<?php
include "../../../myDatabase.php";
$registrationNo = $_GET['registrationNo'];
$ro = new database();
$ro->getPatientProfile($registrationNo);
$ro->coconutFormStart("get", "registrationCensusDelete1.php");
$ro->coconutHidden("registrationNo", $registrationNo);
echo "<Br><Br><br><br><br><Br>";
$ro->coconutBoxStart_red("600", "120");
echo "<br>\t";
echo "<font size=3 color=red>You are about to delete the record of " . $ro->getPatientRecord_lastName() . ", " . $ro->getPatientRecord_firstName() . " <br>with a registration No#: " . $registrationNo . " and register by " . $ro->getRegistrationDetails_registeredBy() . "</font>";
echo "<br><br>";
$ro->coconutButton("Delete");
$ro->coconutBoxStop();
$ro->coconutFormStop();
a.document.write(document.getElementById(printData).innerHTML.replace(/<a\/?[^>]+>/gi, ''));
a.document.close();
a.focus();
a.print();
a.close();
}
</script>
<a href='#' onClick="printF('printData')" style="text-decoration:none;"><?php
echo $ro->coconutImages("printer.jpeg");
?>
<font color=red>Print</font></a><Br><Br>
<?php
echo "<div id='printData'>";
echo "Reg#: " . $registrationNo . " Batch#: " . $dispensedNo;
echo "<br>";
echo "Name: " . $ro->getPatientRecord_lastName() . ", " . $ro->getPatientRecord_firstName();
echo "<br>";
echo "PHIC:" . $ro->getPatientRecord_phic() . " + " . $ro->getRegistrationDetails_company();
echo "<br>";
echo "Date" . date("M d, Y") . " @ " . $ro->getSynapseTime();
echo "<Br>";
echo "Room:" . $ro->getRegistrationDetails_room();
echo "<br>";
echo "Pharmacy:" . $username;
echo "<br>";
echo "Doctor:" . $ro->getAttendingDoc($registrationNo, "Attending");
echo "<table border=1 cellpadding=1 cellspacing=1>";
echo "<tr>";
echo "<th>Particulars</th>";
echo "<th>QTY</th>";
echo "</tr>";
<tr>
<td width="240"><font size=5>Reg No.</font> </td>
<td width="318"><font size=5><?php
echo $registrationNo;
?>
</font></td>
<td width="205"><font size=5>Date Admitted</font> </td>
<td width="118"><?php
echo $ro->getRegistrationDetails_dateRegistered();
?>
</td>
</tr>
<tr>
<td><font size=5>Patient Name</font> </td>
<td><font size=5><?php
echo $ro->getPatientRecord_lastName() . ", " . $ro->getPatientRecord_firstName() . " " . $ro->getPatientRecord_middleName();
?>
</font></td>
<td><font size=5>Time Admitted</font> </td>
<td><font size=5><?php
echo $ro->getRegistrationDetails_timeRegistered();
?>
</font></td>
<td width="9"> </td>
</tr>
<tr>
<td><font size=5>Age</font></td>
<td><font size=5> <?php
echo $ro->getPatientRecord_age();
?>
</font></td>
<?php
include "../../../myDatabase.php";
$labTest = $_GET['labTest'];
$itemNo = $_GET['itemNo'];
$registrationNo = $_GET['registrationNo'];
$branch = $_GET['branch'];
$description = $_GET['description'];
$logNo = $_GET['logNo'];
$medTech = $_GET['medTech'];
$pathologist = $_GET['pathologist'];
$ro = new database();
$ro->coconutDesign();
$ro->getPatientProfile($registrationNo);
echo "<br><br> <font size=3>Name:</font> <input type=text name='patientName' style='border-bottom:1px solid #000;\nborder-top:0px solid #000;\nborder-left:0px solid #000;\nborder-right:0px solid #000; \nheight: 30px; width: 320px;\n ' value='" . $ro->getPatientRecord_lastName() . ", " . $ro->getPatientRecord_firstName() . "'>";
echo "<Br>";
echo " <font size=4>Log No:</font> ";
echo " <input type=text name='logNo' style='border-bottom:1px solid #000;\nborder-top:0px solid #000;\nborder-left:0px solid #000;\nborder-right:0px solid #000; \nheight: 30px; width: 320px;' value='{$logNo}'>";
echo "<Br>";
echo " <font size=4>Pathologist:</font> ";
echo " <input type=text name='pathologist' style='border-bottom:1px solid #000;\nborder-top:0px solid #000;\nborder-left:0px solid #000;\nborder-right:0px solid #000; \nheight: 30px; width: 320px;' value='{$pathologist}'>";
echo "<Br>";
echo " <font size=4>Med Tech:</font> ";
echo " <input type=text name='medTech' style='border-bottom:1px solid #000;\nborder-top:0px solid #000;\nborder-left:0px solid #000;\nborder-right:0px solid #000; \nheight: 30px; width: 320px;' value='{$medTech}'>";
$ro->getLabHeader($labTest, $itemNo, $registrationNo, $branch, $logNo, $medTech, $pathologist);
<?php
include "../../../myDatabase.php";
session_start();
$registrationNo = $_GET['registrationNo'];
$ro = new database();
$ro->getPatientProfile($registrationNo);
$ro->coconutDesign();
$ro->coconutHeading("User Verification", "COCONUT/NURSING/initializeNursing.php");
unset($_SESSION['registrationNo']);
session_destroy();
echo "<Br>";
echo "<center>";
$ro->coconutImages("lock2.jpeg");
echo " <font size=2 color=red>Pls Login first to access the Profile of " . $ro->getPatientRecord_lastName() . ", " . $ro->getPatientRecord_firstName() . " in " . $ro->getRegistrationDetails_room() . " </font>";
echo "<br>";
$ro->coconutFormStart("post", "verifyUser1.php");
$ro->coconutHidden("registrationNo", $registrationNo);
$ro->coconutBoxStart("500", "150");
echo "<br><table border=0>";
echo "<tr>";
echo "<Td>" . $ro->coconutText("Username") . "</tD>";
echo "<td>";
$ro->coconutTextBox("username", "");
echo "</td>";
echo "</tr>";
echo "<tr>";
echo "<td>" . $ro->coconutText("Password") . "</td>";
echo "<td>";
echo "<input type=password name='password' class='txtBox' value=''>";
echo "</td>";
//$module = $_SESSION['module'];
$_SESSION['username'] = $username;
//$_SESSION['registrationNo'] = $registrationNo;
$ro = new database();
$ro->getPatientProfile($_GET['registrationNo']);
if (!isset($_SESSION['username']) || !isset($_SESSION['registrationNo'])) {
header("Location:/COCONUT/patientProfile/unknownUser/verifyUser.php?registrationNo={$_GET['registrationNo']} ");
die;
}
if ($_GET['username'] == "") {
$ro->gotoPage("http://" . $ro->getMyUrl() . "/COCONUT/patientProfile/unknownUser/verifyUser.php?registrationNo={$registrationNo}");
}
?>
<title><?php
$ro->getPatientProfile($registrationNo);
echo $ro->getPatientRecord_lastName() . ", " . $ro->getPatientRecord_firstName();
?>
</title>
<link rel="stylesheet" type="text/css" href="http://<?php
echo $ro->getMyUrl();
?>
/COCONUT/flow/rickyCSS1.css" />
<script type="text/javascript" src="http://<?php
echo $ro->getMyUrl();
?>
/jquery.js"></script>
<script type="text/javascript" src="http://<?php
echo $ro->getMyUrl();
?>
/jquery.autocomplete.js"></script>
<link rel="stylesheet" type="text/css" href="http://<?php
a.document.close();
a.focus();
a.print();
a.close();
}
</script>
<a href='#' onClick="printF('printData')" style="text-decoration:none;"><?php
echo $ro->coconutImages("printer.jpeg");
?>
<font color=red>Print</font></a><Br><Br>
<?php
echo "<div id='printData'>";
echo "\n<style type='text/css'>\n<!--\n.style1 {font-family: Arial;font-size: 16px;color: #000000;font-weight: bold;}\n.style2 {font-family: 'Times New Roman';font-size: 16px;color: #FF0000;font-weight: bold;}\n.style3 {text-decoration: none;font-family: Arial;font-size: 12px;color: #000000;font-weight: bold;}\n.style4 {font-family: Arial;font-size: 12px;color: #000000;font-weight: bold;}\n.style5 {font-family: Arial;font-size: 14px;color: #000000;}\n.style6 {font-family: Arial;font-size: 12px;color: #FFFFFF;}\n.style7 {font-family: Arial;font-size: 11px;color: #000000;}\n.style8 {font-family: Arial;font-size: 12px;color: #FFFFFF;font-weight: bold;}\n-->\n</style>\n";
echo "<span class='style4'>Reg#: </span><span class='style5'>" . $registrationNo . "</span><span class='style4'> Batch#: </span><span class='style5'>" . $dispensedNo . "</span>";
echo "<br>";
echo "<span class='style4'>Name: </span><span class='style5'>" . $ro->getPatientRecord_lastName() . ", " . $ro->getPatientRecord_firstName() . "</span>";
echo "<br>";
echo "<span class='style4'>PHIC: </span><span class='style5'>" . $ro->getPatientRecord_phic() . " + " . $ro->getRegistrationDetails_company() . "</span>";
echo "<br>";
echo "<span class='style4'>Date: </span><span class='style5'>" . date("M d, Y") . " @ " . $ro->getSynapseTime() . "</span>";
echo "<Br>";
echo "<span class='style4'>Room: </span><span class='style5'>" . $ro->getRegistrationDetails_room() . "</span>";
echo "<br>";
echo "<span class='style4'>Pharmacy: </span><span class='style5'>" . $username . "</span>";
echo "<br>";
echo "<span class='style4'>Doctor: </span><span class='style5'>" . $ro->getAttendingDoc($registrationNo, "Attending") . "</span>";
echo "<br /><br />";
echo "<table border=1 bordercolor=black cellpadding=0 cellspacing=0>";
echo "<tr>";
echo "<td class='style4'> Particulars </td>";
echo "<td class='style4'> QTY </td>";
<?php
include "../../myDatabase.php";
$registrationNo = $_GET['registrationNo'];
$ro = new database();
$ro->getPatientProfile($registrationNo);
echo "<br>";
echo "<center><font size=4><b>" . $ro->getReportInformation("hmoSOA_name") . "</b></font>";
echo "<br><font size=2>" . $ro->getReportInformation("hmoSOA_address") . "</font>";
echo "<hr>";
echo "<table border=0>";
echo "<tr>";
echo "<td><font size=3>Reg#:</font></td><td><font size=3>" . $registrationNo . "</font></td>\n<td width='30%'> </td>\n<td><font size=3>Time Admitted:</font></td>\n<td><font size=2><input type=text style='border:0px solid #000' value='" . $ro->getRegistrationDetails_timeRegistered() . "' readonly></font></tD>\n";
echo "</tr>";
echo "<tr>";
echo "<td><font size=3>Patient:</font></tD><td><font size=3>" . $ro->getPatientRecord_lastName() . ", " . $ro->getPatientRecord_firstName() . " " . $ro->getPatientRecord_middleName() . "</font></tD>\n<td width='30%'> </td>\n<td><font size=3>Date Admitted:</font></td>\n<td><font size=3>" . $ro->getRegistrationDetails_dateRegistered() . "</font></tD>\n";
echo "</tR>";
echo "<tr>";
echo "<td><font size=3>Age:</font></td><td><font size=3>" . $ro->getPatientRecord_age() . "</font></tD>\n<td width='30%'> </td>\n<td><font size=3>Sex:</font></td><td><font size=3>" . $ro->getPatientRecord_gender() . "</font></tD>\n";
echo "</tr>";
echo "<tr>";
echo "<td><font size=3>Company:</font></tD><td><font size=3>" . $ro->getRegistrationDetails_company() . "</font></tD>\n<td width='30%'> </td>\n<td><font size=3>PhilHealth:</font></td><td><font size=3>" . $ro->getPatientRecord_phicType() . "</font></tD>\n";
echo "</tr>";
echo "<tr>";
echo "<td><font size=3>Height:</font></tD><td><font size=3>" . $ro->getRegistrationDetails_height() . "</font></tD>\n<td width='30%'> </td>\n<td><font size=3>Weight:</font></td><td><font size=3>" . $ro->getRegistrationDetails_weight() . "</font></tD>\n";
echo "</tr>";
echo "<tr>";
echo "<td><font size=3>Temperature:</font></tD><td><font size=3>" . $ro->getRegistrationDetails_temperature() . "</font></tD>\n<td width='30%'> </td>\n<td><font size=3>Blood Pressure:</font></td><tD><font size=3>" . $ro->getRegistrationDetails_bloodPressure() . "</font></tD>\n";
echo "</tr>";
echo "<tr>";
echo "<td><font size=3>Diagnosis:</font></tD><td><font size=3>" . $ro->getRegistrationDetails_IxDx() . "</font></tD>\n<td width='30%'> </td>\n<td><font size=3>Att. Physician:</font></td>\n<td>" . $ro->getAttendingDoc($registrationNo, "Attending") . "</tD>\n";
<?php
include "../../myDatabase.php";
$registrationNo = $_GET['registrationNo'];
$ro = new database();
$ro->coconutDesign();
$ro->getPatientProfile($registrationNo);
echo "<br><font color=red>" . $ro->getPatientRecord_lastName() . ", " . $ro->getPatientRecord_firstName() . "</font>";
echo "<Br>";
echo "<font color=black>{$registrationNo}</font>";
echo "<Br><br><br>";
$ro->coconutFormStart("get", "rBanny_discount.php");
$ro->coconutHidden("registrationNo", $registrationNo);
$ro->coconutBoxStart("500", "90");
echo "<Br>";
echo "<table>";
echo "<tr>";
echo "<td>Discount: </td>";
echo "<td>";
$ro->coconutTextBox("discount", "");
echo "</td>";
echo "</tr>";
echo "</table>";
echo "<br>";
$ro->coconutButton("Proceed");
$ro->coconutBoxStop();
$ro->coconutFormStop();
$timeCharge = $afetch['timeCharge'];
$chargeBy = $afetch['chargeBy'];
}
}
$birthDatefmt = date("m/d/Y", strtotime($ro->getPatientRecord_birthDate()));
$birthDate = explode("/", $birthDatefmt);
$age = date("md", date("U", mktime(0, 0, 0, $birthDate[0], $birthDate[1], $birthDate[2]))) > date("md") ? date("Y") - $birthDate[2] - 1 : date("Y") - $birthDate[2];
if ($ro->getRegistrationDetails_room() == "") {
$widthroom = "150";
} else {
$widthroom = "auto";
}
if ($ro->getRegistrationDetails_company() == "") {
$widthcom = "150";
} else {
$widthcom = "auto";
}
echo "\n<div align='left'>\n <table width='100%' border='0' cellpadding='0' cellspacing='0'>\n <tr>\n <td><table width='100%' border='0' cellpadding='0' cellspacing='0'>\n <tr>\n <td width='50%'><div align='left'><table border='0' cellspacing='0' cellpadding='0'>\n <tr>\n <td width='auto'><div align='left' class='couriernew13black'>Patient ID</div></td>\n <td width='10'><div align='center' class='couriernew13black'>:</div></td>\n <td width='auto' class='table1Bottom'><div align='left' class='couriernew15blackbold'>" . $ro->getRegistrationDetails_patientNo() . "</div></td>\n </tr>\n </table></div></td>\n <td width='50%'><div align='right'><table border='0' cellspacing='0' cellpadding='0'>\n <tr>\n <td width='auto'><div align='left' class='couriernew13black'>Date-Time Printed</div></td>\n <td width='10'><div align='center' class='couriernew13black'>:</div></td>\n <td width='auto' class='table1Bottom'><div align='left' class='couriernew15blackbold'>" . date("m/d/Y H:i") . "</div></td>\n </tr>\n </table></div></td>\n </tr>\n </table></td>\n </tr>\n <tr>\n <td height='6'></td>\n </tr>\n <tr>\n <td><table width='100%' border='0' cellpadding='0' cellspacing='0'>\n <tr>\n <td width='auto'><div align='left'><table border='0' cellspacing='0' cellpadding='0'>\n <tr>\n <td width='auto'><div align='left' class='couriernew13black'>Patient Name</div></td>\n <td width='10'><div align='center' class='couriernew13black'>:</div></td>\n <td width='auto' class='table1Bottom'><div align='left' class='couriernew15blackbold'>" . $ro->getPatientRecord_lastName() . ", " . $ro->getPatientRecord_firstName() . " " . $ro->getPatientRecord_middleName() . "</div></td>\n </tr>\n </table></div></td>\n <td width='auto'><div align='right'><table border='0' cellspacing='0' cellpadding='0'>\n <tr>\n <td width='auto'><div align='left' class='couriernew13black'>Date-Time Requested</div></td>\n <td width='10'><div align='center' class='couriernew13black'>:</div></td>\n <td width='auto' class='table1Bottom'><div align='left' class='couriernew15blackbold'>" . date("m/d/Y", strtotime($dateCharge)) . " " . date("H:i", strtotime($timeCharge)) . "</div></td>\n </tr>\n </table></div></td>\n </tr>\n </table></td>\n </tr>\n <tr>\n <td height='6'></td>\n </tr>\n <tr>\n <td><table width='100%' border='0' cellpadding='0' cellspacing='0'>\n <tr>\n <td width='auto'><div align='left'><table border='0' cellspacing='0' cellpadding='0'>\n <tr>\n <td width='auto'><div align='left' class='couriernew13black'>Date Of Birth</div></td>\n <td width='10'><div align='center' class='couriernew13black'>:</div></td>\n <td width='auto' class='table1Bottom'><div align='left' class='couriernew15blackbold'>" . date("M d, Y", strtotime($ro->getPatientRecord_birthDate())) . "</div></td>\n </tr>\n </table></div></td>\n <td width='auto'><div align='right'><table border='0' cellspacing='0' cellpadding='0'>\n <tr>\n <td width='auto'><div align='left' class='couriernew13black'>Requested By</div></td>\n <td width='10'><div align='center' class='couriernew13black'>:</div></td>\n <td width='150' class='table1Bottom'><div align='left' class='couriernew15blackbold'>{$chargeBy}</div></td>\n </tr>\n </table></div></td>\n </tr>\n </table></td>\n </tr>\n <tr>\n <td height='6'></td>\n </tr>\n <tr>\n <td><table width='100%' border='0' cellpadding='0' cellspacing='0'>\n <tr>\n <td width='auto'><div align='left'><table border='0' cellspacing='0' cellpadding='0'>\n <tr>\n <td width='auto'><div align='left' class='couriernew13black'>Age</div></td>\n <td width='10'><div align='center' class='couriernew13black'>:</div></td>\n <td width='30' class='table1Bottom'><div align='left' class='couriernew15blackbold'>{$age}</div></td>\n <td width='10'></td>\n <td width='auto'><div align='left' class='couriernew13black'>Gender</div></td>\n <td width='10'><div align='center' class='couriernew13black'>:</div></td>\n <td width='80' class='table1Bottom'><div align='left' class='couriernew15blackbold'>" . strtoupper($ro->getPatientRecord_Gender()) . "</div></td>\n </tr>\n </table></div></td>\n <td width='auto'><div align='right'><table border='0' cellspacing='0' cellpadding='0'>\n <tr>\n <td width='auto'><div align='left' class='couriernew13black'>Physician</div></td>\n <td width='10'><div align='center' class='couriernew13black'>:</div></td>\n <td width='auto' class='table1Bottom'><div align='left' class='couriernew15blackbold'>" . $ro->getAttendingDoc($registrationNo, "ATTENDING") . "</div></td>\n </tr>\n </table></div></td>\n </tr>\n </table></td>\n </tr>\n <tr>\n <td height='6'></td>\n </tr>\n <tr>\n <td><table width='100%' border='0' cellpadding='0' cellspacing='0'>\n <tr>\n <td width='auto'><div align='left'><table border='0' cellspacing='0' cellpadding='0'>\n <tr>\n <td width='auto'><div align='left' class='couriernew13black'>Room</div></td>\n <td width='10'><div align='center' class='couriernew13black'>:</div></td>\n <td width='{$widthroom}' class='table1Bottom'><div align='left' class='couriernew15blackbold'>" . $ro->getRegistrationDetails_room() . "</div></td>\n </tr>\n </table></div></td>\n <td width='auto'><div align='right'><table border='0' cellspacing='0' cellpadding='0'>\n <tr>\n <td width='auto'><div align='left' class='couriernew13black'>Company</div></td>\n <td width='10'><div align='center' class='couriernew13black'>:</div></td>\n <td width='{$widthcom}' class='table1Bottom'><div align='left' class='couriernew15blackbold'>" . $ro->getRegistrationDetails_company() . "</div></td>\n </tr>\n </table></div></td>\n </tr>\n </table></td>\n </tr>\n <tr>\n <td height='20'></td>\n </tr>\n <tr>\n <td><div align='left' class='couriernew15black'>REQUEST/S</div></td>\n </tr>\n <tr>\n <td height='10'></td>\n </tr>\n <tr>\n <td><table width='100%' border='0' cellpadding='0' cellspacing='0'>\n <tr>\n <td width='auto'><div align='left' class='couriernew12black'>DESCRIPTION</div></td>\n </tr>\n";
$asql = mysql_query("SELECT description, timeCharge, remarks, chargeBy, status FROM patientCharges WHERE registrationNo = '{$registrationNo}' AND departmentStatus = '' AND title = 'LABORATORY' AND status NOT LIKE 'DELETED_%%%%%%' AND dateCharge='{$dateCharge}' ");
while ($afetch = mysql_fetch_array($asql)) {
echo "\n <tr>\n <td><div align='left' class='couriernew16blackbold'>" . $afetch['description'] . "</div></td>\n </tr>\n";
if ($afetch['remarks'] != "") {
echo "\n <tr>\n <td valign='top'><div align='left' class='couriernew12black'>(" . $afetch['remarks'] . ")</div></td>\n </tr>\n";
}
}
echo "\n </table></td>\n </tr>\n </table></td>\n</div>\n";
?>
</body>
</html>
<?php
include "../../../myDatabase2.php";
$registrationNo = $_POST['registrationNo'];
$itemNo = $_POST['itemNo'];
$chargesCode = $_POST['chargesCode'];
$username = $_POST['username'];
$date = $_POST['date'];
$result = $_POST['result'];
$remarks = $_POST['remarks'];
$morphology = $_POST['morphology'];
$ro = new database();
$ro->getPatientProfile($registrationNo);
$ro->coconutDesign();
echo "<br><br><br>";
echo "<center><font color=red size=2>To Add the Result of [" . strtoupper($ro->getPatientRecord_lastName() . " " . $ro->getPatientRecord_firstName()) . "] enter your username and password</font></center>";
$ro->coconutFormStart("post", "logBeforeResult1.php");
$ro->coconutHidden("registrationNo", $registrationNo);
$ro->coconutHidden("itemNo", $itemNo);
$ro->coconutHidden("chargesCode", $chargesCode);
$ro->coconutHidden("username", $username);
$ro->coconutHidden("date", $date);
$ro->coconutHidden("result", $result);
$ro->coconutHidden("remarks", $remarks);
$ro->coconutHidden("morphology", $morphology);
$ro->coconutBoxStart("500", "160");
echo "<br>";
echo "<table border=0>";
echo "<tr>";
echo "<Td>Username </td>";
echo "<td>";
if ($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>"
.astyle {text-decoration: none;}
.table1Bottom {border-bottom: 1px solid #000000;}
</style>
</head>
<body>
<?php
include "../../myDatabase2.php";
$ro = new database();
$registrationNo = $_GET['registrationNo'];
$dateCharge = $_GET['dateCharge'];
mysql_connect($ro->myHost(), $ro->getUser(), $ro->getPass());
mysql_select_db($ro->getDB());
$ro->getPatientProfile($registrationNo);
$birthDatefmt = date("m/d/Y", strtotime($ro->getPatientRecord_birthDate()));
$birthDate = explode("/", $birthDatefmt);
$age = date("md", date("U", mktime(0, 0, 0, $birthDate[0], $birthDate[1], $birthDate[2]))) > date("md") ? date("Y") - $birthDate[2] - 1 : date("Y") - $birthDate[2];
echo "\n<div align='left'>\n <table width='345' border='0' cellpadding='0' cellspacing='0' bordercolor='#000000'>\n <tr>\n <td valign='top'><table width='100%' border='0' cellpadding='0' cellspacing='0' bordercolor='#000000'>\n <tr>\n <td valign='top'><table width='100%' border='0' cellpadding='0' cellspacing='0'>\n <tr>\n <td height='6' colspan='6'></td>\n </tr>\n <tr>\n <td width='80'><div align='left' class='couriernew11black'> Patient ID</div></td>\n <td width='6'><div align='center' class='couriernew11black'>:</div></td>\n <td width='75'><div align='left' class='couriernew13blackbold'><u>" . $ro->getRegistrationDetails_patientNo() . "</u></div></td>\n <td width='35'><div align='left' class='couriernew11black'>Date</div></td>\n <td width='6'><div align='center' class='couriernew11black'>:</div></td>\n <td width='auto'><div align='right' class='couriernew10blackbold'><u>" . date("m/d/Y - H:i:s") . "</u> </div></td>\n </tr>\n <tr>\n <td height='6' colspan='6'></td>\n </tr>\n </table></td>\n </tr>\n <tr>\n <td valign='top'><table width='100%' border='0' cellpadding='0' cellspacing='0'>\n <tr>\n <td height='10'><div align='left' class='couriernew12black'> Patient Name:</div></td>\n </tr>\n <tr>\n <td width='auto'><div align='left' class='couriernew14blackbold'> <u>" . $ro->getPatientRecord_lastName() . ", " . $ro->getPatientRecord_firstName() . " " . $ro->getPatientRecord_middleName() . " </u></div></td>\n </tr>\n </table></td>\n </tr>\n <tr>\n <td valign='top'><table width='100%' border='0' cellpadding='0' cellspacing='0'>\n <tr>\n <td height='10' colspan='6'></td>\n </tr>\n <tr>\n <td width='45'><div align='left' class='couriernew12black'> B-Date</div></td>\n <td width='6'><div align='center' class='couriernew12black'>:</div></td>\n <td width='196'><div align='left' class='couriernew12blackbold'><u>" . $ro->getPatientRecord_birthDate() . "</u></div></td>\n <td width='50'><div align='left' class='couriernew12black'>Age/Sex</div></td>\n <td width='6'><div align='center' class='couriernew12black'>:</div></td>\n <td width='auto'><div align='right' class='couriernew12blackbold'><u>{$age}/" . strtoupper($ro->getPatientRecord_Gender()) . "</u> </div></td>\n </tr>\n </table></td>\n </tr>\n <tr>\n <td valign='top'><table width='100%' border='0' cellpadding='0' cellspacing='0'>\n <tr>\n <td height='6' colspan='3'></td>\n </tr>\n <tr>\n <td width='55'><div align='left' class='couriernew12black'> Physician</div></td>\n <td width='6'><div align='center' class='couriernew12black'>:</div></td>\n <td width='auto'><div align='left' class='couriernew12blackbold'><u>" . $ro->getAttendingDoc($registrationNo, "ATTENDING") . "</u></div></td>\n </tr>\n </table></td>\n </tr>\n <tr>\n <td valign='top'><table width='100%' border='0' cellpadding='0' cellspacing='0'>\n <tr>\n <td height='6' colspan='3'></td>\n </tr>\n <tr>\n <td width='30'><div align='left' class='couriernew12black'> Room</div></td>\n <td width='6'><div align='center' class='couriernew12black'>:</div></td>\n <td width='auto'><div align='left' class='couriernew12blackbold'><u>" . $ro->getRegistrationDetails_room() . "</u> </div></td>\n </tr>\n </table></td>\n </tr>\n <tr>\n <td valign='top'><table width='100%' border='0' cellpadding='0' cellspacing='0'>\n <tr>\n <td height='20'></td>\n </tr>\n <tr>\n <td><div align='center'><table width='100%' border='0' cellpadding='0' cellspacing='0'>\n <tr>\n <td width='auto'><div align='left' class='couriernew10blackbold'> Description </div></td>\n </tr>\n";
$asql = mysql_query("SELECT description,timeCharge,remarks,chargeBy,status FROM patientCharges WHERE registrationNo = '{$registrationNo}' AND departmentStatus = '' AND title = 'LABORATORY' AND status NOT LIKE 'DELETED_%%%%%%' AND dateCharge='{$dateCharge}' ");
while ($afetch = mysql_fetch_array($asql)) {
echo "\n <tr>\n <td valign='top'><div align='left' class='couriernew14blackbold'> " . $afetch['description'] . " </div></td>\n </tr>\n";
if ($afetch['remarks'] != "") {
echo "\n <tr>\n <td valign='top'><div align='left' class='couriernew11black'> (" . $afetch['remarks'] . ") </div></td>\n </tr>\n";
}
}
echo "\n </table></div></td>\n </tr>\n </table></td>\n </tr>\n </table></td>\n </tr>\n </table>\n</div>\n";
?>
</body>
</html>
<?php
include "../../myDatabase.php";
$registrationNo = $_GET['registrationNo'];
$ro = new database();
$ro->getPatientProfile($registrationNo);
echo "<br>";
echo "<center><font size=4><b>" . $ro->getReportInformation("hmoSOA_name") . "</b></font>";
echo "<br><font size=2>" . $ro->getReportInformation("hmoSOA_address") . "</font>";
echo "<hr>";
echo "<table border=0>";
echo "<tr>";
echo "<td><font size=3>Reg#:</font></td><td><font size=3>" . $registrationNo . "</font></td>\n<td width='30%'> </td>\n<td><font size=3>Time Admitted:</font></td>\n<td><font size=2><input type=text style='border:0px solid #000' value='" . $ro->getRegistrationDetails_timeRegistered() . "' readonly></font></tD>\n";
echo "</tr>";
echo "<tr>";
echo "<td><font size=3>Patient:</font></tD><td><font size=3>" . $ro->getPatientRecord_lastName() . ", " . $ro->getPatientRecord_firstName() . " " . $ro->getPatientRecord_middleName() . "</font></tD>\n<td width='30%'> </td>\n<td><font size=3>Date Admitted:</font></td>\n<td><font size=3>" . $ro->getRegistrationDetails_dateRegistered() . "</font></tD>\n";
echo "</tR>";
echo "<tr>";
echo "<td><font size=3>Age:</font></td><td><font size=3>" . $ro->getPatientRecord_age() . "</font></tD>\n<td width='30%'> </td>\n<td><font size=3>Sex:</font></td><td><font size=3>" . $ro->getPatientRecord_gender() . "</font></tD>\n";
echo "</tr>";
echo "<tr>";
echo "<td><font size=3>Company:</font></tD><td><font size=3>" . $ro->getRegistrationDetails_company() . "</font></tD>\n<td width='30%'> </td>\n<td><font size=3>PhilHealth:</font></td><td><font size=3>" . $ro->getPatientRecord_phicType() . "</font></tD>\n";
echo "</tr>";
echo "<tr>";
echo "<td><font size=3>Height:</font></tD><td><font size=3>" . $ro->getRegistrationDetails_height() . "</font></tD>\n<td width='30%'> </td>\n<td><font size=3>Weight:</font></td><td><font size=3>" . $ro->getRegistrationDetails_weight() . "</font></tD>\n";
echo "</tr>";
echo "<tr>";
echo "<td><font size=3>Temperature:</font></tD><td><font size=3>" . $ro->getRegistrationDetails_temperature() . "</font></tD>\n<td width='30%'> </td>\n<td><font size=3>Blood Pressure:</font></td><tD><font size=3>" . $ro->getRegistrationDetails_bloodPressure() . "</font></tD>\n";
echo "</tr>";
echo "<tr>";
echo "<td><font size=3>Diagnosis:</font></tD><td><font size=3>" . $ro->getRegistrationDetails_IxDx() . "</font></tD>\n<td width='30%'> </td>\n<td><font size=3>Att. Physician:</font></td>\n<td>" . $ro->getAttendingDoc($registrationNo, "Attending") . "</tD>\n";
$hospitalBill_cash = 0;
$hospitalBill_phic = 0;
$hospitalBill_company = 0;
$hospitalBill_gt = 0;
$pf_cash = 0;
$pf_phic = 0;
$pf_company = 0;
$pf_gt = 0;
echo "<center><div style='border:0px solid #000000; width:700px; height:auto; border-color:black black black black;'>";
echo "";
echo "<font size=5><b>" . $ro->getReportInformation("hmoSOA_name") . "</b></font>";
echo "<br><font size=2>" . $ro->getReportInformation("hmoSOA_address") . "</font>";
echo "<br><br><center>";
echo "<table>";
echo "<tr>";
echo "<td>" . $ro->coconutText("Name") . ": </td><td> " . $ro->getPatientRecord_lastName() . ", " . $ro->getPatientRecord_firstName() . "</td>";
echo "<td> </td><td>" . $ro->coconutText("Reg#") . "</td><td> {$registrationNo}</td>";
echo "</tr>";
echo "<tr>";
echo "<Td>" . $ro->coconutText("PHIC") . ": </td><td> " . $ro->getPatientRecord_phic() . "</td>";
echo "<td> </td>";
echo "<td>CaseType:</td><TD>" . $ro->getRegistrationDetails_caseType() . "</tD>";
echo "</tr>";
echo "<tr>";
echo "<Td>" . $ro->coconutText("Company") . ": </td><td> " . $ro->getRegistrationDetails_company() . "</td>";
echo "<td> </tD>";
echo "<Td>" . $ro->coconutText("Fx Diagnosis:") . ": </td><td> " . $ro->getRegistrationDetails_finalDiagnosis() . "</td>";
echo "</tr>";
echo "<tr>";
echo "<Td>" . $ro->coconutText("Admitted") . ": </td><td> " . $ro->getRegistrationDetails_dateRegistered() . "</td>";
echo "<td> </td>";
<?php
include "../../myDatabase.php";
$registrationNo = $_GET['registrationNo'];
//$username = $_GET['username'];
$ro = new database();
/*
$ro->getBatchNo();
$myFile = "/opt/lampp/htdocs/COCONUT/trackingNo/batchNo.dat";
$fh = fopen($myFile, 'r');
$batchNo = fread($fh, 100);
fclose($fh);
*/
echo "\n\n<style type='text/css'>\na \n{ \ntext-decoration:none;\ncolor:black;\nfont-weight:bold;\n }\nul { list-style-type:none; }\ndisplay: block;\n</style>\n\n";
$ro->getPatientProfile($registrationNo);
echo "<br><hr><font size=2 color=red>" . $ro->getPatientRecord_lastName() . " " . $ro->getPatientRecord_firstName() . " " . $ro->getPatientRecord_middleName() . "</font><hr>";
echo "<ul>";
echo "<li><a href='http://" . $ro->getMyUrl() . "/COCONUT/patientProfile/patientProfile_right.php?registrationNo=" . $ro->getRegistrationDetails_registrationNo() . "' target='rightFrame'><font size=2>Information</font></a></li>";
echo "<li><a href='http://" . $ro->getMyUrl() . "/COCONUT/patientProfile/soaOption.php?registrationNo={$registrationNo}&username='******'rightFrame'><font size=2>S.O.A</font></a></li>";
echo "<li><a href='http://" . $ro->getMyUrl() . "/COCONUT/Doctor/doctorModule/soapListed.php?registrationNo={$registrationNo}&username='******'rightFrame'><font size=2>S.O.A.P</font></a></li>";
echo "<li><a href='http://" . $ro->getMyUrl() . "/COCONUT/Results/labResultName.php?registrationNo={$registrationNo}&title=LABORATORY&username='******'rightFrame'><font size=2>Lab Results</font></a></li>";
echo "<li><a href='http://" . $ro->getMyUrl() . "/COCONUT/Results/Radiology/radioResult_list.php?registrationNo={$registrationNo}&username='******'rightFrame'><font size=2>Radio Results</font></a></li>";
echo "<li><a href='http://" . $ro->getMyUrl() . "/COCONUT/Homepage/viewNote_homepage.php?noteType=Comments®istrationNo=" . $ro->getRegistrationDetails_registrationNo() . "' target='rightFrame'><font size=2>Comments</font></a></li>";
echo "</ul>";
echo "<center><Br>";
echo "<font color=red size=1>Pls Proceed to Billing for Complains,Questions etc.</font>";
echo "\n<Td> <input type=checkbox class='checkBox' name='facility'><font size=2>T-L4/L3</font> <input type=checkbox class='checkBox' name='facility'><font size=2>ASC</font> <input type=checkbox name='facility' ><font size=2>RHU</font><br>\n <input type=checkbox name='facility'><font size=2>S-L2</font> <input type=checkbox name='facility'><font size=2>FDC</font>\n <input type=checkbox name='facility'><font size=2>TB-DOTS</font><br>\n <input type=checkbox name='facility' checked><font size=2>P-L1</font>\n <input type=checkbox name='facility'><font size=2>MCP</font>\n <input type=checkbox name='facility'><font size=2>__________</font><br> \n <font size=1>(OTHERS)</font>\n</tD>\n</tr>\n</table>\n";
} else {
if ($ro->getReportInformation("Facility") == "MCP") {
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'><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' checked><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 {
echo "\n<Td> <input type=checkbox style='outline: 1px solid #000000;' class='checkBox' name='facility'><font size=1>T-L4/L3</font> <input type=checkbox style='outline: 1px solid #000000;' class='checkBox' name='facility'><font size=1>ASC</font> <input type=checkbox style='outline: 1px solid #000000;' name='facility' ><font size=1>RHU</font><br>\n <input type=checkbox style='outline: 1px solid #000000;' name='facility'><font size=1>S-L2</font> <input type=checkbox style='outline: 1px solid #000000;' name='facility'><font size=1>FDC</font>\n <input type=checkbox style='outline: 1px solid #000000;' name='facility'><font size=1>TB-DOTS</font><br>\n <input type=checkbox style='outline: 1px solid #000000;' name='facility'><font size=1>P-L1</font>\n <input type=checkbox style='outline: 1px solid #000000;' name='facility'><font size=1>MCP</font>\n <input type=checkbox style='outline: 1px solid #000000;' name='facility' checked><font size=1><u> " . $ro->getReportInformation("Facility") . " </u></font><br> \n <font size=1>(OTHERS)</font>\n</tD>\n</tr>\n</table>\n";
}
}
}
}
}
}
}
}
//END OF "CATEGORY OF FACILITY"
echo "\n\n<Table width='860' align='center' border=0>\n<tr>\n<Td width='271'><font size=2>6. Name of Patient:</font></tD>\n</tr>\n<Tr>\n<td><input type=text value='" . $ro->getPatientRecord_lastName() . ", " . $ro->getPatientRecord_firstName() . " " . $ro->getPatientRecord_middleName() . "' class='patientName'><br><font size=1>Last Name</font> <font size=1>First Name</font> <font size=1>Middle Name</font></td>\n</tr>\n</table>\n";
$bday = preg_split("/\\_/", $ro->getPatientRecord_Birthdate());
echo "<br>";
echo "<table width='860' align='center' border=0>";
echo "<tr>";
echo "<Td width='110'><font size=2>. Date of Birth:</font></td>";
echo "<tD width='170'>";
echo "<input type=text maxlength=1 class='panz' value='" . substr($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($pinNo[0], 3, 1) . "'>-<input type=text maxlength=1 class='panz' value='" . substr($pinNo[0], 11, 1) . "'><input type=text maxlength=1 class='panz1' value='" . substr($pinNo[0], 11, 1) . "'><input type=text maxlength=1 class='panz1' value='" . substr($pinNo[0], 11, 1) . "'><input type=text maxlength=1 class='panz1' value='" . substr($pinNo[0], 11, 1) . "'>";
echo "</td>";
/********
if(strlen($bday[1]) > 1) {
echo "-<u>|".substr($bday[1],-2)."|".substr($bday[1],2)."</u>-<u>|".substr($bday[2],-4,1)."|".substr($bday[2],-3,1)."|".substr($bday[2],-2,1)."|".substr($bday[2],-1,1)."|</u></td>";
}else {
echo "-<u>|0|".substr($bday[1],-1)."|</u>-<u>|".substr($bday[2],-4,1)."|".substr($bday[2],-3,1)."|".substr($bday[2],-2,1)."|".substr($bday[2],-1,1)."|</u><br> <font size=1>(month-day-year)</font></td>";
}
$type = $_GET['type'];
$dept = $_GET['dept'];
$ro = new database();
$ro->getPatientProfile($registrationNo);
mysql_connect($ro->myHost(), $ro->getUser(), $ro->getPass());
mysql_select_db($ro->getDB());
$asql = mysql_query("SELECT * FROM patientCharges WHERE registrationNo='{$registrationNo}' AND status NOT LIKE 'DELETED_%%%%'");
$acount = mysql_num_rows($asql);
if ($acount != 0) {
$ro->coconutFormStart("get", "selectShift_registered.php?username={$username}");
$ro->coconutHidden("registrationNo", $registrationNo);
$ro->coconutHidden("username", $username);
echo "<Br><Br><br><br><br><Br>";
$ro->coconutBoxStart_red("600", "120");
echo "<br>\t";
echo "<font size=3 color=red>Unable to delete " . $ro->getPatientRecord_lastName() . ", " . $ro->getPatientRecord_firstName() . " with a registration No#: " . $registrationNo . ".<br>You must delete all charges before you can delete this patient.</font>";
echo "<br><br>";
$ro->coconutButton("Back");
$ro->coconutBoxStop();
$ro->coconutFormStop();
} else {
$ro->coconutFormStart("post", "registrationCensusDelete1.php?registrationNo={$registrationNo}&username={$username}&fromMonth={$fromMonth}&fromDay={$fromDay}&fromYear={$fromYear}&toMonth={$toMonth}&toDay={$toDay}&toYear={$toYear}&type={$type}&dept={$dept}");
echo "<Br><Br><br><br><br><Br>";
$ro->coconutBoxStart_red("600", "148");
echo "<br>\t";
echo "<font size=3 color=red>You are about to delete the record of " . $ro->getPatientRecord_lastName() . ", " . $ro->getPatientRecord_firstName() . " <br>with a registration No#: " . $registrationNo . " and register by " . $ro->getRegistrationDetails_registeredBy() . "</font>";
echo "<br><br>Enter Authorized Username and Password to Delete Patient<br>";
echo "<input type='text' name='uname' placeholder='Username' autocomplete='off' value='' size='10' /><input type='password' name='delpass' placeholder='Password' autocomplete='off' value='' size='10' /><br /><br />";
$ro->coconutButton("Delete");
$ro->coconutBoxStop();
$ro->coconutFormStop();
$toTime_minutes = $_GET['toTime_minutes'];
$toTime_seconds = $_GET['toTime_seconds'];
$shift = $_GET['shift'];
$ro = new database();
$ro->getPatientProfile($registrationNo);
?>
<?php
/*
echo "<table border=1 cellpadding=0 cellspacing=0 rules=all>";
echo "<tr>";
echo "<th bgcolor='#3b5998'> <font color=white class='head'></font> </th>";
echo "<th bgcolor='#3b5998'> <font color=white class='head'></font> </th>";
echo "<th bgcolor='#3b5998'> <font color=white class='head'>Description</font> </th>";
echo "<th bgcolor='#3b5998'> <font color=white class='head'>Price</font> </th>";
echo "<th bgcolor='#3b5998'> <font color=white class='head'>QTY</font> </th>";
echo "<th bgcolor='#3b5998'> <font color=white class='head'>Disc</font> </th>";
echo "<th bgcolor='#3b5998'> <font color=white class='head'>Total</font> </th>";
echo "<th bgcolor='#3b5998'> <font color=white class='head'>Time</font> </th>";
echo "<th bgcolor='#3b5998'> <font color=white class='head'>Date</font> </th>";
echo "<th bgcolor='#3b5998'> <font color=white class='head'>User</font> </th>";
echo "<th bgcolor='#3b5998'> <font color=white class='head'>Payment</font> </th>";
echo "</tr>";
*/
$ro->getPatientChargesUnpaid($month, $day, $year, $fromTime_hour, $fromTime_minutes, $fromTime_seconds, $toTime_hour, $toTime_minutes, $toTime_seconds, $username, $registrationNo, $shift, "UNPAID", "");
//echo "</table>";
echo "<br>";
echo "<form method='post' action='/COCONUT/currentPatient/patientInterface1.php' target='_blank'><input id='namez' style='border:1px solid #000; color:red;' type='submit' value='(" . $registrationNo . ") " . $ro->getPatientRecord_lastName() . ", " . $ro->getPatientRecord_firstName() . "'>\n<input type='hidden' name='registrationNo' value='{$registrationNo}'><input type='hidden' name='username' value='" . $username . "'></form>";
}
}
}
$dateUnregistered_day = "|" . substr($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;
