<!DOCTYPE html>
<html class="no-js" lang="en" dir="ltr">
<head>
    <meta charset="utf-8">
    <meta http-equiv="x-ua-compatible" content="ie=edge">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title>Invoice No. {{ patientBilling.invoiceNo }}</title>
</head>
<body style="font-family:'Arial'; font-size:15px;">
<div style="width: 816px; height: 1056px; box-sizing:border-box; padding:80px; padding-top:30px; margin: 0 auto; box-shadow:3px 1px 10px 1px;">
    {% set patient = patientBilling.patient %}
    {% set branch = patientBilling.healthFacilityForAddress|default('') %}
    {% set company = patientBilling.healthFacilityForAddress.company|default('') %}
    {% set street = patientBilling.healthFacilityForAddress.street|default('') %}
    {% set city = patientBilling.healthFacilityForAddress.city.description|default('') %}
    {% set postalCode = patientBilling.healthFacilityForAddress.postalCode.description|default('') %}
    <div style="width:100%; height: 90px; position: relative; text-align: left;">
        <div style="height: 90px; width: 100%;">
            {% if patientBilling.payerType != 'Financing' %}
                <img src="{{ app.request.getSchemeAndHttpHost() ~ company.photoWebPath|default('') }}" style="height: 100%; width:auto;"/>
            {% else %}
                <img src="{{ app.request.getSchemeAndHttpHost() ~ patientBilling.patientPaymentFinancing.financingCompany.photoWebPath is defined and patientBilling.patientPaymentFinancing.financingCompany.photoWebPath is not empty ? app.request.getSchemeAndHttpHost() ~ patientBilling.patientPaymentFinancing.financingCompany.photoWebPath : '/uploads/company/photo/'~patientBilling.patient.healthFacility.company.parsedPhotoDescription|default('') }}" style="height: 100%; width:auto;"/>
            {% endif %}
        </div>
        {% if patientBilling.payerType != 'Financing' %}
            <div style="width: 100%; margin-bottom:10px;">
            <p style="font-size:16px; font-weight:500; margin-top:0; margin-bottom:5px;"><b>{{ company.description|default('') }}</b></p>
            {#<p style="font-size:16px; font-weight:500; margin-top:0; margin-bottom:5px;"><b>{{ branch.description|default('') }}</b></p>#}
            <p style=" margin:3px 0; font-size: 12px;">{{ street }}</p>
            <p style=" margin:3px 0; font-size: 12px;">{{ city }} {{ postalCode }}</p>
            <p style=" margin:3px 0; font-size: 12px;">{{ branch.concatenatedPhoneNo|default('') }}</p>
            <p style=" margin:3px 0; font-size: 12px;">{{ branch.concatenatedMobileNo|default('') }}</p>
            <p style=" margin:3px 0; font-size: 12px;">{{ branch.concatenatedEmail|default('') }}</p>

        {% else %}
            {% set financingCompany = patientBilling.patientPaymentFinancing.financingCompany %}

            <p style="font-size:18px; font-weight:500; margin-top:0; margin-bottom:5px;"><b>{{ financingCompany.description }}</b></p>
            <p style=" margin:3px 0;">{{ financingCompany.street }}</p>
            <p style=" margin:3px 0;">{{ financingCompany.city.description }} {{ financingCompany.postalCode.description }}</p>
            <p style=" margin:3px 0;">{{ financingCompany.concatenatedPhoneNo|default('') }}</p>
            <p style=" margin:3px 0;">{{ financingCompany.concatenatedMobileNo|default('') }}</p>
            <p style=" margin:3px 0;">{{ financingCompany.concatenatedEmail|default('') }}</p>
            {#<p style="margin-top:8px; margin-bottom:0; font-size:18px; color: darkblue; font-weight:500;">INVOICE</p>#}
            </div>
        {% endif %}
    </div>
    <div style="width:100%; height: 135px; position: relative;">
        <div style="width:100%; height: 155px;">
            <div style="width:30%; float:right; box-sizing:border-box; padding:5px; text-align: right;">
                <p style="font-size:15px; font-weight:500; margin-top:0; margin-bottom:7px;"><strong>DATE</strong> : {{ patientBilling.billingDateAsString|date('F j, Y') }}</p>
                <p style="font-size:15px; font-weight:500; margin-top:0; margin-bottom:1px;"><strong>INVOICE #</strong> : {{ patientBilling.invoiceNo ? patientBilling.invoiceNo : patientBilling.prevSysInvoiceNo }}</p>
            </div>
            <div style="box-sizing: border-box; height:auto; width: 70%; float: left;">
                <div style="padding: 5px;">
                    <p style="margin:0; margin-bottom:5px;"><strong>{{ patient.firstName }} {{ patient.lastName }}</strong></p>
                    <p style="margin:0; margin-bottom:2px; font-size: 15px;">{{ patient.street }}</p>
                    <p style="margin:0; margin-bottom:2px; font-size: 15px;">{{ patient.city.description|default('') ~ ', ' ~ patient.city.province.description|default('') }}</p>
                    <p style="margin:0; margin-bottom:2px; font-size: 15px;">{{ patient.postalCode.description|default('') }}</p>
                </div>
            </div>
        </div>
    </div>
    <div style="margin-top:20px;">
        <table width="100%" style="border-collapse: collapse; border: 1px solid #cacaca;">
            <thead>
            <tr>
                <td style="color:#000; font-size:15px; padding: 5px; border: 1px solid #cacaca;"><strong>DESCRIPTION</strong></td>
                <td style="color:#000; font-size:15px; padding: 5px; text-align: right; border: 1px solid #cacaca;"><strong>QTY</strong></td>
                <td style="color:#000; font-size:15px; padding: 5px; text-align: right; border: 1px solid #cacaca;"><strong>UNIT PRICE</strong></td>
                <td style="color:#000; font-size:15px; padding: 5px; text-align: right; border: 1px solid #cacaca;"><strong>AMOUNT</strong></td>
            </tr>
            </thead>
            <tbody>
            {% set totalReturnAmt = 0 %}
            {% set status = '' %}
            {% set isReturn = 0 %}

            {#{% set refundAmt = 0 %}#}
            {#{% if patientBilling.patientBillingRefunds|length > 0 %}#}
            {#{% for refunds in patientBilling.patientBillingRefunds %}#}
            {#{% set refundAmt = refundAmt + refunds.amount %}#}
            {#{% endfor %}#}
            {#{% endif %}#}

            {% for pbb in patientBilling.patientBillingBreakdowns %}
                {% set pc = pbb.patientChart %}
                {% set description = pbb.description %}
                {% set status = pbb.status|default('') %}
                {% if constant('RxconnexionBundle\\Entity\\PatientBillingBreakdownEntity::TYPE_CHART_PROCEDURE') == pbb.type %}
                    {% set description = pbb.chartProcedure.description %}
                {% elseif constant('RxconnexionBundle\\Entity\\PatientBillingBreakdownEntity::TYPE_ITEM') == pbb.type %}
                    {% set description = pbb.item.description %}
                {% endif %}

                {% if status == 'Return' %}
                    {% set isReturn = 1 %}
                    {% set totalReturnAmt = totalReturnAmt + pbb.amount %}
                {% endif %}

                <tr>
                    {#<td style="font-size:12px;">{{ pc.chartDateAsString|default('') }}</td>
                    <td style="font-size:12px;">{{ pc ? 'Services' : 'Misc.' }}</td>#}
                    <td style="padding:5px; font-size:15px; border: 1px solid #cacaca;">{{ description }}</td>
                    <td style="padding:5px; text-align: right; font-size:15px; border: 1px solid #cacaca;">{{ pbb.invoicequantity|number_format(0, '.', ',') }}</td>
                    <td style="padding:5px; text-align: right; font-size:15px; border: 1px solid #cacaca;">{{ pbb.invoiceprice|number_format(2, '.', ',') }}</td>
                    <td style="padding:5px; text-align: right; font-size:15px; border: 1px solid #cacaca;">{{ pbb.invoiceamount|number_format(2, '.', ',') }}</td>
                </tr>
            {% endfor %}
            <tr style="border-top:1px solid #cacaca;">
                <td colspan="3" style="text-align: right; padding:5px;">Total:</td>
                {#<td style="text-align: right; padding:5px;">{{ patientBilling.patientBillingRefunds|length > 0 or isReturn == 1 ? (patientBilling.amountDue + totalReturnAmt)|number_format(2, '.', ',') : patientBilling.amountDue|number_format(2, '.', ',') }}</td>#}
                <td style="text-align: right; padding:5px;">{{ patientBilling.invoiceamountDue|number_format(2, '.', ',') }}</td>
            </tr>
            {#<tr>
                <td style="height: 30px;"></td>
            </tr>
            <tr>
                <td colspan="3" style="text-align: right;">Total:</td>
                <td style="text-align: right;">{{ patientBilling.amountDue|number_format(2, '.', ',') }}</td>
            </tr>
            <tr>
                <td style="height: 20px;"></td>
            </tr>
            <tr>
                <td colspan="3" style="text-align: right;">Payment Made:</td>
                <td style="text-align: right;">{{ patientBilling.amountPaid|number_format(2, '.', ',') }}</td>
            </tr>
            <tr>
                {% if constant('RxconnexionBundle\\Entity\\PatientBillingEntity::PAYER_TYPE_FINANCING') == patientBilling.payerType %}
                    <td colspan="3" style="text-align: right;">Balance Due(Financing):</td>
                {% else %}
                    <td colspan="3" style="text-align: right;">Balance Due:</td>
                {% endif %}
                <td style="text-align: right; border-top: 4px double #aaaaaa; font-weight: 600; font-size: 18px;">{{ patientBilling.amountBalance|number_format(2, '.', ',') }}</td>
            </tr>#}
            </tbody>
        </table>
    </div>

    <div style="width: 100%;">
        <p style="margin-top:20px;"><strong>PAYMENTS</strong></p>
        <table width="100%" style="border-collapse: collapse; float: right;">
            <thead>
            <tr>
                <td style="font-size:15px; padding: 5px; text-align: center;border:1px solid #cacaca;">DATE</td>
                <td style="font-size:15px; padding: 5px; text-align: center;border:1px solid #cacaca;">TYPE</td>
                <td style="font-size:15px; padding: 5px; text-align: right;border:1px solid #cacaca;">AMOUNT</td>
            </tr>
            </thead>
            <tbody>
            {% for pp in patientBilling.patientPayments if pp.paymentStatus != constant('RxconnexionBundle\\Entity\\PatientPaymentEntity::PAYMENT_STATUS_VOID') %}
                {% set payType = pp.payTypeForPrint %}
                {% set amount = pp.amount %}
                {% set payDate = pp.payDateAsString|date('F j, Y') %}
                <tr>
                    <td style="text-align: center; font-size: 15px;border:1px solid #cacaca; padding:5px;">{{ payDate }}</td>
                    <td style="text-align: center; font-size: 15px;border:1px solid #cacaca;padding:5px;">{{ payType }}</td>
                    <td style="text-align: right; font-size: 15px;border:1px solid #cacaca;padding:5px;">{{ amount|number_format(2, '.', ',') }}</td>
                </tr>
            {% endfor %}
            <tr>
                <td style="height: 30px;"></td>
            </tr>
            <tr>
                <td style="height: 20px;"></td>
            </tr>
            <tr>
                <td colspan="2" style="text-align: right;">Payment :</td>
                <td style="text-align: right;">{{ patientBilling.amountPaid|number_format(2, '.', ',') }}</td>
            </tr>
            <tr>
                {% if constant('RxconnexionBundle\\Entity\\PatientBillingEntity::PAYER_TYPE_FINANCING') == patientBilling.payerType %}
                    <td colspan="2" style="text-align: right;">Balance Due:</td>
                {% else %}
                    <td colspan="2" style="text-align: right;">Balance :</td>
                {% endif %}
                {#<td style="text-align: right; border-top: 1px solid #aaaaaa; font-weight: 600; font-size: 18px;">{{ patientBilling.patientBillingRefunds|length > 0 or isReturn == 1 ? (patientBilling.amountBalance + totalReturnAmt - patientBilling.amountRefunded|default(0))|number_format(2, '.', ',') : patientBilling.amountBalance|number_format(2, '.', ',') }}</td>#}
                <td style="text-align: right; border-top: 1px solid #aaaaaa; font-weight: 600; font-size: 18px;">{{ patientBilling.invoiceamountBalance|number_format(2, '.', ',') }}</td>
            </tr>
            </tbody>
        </table>
    </div>

    <div style="width:50%; height: 155px; float:left;">
        <br>
        <p>{{ patientBilling.note }}</p>
        <h5>ALL SALES ARE FINAL</h5>
    </div>
</div>
</body>
</html>