152 lines
7.1 KiB
PHP
Executable File
152 lines
7.1 KiB
PHP
Executable File
<?php
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// $this->titre = "INTER-SANTE - Nouveau Dossier Remboursement classique";
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$numeroBeneficiaire = $_SESSION['numeroBeneficiaire_C'];
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$nomPatient = $_SESSION['beneficiaire_C'];
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?>
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<legend> <?= _("Nouveau Dossier Hors Tiers Payant") . " => " . _("ID BORD") . " : 0 " . " => " . _("Patient") . " : " . $nomPatient . " ( " . $numeroBeneficiaire . " )" ?></legend>
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<input class="sr-only" type="text" id="codeTypePrestataire" name="codeTypePrestataire" value="CSO">
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<input class="sr-only" type="text" id="codePrestataire" name="codePrestataire" value="<?= $_SESSION['codePrestataire_C'] ?>">
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<table class="table table-responsive table-condensed" style='font-size:10pt;'>
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<tbody>
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<tr>
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<td width="10%" class="required"> <?= _("Demandeur") ?> </td>
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<td width="45%" ><INPUT class="form-control majuscule" TYPE="text" id="demandeur" NAME="demandeur" onchange="javascript:Maj_beneficiaire();" style='font-size:10pt;' required AUTOCOMPLETE="OFF" autofocus></td>
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<td width="10%" align="center" class="required"> <?= _("Lien Parenté") ?> </td>
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<td>
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<SELECT class="form-control" id="codeLienDemandeur" NAME="codeLienDemandeur" onchange="javascript:Maj_lienparente();" required AUTOCOMPLETE="OFF" style='font-size:10pt;'>
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<?php liste_options($liendemandeur,""); ?>
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</SELECT>
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</td>
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</tr>
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<tr>
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<td> <?= _("Prestataire Cons") ?> </td>
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<td>
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<?php if ($_SESSION['prestataire_C']>" "): ?>
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<button id="button_popRecherchePrestataire" NAME="button_popRecherchePrestataire" type="button"class="form-control btn btn-primary" data-bs-toggle="modal" data-bs-target="#popRecherchePrestataire" style='font-size:10pt;' style='font-size:10pt;' ><span id="nomPrestataire" name="nomPrestataire"> <?= $_SESSION['prestataire_C'] ?> </span></button>
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<?php else : ?>
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<button id="button_popRecherchePrestataire" NAME="button_popRecherchePrestataire" type="button" class="form-control btn btn-primary" data-bs-toggle="modal" data-bs-target="#popRecherchePrestataire" style='font-size:10pt;' ><span id="nomPrestataire" name="nomPrestataire"> <?= _("Tous / Rechercher Prestataire...") ?> </span></button>
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<?php endif; ?>
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<INPUT class="sr-only" TYPE="text" id="prestataireConsultation" NAME="prestataireConsultation" >
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</td>
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<td align="center" class="required"> <?= _("Date Cons") ?> </td>
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<td> <INPUT class="form-control datepicker" TYPE="text" id="dateConsultation" NAME="dateConsultation" value="" required AUTOCOMPLETE="OFF" style='font-size:10pt;' ></td>
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</tr>
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<tr>
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<td class="required"> <?= _("Raison Consult") ?> </td>
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<td>
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<SELECT class="form-control" id="codeRaisonConsultation" NAME="codeRaisonConsultation" required AUTOCOMPLETE="OFF" autofocus style='font-size:10pt;'>
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<?php liste_options($raison, ""); ?>
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</SELECT>
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</td>
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<td align="center" > Hospit ?</td>
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<td>
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<SELECT class="form-control" id="hospitalisation" NAME="hospitalisation" style='font-size:10pt;' >
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<?php liste_options($ouinonhospit, ""); ?>
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</SELECT>
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</td>
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</tr>
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<tr>
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<td class="required"> <?= _("Bénéficiaire") ?> </td>
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<td ><INPUT class="form-control majuscule" TYPE="text" id="beneficiaireReglement" NAME="beneficiaireReglement" style='font-size:10pt;' required AUTOCOMPLETE="OFF" ></td>
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<td align="center" class="required"> <?= _("Lien Parenté") ?> </td>
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<td>
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<SELECT class="form-control" id="codeLienBeneficiaire" NAME="codeLienBeneficiaire" required AUTOCOMPLETE="OFF" style='font-size:10pt;'>
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<?php liste_options($lienbeneficiaire,""); ?>
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</SELECT>
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</td>
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</tr>
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<tr>
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<td colspan="4"> <input style='text-align:center; font-size:11pt; background-color:green;color:white;' class="form-control" type="text" value= "Informations sur le paiement proposées par le bénéficiaire" disabled > </td>
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</tr>
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<tr>
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<td > <?= _("Mode P") ?> </td>
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<td>
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<SELECT class="form-control" id="codeModePaiementDemande" NAME="codeModePaiementDemande" required AUTOCOMPLETE="OFF" style='font-size:10pt;' >
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<?php liste_options($modepaiement,""); ?>
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</SELECT>
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</td>
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<td align="center"> <?= _("Banque Bénéf") ?> </td>
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<td>
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<SELECT style='font-size:10pt;' class="form-control" id="codeBanqueBeneficiaire" NAME="codeBanqueBeneficiaire" required AUTOCOMPLETE="OFF" >
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<?php liste_options($banque, ""); ?>
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</SELECT>
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</td>
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</tr>
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<tr>
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<td> <?= _("No Cpte Bénéf") ?> </td>
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<td > <INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="numeroCompteBeneficiaire" NAME="numeroCompteBeneficiaire" required AUTOCOMPLETE="OFF" > </td>
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<td align="center"> Observations </td>
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<td ><INPUT class="form-control" TYPE="text" id="observations" NAME="observations" style='font-size:10pt;' ></td>
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</tr>
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<tr>
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<td> </td>
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<td colspan="3"> <input id="btn_enreg" name="btn_enreg" class = "form-control btn btn-primary" type="button" value="<?= _("Enregistrer le Dossier...") ?>" onClick="javascript:enregistrer_dossier_classique();" style='font-size:10pt;' > </td>
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</tr>
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</tbody>
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</table>
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<div class="modal fade" id="popRecherchePrestataire" role="dialog" data-bs-backdrop="static" data-bs-keyboard="false" >
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<div class="modal-dialog modal-lg">
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<div class="modal-content">
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<div class="modal-header">
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<button id="btn_close_pop" name="btn_close_pop" type="button" class="close" data-bs-dismiss="modal"> <?= _("Fermer") ?> </button>
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<h4 class="modal-title"> <?= _("Rechercher un prestataire...") ?> </h4>
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</div>
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<div class="modal-body">
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<div id="div_listeprestataires" onkeypress="javascript:ctrlkeypresstype_prestataire(event);">
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<table class="table table-striped table-bordered table-hover table-condensed table-responsive" style='font-size:10pt;'>
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<thead>
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<tr>
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<th style="text-align:center" width="15%" > Code </th>
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<th width="50%" style="text-align:center" > <?= _("Nom contenant...") ?> </th>
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<th colspan="2" style="text-align:center" > Type </th>
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</tr>
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</thead>
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<tbody>
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<tr>
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<td><input type="text" class="form-control" id="codesearch" name="codesearch" autofocus style='font-size:10pt;' ></td>
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<td><input type="text" class="form-control" id="nomsearch" name="nomsearch" autofocus style='font-size:10pt;' ></td>
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<td><input type="button" class = "form-control btn btn-info" style='font-size:10pt;' value="<?= _("Rechercher...") ?>" onclick="javascript:afficher_pop_recherche_prestataire_type_prestataire('CSO');" /></td>
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<td><input type="button" class = "form-control btn btn-info" style='font-size:10pt;' value="<?= _("Ré-initialiser...") ?>" onclick="javascript:reinitialiser_prestataire(); " /></td>
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</tr>
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</tbody>
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</table>
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</div>
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</div>
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<div class="modal-footer">
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<button id="close_pop" name="close_pop" type="button" class="btn btn-default" data-bs-dismiss="modal"> <?= _("Fermer") ?> </button>
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</div>
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</div>
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</div>
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</div>
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