Merge branch 'dev' of bitbucket.org:jubilian/nhance into dev
This commit is contained in:
commit
94a625fdcf
@ -123,13 +123,21 @@ class VidalApiController extends BaseController
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}
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public function newClaim(){
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public function newClaim()
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{
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$postData = $this->request->getPost();
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if (empty($postData)) {
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return $this->response->setJSON([
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'status' => false,
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'message' => 'Empty Data Given.',
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'data' => $postData
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]);
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}
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helper('api');
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$url = ''. getenv('VIDAL_API_BASE_URL').'/submitClaim';
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$url = getenv('VIDAL_API_BASE_URL') . '/submitClaim';
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$method = 'POST';
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$headers = [
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@ -138,27 +146,38 @@ class VidalApiController extends BaseController
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];
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$body = [
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'username:' .getenv('VIDAL_API_USERNAME').'',
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'password:' .getenv('VIDAL_API_PASSWORD').'',
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'PolicyNo:' .$postData['policyNo'] ?? '',
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'enrollmentId:' .$postData['enrollmentId'] ?? '',
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'typeOfClaim:' .$postData['typeOfClaim'] ?? '',
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'claimSubType:' .$postData['claimSubType'] ?? '',
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'requestedAmount:' .$postData['requestedAmount'] ?? '',
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'ailmentType:' .$postData['ailmentType'] ?? '',
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'admissionDate:' .$postData['admissionDate'] ?? '',
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'dischargeDate:' .$postData['dischargeDate'] ?? '',
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'hospitalName:' .$postData['hospitalName'] ?? '',
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'empanelmentNo:' .$postData['empanelmentNo'] ?? '',
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'documentType:' .$postData['documentType'] ?? '',
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'ailmentName:' .$postData['ailmentName'] ?? '',
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'hospitalAddress:' .$postData['hospitalAddress'] ?? '',
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'hospitalState:' .$postData['hospitalState'] ?? '',
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'hospitalCity:' .$postData['hospitalCity'] ?? '',
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'hospitalPinCode:' .$postData['hospitalPinCode'] ?? '',
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'hospitalPhoneNo:' .$postData['hospitalPhoneNo'] ?? ''
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'username' => getenv('VIDAL_API_USERNAME'),
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'password' => getenv('VIDAL_API_PASSWORD'),
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'policyNo' => $postData['policyNo'] ?? '',
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'enrollmentId' => $postData['enrollmentId'] ?? '',
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'typeOfClaim' => $postData['typeOfClaim'] ?? '',
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'claimSubType' => $postData['claimSubType'] ?? '',
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'requestedAmount' => $postData['requestedAmount'] ?? '',
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'ailmentType' => $postData['ailmentType'] ?? '',
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'admissionDate' => $postData['admissionDate'] ?? '',
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'dischargeDate' => $postData['dischargeDate'] ?? '',
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'hospitalName' => $postData['hospitalName'] ?? '',
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'empanelmentNo' => $postData['empanelmentNo'] ?? '',
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'documentType' => $postData['documentType'] ?? '',
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'ailmentName' => $postData['ailmentName'] ?? '',
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'hospitalAddress' => $postData['hospitalAddress'] ?? '',
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'hospitalState' => $postData['hospitalState'] ?? '',
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'hospitalCity' => $postData['hospitalCity'] ?? '',
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'hospitalPinCode' => $postData['hospitalPinCode'] ?? '',
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'hospitalPhoneNo' => $postData['hospitalPhoneNo'] ?? '',
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];
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// ✅ Handle file upload
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if ($file = $this->request->getFile('File')) {
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if ($file->isValid() && !$file->hasMoved()) {
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$filePath = $file->getTempName();
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$originalName = $file->getClientName();
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$mimeType = $file->getMimeType();
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$body['File'] = new \CURLFile($filePath, $mimeType, $originalName);
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}
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}
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$response = call_third_party_api($url, $method, $headers, $body);
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if($response['status'] != true){
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@ -170,10 +189,10 @@ class VidalApiController extends BaseController
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}
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return $this->response->setJSON($response);
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}
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public function enrollment(){
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$postData = $this->request->getJSON(true);
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@ -59,6 +59,7 @@ if (!function_exists('call_third_party_api')) {
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}
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$decoded = json_decode($response, true);
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return [
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'status' => ($httpCode >= 200 && $httpCode < 300),
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'data' => $decoded ?: $response, // fallback to raw response
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@ -249,7 +249,7 @@
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/* Force all text across the entire app to black */
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html, body, * {
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color: #000 !important;
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/* color: #000 !important; */
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}
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@ -496,7 +496,7 @@
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<style>
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*{
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font-family: Inter, sans-serif !important;
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font-family: 'Poppins' !important;
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}
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.content{
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min-height: 70vh;
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@ -552,7 +552,12 @@ rgba(0, 153, 158, 0.5) (transparent)
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font-style: normal;
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font-size: 18px;
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line-height: 1;
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letter-spacing: 0;
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letter-spacing: 0;
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color:black;
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}
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.font-color-black{
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color:black;
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}
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.app-text-left {
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@ -583,7 +588,7 @@ rgba(0, 153, 158, 0.5) (transparent)
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a.app-text-primary:hover, a.app-text-primary:focus {
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color: rgba(0, 153, 158, 0.5); !important; }
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color: rgba(0, 153, 158, 0.5) !important; }
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a.app-text-secondary:hover, a.app-text-secondary:focus {
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color: rgba(226, 103, 40, 0.5) !important; }
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@ -701,7 +706,25 @@ a.app-badge-secondary:focus, a.app-badge-secondary.focus {
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</style>
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<style>
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label{
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font-weight: 500 !important;
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font-size:0.875rem !important;
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}
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</style>
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<style>
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.dataTables_info{
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font-weight: 500 !important;
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color:#000 !important;
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}
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</style>
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<style>
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.right-bar{
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right : -300px;
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}
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</style>
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@ -88,9 +88,6 @@ tbody tr {
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white-space: nowrap !important;
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} */
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.app-text-black{
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color: #000000 !important;
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}
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.text-custom-grey{
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font-size: 0.85em;
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color: #6c757d !important;
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@ -215,7 +212,7 @@ table thead th {
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</div>
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</div>
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<div>
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<table id="scroll-horizontal-datatable" class="table w-100 nowrap app-text-black text-custom app-font-family">
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<table id="scroll-horizontal-datatable" class="table w-100 nowrap text-custom-black text-custom app-font-family">
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<thead class="app-table-head">
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<tr>
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<th>Ticket ID</th>
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@ -257,15 +254,17 @@ table thead th {
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<td class="app-text-left"><?php echo $row['assignee_name'] ? $row['assignee_name'] : '-'; ?></td>
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<td class="app-text-left">
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<?php if (!empty($row['created_at'])):
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$cdt = new DateTime($row['created_at']);
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echo $cdt->format('d/m/Y') . "<br><span class='time'> " . $cdt->format('h:i a') . "</span>";
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$cd = date("j F Y", strtotime($row['created_at']));
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$ct = date("h:i a", strtotime($row['created_at']));
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echo $cd . "<br><span class='time'> " . $ct . "</span>";
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endif;
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?>
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</td>
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<td class="app-text-left">
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<?php if (!empty($row['updated_at'])):
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$udt = new DateTime($row['updated_at']);
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echo $udt->format('d/m/Y') . "<br><span class='time'> " . $udt->format('h:i a') . "</span>";
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$ud = date("j F Y", strtotime($row['updated_at']));
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$ut = date("h:i a", strtotime($row['updated_at']));
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echo $ud . "<br><span class='time'> " . $ut . "</span>";
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endif;
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?>
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</td>
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@ -359,7 +358,7 @@ table thead th {
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<select class="form-control" id="ticket_type" name="ticket_type" required onchange="hideandshowpolicy()">
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<option value="">Select Ticket Type</option>
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<option value="Sales" selected >Sales</option>
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<option value="Service">Service</option>
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<option value="Service">Service</option>
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<!-- <option value="0">+ Add New</option>
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<?php if (!empty($ticket_type)): ?>
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<?php foreach ($ticket_type as $t): ?>
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@ -49,7 +49,7 @@
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}
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.conversation-card{
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border-radius: 15px !important;
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border-radius: 25px !important;
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box-shadow: 0 2px 4px 0 #00000040;
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}
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@ -196,7 +196,7 @@ hr{
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</div>
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<div class="row mb-2">
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<div class="col-4 app-subtitle app-text-grey app-font-family">Policy Number</div>
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<div class="col-8 app-text text-end app-font-family" style="font-weight: 500 !important;">
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<div class="col-8 app-text text-end app-font-family app-text-black" style="font-weight: 500 !important;">
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<?= (!empty($master[0]['policy_no']) && strtolower($master[0]['policy_no']) !== 'null')
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? '<u class="app-text-black">
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<a href="javascript:void(0);"
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@ -272,7 +272,7 @@ hr{
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<!-- Conversation Card -->
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<div class="card mb-3 conversation-card">
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<div class="card-header d-flex justify-content-between align-items-center" style="background:none; border:none; padding-bottom: 0px;">
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<p class="sub-title-text app-font-family" >Conversation</p>
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<p class="sub-title-text app-font-family app-text-black" >Conversation</p>
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</div>
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<div class="card-body recard-scroll" style="padding:0 27px !important; margin:0 !important; background:#F5FFFF;">
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<?php if(!empty($notes)): ?>
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@ -304,7 +304,7 @@ hr{
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<?php else: ?>
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<div class="d-flex justify-content-center align-items-center app-font-family"
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style="height: 45vh; width:100%;">
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<p class="text-center app-font-family"><i>No Data Found</i></p>
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<p class="text-center app-font-family font-color-black"><i>No Data Found</i></p>
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</div>
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<?php endif; ?>
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</div>
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@ -419,9 +419,11 @@ hr{
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<h5 class="app-font-family app-text"><?php echo '# '.$rt['thz_id']." / ".$rt['ticket_type']; ?></h5>
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<small classs="app-font-family" style="font-size:7px;">
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<?php if (!empty($rt['created_at'])):
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$cdt = new DateTime($rt['created_at']);
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echo $cdt->format('d/m/Y') . "<span class='time'> " . $cdt->format('h:i a') . "</span>";
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endif; ?>
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$cd = date("j F Y", strtotime($rt['created_at']));
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$ct = date("h:i a", strtotime($rt['created_at']));
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echo $cd . " " . $ct;
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endif;
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?>
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</small>
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</div>
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<p class="mt-1 app-font-family"
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@ -435,7 +437,7 @@ hr{
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else: ?>
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<div class="d-flex justify-content-center align-items-center"
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style="height: 50vh; width:100%;">
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<p class="text-center"><i>No Data Found</i></p>
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<p class="text-center font-color-black" ><i>No Data Found</i></p>
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</div>
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<?php endif; ?>
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</div>
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@ -459,7 +461,7 @@ hr{
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else: ?>
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<div class="d-flex justify-content-center align-items-center"
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style="height: 50vh; width:100%;">
|
||||
<p class="text-center"><i>No Data Found</i></p>
|
||||
<p class="text-center font-color-black"><i>No Data Found</i></p>
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</div>
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<?php endif; ?>
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</div>
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@ -13,7 +13,7 @@
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<div class="row">
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<div class="col-12">
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<div class="card-body">
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<form role="form" class="parsley-examples" method="post" id="ticket_auto_query"
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||||
<form role="form" class="parsley-examples" style="color:black;" method="post" id="ticket_auto_query"
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enctype="multipart/form-data">
|
||||
<div class="form-group">
|
||||
<div class="form-row">
|
||||
|
||||
@ -2,6 +2,11 @@
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||||
.bg-staff {
|
||||
background-color: #FFF5E5;
|
||||
}
|
||||
|
||||
.label-font-size{
|
||||
font-size:0.875rem;
|
||||
}
|
||||
|
||||
</style>
|
||||
<div class="row">
|
||||
<div class="col-12">
|
||||
@ -22,49 +27,49 @@
|
||||
<!-- Navigation Tabs -->
|
||||
<ul class="nav nav-pills navtab-bg">
|
||||
<li class="nav-item">
|
||||
<a href="#general-tab" data-toggle="tab" class="nav-link px-2 py-1 active" id="general_tab"
|
||||
<a href="#general-tab" data-toggle="tab" class="nav-link px-2 py-1 active label-font-size" id="general_tab"
|
||||
aria-expanded="true">
|
||||
<i class="mdi mdi-ticket-account"></i>
|
||||
<span class="d-none d-sm-inline-block">General</span>
|
||||
<span class="d-none d-sm-inline-block ">General</span>
|
||||
</a>
|
||||
</li>
|
||||
<li class="nav-item">
|
||||
<a href="#reply-tab" data-toggle="tab" class="nav-link px-2 py-1" id="reply_tab"
|
||||
<a href="#reply-tab" data-toggle="tab" class="nav-link px-2 py-1 label-font-size" id="reply_tab"
|
||||
aria-expanded="false">
|
||||
<i class="mdi mdi-message-processing"></i>
|
||||
<span class="d-none d-sm-inline-block">Reply</span>
|
||||
</a>
|
||||
</li>
|
||||
<li class="nav-item">
|
||||
<a href="#note-tab" data-toggle="tab" class="nav-link px-2 py-1" id="note_tab"
|
||||
<a href="#note-tab" data-toggle="tab" class="nav-link px-2 py-1 label-font-size" id="note_tab"
|
||||
aria-expanded="false">
|
||||
<i class="mdi mdi-note-text"></i>
|
||||
<span class="d-none d-sm-inline-block">Notes</span>
|
||||
</a>
|
||||
</li>
|
||||
<li class="nav-item">
|
||||
<a href="#history-tab" data-toggle="tab" class="nav-link px-2 py-1" id="history_tab"
|
||||
<a href="#history-tab" data-toggle="tab" class="nav-link px-2 py-1 label-font-size" id="history_tab"
|
||||
aria-expanded="false">
|
||||
<i class="mdi mdi-history"></i>
|
||||
<span class="d-none d-sm-inline-block">History</span>
|
||||
</a>
|
||||
</li>
|
||||
<li class="nav-item">
|
||||
<a href="#autoQuery-tab" data-toggle="tab" class="nav-link px-2 py-1" id="auto_query_tab"
|
||||
<a href="#autoQuery-tab" data-toggle="tab" class="nav-link px-2 py-1 label-font-size" id="auto_query_tab"
|
||||
aria-expanded="false">
|
||||
<i class="mdi mdi-robot mr-1"></i>
|
||||
<span class="d-none d-sm-inline-block">Auto Query Content</span>
|
||||
</a>
|
||||
</li>
|
||||
<li class="nav-item">
|
||||
<a href="#uploads-tab" data-toggle="tab" class="nav-link px-2 py-1" id="uploads_tab"
|
||||
<a href="#uploads-tab" data-toggle="tab" class="nav-link px-2 py-1 label-font-size" id="uploads_tab"
|
||||
aria-expanded="false">
|
||||
<i class="mdi mdi-file mr-1"></i>
|
||||
<span class="d-none d-sm-inline-block">Claim Files</span>
|
||||
</a>
|
||||
</li>
|
||||
<li class="nav-item">
|
||||
<a href="#viewpolicyterms-tab" data-toggle="tab" class="nav-link px-2 py-1" id="viewpolicyterms_tab"
|
||||
<a href="#viewpolicyterms-tab" data-toggle="tab" class="nav-link px-2 py-1 label-font-size" id="viewpolicyterms_tab"
|
||||
aria-expanded="false">
|
||||
<i class="mdi mdi-eye mr-1"></i>
|
||||
<span class="d-none d-sm-inline-block">View Policy Terms</span>
|
||||
|
||||
@ -23,6 +23,14 @@
|
||||
color: #0056b3;
|
||||
font-size: 24px;
|
||||
}
|
||||
|
||||
.label-font-size{
|
||||
font-size:0.875rem;
|
||||
}
|
||||
|
||||
|
||||
|
||||
|
||||
</style>
|
||||
<div class="row">
|
||||
<div class="col-12">
|
||||
@ -51,14 +59,14 @@
|
||||
|
||||
<div class="form-group">
|
||||
|
||||
<h5>Employee Details</h5>
|
||||
<h4>Employee Details</h4>
|
||||
<hr>
|
||||
|
||||
<!-- first_data_points -->
|
||||
<div class="form-row">
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="emp_code">Employee ID <span class="text-danger">*</span> <i class="mdi mdi-magnify text-danger"
|
||||
<label for="emp_code" class="label-font-size">Employee ID <span class="text-danger">*</span> <i class="mdi mdi-magnify text-danger"
|
||||
aria-hidden="true" onclick="openFetchEmpDataodal(this)"></i> <span
|
||||
class="text-danger"></span></label>
|
||||
<input type="text" class="form-control" id="emp_code" placeholder="Enter Employee ID"
|
||||
@ -67,7 +75,7 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="emp_name">Employee Name <span class="text-danger">*</span></label>
|
||||
<label for="emp_name" class="label-font-size">Employee Name <span class="text-danger">*</span></label>
|
||||
<input type=hidden id="emp_id" name="emp_id" value="<?= isset($ticket_data['emp_id']) ? $ticket_data['emp_id'] : '' ?>">
|
||||
<input type="text" class="form-control" id="emp_name" placeholder="Enter Employee Name"
|
||||
value="<?= isset($ticket_data['emp_name']) ? $ticket_data['emp_name'] : '' ?>"
|
||||
@ -75,13 +83,13 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="insured_name"> Insured Name <span class="text-danger">*</span></label>
|
||||
<label for="insured_name" class="label-font-size"> Insured Name <span class="text-danger">*</span></label>
|
||||
<input type=hidden id="insured_emp_id" name="insured_emp_id" value="<?= isset($ticket_data['insured_emp_id']) ? $ticket_data['insured_emp_id'] : '' ?>">
|
||||
<input class="form-control" id="insured_name" name="insured_name" value="<?= isset($ticket_data['insured_name']) ? $ticket_data['insured_name'] : '' ?>" required>
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="relationship"> Relationship <span class="text-danger">*</span></label>
|
||||
<label for="relationship" class="label-font-size"> Relationship <span class="text-danger">*</span></label>
|
||||
<select class="form-control" id="relationship" name="relationship" required>
|
||||
<option value="">Select Relationship</option>
|
||||
<?php
|
||||
@ -96,54 +104,54 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="policy_no">Policy No <span class="text-danger"></span></label>
|
||||
<label for="policy_no" class="label-font-size">Policy No <span class="text-danger"></span></label>
|
||||
<input type="text" class="form-control" id="policy_no"
|
||||
value="<?= isset($ticket_data['policy_no']) ? $ticket_data['policy_no'] : '' ?>"
|
||||
name="policy_no" placeholder="Policy Number">
|
||||
</div>
|
||||
<div class="form-group col-md-3">
|
||||
<label for="tpa_no">TPA ID <span class="text-danger"></span></label>
|
||||
<label for="tpa_no" class="label-font-size">TPA ID <span class="text-danger"></span></label>
|
||||
<input type="text" class="form-control" id="tpa_no" placeholder="Enter TPA ID"
|
||||
value="<?= isset($ticket_data['tpa_no']) ? $ticket_data['tpa_no'] : '' ?>"
|
||||
name="tpa_no">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="emp_mobile">Employee Mobile No <span class="text-danger">*</span></label>
|
||||
<label for="emp_mobile" class="label-font-size">Employee Mobile No <span class="text-danger">*</span></label>
|
||||
<input type="text" class="form-control" id="emp_mobile" placeholder="Enter EMP Mobile"
|
||||
value="<?= isset($ticket_data['emp_mobile']) ? $ticket_data['emp_mobile'] : '' ?>"
|
||||
name="emp_mobile" required>
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="emp_mail">Employee Mail ID <span class="text-danger">*</span></label>
|
||||
<label for="emp_mail" class="label-font-size">Employee Mail ID <span class="text-danger">*</span></label>
|
||||
<input type="text" class="form-control" id="emp_mail" placeholder="Enter EMP Mail"
|
||||
value="<?= isset($ticket_data['emp_mail']) ? $ticket_data['emp_mail'] : '' ?>"
|
||||
name="emp_mail" required>
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="emp_personal_mail">Employee Personal Mail ID</label>
|
||||
<label for="emp_personal_mail" class="label-font-size">Employee Personal Mail ID</label>
|
||||
<input type="text" class="form-control" id="emp_personal_mail" placeholder="Enter EMP Personal Mail"
|
||||
value="<?= isset($ticket_data['emp_personal_mail']) ? $ticket_data['emp_personal_mail'] : '' ?>"
|
||||
name="emp_personal_mail">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="client_name">Corporate Name <span class="text-danger">*</span></label>
|
||||
<label for="client_name" class="label-font-size">Corporate Name <span class="text-danger">*</span></label>
|
||||
<input type="hidden" id="client_id" name="client_id" value="<?= isset($ticket_data['client_id']) ? $ticket_data['client_id'] : '' ?>">
|
||||
<input type="text" class="form-control" id="client_name" placeholder="Client" value="<?= isset($ticket_data['client_name']) ? $ticket_data['client_name'] : '' ?>" readonly required>
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="insurer_id">Insurer <span class="text-danger">*</span></label>
|
||||
<label for="insurer_id" class="label-font-size">Insurer <span class="text-danger">*</span></label>
|
||||
<input type=hidden id="insurer_id" name="insurer_id" value="<?= isset($ticket_data['insurer_id']) ? $ticket_data['insurer_id'] : '' ?>">
|
||||
<input type=text class="form-control" id="insurer_name" placeholder="Insurer" value="<?= isset($ticket_data['insurer_name']) ? $ticket_data['insurer_name'] : '' ?>" readonly required>
|
||||
</div>
|
||||
<input type="hidden" id="empIDHidden" onchange="getClientPolicy()">
|
||||
<div class="col-md-3">
|
||||
<div class="form-group">
|
||||
<label>Policy <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size">Policy <span class="text-danger">*</span></label>
|
||||
<select id="emp_client_policy" name="client_policy_id"
|
||||
class="form-control custom-select" required onchange="setMinDateDOA(this.value); setInsurerAndTPAData(this)">
|
||||
<?php if (!empty($ticket_data['client_policy_id'])) { ?>
|
||||
@ -156,13 +164,13 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="tpa_name">TPA <span class="text-danger"></span></label>
|
||||
<label class="label-font-size" for="tpa_name">TPA <span class="text-danger"></span></label>
|
||||
<input type=hidden id="tpa_id" name="tpa_id" value="<?= isset($ticket_data['tpa_id']) ? $ticket_data['tpa_id'] : '' ?>">
|
||||
<input type=text class="form-control" id="tpa_name" placeholder="TPA" value="<?= isset($ticket_data['tpa_name']) ? $ticket_data['tpa_name'] : '' ?>" readonly>
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="acm_id">Account Manager <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size" for="acm_id">Account Manager <span class="text-danger">*</span></label>
|
||||
<select class="form-control" id="acm_id" name="acm_id" required>
|
||||
<!-- <option value="0">Select Account Manager</option> -->
|
||||
<?php
|
||||
@ -195,7 +203,7 @@
|
||||
<div class="form-row">
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="claim_status">Status <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size" for="claim_status">Status <span class="text-danger">*</span></label>
|
||||
<select class="form-control" id="claim_status_id" name="claim_status_id" required>
|
||||
<!-- <option value="0">Select status</option> -->
|
||||
<?php
|
||||
@ -210,7 +218,7 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="priority">Priority <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size" for="priority">Priority <span class="text-danger">*</span></label>
|
||||
<select class="form-control" id="priority" name="priority" required>
|
||||
<!-- <option value="0">Select Priority</option> -->
|
||||
<?php
|
||||
@ -225,7 +233,7 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="mode_of_intimation"> Mode of Submission <span
|
||||
<label class="label-font-size" for="mode_of_intimation"> Mode of Submission <span
|
||||
class="text-danger">*</span></label>
|
||||
<select class="form-control" id="mode_of_intimation" name="mode_of_intimation" required>
|
||||
<!-- <option value="0">Select Mode</option> -->
|
||||
@ -241,7 +249,7 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="claim_type"> Claim Type <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size" for="claim_type"> Claim Type <span class="text-danger">*</span></label>
|
||||
<select class="form-control" id="claim_type" name="claim_type" required>
|
||||
<!-- <option value="0">Select claim Type</option> -->
|
||||
<?php
|
||||
@ -256,7 +264,7 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="hospital_name">Hospital Name <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size" for="hospital_name">Hospital Name <span class="text-danger">*</span></label>
|
||||
<input type="text" class="form-control" id="hospital_name"
|
||||
placeholder="Enter Hospital Name"
|
||||
value="<?= isset($ticket_data['hospital_name']) ? $ticket_data['hospital_name'] : '' ?>"
|
||||
@ -264,20 +272,20 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="doa">DOA <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size" for="doa">DOA <span class="text-danger">*</span></label>
|
||||
<input type="text" class="form-control" id="doa" placeholder="Enter DOA"
|
||||
value="<?= isset($ticket_data['doa']) ? $ticket_data['doa'] : '' ?>"
|
||||
name="doa" required>
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="dod">DOD <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size" for="dod">DOD <span class="text-danger">*</span></label>
|
||||
<input type="text" class="form-control" id="dod" placeholder="Enter DOD"
|
||||
value="<?= isset($ticket_data['dod']) ? $ticket_data['dod'] : '' ?>" name="dod" required>
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="claim_amount">Claim Amount <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size" for="claim_amount">Claim Amount <span class="text-danger">*</span></label>
|
||||
<input type="text" class="form-control" id="claim_amount"
|
||||
placeholder="Enter Claim Amount"
|
||||
value="<?= isset($ticket_data['claim_amount']) ? $ticket_data['claim_amount'] : '' ?>"
|
||||
@ -285,7 +293,7 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label id="pod_no_label_1" for="pod_no">POD No with Courier Name <span id="pod_no_label_1_span" class="text-danger"></span></label>
|
||||
<label class="label-font-size" id="pod_no_label_1" for="pod_no">POD No with Courier Name <span id="pod_no_label_1_span" class="text-danger"></span></label>
|
||||
<input type="text" class="form-control" id="pod_no" placeholder="Enter POD NO"
|
||||
value="<?= isset($ticket_data['pod_no']) ? $ticket_data['pod_no'] : '' ?>"
|
||||
name="pod_no">
|
||||
@ -302,108 +310,108 @@
|
||||
<div class="form-row">
|
||||
|
||||
<div class="form-group col-md-3 up_cnu" style="display: none;">
|
||||
<label for="claim_number">Claim Number <span class="text-danger"></span></label>
|
||||
<label class="label-font-size" for="claim_number">Claim Number <span class="text-danger"></span></label>
|
||||
<input type="text" class="form-control" id="claim_number" placeholder="Enter Claim NO"
|
||||
value="<?= isset($ticket_data['claim_number']) ? $ticket_data['claim_number'] : '' ?>"
|
||||
name="claim_number">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3 up_cnu" style="display: none;">
|
||||
<label for="registration_date">Registration Date</label>
|
||||
<label class="label-font-size" for="registration_date">Registration Date</label>
|
||||
<input type="text" class="form-control datepicker" id="registration_date" placeholder="Select Registration Date"
|
||||
value="<?= isset($ticket_data['registration_date']) ? $ticket_data['registration_date'] : '' ?>" name="registration_date">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3 cda_ir" style="display: none;">
|
||||
<label for="raised_date">Raised Date</label>
|
||||
<label class="label-font-size" for="raised_date">Raised Date</label>
|
||||
<input type="text" class="form-control datepicker" id="raised_date" placeholder="Select Raised Date"
|
||||
value="<?= isset($ticket_data['raised_date']) ? $ticket_data['raised_date'] : '' ?>" name="raised_date">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3 up_qdr" style="display: none;">
|
||||
<label for="query_received_date">Query Received Date</label>
|
||||
<label class="label-font-size" for="query_received_date">Query Received Date</label>
|
||||
<input type="text" class="form-control datepicker" id="query_received_date" placeholder="Select Query Received Date"
|
||||
value="<?= isset($ticket_data['query_received_date']) ? $ticket_data['query_received_date'] : '' ?>" name="query_received_date">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3 rejected" style="display: none;">
|
||||
<label for="denial_reason">Denial Reason</label>
|
||||
<label class="label-font-size" for="denial_reason">Denial Reason</label>
|
||||
<input type="text" class="form-control" id="denial_reason" placeholder="Enter Denial Reason"
|
||||
value="<?= isset($ticket_data['denial_reason']) ? $ticket_data['denial_reason'] : '' ?>" name="denial_reason">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3 rejected" style="display: none;">
|
||||
<label for="denial_date">Denial Date</label>
|
||||
<label class="label-font-size" for="denial_date">Denial Date</label>
|
||||
<input type="text" class="form-control datepicker" id="denial_date" placeholder="Select Denial Date"
|
||||
value="<?= isset($ticket_data['denial_date']) ? $ticket_data['denial_date'] : '' ?>" name="denial_date">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3 approved" style="display: none;">
|
||||
<label for="approved_amount">Approved Amount</label>
|
||||
<label class="label-font-size" for="approved_amount">Approved Amount</label>
|
||||
<input type="text" class="form-control" id="approved_amount" placeholder="Enter Approved Amount"
|
||||
value="<?= isset($ticket_data['approved_amount']) ? $ticket_data['approved_amount'] : '' ?>" name="approved_amount">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3 approved" style="display: none;">
|
||||
<label for="approved_date">Approved Date</label>
|
||||
<label class="label-font-size" for="approved_date">Approved Date</label>
|
||||
<input type="text" class="form-control datepicker" id="approved_date" placeholder="Select Approved Date"
|
||||
value="<?= isset($ticket_data['approved_date']) ? $ticket_data['approved_date'] : '' ?>" name="approved_date">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-6 approved" style="display: none;">
|
||||
<label for="approved_letter">Approved Letter</label>
|
||||
<label class="label-font-size" for="approved_letter">Approved Letter</label>
|
||||
<input type="text" class="form-control" id="approved_letter" placeholder="Enter Approved Letter"
|
||||
value="<?= isset($ticket_data['approved_letter']) ? $ticket_data['approved_letter'] : '' ?>" name="approved_letter">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-6 approved" style="display: none;">
|
||||
<label for="approved_description">Approved Description</label>
|
||||
<label class="label-font-size" for="approved_description">Approved Description</label>
|
||||
<input type="text" class="form-control" id="approved_description" placeholder="Enter Approved Description"
|
||||
value="<?= isset($ticket_data['approved_description']) ? $ticket_data['approved_description'] : '' ?>" name="approved_description">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3 settled" style="display: none;">
|
||||
<label for="utr_details">UTR Details</label>
|
||||
<label class="label-font-size" for="utr_details">UTR Details</label>
|
||||
<input type="text" class="form-control" id="utr_details" placeholder="Enter UTR Details"
|
||||
value="<?= isset($ticket_data['utr_details']) ? $ticket_data['utr_details'] : '' ?>" name="utr_details">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3 settled" style="display: none;">
|
||||
<label for="settled_date">Settled Date</label>
|
||||
<label class="label-font-size" for="settled_date">Settled Date</label>
|
||||
<input type="text" class="form-control datepicker" id="settled_date" placeholder="Select Settled Date"
|
||||
value="<?= isset($ticket_data['settled_date']) ? $ticket_data['settled_date'] : '' ?>" name="settled_date">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-6 settled" style="display: none;">
|
||||
<label for="settle_letter">Settle Letter</label>
|
||||
<label class="label-font-size" for="settle_letter">Settle Letter</label>
|
||||
<input type="text" class="form-control" id="settle_letter" placeholder="Enter Settle Letter"
|
||||
value="<?= isset($ticket_data['settle_letter']) ? $ticket_data['settle_letter'] : '' ?>" name="settle_letter">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3 payment" style="display: none;">
|
||||
<label for="pay_initiate_date">Payment Initiate Date</label>
|
||||
<label class="label-font-size" for="pay_initiate_date">Payment Initiate Date</label>
|
||||
<input type="text" class="form-control datepicker" id="pay_initiate_date" placeholder="Select Payment Initiate Date"
|
||||
value="<?= isset($ticket_data['pay_initiate_date']) ? $ticket_data['pay_initiate_date'] : '' ?>" name="pay_initiate_date">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3 canceled" style="display: none;">
|
||||
<label for="cancel_remark">Cancel Remark</label>
|
||||
<label class="label-font-size" for="cancel_remark">Cancel Remark</label>
|
||||
<textarea class="form-control" id="cancel_remark" rows="1" placeholder="Enter Cancel Remark" name="cancel_remark"><?= isset($ticket_data['cancel_remark']) ? $ticket_data['cancel_remark'] : '' ?></textarea>
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3 returned" style="display: none;">
|
||||
<label for="return_remark">Return Remark</label>
|
||||
<label class="label-font-size" for="return_remark">Return Remark</label>
|
||||
<textarea class="form-control" id="return_remark" rows="1" placeholder="Enter Return Remark" name="return_remark"><?= isset($ticket_data['return_remark']) ? $ticket_data['return_remark'] : '' ?></textarea>
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-6 returned" style="display: none;">
|
||||
<label for="awb_no_courier_name">Return AWB No with Courier Name</label>
|
||||
<label class="label-font-size" for="awb_no_courier_name">Return AWB No with Courier Name</label>
|
||||
<input type="text" class="form-control" id="awb_no_courier_name" placeholder="eg : 0001/ST Courier"
|
||||
value="<?= isset($ticket_data['awb_no_courier_name']) ? $ticket_data['awb_no_courier_name'] : '' ?>" name="awb_no_courier_name">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3 non_id" style="display: none;">
|
||||
<label for="non_id_reason">Non ID Reason <span id="non_id_reason_lable_id" class="text-danger"></span></label>
|
||||
<label class="label-font-size" for="non_id_reason">Non ID Reason <span id="non_id_reason_lable_id" class="text-danger"></span></label>
|
||||
<select class="form-control" id="non_id_reason" name="non_id_reason">
|
||||
<option value="">Select Reason</option>
|
||||
<?php
|
||||
|
||||
@ -16,6 +16,11 @@
|
||||
color: #0056b3;
|
||||
font-size: 24px;
|
||||
}
|
||||
|
||||
.label-font-size{
|
||||
font-size:0.875rem;
|
||||
}
|
||||
|
||||
</style>
|
||||
|
||||
<div class="row">
|
||||
@ -51,7 +56,7 @@
|
||||
<div class="form-row">
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="emp_code">Employee ID <span class="text-danger">*</span> <i class="mdi mdi-magnify text-danger"
|
||||
<label class="label-font-size" for="emp_code">Employee ID <span class="text-danger">*</span> <i class="mdi mdi-magnify text-danger"
|
||||
aria-hidden="true" onclick="openFetchEmpDataodal(this)"></i> <span class="text-danger"></span></label>
|
||||
<input type="text" class="form-control" id="emp_code" placeholder="Enter Employee ID"
|
||||
value="<?= isset($ticket_data['emp_code']) ? $ticket_data['emp_code'] : '' ?>"
|
||||
@ -59,7 +64,7 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="emp_name">Employee Name <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size" for="emp_name">Employee Name <span class="text-danger">*</span></label>
|
||||
<input type=hidden id="emp_id" name="emp_id" value="<?= isset($ticket_data['emp_id']) ? $ticket_data['emp_id'] : '' ?>">
|
||||
<input type="text" class="form-control" id="emp_name" placeholder="Enter Employee Name"
|
||||
value="<?= isset($ticket_data['emp_name']) ? $ticket_data['emp_name'] : '' ?>"
|
||||
@ -67,41 +72,41 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="emp_mobile">Employee Mobile No <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size" for="emp_mobile">Employee Mobile No <span class="text-danger">*</span></label>
|
||||
<input type="text" class="form-control" id="emp_mobile" placeholder="Enter EMP Mobile"
|
||||
value="<?= isset($ticket_data['emp_mobile']) ? $ticket_data['emp_mobile'] : '' ?>"
|
||||
name="emp_mobile" required>
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="emp_mail">Employee Mail ID <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size" for="emp_mail">Employee Mail ID <span class="text-danger">*</span></label>
|
||||
<input type="text" class="form-control" id="emp_mail" placeholder="Enter EMP Mail"
|
||||
value="<?= isset($ticket_data['emp_mail']) ? $ticket_data['emp_mail'] : '' ?>"
|
||||
name="emp_mail" required>
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="emp_personal_mail">Employee Personal Mail ID</label>
|
||||
<label class="label-font-size" for="emp_personal_mail">Employee Personal Mail ID</label>
|
||||
<input type="text" class="form-control" id="emp_personal_mail" placeholder="Enter EMP Personal Mail"
|
||||
value="<?= isset($ticket_data['emp_personal_mail']) ? $ticket_data['emp_personal_mail'] : '' ?>"
|
||||
name="emp_personal_mail">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="policy_no">Policy No <span class="text-danger"></span></label>
|
||||
<label class="label-font-size" for="policy_no">Policy No <span class="text-danger"></span></label>
|
||||
<input type="text" class="form-control" id="policy_no"
|
||||
value="<?= isset($ticket_data['policy_no']) ? $ticket_data['policy_no'] : '' ?>"
|
||||
name="policy_no">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="client_name">Corporate Name <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size" for="client_name">Corporate Name <span class="text-danger">*</span></label>
|
||||
<input type="hidden" id="client_id" name="client_id" value="<?= isset($ticket_data['client_id']) ? $ticket_data['client_id'] : '' ?>">
|
||||
<input type="text" class="form-control" id="client_name" placeholder="Client" value="<?= isset($ticket_data['client_name']) ? $ticket_data['client_name'] : '' ?>" readonly required>
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="insurer_id">Insurer <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size" for="insurer_id">Insurer <span class="text-danger">*</span></label>
|
||||
<input type=hidden id="insurer_id" name="insurer_id" value="<?= isset($ticket_data['insurer_id']) ? $ticket_data['insurer_id'] : '' ?>">
|
||||
<input type=text class="form-control" id="insurer_name" placeholder="Insurer" value="<?= isset($ticket_data['insurer_name']) ? $ticket_data['insurer_name'] : '' ?>" readonly required>
|
||||
</div>
|
||||
@ -109,7 +114,7 @@
|
||||
|
||||
<div class="col-md-3">
|
||||
<div class="form-group">
|
||||
<label>Policy <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size">Policy <span class="text-danger">*</span></label>
|
||||
<select id="emp_client_policy" name="client_policy_id"
|
||||
class="form-control custom-select" required onchange="setDateValidation(this.value,true); setInsurerAndTPAData(this)"
|
||||
<?= isset($ticket_data['client_policy_id'])?" class = 'readonly-select'":'' ?>
|
||||
@ -124,7 +129,7 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="acm_id">Account Manager <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size" for="acm_id">Account Manager <span class="text-danger">*</span></label>
|
||||
<select class="form-control" id="acm_id" name="acm_id" required>
|
||||
<!-- <option value="0">Select Account Manager</option> -->
|
||||
<?php
|
||||
@ -149,7 +154,7 @@
|
||||
<div class="form-row">
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="ticket_type_id"> Policy Type <span class="text-danger"></span></label>
|
||||
<label class="label-font-size" for="ticket_type_id"> Policy Type <span class="text-danger"></span></label>
|
||||
<select class="form-control readonly-select" id="ticket_type_id" name="ticket_type_id" readonly>
|
||||
<?php
|
||||
if (isset($ticket_type) && count($ticket_type)) {
|
||||
@ -165,7 +170,7 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="claim_status">Status <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size" for="claim_status">Status <span class="text-danger">*</span></label>
|
||||
<select class="form-control" id="claim_status_id" name="claim_status_id" required>
|
||||
<!-- <option value="0">Select status</option> -->
|
||||
<?php
|
||||
@ -180,7 +185,7 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="claim_type"> Claim Type <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size" for="claim_type"> Claim Type <span class="text-danger">*</span></label>
|
||||
<select class="form-control" id="claim_type" name="claim_type" required>
|
||||
<!-- <option value="0">Select claim Type</option> -->
|
||||
<?php
|
||||
@ -195,7 +200,7 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="date_of_join">Date of joining<span class="text-danger"></span></label>
|
||||
<label class="label-font-size" for="date_of_join">Date of joining<span class="text-danger"></span></label>
|
||||
<input type="text" class="form-control" id="date_of_join"
|
||||
placeholder="Enter Joining Date"
|
||||
value="<?= isset($ticket_data['date_of_join']) ? $ticket_data['date_of_join'] : '' ?>"
|
||||
@ -203,7 +208,7 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="date_of_incep">Date of Inception<span class="text-danger"></span></label>
|
||||
<label class="label-font-size" for="date_of_incep">Date of Inception<span class="text-danger"></span></label>
|
||||
<input type="text" class="form-control" id="date_of_incep"
|
||||
placeholder="Enter Inception Date"
|
||||
value="<?= isset($ticket_data['date_of_incep']) ? $ticket_data['date_of_incep'] : '' ?>"
|
||||
@ -211,13 +216,13 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="dob">Date of Birth <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size" for="dob">Date of Birth <span class="text-danger">*</span></label>
|
||||
<input type="text" class="form-control" id="dob" placeholder="Enter Birth Date"
|
||||
value="<?= isset($ticket_data['dob']) ? $ticket_data['dob'] : '' ?>" name="dob" required>
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="date_of_accident">Date of Accident <span class="text-danger"></span></label>
|
||||
<label class="label-font-size" for="date_of_accident">Date of Accident <span class="text-danger"></span></label>
|
||||
<input type="text" class="form-control" id="date_of_accident"
|
||||
placeholder="Enter Accident Date"
|
||||
value="<?= isset($ticket_data['date_of_accident']) ? $ticket_data['date_of_accident'] : '' ?>"
|
||||
@ -225,7 +230,7 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="date_of_death">Date of Death <span class="text-danger"></span></label>
|
||||
<label class="label-font-size" for="date_of_death">Date of Death <span class="text-danger"></span></label>
|
||||
<input type="date_of_death" class="form-control" id="date_of_death"
|
||||
placeholder="Enter Death Date"
|
||||
value="<?= isset($ticket_data['date_of_death']) ? $ticket_data['date_of_death'] : '' ?>"
|
||||
@ -233,7 +238,7 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="date_of_intimat">Date of Intimation <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size" for="date_of_intimat">Date of Intimation <span class="text-danger">*</span></label>
|
||||
<input type="text" class="form-control" id="date_of_intimat"
|
||||
placeholder="Enter Intimation Date"
|
||||
value="<?= isset($ticket_data['date_of_intimat']) ? $ticket_data['date_of_intimat'] : '' ?>"
|
||||
@ -241,7 +246,7 @@
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3">
|
||||
<label for="si_amt">Sum insured <span class="text-danger">*</span></label>
|
||||
<label class="label-font-size" for="si_amt">Sum insured <span class="text-danger">*</span></label>
|
||||
<input type="text" class="form-control" id="si_amt" placeholder="Enter SI"
|
||||
value="<?= isset($ticket_data['si_amt']) ? $ticket_data['si_amt'] : '' ?>"
|
||||
name="si_amt" required>
|
||||
@ -257,59 +262,59 @@
|
||||
<div class="form-row">
|
||||
|
||||
<div class="form-group col-md-3 approved" style="display: none;">
|
||||
<label for="approved_amount">Approved Amount</label>
|
||||
<label class="label-font-size" for="approved_amount">Approved Amount</label>
|
||||
<input type="text" class="form-control" id="approved_amount" placeholder="Enter Approved Amount"
|
||||
value="<?= isset($ticket_data['approved_amount']) ? $ticket_data['approved_amount'] : '' ?>" name="approved_amount">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3 approved" style="display: none;">
|
||||
<label for="approved_date">Approved Date</label>
|
||||
<label class="label-font-size" for="approved_date">Approved Date</label>
|
||||
<input type="text" class="form-control datepicker" id="approved_date" placeholder="Select Approved Date"
|
||||
value="<?= isset($ticket_data['approved_date']) ? $ticket_data['approved_date'] : '' ?>" name="approved_date">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-6 approved" style="display: none;">
|
||||
<label for="approved_letter">Approved Letter</label>
|
||||
<label class="label-font-size" for="approved_letter">Approved Letter</label>
|
||||
<input type="text" class="form-control" id="approved_letter" placeholder="Enter Approved Letter"
|
||||
value="<?= isset($ticket_data['approved_letter']) ? $ticket_data['approved_letter'] : '' ?>" name="approved_letter">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-6 approved" style="display: none;">
|
||||
<label for="approved_description">Approved Description</label>
|
||||
<label class="label-font-size" for="approved_description">Approved Description</label>
|
||||
<input type="text" class="form-control" id="approved_description" placeholder="Enter Approved Description"
|
||||
value="<?= isset($ticket_data['approved_description']) ? $ticket_data['approved_description'] : '' ?>" name="approved_description">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3 settled" style="display: none;">
|
||||
<label for="utr_details">UTR Details</label>
|
||||
<label class="label-font-size" for="utr_details">UTR Details</label>
|
||||
<input type="text" class="form-control" id="utr_details" placeholder="Enter UTR Details"
|
||||
value="<?= isset($ticket_data['utr_details']) ? $ticket_data['utr_details'] : '' ?>" name="utr_details">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3 settled" style="display: none;">
|
||||
<label for="settled_date">Settled Date</label>
|
||||
<label class="label-font-size" for="settled_date">Settled Date</label>
|
||||
<input type="text" class="form-control datepicker" id="settled_date" placeholder="Select Settled Date"
|
||||
value="<?= isset($ticket_data['settled_date']) ? $ticket_data['settled_date'] : '' ?>" name="settled_date">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-6 settled" style="display: none;">
|
||||
<label for="settle_letter">Settle Letter</label>
|
||||
<label class="label-font-size" for="settle_letter">Settle Letter</label>
|
||||
<input type="text" class="form-control" id="settle_letter" placeholder="Enter Settle Letter"
|
||||
value="<?= isset($ticket_data['settle_letter']) ? $ticket_data['settle_letter'] : '' ?>" name="settle_letter">
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3 canceled" style="display: none;">
|
||||
<label for="cancel_remark">Cancel Remark</label>
|
||||
<label class="label-font-size" for="cancel_remark">Cancel Remark</label>
|
||||
<textarea class="form-control" id="cancel_remark" rows="1" placeholder="Enter Cancel Remark" name="cancel_remark"><?= isset($ticket_data['cancel_remark']) ? $ticket_data['cancel_remark'] : '' ?></textarea>
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-3 returned" style="display: none;">
|
||||
<label for="return_remark">Return Remark</label>
|
||||
<label class="label-font-size" for="return_remark">Return Remark</label>
|
||||
<textarea class="form-control" id="return_remark" rows="1" placeholder="Enter Return Remark" name="return_remark"><?= isset($ticket_data['return_remark']) ? $ticket_data['return_remark'] : '' ?></textarea>
|
||||
</div>
|
||||
|
||||
<div class="form-group col-md-6 returned" style="display: none;">
|
||||
<label for="awb_no_courier_name">AWB No with Courier Name</label>
|
||||
<label class="label-font-size" for="awb_no_courier_name">AWB No with Courier Name</label>
|
||||
<input type="text" class="form-control" id="awb_no_courier_name" placeholder="eg : 0001/ST Courier"
|
||||
value="<?= isset($ticket_data['awb_no_courier_name']) ? $ticket_data['awb_no_courier_name'] : '' ?>" name="awb_no_courier_name">
|
||||
</div>
|
||||
|
||||
@ -1,7 +1,7 @@
|
||||
<div class="row">
|
||||
<div class="col-12">
|
||||
<div class="card-body">
|
||||
<form role="form" class="parsley-examples" method="post" id="ticket_reply_form" enctype="multipart/form-data">
|
||||
<form role="form" class="parsley-examples" style="color:black;" method="post" id="ticket_reply_form" enctype="multipart/form-data">
|
||||
<div class="form-group">
|
||||
<div class="form-row">
|
||||
<!-- Email To Field -->
|
||||
|
||||
Loading…
Reference in New Issue
Block a user