59 lines
3.8 KiB
PHP
Executable File
59 lines
3.8 KiB
PHP
Executable File
<?php $this->titre = "INTER-SANTE - Fiche Décompte";
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$numeroDecompte = $reglement['numeroDecompte'];
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$idReglement = $_SESSION['idReglement_C'];
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?>
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<script type="text/javascript">
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</script>
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<div id="reglement">
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<input class="sr-only" type="text" id="idReglement" name="idReglement" value="<?= $idReglement ?>" >
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<input class="sr-only" type="text" id="fraisReel" name="fraisReel" value="<?= $this->nettoyer($reglement['fraisReel']) ?>" >
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<input class="sr-only" type="text" id="montantTm" name="montantTm" value="<?= $this->nettoyer($reglement['montantTm']) ?>" >
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<input class="sr-only" type="text" id="montantArembourser" name="montantArembourser" value="<?= $this->nettoyer($reglement['montantArembourser']) ?>" >
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<input class="sr-only" type="text" id="fraisExclu" name="fraisExclu" value="<?= $this->nettoyer($reglement['fraisExclu']) ?>" >
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<input class="sr-only" type="text" id="fraisRetenu" name="fraisRetenu" value="<?= $this->nettoyer($reglement['fraisRetenu']) ?>" >
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<input class="sr-only" type="text" id="montantForce" name="montantForce" value="<?= $this->nettoyer($reglement['montantForce']) ?>" >
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<input class="sr-only" type="text" id="montantApayer" name="montantApayer" value="<?= $this->nettoyer($reglement['montantApayer']) ?>" >
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<input class="sr-only" type="text" id="nbExclues" name="nbExclues" value="<?= $this->nettoyer($reglement['nbExclues']) ?>" >
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<input class="sr-only" type="text" id="nbNonTraite" name="nbNonTraite" value="<?= $this->nettoyer($reglement['nbNonTraite']) ?>" >
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<input style='text-align:center; font-size:11pt;' class="form-control" type="text" value= "Fiche Décompte No : <?= $numeroDecompte ?> => Prestataire : <?= $reglement['prestataire'] ?>" readonly >
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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%" > <?= _("Période") ?> </td>
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<td width="15%" > <INPUT style='font-size:10pt;' class="form-control" TYPE="text" value="<?= $this->nettoyer($reglement['periode']) ?>" readonly> </td>
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<td width="10%" align="center"> <?= _("Système") ?> </td>
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<td width="15%" ><INPUT style='font-size:10pt;' class="form-control" TYPE="text" value="<?= dateheureLang($this->nettoyer($reglement['dateSysteme'])) ?>" readonly ></td>
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<td width="10%" align="center"> <?= _("Frais") ?> </td>
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<td width="15%" > <INPUT style='font-size:10pt; text-align:center;' class="form-control" TYPE="text" value="<?= format_N($this->nettoyer($reglement['fraisReel'])) ?>" readonly > </td>
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<td width="10%" align="center"> <?= _("Ticket Mod") ?> </td>
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<td width="15%" > <INPUT style='font-size:10pt; color:red; text-align:center;' class="form-control" TYPE="text" value="<?= format_N($this->nettoyer($reglement['montantTm'])) ?>" readonly ></td>
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</tr>
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<tr>
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<td> <?= _("A Remb") ?> </td>
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<td><INPUT style='font-size:10pt; text-align:center; text-align:center;' class="form-control" TYPE="text" value="<?= format_N($this->nettoyer($reglement['montantArembourser'])) ?>" readonly ></td>
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<td align="center"> <?= _("Dépas") ?> </td>
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<td><INPUT style='font-size:10pt; color:red;text-align:center; text-align:center;' class="form-control" TYPE="text" value="<?= format_N($this->nettoyer($reglement['fraisExclu'])) ?>" readonly ></td>
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<td align="center"> <?= _("Frais") ?> </td>
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<td><INPUT style='font-size:10pt; color:blue; text-align:center;' class="form-control" TYPE="text" value="<?= format_N($this->nettoyer($reglement['fraisRetenu'])) ?>" readonly ></td>
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<td align="center"> <?= _("A payer") ?> </td>
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<td><INPUT style='font-size:10pt; text-align:center; color:blue;' class="form-control" TYPE="text" value="<?= format_N($this->nettoyer($reglement['montantApayer'])) ?>" readonly ></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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