File: /home/imensosw/www/imenso.co/dev/mps-new/accounts-2.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");
setTimeout(function(){
$('.sidebar_nav a').removeClass('active');
$('.sidebar_nav a').eq(2).addClass('active');
},100);
});
</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="">HIPPA 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-->
<!-- 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="">HIPPA 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="statements.html" class="btn btn-login">Submit</a>
</div>
</div>
</div>
</div> <!--/ Add new-->
<div class="container-fluid">
<div id="includedContent"></div>
<div class="right right_panel">
<div class="m-5">
<div class="container-fluid">
<div class="row statement">
<div class="col-md-12 mb-3 header_area">
<div class="d-flex justify-content-between align-items-center">
<h4 calss="mb-0">View Statements and Accounts Details</h4>
</div>
<hr />
</div>
</div>
<div class="row mt-4">
<div class="col-md-3">
<div class="ac__card-2">
<span>Payment Code</span>
<h4>145699002</h4>
<span>Balance: <strong>$1022.25</strong></span>
<hr>
<a href="javascript:;" data-toggle="modal" data-target="#hippaVerfication" class="v-sml-btn btn-block mb-1"> View Account Details </a>
<a href="javascript:;" data-toggle="modal" data-target="#hippaVerfication2" class="v-sml-btn btn-block"> View Statement </a>
</div>
</div>
<div class="col-md-3">
<div class="ac__card-2">
<span>Payment Code</span>
<h4>145699000</h4>
<span>Balance: <strong>$1400.25</strong></span>
<hr>
<a href="javascript:;" data-toggle="modal" data-target="#hippaVerfication" class="v-sml-btn btn-block mb-1"> View Account Details </a>
<a href="javascript:;" data-toggle="modal" data-target="#hippaVerfication2" class="v-sml-btn btn-block"> View Statement </a>
</div>
</div>
<div class="col-md-3">
<div class="ac__card-2">
<span>Payment Code</span>
<h4>145698992</h4>
<span>Balance: <strong>$1230.00</strong></span>
<hr>
<a href="javascript:;" data-toggle="modal" data-target="#hippaVerfication" class="v-sml-btn btn-block mb-1"> View Account Details </a>
<a href="javascript:;" data-toggle="modal" data-target="#hippaVerfication2" class="v-sml-btn btn-block"> View Statement </a>
</div>
</div>
<div class="col-md-3">
<div class="ac__card-2">
<span>Payment Code</span>
<h4>145698905</h4>
<span>Balance: <strong>$1802.50</strong></span>
<hr>
<a href="javascript:;" data-toggle="modal" data-target="#hippaVerfication" class="v-sml-btn btn-block mb-1"> View Account Details </a>
<a href="javascript:;" data-toggle="modal" data-target="#hippaVerfication2" class="v-sml-btn btn-block"> View Statement </a>
</div>
</div>
<div class="col-md-3">
<div class="ac__card-2">
<span>Payment Code</span>
<h4>145698885</h4>
<span>Balance: <strong>$1330.00</strong></span>
<hr>
<a href="javascript:;" data-toggle="modal" data-target="#hippaVerfication" class="v-sml-btn btn-block mb-1"> View Account Details </a>
<a href="javascript:;" data-toggle="modal" data-target="#hippaVerfication2" class="v-sml-btn btn-block"> View Statement </a>
</div>
</div>
<div class="col-md-3">
<div class="ac__card-2">
<span>Payment Code</span>
<h4>145698752</h4>
<span>Balance: <strong>$750.50</strong></span>
<hr>
<a href="javascript:;" data-toggle="modal" data-target="#hippaVerfication" class="v-sml-btn btn-block mb-1"> View Account Details </a>
<a href="javascript:;" data-toggle="modal" data-target="#hippaVerfication2" class="v-sml-btn btn-block"> View Statement </a>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</body>
</html>