316 lines
22 KiB
PHP
Executable File
316 lines
22 KiB
PHP
Executable File
<!--sidebar end-->
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<!--main content start-->
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<section id="main-content">
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<section class="wrapper site-min-height">
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<!-- page start-->
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<section class="panel">
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<header class="panel-heading">
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<?php
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if (!empty($ot_payment->id)) {
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echo '<i class="fa fa-edit"></i> '. lang('edit_ot_payment');
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} else
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echo '<i class="fa fa-plus-circle"></i> '. lang('add_ot_payment');
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?>
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</header>
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<div class="panel-body">
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<div class="adv-table editable-table ">
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<div class="clearfix">
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<div class="col-lg-12">
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<section class="panel">
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<div class="panel-body">
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<form role="form" action="finance/addOtPayment" method="post" enctype="multipart/form-data">
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<div class="col-md-6">
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<div class="col-md-3 payment_label">
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<label for="exampleInputEmail1"><?php echo lang('patient'); ?></label>
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</div>
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<div class="col-md-9">
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<select class="form-control m-bot15" name="patient" value=''>
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<?php foreach ($patients as $patient) { ?>
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<option value="<?php echo $patient->id; ?>" <?php
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if (!empty($ot_payment->patient)) {
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if ($ot_payment->patient == $patient->id) {
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echo 'selected';
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}
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}
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?> ><?php echo $patient->name; ?> </option>
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<?php } ?>
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</select>
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</div>
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</div>
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<div class="col-md-6">
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<div class="col-md-3 payment_label">
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<label for="exampleInputEmail1"><?php echo lang('consultant_surgeon'); ?></label>
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</div>
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<div class="col-md-9">
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<select class="form-control m-bot15" name="doctor_c_s" value=''>
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<option value="None">Select</option>
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<?php foreach ($doctors as $doctor) { ?>
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<option value="<?php echo $doctor->id; ?>"<?php
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if (!empty($ot_payment->doctor_c_s)) {
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if ($ot_payment->doctor_c_s == $doctor->id) {
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echo 'selected';
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}
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}
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?>><?php echo $doctor->name; ?> </option>
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<?php } ?>
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</select>
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</div>
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</div>
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<div class="col-md-6">
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<div class="col-md-3 payment_label">
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<label for="exampleInputEmail1"><?php echo lang('assistant_surgeon'); ?> (1) </label>
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</div>
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<div class="col-md-9">
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<select class="form-control m-bot15" name="doctor_a_s_1" value=''>
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<option value="None">Select</option>
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<?php foreach ($doctors as $doctor) { ?>
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<option value="<?php echo $doctor->id; ?>"<?php
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if (!empty($ot_payment->doctor_a_s_1)) {
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if ($ot_payment->doctor_a_s_1 == $doctor->id) {
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echo 'selected';
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}
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}
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?>><?php echo $doctor->name; ?> </option>
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<?php } ?>
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</select>
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</div>
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</div>
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<div class="col-md-6">
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<div class="col-md-3 payment_label">
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<label for="exampleInputEmail1"><?php echo lang('assistant_surgeon'); ?> (2) </label>
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</div>
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<div class="col-md-9">
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<select class="form-control m-bot15" name="doctor_a_s_2" value=''>
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<option value="None">Select</option>
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<?php foreach ($doctors as $doctor) { ?>
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<option value="<?php echo $doctor->id; ?>"<?php
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if (!empty($ot_payment->doctor_a_s_2)) {
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if ($ot_payment->doctor_a_s_2 == $doctor->id) {
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echo 'selected';
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}
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}
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?>><?php echo $doctor->name; ?> </option>
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<?php } ?>
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</select>
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</div>
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</div>
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<div class="col-md-6">
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<div class="col-md-3 payment_label">
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<label for="exampleInputEmail1"><?php echo lang('anaestheasist'); ?></label>
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</div>
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<div class="col-md-9">
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<select class="form-control m-bot15" name="doctor_anaes" value=''>
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<option value="None">Select</option>
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<?php foreach ($doctors as $doctor) { ?>
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<option value="<?php echo $doctor->id; ?>"<?php
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if (!empty($ot_payment->doctor_anaes)) {
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if ($ot_payment->doctor_anaes == $doctor->id) {
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echo 'selected';
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}
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}
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?>><?php echo $doctor->name; ?> </option>
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<?php } ?>
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</select>
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</div>
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</div>
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<div class="col-md-6">
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<div class="col-md-3 payment_label">
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<label for="exampleInputEmail1"><?php echo lang('nature_of_operation'); ?></label>
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</div>
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<div class="col-md-9">
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<input type="text" value="<?php
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if (!empty($ot_payment->n_o_o)) {
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echo $ot_payment->n_o_o;
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}
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?>" class="form-control pay_in" name="n_o_o" id="exampleInputEmail1">
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</div>
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</div>
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<div class="row">
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</div>
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<div class="col-md-12 payment">
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<div class="col-md-3 payment_label">
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<label class="payment_label"><strong><?php echo lang('payment_categories'); ?></strong></label>
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</div>
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<div class="col-md-3 payment_label">
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<label class="payment_label"><strong><?php echo lang('amunt'); ?></strong></label>
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</div>
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</div>
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<div class="col-md-12 payment">
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<div class="col-md-3 payment_label">
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<label for="exampleInputEmail1"><?php echo lang('consultant_surgeon'); ?></label>
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</div>
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<div class="col-md-9">
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<input type="text" class="form-control pay_in" name="c_s_f" id="exampleInputEmail1" value="<?php
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if (!empty($ot_payment->c_s_f)) {
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echo $ot_payment->c_s_f;
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}
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?>" placeholder="<?php echo $settings->currency; ?>">
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</div>
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</div>
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<div class="col-md-12 payment">
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<div class="col-md-3 payment_label">
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<label for="exampleInputEmail1"><?php echo lang('assistant_surgeon'); ?> (1)</label>
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</div>
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<div class="col-md-9">
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<input type="text" class="form-control pay_in" name="a_s_f_1" id="exampleInputEmail1" value="<?php
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if (!empty($ot_payment->a_s_f_1)) {
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echo $ot_payment->a_s_f_1;
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}
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?>" placeholder="<?php echo $settings->currency; ?>">
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</div>
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</div>
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<div class="col-md-12 payment">
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<div class="col-md-3 payment_label">
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<label for="exampleInputEmail1"><?php echo lang('assistant_surgeon'); ?> (2)</label>
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</div>
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<div class="col-md-9">
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<input type="text" class="form-control pay_in" name="a_s_f_2" id="exampleInputEmail1" value="<?php
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if (!empty($ot_payment->a_s_f_2)) {
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echo $ot_payment->a_s_f_2;
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}
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?>" placeholder="<?php echo $settings->currency; ?>">
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</div>
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</div>
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<div class="col-md-12 payment">
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<div class="col-md-3 payment_label">
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<label for="exampleInputEmail1"><?php echo lang('anaestheasist'); ?> <?php echo lang('fee'); ?></label>
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</div>
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<div class="col-md-9">
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<input type="text" class="form-control pay_in" name="anaes_f" id="exampleInputEmail1" value="<?php
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if (!empty($ot_payment->anaes_f)) {
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echo $ot_payment->anaes_f;
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}
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?>" placeholder="<?php echo $settings->currency; ?>">
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</div>
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</div>
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<div class="col-md-12 payment">
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<div class="col-md-3 payment_label">
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<label for="exampleInputEmail1"><?php echo lang('ot_charge'); ?></label>
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</div>
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<div class="col-md-9">
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<input type="text" class="form-control pay_in" name="ot_charge" id="exampleInputEmail1" value="<?php
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if (!empty($ot_payment->ot_charge)) {
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echo $ot_payment->ot_charge;
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}
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?>" placeholder="<?php echo $settings->currency; ?>">
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</div>
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</div>
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<div class="col-md-12 payment">
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<div class="col-md-3 payment_label">
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<label for="exampleInputEmail1"><?php echo lang('cabin_rent'); ?></label>
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</div>
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<div class="col-md-9">
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<input type="text" class="form-control pay_in" name="cab_rent" id="exampleInputEmail1" value="<?php
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if (!empty($ot_payment->cab_rent)) {
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echo $ot_payment->cab_rent;
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}
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?>" placeholder="<?php echo $settings->currency; ?>">
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</div>
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</div>
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<div class="col-md-12 payment">
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<div class="col-md-3 payment_label">
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<label for="exampleInputEmail1"><?php echo lang('seat_rent'); ?></label>
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</div>
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<div class="col-md-9">
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<input type="text" class="form-control pay_in" name="seat_rent" id="exampleInputEmail1" value="<?php
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if (!empty($ot_payment->seat_rent)) {
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echo $ot_payment->seat_rent;
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}
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?>" placeholder="<?php echo $settings->currency; ?>">
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</div>
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</div>
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<div class="col-md-12 payment">
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<div class="col-md-3 payment_label">
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<label for="exampleInputEmail1"><?php echo lang('others'); ?></label>
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</div>
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<div class="col-md-9">
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<input type="text" class="form-control pay_in" name="others" id="exampleInputEmail1" value="<?php
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if (!empty($ot_payment->others)) {
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echo $ot_payment->others;
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}
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?>" placeholder="<?php echo $settings->currency; ?>">
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</div>
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</div>
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<div class="col-md-12 payment">
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<div class="col-md-3 payment_label">
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<label for="exampleInputEmail1"><?php echo lang('discount'); ?> <?php
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if ($discount_type == 'percentage') {
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echo ' (%)';
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}
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?> </label>
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</div>
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<div class="col-md-9">
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<input type="text" class="form-control pay_in" name="discount" id="exampleInputEmail1" value='<?php
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if (!empty($ot_payment->discount)) {
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$discount = explode('*', $ot_payment->discount);
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echo $discount[0];
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}
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?>' placeholder="Discount">
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</div>
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</div>
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<!--
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<div class="col-md-12 payment">
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<div class="col-md-3 payment_label">
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<label for="exampleInputEmail1">Vat (%)</label>
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</div>
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<div class="col-md-9">
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<input type="text" class="form-control pay_in" name="vat" id="exampleInputEmail1" value='<?php
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if (!empty($payment->vat)) {
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echo $payment->vat;
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}
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?>' placeholder="%">
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</div>
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</div>
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-->
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<div class="row">
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</div>
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<div class="col-md-12 payment">
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<div class="col-md-3 payment_label">
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<label for="exampleInputEmail1"><?php echo lang('amount_received'); ?></label>
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</div>
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<div class="col-md-9">
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<input type="text" class="form-control pay_in" name="amount_received" id="exampleInputEmail1" value="<?php
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if (!empty($ot_payment->amount_received)) {
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echo $ot_payment->amount_received;
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}
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?>" placeholder="<?php echo $settings->currency; ?>">
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</div>
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</div>
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<div class="form-group">
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<div class="col-md-12">
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<div class="col-md-3">
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</div>
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<div class="col-md-6">
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<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
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</div>
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<div class="col-md-3">
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</div>
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</div>
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</div>
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<input type="hidden" name="id" value='<?php
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if (!empty($ot_payment->id)) {
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echo $ot_payment->id;
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}
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?>'>
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</form>
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</div>
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</section>
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</div>
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</div>
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</div>
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</div>
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</section>
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<!-- page end-->
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</section>
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</section>
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<!--main content end-->
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<!--footer start-->
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