{# Presentation layer for the insurance card used in the patient demographics. @package OpenEMR @link http://www.open-emr.org @author Stephen Nielson @copyright Copyright (c) 2024 Care Management Solutions, Inc. @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3 #} {% extends "patient/card/card_base.html.twig" %} {% block content %}
{% for t,data in ins %}
{% for c in data.policies %}
{{ c.type|capitalize|text }} {{ "Insurance"|xlt }} {% if c.dispFromDate == true %}{{ "from"|xlt}} {{ c.date|shortDate|text }} {% endif %} {{ "until"|xlt }} {{ (c.date_end) ? c.date_end|shortDate| text : "Present"|xlt }}
{% if c.insco is defined %} {{ "Insurer"|xlt }}
{{ c.insco.name|text }}
{{ c.insco.address.line1|text }}
{{ (c.insco.address.line2 != "") ? c.insco.address.line2|text ~ "
"|raw }} {{ c.insco.address.city|text }} {{ c.insco.address.state|text }}, {{ c.insco.address.postal|text }}
{% else %} {{ "Unassigned"|xlt }} {% endif %}
{% set showState = (c.subscriber_state != "") ? true : false %} {% set showCountry = (c.subscriber_country != "") ? true : false %} {% set showPostal = (c.subscriber_postal_code != "") ? true : false %} {{ "Subscriber"|xlt }}
{{ c.subscriber_full_name|text }}{{ c.subscriber_relationship != "" ? " (" ~ c.subscriber_relationship|capitalize|text ~ ")" : "" }}
{{ c.subscriber_street|text }}
{{ c.subscriber_city|text }}{{ showState == true ? " " ~ c.subscriber_state|text : ""}}{{ showPostal == true ? ", " ~ c.subscriber_postal_code|text : "" }} {{ showCountry == true ? " " ~ c.subscriber_country|text : ""}}
{% if c.subscriber_ss != "" %} {{ "S.S."|xlt }} {{ c.subscriber_ss|text }}
{% endif %} {% if c.subscriber_DOB %} {{ "D.O.B."|xlt }} {{ c.subscriber_DOB|shortDate|text }}
{% endif %} {% if c.subscriber_phone %} {{ "Phone"|xlt }} {{ c.subscriber_phone|text }}
{% endif %}
{% set showState = (c.subscriber_employer_state != "") ? true : false %} {% set showCountry = (c.subscriber_employer_country != "") ? true : false %} {% set showPostal = (c.subscriber_employer_postal_code != "") ? true : false %} {{ "Subscriber Employer"|xlt }}
{{ c.subscriber_employer|text }}
{{ c.subscriber_employer_street|text }}
{{ c.subscriber_employer_city|text }}{{ showState == true ? " " ~ c.subscriber_employer_state|text : ""}}{{ showPostal == true ? ", " ~ c.subscriber_employer_postal_code|text : "" }} {{ showCountry == true ? " " ~ c.subscriber_employer_country|text : ""}}
{{ "Plan Name"|xlt }}: {{ c.plan_name|text }}
{{ "Policy Number"|xlt }}: {{ c.policy_number|text }}
{{ "Group Number"|xlt }}: {{ c.group_number|text }}
{{ "Copay"|xlt }}: {{ c.copay|text }}
{{ "Accepts Assignment"|xlt }}: {{ c.accept_assignment == 'TRUE' ? "Yes"|xlt : "No"|xlt }}
{% if c.policy_type %}
{{ "Secondary Medicare Type"|xlt }}: {{ c.policy_type|text }}
{% endif %}
{% endfor %}
{% endfor %}
{% if enable_eligibility_requests %}
{{ eligibility }}
{% else %} {{ eligibility }} {% endif %}
{% endblock %}