103 lines
3.3 KiB
PHP
Executable File
103 lines
3.3 KiB
PHP
Executable File
<!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=UTF-8' />
|
|
|
|
<title>WeCuro</title>
|
|
<link rel="shortcut icon" type="image/x-icon" href="<?php echo base_url(); ?>common/app-assets/images/ico/favicon.png">
|
|
<link rel='stylesheet' type='text/css' href='<?php echo base_url(); ?>common/assets/css/bill_style.css' />
|
|
</head>
|
|
|
|
<body onload="window.print()">
|
|
|
|
<div id="page-wrap">
|
|
<div>
|
|
<div class="header">INVOICE</div>
|
|
<div>
|
|
<div id="customer-title">WeCuro</div>
|
|
<div id="logo">
|
|
<img class="logo" src="<?php echo base_url(); ?>/common/app-assets/images/logo/logo.png" alt="logo" />
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<div style="clear:both"></div>
|
|
|
|
<div id="customer">
|
|
<div class="address">
|
|
<?= $patient->first_name." ".$patient->last_name ?><br>
|
|
<?php
|
|
$address = json_decode($patient->address);
|
|
echo($address->address.",".$address->Apartment.",".$address->City.",".$address->State.",".$address->Zipcode.",".$address->County);
|
|
?><br>
|
|
<?= $patient->telephone ?>
|
|
</div>
|
|
|
|
<table id="meta">
|
|
<tr>
|
|
<td class="meta-head">Invoice #</td>
|
|
<td><div><?= $data->invoice_id; ?></div></td>
|
|
</tr>
|
|
<tr>
|
|
<td class="meta-head">Date</td>
|
|
<td><div id="date"><?= date('m-d-Y', strtotime($data->billing_end)); ?></div></td>
|
|
</tr>
|
|
</table>
|
|
</div>
|
|
|
|
<table id="items">
|
|
<tr>
|
|
<th>Description</th>
|
|
<th>Unit Cost</th>
|
|
<th>Quantity/Hr Rate</th>
|
|
<th>Amount</th>
|
|
</tr>
|
|
|
|
<tr class="item-row">
|
|
<td class="description"><div><?= $patient->patient_level_services->name ?></div></td>
|
|
<td class="cost">$<?= $data->rate ?>.00</td>
|
|
<td class="qty"><?= $data->bill_units ?></td>
|
|
<td class="price">$<?= $data->rate*$data->bill_units ?>.00</td>
|
|
</tr>
|
|
|
|
<tr class="item-row">
|
|
<td colspan="4"></td>
|
|
</tr>
|
|
|
|
<tr id="hiderow">
|
|
<td colspan="4"></td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td colspan="2" class="blank"> </td>
|
|
<td colspan="1" class="total-line">Subtotal</td>
|
|
<td class="total-value"><div id="subtotal">$<?= $data->rate*$data->bill_units ?>.00</div></td>
|
|
</tr>
|
|
<tr>
|
|
|
|
<td colspan="2" class="blank"> </td>
|
|
<td colspan="1" class="total-line">Discount</td>
|
|
<td class="total-value"><div id="total">$0.00</div></td>
|
|
</tr>
|
|
<tr>
|
|
<td colspan="2" class="blank"> </td>
|
|
<td colspan="1" class="total-line">(Tax Rate)</td>
|
|
<td class="total-value"><Div id="paid">0%</div></td>
|
|
</tr>
|
|
<tr>
|
|
<td colspan="2" class="blank"> </td>
|
|
<td colspan="1" class="total-line balance">Tax</td>
|
|
<td class="total-value balance"><div class="due">$0.00</div></td>
|
|
</tr>
|
|
</table>
|
|
|
|
<div id="terms">
|
|
<h5>Terms</h5>
|
|
<div>NET 30 Days. Finance Charge of 1.5% will be made on unpaid balances after 30 days.</div>
|
|
</div>
|
|
<div class="footer">Invoice was created on a computer and is valid without the signature and seal</div>
|
|
</div>
|
|
|
|
</body>
|
|
|
|
</html>
|