// Still missing...
if (empty($frow)) {
$alertmsg = xl("No Primary Business Entity selected in facility list");
}
// Loop on array of PIDS
$saved_pages = $pages;
//Save calculated page count of a single fee sheet
foreach ($pid_list as $pid) {
if ($form_fill) {
// Get the patient's name and chart number.
$patdata = getPatientData($pid);
}
// This tracks our position in the $SBCODES array.
$cindex = 0;
while (--$pages >= 0) {
$html .= genFacilityTitle(xl('Superbill/Fee Sheet'), -1);
$html .= "\n<table class='bordertbl' cellspacing='0' cellpadding='0' width='100%'>\n<tr>\n<td valign='top'>\n<table border='0' cellspacing='0' cellpadding='0' width='100%'>\n<tr>\n<td class='toprow' style='width:10%'></td>\n<td class='toprow' style='width:10%'></td>\n<td class='toprow' style='width:25%'></td>\n<td class='toprow' style='width:55%'></td>\n</tr>";
$cindex = genColumn($cindex);
// Column 1
if ($pages == 0) {
// if this is the last page
$html .= "<tr>\n<td colspan='3' valign='top' class='fshead' style='height:" . $lheight * 2 . "pt'>";
$html .= xl('Patient', 'r');
$html .= ":<br />";
if ($form_fill) {
$html .= $patdata['fname'] . ' ' . $patdata['mname'] . ' ' . $patdata['lname'] . "<br />\n";
$html .= $patdata['street'] . "<br />\n";
$html .= $patdata['city'] . ', ' . $patdata['state'] . ' ' . $patdata['postal_code'] . "\n";
}
$html .= "</td>\n<td valign='top' class='fshead'>";
$html .= xl('DOB', 'r');
font-size: 14pt;
font-weight: bold;
}
.ftitlecell2 {
vertical-align: top;
text-align: right;
font-size: 9pt;
}
</style>
</head>
<body bgcolor='#ffffff'>
<form>
<?php
echo genFacilityTitle($formtitle, -1);
?>
<span class='subhead'>
<?php
echo xlt('Patient');
?>
: ________________________________________
<?php
echo xlt('Clinic');
?>
: ____________________
<?php
echo xlt('Date');
?>
: ____________________<br /> <br />
</script>
</head>
<body bgcolor='#ffffff'>
<form name='theform' method='post' action='printed_fee_sheet.php?fill=<?php
echo $form_fill;
?>
'
onsubmit='return top.restoreSession()'>
<center>
<?php
while (--$pages >= 0) {
?>
<?php
echo genFacilityTitle(xl('Fee Sheet'), -1);
?>
<table class='bordertbl' cellspacing='0' cellpadding='0' width='100%'>
<tr>
<td valign='top'>
<table border='0' cellspacing='0' cellpadding='0' width='100%'>
<tr>
<td class='toprow' style='width:10%'></td>
<td class='toprow' style='width:10%'></td>
<td class='toprow' style='width:25%'></td>
<td class='toprow' style='width:55%'></td>
</tr>
<?php
$cindex = genColumn($cindex);
// Column 1
font-size: 14pt;
font-weight: bold;
}
.ftitlecell2 {
vertical-align: top;
text-align: right;
font-size: 9pt;
}
</style>
</head>
<body bgcolor='#ffffff'>
<form>
<?php
echo genFacilityTitle(xl('Registration Form'), -1);
?>
<?php
function end_cell()
{
global $item_count, $cell_count;
if ($item_count > 0) {
echo "</td>";
$item_count = 0;
}
}
function end_row()
{
global $cell_count, $CPR;
end_cell();
$trow['id'] = ' ';
}
if (empty($patient_id)) {
$patient_id = ' ';
}
if (empty($facrow['facility_npi'])) {
$facrow['facility_npi'] = ' ';
}
$s = '';
$fh = fopen($template_file, 'r');
while (!feof($fh)) {
$s .= fread($fh, 8192);
}
fclose($fh);
$s = str_replace("{header1}", genFacilityTitle($TEMPLATE_LABELS['label_form1_title'], -1), $s);
$s = str_replace("{header2}", genFacilityTitle($TEMPLATE_LABELS['label_form2_title'], -1), $s);
$s = str_replace("{fac_name}", $facrow['name'], $s);
$s = str_replace("{fac_facility_npi}", $facrow['facility_npi'], $s);
$s = str_replace("{ref_id}", $trow['id'], $s);
$s = str_replace("{ref_pid}", $patient_id, $s);
$s = str_replace("{pt_age}", $patient_age, $s);
$fres = sqlStatement("SELECT * FROM layout_options " . "WHERE form_id = 'REF' ORDER BY group_name, seq");
while ($frow = sqlFetchArray($fres)) {
$data_type = $frow['data_type'];
$field_id = $frow['field_id'];
$currvalue = '';
if (isset($trow[$field_id])) {
$currvalue = $trow[$field_id];
}
$s = str_replace("{ref_{$field_id}}", generate_display_field($frow, $currvalue), $s);
}
