320 lines
11 KiB
PHP
320 lines
11 KiB
PHP
<!DOCTYPE html>
|
|
<html lang="en">
|
|
<head>
|
|
<meta charset="UTF-8">
|
|
<meta name="viewport" content="width=device-width, initial-scale=1.0">
|
|
<style>
|
|
.triangle1 {
|
|
width: 0;
|
|
height: 0;
|
|
border-left: 10.24px solid transparent;
|
|
border-right: 318.24px solid transparent;
|
|
border-bottom: 75.5px solid #008C8C;
|
|
position: absolute;
|
|
top: -55.12px;
|
|
left: -60.91px;
|
|
transform: rotate(-12deg);
|
|
}
|
|
|
|
.triangle2 {
|
|
width: 0;
|
|
height: 0;
|
|
border-left: 10.24px solid transparent;
|
|
border-right: 550.24px solid transparent;
|
|
border-bottom: 110.5px solid #19BBBB;
|
|
position: absolute;
|
|
top: -55.12px;
|
|
left: -100.91px;
|
|
transform: rotate(-20deg);
|
|
}
|
|
|
|
body {
|
|
margin: 0;
|
|
padding: 0;
|
|
height: 100vh;
|
|
background-color: #ffffff; /* Ganti dengan warna latar belakang yang diinginkan */
|
|
}
|
|
.content {
|
|
padding: 20px;
|
|
text-align: left;
|
|
}
|
|
|
|
.content img {
|
|
width: 25%;
|
|
max-width: 600px; /* batasan lebar maksimum gambar */
|
|
margin-top: 20px; /* jarak antara segitiga dan gambar */
|
|
}
|
|
.corner-text {
|
|
font-family: 'Calibri', sans-serif;
|
|
font-size: 14px;
|
|
color: #666666;
|
|
position: absolute;
|
|
}
|
|
|
|
.top-right {
|
|
top: 10px;
|
|
right: 10px;
|
|
}
|
|
|
|
.bottom-right {
|
|
bottom: 10px;
|
|
right: 10px;
|
|
}
|
|
.bottom-left {
|
|
bottom: 10px;
|
|
left: 10px;
|
|
text-align: left;
|
|
}
|
|
.title-container {
|
|
display: flex;
|
|
flex-direction: column;
|
|
align-items: center;
|
|
text-align: center;
|
|
position: relative;
|
|
margin-top: 40px;
|
|
}
|
|
|
|
.title {
|
|
font-family: 'Calibri', sans-serif;
|
|
font-size: 18px;
|
|
margin-bottom: 5px;
|
|
}
|
|
|
|
.additional-text {
|
|
font-family: 'Calibri', sans-serif;
|
|
font-size: 12px;
|
|
}
|
|
.claim-info {
|
|
font-family: 'Calibri', sans-serif;
|
|
font-size: 14px;
|
|
/* color: #008C8C; */
|
|
text-align: left;
|
|
margin-top: 20px;
|
|
}
|
|
|
|
.table-items {
|
|
font-family: 'Calibri', sans-serif;
|
|
font-size: 14px;
|
|
/* color: #008C8C; */
|
|
text-align: left;
|
|
margin-top: 20px;
|
|
}
|
|
|
|
table {
|
|
width: 100%;
|
|
border-collapse: collapse;
|
|
margin-top: 10px;
|
|
}
|
|
|
|
table, th, td {
|
|
/* border: 1px solid #008C8C; */
|
|
}
|
|
|
|
th, td {
|
|
padding: 4px;
|
|
text-align: left;
|
|
}
|
|
.hot-line {
|
|
font-family: 'Calibri', sans-serif;
|
|
background-color: #048B8C;
|
|
text-align: center;
|
|
align-items: center;
|
|
font-size: 14px;
|
|
margin-top: 10px;
|
|
padding: 2px;
|
|
color: #ffffff;
|
|
}
|
|
.txt-tindakan {
|
|
font-family: 'Calibri', sans-serif;
|
|
margin-top: 10px;
|
|
font-size: 14px;
|
|
}
|
|
.txt-pernyataan {
|
|
font-family: 'Calibri', sans-serif;
|
|
margin-top: 40px;
|
|
font-size: 14px;
|
|
}
|
|
</style>
|
|
</head>
|
|
<body>
|
|
<div class="triangle2"></div>
|
|
<div class="triangle1"></div>
|
|
<div class="content">
|
|
<div class="corner-text top-right">
|
|
The Future Of Healthcare At Your Fingertips
|
|
</div>
|
|
<img src="data:image/png;base64,{{ base64_encode(file_get_contents( public_path('images/logo-default.png') )) }}">
|
|
<div class="title-container">
|
|
<div class="title">
|
|
<b>SURAT JAMINAN</b>
|
|
</div>
|
|
<div class="additional-text">
|
|
(SURAT JAMINAN INI HARUS DITANDATANGANI OLEH PASIEN)
|
|
</div>
|
|
</div>
|
|
<table class="claim-info">
|
|
<tr>
|
|
<td style="width: 20%;">No. Klaim</td>
|
|
<td style="width: 1%;">:</td>
|
|
<td style="width: 29%;">{{$request_logs->code}}</td>
|
|
<td style="width: 20%;">Tanggal</td>
|
|
<td style="width: 1%;">:</td>
|
|
<td style="width: 29%;">{{ \Carbon\Carbon::parse($request_logs->submission_date)->format('d M Y') }}</td>
|
|
</tr>
|
|
<tr>
|
|
<td>Kepada</td>
|
|
<td>:</td>
|
|
<td>{{ $rumahSakit->nama_rumahsakit }}</td>
|
|
<td>Plan Polis</td>
|
|
<td>:</td>
|
|
<td>{{ $dataMember->code_plan }}</td>
|
|
</tr>
|
|
</table>
|
|
<div class="hot-line">
|
|
Call Center LinkSehat : 08114123962
|
|
</div>
|
|
<div class="txt-tindakan">
|
|
Link Sehat bertindak mewakili perusahaan asuransi/penanggung untuk mengeluarkan Surat Jaminan Awal untuk peserta dibawah ini :
|
|
</div>
|
|
<table class="claim-info">
|
|
<tr>
|
|
<td style="width: 20%;">Jenis Surat Jaminan</td>
|
|
<td style="width: 1%;">:</td>
|
|
<td style="width: 29%;"><b>SURAT JAMINAN AKHIR</b></td>
|
|
<td style="width: 20%;">Penjamin</td>
|
|
<td style="width: 1%;">:</td>
|
|
<td style="width: 29%;">{{ $dataMember->penjamin }}</td>
|
|
</tr>
|
|
<tr>
|
|
<td>Nama Peserta</td>
|
|
<td>:</td>
|
|
<td>{{ $dataMember->name }}</td>
|
|
<td>Nama Perusahaan</td>
|
|
<td>:</td>
|
|
<td>{{ $dataMember->nama_perusahaan }}</td>
|
|
</tr>
|
|
<tr>
|
|
<td>Nama Karyawan</td>
|
|
<td>:</td>
|
|
<td>{{ $namaKaryawan }}</td>
|
|
<td>No. Polis</td>
|
|
<td>:</td>
|
|
<td>{{ $dataMember->code_plan }}</td>
|
|
</tr>
|
|
<tr>
|
|
<td>Tanggal Lahir</td>
|
|
<td>:</td>
|
|
<td>{{ \Carbon\Carbon::parse($dataMember->birth_date)->format('d M Y') }}</td>
|
|
<!-- <td>Produk</td>
|
|
<td>:</td>
|
|
<td>{{ $dataMember->no_polis }}</td> -->
|
|
<td>Tipe</td>
|
|
<td>:</td>
|
|
<td>{{ $dataMember->limit_rules == '999999999' ? 'As Charge' : 'Max Amount, Rp '.number_format($dataMember->limit_rules, 2, ',', '.') }}</td>
|
|
</tr>
|
|
<tr>
|
|
<td>Jenis Kelamin</td>
|
|
<td>:</td>
|
|
<td>{{ $dataMember->gender == 'male' ? 'Laki-Laki' : 'Perempuan' }}</td>
|
|
<!-- <td>Tipe</td>
|
|
<td>:</td>
|
|
<td>{{ $dataMember->limit_rules == '999999999' ? 'As Charge' : 'Max Amount, Rp '.number_format($dataMember->limit_rules, 2, ',', '.') }}</td> -->
|
|
<td>Status Polis</td>
|
|
<td>:</td>
|
|
<td>{{ $dataMember->status_polis == 'active' ? 'Aktif' : 'Tidak Aktif' }}</td>
|
|
</tr>
|
|
<tr>
|
|
<td>Member ID</td>
|
|
<td>:</td>
|
|
<td>{{ $dataMember->member_id }}</td>
|
|
<!-- <td>Status Polis</td>
|
|
<td>:</td>
|
|
<td>{{ $dataMember->status_polis == 'active' ? 'Aktif' : 'Tidak Aktif' }}</td> -->
|
|
<td>Tanggal Mulai/Akhir</td>
|
|
<td>:</td>
|
|
<td>{{ \Carbon\Carbon::parse($dataMember->mulai)->format('d M Y') }} - {{ \Carbon\Carbon::parse($dataMember->akhir)->format('d M Y') }}</td>
|
|
</tr>
|
|
<tr>
|
|
<td>Identitas Peserta</td>
|
|
<td>:</td>
|
|
<td>{{ $dataMember->nik }}</td>
|
|
<!-- <td>Tanggal Mulai Akhir</td>
|
|
<td>:</td>
|
|
<td>{{ \Carbon\Carbon::parse($dataMember->mulai)->format('d M Y') }} - {{ \Carbon\Carbon::parse($dataMember->akhir)->format('d M Y') }}</td> -->
|
|
<td>Mata Uang</td>
|
|
<td>:</td>
|
|
<td>{{ $dataMember->mata_uang }}</td>
|
|
</tr>
|
|
<tr>
|
|
<td>Hak Kamar Pasien</td>
|
|
<td>:</td>
|
|
<td></td>
|
|
<td>Alamat Provider</td>
|
|
<td>:</td>
|
|
<td>{{ $rumahSakit->alamat_rumahsakit }}</td>
|
|
</tr>
|
|
<tr>
|
|
<td>Tanggal Pembayaran</td>
|
|
<td>:</td>
|
|
<td></td>
|
|
|
|
</tr>
|
|
</table>
|
|
<table class="table-items">
|
|
<thead>
|
|
<tr style="background-color: #F4F6F8;">
|
|
<td style="width: 5%; text-align: left;"><b>No.</b></td>
|
|
<td style="width: 25%; text-align: left;"><b>Item Layanan</b></td>
|
|
<td style="width: 15%; text-align: left;"><b>Total Klaim</b></td>
|
|
<td style="width: 20%; text-align: left;"><b>Total Disetujui</b></td>
|
|
<td style="width: 20%; text-align: left;"><b>Total Selisih</b></td>
|
|
<td style="width: 15%; text-align: left;"><b>Keterangan</b></td>
|
|
</tr>
|
|
</thead>
|
|
<tbody>
|
|
@php
|
|
$No = 1;
|
|
$total_claim = 0;
|
|
$total_disetujui = 0;
|
|
$total_selisih = 0;
|
|
@endphp
|
|
@foreach($dataClaimLog as $claimLog)
|
|
@php
|
|
$total_claim += $claimLog->amount_incurred;
|
|
$total_disetujui += $claimLog->amount_approved;
|
|
$total_selisih += $claimLog->excess_paid;
|
|
@endphp
|
|
<tr>
|
|
<td>{{ $No++ }}</td>
|
|
<td>{{ $claimLog->benfit}}</td>
|
|
<td>{{ number_format($claimLog->amount_incurred, 2, ',', '.') }}</td>
|
|
<td>{{ number_format($claimLog->amount_approved, 2, ',', '.') }}</td>
|
|
<td>{{ number_format($claimLog->excess_paid, 2, ',', '.') }}</td>
|
|
<td>{{ $claimLog->keterangan}}</td>
|
|
</tr>
|
|
@endforeach
|
|
</tbody>
|
|
<tfoot>
|
|
<tr>
|
|
<td style="background-color: #F4F6F8;" colspan="2"><b>Total</b></td>
|
|
<td style="background-color: #F4F6F8;" ><b>{{ number_format($total_claim, 2, ',', '.') }}</b></td>
|
|
<td style="background-color: #F4F6F8;" ><b>{{ number_format($total_disetujui, 2, ',', '.') }}</b></td>
|
|
<td style="background-color: #F4F6F8;" ><b>{{ number_format($total_selisih, 2, ',', '.') }}</b></td>
|
|
<td style="background-color: #F4F6F8;" ></td>
|
|
</tr>
|
|
</tfoot>
|
|
|
|
</table>
|
|
<div class="corner-text bottom-right">
|
|
The Future Of Healthcare At Your Fingertips
|
|
</div>
|
|
<div class="corner-text bottom-left">
|
|
<b>PT Link Medis Sehat</b><br>
|
|
<b>Primaya Hospital Corporate</b><br>
|
|
Graha Cempaka Mas Blok D5-6<br>
|
|
Jl. Let. Jend. Suprapto, Jakarta Pusat 10640, Indonesia<br>
|
|
<b>Telp</b> (021) 4217746/47
|
|
</div>
|
|
</div>
|
|
</body>
|
|
</html> |