159 lines
6.6 KiB
HTML
159 lines
6.6 KiB
HTML
<!DOCTYPE html>
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<html lang="id">
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<head>
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<meta charset="UTF-8">
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<meta name="viewport" content="width=device-width, initial-scale=1.0">
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<title>Admin Billing INACBG</title>
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<link href="https://cdn.jsdelivr.net/npm/bootstrap@5.3.2/dist/css/bootstrap.min.css" rel="stylesheet">
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<link rel="stylesheet" href="styles.css">
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</head>
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<body>
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<div class="container-fluid">
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<div class="row h-100">
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<!-- Sidebar -->
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<div class="col-md-3 sidebar">
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<div class="sidebar-header">
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<h5>Ruangan</h5>
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</div>
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<div class="ruangan-list" id="ruanganList">
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<!-- Will be populated by JS -->
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</div>
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</div>
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<!-- Main Content -->
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<div class="col-md-9 main-content">
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<!-- Header -->
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<div class="header">
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<div class="d-flex justify-content-between align-items-center">
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<h2>Data Billing Pasien</h2>
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<div class="text-muted small" id="currentDate"></div>
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</div>
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<div class="search-box mt-3">
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<input type="text" id="searchInput" class="form-control" placeholder="Cari billing pasien dian">
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</div>
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</div>
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<!-- Billing Table -->
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<div class="billing-table-container">
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<table class="table table-hover">
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<thead>
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<tr>
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<th>ID Pasien</th>
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<th>Nama</th>
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<th>Billing Sign</th>
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<th>Action</th>
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</tr>
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</thead>
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<tbody id="billingTableBody">
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<!-- Will be populated by JS -->
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</tbody>
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</table>
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</div>
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</div>
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</div>
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</div>
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<!-- Edit Modal -->
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<div class="modal fade" id="editModal" tabindex="-1" aria-labelledby="editModalLabel" aria-hidden="true">
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<div class="modal-dialog modal-lg">
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<div class="modal-content">
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<div class="modal-header">
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<h5 class="modal-title" id="editModalLabel">Data Pasien</h5>
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<button type="button" class="btn-close" data-bs-dismiss="modal" aria-label="Close"></button>
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</div>
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<div class="modal-body">
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<!-- Patient Info Section -->
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<div class="mb-4">
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<h6 class="text-secondary">Nama Lengkap</h6>
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<input type="text" id="modalNamaPasien" class="form-control" readonly>
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</div>
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<div class="row mb-4">
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<div class="col-md-6">
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<h6 class="text-secondary">ID Pasien</h6>
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<input type="text" id="modalIdPasien" class="form-control" readonly>
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</div>
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<div class="col-md-6">
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<h6 class="text-secondary">Kelas</h6>
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<input type="text" id="modalKelas" class="form-control" readonly>
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</div>
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</div>
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<!-- Tindakan & Pemeriksaan -->
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<div class="mb-4">
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<h6 class="text-secondary">Tindakan dan Pemeriksaan Penunjang</h6>
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<input type="text" id="modalTindakan" class="form-control" readonly placeholder="(diambil dari billing)">
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</div>
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<div class="mb-4">
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<h6 class="text-secondary">Total Tarif RS</h6>
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<input type="text" id="modalTotalTarif" class="form-control" readonly>
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</div>
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<!-- ICD Codes -->
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<div class="row mb-4">
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<div class="col-md-6">
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<h6 class="text-secondary">ICD 9</h6>
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<input type="text" id="modalICD9" class="form-control" readonly>
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</div>
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<div class="col-md-6">
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<h6 class="text-secondary">ICD 10</h6>
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<input type="text" id="modalICD10" class="form-control" readonly>
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</div>
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</div>
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<!-- INACBG Form -->
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<div class="mb-4">
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<h6 class="text-secondary">INA CBG</h6>
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<form id="inacbgForm">
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<div class="row mb-3">
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<div class="col-md-6">
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<label class="form-label">Tipe INACBG</label>
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<select id="tipeInacbg" class="form-select">
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<option value="">-- Pilih Tipe --</option>
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<option value="RI">RI (Rawat Inap)</option>
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<option value="RJ">RJ (Rawat Jalan)</option>
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</select>
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</div>
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</div>
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<div class="row mb-3">
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<div class="col-md-6">
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<label class="form-label">Masukkan Kode INA CBGS</label>
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<select id="inacbgCode" class="form-select" disabled>
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<option value="">-- Pilih Tipe INACBG Dulu --</option>
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</select>
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</div>
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<div class="col-md-6 d-flex align-items-end">
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<button type="button" id="addCodeBtn" class="btn btn-primary">+</button>
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</div>
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</div>
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<div id="codeList" class="mb-3">
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<!-- Added codes will appear here -->
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</div>
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<div class="row mb-3">
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<div class="col-md-6">
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<label class="form-label">Total Klaim BJPS <span class="text-muted small">(Otomatis)</span></label>
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<input type="number" id="totalKlaim" class="form-control" placeholder="0" readonly>
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</div>
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</div>
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<div id="formAlert" class="alert d-none" role="alert"></div>
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<div class="d-grid gap-2">
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<button type="submit" class="btn btn-success">Save</button>
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</div>
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</form>
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</div>
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</div>
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</div>
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</div>
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</div>
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<script src="https://cdn.jsdelivr.net/npm/bootstrap@5.3.2/dist/js/bootstrap.bundle.min.js"></script>
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<script src="scriptAdmin.js"></script>
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</body>
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</html>
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