| Current Path : /home1/savoy/www/savoyglobal.net/sibs_draft/system/application/views/Claims/ |
Linux gator3171.hostgator.com 4.19.286-203.ELK.el7.x86_64 #1 SMP Wed Jun 14 04:33:55 CDT 2023 x86_64 |
| Current File : /home1/savoy/www/savoyglobal.net/sibs_draft/system/application/views/Claims/editclaimforms.php |
<?php if ( ! defined('BASEPATH')) exit('No direct script access allowed');?>
<?php
/*
* To change this template, choose Tools | Templates
* and open the template in the editor.
*/
foreach($viewinfo as $updata)
{
$claimformid = $updata['id'];
$cover_id=$updata['cover_id'];
$company_id=$updata['company_id'];
$description=$updata['formname'];
}
$cr=$this->mastermodel->get_data_srow('covers',$cover_id,'id');
$sg=$this->mastermodel->get_data_srow('segment_insurances',$cr->segment_id,'id');
$ci = $this->mastermodel->get_data_srow('insurance_company',$company_id,'id');
?>
<div class="select-bar">
<label>
<img src="<?=base_url()?>/assets/images/backbutton.png" title="Back" class="clickimage" onclick="loadclaimforms('<?=$_SESSION['pagenum']?>','<?=$_SESSION['searchoption']?>','<?=$_SESSION['searchtxt']?>')" alt="Back" align = "center" width="25" height="25" /></label>
</div>
<?php
$attributes = array('id' => 'customForm');
echo form_open_multipart('claims/editclaimforms',$attributes);
?>
<fieldset>
<legend>Update Claim Forms</legend>
<?php
echo form_hidden('claimformsid',$claimformid);
?>
<ul>
<li id="typelist">
<?php
echo "
<label for='branch'>Insurance Classification</label><select name='segment_id' id='segment_id' onchange=\"showcover()\">";
echo "<option value='".$sg->id."'>".$sg->segment."</option>";
foreach($segment as $seg)
{
if($seg['segment']!=$sg->segment)
echo "<option value='".$seg['id']."'>".$seg['segment']."</option>";
}
// echo "<option value='". $list['id'] . "'>" . $list['segment'] . "</option>";
echo "</select>";
?><span id="segment_idInfo" class="red_bold">*</span>
</li>
<li id="coverlist">
<?php
echo "
<label for='branch'>Type Of Cover</label><select name='cover_id' id='cover_id' >";
echo "<option value='".$cr->id."'>".$cr->cover."</option>";
foreach($cover as $clist)
{
if($clist['cover']!=$cr->cover)
echo "<option value='".$clist['id']."'>".$clist['cover']."</option>";
}
// echo "<option value='". $list['id'] . "'>" . $list['segment'] . "</option>";
echo "</select>";
?><span id="cover_idInfo" class="red_bold">*</span>
</li>
<li>
<?php
echo " <label for='branch'>Company Name</label><select name='company_id' id='company_id' >";
echo "<option value='".$ci->id."'>".$ci->company_name."</option>";
foreach ($inscompany as $cilist)
{
if($cilist['$inscompany']!=$ci->company_name)
echo "<option value='". $list['id'] . "'>" . $list['company_name'] . "</option>";
}
echo "</select>";
?>
</li>
<li>
<label for="country">Form Name</label>
<?php echo form_input('formname',$description).form_error('description'); ?>
</li>
<li></li>
<li><label for="submit"> </label>
<button type="submit" id="submit" onclick="return validateform('segment_id','cover_id');">Update</button>
</li>
</ul>
</fieldset>
<?php echo form_close();?>