156 lines
5.6 KiB
HTML
156 lines
5.6 KiB
HTML
<!DOCTYPE html>
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<html lang="en">
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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>Payment Receipt - {{ payment_details.receipt_number }}</title>
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</head>
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<body>
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<!-- Hospital Header -->
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<div class="receipt-header">
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<div class="hospital-name">{{ hospital_info.name }}</div>
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{% if hospital_info.address %}
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<div class="hospital-address">{{ hospital_info.address }}</div>
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{% endif %}
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<div class="hospital-contact">
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{% if hospital_info.phone %}Phone: {{ hospital_info.phone }}{% endif %}
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{% if hospital_info.email %} | Email: {{ hospital_info.email }}{% endif %}
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{% if hospital_info.website %} | {{ hospital_info.website }}{% endif %}
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</div>
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<div class="receipt-title">PAYMENT RECEIPT</div>
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</div>
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<!-- Receipt Information -->
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<div class="section-title">Receipt Information</div>
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<table class="detail-table">
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<tr>
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<td class="detail-label">Receipt Number:</td>
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<td><strong>{{ payment_details.receipt_number }}</strong></td>
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</tr>
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<tr>
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<td class="detail-label">Payment Date:</td>
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<td>{{ payment_details.payment_date|date:"M d, Y H:i" }}</td>
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</tr>
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<tr>
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<td class="detail-label">Print Date:</td>
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<td>{{ print_date|date:"M d, Y H:i" }}</td>
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</tr>
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<tr>
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<td class="detail-label">Processed By:</td>
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<td>{{ payment_details.processed_by.get_full_name|default:payment_details.processed_by.username }}</td>
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</tr>
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</table>
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<!-- Patient Information -->
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<div class="section-title">Patient Information</div>
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<table class="detail-table">
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<tr>
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<td class="detail-label">Patient Name:</td>
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<td><strong>{{ payment_details.patient.get_full_name }}</strong></td>
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</tr>
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<tr>
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<td class="detail-label">Patient ID:</td>
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<td>{{ payment_details.patient.patient_id|default:payment_details.patient.pk }}</td>
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</tr>
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{% if payment_details.patient.phone %}
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<tr>
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<td class="detail-label">Phone:</td>
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<td>{{ payment_details.patient.phone }}</td>
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</tr>
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{% endif %}
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{% if payment_details.patient.email %}
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<tr>
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<td class="detail-label">Email:</td>
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<td>{{ payment_details.patient.email }}</td>
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</tr>
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{% endif %}
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</table>
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<!-- Bill Information -->
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<div class="section-title">Bill Information</div>
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<table class="detail-table">
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<tr>
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<td class="detail-label">Bill Number:</td>
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<td><strong>{{ payment_details.bill.bill_number }}</strong></td>
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</tr>
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<tr>
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<td class="detail-label">Bill Date:</td>
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<td>{{ payment_details.bill.bill_date|date:"M d, Y" }}</td>
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</tr>
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<tr>
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<td class="detail-label">Due Date:</td>
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<td>{{ payment_details.bill.due_date|date:"M d, Y"|default:"N/A" }}</td>
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</tr>
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<tr>
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<td class="detail-label">Total Bill Amount:</td>
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<td>${{ payment_details.bill.total_amount|floatformat:2 }}</td>
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</tr>
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<tr>
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<td class="detail-label">Previous Payments:</td>
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<td>${{ payment_details.bill.paid_amount|floatformat:2|default:"0.00" }}</td>
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</tr>
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<tr>
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<td class="detail-label">Remaining Balance:</td>
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<td><strong>${{ payment_details.balance_after_payment|floatformat:2 }}</strong></td>
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</tr>
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</table>
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<!-- Payment Details -->
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<div class="section-title">Payment Details</div>
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<table class="detail-table">
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<tr>
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<td class="detail-label">Payment Method:</td>
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<td>{{ payment_details.payment_method }}</td>
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</tr>
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{% if payment_details.reference_number %}
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<tr>
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<td class="detail-label">Reference Number:</td>
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<td><strong>{{ payment_details.reference_number }}</strong></td>
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</tr>
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{% endif %}
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{% if payment_details.notes %}
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<tr>
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<td class="detail-label">Notes:</td>
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<td>{{ payment_details.notes }}</td>
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</tr>
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{% endif %}
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</table>
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<!-- Amount Paid -->
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<div class="amount-paid">
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<div>Amount Paid</div>
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<div class="amount-value">${{ payment_details.amount_paid|floatformat:2 }}</div>
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</div>
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<!-- Payment Status -->
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<div style="text-align: center; margin: 30px 0;">
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<div style="font-size: 18px; font-weight: bold;">✓ Payment Received Successfully</div>
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<div style="margin-top: 10px;">Thank you for your payment. This receipt serves as proof of payment.</div>
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</div>
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<!-- Important Notes -->
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<div class="section-title">Important Notes</div>
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<ul style="margin: 0; padding-left: 20px;">
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<li>Please keep this receipt for your records</li>
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<li>This is a computer-generated receipt</li>
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<li>For any queries, contact our billing department</li>
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{% if payment_details.balance_after_payment > 0 %}
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<li>Outstanding balance: ${{ payment_details.balance_after_payment|floatformat:2 }}</li>
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{% endif %}
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</ul>
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<!-- Footer -->
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<div class="footer">
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<div style="text-align: center;">
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<div class="signature-line"></div>
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<div>Authorized Signature</div>
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</div>
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<div style="text-align: center; margin-top: 20px;">
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Generated on {{ print_date|date:"M d, Y \a\t H:i" }} | Receipt ID: {{ payment_details.receipt_number }}
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</div>
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</div>
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</body>
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</html>
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