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/modules/ecombill/confirmpayment.php

https://bitbucket.org/vincentbii/amurt
PHP | 242 lines | 195 code | 31 blank | 16 comment | 8 complexity | df7ea39d04b2a9fb09a878a24ce90fa2 MD5 | raw file
Possible License(s): GPL-2.0, Apache-2.0, LGPL-2.1, MPL-2.0-no-copyleft-exception, MIT, BSD-3-Clause, LGPL-2.0, GPL-3.0 
    

  1. <?php
    2. 

  2. error_reporting(E_COMPILE_ERROR|E_ERROR|E_CORE_ERROR);
    3. 

  3. /**
    4. 

  4. * 
    5. 

  5. * 
    6. 

  6. * 
    7. 

  7. * 
    8. 

  8. */
    9. 

  9. require('./roots.php');
    10. 

  10. require($root_path.'include/inc_environment_global.php');
    11. 

  11. define('NO_CHAIN',1);
    12. 

  12. $lang_tables[]='billing.php';
    13. 

  13. define('LANG_FILE','aufnahme.php');
    14. 

  14. $local_user='aufnahme_user';
    15. 

  15. require_once($root_path.'include/inc_front_chain_lang.php');
    16. 

  16. require_once($root_path.'include/inc_date_format_functions.php');
    17. 

  17. 

  18. 	/*include('includes/condb.php');
    19. 

  19. 	error_reporting(0);
    20. 

  20. 	connect_db();
    21. 

  21. 	*/
    22. 

  22. 		
    23. 

  23. 	$patqry="SELECT e.*,p.* FROM care_encounter AS e, care_person AS p WHERE e.encounter_nr=$patientno AND e.pid=p.pid";
    24. 

  24. 	//$resultpatqry=mysql_query($patqry);
    25. 

  25. 	if($resultpatqry=$db->Execute($patqry)){
    26. 

  26. 		if($resultpatqry->RecordCount()){
    27. 

  27. 			$patient=$resultpatqry->FetchRow();
    28. 

  28. 		}
    29. 

  29. 	}
    30. 

  30. 	
    31. 

  31. 	$presdatetime=date("Y-m-d H:i:s");
    32. 

  32. 

  33. $breakfile='patient_payment.php'.URL_APPEND.'&patientno='.$patientno.'&full_en='.$full_en;
    34. 

  34. 	
    35. 

  35. ?>
    36. 

  36. <?php html_rtl($lang); ?>
    37. 

  37. <head>
    38. 

  38. <?php echo setCharSet(); ?>
    39. 

  39. <title><?php echo $LDBillPayment; ?></title>
    40. 

  40. <SCRIPT language="JavaScript">
    41. 

  41. <!--
    42. 

  42. 	function submitform()
    43. 

  43. 	{		
    44. 

  44. 		document.confirmpayment.action = "postpayment.php";
    45. 

  45. 		document.confirmpayment.submit();
    46. 

  46. 	}
    47. 

  47. //-->
    48. 

  48. </SCRIPT>
    49. 

  49. </head>
    50. 

  50. <body bgcolor="#FFFFFF" topmargin=0 leftmargin=0 marginwidth=0 marginheight=0>
    51. 

  51. 

  52. <table border="0" width="101%" bgcolor=#99ccff>
    53. 

  53.       <tr>
    54. 

  54.         <td width="101%"><font color="#330066" size="+2" face="Arial"><strong><?php echo $LDeComBill; ?> -
    55. 

  55.           <?php echo $LDPaymentPreview; ?></strong></font></td>
    56. 

  56.       </tr>
    57. 

  57.     </table>
    58. 

  58. <blockquote>
    59. 

  59.   
    60. 

  60.   <form name="confirmpayment" method="POST" action="">
    61. 

  61.     
    62. 

  62.     <div align="center">
    63. 

  63.     
    64. 

  64.     
    65. 

  65.     <table border="0" width="95%" bordercolor="#000000">
    66. 

  66.      	<tr>
    67. 

  67.              	<td colspan=5 valign="top" height=30 bordercolor="#FFFFFF"><b><?php echo $LDGeneralInfo; ?>:</b></td>
    68. 

  68.               </tr>         
    69. 

  69.                
    70. 

  70.               <tr>
    71. 

  71.                    <td valign=top width="20%"><?php echo $LDPatientName; ?>:</td>
    72. 

  72.     	           <td valign=top width="20%"><?php echo $patient['title'].' '.$patient['name_first'].' '.$patient['name_last'];?></td>
    73. 

  73. 	               <td valign=top width="20%">&nbsp;</td>
    74. 

  74.                    <td valign=top width="10%"><?php echo $LDReceiptNumber; ?>:</td>
    75. 

  75.                    <td valign=top width="30%">
    76. 

  76.                    <?php 
    77. 

  77.     		       echo $receipt_no;
    78. 

  78.                    ?>
    79. 

  79.                    </td>
    80. 

  80.               </tr>
    81. 

  81.               
    82. 

  82.               <tr>
    83. 

  83.                    <td valign=top width="20%"><?php echo $LDPatientAddress; ?>:</td>
    84. 

  84.                <td valign=top width="20%"><?php echo $patient['addr_str'].' '.$patient['addr_str_nr'].'<br>'.$patient['addr_zip'].' '.$patient['addr_citytown_nr'];?></td>
    85. 

  85.                    <td valign=top width="20%">&nbsp;</td>
    86. 

  86.                    <td valign=top width="10%"><?php echo $LDBillDate; ?>:</td>
    87. 

  87.                    <td valign=top width="30%">
    88. 

  88.                    <?php 
    89. 

  89.                    if($receiptid=="")
    90. 

  90.                    {              
    91. 

  91.     					echo formatDate2Local($presdatetime,$date_format,1); 
    92. 

  92.                    }
    93. 

  93.                    else
    94. 

  94.                    {
    95. 

  95.     					$oldbillquery="SELECT payment_date from care_billing_payment WHERE receipt_no=$receipt_no";
    96. 

  96.         				if($oldbillqueryresult=$db->Execute($oldbillquery)){
    97. 

  97. 							if($oldbillqueryresult->RecordCount()){
    98. 

  98. 								$ob=$oldbillqueryresult->FetchRow();
    99. 

  99. 								echo formatDate2Local($ob['payment_date'],$date_format,1);
    100. 

  100. 							}
    101. 

  101. 						}
    102. 

  102.                    }
    103. 

  103. /*    			$oldbillqueryresult=mysql_query($oldbillquery);
    104. 

  104.     			$oldbilldate=mysql_result($oldbillqueryresult,0,'bill_item_date');
    105. 

  105.     			echo $oldbilldate;
    106. 

  106.                    }
    107. 

  107. */                   ?>
    108. 

  108.                    </td>
    109. 

  109.               </tr>
    110. 

  110.                  
    111. 

  111.      	 <tr>
    112. 

  112.                    <td valign=top width="20%"><?php echo $LDPatientType; ?>:</td>
    113. 

  113.                    <td valign=top width="20%"><?php echo $patient['encounter_class_nr'];?></td>
    114. 

  114.                    <td valign=top width="20%">&nbsp;</td>
    115. 

  115.                    <td valign=top width="10%">&nbsp;</td>
    116. 

  116.                    <td valign=top width="30%">&nbsp;</td>
    117. 

  117.               </tr>
    118. 

  118.                  
    119. 

  119.               <tr>
    120. 

  120.                    <td valign=top width="20%"><?php echo $LDDateofBirth; ?>:</td>
    121. 

  121.                    <td valign=top width="20%"><?php echo $patient['date_birth'];?></td>
    122. 

  122.                    <td valign=top width="20%">&nbsp;</td>
    123. 

  123.      	      <td valign=top width="10%">&nbsp;</td>
    124. 

  124.                    <td valign=top width="30%">&nbsp;</td>
    125. 

  125.               </tr>
    126. 

  126.                  
    127. 

  127.               <tr>
    128. 

  128.                    <td valign=top width="20%"><?php echo $LDSex; ?>:</td>
    129. 

  129.                    <td valign=top width="20%"><?php echo $patient['sex'];?></td>
    130. 

  130.                    <td valign=top width="20%">&nbsp;</td>
    131. 

  131.      	      <td valign=top width="10%">&nbsp;</td>
    132. 

  132.                    <td valign=top width="30%">&nbsp;</td>
    133. 

  133.               </tr>
    134. 

  134.                  
    135. 

  135.               <tr>
    136. 

  136.                    <td valign=top width="20%"><?php echo $LDPatientNumber; ?>:</td>
    137. 

  137.                    <td valign=top width="20%"><?php echo $full_en;?></td>
    138. 

  138.                    <td valign=top width="20%">&nbsp;</td>
    139. 

  139.      	      <td valign=top width="10%">&nbsp;</td>
    140. 

  140.                    <td valign=top width="30%">&nbsp;</td>              
    141. 

  141.               </tr>
    142. 

  142.                  
    143. 

  143.               <tr>
    144. 

  144.      	     <td valign=top width="20%"><?php echo $LDDateofAdmission; ?>:</td>
    145. 

  145.      	     <td valign=top width="20%"><?php echo formatDate2Local($patient['encounter_date'],$date_format);?></td>
    146. 

  146.      	     <td valign=top width="20%">&nbsp;</td>
    147. 

  147.      	     <td valign=top width="10%">&nbsp;</td>
    148. 

  148.                   <td valign=top width="30%">&nbsp;</td>
    149. 

  149.               </tr>
    150. 

  150.                  
    151. 

  151.               <tr>
    152. 

  152.      	     <td colspan="5" height="1" width="641" bordercolor="#FFFFFF">&nbsp;</td>
    153. 

  153.               </tr>
    154. 

  154.               
    155. 

  155.               <tr>
    156. 

  156.                   <td colspan="5" height="30" width="641" bordercolor="#FFFFFF"><p><b><?php echo $LDPaymentInformation; ?>:</b></p></td>
    157. 

  157.               </tr>
    158. 

  158.                  
    159. 

  159.           </table>
    160. 

  160.     
    161. 

  161.     
    162. 

  162.     
    163. 

  163.       
    164. 

  164.         
    165. 

  165.   <table cellSpacing="1" cellPadding="3" width="522" bgColor="#999999" border="0" height="138">
    166. 

  166.  	<tr bgColor="#eeeeee">
    167. 

  167. 	   <td align="left" height="37" width="7738"><font size="4" color="#FF0000">&nbsp;<?php echo $LDModeofPayment; ?>:</font></td>
    168. 

  168. 	   <?php
    169. 

  169. 	      if(strstr($_SERVER['QUERY_STRING'],"mode1")!="")
    170. 

  170. 	      {
    171. 

  171. 		  echo "<tr bgColor=\"#eeeeee\">";
    172. 

  172. 		  echo "<td align=\"center\" height=\"7\" width=\"3182\">";
    173. 

  173. 		  echo "<p align=\"left\">";
    174. 

  174. 		  echo "<i><b>$LDCash</b></i>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p>";
    175. 

  175. 		  echo "<p align=\"left\">$LDAmount&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
    176. 

  176. 		  echo $amtcash;
    177. 

  177. 		  echo "<input type=\"hidden\" name=\"amtcash\" value=\"".$amtcash."\">";
    178. 

  178. 	      }
    179. 

  179. 	  ?>
    180. 

  180.   </td></tr>
    181. 

  181.   <?php
    182. 

  182.   	if(strstr($_SERVER['QUERY_STRING'],"mode2")!="")
    183. 

  183.   	{
    184. 

  184. 		echo "<tr bgColor=\"#dddddd\" height=\"1\">";
    185. 

  185. 		  echo "<td height=\"5\" width=\"7738\">";
    186. 

  186. 		  echo "<img height=\"1\" src=\"pics/hor_bar.bmp\" width=\"5\"></td></tr><tr bgColor=\"#eeeeee\"><td align=\"center\" height=\"7\" width=\"3182\">";
    187. 

  187. 		  echo "<p style=\"line-height: 150%\" align=\"left\">";
    188. 

  188. 		  echo "<i><b>$LDCreditCard</b></i>";
    189. 

  189. 		  echo "<p style=\"line-height: 100%; word-spacing: 0; text-indent: 0; margin: 0\" align=\"left\">";
    190. 

  190. 		  echo "$LDCardNumber&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;".$cdno."&nbsp;</p>";
    191. 

  191. 		  echo "<p style=\"line-height: 100%; word-spacing: 0; text-indent: 0; margin: 0\" align=\"left\">
    192. 

  192. 			$LDAmount&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;".$amtcc."</p>";
    193. 

  193. 		  
    194. 

  194. 		echo "</td></tr>";
    195. 

  195. 		echo "<input type=\"hidden\" name=\"cdno\" value=\"".$cdno."\">";
    196. 

  196.     		echo "<input type=\"hidden\" name=\"amtcc\" value=\"".$amtcc."\">";
    197. 

  197. 	}	
    198. 

  198.   ?>
    199. 

  199.   <?php
    200. 

  200. 	if(strstr($_SERVER['QUERY_STRING'],"mode3")!="")
    201. 

  201. 	{
    202. 

  202. 	  echo "<tr bgColor=\"#dddddd\" height=\"1\"><td height=\"5\" width=\"7738\">";
    203. 

  203. 	    echo "<img height=\"1\" src=\"pics/hor_bar.bmp\" width=\"5\">";
    204. 

  204. 	    echo "</td></tr>";
    205. 

  205. 	    echo "<tr bgColor=\"#eeeeee\"><td align=\"center\" height=\"7\" width=\"3182\">";
    206. 

  206. 	    echo "<p style=\"line-height: 150%; word-spacing: 0; margin: 0\" align=\"left\"><i><b>$LDCheck</b>&nbsp;</i>";
    207. 

  207. 	    echo "<p style=\"line-height: 100%; word-spacing: 0; margin: 0\" align=\"left\">$LDCheckNumber";
    208. 

  208. 	    echo $chkno;
    209. 

  209. 	    echo "<p style=\"line-height: 100%; word-spacing: 0; margin: 0\" align=\"left\">$LDAmount&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
    210. 

  210. 	    echo $amtcheque;
    211. 

  211. 	    echo "</td></tr>";
    212. 

  212. 	    echo "<input type=\"hidden\" name=\"chkno\" value=\"".$chkno."\">";
    213. 

  213. 	    echo "<input type=\"hidden\" name=\"amtcheque\" value=\"".$amtcheque."\">";
    214. 

  214.     	}	
    215. 

  215.   ?>
    216. 

  216.     
    217. 

  217.     <input type="hidden" name="patientno" value="<?php echo $patientno; ?>">
    218. 

  218.     <input type="hidden" name="hidden" value="C6#C7#C8#">
    219. 

  219.     <input type="hidden" name="receipt_no" value="<?php echo $receipt_no; ?>">   
    220. 

  220.     <input type="hidden" name="lang" value="<?php echo $lang ?>">
    221. 

  221.     <input type="hidden" name="sid" value="<?php echo $sid ?>">
    222. 

  222.     <input type="hidden" name="full_en" value="<?php echo $full_en ?>">
    223. 

  223.     </table>		
    224. 

  224.     <p>&nbsp;
    225. 

  225. 	<a href="javascript:submitform();"><img <?php echo createLDImgSrc($root_path,'savedisc.gif','0'); ?>></a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
    226. 

  226. 	<a href="<?php echo $breakfile ?>"><img <?php echo createLDImgSrc($root_path,'cancel.gif','0'); ?>></a>      </center>
    227. 

  227. 

  228.     </div>
    229. 

  229.     <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
    230. 

  230. <!--     <input type="button" value="Save" name="B1" Onclick="javascript:submitform();">
    231. 

  231.     <input type="button" value="Goback" name="B2" Onclick="javascript:history.go(-1);">
    232. 

  232.  -->    </p>
    233. 

  233.    </form>
    234. 

  234. </blockquote>
    235. 

  235. 

  236. <?php
    237. 

  237. require($root_path.'include/inc_load_copyrite.php');
    238. 

  238. ?>
    239. 

  239.  
    240. 

  240. </body>
    241. 

  241. </html>
    242. 

  242. 

  243.