{{ setupHeader(['opener', 'erx']) }} {% if forceClose %} {% endif %}

{{ ((mode == "add") ? "Add Facility" : "Edit Facility")|xlt }}

{{ 'Cancel'|xlt }} {{ 'Save'|xlt }}

{% if mode == "edit" %} {% endif %}

{{ 'Phone'|xlt }}

{{ 'Fax'|xlt }}

{{ 'Website'|xlt }}

{{ 'Email'|xlt }}

{{ 'Color'|xlt }}

{{ 'POS Code'|xlt }}

{{ 'CLIA Number'|xlt }}

{{ 'Tax ID'|xlt }}

{{ (simple_dems == true) ? 'Facility Code'|xlt : 'Facility NPI'|xlt }}

{{ 'IBAN'|xlt }}

{{ 'Facility Taxonomy'|xlt }}

{{ 'Billing Attn'|xlt }}

{{ 'Facility Lab Code'|xlt }}

{{ 'OID'|xlt }}:

{{ 'Billing Location'|xlt }}

{{ 'Accepts Assignment'|xlt }}

({{ 'only if billing location'|xlt }})

{{ 'Service Location'|xlt }}

{% set _oc = (erxEnabled) ? 'onchange="return displayAlert()"' : '' %} {% set _pbeCheck = (facility.primary_business_entity == 1) ? 'checked' : '' %} {{ 'Primary Business Entity'|xlt }}

{{ 'Facility Inactive'|xlt }}

{{ 'Info'|xlt }}

* {{ 'Required'|xlt }}

{% if alertMsg %} {% endif %}