{% extends "base.html" %} {% load static %} {% block title %}Payment {{ object.payment_number }} - {{ block.super }}{% endblock %} {% block content %}

Payment {{ object.payment_number }}

Back to List {% if object.status == 'PENDING' %} Edit Payment {% endif %}
{% if object.status == 'FAILED' %}
Payment Failed
This payment failed to process. Please check the payment details and try again. {% if object.failure_reason %}
Reason: {{ object.failure_reason }} {% endif %}
{% elif object.status == 'PENDING' %}
Payment Pending
This payment is pending processing. It may take a few minutes to complete.
{% elif object.status == 'COMPLETED' %}
Payment Completed
This payment has been successfully processed and applied to the bill.
{% elif object.status == 'REFUNDED' %}
Payment Refunded
This payment has been refunded on {{ object.refunded_date|date:"M d, Y" }}.
{% endif %}
Payment Information
Payment Number: {{ object.payment_number }}
Payment Date: {{ object.payment_date|date:"M d, Y" }}
Payment Amount: ${{ object.payment_amount|floatformat:2 }}
Payment Method: {{ object.get_payment_method_display }}
Status: {% if object.status == 'PENDING' %} Pending {% elif object.status == 'PROCESSING' %} Processing {% elif object.status == 'COMPLETED' %} Completed {% elif object.status == 'FAILED' %} Failed {% elif object.status == 'REFUNDED' %} Refunded {% endif %}
Reference Number: {{ object.reference_number|default:"-" }}
Processed: {% if object.processed_at %} {{ object.processed_at|date:"M d, Y g:i A" }} {% else %} Not processed {% endif %}
Created: {{ object.created_at|date:"M d, Y g:i A" }}
{% if object.notes %}
Notes:

{{ object.notes }}

{% endif %}
Related Bill
Bill Number: {{ object.medical_bill.bill_number }}
Bill Date: {{ object.medical_bill.bill_date|date:"M d, Y" }}
Bill Status: {% if object.medical_bill.status == 'DRAFT' %} Draft {% elif object.medical_bill.status == 'PENDING' %} Pending {% elif object.medical_bill.status == 'SUBMITTED' %} Submitted {% elif object.medical_bill.status == 'PARTIAL_PAID' %} Partially Paid {% elif object.medical_bill.status == 'PAID' %} Paid {% elif object.medical_bill.status == 'OVERDUE' %} Overdue {% elif object.medical_bill.status == 'COLLECTIONS' %} Collections {% elif object.medical_bill.status == 'WRITTEN_OFF' %} Written Off {% elif object.medical_bill.status == 'CANCELLED' %} Cancelled {% endif %}
Total Amount: ${{ object.medical_bill.total_amount|floatformat:2 }}
Paid Amount: ${{ object.medical_bill.paid_amount|floatformat:2 }}
Balance Due: ${{ object.medical_bill.balance_amount|floatformat:2 }}
Patient Information
Patient Name: {{ object.medical_bill.patient.get_full_name }}
MRN: {{ object.medical_bill.patient.mrn }}
Date of Birth: {{ object.medical_bill.patient.date_of_birth|date:"M d, Y" }}
Phone: {{ object.medical_bill.patient.phone_number|default:"-" }}
Email: {{ object.medical_bill.patient.email|default:"-" }}
Address: {% if object.medical_bill.patient.address %} {{ object.medical_bill.patient.address }}
{{ object.medical_bill.patient.city }}, {{ object.medical_bill.patient.state }} {{ object.medical_bill.patient.zip_code }} {% else %} - {% endif %}
{% if object.payment_method_details %}
Payment Method Details
{% if object.payment_method == 'CREDIT_CARD' or object.payment_method == 'DEBIT_CARD' %}
Card Number: **** **** **** {{ object.payment_method_details.last_four|default:"-" }}
Card Holder: {{ object.payment_method_details.card_holder|default:"-" }}
Authorization Code: {{ object.payment_method_details.auth_code|default:"-" }}
Transaction ID: {{ object.payment_method_details.transaction_id|default:"-" }}
{% elif object.payment_method == 'CHECK' %}
Check Number: {{ object.payment_method_details.check_number|default:"-" }}
Bank Name: {{ object.payment_method_details.bank_name|default:"-" }}
Routing Number: {{ object.payment_method_details.routing_number|default:"-" }}
Account Number: {% if object.payment_method_details.account_last_four %} **** **** {{ object.payment_method_details.account_last_four }} {% else %} - {% endif %}
{% elif object.payment_method == 'BANK_TRANSFER' %}
Transaction ID: {{ object.payment_method_details.transaction_id|default:"-" }}
Bank Account: {% if object.payment_method_details.account_last_four %} **** **** {{ object.payment_method_details.account_last_four }} {% else %} - {% endif %}
{% elif object.payment_method == 'INSURANCE' %}
Insurance Company: {{ object.payment_method_details.insurance_company|default:"-" }}
Claim Number: {{ object.payment_method_details.claim_number|default:"-" }}
EOB Number: {{ object.payment_method_details.eob_number|default:"-" }}
Check Number: {{ object.payment_method_details.check_number|default:"-" }}
{% endif %}
{% endif %}
Payment Summary
Payment Amount: ${{ object.payment_amount|floatformat:2 }}
{% if object.processing_fee %}
Processing Fee: ${{ object.processing_fee|floatformat:2 }}
Total Processed: ${{ object.total_processed_amount|floatformat:2 }}
{% endif %}
Quick Actions
Print Receipt Email Receipt View Bill {% if object.status == 'PENDING' %} Edit Payment Process Payment {% elif object.status == 'COMPLETED' %} Process Refund {% endif %}
Payment History
Payment Created

{{ object.created_at|date:"M d, Y g:i A" }}

{% if object.status != 'PENDING' %}
Payment {{ object.get_status_display }}

{% if object.processed_at %} {{ object.processed_at|date:"M d, Y g:i A" }} {% else %} {{ object.updated_at|date:"M d, Y g:i A" }} {% endif %}

{% endif %} {% if object.status == 'REFUNDED' %}
Payment Refunded

{{ object.refunded_date|date:"M d, Y g:i A"|default:"Unknown" }}

{% endif %}
{% endblock %}