|
|
<div class="col-md-4">
|
||
|
|
<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']) ?>"/>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<div class="form-group">
|
||
|
|
<label label-default="label-default" class="control-label"><?php echo xlt('Card CVV'); ?></label>
|
||
|
|
<div class="controls">
|
||
|
|
<div class="row">
|
||
|
|
<div class="col-md-3">
|
||
|
|
<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="" />
|
||
|
|
</div>
|
||
|
|
<div class="col-md-3">
|
||
|
|
<img src='./images/img_cvc.png' style='height: 40px; width: auto' />
|
||
|
|
</div>
|
||
|
|
<div class="col-md-6">
|
||
|
|
<h4 style="display: inline-block;"><?php echo xlt('Payment Amount'); ?>:
|
||
|
|
<span class="font-weight-bold"><span id="payTotal"></span></span></h4>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<input type='hidden' name='pid' id='pid' value='<?php echo attr($pid) ?>'/>
|
||
|
|
<input type='hidden' name='mode' id='mode' value=''/>
|
||
|
|
<input type='hidden' name='cc_type' id='cc_type' value=''/>
|
||
|
|
<input type='hidden' name='payment' id='paymentAmount' value=''/>
|
||
|
|
<input type='hidden' name='invValues' id='invValues' value=''/>
|
||
|
|
<input type="hidden" name="dataValue" id="dataValue" />
|
||
|
|
<input type="hidden" name="dataDescriptor" id="dataDescriptor" />
|
||
|
|
</fieldset>
|
||
|
|
</form>
|
||
|
|
<?php } else { ?>
|
||
|
|
<form method="post" name="payment-form" id="payment-form">
|
||
|
|
<fieldset>
|
||
|
|
<div class="form-group">
|
||
|
|
<label label-default="label-default"><?php echo xlt('Name on Card'); ?></label>
|
||
|
|
<div class="controls">
|
||
|
|
<input name="cardHolderName" id="cardHolderName" type="text" class="form-control" pattern="\w+ \w+.*" title="<?php echo xla('Fill your first and last name'); ?>" value="<?php echo attr($patdata['fname']) . ' ' . attr($patdata['lname']) ?>" />
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<div class="form-group">
|
||
|
|
<label for="card-element"><?php echo xlt('Credit or Debit Card') ?></label>
|
||
|
|
<div class="form-group" id="card-element"></div>
|
||
|
|
<div id="card-errors" role="alert"></div>
|
||
|
|
</div>
|
||
|
|
<div class="col-md-6">
|
||
|
|
<h4 style="display: inline-block;"><?php echo xlt('Payment Amount'); ?>:
|
||
|
|
<strong><span id="payTotal"></span></strong></h4>
|
||
|
|
</div>
|
||
|
|
<input type='hidden' name='mode' id='mode' value=''/>
|
||
|
|
<input type='hidden' name='cc_type' id='cc_type' value=''/>
|
||
|
|
<input type='hidden' name='payment' id='paymentAmount' value=''/>
|
||
|
|
<input type='hidden' name='invValues' id='invValues' value=''/>
|
||
|
|
</fieldset>
|
||
|
|
</form>
|
||
|
|
<?php } ?>
|
||
|
|
</div>
|
||
|
|
<!-- Body -->
|
||
|
|
<div class="modal-footer">
|
||
|
|
<div class="button-group">
|
||
|
|
<button type="button" class="btn btn-secondary" data-dismiss="modal"><?php echo xlt('Cancel'); ?></button>
|
||
|
|
<?php
|
||
|
|
if ($GLOBALS['payment_gateway'] == 'InHouse') { ?>
|
||
|
|
<button id="paySubmit" class="btn btn-primary"><?php echo xlt('Send Payment'); ?></button>
|
||
|
|
<?php } elseif ($GLOBALS['payment_gateway'] == 'AuthorizeNet') { ?>
|
||
|
|
<button id="payAurhorizeNet" class="btn btn-primary"
|
||
|
|
onclick="sendPaymentDataToAnet(event)"><?php echo xlt('Pay Now'); ?></button>
|
||
|
|
<?php }
|
||
|
|
if ($GLOBALS['payment_gateway'] == 'Stripe') { ?>
|
||
|
|
<button id="stripeSubmit" class="btn btn-primary"><?php echo xlt('Pay Now'); ?></button>
|
||
|
|
<?php } ?>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<script>
|
||
|
|
var ccerr = <?php echo xlj('Invalid Credit Card Number'); ?>
|
||
|
|
|
||
|
|
// In House CC number Validation
|
||
|
|
/*$('#cardNumber').validateCreditCard(function (result) {
|
||
|
|
var r = (result.card_type === null ? '' : result.card_type.name.toUpperCase())
|
||
|
|
var v = (result.valid === true ? ' Valid Number' : ' Validating')
|
||
|
|
if (result.valid === true) {
|
||
|
|
document.getElementById("cardtype").style.color = "#00aa00";
|
||
|
|
} else {
|
||
|
|
document.getElementById("cardtype").style.color = "#aa0000";
|
||
|
|
}
|
||
|
|
$('#cardtype').text(r + v);
|
||
|
|
});*/
|
||
|
|
|
||
|
|
// In House CC Validation
|
||
|
|
function validateCC() {
|
||
|
|
var result = $('#cardNumber').validateCreditCard();
|
||
|
|
var r = (result.card_type == null ? '' : result.card_type.name.toUpperCase())
|
||
|
|
var v = (result.valid == true ? ' Valid Card Number' : ' Invalid Card Number')
|
||
|
|
if (result.valid === true) {
|
||
|
|
document.getElementById("cardtype").style.color = "#00aa00";
|
||
|
|
} else {
|
||
|
|
document.getElementById("cardtype").style.color = "#aa0000";
|
||
|
|
}
|
||
|
|
$('#cardtype').text(r + v);
|
||
|
|
$('#cc_type').val(r);
|
||
|
|
if (!result.valid) {
|
||
|
|
alert(ccerr);
|
||
|
|
return false;
|
||
|
|
}
|
||
|
|
else {
|
||
|
|
return true;
|
||
|
|
}
|
||
|
|
}
|
||
|
|
</script>
|
||
|
|
|
||
|
|
<?php if ($GLOBALS['payment_gateway'] == 'AuthorizeNet' && isset($_SESSION['patient_portal_onsite_two'])) {
|
||
|
|
// Include Authorize.Net dependency to tokenize card.
|
||
|
|
// Will return a token to use for payment request keeping
|
||
|
|
// credit info off the server.
|
||
|
|
?>
|
||
|
|
<script>
|
||
|
|
function sendPaymentDataToAnet(e) {
|
||
|
|
e.preventDefault();
|
||
|
|
const authData = {};
|
||
|
|
authData.clientKey = publicKey;
|
||
|
|
authData.apiLoginID = apiKey;
|
||
|
|
|
||
|
|
const cardData = {};
|
||
|
|
cardData.cardNumber = document.getElementById("cardNumber").value;
|
||
|
|
cardData.month = document.getElementById("expMonth").value;
|
||
|
|
cardData.year = document.getElementById("expYear").value;
|
||
|
|
cardData.cardCode = document.getElementById("cardCode").value;
|
||
|
|
cardData.fullName = document.getElementById("cardHolderName").value;
|
||
|
|
cardData.zip = document.getElementById("cczip").value;
|
||
|
|
|
||
|
|
const secureData = {};
|
||
|
|
secureData.authData = authData;
|
||
|
|
secureData.cardData = cardData;
|
||
|
|
|
||
|
|
Accept.dispatchData(secureData, acceptResponseHandler);
|
||
|
|
|
||
|
|
function acceptResponseHandler(response) {
|
||
|
|
if (response.messages.resultCode === "Error") {
|
||
|
|
let i = 0;
|
||
|
|
let errorMsg = '';
|
||
|
|
while (i < response.messages.message.length) {
|
||
|
|
errorMsg = errorMsg + response.messages.message[i].code + ": " +response.messages.message[i].text;
|
||
|
|
console.log(errorMsg);
|
||
|
|
i = i + 1;
|
||
|
|
}
|
||
|
|
alert(errorMsg);
|
||
|
|
} else {
|
||
|
|
paymentFormUpdate(response.opaqueData);
|
||
|
|
}
|
||
|
|
}
|
||
|
|
}
|
||
|
|
|
||
|
|
function paymentFormUpdate(opaqueData) {
|
||
|
|
// this is card tokenized
|
||
|
|
document.getElementById("dataDescriptor").value = opaqueData.dataDescriptor;
|
||
|
|
document.getElementById("dataValue").value = opaqueData.dataValue;
|
||
|
|
let oForm = document.forms['paymentForm'];
|
||
|
|
oForm.elements['mode'].value = "AuthorizeNet";
|
||
|
|
let inv_values = JSON.stringify(getFormObj('invoiceForm'));
|
||
|
|
document.getElementById("invValues").value = inv_values;
|
||
|
|
|
||
|
|
// empty out the fields before submitting to server.
|
||
|
|
document.getElementById("cardNumber").value = "";
|
||
|
|
document.getElementById("expMonth").value = "";
|
||
|
|
document.getElementById("expYear").value = "";
|
||
|
|
document.getElementById("cardCode").value = "";
|
||
|
|
|
||
|
|
// Submit payment to server
|
||
|
|
fetch('./lib/paylib.php', {
|
||
|
|
method: 'POST',
|
||
|
|
body: new FormData(oForm)
|
||
|
|
}).then(function(response) {
|
||
|
|
if (!response.ok) {
|
||
|
|
throw Error(response.statusText);
|
||
|
|
}
|
||
|
|
return response.text();
|
||
|
|
}).then(function(data) {
|
||
|
|
if(data !== 'ok') {
|
||
|
|
alert(data);
|
||
|
|
return;
|
||
|
|
}
|
||
|
|
alert(chargeMsg);
|
||
|
|
window.location.reload(false);
|
||
|
|
}).catch(function(error) {
|
||
|
|
alert(error)
|
||
|
|
});
|
||
|
|
}
|
||
|
|
</script>
|
||
|
|
<?php } // end authorize.net ?>
|
||
|
|
|
||
|
|
<?php if ($GLOBALS['payment_gateway'] == 'Stripe' && isset($_SESSION['patient_portal_onsite_two'])) { // Begin Include Stripe ?>
|
||
|
|
<script>
|
||
|
|
const stripe = Stripe(publicKey);
|
||
|
|
const elements = stripe.elements();// Custom styling can be passed to options when creating an Element.
|
||
|
|
const style = {
|
||
|
|
base: {
|
||
|
|
color: '#32325d',
|
||
|
|
lineHeight: '1.2rem',
|
||
|
|
fontSmoothing: 'antialiased',
|
||
|
|
fontSize: '16px',
|
||
|
|
'::placeholder': {
|
||
|
|
color: '#8e8e8e'
|
||
|
|
}
|
||
|
|
},
|
||
|
|
invalid: {
|
||
|
|
color: '#fa755a',
|
||
|
|
iconColor: '#fa755a'
|
||
|
|
}
|
||
|
|
|
||
|
|
};
|
||
|
|
// Create an instance of the card Element.
|
||
|
|
const card = elements.create('card', {style: style});
|
||
|
|
// Add an instance of the card Element into the `card-element` <div>.
|
||
|
|
card.mount('#card-element');
|
||
|
|
// Handle real-time validation errors from the card Element.
|
||
|
|
card.addEventListener('change', function (event) {
|
||
|
|
let displayError = document.getElementById('card-errors');
|
||
|
|
if (event.error) {
|
||
|
|
displayError.textContent = event.error.message;
|
||
|
|
} else {
|
||
|
|
displayError.textContent = '';
|
||
|
|
}
|
||
|
|
});
|
||
|
|
// Handle form submission.
|
||
|
|
let form = document.getElementById('stripeSubmit');
|
||
|
|
form.addEventListener('click', function (event) {
|
||
|
|
event.preventDefault();
|
||
|
|
stripe.createToken(card).then(function (result) {
|
||
|
|
if (result.error) {
|
||
|
|
// Inform the user if there was an error.
|
||
|
|
let errorElement = document.getElementById('card-errors');
|
||
|
|
errorElement.textContent = result.error.message;
|
||
|
|
} else {
|
||
|
|
// Send the token to server.
|
||
|
|
stripeTokenHandler(result.token);
|
||
|
|
}
|
||
|
|
});
|
||
|
|
});
|
||
|
|
// Submit the form with the token ID.
|
||
|
|
function stripeTokenHandler(token) {
|
||
|
|
// Insert the token ID into the form so it gets submitted to the server
|
||
|
|
let oForm = document.forms['payment-form'];
|
||
|
|
oForm.elements['mode'].value = "Stripe";
|
||
|
|
|
||
|
|
let inv_values = JSON.stringify(getFormObj('invoiceForm'));
|
||
|
|
document.getElementById("invValues").value = inv_values;
|
||
|
|
|
||
|
|
let hiddenInput = document.createElement('input');
|
||
|
|
hiddenInput.setAttribute('type', 'hidden');
|
||
|
|
hiddenInput.setAttribute('name', 'stripeToken');
|
||
|
|
hiddenInput.setAttribute('value', token.id);
|
||
|
|
oForm.appendChild(hiddenInput);
|
||
|
|
|
||
|
|
// Submit payment to server
|
||
|
|
fetch('./lib/paylib.php', {
|
||
|
|
method: 'POST',
|
||
|
|
body: new FormData(oForm)
|
||
|
|
}).then(function(response) {
|
||
|
|
if (!response.ok) {
|
||
|
|
throw Error(response.statusText);
|
||
|
|
}
|
||
|
|
return response.text();
|
||
|
|
}).then(function(data) {
|
||
|
|
if(data !== 'ok') {
|
||
|
|
alert(data);
|
||
|
|
return;
|
||
|
|
}
|
||
|
|
alert(chargeMsg);
|
||
|
|
window.location.reload(false);
|
||
|
|
}).catch(function(error) {
|
||
|
|
alert(error)
|
||
|
|
});
|
||
|
|
}
|
||
|
|
</script>
|
||
|
|
<?php } ?>
|
||
|
|
|
||
|
|
<?php
|
||
|
|
if ($GLOBALS['payment_gateway'] == 'Sphere' && isset($_SESSION['patient_portal_onsite_two'])) {
|
||
|
|
echo (new SpherePayment('patient', $pid))->renderSphereJs();
|
||
|
|
}
|
||
|
|
?>
|
||
|
|
|
||
|
|
</body>
|
||
|
|
<?php } // end else display ?>
|