<th align='left'><?php 
echo xlt('Field');
?>
</th>
  <th align='left'><?php 
echo xlt('Current Value');
?>
</th>
  <th align='left'><?php 
echo xlt('New Value');
?>
</th>
 </tr>

<?php 
$insrow = getInsuranceData($pid, $result['fields']['type']);
foreach ($insurance_layout as $lorow) {
    $data_type = $lorow['data_type'];
    $field_id = $lorow['field_id'];
    $list_id = $lorow['list_id'];
    $field_title = $lorow['title'];
    $currvalue = '';
    if (isset($insrow[$field_id])) {
        $currvalue = $insrow[$field_id];
    }
    $newvalue = '';
    if (isset($result['fields'][$field_id])) {
        $newvalue = trim($result['fields'][$field_id]);
    }
    // Translate $newvalue for certain field types including lists.
    if ($newvalue !== '') {

 $patient = getPatientData($p_id);
 $xml_array['status'] = 0;
 $xml_array['reason'] = "Success patient processing record";
 if ($patient) {
     $xml_array['Patient']['demographics'] = $patient;
     $ethencity_query = "SELECT option_id, title FROM list_options WHERE list_id  = 'ethnicity' AND `option_id` = ?";
     $patientData = $patient["ethnicity"];
     $ethencity_result = sqlQuery($ethencity_query, array($patientData));
     if ($ethencity_result) {
         $xml_array['Patient']['demographics']['ethnicityvalue'] = $ethencity_result['title'];
     } else {
         $xml_array['Patient']['demographics']['ethnicityvalue'] = '';
     }
     $p_insurance = getInsuranceData($p_id);
     $s_insurance = getInsuranceData($p_id, 'secondary');
     $o_insurance = getInsuranceData($p_id, 'tertiary');
     if ($p_insurance || $s_insurance) {
         $xml_array['Patient']['insurancelist']['status'] = 0;
         $xml_array['Patient']['insurancelist']['insuranceitem-1'] = $p_insurance;
         $xml_array['Patient']['insurancelist']['insuranceitem-2'] = $s_insurance;
         $xml_array['Patient']['insurancelist']['insuranceitem-3'] = $o_insurance;
     } else {
         $xml_array['Patient']['insurancelist']['status'] = 1;
         $xml_array['Patient']['insurancelist']['reason'] = 'No insurance data found';
     }
     $patient_hisory = getHistoryData($p_id);
     if ($patient_hisory) {
         $xml_array['Patient']['history']['status'] = 0;
         $xml_array['Patient']['history'] = $patient_hisory;
     } else {
         $xml_array['Patient']['history']['status'] = 1;

    }
    ++$item_count;
    generate_form_field($frow, $currvalue);
}
end_group();
?>

<?php 
if (!$GLOBALS['simplified_demographics']) {
    $insurancei = getInsuranceProviders();
    $pid = 0;
    $insurance_headings = array(xl("Primary Insurance Provider"), xl("Secondary Insurance Provider"), xl("Tertiary Insurance provider"));
    $insurance_info = array();
    $insurance_info[1] = getInsuranceData($pid, "primary");
    $insurance_info[2] = getInsuranceData($pid, "secondary");
    $insurance_info[3] = getInsuranceData($pid, "tertiary");
    echo "<br /><span class='bold'><input type='checkbox' name='form_cb_ins' value='1' " . "onclick='return divclick(this,\"div_ins\");'";
    if ($display_style == 'block') {
        echo " checked";
    }
    echo " /><b>" . xl('Insurance') . "</b></span>\n";
    echo "<div id='div_ins' class='section' style='display:{$display_style};'>\n";
    for ($i = 1; $i <= 3; $i++) {
        $result3 = $insurance_info[$i];
        ?>
<table border="0">
 <tr>
  <td valign='top' colspan='2'>
   <span class='required'><?php 
        echo $insurance_headings[$i - 1] . ":";
        ?>

 public static function batch_despatch($var, $func, $data_credentials)
 {
     global $pid;
     if (UserService::valid($data_credentials)) {
         require_once "../../library/invoice_summary.inc.php";
         require_once "../../library/options.inc.php";
         require_once "../../library/acl.inc";
         require_once "../../library/patient.inc";
         if ($func == 'ar_responsible_party') {
             $patient_id = $pid;
             $encounter_id = $var['encounter'];
             $x['ar_responsible_party'] = ar_responsible_party($patient_id, $encounter_id);
             return UserService::function_return_to_xml($x);
         } elseif ($func == 'getInsuranceData') {
             $type = $var['type'];
             $given = $var['given'];
             $x = getInsuranceData($pid, $type, $given);
             return UserService::function_return_to_xml($x);
         } elseif ($func == 'generate_select_list') {
             $tag_name = $var['tag_name'];
             $list_id = $var['list_id'];
             $currvalue = $var['currvalue'];
             $title = $var['title'];
             $empty_name = $var['empty_name'];
             $class = $var['class'];
             $onchange = $var['onchange'];
             $x['generate_select_list'] = generate_select_list($tag_name, $list_id, $currvalue, $title, $empty_name, $class, $onchange);
             return UserService::function_return_to_xml($x);
         } elseif ($func == 'xl_layout_label') {
             $constant = $var['constant'];
             $x['xl_layout_label'] = xl_layout_label($constant);
             return UserService::function_return_to_xml($x);
         } elseif ($func == 'generate_form_field') {
             $frow = $var['frow'];
             $currvalue = $var['currvalue'];
             ob_start();
             generate_form_field($frow, $currvalue);
             $x['generate_form_field'] = ob_get_contents();
             ob_end_clean();
             return UserService::function_return_to_xml($x);
         } elseif ($func == 'getInsuranceProviders') {
             $i = $var['i'];
             $provider = $var['provider'];
             $insurancei = getInsuranceProviders();
             $x = $insurancei;
             return $x;
         } elseif ($func == 'get_layout_form_value') {
             $frow = $var['frow'];
             $_POST = $var['post_array'];
             $x['get_layout_form_value'] = get_layout_form_value($frow);
             return UserService::function_return_to_xml($x);
         } elseif ($func == 'updatePatientData') {
             $patient_data = $var['patient_data'];
             $create = $var['create'];
             updatePatientData($pid, $patient_data, $create);
             $x['ok'] = 'ok';
             return UserService::function_return_to_xml($x);
         } elseif ($func == 'updateEmployerData') {
             $employer_data = $var['employer_data'];
             $create = $var['create'];
             updateEmployerData($pid, $employer_data, $create);
             $x['ok'] = 'ok';
             return UserService::function_return_to_xml($x);
         } elseif ($func == 'newHistoryData') {
             newHistoryData($pid);
             $x['ok'] = 'ok';
             return UserService::function_return_to_xml($x);
         } elseif ($func == 'newInsuranceData') {
             $_POST = $var[0];
             foreach ($var as $key => $value) {
                 if ($key >= 3) {
                     $var[$key] = formData($value);
                 }
                 if ($key >= 1) {
                     $parameters[$key] = $var[$key];
                 }
             }
             $parameters[12] = fixDate($parameters[12]);
             $parameters[27] = fixDate($parameters[27]);
             call_user_func_array('newInsuranceData', $parameters);
             $x['ok'] = 'ok';
             return UserService::function_return_to_xml($x);
         } elseif ($func == 'generate_layout_validation') {
             $form_id = $var['form_id'];
             ob_start();
             generate_layout_validation($form_id);
             $x = ob_get_clean();
             return $x;
         }
     } else {
         throw new SoapFault("Server", "credentials failed");
     }
 }

$o_insurance_company = $_POST['o_provider'];
$o_subscriber_employer_status = $_POST['o_subscriber_employer'];
$o_group_number = $_POST['o_group_number'];
$o_plan_name = $_POST['o_plan_name'];
$o_subscriber_relationship = $_POST['o_subscriber_relationship'];
$o_insurance_id = $_POST['o_insurance_id'];
$image_data = isset($_POST['image_data']) ? $_POST['image_data'] : '';
if ($userId = validateToken($token)) {
    $user = getUsername($userId);
    $acl_allow = acl_check('patients', 'demo', $user);
    if ($acl_allow) {
        $postData = array('id' => $id, 'title' => $title, 'fname' => $firstname, 'lname' => $lastname, 'mname' => $middlename, 'sex' => $sex, 'status' => $status, 'drivers_license' => $drivers_lincense, 'contact_relationship' => $contact_relationship, 'phone_biz' => $phone_biz, 'phone_cell' => $phone_cell, 'phone_contact' => $phone_contact, 'phone_home' => $phone_home, 'DOB' => $dob, 'language' => $language, 'financial' => $financial, 'street' => $street, 'postal_code' => $postal_code, 'city' => $city, 'state' => $state, 'country_code' => $country_code, 'ss' => $ss, 'occupation' => $occupation, 'email' => $email, 'race' => $race, 'ethnicity' => $ethnicity, 'usertext1' => $usertext1, 'genericname1' => $nickname, 'mothersname' => $mothersname, 'guardiansname' => $guardiansname);
        updatePatientData($patientId, $postData, $create = false);
        $primary_insurace_data = getInsuranceData($patientId);
        $secondary_insurace_data = getInsuranceData($patientId, 'secondary');
        $other_insurace_data = getInsuranceData($patientId, 'tertiary');
        $p_insurace_data = array('provider' => $p_insurance_company, 'group_number' => $p_group_number, 'plan_name' => $p_plan_name, 'subscriber_employer' => $p_subscriber_employer_status, 'subscriber_relationship' => $p_subscriber_relationship, 'policy_number' => $p_insurance_id);
        if ($primary_insurace_data) {
            updateInsuranceData($primary_insurace_data['id'], $p_insurace_data);
        } else {
            newInsuranceData($patientId, $type = "primary", $p_insurance_company, $policy_number = $p_insurance_id, $group_number = $p_group_number, $plan_name = $p_plan_name, $subscriber_lname = "", $subscriber_mname = "", $subscriber_fname = "", $subscriber_relationship = $p_subscriber_relationship, $subscriber_ss = "", $subscriber_DOB = "", $subscriber_street = "", $subscriber_postal_code = "", $subscriber_city = "", $subscriber_state = "", $subscriber_country = "", $subscriber_phone = "", $subscriber_employer = $p_subscriber_employer_status, $subscriber_employer_street = "", $subscriber_employer_city = "", $subscriber_employer_postal_code = "", $subscriber_employer_state = "", $subscriber_employer_country = "", $copay = "", $subscriber_sex = "", $effective_date = "0000-00-00", $accept_assignment = "TRUE");
        }
        $s_insurace_data = array('provider' => $s_insurance_company, 'group_number' => $s_group_number, 'plan_name' => $s_plan_name, 'subscriber_employer' => $s_subscriber_employer_status, 'subscriber_relationship' => $s_subscriber_relationship, 'policy_number' => $s_insurance_id);
        if ($secondary_insurace_data) {
            updateInsuranceData($secondary_insurace_data['id'], $s_insurace_data);
        } else {
            newInsuranceData($patientId, $type = "secondary", $s_insurance_company, $policy_number = $s_insurance_id, $group_number = $s_group_number, $plan_name = $s_plan_name, $subscriber_lname = "", $subscriber_mname = "", $subscriber_fname = "", $subscriber_relationship = $s_subscriber_relationship, $subscriber_ss = "", $subscriber_DOB = "", $subscriber_street = "", $subscriber_postal_code = "", $subscriber_city = "", $subscriber_state = "", $subscriber_country = "", $subscriber_phone = "", $subscriber_employer = $s_subscriber_employer_status, $subscriber_employer_street = "", $subscriber_employer_city = "", $subscriber_employer_postal_code = "", $subscriber_employer_state = "", $subscriber_employer_country = "", $copay = "", $subscriber_sex = "", $effective_date = "0000-00-00", $accept_assignment = "TRUE");
        }
        $o_insurace_data = array('provider' => $o_insurance_company, 'group_number' => $o_group_number, 'plan_name' => $o_plan_name, 'subscriber_employer' => $o_subscriber_employer_status, 'subscriber_relationship' => $o_subscriber_relationship, 'policy_number' => $o_insurance_id);
        if ($other_insurace_data) {
            updateInsuranceData($other_insurace_data['id'], $o_insurace_data);

        $to_url = "<td> <a href = {$web_root}" . "/controller.php?document&retrieve&patient_id={$pid}&document_id={$doc_id}" . "/tmp{$extension}" . " onclick=top.restoreSession(); class='image_modal'>" . " <img src = {$web_root}" . "/controller.php?document&retrieve&patient_id={$pid}&document_id={$doc_id}" . " width=100 alt='{$doc_catg}:{$image_file}'>  </a> </td> <td valign='center'>" . htmlspecialchars($doc_catg) . '<br />&nbsp;' . htmlspecialchars($image_file) . "</td>";
    } else {
        $to_url = "<td> <a href='" . $web_root . "/controller.php?document&retrieve" . "&patient_id={$pid}&document_id={$doc_id}'" . " onclick='top.restoreSession()' class='css_button_small'>" . "<span>" . htmlspecialchars(xl("View"), ENT_QUOTES) . "</a> &nbsp;" . htmlspecialchars("{$doc_catg} - {$image_file}", ENT_QUOTES) . "</span> </td>";
    }
    echo "<table><tr>";
    echo $to_url;
    echo "</tr></table>";
}
// Determine if the Vitals form is in use for this site.
$tmp = sqlQuery("SELECT count(*) AS count FROM registry WHERE " . "directory = 'vitals' AND state = 1");
$vitals_is_registered = $tmp['count'];
// Get patient/employer/insurance information.
//
$result = getPatientData($pid, "*, DATE_FORMAT(DOB,'%Y-%m-%d') as DOB_YMD");
$result2 = getEmployerData($pid);
$result3 = getInsuranceData($pid, "primary", "copay, provider, DATE_FORMAT(`date`,'%Y-%m-%d') as effdate");
$insco_name = "";
if ($result3['provider']) {
    // Use provider in case there is an ins record w/ unassigned insco
    $insco_name = getInsuranceProvider($result3['provider']);
}
?>
<html>

<head>
<?php 
html_header_show();
?>
<link rel="stylesheet" href="<?php 
echo $css_header;
?>

<a href="javascript:auto_populate_employer_address();" class=link_submit><?php 
xl('Copy Values', 'e');
?>
</a>
</form>

<?php 
if (isset($_GET[set_pid])) {
    if (!isset($_POST[insurance])) {
        $insurance = "primary";
    } else {
        $insurance = $_POST[insurance];
    }
    $result = getPatientData($_GET[set_pid]);
    // $result2 = getEmployerData($_GET{set_pid}); // not used!
    $result3 = getInsuranceData($_GET[set_pid], $insurance);
    ?>

<script language=javascript>
<!--
function auto_populate_employer_address(){
 var df = opener.document.demographics_form;
 df.i<?php 
    echo $browsenum;
    ?>
subscriber_fname.value='<?php 
    echo $result3[subscriber_fname];
    ?>
';
 df.i<?php 
    echo $browsenum;

 $provider_id = $userId;
 $patientId = 1;
 $pid = 1;
 sqlStatement("lock tables patient_data read");
 $result = sqlQuery("select max(pid)+1 as pid from patient_data");
 sqlStatement("unlock tables");
 if ($result['pid'] > 1) {
     $patientId = $result['pid'];
     $pid = $result['pid'];
 }
 $postData = array('title' => $title, 'fname' => $firstname, 'lname' => $lastname, 'mname' => $middlename, 'sex' => $sex, 'status' => $status, 'drivers_license' => $drivers_lincense, 'contact_relationship' => $contact_relationship, 'phone_biz' => $phone_biz, 'phone_cell' => $phone_cell, 'phone_contact' => $phone_contact, 'phone_home' => $phone_home, 'DOB' => $dob, 'language' => $language, 'financial' => $financial, 'street' => $street, 'postal_code' => $postal_code, 'city' => $city, 'state' => $state, 'country_code' => $country_code, 'ss' => $ss, 'occupation' => $occupation, 'email' => $email, 'race' => $race, 'ethnicity' => $ethnicity, 'pubpid' => $pid, 'usertext1' => $usertext1, 'genericname1' => $nickname, 'mothersname' => $mothersname, 'guardiansname' => $guardiansname, 'providerID' => $provider_id, 'ref_providerID' => 0, 'financial_review' => '0000-00-00 00:00:00', 'hipaa_allowsms' => '', 'hipaa_allowemail' => '', 'deceased_date' => '0000-00-00 00:0');
 $p_id = updatePatientData($patientId, $postData, $create = true);
 if ($p_id) {
     $primary_insurace_data = getInsuranceData($p_id);
     $secondary_insurace_data = getInsuranceData($p_id, 'secondary');
     $other_insurace_data = getInsuranceData($p_id, 'tertiary');
     $p_insurace_data = array('provider' => $p_insurance_company, 'group_number' => $p_group_number, 'plan_name' => $p_plan_name, 'subscriber_employer' => $p_subscriber_employer_status, 'subscriber_relationship' => $p_subscriber_relationship, 'policy_number' => $p_insurance_id);
     if ($primary_insurace_data) {
         updateInsuranceData($primary_insurace_data['id'], $p_insurace_data);
     } else {
         newInsuranceData($patientId, $type = "primary", $p_insurance_company, $policy_number = $p_insurance_id, $group_number = $p_group_number, $plan_name = $p_plan_name, $subscriber_lname = "", $subscriber_mname = "", $subscriber_fname = "", $subscriber_relationship = $p_subscriber_relationship, $subscriber_ss = "", $subscriber_DOB = "", $subscriber_street = "", $subscriber_postal_code = "", $subscriber_city = "", $subscriber_state = "", $subscriber_country = "", $subscriber_phone = "", $subscriber_employer = $p_subscriber_employer_status, $subscriber_employer_street = "", $subscriber_employer_city = "", $subscriber_employer_postal_code = "", $subscriber_employer_state = "", $subscriber_employer_country = "", $copay = "", $subscriber_sex = "", $effective_date = "0000-00-00", $accept_assignment = "TRUE");
     }
     $s_insurace_data = array('provider' => $s_insurance_company, 'group_number' => $s_group_number, 'plan_name' => $s_plan_name, 'subscriber_employer' => $s_subscriber_employer_status, 'subscriber_relationship' => $s_subscriber_relationship, 'policy_number' => $s_insurance_id);
     if ($secondary_insurace_data) {
         updateInsuranceData($secondary_insurace_data['id'], $s_insurace_data);
     } else {
         newInsuranceData($p_id, $type = "secondary", $s_insurance_company, $policy_number = $s_insurance_id, $group_number = $s_group_number, $plan_name = $s_plan_name, $subscriber_lname = "", $subscriber_mname = "", $subscriber_fname = "", $subscriber_relationship = $s_subscriber_relationship, $subscriber_ss = "", $subscriber_DOB = "", $subscriber_street = "", $subscriber_postal_code = "", $subscriber_city = "", $subscriber_state = "", $subscriber_country = "", $subscriber_phone = "", $subscriber_employer = $s_subscriber_employer_status, $subscriber_employer_street = "", $subscriber_employer_city = "", $subscriber_employer_postal_code = "", $subscriber_employer_state = "", $subscriber_employer_country = "", $copay = "", $subscriber_sex = "", $effective_date = "0000-00-00", $accept_assignment = "TRUE");
     }
     $o_insurace_data = array('provider' => $o_insurance_company, 'group_number' => $o_group_number, 'plan_name' => $o_plan_name, 'subscriber_employer' => $o_subscriber_employer_status, 'subscriber_relationship' => $o_subscriber_relationship, 'policy_number' => $o_insurance_id);
     if ($other_insurace_data) {
         updateInsuranceData($other_insurace_data['id'], $o_insurace_data);