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@@ -8,48 +8,48 @@ | |
<p class="text-center">J.P. Laurel Ave. corner Banawe St. Brgy Aquino Davao City, Philippines</p> | ||
<p class="text-center">Telephone: (082) 300-5345 Email: [email protected]</p> | ||
<h5 class="text-center"> | ||
PATIENT'S | ||
{{t "print.invoice.titles.patients"}} | ||
</h5> | ||
<h5 class="text-center"> | ||
BILLING STATEMENT | ||
{{t "print.invoice.titles.billing_statement"}} | ||
</h5> | ||
<table> | ||
<tr> | ||
<td colspan="2" class="col-xs-8"> | ||
NAME OF PATIENT: {{model.patient.displayName}} | ||
{{t "print.invoice.labels.patient_name"}} {{model.patient.displayName}} | ||
</td> | ||
<td class="col-xs-4"> | ||
PATIENT #:{{model.patient.displayPatientId}} | ||
{{t "print.invoice.labels.patient_name"}} {{model.patient.displayPatientId}} | ||
</td> | ||
</tr> | ||
<tr> | ||
<td class="col-xs-5"> | ||
AGE: {{model.patient.age}} | ||
{{t "print.invoice.labels.patient_age"}} {{model.patient.age}} | ||
</td> | ||
<td class="col-xs-3"> | ||
ADMITTED: {{date-format model.visit.startDate}} | ||
{{t "print.invoice.labels.date_admitted"}}{{date-format model.visit.startDate}} | ||
</td> | ||
<td class="col-xs-4"></td> | ||
</tr> | ||
<tr> | ||
<td class="col-xs-5"></td> | ||
<td class="col-xs-3">DISCHARGE: {{date-format model.visit.endDate}}</td> | ||
<td class="col-xs-3">{{t "print.invoice.labels.date_discharged"}}{{date-format model.visit.endDate}}</td> | ||
<td class="col-xs-4"></td> | ||
</tr> | ||
<tr> | ||
<td colspan="3" class="col-xs-12"> | ||
ADDRESS: {{model.patient.displayAddress}} | ||
{{t "print.invoice.labels.patient_address"}} {{model.patient.displayAddress}} | ||
</td> | ||
</tr> | ||
</table> | ||
<table class="table"> | ||
<tr class="table-header"> | ||
<th>Description</th> | ||
<th class="text-right">Actual Charges</th> | ||
<th class="text-right">Discount</th> | ||
<th class="text-right">PhilHealth</th> | ||
<th class="text-right">HMO/COM</th> | ||
<th class="text-right">Excess</th> | ||
<th>{{t "labels.description"}}</th> | ||
<th class="text-right">{{t "billing.labels.actual_charges"}}</th> | ||
<th class="text-right">{{t "labels.discount"}}</th> | ||
<th class="text-right">{{t "billing.labels.phil_health"}}</th> | ||
<th class="text-right">{{t "billing.labels.hmo_com"}}</th> | ||
<th class="text-right">{{t "labels.excess"}}</th> | ||
</tr> | ||
{{#each model.lineItemsByCategory as |categoryGroup|}} | ||
<tr> | ||
|
@@ -78,7 +78,7 @@ | |
</tr> | ||
{{/each}} | ||
<tr> | ||
<td><strong>Total {{categoryGroup.category}}</strong></td> | ||
<td><strong>{{t 'labels.total'}} {{categoryGroup.category}}</strong></td> | ||
<td class="text-right"><strong>{{number-format categoryGroup.total}}</strong></td> | ||
<td class="text-right"><strong>{{number-format categoryGroup.discount}}</strong></td> | ||
<td class="text-right"><strong>{{number-format categoryGroup.nationalInsurance}}</strong></td> | ||
|
@@ -87,21 +87,21 @@ | |
</tr> | ||
{{/each}} | ||
<tr> | ||
<td><strong>Total</strong></td> | ||
<td><strong>{{t 'labels.total'}}</strong></td> | ||
<td class="text-right"><strong>{{number-format model.total}}</strong></td> | ||
<td class="text-right"><strong>{{number-format model.discount}}</strong></td> | ||
<td class="text-right"><strong>{{number-format model.nationalInsurance}}</strong></td> | ||
<td class="text-right"><strong>{{number-format model.privateInsurance}}</strong></td> | ||
<td class="text-right"><strong>{{number-format model.amountOwed}}</strong></td> | ||
</tr> | ||
<tr> | ||
<td><strong>Payments/Deposits</strong></td> | ||
<td><strong>{{t 'billing.labels.payments_deposits'}}</strong></td> | ||
<td colspan="4"></td> | ||
<td class="text-right">-{{number-format model.paidTotal}}</td> | ||
<td></td> | ||
</tr> | ||
<tr> | ||
<td><strong>Grand Total</strong></td> | ||
<td><strong>{{t 'labels.grand_total'}}</strong></td> | ||
<td colspan="4"></td> | ||
<td class="text-right"><strong>{{number-format model.remainingBalance}}</strong></td> | ||
<td></td> | ||
|
@@ -111,41 +111,41 @@ | |
{{#if model.visit.dischargeInfo}} | ||
<tr> | ||
<td class="col-xs-12"> | ||
Discharge Notes: {{model.visit.dischargeInfo}} | ||
{{t 'print.invoice.labels.discharge_notes'}} {{model.visit.dischargeInfo}} | ||
</td> | ||
</tr> | ||
{{/if}} | ||
{{#if model.remarks}} | ||
<tr> | ||
<td class="col-xs-12"> | ||
Remarks: {{model.remarks}} | ||
{{t 'print.invoice.labels.remarks'}} {{model.remarks}} | ||
</td> | ||
</tr> | ||
{{/if}} | ||
<tr> | ||
<td class="col-xs-7"></td> | ||
<td class="col-xs-5">were deducted during my confinement</td> | ||
<td class="col-xs-5">{{t 'print.invoice.messages.where_conducted'}}</td> | ||
</tr> | ||
<tr> | ||
<td class="col-xs-8">Billed by: {{model.modifiedBy}}</td> | ||
<td class="col-xs-4">__________________________________________</td> | ||
<td class="col-xs-8">{{t 'print.invoice.labels.billed_by'}} {{model.modifiedBy}}</td> | ||
<td class="col-xs-4">{{t 'print.invoice.labels.spacer'}}</td> | ||
</tr> | ||
<tr> | ||
<td class="col-xs-8">Bill Date: {{date-format model.billDate}}</td> | ||
<td class="text-center col-xs-4">Patient-Member</td> | ||
<td class="col-xs-8">{{t 'print.invoice.labels.billed_date'}} {{date-format model.billDate}}</td> | ||
<td class="text-center col-xs-4">{{t 'print.titles.titles.patient_member'}}</td> | ||
</tr> | ||
<tr> | ||
<td class="col-xs-8"></td> | ||
<td class="col-xs-4">__________________________________________</td> | ||
<td class="col-xs-4">{{t 'print.invoice.labels.spacer'}}</td> | ||
</tr> | ||
<tr> | ||
<td class="col-xs-8">Certified Correct by: Leron L. Lehman- Executive Director</td> | ||
<td class="text-center col-xs-4">Relationship/Contact no.</td> | ||
<td class="col-xs-8">Certified Correct by: Leron L. Lehman- Executive Director}</td> | ||
<td class="text-center col-xs-4">{{t 'print.titles.titles.rel_contact'}}</td> | ||
</tr> | ||
</table> | ||
</div> | ||
<div class="panel-footer"> | ||
{{#link-to 'invoices.edit' model class="btn btn-default warning" }}Return{{/link-to}} | ||
{{#link-to "invoices.edit" model class="btn btn-default warning" }}{{t 'buttons.return_button'}}{{/link-to}} | ||
</div> | ||
</div> | ||
{{/print-this}} | ||
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