<?php
session_start();
include("dbConfig.php");
if(isset($_SESSION['username']) && isset($_SESSION['name']))
{
    $username=$_SESSION['username'];
    $name=$_SESSION['name'];
}
else
{
     echo '<META http-equiv="refresh" content="0;logout.php">';
}

?><?php
include("dbConfig.php");
if(isset($_POST['Patid']) && isset($_POST['insurenceno']) ){
    $patid=$_POST['Patid'];
    $InsuranceNo = $_POST['insurenceno'];
    
    // `SlNo`, `PatId`, `Name`, `AdmitDate`, `AdmitTime`, `FHName`, `Contact`, `EmContact`, `Email`, `Dob`, `Age`, `Gender`, `BloodGroup`, `BodyWeight`, `Height`, `Photo`, `Address`, `Mark`, `Consultant`, `AadhaarNo`, `PatientType`, `CaseType`, `WardType`, `AdvanceAmount`, `PaymentMode`, `Discountdisp`, `DiscountAmount`, `InsuranceName`, `InsuranceNo`, `PreparedBy`, `DischargeDate`
    
    
    $sqlSearch = "SELECT * FROM `patientdetails` WHERE patientdetails.PatId='$patid' AND patientdetails.InsuranceNo='$InsuranceNo' ";
    $qu1=mysqli_query($db,$sqlSearch);
    while($row=$qu1->fetch_assoc()){
         $title = $row['title'];
        $Name = $row['Name'];
        $Contact = $row['Contact'];
        $PatientType = $row['PatientType'];
        $PatId = $row['PatId'];
        $PaymentMode = $row['PaymentMode'];
        $InsuranceName = $row['InsuranceName'];
        $InsuranceNo = $row['InsuranceNo'];
    }





?>

<!DOCTYPE html>
<html>
<head>
  <title>
    
  </title>
  <meta charset="UTF-8">
  <link href="assets/img/favicon.png" rel="icon">
  <link href="assets/img/apple-touch-icon.png" rel="apple-touch-icon">
  <script src='https://maxcdn.bootstrapcdn.com/bootstrap/4.3.1/js/bootstrap.min.js'></script>
<script src='https://cdnjs.cloudflare.com/ajax/libs/jquery/3.2.1/jquery.min.js'></script>
<link href='https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.0.3/css/font-awesome.css'>
<link href='https://maxcdn.bootstrapcdn.com/bootstrap/4.3.1/css/bootstrap.min.css'>
  <!-- Google Fonts -->
  <link href="https://fonts.googleapis.com/css?family=Open+Sans:300,300i,400,400i,700,700i|Raleway:300,400,500,700,800|Montserrat:300,400,700" rel="stylesheet">
<link href='https://maxcdn.bootstrapcdn.com/bootstrap/4.3.1/css/bootstrap.min.css'>
<link href='https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.0.3/css/font-awesome.css'>

  <!-- Vendor CSS Files -->
  <link href="assets/vendor/bootstrap/css/bootstrap.min.css" rel="stylesheet">
  <link href="assets/vendor/ionicons/css/ionicons.min.css" rel="stylesheet">
  <link href="assets/vendor/animate.css/animate.min.css" rel="stylesheet">
  <link href="assets/vendor/font-awesome/css/font-awesome.min.css" rel="stylesheet">
  <link href="assets/vendor/venobox/venobox.css" rel="stylesheet">
  <link href="assets/vendor/owl.carousel/assets/owl.carousel.min.css" rel="stylesheet">
  <link href="assets/vendor/boxicons/css/boxicons.min.css" rel="stylesheet">
  <script src="https://code.jquery.com/jquery.min.js"></script>
  <script src="jquery.dependent.fields.js"></script>
  <!-- Template Main CSS File -->
  <link href="assets/css/style.css" rel="stylesheet">
  <script src="https://code.jquery.com/jquery.min.js"></script>
<script src="jquery.dependent.fields.js"></script>
<style type="text/css">
.nav-menu a {
    padding: 3px 3px;
}

.footer {
   position: fixed;
   left: 0;
   bottom: 0;
   width: 100%;
   background-color: #efe8e8;
   color: black;
   text-align: center;
   padding:4px;
   font-size:12px;
}.footer a{
  font-weight: bold;
  color:#0c0c67;
}
  .hide {
  display: none;
}
h4{
  padding-top: 5px;
  padding-bottom: 0px;
  color:#1abfbf;
  font-weight: bold;
}
hr{
  background-color:#1abfbf;
}
span{
  color: red;
}
</style>
</head>
<body>
  <div style="text-align: center">
     <img src="assets/img/logo.png" width="100px" height="100px">
  </div>
     <header id="header">     

    <div class="container">
    <nav id="nav-menu-container">
        <ul class="nav-menu">
      <li class="menu-active">
        <a class="nav-link" style="padding:2;font-size:14px" href="index.php">Home</a>
      </li>
            <li class="menu-has-children">
        <a class="nav-link" style="padding:2;font-size:14px" href="#">IPD Patients</a>
        <ul>
              <li><a href="AddPatient.php">IPD Patient Registration</a></li>
              <li><a href="AddAdvance.php">IPD add Advance</a></li>
              <li><a href="UpdateWard.php">Update Ward</a></li>
              <li><a href="IPDPatients.php">View IPD Patients</a></li>
              
        </ul>
      </li>
      <li class="menu-has-children">
        <a class="nav-link" style="padding:2;font-size:14px" href="#">OPD Patients</a>
        <ul>
            <li><a href="OPDRegistration.php">OPD Patient Registration</a></li>
            <li><a href="OPDPatients.php">View OPD Patients</a></li>
        </ul>
      </li>
      <li class="menu-has-children">
        <a class="nav-link" style="padding:2;font-size:14px" href="#">Staff</a>
        <ul>
              <li><a href="AddStaff.php">Add Staff</a></li>
              <li><a href="StaffList.php">Staff List</a></li>
        </ul>
      </li>
      <li class="menu-has-children">
        <a class="nav-link" style="padding:2;font-size:14px" href="#">Billing</a>
        <ul>
              <li><a href="billingId.php">Generate Consolidate Bill</a></li>
              <li><a href="InvestigationId.php">Generate Investigation Bill</a></li>
              <li><a href="FinaleBillId.php">Generate Discharge Bill</a></li>
              <li><a href="SearchBill.php">Search Bill</a></li>
        </ul>
      </li>
      <li class="menu-has-children">
        <a class="nav-link" style="padding:2;font-size:14px" href="#">Particular</a>
        <ul>
              <li><a href="AddParticulars.php">Add Particulars</a></li>
              <li><a href="ViewParticulars.php">View Particulars</a></li>
        </ul>
      </li>
      <li class="menu-has-children">
        <a class="nav-link" style="padding:2;font-size:14px" href="#">Report</a>
        <ul>
               <li><a href="UploadReport.php">Upload Patient Report</a></li>
              <li><a href="DailyTrans.php">Transactions</a></li>
              <li><a href="userTrans.php">User Transactions</a></li>
              <li><a href="ViewReport.php">View Patient Reports</a></li>
              
        </ul>
      </li>
      <li class="menu-has-children">
        <a class="nav-link" style="padding:2;font-size:14px" href="#" style="font-size:15px"><? echo $name?></a>
        <ul>
               <li><a href="logout.php">Logout</a></li>
              <li><a href="ResetPassword.php">Reset Password</a></li>              
        </ul>
      </li>
        </ul>
      </nav><!-- #nav-menu-container -->
    </div>
  </header><!-- End Header -->   
  <section>
  <div class="row">
<div class="col-md-2"></div> 
<div class="col-md-8">
  <div class="shadow p-3 mb-5 bg-light rounded">
 
 
    



<form method="POST" action="insurance_print.php">
  <h2 style="text-align: center;font-weight: bold;color:#fff;background-color: #1abfbf;padding:10px;">Generate Bill</h2>
<h4>Patient Details</h4>
<hr>  
<div class="col-md-10">
   <table class="table table-borderless">
    <tr>
      <td>Patient Id</td>
      <td>:<strong><?echo $patid;?></strong></td>
      <td></td><td></td>
      <td>Phone No</td>
      <td>:<strong><?echo $Contact;?></strong></td>
      <input type="hidden" name="patid" value="<?echo $patid;?>">
    </tr>
    <tr>
      <td>Patient Name</td>
      <td>:<strong><?php echo $title . ' ' . $Name; ?></strong></td>
      <td></td><td></td>
      <td>Patient Type</td>
  <td>:<strong><?echo $PatientType;?></strong></td>
    </tr>

  </table>
</div>

<h4>Service Details</h4>
<hr>
<div class="row">
  <div class="form-group col">
  <label for="">Particulars<span>*</span></label>
  <select class="form-control" name="Particulars[]" required>
    <option value="">Choose Option</option>
    <?
   $qu2=mysqli_query($db,"SELECT * FROM particulars");
    while($row=$qu2->fetch_assoc()){
       $desp=$row['Description'];
        echo "<option value=\"$desp\">$desp</option>";
      }
?>
  </select>
</div>
<div class="form-group col">
  <label for="">Quantity<span>*</span></label>
  <input  class="form-control" type="text" name="Quantity[]" id="" required>
</div>
<div class="form-group col">
</div>
</div>
<div class="input-group control-group after-add-more">         
 <button class="btn btn-success add-more" type="button"><i class="glyphicon glyphicon-plus"></i>Add Particulars</button>
</div><br>
<!--<h4>Doctor Details</h4>
<hr>
<div class="row">
<div class="form-group col">
  <label for="">Doctor Name</label>
  <input  class="form-control" type="text" name="Doctor_name" id="">
</div>
<div class="form-group col">
</div>
</div>-->


 
<br>
<h4>Payment Details</h4>
<hr>
    <div class="row">
         <div class="form-group col">
          <label for="">Bill Type<span>*</span></label>
          <?php 
            if($PaymentMode == "Insurance"){
          ?>
          <select class="form-control" name="billtype" id="PaymentMode" required>
            <option value="">Choose Option</option>
            <option value="Cash">Cash</option>
            <option value="Card">Card</option>
            <option value="Credit">Credit</option>
            <option value="Cheque">Cheque</option>
            <option value="UPI">UPI</option>
            <option value="Net Banking">Net Banking</option>
            <option value="Cash and Card">Cash and Card</option>
            <option value="Insurance" selected>Insurance</option>
            <option value="ABRK">ABRK</option>
          </select>
          <?php }else{ ?>
          <select class="form-control" name="billtype" id="PaymentMode" required>
            <option value="">Choose Option</option>
            <option value="Cash">Cash</option>
            <option value="Card">Card</option>
            <option value="Credit">Credit</option>
            <option value="Cheque">Cheque</option>
            <option value="UPI">UPI</option>
            <option value="Net Banking">Net Banking</option>
            <option value="Cash and Card">Cash and Card</option>
            <option value="Insurance">Insurance</option>
            <option value="ABRK">ABRK</option>
          </select>
          <?php } ?>
        </div>
    </div>
    <div class="row" id="InsDetails">    
    <div class="form-group col" >
      <label for="InsuranceName">Insurance Name<span>*</span></label>
      <input  class="form-control" type="text" name="InsuranceName" id="InsuranceName" value="<?php echo $InsuranceName; ?>" >
    </div>
    <div class="form-group col">
      <label for="InsuranceNo">Insurance No<span>*</span></label>
      <input  class="form-control" type="text" name="InsuranceNo" id="InsuranceNo" value="<?php echo $InsuranceNo; ?>" >
    </div>

  </div>
 <div class="row">
<div class="form-group col">
    <?php 
        $InsuranceName;
        $InsuranceNo;
    ?>
    <label for="bdate">Date<span>*</span></label>
      <input class="form-control" type="date" name="bdate"  id="bdate" required>
  </div>
<div class="form-group col">
    <label for="btime">Time<span>*</span></label>
      <input class="form-control" type="time" name="btime" id="btime"    required>
  </div>
</div>


<div style="text-align: center">
  <button type="submit" class="btn btn-primary">Preview</button>
<a href="invoice.php"><button type="button" class="btn btn-info">Cancel</button></a>
</div>

</form>
</div>
</div> 
<div class="col-md-2"></div>    
  </div>
  <section>


<!--<button type="submit" class="btn btn-danger">test</button>-->

<div class="copy hide">
   <div class="control-group row">
 <div class="form-group col">
  <label for="">Particulars</label>
  <select class="form-control" name="Particulars[]">
    <option value="">Choose Option</option>
<?
   $qu2=mysqli_query($db,"SELECT * FROM particulars");
    while($row=$qu2->fetch_assoc()){
        $desp=$row['Description'];
        echo "<option value=\"$desp\">$desp</option>";
      }
?>
  </select>
</div>
<div class="form-group col">
  <label for="">Quantity</label>
  <input  class="form-control" type="text" name="Quantity[]" id="">
</div>
  <div class="input-group-btn col" style="margin-top:30px;"> 
    <button class="btn btn-danger remove" type="button"><i class="glyphicon glyphicon-remove"></i> Remove</button>
 </div>
</div>
</div>


 
</section>
 
</section>
  <script type="text/javascript">


    $(document).ready(function() {


      $(".add-more").click(function(){ 
          var html = $(".copy").html();
          $(".after-add-more").before(html);
      });


      $("body").on("click",".remove",function(){ 
          $(this).parents(".control-group").remove();
      });


    });


</script>
      <script type="text/javascript">
    $("#PaymentMode").change(function() {
  if ($(this).val() == "Insurance") {
    $('#InsDetails').show();
    $('#InsuranceName').attr('required', '');
    $('#InsuranceName').attr('data-error', 'This field is required.');
    $('#InsuranceNo').attr('required', '');
    $('#InsuranceNo').attr('data-error', 'This field is required.');
  } 

  else{
    $('#InsDetails').hide();
    $('#InsuranceName').removeAttr('required');
    $('#InsuranceName').removeAttr('data-error');
    $('#InsuranceNo').removeAttr('required');
    $('#InsuranceNo').removeAttr('data-error');
  }
});
$("#PaymentMode").trigger("change");
</script>
<div class="footer">
        &copy; Copyright 2024 All Rights Reserved <strong>Vidyaranya Hospital PVt LTD.</strong>. | Designed by <a href="http://www.vatsinsoft.in/">Vatsin Soft</a>
      </div>
 <script src='https://maxcdn.bootstrapcdn.com/bootstrap/4.3.1/js/bootstrap.min.js'></script>
  <script src='https://cdnjs.cloudflare.com/ajax/libs/jquery/3.2.1/jquery.min.js'></script>
  <script src="assets/vendor/jquery/jquery.min.js"></script>
  <script src="assets/vendor/bootstrap/js/bootstrap.bundle.min.js"></script>
  <script src="assets/vendor/jquery.easing/jquery.easing.min.js"></script>
  <script src="assets/vendor/php-email-form/validate.js"></script>
  <script src="assets/vendor/wow/wow.min.js"></script>
  <script src="assets/vendor/venobox/venobox.min.js"></script>
  <script src="assets/vendor/owl.carousel/owl.carousel.min.js"></script>
  <script src="assets/vendor/jquery-sticky/jquery.sticky.js"></script>
  <script src="assets/vendor/superfish/superfish.min.js"></script>
  <script src="assets/vendor/hoverIntent/hoverIntent.js"></script>
  <script src="assets/vendor/isotope-layout/isotope.pkgd.min.js"></script>
  <script src="assets/js/main.js"></script>
</body>
</html>
<?php } ?>