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