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: / home / hearthospit / public_html / billing.hearthospitalpatna.com / application / views / admin /

Filename : tpa-tariff.php

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<div class="page-wrapper">
	
	<!-- ============================================================== -->
	<!-- Bread crumb and right sidebar toggle -->
	<!-- ============================================================== -->
	<div class="page-breadcrumb">
		<div class="row">
			<div class="col-7 align-self-center">
				<h4 class="page-title">Insurance Tariff of : <?php echo $tpa[0]['name'] ?> </h4>
				<div class="d-flex align-items-center">
					<nav aria-label="breadcrumb">
						<ol class="breadcrumb">
							<li class="breadcrumb-item"><a href="#"></a></li>
						</ol>
					</nav>
				
				</div>
			</div>
			<div class="col-5 align-self-center">
			<div class="d-flex no-block justify-content-end align-items-center">
			
			</div>
			</div>
		</div>
	</div>


 <div class="container-fluid">
        <!-- ============================================================== -->
        <!-- Start Page Content -->
        <!-- ============================================================== -->

	
	<div class="row">
		<div class="col-12">
			<div class="card">
				<div class="card-body">
					 <button type="button" role="button" class="btn btn-primary add-more" style="position: absolute;
    right: 10px;
    top: 52px;"><i class="fa fa-plus"></i></button>
					 <?php
                        if($msg!=""){

                         ?>
                         <div class="row">
                           <div class="col-md-4"></div>
                           <div class="col-md-4"><div class="alert alert-success"><?=$msg?></div></div>
                         </div>

                       <?php } ?>
				<form method="post">
				<div class="row">
<?php 
$ct=0;
foreach($tariffs as $bl){
$ct++;
if(empty($bl["xsrc"])){
?>
                           

                       <?php 
                       	?>
  <div class="col-md-3">
                                <div class="form-group">
                                    <input type="text" class="form-control" readonly="" required="" name="field[]" value="<?=$bl['name']?>" placeholder="Field name">
                                    <input type="hidden"  name="fieldid[]" value="<?=$bl['id']?>">
                                </div>

                           </div>
                            

                           <div class="col-md-2" <?php if($ct%2==1){ ?> style="border-right: 1px solid #9e9e9e;" <?php } ?>>
                                <div class="form-group">
                                    <input type="text" class="form-control"  name="price[]" placeholder="Price" value="<?=$bl['price']?>">
                                </div>

                           </div>
                       	<?php
                       }

                   } ?>   
<div class="col-md-12">

                       <?php 
$ct=0;
foreach($bft as $bl){
$ct++;
?>
<div class="row">
	  <?php if(!empty($bl["edit"])){ ?>
                            <div class="col-md-4">
                                <div class="form-group">
                                    <input type="text" class="form-control bldip"  required="" name="bfield[]" value="<?=$bl['name']?>" placeholder="Field name">
                                    <input type="hidden"  name="bfieldid[]" value="<?=$bl['id']?>">
                                </div>

                           </div>
                       <?php }else{ ?>
<div class="col-md-4">
                                <div class="form-group">
                                    <input type="text" class="form-control bldip" readonly="" required="" name="xbfield[]" value="<?=$bl['name']?>" placeholder="Field name">
                                    <input type="hidden"  name="xbfieldid[]" value="<?=$bl['id']?>">
                                </div>

                           </div>
                       <?php } ?>
                            
	  <?php if(!empty($bl["edit"])){ ?>
                           <div class="col-md-3" <?php if($ct%2==1){ ?> style="border-right: 1px solid #9e9e9e;" <?php } ?>>
                                <div class="form-group">
                                    <input type="text" class="form-control "  name="bprice[]" placeholder="Price" value="<?=$bl['price']?>">
                                </div>

                           </div>
                       <?php }else{ ?>
<div class="col-md-3" <?php if($ct%2==1){ ?> style="border-right: 1px solid #9e9e9e;" <?php } ?>>
                                <div class="form-group">
                                    <input type="text" class="form-control"  name="xbprice[]" placeholder="Price" value="<?=$bl['price']?>">
                                </div>

                           </div>
                       <?php } ?>
                            <?php if($slistr[0]['is_cghs']==1){ ?>

                           <div class="col-md-3">
                                <div class="form-group">
                                    <input type="text" class="form-control"  name="xbcode[]" placeholder="CGHS Rate code" value="<?=$bl['code']?>" />
                                </div>

                           </div>
                       <?php }else{ ?>
                       	 <div class="col-md-2">
                       	<input type="hidden" name="xbcode[]" />
                       </div>

                       <?php }?>
                       <?php if(!empty($bl["edit"])){ ?>
                       <div class="col-md-2">
                                <div class="form-group">
                                    <button type="button" role="button" class="btn btn-danger remove-more" ><i class="fa fa-times"></i></button>
                                </div>

                           </div>
                       <?php } ?>
                       </div>


                       <?php } ?> 
                       </div> 
                       <div class="col-md-12"> 

<?php 
$count=0;
foreach($tariffs as $fr){
$count++;
if(!empty($fr["xsrc"])){
 ?>
                           <div class="row ">

                            <div class="col-md-3">
                                <div class="form-group">
                                    <input type="text" class="form-control" required name="xfield[]" value="<?=$fr['name']?>" placeholder="Field name" />
                                    <input type="hidden"  name="xdid[]" value="<?=$fr['id']?>"  />
                                </div>

                           </div>
                            <div class="col-md-2">
                                <div class="form-group">
                                   <select class="form-control" required name="xtype[]" >
                                       <option value="">Select field type</option>
                                       <?php foreach($format_type as $ft){ ?>
                                        <option value="<?=$ft['id']?>" <?php if($fr['format_type_id']==$ft["id"]){ echo "selected";} ?>><?=$ft['name']?></option>
                                       <?php } ?>
                                   </select>
                                </div>

                           </div>

                           <div class="col-md-2">
                                <div class="form-group">
                                    <input type="text" class="form-control" required name="xprice[]" placeholder="Unit price" value="<?=$fr['price']?>" />
                                </div>

                           </div>

                           <?php if($slistr[0]['is_cghs']==1){ ?>

                           <div class="col-md-2">
                                <div class="form-group">
                                    <input type="text" class="form-control" required name="xcode[]" placeholder="CGHS Rate code" value="<?=$fr['code']?>" />
                                </div>

                           </div>
                       <?php }else{
                       	?>
                       	  <div class="col-md-2">
                       	<input type="hidden" name="xcode[]" />
                       </div>
                       	<?php
                       } ?>
                           <div class="col-md-2">
                                <div class="form-group">
                                    <button type="button" role="button" class="btn btn-danger remove-more" ><i class="fa fa-times"></i></button>
                                </div>

                           </div>
                           
                       </div>


<?php }} ?>
                       </div>
                       <div class="col-md-12"> 
                         
                           <div class="row" style="border-top: 1px solid #9e9e9e33;
    padding-top: 10px;"></div>
 

                           <div class="row copyarea">

                            <div class="col-md-3">
                                <div class="form-group">
                                	<label>Field Name</label>
                                    <input type="text" class="form-control"  name="efield[]" placeholder="Field name" />
                                </div>

                           </div>
                            <div class="col-md-2">
                                <div class="form-group">
                                	<label>Type</label>
                                   <select class="form-control"  name="etype[]" >
                                  
                                      
                                       <?php foreach($format_type as $ft){ ?>
                                        <option value="<?=$ft['id']?>"><?=$ft['name']?></option>
                                       <?php } ?>
                                   </select>
                                </div>

                           </div>

                           <div class="col-md-2">
                                <div class="form-group">
                                	<label>Unit Price</label>
                                    <input type="text" class="form-control"  name="eprice[]" placeholder="Unit price" />
                                </div>

                           </div>
                           <div class="col-md-2">
                                <div class="form-group">
                                	<label>Is blood test?</label>
                                    <select class="form-control" name="eisblood[]">
                                    	<option value="0">No</option>
                                    	<option value="1">Yes</option>
                                    </select>
                                </div>

                           </div>
                           
                           <div class="col-md-2">
                                <div class="form-group">
                                	<br>
                                    <button type="button" role="button" class="btn btn-danger remove-more" style="display: none;"><i class="fa fa-times"></i></button>
                                </div>

                           </div>


                           
                       </div>
                       <div class="pastearea">

                       </div>



                       </div>
                       
                       <div class="row">
                           <div class="col-md-12" style="text-align:center;"> <input type="submit" name="sbmt" value="Save Now" class="btn btn-primary" /></div>
                       </div>
                       </form>
                   </div>
				</div>
			</div>
		</div>
	</div>
</div>
</div>

Name	Size	Last Modified	Owner	Permissions
add-test.php	7.778 KB	January 21 2020 7:10:06	hearthospit	0644
all-bill.php	5.112 KB	January 21 2020 7:10:05	hearthospit	0644
biliing.php	1.233 KB	January 21 2020 7:10:05	hearthospit	0644
blood-format.php	3.783 KB	January 21 2020 7:10:06	hearthospit	0644
company.php	5.147 KB	January 21 2020 7:10:06	hearthospit	0644
cpwd.php	3.35 KB	January 21 2020 7:10:06	hearthospit	0644
discharge.php	25.654 KB	March 17 2020 4:12:57	hearthospit	0644
edit-company.php	2.938 KB	January 21 2020 7:10:06	hearthospit	0644
edit-dep.php	2.536 KB	January 21 2020 7:10:05	hearthospit	0644
edit-format.php	5.87 KB	January 21 2020 7:10:05	hearthospit	0644
edit-patient.php	4.533 KB	January 21 2020 7:10:06	hearthospit	0644
edit.php	15.325 KB	January 21 2020 7:10:05	hearthospit	0644
edit-tpa.php	2.628 KB	January 21 2020 7:10:06	hearthospit	0644
index.php	6.772 KB	July 31 2024 6:52:56	hearthospit	0644
list-dep.php	2.544 KB	January 21 2020 7:10:06	hearthospit	0644
list-format.php	3.408 KB	January 21 2020 7:10:06	hearthospit	0644
list-tpa.php	5.025 KB	January 21 2020 7:10:05	hearthospit	0644
login.php	9.014 KB	January 21 2020 7:10:06	hearthospit	0644
new-dep.php	2.507 KB	January 21 2020 7:10:06	hearthospit	0644
new-format.php	5.29 KB	January 21 2020 7:10:06	hearthospit	0644
patient.php	7.822 KB	January 21 2020 7:10:05	hearthospit	0644
plan.php	11.472 KB	January 21 2020 7:10:06	hearthospit	0644
reset.php	10.114 KB	January 21 2020 7:10:05	hearthospit	0644
settings.php	6.073 KB	January 21 2020 7:10:06	hearthospit	0644
sign.php	2.872 KB	January 21 2020 7:10:05	hearthospit	0644
tpa-tariff.php	11.428 KB	January 21 2020 7:10:06	hearthospit	0644
users.php	5.345 KB	January 21 2020 7:10:06	hearthospit	0644

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