<?php
include "../../myDatabase.php";
$ro = new database();
echo "<style type='text/css'>@import url('http://localhost/COCONUT/myCSS/newCSS.css');</style>";
?>
<div id="main">
<div style="border:1px solid #000; height:auto; width:600px; border-color:black black black black; ">
<br><center><font size=3 color=red><?php
echo $ro->getReportInformation("hmoSOA_name");
?>
</font>
<br>
<font size=2><?php
echo $ro->getReportInformation("hmoSOA_address");
?>
</font>
<br><br>
</div>
<br><Br>
<font size=4 color=red>There is No Exact Code</font>
</div>
<div id="list1" class="link-list" style="border:1px solid #000; height:528px; border-color:white black white white; ">
<br><br>
<Br><br>
<font size=1>Patient Code</font><br>
<form method="post" action="checker.php">
<input type=text name="code" autocomplete="off" style="border:1px solid #000; width:138px;"><Br>
<?php
include "../../myDatabase.php";
$fromMonth = $_GET['fromMonth'];
$fromDay = $_GET['fromDay'];
$fromYear = $_GET['fromYear'];
$toMonth = $_GET['toMonth'];
$toDay = $_GET['toDay'];
$toYear = $_GET['toYear'];
$branch = $_GET['branch'];
$company = $_GET['company'];
$ro = new database();
echo "<center>" . $ro->getReportInformation("hmoSOA_name") . "</center>";
echo "<center>" . $ro->getReportInformation("hmoSOA_address") . "</center>";
echo "<center><font size=5>Statement of Account</font><center>";
echo "<center>{$company}</center>";
echo "<center><font size=2>{$fromMonth} {$fromDay}, {$fromYear} - {$toMonth} {$toDay}, {$toYear}</font></center><br>";
echo "<font size=2>We are billing you the amount below representing the hospitalization charge incured by<br> your cardholders</font>";
$ro->hmoSOA_ipd($company, $fromMonth, $fromDay, $fromYear, $toMonth, $toDay, $toYear, $branch);
<?php
include "../../myDatabase.php";
$ro = new database();
?>
<?php
echo "\n\n<style type='text/css'> \n \nBODY {\n\tPADDING-RIGHT: 0px;\n\tPADDING-LEFT: 0px;\n\tPADDING-BOTTOM: 0px;\n\tMARGIN: 0px;\n\tbackground-color:;\t\n \n}\n.style1 {\n\tfont-family: Geneva, Arial, Helvetica, sans-serif;\n\tfont-size:small;\n}\n.style3 {font-family: Geneva, Arial, Helvetica, sans-serif; font-size: 45px;}\n.style5 {font-size: x-small}\n\n.style55 {font-size: medium; font-family: Geneva, Arial, Helvetica, sans-serif; }\n.style56 {font-size: medium}\n.style58 {font-family: Geneva, Arial, Helvetica, sans-serif; font-size: small; font-style: italic; }\n.style60 {font-size: small; font-family: Geneva, Arial, Helvetica, sans-serif; font-weight: bold; }\n.style65 {font-size: 12px}\n.style69 {font-size: 10px}\n\n.labelz {\nfont-size:13px;\n}\n\n.pan {\nfont-size:10px;\n}\n\n.panData {\nfont-size:14px;\n}\n\n.pin {\nfont-size:17px;\n}\n\n.pinData {\npadding:35px 0px 25px 0px;\n}\n\n.birth {\nfont-size:18px;\n}\n\n.checkBox {\n\tborder: 1px solid #000;\n}\n\n.daysClaimed {\n\tborder: 1px solid #000;\n\tcolor: #000;\n\theight: 18px;\n\twidth: 25px;\n\tborder-color:white black black black;\n\ttext-align:center;\n}\n\n.daysClaimed1{\n\tborder: 1px solid #000;\n\tcolor: #000;\n\theight: 18px;\n\twidth: 20px;\n\tborder-color:white black black white;\n\ttext-align:center;\n}\n\n\n.death {\n\tborder: 1px solid #000;\n\tcolor: #000;\n\theight: 18px;\n\twidth: 13px;\n\tborder-color:white black black black;\n\ttext-align:center;\n}\n\n.death1{\n\tborder: 1px solid #000;\n\tcolor: #000;\n\theight: 18px;\n\twidth: 13px;\n\tborder-color:white black black white;\n\ttext-align:center;\n}\n\n\n.hospitalName{\n\tborder: 1px solid #000;\n\tcolor: #000;\n\theight: 28px;\n\twidth: 440px;\n\tborder-color:white white black white;\n\tfont-size:15px;\n\n}\n\n\n.patientName{\n\tborder: 1px solid #000;\n\tcolor: #000;\n\theight: 28px;\n\twidth: 740px;\n\tborder-color:white white black white;\n\tfont-size:17px;\n\n}\n\n\n.phicTable{\n\tborder: 1px solid #000;\n\tcolor: #000;\n\theight: 28px;\n\twidth: 110px;\n\tborder-color:white white white white;\n\tfont-size:17px;\n\ttext-align:center;\n}\n\n\n.phicTableRemarks{\n\tborder: 1px solid #000;\n\tcolor: #000;\n\theight: 28px;\n\twidth: 170px;\n\tborder-color:white white white white;\n\tfont-size:15px;\n\ttext-align:center;\n}\n\n#phicRow:hover {\nbackground-color:yellow;\ncolor:black;\n}\n\n\n.icd10{\n\tborder: 1px solid #000;\n\tcolor: #000;\n\theight: 20px;\n\twidth: 215px;\n\tborder-color:white white black white;\n\tfont-size:15px;\n\tpadding:2px 2px 2px 2px;\n}\n\n.admissionDiagnosis{\n\tborder: 1px solid #000;\n\tcolor: #000;\n\theight: auto;\n\twidth: 235px;\n\tborder-color:white white white white;\n\tfont-size:15px;\n\n}\n\n\n.finalDiagnosis{\n\tborder: 1px solid #000;\n\tcolor: #000;\n\theight: auto;\n\twidth: 565px;\n\tborder-color:white white white white;\n\tfont-size:15px;\n\n}\n\n\n.box{\n\tborder: 1px solid #000;\n\tcolor: #000;\n\theight: 18px;\n\twidth: 25px;\n\tborder-color:white black black black;\n\tfont-size:18px;\n\ttext-align:center;\n}\n\n.panz{\n\tborder: 1px solid #000;\n\tcolor: #000;\n\theight: 18px;\n\twidth: 20px;\n\tborder-color:white black black black;\n\tfont-size:15px;\n\ttext-align:center;\n}\n\n.panz1{\n\tborder: 1px solid #000;\n\tcolor: #000;\n\theight: 18px;\n\twidth: 20px;\n\tborder-color:white black black white;\n\tfont-size:15px;\n\ttext-align:center;\n}\n\n</style> \n\n\n";
echo "\n\n<table width='860' border='0' align='center' cellpadding='0' cellspacing='0'>\n <tr>\n <td width='465' rowspan='4'><img src='http://" . $ro->getMyUrl() . "/COCONUT/myImages/logoclaims.jpg' width='261' height='90'/></td>\n <td width='448'><div align='left'><span class='style1'>This Form may be reproduced and is NOT FOR SALE</span></div></td>\n </tr>\n <tr>\n <td><div align='center' class='style3'>CF2</div></td>\n </tr>\n <tr>\n <td><div align='center'><span class='style5'>(Claim Form)<br />\n Revised February 2010</span><br />\n </div></td>\n </tr>\n <tr>\n <td><img src='http://" . $ro->getMyUrl() . "/COCONUT/myImages/Graphic2.jpg' width='416' height='32' /><br /></td>\n </tr>\n</table>\n";
echo "\n\n\n<table width='860' border='0' align='center' cellpadding='0' cellspacing='0'>\n <tr>\n <td><span class='style1'><font size=1><b>IMPORTANT REMINDERS</b></font></span></td>\n </tr>\n <tr>\n <td><span class='style1'><font size=1>PLEASE WRITE IN CAPITAL <b>LETTERS</b> AND <b>CHECK</b> THE APPROPRIATE BOXES.</font></span></td>\n </tr>\n <tr>\n <td><font size=1>For local confinement, this form together with CF1 and other supporting documents should be filed within <b>60 DAYS</b> from date of discharge. </font> </td>\n </tr>\n <tr>\n <td class='style1'><font size=1>All information required in this form are necessary and claim forms with incomplete information shall not be processed.</font></td>\n </tr>\n <tr>\n <td><span class='style1'><font size=1>FALSE/INCORRECT INFORMATION OR MISREPRESENTATION SHALL BE SUBJECT TO CRIMINAL, CIVIL OR ADMINISTRATIVE LIABILITIES</font></span></td>\n </tr>\n</table>\n\n";
echo "\n\n<br />\n<table width='860' border='0' align='center' cellpadding='0' cellspacing='0' bordercolor='#000000'>\n <tr>\n <td><div align='center' style='border:1px #000 solid;'><font size=3><b>PART 1 - PROVIDER INFORMATION (Institutional Health Care Provider to fill out items 1 to 13)</b></font></font> </div></td>\n </tr>\n</table>\n<br><table width='860' border='0' align='center' cellpadding='0' cellspacing='0'>\n <tr>\n <td width='115'><span class='style7'><font size=2>1. Name of Facility:</font></span></td>\n <td width='725'><input class='hospitalName' type=text value='" . $ro->getReportInformation("hmoSOA_name") . "' ></td>\n </tr>\n <tr>\n <td><span class='style7'><font size=2>2. Address:</font></span></td>\n <td><input type=text class='hospitalName' value='" . $ro->getReportInformation("hmoSOA_address") . "'></td>\n </tr>\n</table>\n";
$pinNo = preg_split("/\\-/", $ro->getRegistrationDetails_PIN());
//kkuning ung phic pin No
echo "\n<table width='860' border='0' align='center' cellpadding='0' cellspacing='0'>\n <tr>\n <td width='190'><span class='style7'><font size=1>3. PhilHealth Accreditation No.(PAN):</font> </span><br /><font size=1><b>\n( Institutional Health Care Provider )</b></font></td>\n <td>\n<input type=text class='panz' maxlength=1 value='" . substr($ro->getReportInformation("PAN"), -9, 1) . "'><input type=text class='panz1' maxlength=1 value='" . substr($ro->getReportInformation("PAN"), -8, 1) . "'><input type=text maxlength=1 class='panz1' value='" . substr($ro->getReportInformation("PAN"), -7, 1) . "'><input type=text class='panz1' maxlength=1 value='" . substr($ro->getReportInformation("PAN"), -6, 1) . "'><input type=text maxlength=1 class='panz1' value='" . substr($ro->getReportInformation("PAN"), -5, 1) . "'><input type=text maxlength=1 class='panz1' value='" . substr($ro->getReportInformation("PAN"), -4, 1) . "'><input type=text maxlength=1 class='panz1' value='" . substr($ro->getReportInformation("PAN"), -3, 1) . "'><input type=text maxlength=1 class='panz1' value='" . substr($ro->getReportInformation("PAN"), -2, 1) . "'><input type=text maxlength=1 class='panz1' value='" . substr($ro->getReportInformation("PAN"), -1, 1) . "'>\n </td>\n<Td width='240'><font size=2>4.Category of Facility:</font></td>\n </tr>\n<tr>\n<Td><Font size='1'>5.PhilHealth Identification No.(PIN):</font><br><font size=1> \n\n\n( Member )</font></td>\n<td>";
echo "<input type=text maxlength=1 class='panz' value='" . substr($pinNo[0], 0, 1) . "'><input type=text maxlength=1 class='panz1' value='" . substr($pinNo[0], 1, 1) . "'>-";
echo "<input type=text maxlength=1 class='panz' value='" . substr($pinNo[0], 2, 1) . "'><input type=text maxlength=1 class='panz1' value='" . substr($pinNo[0], 3, 1) . "'><input type=text maxlength=1 class='panz1' value='" . substr($pinNo[0], 4, 1) . "'><input type=text maxlength=1 class='panz1' value='" . substr($pinNo[0], 5, 1) . "' ><input type=text maxlength=1 class='panz1' value='" . substr($pinNo[0], 6, 1) . "' ><input type=text maxlength=1 class='panz1' value='" . substr($pinNo[0], 7, 1) . "'><input type=text maxlength=1 class='panz1' value='" . substr($pinNo[0], 8, 1) . "'><input type=text maxlength=1 class='panz1' value='" . substr($pinNo[0], 9, 1) . "'><input type=text maxlength=1 class='panz1' value='" . substr($pinNo[0], 10, 1) . "'>-<input type=text maxlength=1 class='panz' value='" . substr($pinNo[0], 11, 1) . "'>";
//echo "<u><font size=3>".$ro->getRegistrationDetails_PIN()."</font></u>";
///CATEGORY OF FACILITY
if ($ro->getReportInformation("Facility") == "T-L4/L3") {
echo "\n<Td> <input type=checkbox class='checkBox' name='facility' checked><font size=2>T-L4/L3</font> <input type=checkbox class='checkBox' name='facility'><font size=2>ASC</font> <input type=checkbox name='facility'><font size=2>RHU</font><br>\n <input type=checkbox name='facility'><font size=2>S-L2</font> <input type=checkbox name='facility'><font size=2>FDC</font>\n <input type=checkbox name='facility'><font size=2>TB-DOTS</font><br>\n <input type=checkbox name='facility'><font size=2>P-L1</font>\n <input type=checkbox name='facility'><font size=2>MCP</font>\n <input type=checkbox name='facility'><font size=2>__________</font><br> \n <font size=1>(OTHERS)</font>\n</tD>\n</tr>\n</table>\n";
} else {
if ($ro->getReportInformation("Facility") == "ASC") {
echo "\n<Td> <input type=checkbox class='checkBox' name='facility'><font size=2>T-L4/L3</font> <input type=checkbox class='checkBox' name='facility' checked><font size=2>ASC</font> <input type=checkbox name='facility'><font size=2>RHU</font><br>\n <input type=checkbox name='facility'><font size=2>S-L2</font> <input type=checkbox name='facility'><font size=2>FDC</font>\n <input type=checkbox name='facility'><font size=2>TB-DOTS</font><br>\n <input type=checkbox name='facility'><font size=2>P-L1</font>\n <input type=checkbox name='facility'><font size=2>MCP</font>\n <input type=checkbox name='facility'><font size=2>__________</font><br> \n <font size=1>(OTHERS)</font>\n</tD>\n</tr>\n</table>\n";
} else {
if ($ro->getReportInformation("Facility") == "RHU") {
echo "\n<Td> <input type=checkbox class='checkBox' name='facility'><font size=2>T-L4/L3</font> <input type=checkbox class='checkBox' name='facility'><font size=2>ASC</font> <input type=checkbox name='facility' checked><font size=2>RHU</font><br>\n <input type=checkbox name='facility'><font size=2>S-L2</font> <input type=checkbox name='facility'><font size=2>FDC</font>\n <input type=checkbox name='facility'><font size=2>TB-DOTS</font><br>\n <input type=checkbox name='facility'><font size=2>P-L1</font>\n <input type=checkbox name='facility'><font size=2>MCP</font>\n <input type=checkbox name='facility'><font size=2>__________</font><br> \n <font size=1>(OTHERS)</font>\n</tD>\n</tr>\n</table>\n";
} else {
if ($ro->getReportInformation("Facility") == "S-L2") {
echo "\n<Td> <input type=checkbox class='checkBox' name='facility'><font size=2>T-L4/L3</font> <input type=checkbox class='checkBox' name='facility'><font size=2>ASC</font> <input type=checkbox name='facility' ><font size=2>RHU</font><br>\n <input type=checkbox name='facility' checked><font size=2>S-L2</font> <input type=checkbox name='facility'><font size=2>FDC</font>\n <input type=checkbox name='facility'><font size=2>TB-DOTS</font><br>\n <input type=checkbox name='facility'><font size=2>P-L1</font>\n <input type=checkbox name='facility'><font size=2>MCP</font>\n <input type=checkbox name='facility'><font size=2>__________</font><br> \n <font size=1>(OTHERS)</font>\n</tD>\n</tr>\n</table>\n";
} else {
<?php
include "../../../myDatabase.php";
$username = $_GET['username'];
$doctor = $_GET['doctor'];
$month = $_GET['month'];
$day = $_GET['day'];
$year = $_GET['year'];
$fromTime_hour = $_GET['fromTime_hour'];
$fromTime_minutes = $_GET['fromTime_minutes'];
$fromTime_seconds = $_GET['fromTime_seconds'];
$toTime_hour = $_GET['toTime_hour'];
$toTime_minutes = $_GET['toTime_minutes'];
$toTime_seconds = $_GET['toTime_seconds'];
$ro = new database();
echo "<center><font size=5><b>" . $ro->getReportInformation("hmoSOA_name") . "</b></font></centeR>";
$ro->getDoctorPatientReport($username, $doctor, $month, $day, $year, $fromTime_hour, $fromTime_minutes, $fromTime_seconds, $toTime_hour, $toTime_minutes, $toTime_seconds);
<?php
include "../../../myDatabase.php";
$doctorName = $_GET['doctorName'];
$month = $_GET['month'];
$day = $_GET['day'];
$year = $_GET['year'];
$month1 = $_GET['month1'];
$day1 = $_GET['day1'];
$year1 = $_GET['year1'];
$ro = new database();
echo "<center><font size=5><b>" . $ro->getReportInformation("hmoSOA_name") . "</b></font>\n<br> <font size=4><b>PF LISTING</b></font>\n<br><font size=2><b>( {$month} {$day}, {$year} - {$month1} {$day1}, {$year1} )</b></font>\n\n</centeR>";
echo "<br><br>";
$ro->individual_doc_PF($doctorName, $month, $day, $year, $month1, $day1, $year1);
echo "<Br><br><br>";
<?php
include "../../myDatabase.php";
$registrationNo = $_GET['registrationNo'];
$ro = new database();
$ro->getPatientProfile($registrationNo);
$ro->getReportInformation(hmoSOA_name);
$ro->getReportInformation(hmoSOA_address);
?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
<title>Untitled Document</title>
<style type="text/css">
<!--
.style1 {font-size: 24px}
.style2 {font-size: 16px}
-->
</style>
</head>
<body>
<form id="form1" name="form1" method="post" action="">
<p> </p>
<table width="900" border="1" cellspacing="0" cellpadding="0">
<tr>
<td><div align="center"><span class="style1">SANDIG MEDICAL CLINIC AND HOSPITAL </span></div></td>
</tr>
<tr>
<?php
include "../myDatabase.php";
$remitted = $_GET['departmentStatus'];
$username = $_GET['username'];
$quantity = $_GET['quantity'];
$batchNo = $_GET['batchNo'];
$dispensed = $_GET['dispensed'];
$countz = count($remitted);
$qty = count($quantity);
$disp = count($dispensed);
$ro = new database();
$ro->getDispensedNo();
$myFile = $ro->getReportInformation("homeRoot") . "/COCONUT/trackingNo/dispensedNo.dat";
$fh = fopen($myFile, 'r');
$dispensedNo = fread($fh, 100);
fclose($fh);
$timezone = "Asia/Manila";
date_default_timezone_set($timezone);
for ($i = 0, $g = 0; $i < $countz, $g < $qty; $i++, $g++) {
//FOR LOOP
if ($ro->checkInventory($remitted[$i]) == "PHARMACY" || $ro->checkInventory($remitted[$i]) == "CSR") {
if ($ro->getChargesStatus($remitted[$i]) != "Return") {
$ro->remitNow($remitted[$i], "dispensedBy_" . $username);
$ro->editNow("patientCharges", "itemNo", $remitted[$i], "departmentStatus_time", date("H:i:s"));
//MAGBBWAS SA QUANTITY NG CURRENT INVENTORY
$ro->changeQTY($ro->getChargesCode($remitted[$i]), $ro->getCurrentQTY($ro->getChargesCode($remitted[$i])) - $quantity[$g]);
//echo $ro->getChargesCode($remitted[$i])."_".$remitted[$i];
//echo $quantity;
} else {
$ro->changeQTY($ro->getChargesCode($remitted[$i]), $ro->getCurrentQTY($ro->getChargesCode($remitted[$i])) + $quantity[$g]);
.style2 {
font-family: Verdana;
font-size: 12px;
color: #000000;
font-weight: bold;
}
.style3 {
font-family: Verdana;
font-size: 10px;
color: #000000;
font-weight: bold;
}
.style4 {
font-family: Verdana;
font-size: 9px;
color: #000000;
}
-->
</style>
</head>
<body>
<?php
echo "\n<div align='center'>\n <table width='1000' border='0' cellspacing='0' cellpadding='0'>\n <tr>\n <td height='92'><div align='center'><span class='style1'>Republic of the Philippines</span><br />\n <span class='style2'>PHILIPPINE HEALTH INSURANCE CORPORATION</span><br />\n <span class='style1'>14th Floor, Citystate Centre<br />\n 709 Shaw Blvd., Pasig City</span><br />\n <br />\n <span class='style2'>TRANSMITTAL LETTER - {$type}</span></div></td>\n </tr>\n <tr>\n <td height='20'></td>\n </tr>\n <tr>\n <td height='450' valign='top'><div align='center'>\n <table width='100%' border='1' cellpadding='0' cellspacing='0' bordercolor='#000000'>\n <tr>\n <td height='35' colspan='4'><div align='left'><span class='style1'> NAME OF HOSPITAL</span><br />\n <span class='style2'> " . $ro->getReportInformation("hmoSOA_name") . "</span></div></td>\n <td width='16%' rowspan='2'><div align='center'><span class='style1'>ACCREDITATION<br /><br /></span>\n <span class='style3'>312432<br />\n / 312432 </span></div></td>\n <td colspan='2'><div align='left'><span class='style1'> DATE FILED:</span> <span class='style3'> {$fromMonth} {$fromDay}, {$fromYear} </span> </div></td>\n </tr>\n <tr>\n <td height='35' colspan='4'><div align='left'><span class='style1'> ADDRESS</span><br />\n <span class='style3'> " . $ro->getReportInformation("hmoSOA_address") . "</span> </div></td>\n <td colspan='2'><div align='left'><span class='style1'> TRANSMITTAL NUMBER:</span> <span class='style3'>" . date("His") . " - {$tn3}</span> </div></td>\n </tr>\n <tr>\n <td height='25' colspan='2' class='style3'><div align='center'>PHI No. G/S </div></td>\n <td width='18%' class='style3'><div align='center'>Name of Member </div></td>\n <td width='18%' class='style3'><div align='center'>Name of Patient </div></td>\n <td class='style3'><div align='center'>Confinement Period </div></td>\n <td width='27%' class='style3'><div align='center'>Final Diagnosis </div></td>\n <td width='10%' class='style3'><div align='center'>Amount Claim </div></td>\n </tr>\n";
$ro->phicTransmital($fromMonth, $fromDay, $fromYear, $type);
echo "\n </table>\n </div></td>\n </tr>\n <tr>\n <td height='70'><div align='left'>\n <table width='100%' border='0' cellspacing='0' cellpadding='0'>\n <tr>\n <td height='30' colspan='6'><div align='left' class='style1'>This is to certify that all claims and information stated above are true and correct based on my personal knowledge and on hospital records. </div></td>\n </tr>\n <tr>\n <td width='20%'><div align='left' class='style1'>PAGE NO.: 1</div></td>\n <td width='31%'></td>\n <td width='9%' class='style1'><div align='left'>Signature</div></td>\n <td width='2%' class='style1'><div align='center'>:</div></td>\n <td colspan='2' class='style1'>_________________________________</td>\n </tr>\n <tr>\n <td></td>\n <td></td>\n <td class='style1'><div align='left'>Name (Print) </div></td>\n <td class='style1'><div align='center'>:</div></td>\n <td colspan='2' class='style1'>________<u>Ricardo Osit</u>__________</td>\n </tr>\n <tr>\n <td></td>\n <td></td>\n <td class='style1'></td>\n <td class='style1'></td>\n <td width='20%' class='style4'><div align='center'>Quality Management Representative </div></td>\n <td width='18%' class='style1'></td>\n </tr>\n </table>\n </div></td>\n </tr>\n\t<tr>\n\t <td colspan='7'> </td>\n\t</tr>\n </table>\n</div>\n";
?>
</body>
</html>
$(this).parent().prev().find("span.arrow:first").removeClass("pre_hover");
}
);
</script>
<?php
$description1 = $_GET['description'];
$genericName1 = $_GET['genericName'];
if ($status == "new") {
$ro->getInventoryStockCardNo();
$myFile = $ro->getReportInformation("homeRoot") . "/COCONUT/trackingNo/stockCardNo.dat";
$fh = fopen($myFile, 'r');
$stockCardNo = fread($fh, 100);
fclose($fh);
} else {
$stockCardNo = $oldStockCardNo;
}
echo "<body onload='DisplayTime();'>";
echo "<form method='post' action='addInventory_insert.php'>";
echo "<input type='hidden' name='description1' value='{$description1}' />";
echo "<input type='hidden' name='genericName1' value='{$genericName1}' />";
echo "<input type='hidden' name='classification' value='' />";
echo "<br><center><div style='border:1px solid #000000; width:500px; height:500px; border-color:black black black black;'>";
echo "<br><table border=0 cellpadding=0 cellspacing=0>";
echo "<input type=hidden name='inventoryType' value='medicine'>";
echo "<input type=hidden name='addedBy' value='{$username}'>";
<?php
include "../../myDatabase.php";
$username = $_GET['username'];
$ro = new database();
echo " \n <html>\n<head>\n<script type='text/javascript'>\nfunction RefreshTable()\n{\nif (window.XMLHttpRequest)\n{// code for IE7+, Firefox, Chrome, Opera, Safari\nxmlhttp=new XMLHttpRequest();\n}\nelse\n{// code for IE6, IE5\nxmlhttp=new ActiveXObject('Microsoft.XMLHTTP');\n}\nxmlhttp.onreadystatechange=function()\n{\nif (xmlhttp.readyState==4 && xmlhttp.status==200)\n{\ndocument.getElementById('tablediv').innerHTML=xmlhttp.responseText;\n}\n}\nxmlhttp.open('GET','requestDelete.php?username={$username}',true);\nxmlhttp.send();\n\nwindow.setTimeout(function(){ RefreshTable()}," . $ro->getReportInformation("exceededLimit") . ");\n}\n\n</script>\n</head>\n<body onload=RefreshTable()>\n <div id=tablediv></div>\n</body>\n</html>";
if ($ro->getTotal("phic", "PROFESSIONAL FEE", $registrationNo) > 0) {
$pf_phic += $ro->getPatient_phic();
} else {
}
if ($ro->getTotal("company", "PROFESSIONAL FEE", $registrationNo) > 0) {
$pf_company += $ro->getPatient_company();
} else {
}
if ($ro->getTotal("cashUnpaid", "PROFESSIONAL FEE", $registrationNo) > 0) {
$pf_cash += $ro->getPatient_cashUnpaid();
} else {
}
/*****************************************************/
/************* DISCOUNT ******************************/
$patientDiscount = 0;
if ($ro->getRegistrationDetails_discount() != "") {
$patientDiscount = $ro->getRegistrationDetails_discount();
} else {
$patientDiscount = "0.00";
}
/*****************************************************/
/***************** PAYMENT **************************/
$ro->getPaymentHistory_showUp_returnPaid_setter($registrationNo);
/****************************************************/
$gross = $hospitalBill_cash - $ro->getPaymentHistory_showUp_returnPaid();
$grandTotal = $gross - $ro->getRegistrationDetails_discount() + $pf_cash;
$content = "\n<div align='center' style='border:0px solid #000000; width:700px; height:auto; border-color:black black black black;' >\n<font size=5><b>" . $ro->getReportInformation("hmoSOA_name") . "</b></font>\n<br><font size=2>" . $ro->getReportInformation("hmoSOA_address") . "</font>\n<br><br>\n</div>\n<table >\n<tr>\n<td><b>" . $ro->coconutText("Name") . ":</b> </td><td> " . $ro->getPatientRecord_lastName() . ", " . $ro->getPatientRecord_firstName() . "</td>\n<td> </td><td>" . $ro->coconutText("Reg#") . "</td><td> {$registrationNo}</td>\n</tr>\n\n<tr>\n<Td><b>" . $ro->coconutText("PHIC") . ":</b> </td><td> " . $ro->getPatientRecord_phic() . "</td>\n<td> </td>\n<td><b>CaseType:</b></td><TD>" . $ro->getRegistrationDetails_caseType() . "</tD>\n</tr>\n\n<tr>\n<Td><b>" . $ro->coconutText("Company") . ":</b> </td><td> " . $ro->getRegistrationDetails_company() . "</td>\n<td> </tD>\n<Td><b>" . $ro->coconutText("Fx Diagnosis:") . ":</b> </td><td> " . $ro->getRegistrationDetails_finalDiagnosis() . "</td>\n</tr>\n\n<tr>\n<Td><b>" . $ro->coconutText("Admitted") . ":</b> </td><td> " . $ro->getRegistrationDetails_dateRegistered() . "</td>\n<td> </td>\n<Td><b>" . $ro->coconutText("Discharged") . ":</b> </td><td> " . $ro->getRegistrationDetails_dateUnregistered() . "</td>\n</tr>\n\n<tr>\n<Td><b>" . $ro->coconutText("Age") . ":</b></tD><td> " . $ro->getPatientRecord_age() . "</tD>\n<tD> </tD>\n<Td><b>" . $ro->coconutText("Room:") . "</b></tD><td>" . $ro->getRegistrationDetails_room() . "</tD>\n</tr>\n\n<tr>\n<td><b>" . $ro->coconutText("Att.Doctor") . ":</b></tD><td> <font size=2>" . $ro->getAttendingDoc($registrationNo, "Attending") . "</font></td>\n<td></td>\n<td><b>" . $ro->coconutText("Admitting Doc") . ":</b></td><tD> <font size=2>" . $ro->getAttendingDoc($registrationNo, "Admitting") . "</font></tD>\n</tr>\n</table>\n\n<table>\n<td><b>Address:</b> </tD>\n<tD>" . $ro->getPatientRecord_address() . "</tD>\n</table>\n\n<br><br>\n\n<table border=1 cellpadding=1 cellspacing=0>\n<tr>\n<th> Particular </th>\n<th> Actual </th>\n<th> PhilHealth </th>\n<th> Company </th>\n<th> Cash </th>\n</tr>\n\n<tr>\n<td> Medicine </td>\n<Td> {$medActual}</td>\n<td> {$medPHIC}</td>\n<td> {$medCompany}</td>\n<td> {$medCash}</td>\n</tr>\n\n\n<Tr>\n<td> Supplies</td>\n<td> {$supActual}</td>\n<td> {$supPHIC}</td>\n<td> {$supCompany}</td>\n<Td> {$supCash}</td>\n</tr>\n\n<Tr>\n<td> Laboratory</td>\n<td> {$labActual}</td>\n<td> {$labPHIC}</td>\n<td> {$labCompany}</td>\n<Td> {$labCash}</td>\n</tr>\n\n<Tr>\n<td> Radiology</td>\n<td> {$radActual}</td>\n<td> {$radPHIC}</td>\n<td> {$radCompany}</td>\n<Td> {$radCash}</td>\n</tr>\n\n<Tr>\n<td> Nursing Charges</td>\n<td> {$nsChargesActual}</td>\n<td> {$nsChargesPHIC}</td>\n<td> {$nsChargesCompany}</td>\n<Td> {$nsChargesCash}</td>\n</tr>\n\n<Tr>\n<td> Miscellaneous</td>\n<td> {$miscActual}</td>\n<td> {$miscPHIC}</td>\n<td> {$miscCompany}</td>\n<Td> {$miscCash}</td>\n</tr>\n\n<Tr>\n<td> Others</td>\n<td> {$othersActual}</td>\n<td> {$othersPHIC}</td>\n<td> {$othersCompany}</td>\n<Td> {$othersCash}</td>\n</tr>\n\n<Tr>\n<td> OR/DR/ER Fee</td>\n<td> {$orActual}</td>\n<td> {$orPHIC}</td>\n<td> {$orCompany}</td>\n<Td> {$orCash}</td>\n</tr>\n\n<Tr>\n<td> Rehab</td>\n<td> {$rehabActual}</td>\n<td> {$rehabPHIC}</td>\n<td> {$rehabCompany}</td>\n<Td> {$rehabCash}</td>\n</tr>\n\n<Tr>\n<td><font size=2>Room @ " . $ro->getQTY_room($registrationNo) . " day(s)</font> </td>\n<td> {$roomActual}</td>\n<td> {$roomPHIC}</td>\n<td> {$roomCompany}</td>\n<Td> {$roomCash}</td>\n</tr>\n\n<Tr>\n<td> <b>Hospital Bill</b></tD>\n<td> <b>" . number_format($hospitalBill_gt, 2) . "</b></tD>\n<td> <b>" . number_format($hospitalBill_phic, 2) . "</b></tD>\n<td> <b>" . number_format($hospitalBill_company, 2) . "</b></tD>\n<td> <b>" . number_format($hospitalBill_cash, 2) . "</b></tD>\n</tr>\n\n<Tr>\n<td> </tD>\n<td> </tD>\n<td> </tD>\n<td> </tD>\n<td> </tD>\n</tr>\n\n<tr>\n<td> </tD>\n<td> </tD>\n<td> </tD>\n<td> </tD>\n<td> </tD>\n</tr>\n\n" . $ro->getPatientDoc_soa2pdf($registrationNo) . "\n\n<tr>\n<td> <b>Professional Fee</b></tD>\n<td> <b>" . number_format($pf_gt, 2) . "</b></tD>\n<td> <b>" . number_format($pf_phic, 2) . "</b></tD>\n<td> <b>" . number_format($pf_company, 2) . "</b></tD>\n<td> <b>" . number_format($pf_cash, 2) . "</b></tD>\n</tr>\n\n\n<Tr>\n<td> </tD>\n<td> </tD>\n<td> </tD>\n<td> </tD>\n<td> </tD>\n</tr>\n\n<tr>\n<td> </tD>\n<td> </tD>\n<td> </tD>\n<td> </tD>\n<td> </tD>\n</tr>\n\n\n<tr>\n<td> <b>Total</b></tD>\n<td> <b>" . number_format($hospitalBill_gt + $pf_gt, 2) . "</b></tD>\n<td> <b>" . number_format($hospitalBill_phic + $pf_phic, 2) . "</b></tD>\n<td> <b>" . number_format($hospitalBill_company + $pf_company, 2) . "</b></tD>\n<td> <b>" . number_format($hospitalBill_cash + $pf_cash, 2) . "</b></tD>\n</tr>\n\n\n<tr>\n<td> <b>Discount</b></tD>\n<td> </tD>\n<td> </tD>\n<td> </tD>\n<td> <b>" . number_format($patientDiscount, 2) . "</b></tD>\n</tr>\n\n<tr>\n<td> <b>Grand Total</b></tD>\n<td> </tD>\n<td> </tD>\n<td> </tD>\n<td> <b>" . number_format($grandTotal, 2) . "</b></tD>\n</tr>\n\n<tr>\n<td> <b>Payments</b></tD>\n<td> </tD>\n<td> </tD>\n<td> </tD>\n<td> <b>" . number_format($ro->getPaymentHistory_showUp_returnPaid(), 2) . "</b></tD>\n</tr>\n\n<tr>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n</tr>\n\n\n<tr>\n<td> <b>BALANCE</b></td>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> <b> " . number_format($hospitalBill_cash + $pf_cash - $ro->getPaymentHistory_showUp_returnPaid(), 2) . " </b></td>\n</tr>\n\n</table>\n\n<br><br><br><br>\n<hr>\n<br><br>\n\n<Table>\n\n<td style='width:90%;'>\n<font size=2><u>MYNARD A. BAJO</u><Br><b>Billing Officer</b></font>\n</td>\n\n\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n\n\n\n\n\n<td>\n<font size=2><u>HAZEL S. CASTIGADOR</u><Br><b>Medical Clerk</b></font>\n</td>\n\n\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n\n<tr>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n\n<tD> \n<font size=2>Certified Correct:<br></font>\n<br>\n<font size=2><u>MARIBETH B. SANDIG</u><Br><b>Hospital Administrator</b></font>\n</tD>\n</tr>\n</table>\n\n<br><br><br><br><br><br><br>\n\n\n\n\n\n";
$pdfFile = "/opt/lampp/htdocs/SOA_" . $ro->getPatientRecord_lastName() . "_" . $ro->getPatientRecord_firstName() . "-" . $registrationNo . ".pdf";
$html2pdf->WriteHTML($content);
$html2pdf->Output($pdfFile);
//echo "<table border=1>".$ro->getPatientDoc_soa2pdf($registrationNo)."</table>"
<?php
include "../../../myDatabase.php";
$username = $_GET['username'];
$fromMonth = $_GET['fromMonth'];
$fromDay = $_GET['fromDay'];
$fromYear = $_GET['fromYear'];
$toMonth = $_GET['toMonth'];
$toDay = $_GET['toDay'];
$toYear = $_GET['toYear'];
$type = $_GET['type'];
$ro = new database();
echo "<center>";
echo "<font size=6>" . $ro->getReportInformation("hmoSOA_name") . "</font><bR>";
echo "<font size=3>" . $ro->getReportInformation("hmoSOA_address") . "</font><br><bR>";
echo "<font size=4><b>Doctor's PF Summary ({$type})</b></font><br>";
echo "<font size=2>({$fromMonth} {$fromDay}, {$fromYear} - {$toMonth} {$toDay}, {$toYear})</font><br><br>";
echo "<center>";
echo "<table border=2 cellpadding=0 cellspacing=0 rules=all>";
echo "<tr>";
echo "<th> Doctor </th>";
$ro->getHeaderBranch();
// ggwing table header ung mga branch
echo "<th> <b>TOTAL</b> </th>";
echo "</tr>";
$ro->listDoctorAsRow($type, $fromMonth, $fromDay, $fromYear, $toMonth, $toDay, $toYear);
echo "</table>";
?>
<?php
include "../../../myDatabase1.php";
$username = $_GET['username'];
$ro = new database();
$ro->coconutDesign();
$ro->getVouchersNo();
$myFile = $ro->getReportInformation("homeRoot") . "/COCONUT/trackingNo/voucherNo.dat";
$fh = fopen($myFile, 'r');
$voucherNo = fread($fh, 100);
fclose($fh);
$ro->coconutFormStart("get", "addVouchers_purchasing1.php");
$ro->coconutBoxStart("500", "420");
$ro->coconutHidden("voucherNo", $voucherNo);
$ro->coconutHidden("siNo", "");
$ro->coconutHidden("invoiceNo", "");
$ro->coconutHidden("vat", "");
$ro->coconutHidden("username", $username);
echo "<br>";
echo "<table>";
echo "<tr>";
echo "<TD>Check#</tD>";
echo "<TD>";
$ro->coconutTextBox("checkNo", "");
echo "</td>";
echo "</tr>";
echo "<tr>";
echo "<TD>Bank</tD>";
echo "<TD>";
$ro->coconutComboBoxStart_long("bank");
echo "<option value=''> </option>";
/LOGINPAGE/module.php"><font color=white>Home</font><span class="arrow"></span></a></li>
<li><a href="#" class="odd"><font color=white>Registration</font><span class="arrow"></span></a></li>
<li><a href="http://<?php
echo $ro->getMyUrl();
?>
/COCONUT/opdRegistration.php?module=REGISTRATION"><font color=white>Verify Patient Record</font><span class="arrow"></span></a></li>
<li><a href="#" class="odd"><font color=yellow><b>Registration Form</b></font><span class="arrow"></span></a></li>
<li><a href="#">Verify Registration<span class="arrow"></span></a></li>
<li><a href="#" class="odd">Patient<span class="arrow"></span></a></li>
<li> </li>
</ol>
<?php
$ro->getRegistrationNo();
$myFile = $ro->getReportInformation("homeRoot") . "/COCONUT/trackingNo/registrationNo.dat";
$fh = fopen($myFile, 'r');
$registrationNo = fread($fh, 100);
fclose($fh);
/*
$ro->getPatientID();
$myFile = "/opt/lampp/htdocs/COCONUT/trackingNo/patientID.dat";
$fh = fopen($myFile, 'r');
$patientNo = fread($fh, 100);
fclose($fh);
*/
//newRecord_insert.php
echo "<br><br>";
echo "<body>";
/****
if($ro->checkBalance($patientNo) != 0) {
$toYear = $_GET['toYear'];
$package = $_GET['package'];
$type = $_GET['type'];
$ro = new database();
$discharged = $fromMonth . "_" . $fromDay . "_" . $fromYear;
$discharged1 = $toMonth . "_" . $toDay . "_" . $toYear;
echo "\n\n<style type='text/css'>\n\n.datez{\n\tborder: 1px solid #000;\n\tcolor: #000;\n\theight: 28px;\n\twidth: 140px;\n\tborder-color:white white white white;\n\tfont-size:17px;\n\n}\n\n</style>\n\n\n";
echo "<center><font size=2>REPUBLIC OF THE PHILIPINES</font>";
echo "<br><font size=3><b>PHILIPINE HEALTH INSURANCE CORPORATION</b></font>";
echo "<br><font size=2>PHILHEALTH REGIONAL OFFICE - XII</font>";
echo "<br><font size=2>3rd FLOOR SIYAMBIO BLDG, ROXAS ST. KORONADAL CITY</font></center>";
echo "<br><br><font size=2>PhilHealth Form No. 4</font>";
echo "<br> <font size=3 color=black><u><i><a href='#'>TRANSMITTAL LIST</a></i></u></font>";
echo "<table width='100%' border=0>";
echo "<tr>";
echo "<td><font size=3>HEALTH CARE PROVIDER:</font> <font size=3><u>" . $ro->getReportInformation("hmoSOA_name") . "</u></font></td>";
echo "<td><font size=3>PHIC ACCREDITATION NO:</font> <font size=3><u>" . $ro->getReportInformation("PAN") . "</u></font></td>";
echo "</tr>";
echo "<Tr>";
echo "<td><font size=3>ADDRESS:</font> <font size=3><u>" . $ro->getReportInformation("hmoSOA_address") . "</u></font></td>";
echo "<tD><font size=3>HOSPITAL CATEGORY:</font> <font size=3><u>Secondary</u></font>\n<br>\n<font size=3>ACCREDITED BED CAPACITY</font> \n<font size=3><u>25 Beds</u></font>\n</td>";
echo "</tr>";
echo "</table>";
echo "<br>";
echo "<Table border=1 cellspacing=0>";
echo "<tr>";
echo "<th><font size=2>PHIC NUMBER</font></th>";
echo "<th> <font size=2>NAME OF<br> MEMBER</font> </th>";
echo "<th><font size=2>NAME/<br>RELATIONSHIP</font></th>";
echo "<th><font size=2>member</font></th>";
echo "<th><font size=2>AGE</font></th>";
include "../../../myDatabase.php";
$registrationNo = $_GET['registrationNo'];
$username = $_GET['username'];
$category = $_GET['category'];
$ro = new database();
$ro->getPatientProfile($registrationNo);
?>
<link rel="stylesheet" type="text/css" href="http://<?php
echo $ro->getMyUrl();
?>
/COCONUT/myCSS/coconutCSS.css" />
<?php
echo "<br><center><div style='border:0px solid #000000; width:825px; height:auto; border-color:black black black black;'>";
echo "<font size=4><b>" . $ro->getReportInformation("hmoSOA_name") . "</b></font><br>";
echo "<font size=2>" . $ro->getReportInformation("hmoSOA_address") . "</font><br>";
echo "<font size=2>" . $ro->getRegistrationDetails_branch() . "</font><br>";
echo "<br><br>";
echo "<table border=0>";
echo "<tr>";
echo "<td><font class='labelz'><b>Name:</b></font></td><td><font size=2>" . $ro->getPatientRecord_completeName() . "</font></td>";
echo "<td> </td>";
echo "<Td><font class='labelz'><b>Registration#:</b></font></td>";
echo "<td><font size=2>" . $ro->getRegistrationDetails_registrationNo() . "</td>";
echo "</tr>";
echo "<tr>";
echo "<Td><font class='labelz'><B>Age:</b></td>";
echo "<Td><font size=2>" . $ro->getPatientRecord_age() . " yrs Old</font></td>";
echo "<Td> </td>";
echo "<td><font class='labelz'><b> Senior:</b></font></td>";
}
}
}
$dateUnregistered_day = "|" . substr($dateUnregistered[1], -2, 1) . "|" . substr($dateUnregistered[1], -1, 1) . "|";
$dateUnregistered_year = "|" . substr($dateUnregistered[2], -4, 1) . "|" . substr($dateUnregistered[2], -3, 1) . "|" . substr($dateUnregistered[2], -2, 1) . "|" . substr($dateUnregistered[2], -1, 1) . "|";
/*******************************************************************/
/*************** TIME DISCHARGED *****************************/
$timeUnregistered = preg_split("/\\:/", $ro->getRegistrationDetails_timeUnregistered());
$timeUnreg = "";
if ($timeUnregistered[0] < 12) {
$timeUnreg = "<span style='font-size:11px;'>|<a style='color:black;'>" . $timeUnregistered[0] . ":" . $timeUnregistered[1] . "</a>| AM |<a style='color:black;'> </a>| PM</span>";
} else {
$timeUnreg = "<span style='font-size:11px;'>|<a style='color:black;'> </a>| AM |<a style='color:black;'>" . $timeUnregistered[0] . ":" . $timeUnegistered[1] . "</a>| PM</span>";
}
/************************************************************/
$content = "\n<table width='860' border='0' align='center' cellpadding='0' cellspacing='0'>\n <tr>\n <td width='430' rowspan='4'><img src='http://" . $ro->getMyUrl() . "/COCONUT/myImages/logoclaims.jpg' width='261' height='90'/></td>\n <td width='348'><div align='left'><span style='font-size:10px;'>This Form may be reproduced and is NOT FOR SALE</span></div></td>\n </tr>\n\n <tr>\n<td> \n \n \n\n<div style='font-size:45px;'>CF2</div></td>\n </tr>\n\n <tr>\n <td>\n \n \n \n<div> <span style='font-size:10px;'>(Claim Form)<br />\n Revised February 2010</span><br />\n </div></td>\n </tr>\n\n <tr>\n <td><img src='http://" . $ro->getMyUrl() . "/COCONUT/myImages/Graphic2.jpg' width='330' height='32' /><br /></td>\n </tr>\n\n</table>\n\n<br><br>\n\n<table width='860' border='0' cellpadding='0' cellspacing='0'>\n\n <tr>\n <td><span style='font-size:8px;'><font size=1><b>IMPORTANT REMINDERS</b></font></span></td>\n </tr>\n\n <tr>\n <td><span style='font-size:8px;'><font size=1>PLEASE WRITE IN CAPITAL <b>LETTERS</b> AND <b>CHECK</b> THE APPROPRIATE BOXES.</font></span></td>\n </tr>\n\n <tr>\n <td><span style='font-size:8px;'>For local confinement, this form together with CF1 and other supporting documents should be filed within <b>60 DAYS</b> from date of discharge. </span> </td>\n </tr>\n\n <tr>\n <td><span style='font-size:8px;'>All information required in this form are necessary and claim forms with incomplete information shall not be processed.</span></td>\n </tr>\n\n <tr>\n <td><span style='font-size:8px;'><font size=1>FALSE/INCORRECT INFORMATION OR MISREPRESENTATION SHALL BE SUBJECT TO CRIMINAL, CIVIL OR ADMINISTRATIVE LIABILITIES</font></span></td>\n </tr>\n\n</table>\n\n\n<br>\n<table width='750' border='0' cellpadding='0' cellspacing='0' bordercolor='#000000'>\n <tr>\n <td><div align='center' style='border:1px #000 solid;'><font size=3><b>PART 1 - PROVIDER INFORMATION (Institutional Health Care Provider to fill out items 1 to 13)</b></font> </div></td>\n </tr>\n</table>\n<br>\n<table width='860' border='0' align='center' cellpadding='0' cellspacing='0'>\n\n <tr>\n <td width='95'><span style='font-size:11px;'><font size=2>1. Name of Facility:</font></span></td>\n <td width='725'><a style='color:black; font-size:11px;'>" . $ro->getReportInformation("hmoSOA_name") . " </a></td>\n </tr>\n\n <tr>\n <td><span style='font-size:11px;'><font size=2>2. Address:</font></span></td>\n <td><a style='font-size:11px; color:black;'>" . $ro->getReportInformation("hmoSOA_address") . "' </a></td>\n </tr>\n\n</table>\n\n<table width='860' border='0' cellpadding='0' cellspacing='0'>\n<tr>\n<td width='170'><span style='font-size:10px;'><font size=1>3. PhilHealth Accreditation No.(PAN):</font> </span><br>\n<span style='font-size:9px;'><b>( Institutional Health Care Provider )</b></span></td>\n<td><a style='font-size:11px; color:black;'>| {$hospitalPin1} | {$hospitalPin2} | {$hospitalPin3} | {$hospitalPin4} | {$hospitalPin5} | {$hospitalPin6} | {$hospitalPin7} | {$hospitalPin8} | {$hospitalPin9} |</a><br> </td>\n<Td> \n \n \n<span style='font-size:11px;'>4.Category of Facility:</span></td>\n</tr>\n\n<tr>\n<Td><span style='font-size:10px;'>5.PhilHealth Identification No.(PIN):</span><br><span style='font-size:9px;'> \n( Member )</span></td>\n<td><a style='font-size:11px; color:black;'>| {$patientPin1} | {$patientPin2} | {$patientPin3} | {$patientPin4} | {$patientPin5} | {$patientPin6} | {$patientPin7} | {$patientPin8} | {$patientPin9} | {$patientPin10} | {$patientPin11} | {$patientPin12} |</a><br> </td>\n\n\n\n<Td>\n \n \n \n<input type='checkbox' style='border:solid 1mm black;' name='facility' checked> <span style='font-size:10px;'>T-L4/L3</span>\n \n<input type='checkbox' style='border:solid 1mm black;' name='facility' checked> <span style='font-size:10px;'>ASC</span>\n \n<input type='checkbox' style='border:solid 1mm black;' name='facility' checked> <span style='font-size:10px;'>RHU</span>\n<br>\n \n \n \n<input type='checkbox' style='border:solid 1mm black;' name='facility' checked> <span style='font-size:10px;'>S-L2</span>\n \n<input type='checkbox' style='border:solid 1mm black;' name='facility' checked> <span style='font-size:10px;'>FDC</span>\n \n<input type='checkbox' style='border:solid 1mm black;' name='facility' value='x'> <span style='font-size:10px;'>TB-DOTS</span>\n<br>\n \n \n \n<input type='checkbox' style='border:solid 1mm black;' name='facility' value='x'> <span style='font-size:10px;'>P-L1</span>\n \n<input type='checkbox' style='border:solid 1mm black;' name='facility' value='x'> <span style='font-size:10px;'>MCP</span>\n \n<input type='checkbox' style='border:solid 1mm black;' name='facility' value='x'> <span style='font-size:10px;'><a> </a><br>\n \n \n \n \n \n\n<span style='font-size:9px;'>(OTHERS)</span>\n</span>\n</tD>\n\n\n</tr>\n\n</table>\n\n\n<Table width='860' border=0>\n<tr>\n<Td width='101'><span style='font-size:11px;'>6. Name of Patient:</span><Br></tD>\n</tr>\n<tr>\n<td><span style='font-size:12px;'><a style='color:black;'>" . $ro->getPatientRecord_lastName() . " \n" . $ro->getPatientRecord_firstName() . " " . $ro->getPatientRecord_middleName() . "\n \n \n \n \n</a></span><br><span style='font-size:11px;'>Last Name</span> <span style='font-size:11px;'>First Name</span> <span style='font-size:11px;'>Middle Name</span></td>\n</tr>\n\n<tr><tD> </tD></tr>\n</table>\n\n<table>\n<Tr>\n<td width='77px;'><span style='font-size:11px;'>7.Date of Birth:</span></td>\n<td width='130px;'><span style='font-size:11px;'><a style='color:black;'>{$month} - {$day} - {$year} </a></span></td>\n<td><span style='font-size:11px;'>8.Age</span></td>\n<td width='250px;'><span style='font size:11px;'><a style='color:black;'>| " . $ro->getPatientRecord_Age() . " |</a></span>\n <span style='font-size:9px;'>Year/s</span> <input type='checkbox' style='border:solid 1mm black;'>\n \n<span style='font-size:9px;'>Month/s</span> <input type='checkbox' style='border:solid 1mm black;'>\n \n<span style='font-size:9px;'>Days/s</span> <input type='checkbox' style='border:solid 1mm black;'>\n</tD>\n<td><span style='font-size:11px;'>9.Sex:</span></tD>\n<td><input type='checkbox' style='border:solid 1mm black;'> <span style='font-size:11px;'>Male</span>\n \n<input type='checkbox' style='border:solid 1mm black;'> <span style='font-size:11px;'>Female</span>\n</td>\n</tr>\n</table>\n\n<br>\n\n<table border=0>\n<tr>\n<tD><span style='font-size:12px;'>10. Confinement Period</span></tD>\n</tr>\n<tr>\n<td width='230px;'><span style='font-size:11px;'>a. Date Admitted:</span> <span style='font-size:11px;'><a style='color:black;'>{$dateRegistered_month}-{$dateRegistered_day}-{$dateRegistered_year}</a></span></td>\n<td width='240px;'><span style='font-size:11px;'>b. Time Addmitted:</span> {$timeReg}</td>\n<td><span style='font-size:11px;'>e. No. of Days Claimed: |<a style='font-size:11px; color:black;'> {$noDaysClaimed} </a>|</span></td>\n</tr>\n\n<tr>\n<td><span style='font-size:11px;'>c. Date Discharged: <a style='font-size:11px; color:black;'>{$dateUnregistered_month}-{$dateUnregistered_day}-{$dateUnregistered_year}</a></span></td>\n\n<td width='240px;'><span style='font-size:11px;'>d. Time Discharged: {$timeUnreg}</span></td>\n<td width='200px;'><span style='font-size:11px;'>f. In case of Death: <a style='color:black; font-size:11px;'>{$inCaseOfDeath}</a></span> <span style='font-size:9px;'>\nSpecify Date (month-day-year)\n</span></td>\n</tr>\n</table>\n\n<table width='100%;' align='left'>\n<tr>\n<td style='width:40%; text-align:left; border:solid 1px #000; background:#fff'><span style='font-size:9px;'> 11.Health Care Providers</span></td>\n<td style='width:15%; text-align:center; border:solid 1px #000; background:#fff'><span style='font-size:9px;'>Actual Charges</span></td>\n<td style='width:15%; text-align:center; border:solid 1px #000; background:#fff'><span style='font-size:9px;'>PhilHealth Benefits</span></td>\n<td style='width:20%; text-align:center; border:solid 1px #000; background:#fff'><span style='font-size:9px;'>For PhilHealth Use <Br> Only(Adjustments/Remarks)</span></td>\n</tr>\n\n<tr>\n<td style='width:40%; height:15px; text-align:left; border:solid 1px #000; background:#fff' ><span style='font-size:9px;'> a.Room and Board Private <input type='checkbox'> Public <input type='checkbox'> </span></td>\n<Td style='width:15%; height:15px; text-align:center; border:solid 1px #000; background:#fff' >{$phicRoom_actual}</tD>\n<Td style='width:15%; height:15px; text-align:center; border:solid 1px #000; background:#fff' >{$phicRoom_cover}</tD>\n<Td style='width:20%; height:15px; text-align:center; border:solid 1px #000; background:#fff' > {$phicRoom_remarks}</tD>\n</tr>\n\n<tr>\n<td style='width:40%; height:15px; text-align:left; border:solid 1px #000; background:#fff' ><span style='font-size:9px;'> b.Drugs and Medicine (Part II for details) </span></td>\n<Td style='width:15%; height:15px; text-align:center; border:solid 1px #000; background:#fff' >{$phicMeds_actual}</tD>\n<Td style='width:15%; height:15px; text-align:center; border:solid 1px #000; background:#fff' >{$phicMeds_cover}</tD>\n<Td style='width:20%; height:15px; text-align:center; border:solid 1px #000; background:#fff' > {$phicMeds_remarks}</tD>\n</tr>\n\n<tr>\n<td style='width:40%; height:15px; text-align:left; border:solid 1px #000; background:#fff' ><span style='font-size:9px;'> c.X-ray/Lab/Supplies & Others (Part III for details) </span></td>\n<Td style='width:15%; height:15px; text-align:center; border:solid 1px #000; background:#fff' >{$phicOthers_actual}</tD>\n<Td style='width:15%; height:15px; text-align:center; border:solid 1px #000; background:#fff' >{$phicOthers_cover}</tD>\n<Td style='width:20%; height:15px; text-align:center; border:solid 1px #000; background:#fff' > {$phicOthers_remarks}</tD>\n</tr>\n\n<tr>\n<td style='width:40%; height:15px; text-align:left; border:solid 1px #000; background:#fff' ><span style='font-size:9px;'> d.Operating Room Fee </span></td>\n<Td style='width:15%; height:15px; text-align:center; border:solid 1px #000; background:#fff' > {$phicOR_actual}</tD>\n<Td style='width:15%; height:15px; text-align:center; border:solid 1px #000; background:#fff' > {$phicOR_cover}</tD>\n<Td style='width:20%; height:15px; text-align:center; border:solid 1px #000; background:#fff' > {$phicOR_remarks}</tD>\n</tr>\n\n<tr>\n<td style='width:40%; height:15px; text-align:left; border:solid 1px #000; background:#fff' ><span style='font-size:9px;'> <b>TOTAL</b> </span></td>\n<Td style='width:15%; height:15px; text-align:center; border:solid 1px #000; background:#fff' >{$phicTotal_actual}</tD>\n<Td style='width:15%; height:15px; text-align:center; border:solid 1px #000; background:#fff' >{$phicTotal_cover}</tD>\n<Td style='width:20%; height:15px; text-align:center; border:solid 1px #000; background:#fff' >{$phicTotal_remarks}</tD>\n</tr>\n\n\n<tr>\n<td style='width:40%; height:15px; text-align:left; border:solid 1px #000; background:#fff' ><span style='font-size:9px;'> e.Benefit Package </span></td>\n<Td style='width:15%; height:15px; text-align:center; border:solid 1px #000; background:#fff' >{$phicPackage_actual}</tD>\n<Td style='width:15%; height:15px; text-align:center; border:solid 1px #000; background:#fff' >{$phicPackage_cover}</tD>\n<Td style='width:20%; height:15px; text-align:center; border:solid 1px #000; background:#fff' >{$phicPackage_remarks}</tD>\n</tr>\n</table>\n\n<table border=0>\n<tr>\n<td width='300px;'><span style='font-size:11px;'>12. Case Type*: <input type='checkbox'> A <input type='checkbox'> B <input type='checkbox'> C <input type='checkbox'> D</span>\n<br>\n<span style='font-size:7px;'>*This is only applicable for claims with fee for service payment <br>mechanism</span>\n</td>\n<td>\n<span style='font-size:11px;'>13.Complete ICD-10 Code/s:" . $ro->getPatientICD_code_2pdf($registrationNo) . "</span><br> \n</td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td><span style='font-size:9px;'><b>(Professional Health Care Providers to fill out items 14 to 16)</b></span></td>\n</tr>\n</table>\n\n\n<table width='860' align='center' cellpadding='0' cellspacing='0'>\n<tr>\n<td width='236' style='border:solid 1px #000;'><span style='font-size:11px;'> 14. Admission Diagnosis</span><br>\n<span style='font-size:11px;'>" . $ro->getRegistrationDetails_IxDx() . "</span>\n</td>\n\n<td width='488' style='border:solid 1px #000;'><span style='font-size:11px;'> 15.Complete Final Diagnosis</span><br>\n<span style='font-size:11px;'>\n" . $ro->getPatientICD_diagnosis_pdf($registrationNo) . "\n</span>\n</td>\n</tr>\n</table>\n<br>\n<br>\n<span style='font-size:11px;'>16.Professional Fees/Charges</span>\n<table border=0>\n<tr>\n<td style='border:1px solid #000; width:150px;'><span style='font-size:8px;'>a.Name of Professional<br>b.PhilHealth Accreditation No.</span></td>\n<td style='border:1px solid #000; width:150px;'><span style='font-size:8px;'>c.Number of Visits/RVS Code<br>d.Inclusive Dates(mm-dd-yyyy)</span> </td>\n<td style='border:1px solid #000; width:75px;'><span style='font-size:8px;'>e.Total Actual PC Charges</span> </td>\n<td style='border:1px solid #000; width:75px;'><span style='font-size:8px;'>f.PhilHealth Benefit</span> </td>\n<td style='border:1px solid #000; width:75px;'><span style='font-size:8px;'>g.Amount paid by members</span> </td>\n<td style='border:1px solid #000; width:75px;'><span style='font-size:8px;'>h.Signature<br>i.Date Signed</span> </td>\n<td style='border:1px solid #000; width:75px;'><span style='font-size:8px;'>For PhilHealth Use Only</span> </td>\n</tr>\n<tr>\n<td style='border:1px solid #000; width:150px; height:20px;' align='center'><a style='font-size:10px; color:black'>{$doctorName1}</a><span style='font-size:9px;'><a style='color:black;'>|{$accNo_1_1}|{$accNo_2_1}|{$accNo_3_1}|{$accNo_4_1}|-|{$accNo_5_1}|{$accNo_6_1}|{$accNo_7_1}|{$accNo_8_1}|{$accNo_9_1}|{$accNo_10_1}|{$accNo_11_1}|-|{$accNo_12_1}|</a></span></td>\n<td style='border:1px solid #000; width:150px; height:20px;' align='center'><span style='font-size:10px;'><a style='color:black;'>{$doctorService1}</a></span><br><span style='font-size:9px;'>{$doctorService_date1}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$actualDoctorCharges1}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$philhealthDoctorCharges1}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$amountPaidByMembers1}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$dateSigned1}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$phicUseOnly1}</span></td>\n</tr>\n\n<tr>\n<td style='border:1px solid #000; width:150px; height:18px;' align='center'><a style='font-size:10px; color:black'>{$doctorName2}</a><span style='font-size:9px;'><a style='color:black;'>|{$accNo_1_2}|{$accNo_2_2}|{$accNo_3_2}|{$accNo_4_2}|-|{$accNo_5_2}|{$accNo_6_2}|{$accNo_7_2}|{$accNo_8_2}|{$accNo_9_2}|{$accNo_10_2}|{$accNo_11_2}|-|{$accNo_12_2}|</a></span></td>\n<td style='border:1px solid #000; width:150px; height:20px;' align='center'><span style='font-size:10px;'><a style='color:black;'>{$doctorService2}</a></span><br><span style='font-size:9px;'>{$doctorService_date2}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$actualDoctorCharges2}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$philhealthDoctorCharges2}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$amountPaidByMembers2}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$dateSigned2}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$phicUseOnly2}</span></td>\n</tr>\n\n<tr>\n<td style='border:1px solid #000; width:150px; height:18px;' align='center'><a style='font-size:10px; color:black'>{$doctorName3}</a><span style='font-size:9px;'><a style='color:black;'>|{$accNo_1_3}|{$accNo_2_3}|{$accNo_3_3}|{$accNo_4_3}|-|{$accNo_5_3}|{$accNo_6_3}|{$accNo_7_3}|{$accNo_8_3}|{$accNo_9_3}|{$accNo_10_3}|{$accNo_11_3}|-|{$accNo_12_3}|</a></span></td>\n<td style='border:1px solid #000; width:150px; height:20px;' align='center'><span style='font-size:10px;'><a style='color:black;'>{$doctorService3}</a></span><br><span style='font-size:9px;'>{$doctorService_date3}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$actualDoctorCharges3}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$philhealthDoctorCharges3}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$amountPaidByMembers3}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$dateSigned3}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$phicUseOnly3}</span></td>\n</tr>\n\n<tr>\n<td style='border:1px solid #000; width:150px; height:18px;' align='center'><a style='font-size:10px; color:black'>{$doctorName4}</a><span style='font-size:9px;'><a style='color:black;'>|{$accNo_1_4}|{$accNo_2_4}|{$accNo_3_4}|{$accNo_4_4}|-|{$accNo_5_4}|{$accNo_6_4}|{$accNo_7_4}|{$accNo_8_4}|{$accNo_9_4}|{$accNo_10_4}|{$accNo_11_4}|-|{$accNo_12_4}|</a></span></td>\n<td style='border:1px solid #000; width:150px; height:20px;' align='center'><span style='font-size:10px;'><a style='color:black;'>{$doctorService4}</a></span><br><span style='font-size:9px;'>{$doctorService_date4}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$actualDoctorCharges4}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$philhealthDoctorCharges4}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$amountPaidByMembers4}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$dateSigned4}</span></td>\n<td style='border:1px solid #000; width:75px; height:20px;' align='center'><span style='font-size:10px;'>{$phicUseOnly4}</span></td>\n</tr>\n\n</table>\n\n<br><br><br><br><br>\n\n<table style='border:1px solid #000;'>\n<tr>\n<td width='740px;' align='center'><span style='font-size:12px;'><b>PART II - DRUGS AND MEDICINES (use additional sheet if necessary)</b></span></td>\n</tr>\n</table>\n<table border='0'>\n<tr>\n<td width='250px;' style='border:1px solid #000;' align='center'><span style='font-size:13px;'>Generic/Brand Name</span></td>\n<td width='170px;' style='border:1px solid #000;' align='center'><span style='font-size:13px'>Preparation</span><br><span style='font-size:8px;'>(dose/cap/syrup/injectible/tab with ml/mg/gm content)</span></td>\n<td width='63px;' style='border:1px solid #000;' align='center'><span style='font-size:13px;'>QTY</span></td>\n<td width='68px;' style='border:1px solid #000;' align='center'><span style='font-size:13px;'>Unit Price</span></td>\n<td width='68px;' style='border:1px solid #000;' align='center'><span style='font-size:13px;'>Actual Charges</span></td>\n<td width='69px;' style='border:1px solid #000;' align='center'><span style='font-size:13px;'>PhilHealth Benefit</span></td>\n</tr>";
//i list lahat ng available variable pra sa phic back medicine
for ($x = 1; $x <= $ro->phicBack_meds_PDF_count($registrationNo); $x++) {
$variableValue = "phicBack_meds_desc" . $x;
// ito ung ----$_GET['<variableValue>'];-----
$variableName = "phicBack_meds_desc" . $x;
// ito ung name ng variable ----<variableName> = $_GET['value'];----
$variableName = $_GET[$variableValue];
// assign variable
$variableValue_preparation = "phicBack_meds_preparation" . $x;
$variableName_preparation = "phicBack_meds_preparation" . $x;
$variableName_preparation = $_GET[$variableValue_preparation];
$variableValue_qty = "phicBack_meds_qty" . $x;
$variableName_qty = "phicBack_meds_qty" . $x;
$variableName_qty = $_GET[$variableValue_qty];
$variableValue_unitPrice = "phicBack_meds_unitPrice" . $x;
