136 lines
6.8 KiB
PHP
Executable File
136 lines
6.8 KiB
PHP
Executable File
<?php
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$this->titre = "INTER-SANTE - Paiement Dossier Classique";
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$idDossierClassique = $dossier['idDossierClassique'];
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$numeroLotDecompte = $dossier['numeroLotDecompte'];
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$montantApayer = $dossier['montantApayer'];
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$regle = $dossier['regle'];
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?>
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<input class="sr-only" type="text" id="idDossierClassique" name="idDossierClassique" value="<?= $idDossierClassique ?>" >
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<input class="sr-only" type="text" id="montantPaye" name="montantPaye" value="<?= $montantApayer ?>" >
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<input style='text-align:center; font-size:11pt;' class="form-control" type="text" value= "<?= _("Dossier de remboursement classique") . " => " . _("No Lot") . " : " . $numeroLotDecompte ?>" readonly >
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<table class="table table-responsive table-condensed" style='font-size:8pt;'>
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<tbody>
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<tr>
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<td width="10%" > <?= _("Prestataire Cons") ?> </td>
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<td width="24%" > <INPUT style='font-size:8pt;' class="form-control" TYPE="text" value="<?= $this->nettoyer($dossier['prestataireConsultation']) ?>" readonly> </td>
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<td width="10%" align="center" > <?= _("Date Cons") ?> </td>
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<td width="23%" > <INPUT style='font-size:8pt;' class="form-control" TYPE="text" value="<?= dateLang($this->nettoyer($dossier['dateConsultation'])) ?>" readonly> </td>
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<td width="10%" align="center" > <?= _("Demandeur") ?> </td>
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<td width="24%" > <INPUT style='font-size:8pt;' class="form-control" TYPE="text" value="<?= $this->nettoyer($dossier['demandeur']) ?>" readonly> </td>
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</tr>
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<tr>
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<td> <?= _("Lien Parenté") ?> </td>
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<td><INPUT style='font-size:8pt;' class="form-control" TYPE="text" value="<?= $dossier['liendemandeur'] ?>" readonly ></td>
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<td align="center" > <?= _("Raison Consult") ?> </td>
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<td><INPUT style='font-size:8pt;' class="form-control" TYPE="text" value="<?= $dossier['raisonconsultation'] ?>" readonly ></td>
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<td align="center" > Hospit ? </td>
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<td><INPUT style='font-size:8pt;' class="form-control" TYPE="text" value="<?= $dossier['libellehospitalisation'] ?>" readonly ></td>
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</tr>
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<tr>
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<td> <?= _("Frais") ?> </td>
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<td><INPUT style='font-size:8pt;' class="form-control" TYPE="text" value="<?= format_N($this->nettoyer($dossier['fraisReel'])) ?>" readonly ></td>
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<td align="center" > <?= _("Ticket Mod") ?> </td>
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<td><INPUT style='font-size:8pt; color:red;' class="form-control" TYPE="text" value="<?= format_N($this->nettoyer($dossier['montantTm'])) ?>" readonly ></td>
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<td align="center" > <?= _("Dépas") ?> </td>
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<td><INPUT style='font-size:8pt; color:red;' class="form-control" TYPE="text" value="<?= format_N($this->nettoyer($dossier['fraisExclu'])) ?>" readonly ></td>
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</tr>
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<tr>
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<td> <?= _("Retenu") ?> </td>
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<td><INPUT style='font-size:8pt; color:red;' class="form-control" TYPE="text" value="<?= format_N($this->nettoyer($dossier['fraisRetenu'])) ?>" readonly ></td>
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<td align="center" > Observations </td>
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<td colspan="3" ><INPUT style='font-size:8pt;' class="form-control" TYPE="text" value="<?= $dossier['observations'] ?>" readonly ></td>
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</tr>
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<tr>
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<td> <?= _("Bénéficiaire") ?> </td>
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<td><INPUT style='font-size:8pt;' class="form-control" TYPE="text" value="<?= $dossier['beneficiaireReglement'] ?>" readonly ></td>
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<td align="center"> <?= _("Lien Parenté") ?> </td>
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<td><INPUT style='font-size:8pt;' class="form-control" TYPE="text" value="<?= $dossier['lienbeneficiaire'] ?>" readonly ></td>
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<td align="center"> <?= _("Situation") ?> </td>
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<?php if($regle!='1'): ?>
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<td align="center"> <input style='text-align:center; font-size:8pt; background-color:red;color:white;' class="form-control" type="text" value="En attente de paiement" readonly > </td>
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<?php else: ?>
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<td align="center"> <input style='text-align:center; font-size:8pt; background-color:blue;color:white;' class="form-control" type="text" value="Réglé / Payé / Paid" readonly > </td>
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<?php endif; ?>
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</tr>
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<tr>
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<td colspan="6"> <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 > <INPUT style='font-size:8pt;' class="form-control" TYPE="text" value="<?= $dossier['modepaiementBeneficiaire'] ?>" readonly > </td>
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<td align="center"> <?= _("Banque Bénéf") ?> </td>
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<td > <INPUT style='font-size:8pt;' class="form-control" TYPE="text" value="<?= $dossier['banqueBeneficiaire'] ?>" readonly > </td>
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<td align="center"> <?= _("No Cpte Bénéf") ?> </td>
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<td > <INPUT style='font-size:8pt;' class="form-control" TYPE="text" value="<?= $dossier['numeroCompteBeneficiaire'] ?>" readonly > </td>
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</tr>
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<tr>
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<td colspan="6"> <input style='text-align:center; font-size:11pt; background-color:blue;color:white;' class="form-control" type="text" value= "Informations sur le paiement du dossier" disabled > </td>
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</tr>
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<tr>
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<td width="10%"> <?= _("Mode P") ?> </td>
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<td>
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<SELECT class="form-control" id="codeModePaiement" NAME="codeModePaiement" required AUTOCOMPLETE="OFF" style='font-size:10pt;' >
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<?php liste_options($modepaiement,""); ?>
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</SELECT>
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</td>
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<td align="center" width="10%" > <?= _("Banque Payeur") ?> </td>
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<td>
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<SELECT style='font-size:10pt;' class="form-control" id="codeBanquePayeur" NAME="codeBanquePayeur" required AUTOCOMPLETE="OFF" >
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<?php liste_options($banque, ""); ?>
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</SELECT>
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</td>
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<td width="10%" align="center"> <?= _("Réf Paiement") ?> </td>
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<td > <INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="referencePaiement" NAME="referencePaiement" placeholder="No Chèque / Virement" required AUTOCOMPLETE="OFF" > </td>
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</tr>
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<tr>
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<td> <?= _("Montant") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" TYPE="text" value="<?= format_N($dossier['montantApayer']) ?>" required AUTOCOMPLETE="OFF" disabled > </td>
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<td align="center"> <?= _("Date Cpt") ?> </td>
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<td><INPUT style='font-size:10pt;' class="form-control datepicker" TYPE="text" id="dateComptable" NAME="dateComptable" value="<?= dateCouranteLang($_SESSION['p_lang']) ?>" required AUTOCOMPLETE="OFF" ></td>
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<td> </td>
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<td colspan="1"> <input style='font-size:10pt;' id="btn_enreg" name="btn_enreg" class = "form-control btn btn-primary" type="button" value="<?= _("Enregistrer le Règlement") ?>" onClick="enregistrer_paiement_dossier_classique();" style='font-size:10pt;' > </td>
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</tr>
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</tbody>
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</table>
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<?php if (isset($msgErreur)): ?>
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<div id ="msgErreur" class="alert alert-danger" style="height:38px; padding:5px;" >
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<H4><?= $msgErreur ?></H4>
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</div>
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<?php endif; ?>
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</form>
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<div id="div_test">
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</div>
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