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<?php
/**
* This allows entry and editing of a "billing note" for the patient.
*
* @package OpenEMR
* @link http://www.open-emr.org
* @author Rod Roark <rod@sunsetsystems.com>
* @author Roberto Vasquez <robertogagliotta@gmail.com>
* @author Brady Miller <brady.g.miller@gmail.com>
* @copyright Copyright (c) 2005 Rod Roark <rod@sunsetsystems.com>
* @copyright Copyright (c) 2019-2020 Brady Miller <brady.g.miller@gmail.com>
* @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
*/
require_once("../globals.php");
require_once("../../library/patient.inc");
require_once("../../library/forms.inc");
use OpenEMR\Common\Csrf\CsrfUtils;
use OpenEMR\Core\Header;
$info_msg = "";
?>
<html>
<head>
<?php Header::setupHeader(['opener']); ?>
<title><?php echo xlt('EOB Posting - Patient Note'); ?></title>
</head>
<body>
<?php
$patient_id = $_GET['patient_id'];
if (!$patient_id) {
die(xlt("You cannot access this page directly."));
}
$row = sqlQuery("Select billing_note From patient_data Where pid=?", [$patient_id]);
if (isset($_POST['form_save'])) {
if (!CsrfUtils::verifyCsrfToken($_POST["csrf_token_form"])) {
CsrfUtils::csrfNotVerified();
}
$thevalue = trim($_POST['form_note']);
sqlStatement("UPDATE patient_data SET " .
"billing_note = ? " .
"WHERE pid = ? ", array($thevalue, $patient_id));
echo "<script>\n";
if ($info_msg) {
echo " alert(" . js_escape($info_msg) . ");\n";
}
echo " dlgclose();\n";
echo "</script></body></html>\n";
exit();
}
$row = sqlQuery("select fname, lname, billing_note " .
"from patient_data where pid = ? limit 1", array($patient_id));
?>
<div class="container">
<div class="row">
<h2><?php echo xlt('Billing Note for ') . text($row['fname']) . " " . text($row['lname']); ?></h2>
</div>
<div class="row mx-auto">
<form method='post' action='sl_eob_patient_note.php?patient_id=<?php echo attr_url($patient_id); ?>'>
<input type="hidden" name="csrf_token_form" value="<?php echo attr(CsrfUtils::collectCsrfToken()); ?>" />
<div class="row">
<div class="col-12 pb-1">
<div class="form-group">
<textarea type='text' name='form_note' class='textarea form-control' rows="3" maxlength="255" placeholder='<?php echo xla('Max 255 characters') ?>'><?php echo attr($row['billing_note']) ?></textarea>
<label><?php echo xlt('Max 255 characters') ?></label>
</div>
</div>
<div class="form-group">
<div class="col-sm-12 text-left position-override" id="search-btn">
<div class="btn-group" role="group">
<button type='submit' class="btn btn-primary btn-save" name='form_save' id="btn-save"><?php echo xlt("Save"); ?></button>
<button type='submit' class="btn btn-secondary btn-cancel" name='form_cancel' id="btn-cancel" onclick='dlgclose();'><?php echo xlt("Cancel"); ?></button>
</div>
</div>
</div>
</div>
</form>
</div>
</div><!--end of container div-->
</body>
</html>