File: /home/imensosw/public_html/imenso.co/dev/mps-new/dashboard.html
<!doctype html>
<html lang="en-US" >
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<link rel="profile" href="http://gmpg.org/xfn/11">
<title>Patient Portal</title>
<link rel='stylesheet' href='css/bootstrap.min.css' media='all' />
<link rel='stylesheet' href='css/style-2.css' media='all' />
<link rel='stylesheet' href='css/responsive.css' media='all' />
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.7.0/css/font-awesome.css" media="all">
<script src="js/jquery.min.js"></script>
<script src="js/bootstrap.min.js"></script>
<script src="js/popover.js"></script>
<!-- <script src="js/popper.min.js" integrity="sha384-b/U6ypiBEHpOf/4+1nzFpr53nxSS+GLCkfwBdFNTxtclqqenISfwAzpKaMNFNmj4" crossorigin="anonymous"></script> -->
<script>
$(function(){
$("#includedContent").load("sidebar.html");
});
</script>
</head>
<body style="background: #F0F4F7;">
<!-- HIPPA Verfication -->
<div class="modal fade" id="hippaVerfication" tabindex="-1" role="dialog" aria-labelledby="" aria-hidden="true">
<div class="modal-dialog" role="document">
<div class="modal-content">
<div class="modal-header">
<h5 class="modal-title" id="">HIPAA Verification</h5>
<button type="button" class="close" data-dismiss="modal" aria-label="Close">
<span aria-hidden="true">×</span>
</button>
</div>
<div class="modal-body">
<form>
<div class="form-group">
<label for="">Payment Code</label>
<input type="text" class="form-control" value="145698752" disabled id="" aria-describedby="emailHelp" placeholder="Payment Code e.g. 14##########">
</div>
<div class="form-group">
<label for="">Enter Date of Birth</label>
<input type="text" class="form-control" id="" placeholder="MM/DD/YYYY">
</div>
</form>
</div>
<div class="modal-footer">
<a href="https://demo.patientbillhelp.com/ViewStatementReport.aspx?pc=HQX03HFXeGf6hXgIV5ldfofvvBhtJvZrr/WVCVCSVhE=" target="_blank" class="btn btn-login">Submit</a>
</div>
</div>
</div>
</div> <!--/ Add new-->
<!-- HIPPA Verfication -->
<div class="modal fade" id="hippaVerfication2" tabindex="-1" role="dialog" aria-labelledby="" aria-hidden="true">
<div class="modal-dialog" role="document">
<div class="modal-content">
<div class="modal-header">
<h5 class="modal-title" id="">HIPAA Verification</h5>
<button type="button" class="close" data-dismiss="modal" aria-label="Close">
<span aria-hidden="true">×</span>
</button>
</div>
<div class="modal-body">
<form>
<div class="form-group">
<label for="">Payment Code</label>
<input type="text" class="form-control" value="145698752" disabled id="" aria-describedby="emailHelp" placeholder="Payment Code e.g. 14##########">
</div>
<div class="form-group">
<label for="">Enter Date of Birth</label>
<input type="text" class="form-control" id="" placeholder="MM/DD/YYYY">
</div>
</form>
</div>
<div class="modal-footer">
<a href="account-details.html" class="btn btn-login">Submit</a>
</div>
</div>
</div>
</div> <!--/ Add new-->
<!-- Payment Code pop up -->
<div class="modal fade" id="paymentCodePopup" tabindex="-1" role="dialog" aria-labelledby="exampleModalLabel" aria-hidden="true">
<div class="modal-dialog" role="document">
<div class="modal-content">
<div class="modal-header">
<h5 class="modal-title" id="exampleModalLabel">Add New Payment Code</h5>
<button type="button" class="close" data-dismiss="modal" aria-label="Close">
<span aria-hidden="true">×</span>
</button>
</div>
<div class="modal-body">
<form>
<div class="form-group">
<label for="">Enter Payment Code</label>
<input type="text" class="form-control" id="" aria-describedby="emailHelp" placeholder="Payment Code e.g. 14##########">
</div>
<div class="form-group">
<label for="">Enter Last Name</label>
<input type="text" class="form-control" id="" placeholder="Last Name e.g. Smith">
</div>
</form>
</div>
<div class="modal-footer">
<button type="button" class="btn btn-login">Submit</button>
</div>
</div>
</div>
</div> <!--/ Add new-->
<!-- Delete Confirmation -->
<div class="modal fade" id="deletePaymentCode" tabindex="-1" role="dialog" aria-labelledby="exampleModalLabel" aria-hidden="true">
<div class="modal-dialog" role="document">
<div class="modal-content">
<div class="modal-header">
<h5 class="modal-title" id="exampleModalLabel">Delete</h5>
<button type="button" class="close" data-dismiss="modal" aria-label="Close">
<span aria-hidden="true">×</span>
</button>
</div>
<div class="modal-body">
Are you sure you want to delete this payment code?
</div>
<div class="modal-footer">
<button type="button" class="btn btn-secondary" data-dismiss="modal">Cancel</button>
<button type="button" class="btn btn-login">Delete</button>
</div>
</div>
</div>
</div>
<div class="container-fluid">
<div id="includedContent"></div>
<div class="right right_panel animate dashboard">
<div class="m-5">
<div class="container-fluid">
<div class="row payment_code mb-5">
<div class="col-md-12 mb-3 header_area">
<div class="d-flex justify-content-between align-items-center">
<h4 calss="mb-0">Dashboard</h4>
<a class="btn btn btn-secondary fix_bottom" data-toggle="modal" data-target="#paymentCodePopup" href="javascript:;"><i class="fa fa-plus"></i> <span>New Payment Code</span></a>
</div>
<hr />
</div>
<div class="col-md-12 mb-4">
<div class="card b-r-4">
<div class="card-body">
<table class="table table_block" id="paymentCode">
<tr>
<td width="25%"><span class="opaq">Facility Name</span><br><strong>The Pediatric Clinic</strong></td>
<td width="15%"><span class="opaq">Payment Code</span><br><strong>#521585</strong></td>
<td width="12%"><span class="opaq">Balance</span><br><strong class="">$1,205.00</strong></td>
<td class="" width="25%">
<a href="javascript:;" data-target="#hippaVerfication" data-toggle="modal" class="card-link"><i class="fa fa-eye"></i> View Statement </a> <br>
<a href="javascript:;" data-target="#hippaVerfication2" data-toggle="modal" class="card-link"> <i class="fa fa-download"></i> View Account Details</a>
</td>
<td style="text-align: center;" width="20%"><a class="btn btn-login mt-1 sml-text" href="pay-bill.html">Make Payment</a></td>
<td class="trash-link text-center" width="5%"><a data-toggle="modal" data-target="#deletePaymentCode" href=""><i class="fa fa-trash-o"></i> </a></td>
</tr>
</table>
</div>
</div>
<div class="card b-r-4">
<div class="card-body">
<table class="table table_block" id="paymentCode">
<tr>
<td width="25%"><span class="opaq">Facility Name</span><br><strong>The Pediatric Clinic</strong></td>
<td width="15%"><span class="opaq">Payment Code</span><br><strong>#535655</strong></td>
<td width="12%"><span class="opaq">Balance</span><br><strong class="">$1,025.00</strong></td>
<td class="" width="25%">
<a href="javascript:;" data-target="#hippaVerfication" data-toggle="modal" class="card-link"><i class="fa fa-eye"></i> View Statement </a> <br>
<a href="javascript:;" data-target="#hippaVerfication2" data-toggle="modal" class="card-link"> <i class="fa fa-download"></i> View Account Details</a>
</td>
<td style="text-align: center;" width="20%"><a class="btn btn-login mt-1 sml-text" href="pay-bill.html">Make Payment</a></td>
<td class="trash-link text-center" width="5%"><a data-toggle="modal" data-target="#deletePaymentCode" href=""><i class="fa fa-trash-o"></i> </a></td>
</tr>
</table>
</div>
</div>
<div class="card b-r-4">
<div class="card-body">
<table class="table table_block" id="paymentCode">
<tr>
<td width="25%"><span class="opaq">Facility Name</span><br><strong>The Pediatric Clinic</strong></td>
<td width="15%"><span class="opaq">Payment Code</span><br><strong>#538910</strong></td>
<td width="12%"><span class="opaq">Balance</span><br><strong class="">$1,550.00</strong></td>
<td class="" width="25%">
<a href="javascript:;" data-target="#hippaVerfication" data-toggle="modal" class="card-link"><i class="fa fa-eye"></i> View Statement </a> <br>
<a href="javascript:;" data-target="#hippaVerfication2" data-toggle="modal" class="card-link"> <i class="fa fa-download"></i> View Account Details</a>
</td>
<td style="text-align: center;" width="20%"><a class="btn btn-login mt-1 sml-text" href="pay-bill.html">Make Payment</a></td>
<td class="trash-link text-center" width="5%"><a data-toggle="modal" data-target="#deletePaymentCode" href=""><i class="fa fa-trash-o"></i> </a></td>
</tr>
</table>
</div>
</div>
</div>
<div class="col-md-12">
<div class="card">
<div class="card-header green-bg-g" style="padding:20px 30px;">
<div class="d-flex justify-content-between align-items-center">
<h4>Recent Payments</h4>
<a href="payment-history.html" class="card-link" style="color:#FFF;"> <span>View Payment History</span> <i class="fa fa-long-arrow-right"></i></a>
</div>
</div>
<div class="card-body">
<div class="table-responsive">
<table class="table">
<tr>
<td><span class="opaq">Date</span><br>05 Jan 2019</td>
<td>
<span class="opaq">Payment Code</span><br>
<span class=""># 502546</span>
</td>
<td>
<span class="opaq">Payment Type</span><br>
<span class="">Card ending XX56</span><br>
</td>
<td> <span class="opaq">Amount</span><br> <strong class="">$1,025.00</strong></td>
</tr>
<tr>
<td><span class="opaq">Date</span><br>25 Dec 2018</td>
<td>
<span class="opaq">Payment Code</span><br>
<span class=""># 501022</span>
</td>
<td>
<span class="opaq">Payment Type</span><br>
<span class="">Bank Account</span><br>
</td>
<td> <span class="opaq">Amount</span><br> <strong class="">$1,300.00</strong></td>
</tr>
<tr>
<td><span class="opaq">Date</span><br>10 Nov 2018</td>
<td>
<span class="opaq">Payment Code</span><br>
<span class=""># 500525</span>
</td>
<td>
<span class="opaq">Payment Type</span><br>
<span class="">Card ending XX56</span><br>
</td>
<td> <span class="opaq">Amount</span><br> <strong class="">$1,350.00</strong></td>
</tr>
<tr>
<td><span class="opaq">Date</span><br>20 Oct 2018</td>
<td>
<span class="opaq">Payment Code</span><br>
<span class=""># 500155</span>
</td>
<td>
<span class="opaq">Payment Type</span><br>
<span class="">Bank Account</span><br>
</td>
<td> <span class="opaq">Amount</span><br> <strong class="">$1,650.00</strong></td>
</tr>
</table>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</body>
</html>