* @author Brady Miller * @author Jerry Padgett * @copyright Copyright (C) 2007 Bo Huynh * @copyright Copyright (C) 2016 Terry Hill * @copyright Copyright (C) 2018 Jerry Padgett * @copyright Copyright (C) 2019 Brady Miller * @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General P */ require_once(__DIR__ . "/../../globals.php"); require_once("$srcdir/api.inc"); require_once("$srcdir/forms.inc"); use OpenEMR\Common\Csrf\CsrfUtils; use OpenEMR\Common\Session\SessionUtil; if (!CsrfUtils::verifyCsrfToken($_POST["csrf_token_form"])) { CsrfUtils::csrfNotVerified(); } // From billing manager so do stuff if (isset($_SESSION['billencounter'])) { $pid = $_SESSION['billpid']; $encounter = $_SESSION['billencounter']; echo ""; } if (!$encounter) { // comes from globals.php die(xlt("Internal error: we do not seem to be in an encounter!")); } if ($_POST["off_work_from"] == "0000-00-00" || $_POST["off_work_from"] == "") { $_POST["is_unable_to_work"] = "0"; $_POST["off_work_to"] = ""; } else { $_POST["is_unable_to_work"] = "1"; } if ($_POST["hospitalization_date_from"] == "0000-00-00" || $_POST["hospitalization_date_from"] == "") { $_POST["is_hospitalized"] = "0"; $_POST["hospitalization_date_to"] = ""; } else { $_POST["is_hospitalized"] = "1"; } $id = formData('id', 'G') + 0; $sets = "pid = ?, groupname = ?, user = ?, authorized = ?, activity = 1, date = NOW(), employment_related = ?, auto_accident = ?, accident_state = ?, other_accident = ?, outside_lab = ?, medicaid_referral_code = ?, epsdt_flag = ?, provider_id = ?, provider_qualifier_code = ?, lab_amount = ?, is_unable_to_work = ?, onset_date = ?, date_initial_treatment = ?, off_work_from = ?, off_work_to = ?, is_hospitalized = ?, hospitalization_date_from = ?, hospitalization_date_to = ?, medicaid_resubmission_code = ?, medicaid_original_reference = ?, prior_auth_number = ?, replacement_claim = ?, icn_resubmission_number = ?, box_14_date_qual = ?, box_15_date_qual = ?, comments = ?"; if (empty($id)) { $newid = sqlInsert( "INSERT INTO form_misc_billing_options SET $sets", [ $pid, $_SESSION["authProvider"], $_SESSION["authUser"], $userauthorized, (isset($_POST["employment_related"]) ? $_POST["employment_related"] : ''), (isset($_POST["auto_accident"]) ? $_POST["auto_accident"] : ''), (isset($_POST["accident_state"]) ? $_POST["accident_state"] : ''), (isset($_POST["other_accident"]) ? $_POST["other_accident"] : ''), (isset($_POST["outside_lab"]) ? $_POST["outside_lab"] : ''), (isset($_POST["medicaid_referral_code"]) ? $_POST["medicaid_referral_code"] : ''), (isset($_POST["epsdt_flag"]) ? $_POST["epsdt_flag"] : ''), (isset($_POST["provider_id"]) ? $_POST["provider_id"] : ''), (isset($_POST["provider_qualifier_code"]) ? $_POST["provider_qualifier_code"] : ''), (isset($_POST["lab_amount"]) ? $_POST["lab_amount"] : ''), (isset($_POST["is_unable_to_work"]) ? $_POST["is_unable_to_work"] : ''), (isset($_POST["onset_date"]) ? $_POST["onset_date"] : ''), (isset($_POST["date_initial_treatment"]) ? $_POST["date_initial_treatment"] : ''), (isset($_POST["off_work_from"]) ? $_POST["off_work_from"] : ''), (isset($_POST["off_work_to"]) ? $_POST["off_work_to"] : ''), (isset($_POST["is_hospitalized"]) ? $_POST["is_hospitalized"] : ''), (isset($_POST["hospitalization_date_from"]) ? $_POST["hospitalization_date_from"] : ''), (isset($_POST["hospitalization_date_to"]) ? $_POST["hospitalization_date_to"] : ''), (isset($_POST["medicaid_resubmission_code"]) ? $_POST["medicaid_resubmission_code"] : ''), (isset($_POST["medicaid_original_reference"]) ? $_POST["medicaid_original_reference"] : ''), (isset($_POST["prior_auth_number"]) ? $_POST["prior_auth_number"] : ''), (isset($_POST["replacement_claim"]) ? $_POST["replacement_claim"] : ''), (isset($_POST["icn_resubmission_number"]) ? $_POST["icn_resubmission_number"] : ''), (isset($_POST["box_14_date_qual"]) ? $_POST["box_14_date_qual"] : ''), (isset($_POST["box_15_date_qual"]) ? $_POST["box_15_date_qual"] : ''), (isset($_POST["comments"]) ? $_POST["comments"] : '') ] ); addForm($encounter, "Misc Billing Options", $newid, "misc_billing_options", $pid, $userauthorized); } else { sqlStatement( "UPDATE form_misc_billing_options SET $sets WHERE id = ?", [ $pid, $_SESSION["authProvider"], $_SESSION["authUser"], $userauthorized, (isset($_POST["employment_related"]) ? $_POST["employment_related"] : ''), (isset($_POST["auto_accident"]) ? $_POST["auto_accident"] : ''), (isset($_POST["accident_state"]) ? $_POST["accident_state"] : ''), (isset($_POST["other_accident"]) ? $_POST["other_accident"] : ''), (isset($_POST["outside_lab"]) ? $_POST["outside_lab"] : ''), (isset($_POST["medicaid_referral_code"]) ? $_POST["medicaid_referral_code"] : ''), (isset($_POST["epsdt_flag"]) ? $_POST["epsdt_flag"] : ''), (isset($_POST["provider_id"]) ? $_POST["provider_id"] : ''), (isset($_POST["provider_qualifier_code"]) ? $_POST["provider_qualifier_code"] : ''), (isset($_POST["lab_amount"]) ? $_POST["lab_amount"] : ''), (isset($_POST["is_unable_to_work"]) ? $_POST["is_unable_to_work"] : ''), (isset($_POST["onset_date"]) ? $_POST["onset_date"] : ''), (isset($_POST["date_initial_treatment"]) ? $_POST["date_initial_treatment"] : ''), (isset($_POST["off_work_from"]) ? $_POST["off_work_from"] : ''), (isset($_POST["off_work_to"]) ? $_POST["off_work_to"] : ''), (isset($_POST["is_hospitalized"]) ? $_POST["is_hospitalized"] : ''), (isset($_POST["hospitalization_date_from"]) ? $_POST["hospitalization_date_from"] : ''), (isset($_POST["hospitalization_date_to"]) ? $_POST["hospitalization_date_to"] : ''), (isset($_POST["medicaid_resubmission_code"]) ? $_POST["medicaid_resubmission_code"] : ''), (isset($_POST["medicaid_original_reference"]) ? $_POST["medicaid_original_reference"] : ''), (isset($_POST["prior_auth_number"]) ? $_POST["prior_auth_number"] : ''), (isset($_POST["replacement_claim"]) ? $_POST["replacement_claim"] : ''), (isset($_POST["icn_resubmission_number"]) ? $_POST["icn_resubmission_number"] : ''), (isset($_POST["box_14_date_qual"]) ? $_POST["box_14_date_qual"] : ''), (isset($_POST["box_15_date_qual"]) ? $_POST["box_15_date_qual"] : ''), (isset($_POST["comments"]) ? $_POST["comments"] : ''), $id ] ); } if (isset($_SESSION['billencounter'])) { SessionUtil::unsetSession(['billpid', 'billencounter']); echo ""; } else { formHeader("Redirecting...."); formJump(); formFooter(); }