{{$request->head_note}} |
|---|
|
|
|
| REFERENTIAL HEALTH SECTOR INFORMATION |
|---|
| Provider Code | User Data | Contract/Coverage Info | Auth. Nos./MIPRES | Payment Info |
|---|---|---|---|---|
|
{{$item->provider_code}} |
Contracting Modality: {{$item->health_contracting_payment_method()->name}} Contract No.: {{$item->contract_number}} Coverage: {{$item->health_coverage()->name}} |
Copayment: {{number_format($item->co_payment, 2)}} Moderating Fee: {{number_format($item->moderating_fee, 2)}} Shared Payments: {{number_format($item->shared_payment, 2)}} Advances: {{number_format($item->advance_payment, 2)}} |
| # | Code | Description | Qty | Unit Value | VAT/IC | Discount | Item Value | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| {{$ItemNro}} | {{$item['code']}} | {{$item['description']}} | {{number_format($item['price_amount'], 2)}} | {{number_format($item['tax_totals'][0]['tax_amount'], 2)}} | @if(isset($item['allowance_charges'])){{number_format($item['allowance_charges'][0]['amount'], 2)}} | @else{{number_format("0", 2)}} | @endif{{number_format($item['invoiced_quantity'] * $item['price_amount'], 2)}} | @else{{$ItemNro}} |
{{$item['code']}} |
@if(isset($item['notes']))
{{$item['description']}} Note: {{$item['notes']}} @else{{$item['description']}} @endif |
{{number_format($item['invoiced_quantity'], 2)}} |
@if(isset($item['tax_totals']))
@if(isset($item['allowance_charges']))
{{number_format(($item['line_extension_amount'] + $item['allowance_charges'][0]['amount']) / $item['invoiced_quantity'], 2)}} |
@else
{{number_format($item['line_extension_amount'] / $item['invoiced_quantity'], 2)}} |
@endif
@else
@if(isset($item['allowance_charges']))
{{number_format(($item['line_extension_amount'] + $item['allowance_charges'][0]['amount']) / $item['invoiced_quantity'], 2)}} |
@else
{{number_format($item['line_extension_amount'] / $item['invoiced_quantity'], 2)}} |
@endif
@endif
@if(isset($item['tax_totals']))
@if(isset($item['tax_totals'][0]['tax_amount']))
{{number_format($item['tax_totals'][0]['tax_amount'] / $item['invoiced_quantity'], 2)}} |
@else
{{number_format(0, 2)}} |
@endif
@else
E |
@endif
@if(isset($item['allowance_charges']))