296 lines
10 KiB
PHP
296 lines
10 KiB
PHP
<?php
|
|
use App\Helpers\Helper;
|
|
?>
|
|
|
|
<!DOCTYPE html>
|
|
<html lang="en">
|
|
<head>
|
|
<meta http-equiv="Content-Type" content="text/html; charset=utf-8"/>
|
|
<title>Surat Jaminan Akhir - {{ $claim->code }}</title>
|
|
|
|
{{-- <link rel="stylesheet" href="{{ public_path('css/app.css') }}"> --}}
|
|
|
|
{{-- @vite('resources/css/app.css') --}}
|
|
{{----}}
|
|
<?php ob_start(); ?>
|
|
@vite('resources/css/app.css')
|
|
<?php
|
|
$viteString = ob_get_contents();
|
|
$publicPath = str_replace(env('APP_URL'),"/var/www/aso/public",$viteString);
|
|
|
|
echo $publicPath;
|
|
ob_end_clean();
|
|
?>
|
|
{{----}}
|
|
{{-- <link rel="stylesheet" href="/var/www/html/aso/public/build/assets/app-179954eb.css"> --}}
|
|
|
|
<style>
|
|
/* @font-face {
|
|
font-family: Public Sans;
|
|
src: url('{{asset('fonts/PublicSans-Medium.ttf')}}');
|
|
src: url('{{asset('fonts/PublicSans-Medium.ttf')}}') format('truetype');
|
|
} */
|
|
@page {
|
|
size: A4;
|
|
margin: 0;
|
|
}
|
|
|
|
html, body {
|
|
width: 210mm;
|
|
height: 297mm;
|
|
font-size: 12px !important;
|
|
}
|
|
@media print {
|
|
html, body {
|
|
width: 210mm;
|
|
height: 297mm;
|
|
}
|
|
/* ... the rest of the rules ... */
|
|
}
|
|
|
|
body {
|
|
font-family: 'Public Sans';
|
|
color: #404040;
|
|
font-size: 20px;
|
|
}
|
|
|
|
td {
|
|
padding: 3px;
|
|
vertical-align: top;
|
|
}
|
|
|
|
#member-detail{
|
|
|
|
}
|
|
#member-detail td {
|
|
width: 50%;
|
|
padding: 10px 0px;
|
|
}
|
|
#member-detail td>div{
|
|
margin-bottom: 5px;
|
|
}
|
|
|
|
.benefit-table-wrapper {
|
|
border: 1px solid #E0E0E0;
|
|
border-radius: 5px;
|
|
overflow: hidden;
|
|
}
|
|
#benefit-table {
|
|
width: 100%;
|
|
border-collapse: collapse;
|
|
}
|
|
|
|
#benefit-table th, #benefit-table th {
|
|
width: 50%;
|
|
}
|
|
|
|
#benefit-table th{
|
|
font-size: 20px;
|
|
font-weight: 400;
|
|
padding: 15px;
|
|
text-align: left;
|
|
}
|
|
|
|
#benefit-table tr:first-child {
|
|
background: #F5F5F5;
|
|
border-bottom: 1px solid #E0E0E0;
|
|
}
|
|
|
|
#benefit-table td {
|
|
padding: 15px;
|
|
font-size: 20px;
|
|
}
|
|
</style>
|
|
</head>
|
|
<body>
|
|
<table style="width: 100%">
|
|
<tr><td colspan="99" style="text-align: center">SURAT JAMINAN AKHIR</td></tr>
|
|
<tr>
|
|
<td style="width: 25%">Kepada</td>
|
|
<td style="width: 25%">: {{ $hospital->name }}</td>
|
|
|
|
<td style="width: 25%">GOP Tanggal</td>
|
|
<td style="width: 25%">: {{ $claim->created_at->format('d-M-y, H:i') }}</td>
|
|
</tr>
|
|
<tr>
|
|
<td>Alamat</td>
|
|
<td>: {{ $hospital->currentAddress->text ?? '' }}</td>
|
|
|
|
<td style="width: 25%">GOP Nomor</td>
|
|
<td style="width: 25%">: {{ $claim->code }}</td>
|
|
</tr>
|
|
<tr>
|
|
<td>No Telpon / Fax</td>
|
|
<td>: </td>
|
|
</tr>
|
|
<tr>
|
|
<td>Email</td>
|
|
<td>: </td>
|
|
</tr>
|
|
</table>
|
|
|
|
<p>Dengan ini jaminan diberikan kepada pasien yang juga merupakan tertanggung/peserta yang diasuransikan "Pasien" dengan data sebagai berikut</p>
|
|
|
|
|
|
<table style="width: 100%">
|
|
<tr><td colspan="99" style="background: red; padding-left: 30px; color: white">A. Identitas Pasien</td></tr>
|
|
<tr>
|
|
<td style="width: 25%">1. Nama Pasien</td>
|
|
<td style="width: 25%">: {{ $member->full_name }}</td>
|
|
|
|
<td style="width: 25%">7. Hak Kelas Kamar</td>
|
|
<td style="width: 25%">: {{ $inpatienBenefit->room_class_coverage ?? '' }}</td>
|
|
</tr>
|
|
<tr>
|
|
<td>2. Tanggal Lahir</td>
|
|
<td>: {{ $member->birth_date ?? '' }}</td>
|
|
|
|
<td>8. Hak Kamar ICU</td>
|
|
<td>: </td>
|
|
</tr>
|
|
<tr>
|
|
<td>3. Jenis Kelamin</td>
|
|
<td>: {{ ($member->gender ?
|
|
($member->gender == 'female' ? 'Perempuan'
|
|
: ($member->gender == 'male' ? 'Laki-Laki'
|
|
: $member->gender)
|
|
) : '') }}</td>
|
|
|
|
<td>9. No Polis</td>
|
|
<td>: {{ $member->currentPolicy?->code ?? '' }}</td>
|
|
</tr>
|
|
<tr>
|
|
<td>4. Nomor e-KTP</td>
|
|
<td>: {{ $member->nric }}</td>
|
|
|
|
<td>10. Nama PH / Perusahaan</td>
|
|
<td>: {{ $member->currentCorporate?->name ?? '' }}</td>
|
|
</tr>
|
|
<tr>
|
|
<td>5. Manfaat</td>
|
|
<td>: {{ $claim->claimRequest?->service?->name ?? '' }}</td>
|
|
|
|
<td>11. Periode Polis</td>
|
|
<td>: {{ $member->currentPolicy ? \Carbon\Carbon::parse($member->currentPolicy->end)->format('d-M-Y') : '' }}</td>
|
|
</tr>
|
|
<tr>
|
|
<td>6. Status Polis</td>
|
|
<td>: {{ $member->currentPolicy?->status ?? '' }}</td>
|
|
|
|
<td>12. Mata Uang</td>
|
|
<td>: {{ $member->currency ?? 'IDR' }}</td>
|
|
</tr>
|
|
|
|
<tr><td colspan="99" style="background: red; padding-left: 30px; color: white">B. Informasi Perawatan</td></tr>
|
|
<tr>
|
|
<td style="width: 25%">1. Tanggal Masuk</td>
|
|
<td style="width: 25%">: {{ $claim->finalEncounter->start ?? "" }}</td>
|
|
|
|
<td style="width: 25%">7. Lama Perawatan</td>
|
|
<td style="width: 25%">: {{ $claim->finalEncounter->duration_day ?? "" }}</td>
|
|
</tr>
|
|
<tr>
|
|
<td>2. Tanggal Keluar</td>
|
|
<td>: {{ $claim->finalEncounter->end }}</td>
|
|
|
|
<td>8. Kamar Perawatan</td>
|
|
<td>: {{ "" }}</td>
|
|
</tr>
|
|
<tr>
|
|
<td>3. Nama Rumah Sakit</td>
|
|
<td>: {{ $hospital->name }}</td>
|
|
|
|
<td>9. Jumlah Tempat Tidur</td>
|
|
<td>: {{ $claim->finalEncounter->number_of_bed }}</td>
|
|
</tr>
|
|
<tr>
|
|
<td>4. Dokter yang Merawat</td>
|
|
<td>: {{ $claim->finalEncounter->doctors->first()->person->name ?? '' }}</td>
|
|
|
|
<td>10. Estimasi Biaya Rawat Inap</td>
|
|
<td>: {{ $claim->total_tagihan ? Helper::currencyIdrFormat($claim->total_tagihan) : "" }}</td>
|
|
</tr>
|
|
<tr>
|
|
<td>5. No. Rekam Medis</td>
|
|
<td>: {{ $claim->finalEncounter->meta->MEDRECID }}</td>
|
|
|
|
<td>11. Diagnosa</td>
|
|
<td>: {{ $claim->diagnosis?->icd?->code ?? '' }}/{{ $claim->diagnosis?->icd?->name ?? '' }}</td>
|
|
</tr>
|
|
|
|
|
|
<tr><td colspan="99" style="background: red; padding-left: 30px; color: white">C. Nilai Jaminan</td></tr>
|
|
<tr>
|
|
<td colspan="99">
|
|
<table style="width: 100%">
|
|
<tr>
|
|
<th>Manfaat Polis</th>
|
|
<th>Biaya Diajukan</th>
|
|
<th>Biaya Dijamin</th>
|
|
<th>Biaya Tidak Dijamin</th>
|
|
</tr>
|
|
@foreach ($claim->items as $item)
|
|
<tr>
|
|
<td style="text-align:left">{{ $item->claim_itemable->description }}</td>
|
|
<td style="text-align:center">{{ Helper::currencyIdrFormat($item->nominal_ditagihkan)}}</td>
|
|
<td style="text-align:center">{{ Helper::currencyIdrFormat($item->nominal_dicover) }}</td>
|
|
<td style="text-align:center">{{ Helper::currencyIdrFormat($item->nominal_ditagihkan - $item->nominal_dicover) }}</td>
|
|
</tr>
|
|
@endforeach
|
|
</table>
|
|
|
|
<p>Tidak Dijamin : Full Cover</p>
|
|
<p>* Bila pasien menempati kamar perawatan di atas manfaat yang dimiliki maka pasien wajib membayar selisih yang timbul dan biaya yang tidak dijamin setelah menjalani perawatan Rumah Sakit</p>
|
|
</td>
|
|
</tr>
|
|
|
|
|
|
<tr><td colspan="99" style="background: red; padding-left: 30px; color: white">D. Otorisasi Surat Jaminan</td></tr>
|
|
<tr><td colspan="99">Surat Jaminan ini diotorisasi oleh PMN</td></tr>
|
|
|
|
<tr>
|
|
<td colspan="99">
|
|
<table style="width: 100%;">
|
|
<tr>
|
|
<td style="max-width: {{1/3}}%; overflow: visible; text-align: center">
|
|
Hormat Kami
|
|
<br>
|
|
<br>
|
|
<br>
|
|
<br>
|
|
<br>
|
|
(PRUMedical Network)
|
|
</td>
|
|
<td style="max-width: {{1/3}}%; overflow: visible; text-align: center">
|
|
Staff Administrasi Rumah Sakit
|
|
<br>
|
|
<br>
|
|
<br>
|
|
<br>
|
|
<br>
|
|
( )
|
|
</td>
|
|
<td style="max-width: {{1/3}}%; overflow: visible; text-align: center">
|
|
PH/Pasien/Keluarga
|
|
<br>
|
|
<br>
|
|
<br>
|
|
<br>
|
|
<br>
|
|
({{ $member->full_name }})
|
|
</td>
|
|
</tr>
|
|
</table>
|
|
</td>
|
|
</tr>
|
|
</table>
|
|
|
|
|
|
|
|
<div>
|
|
<p><strong>*) Surat ini tidak memerlukan tanda tangan karena dicetak secara komputerisasi</strong></p>
|
|
</div>
|
|
|
|
<div style="width: 100%; text-align: right; font-size: 10px; color: #777; margin-top: 20px;"><span style="padding: 15px;">Generated by Primecenter Linksehat at {{ now() }}</span></div>
|
|
</body>
|
|
</html>
|