178 lines
8.7 KiB
PHP
Executable File
178 lines
8.7 KiB
PHP
Executable File
<?php
|
|
$this->titre = "INTER SANTE - Nouveau Dossier Remboursement classique police";
|
|
|
|
$idDossierClassiquePolice = $_SESSION['idDossierClassiquePolice'];
|
|
|
|
$idBeneficiaire = $_SESSION['idBeneficiaire_C'];
|
|
$idPatient = $_SESSION['idBeneficiaire_C'];
|
|
$numeroBeneficiaire = $_SESSION['numeroBeneficiaire_C'];
|
|
$nomPatient = $_SESSION['beneficiaire_C'];
|
|
$adherent = $_SESSION['adherent_C'];
|
|
$codeLienParente = $_SESSION['codeLienParente_C'];
|
|
|
|
?>
|
|
<legend> <?= _("Nouveau Dossier Hors Tiers Payant") . " => " . _("ID Bordéreau") . " : " . $idDossierClassiquePolice . " => " . _("No Bénéf") . " : " . $numeroBeneficiaire ?> </legend>
|
|
|
|
<input class="sr-only" type="text" id="codeTypePrestataire" name="codeTypePrestataire" value="CSO">
|
|
<input class="sr-only" type="text" id="codePrestataire" name="codePrestataire" value="<?= $_SESSION['codePrestataire_C'] ?>">
|
|
|
|
<input class="sr-only" type="text" id="idBeneficiaire" name="idBeneficiaire" value="<?= $idBeneficiaire ?>">
|
|
<input class="sr-only" type="text" id="idPatient" name="idPatient" value="<?= $idBeneficiaire ?>">
|
|
<input class="sr-only" type="text" id="nomPatient" name="nomPatient" value="<?= $nomPatient ?>">
|
|
<input class="sr-only" type="text" id="adherent" name="adherent" value="<?= $adherent ?>">
|
|
<input class="sr-only" type="text" id="numeroBeneficiaire" name="numeroBeneficiaire" value="<?= $numeroBeneficiaire ?>">
|
|
|
|
<table class="table table-responsive table-condensed" style='font-size:10pt;'>
|
|
<tbody>
|
|
<tr>
|
|
<td width="12%" ><?= _("Patient") ?> </td>
|
|
<td width="45%" > <INPUT class="form-control" TYPE="text" style='font-size:10pt;' value="<?= $nomPatient . ' ( ' . $codeLienParente . ' )' ?>" required readonly > </td>
|
|
|
|
<td width="10%" align="center"> <?= _("Adhérent") ?> </td>
|
|
<td> <INPUT class="form-control" TYPE="text" style='font-size:10pt;' value="<?= $adherent ?>" readonly > </td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td width="10%" > <?= _("Demandeur") ?> </td>
|
|
<td width="45%" > <INPUT class="form-control" TYPE="text" id="demandeur" NAME="demandeur" style='font-size:10pt;' value="<?= $dossierpolice['souscripteur'] ?>" required readonly > </td>
|
|
|
|
<td width="10%" align="center"> <?= _("Lien Parenté") ?> </td>
|
|
<td>
|
|
<select class="form-select" id="codeLienDemandeur" NAME="codeLienDemandeur" required style='font-size:10pt;' disabled >
|
|
<?php liste_options($liendemandeur,"S"); ?>
|
|
</SELECT>
|
|
</td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td> <?= _("Prestataire Consulté") ?> </td>
|
|
|
|
<td colspan="3">
|
|
<?php if ($_SESSION['prestataire_C']>" "): ?>
|
|
<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"> <?= $_SESSION['prestataire_C'] ?> </span></button>
|
|
<?php else : ?>
|
|
<button id="button_popRecherchePrestataire" NAME="button_popRecherchePrestataire" type="button" class="form-control btn btn-primary" data-bs-toggle="modal" data-bs-target="#popRecherchePrestataire" style='font-size:10pt;' ><span id="nomPrestataire" name="nomPrestataire"> <?= _("Tous / Rechercher Prestataire...") ?> </span></button>
|
|
<?php endif; ?>
|
|
|
|
<INPUT class="sr-only" TYPE="text" id="prestataireConsultation" NAME="prestataireConsultation" >
|
|
</td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td > <?= _("Date Consultation") ?> </td>
|
|
<td> <INPUT class="form-control datepicker" TYPE="text" id="dateConsultation" NAME="dateConsultation" value="" required style='font-size:10pt;' AUTOCOMPLETE="OFF" autofocus></td>
|
|
|
|
<td class="required" align="center"> <?= _("Affection") ?> </td>
|
|
<td>
|
|
<SELECT id="codeAffection" NAME="codeAffection" class="form-control selectpicker" data-live-search="true" style='font-size:10pt;'>
|
|
<?php liste_options($affections, ""); ?>
|
|
</SELECT>
|
|
</td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td> <?= _("Raison Consultation") ?> </td>
|
|
<td>
|
|
<select class="form-select" id="codeRaisonConsultation" NAME="codeRaisonConsultation" required style='font-size:10pt;'>
|
|
<?php liste_options($raison, ""); ?>
|
|
</SELECT>
|
|
</td>
|
|
|
|
<td align="center" > <?= _("Hospitalisation?") ?></td>
|
|
<td>
|
|
<select class="form-select" id="hospitalisation" NAME="hospitalisation" style='font-size:10pt;' >
|
|
<?php liste_options($ouinonhospit, ""); ?>
|
|
</SELECT>
|
|
</td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td> <?= _("Bénéficiaire") ?> </td>
|
|
<td ><INPUT class="form-control" TYPE="text" id="beneficiaireReglement" NAME="beneficiaireReglement" style='font-size:10pt;' required value="<?= $dossierpolice['souscripteur'] ?>" required readonly ></td>
|
|
|
|
<td align="center"> <?= _("Lien Parenté") ?> </td>
|
|
<td>
|
|
<select class="form-select" id="codeLienBeneficiaire" NAME="codeLienBeneficiaire" required style='font-size:10pt;' disabled >
|
|
<?php liste_options($lienbeneficiaire,"S"); ?>
|
|
</SELECT>
|
|
</td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td colspan="4"> <input style='text-align:center; font-size:11pt; background-color:green !important; color:white;' class="form-control" type="text" value= "<?= _("Informations sur le paiement proposées par le bénéficiaire")?>" disabled > </td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td > <?= _("Mode paiement") ?> </td>
|
|
<td>
|
|
<select class="form-select" id="codeModePaiementDemande" NAME="codeModePaiementDemande" required style='font-size:10pt;' disabled >
|
|
<?php liste_options($modepaiement, $dossierpolice['codeModePaiementDemande']); ?>
|
|
</SELECT>
|
|
</td>
|
|
|
|
<td align="center"> <?= _("Banque Bénéficiaire") ?> </td>
|
|
<td>
|
|
<SELECT style='font-size:10pt;' class="form-select" id="codeBanqueBeneficiaire" NAME="codeBanqueBeneficiaire" disabled >
|
|
<?php liste_options($banque, $dossierpolice['codeBanqueBeneficiaire']); ?>
|
|
</SELECT>
|
|
</td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td> <?= _("No Compte Bénéficiaire") ?> </td>
|
|
<td > <INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="numeroCompteBeneficiaire" NAME="numeroCompteBeneficiaire" value="<?= $dossierpolice['numeroCompteBeneficiaire'] ?>" required readonly > </td>
|
|
|
|
<td align="center"> Observations </td>
|
|
<td ><INPUT class="form-control" TYPE="text" id="observations" NAME="observations" style='font-size:10pt;' value="<?= $dossierpolice['observations'] ?>" readonly ></td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td> </td>
|
|
<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_un_dossier_classique_police();" style='font-size:10pt;' > </td>
|
|
</tr>
|
|
|
|
</tbody>
|
|
</table>
|
|
|
|
|
|
<div class="modal fade" id="popRecherchePrestataire" role="dialog" data-backdrop="static" data-keyboard="false" >
|
|
<div class="modal-dialog modal-lg">
|
|
<div class="modal-content">
|
|
|
|
<div class="modal-header">
|
|
<button id="btn_close_pop" name="btn_close_pop" type="button" class="close" data-bs-dismiss="modal"> <?= _("Fermer") ?> </button>
|
|
<h4 class="modal-title"> <?= _("Rechercher un prestataire...") ?> </h4>
|
|
</div>
|
|
|
|
<div class="modal-body">
|
|
<div id="div_listeprestataires" onkeypress="javascript:ctrlkeypresstype_prestataire(event);">
|
|
<table class="table table-striped table-bordered table-hover table-condensed table-responsive" style='font-size:10pt;'>
|
|
<thead>
|
|
<tr>
|
|
<th style="text-align:center" width="15%" > Code </th>
|
|
<th width="50%" style="text-align:center" > <?= _("Nom contenant...") ?> </th>
|
|
<th colspan="2" style="text-align:center" > Type </th>
|
|
</tr>
|
|
</thead>
|
|
<tbody>
|
|
<tr>
|
|
<td><input type="text" class="form-control" id="codesearch" name="codesearch" autofocus style='font-size:10pt;' ></td>
|
|
<td><input type="text" class="form-control" id="nomsearch" name="nomsearch" autofocus style='font-size:10pt;' ></td>
|
|
<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>
|
|
<td><input type="button" class = "form-control btn btn-info" style='font-size:10pt;' value="<?= _("Ré-initialiser...") ?>" onclick="javascript:reinitialiser_prestataire(); " /></td>
|
|
</tr>
|
|
</tbody>
|
|
</table>
|
|
</div>
|
|
</div>
|
|
|
|
<div class="modal-footer">
|
|
<button id="close_pop" name="close_pop" type="button" class="btn btn-default" data-bs-dismiss="modal"> <?= _("Fermer") ?> </button>
|
|
</div>
|
|
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
|