{% extends 'MainBundle:Master:template.html.twig' %}
{% block scripts %}
    {# CSS #}
    {#Bootstrap#}
    <link rel="stylesheet" href="{{ asset('bundles/main/css/bootstrap.css') }}"/>
    <link rel="stylesheet" href="{{ asset('bundles/indicator/css/bootstrap-select.css') }}"/>
    <link rel="stylesheet" href="{{ asset('bundles/shedule/datatable/css/dataTables.bootstrap.css') }}" >
    <link rel="stylesheet" href="{{ asset('bundles/shedule/datatable/css/dataTables.responsive.css') }}" >
    <link rel="stylesheet" href="{{ asset('bundles/shedule/datatable/css/dataTables.tableTools.css') }}" >
    <link rel="stylesheet" href="{{ asset('bundles/shedule/'~ hrk_skin ~'/dataTableCustom.css') }}"/>
    <link rel="stylesheet" href="{{ asset('bundles/utilities/sweetalert/sweetalert.css') }}">
    <script type="text/javascript" src="{{ asset('bundles/utilities/sweetalert/sweetalert.min.js') }}"></script>
    <link rel="stylesheet" href="{{ asset('bundles/utilities/css/font-awesome.css') }}">
    <link rel="stylesheet" href="{{ asset('bundles/shedule/css/build.css') }}"/>
    
    {# Custom #}
    <link rel="stylesheet" href="{{ asset('bundles/hirukofacturacion/css/customfacturacion.css') }}" />
    
    {# JS #}
    <script src="{{ asset('bundles/fosjsrouting/js/router.js') }}"></script>
    <script src="{{ path('fos_js_routing_js', { callback: 'fos.Router.setData' }) }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/shedule/bootstrap/js/bootstrap.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/indicator/js/bootstrap-select.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/shedule/datatable/js/jquery.dataTables.min.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/shedule/datatable/js/dataTables.tableTools.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/shedule/datatable/js/dataTables.responsive.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/shedule/datatable/js/dataTables.bootstrap.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/shedule/js/blockUI.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/hirukofacturacion/js/consulta_ordenes_cancelar.js') }}"></script>
    <script>
        var SrcSwf = '{{ asset('bundles/indicator/datatable/swf/copy_csv_xls_pdf.swf') }}';
        var loader = "{{ asset('bundles/utilities/images/anim_gif.gif') }}";
        var closer = "{{ asset('bundles/utilities/images/cerrar.png') }}";
        var ClinicalOrder = '{{ ClinicalOrder }}';
        var urlSendFile = '{{ path("SendFile") }}';
        
        var allData = '{{ 'messages.allData'|trans([], 'LocalizationBundle') }}';
        var urlFacturaReciboCaja = '{{ path('hiruko_factura_recibos_caja', {'cit':'cit'}) }}';
        var urlOrdenServicio = '{{ path('hiruko_factura_orden_servicio', {'cit':'cit'}) }}';
        var urlFactura = '{{ path('hiruko_factura', {'cit':'cit'}) }}';
        var urlRecibodePago = '{{ path('hiruko_factura_recibo_pago', {'cit':'cit'}) }}';
        var UrlGuardarOrdenHija = '{{ path("hiruko_facturacion_GuardarOrdenHija") }}';
        var UrlSaveAuthCode = '{{ path("hiruko_facturacion_SaveAuthCode") }}';
        var urlValidarResolucion = '{{ path("hiruko_validar_resolucion") }}';        
        var urlConsultaResolucion = '{{ path("contratos_resolucion_valores")}}';
        var urlConsultarOrdenesCancelar = "{{ path("hiruko_facturacion_buscarCancelarOrden") }}";
        var urlCancelarOrden = "{{ path("hiruko_facturacion_cancelarOrden") }}";
        var urlConsultaConvenios = '{{ path('ConveniosLista') }}';
        var UrlConsultarModalidadesConvenio = '{{ path('hiruko_consultar_modalidades_convenios') }}';
        var urlContratosFacturacion = '{{ path('DefinicionContratosFacturacion') }}';
        var urlConsultaValoresContratos = '{{ path('ValoresContratos') }}';
        var urlConsultaValoresContratosC = '{{ path('ValoresContratosC') }}';
        var UrlDataStudies = '{{ path("studyList") }}';
        var UrlDataRoom = '{{ path("roomList") }}';
        var UrlDataEstudiosContratos = '{{ path('estudiosContratos') }}';
        var urlConsultaValores = '{{ path('ValoresEstudios') }}';        
        var urlRangosMonto = '{{ path("alert_monto") }}';        
        var urlAlertModalidad = '{{ path("alert_modalidad") }}';        
        var urlConsultaFechaContratos = '{{ path('contratos_val_valores') }}';
        var url_anular = '{{ path("hiruko_facturacion_anular") }}';
        var facturacion = '{{ facturacion }}';
        var factura_cafam = '{{ factura_cafam }}';
        var factura_convenio = '{{ factura_convenio }}';
        var select = '{{ 'receive.select'|trans([], 'LocalizationBundle') }}';
        var study = '{{ 'receive.study'|trans([], 'LocalizationBundle') }}';
        var room = '{{ 'receive.room'|trans([], 'LocalizationBundle') }}';
        var cliente = '{{ id_cliente }}';
        var codigo_unico_his = '{{ codigoUnico }}';
        var finalidadTrans = '{{ 'receive.finalidad'|trans([], 'LocalizationBundle') }}';
        var diagnostico= '{{ 'receive.diagnostico'|trans([], 'LocalizationBundle') }}';
        var terapeutico= '{{ 'receive.terapeutico'|trans([], 'LocalizationBundle') }}';
        var proteccion= '{{ 'receive.proteccionEsp'|trans([], 'LocalizationBundle') }}';
        var dteg='{{ 'receive.dteg'|trans([], 'LocalizationBundle') }}';
        var dtel='{{ 'receive.dteg'|trans([], 'LocalizationBundle') }}';
        {% if codigoUnico != '' %}
            var codigo_municipio_His = '{{ resultDataHis['result'].0.muncod }}';
            var descripcion_cie10_His = '{{ resultDataHis['result'].0.coddia|trim }}';
            {% if his_integration == 'true' %}
                var studyIntegrationHIS = '{{ resultDataHis['result'].0.nomact }}';
            {% else %}
                var studyIntegrationHIS = '';
            {% endif %}
        {% else %}
            var studyIntegrationHIS = '';
        {% endif %}
        var signo="$ ";
        var dec=2;
        if(cliente=="RIS-DPI"){
            signo="S/ ";
            dec=2;
        }
    </script>

{% endblock %}
{% block content %}
    {# Container fluid #}
        <div class="container-fluid">
            {# panel primary #}
            <div class="panel panel-primary">
                <div class="panel-heading">
                    <h3 class="panel-title">{{ 'Facturacion.CancelarOrdenes.CancelarOrdenes'|trans([], 'LocalizationBundle') }}</h3>
                </div>
                {# panel-body #}
                <div class="panel-body">
                    {# Formulario de búsqueda #}
                    <div class="row">
                        <div class="form-group">
                            <div class="form-group">
                                <div class="col-md-3">
                                    <div class="input-group">
                                        <div class="input-group-addon"><span class="glyphicon glyphicon-barcode" aria-hidden="true"></span></div>
                                        <input id="txt_codigo_factura" name="codigo" class="form-control cor" placeholder="C&oacute;digo factura">
                                    </div>
                                </div>
                            </div>
                            <div class="form-group">
                                <div class="col-md-3">
                                    <div class="input-group">
                                        <div class="input-group-addon"><span class="glyphicon glyphicon-user" aria-hidden="true"></span></div>
                                        <input id="txt_documento" name="documento" class="form-control cor" placeholder="Documento">
                                    </div>
                                </div>
                            </div>
                        </div>

                        <div class="clearfix"></div>
                        
                        <div class="form-group">
                            <div class="form-group">
                                <div class="col-md-3">
                                    <select id="select_convenios" class="form-control selectpicker" data-live-search="true" data-actions-box="true" data-style="btn-primary" multiple title='Convenios'>
                                        {% for contrato in convenio_contrato %}
                                            <option value="{{ contrato.idEps }}*{{ contrato.idContratos }}*{{ contrato.tipoContrato }}">{{ contrato.name }} - {{ contrato.nombreContrato }}</option>
                                        {% endfor %}
                                    </select>
                                </div>
                            </div>
                             <div class="form-group">
                                <div class="col-md-3">
                                    <div class="input-group">
                                        <div class="input-group-addon"><span class="glyphicon glyphicon-calendar" aria-hidden="true"></span></div>
                                        <input name="dateInit" id="dateInit" class="form-control datepicker cor" placeholder="Fecha inicial">
                                    </div>
                                </div>
                            </div>
                            <div class="form-group">
                                <div class="col-md-3">
                                    <div class="input-group">
                                        <div class="input-group-addon"><span class="glyphicon glyphicon-calendar" aria-hidden="true"></span></div>
                                        <input name="dateEnd" id="dateEnd" class="form-control datepicker cor" placeholder="Fecha final">
                                    </div>
                                </div>
                            </div>
                            <div class="form-group">
                                <div class="form-group">
                                    <div class="col-md-3">
                                        <button class="btn btn-info form-control" id="btn_buscar">Buscar</button>
                                    </div>
                                </div>  
                            </div>
                        </div>

                        <div class="clearfix"></div>
                    </div>
                    {# Fin Formulario de búsqueda #}
                    
                    {# Tabla de resultados #}
                    <div class="row">
                        <div class="col-md-12">
                            <div class="row"><div class="col-md-12"><hr></div></div>
                            <div class="clearfix"></div>
                            <div id="tabla_cancelar_orden">
                            <table id="cancelar_orden" class="table table-bordered table-condensed table-striped table-hover dt-responsive" width="100%" cellspacing="0">
                                <thead>
                                    <tr>
                                        <th>{{ 'Facturacion.CancelarOrdenes.No_Orden'|trans([], 'LocalizationBundle') }}</th>
                                        <th>{{ 'Facturacion.CancelarOrdenes.Fecha_cita'|trans([], 'LocalizationBundle') }}</th>
                                        <th>{{ 'Facturacion.CancelarOrdenes.Documento'|trans([], 'LocalizationBundle') }}</th>
                                        <th>{{ 'Facturacion.CancelarOrdenes.Nombre'|trans([], 'LocalizationBundle') }}</th>
                                        <th>{{ 'Facturacion.CancelarOrdenes.Estudios'|trans([], 'LocalizationBundle') }}</th>
                                        <th>{{ 'Facturacion.CancelarOrdenes.Codigo_Factura'|trans([], 'LocalizationBundle') }}</th>
                                        <th>{{ 'Facturacion.CancelarOrdenes.Fecha_Cancelación'|trans([], 'LocalizationBundle') }}</th>
                                        <th>{{ 'Facturacion.CancelarOrdenes.Usuario_Cancelación'|trans([], 'LocalizationBundle') }}</th>
                                        <th>{{ 'Facturacion.CancelarOrdenes.Comentarios_Cancelación'|trans([], 'LocalizationBundle') }}</th>
                                        <th>{{ 'Facturacion.CancelarOrdenes.No_ordenHija'|trans([], 'LocalizationBundle') }}</th>
                                        <th>{{ 'Facturacion.CancelarOrdenes.CrearOrden'|trans([], 'LocalizationBundle') }}</th>
                                        <th>{{ 'Facturacion.CancelarOrdenes.CancelarOrden'|trans([], 'LocalizationBundle') }}</th>
                                        <th>{{ 'Facturacion.CancelarOrdenes.AnularFactura'|trans([], 'LocalizationBundle') }}</th>
                                    </tr>
                                </thead>
                                <tbody>
                                </tbody>
                            </table>
                            </div>
                        </div>
                    </div>{# Fin Tabla de resultados #}
                </div>{# Fin panel-body #}
            </div>{# Fin panel primary #}
        </div>{# Fin Container fluid #}
    
    {# Ventanas modales #}
        {# Crear orden hija #}
        <div class="modal fade" id="ordenhija" tabindex="-1" role="dialog">
            <div class="modal-dialog" role="document">
                <div class="modal-content">
                    <div class="modal-header">
                        <h4 class="modal-title">{{ 'Facturacion.CancelarOrdenes.Crear_orden_hija'|trans([], 'LocalizationBundle') }}</h4>
                    </div>
                    <div class="modal-body">
                        <div class="container-fluid">
                            <div class="row">
                                <div class="form-group">
                                    <div class="col-md-12">
                                        <h5 id="ordHija_nombre"></h5>
                                        <input id="doc" name="doc" type="hidden" />                                        
                                        <h5 id="ordHija_documento"></h5>
                                        <h5>{{ 'Facturacion.CancelarOrdenes.No_orden_ant'|trans([], 'LocalizationBundle') }}</h5> <h5 id="ordHija_ordenAnt"></h5>
                                        <h5>{{ 'Facturacion.CancelarOrdenes.Val_rec_ant'|trans([], 'LocalizationBundle') }}</h5> <h5 id="valPaciente_anterior"></h5>
                                        <h5 id="sedePadre" style="display: none"><h5>
                                    </div>                                    
                                </div> 

                                <div class="form-gruop"> 
                                    <div class="form-group">
                                        <div class="col-md-3">
                                            <select id="select_procedence" name="select_procedence" class="form-control required selectpicker" data-actions-box="true" data-style="btn-primary" title='Procedencia'>
                                                <optgroup label="Seleccione procedencia">
                                                    <option value="">Seleccione</option>
                                                    {% for provenance in proList %}
                                                        <option value="{{ provenance.id }}">{{ provenance.name }}</option>
                                                    {% endfor %}
                                                </optgroup>
                                            </select>
                                        </div>
                                    </div>
                                    <div class="form-group">
                                        {% if(facturacion=='false') %}
                                            <div class="form-group">
                                                <div class="col-md-3">
                                                    <select id="select_convenio" name="select_convenio" data-id="selConvenio" class="required form-control selectpicker" data-actions-box="true" data-live-search="true" data-style="btn-primary" title='Convenio'>
                                                        <optgroup label="Seleccione convenio">
                                                            <option value="">Seleccione</option>
                                                            {% for eps in epsList %}
                                                                <option value="{{ eps.idEps }}">{{ eps.name }}</option>
                                                            {% endfor %}
                                                         </optgroup>
                                                    </select>
                                                </div>
                                            </div>
                                        {% else %}
                                            {% if(factura_cafam=='true') %}
                                                <div class="form-group">
                                                    <div class="col-md-3">
                                                        <select id="select_contrato" name="select_contrato" data-id="selContrato" class="required form-control selectpicker" data-actions-box="true" data-live-search="true" data-style="btn-primary" title='Contrato'>
                                                            <optgroup label="Seleccione contrato">
                                                                <option value="">Seleccione</option>
                                                                {% for eps in epsList %}
                                                                    <option value="{{ eps.idEps }}*{{ eps.municipio }}">{{ eps.name }}</option>
                                                                {% endfor %}
                                                            </optgroup>
                                                        </select>
                                                    </div>
                                                </div>
                                            {% elseif(factura_convenio=='true') %}
                                                <div class="form-group">
                                                    <div class="col-md-3">
                                                        <select id="select_contrato" name="select_contrato" data-id="selContrato" class="required form-control selectpicker" data-actions-box="true" data-live-search="true" data-style="btn-primary" title='Contrato'>
                                                            <optgroup label="Seleccione contrato">
                                                                {% for eps in epsListContratos %}
                                                                    <option value="{{ eps.idContratos }}">{{ eps.name }} -{{ eps.nombreContrato }}</option>
                                                                {% endfor %}
                                                            </optgroup>
                                                        </select>
                                                    </div>
                                                </div>
                                                <div class="form-group">
                                                    <div class="col-md-3" id="div_convenios">
                                                        <select id="select_convenio" name="select_convenio" data-id="selConvenio" class="required form-control selectpicker" data-actions-box="true" data-live-search="true" data-style="btn-primary" title='Convenio'>
                                                            <optgroup label="Seleccione convenio">
                                                                <option value="">Seleccione</option>
                                                                {% for eps in epsList %}
                                                                    <option value="{{ eps.idEps }}">{{ eps.name }}</option>
                                                                {% endfor %}
                                                            </optgroup>
                                                        </select>
                                                    </div>
                                                </div>
                                            {% else %}
                                                <div class="col-md-6">
                                                    <select id="select_contrato" name="select_contrato" data-id="selContrato" class="required form-control selectpicker" data-actions-box="true" data-live-search="true" data-style="btn-primary" title='Contrato'>
                                                        <optgroup label="Seleccione contrato">
                                                            {% for eps in epsListContratos %}
                                                                <option value="{{ eps.idContratos }}*{{ eps.idEps }}">{{ eps.name }}-{{ eps.nombreContrato }}</option>
                                                            {% endfor %}
                                                        </optgroup>
                                                    </select>
                                                </div>
                                            {% endif %}
                                        {% endif %}
                                    </div>
                                </div>
                                
                                <div class="clearfix"></div>
                                {# Notificación de resoluciones #}
                                <div class="panel panel-default cl_resoluciones">
                                    <div class="panel-body">
                                        <div class="col-md-3 alert alert-success alertCotratos" id="resoluciones" role="alert" > </div>
                                        <div class="col-md-3 alert alert-success alertCotratos" id="resolucionesF" role="alert" > </div>
                                        <div class="col-md-3 alert alert-success alertCotratos" id="contratosVal" role="alert"></div>
                                        <div class="col-md-3 alert alert-success alertCotratos" id="rangoMonto" role="alert"></div>
                                    </div>
                                </div>
                                <div class="clearfix cl_resoluciones"></div>
                                {# Fin Notificación resoluciones #}
                                <div class="form-gruop fields_wrap" style="margin-bottom:10px;">
                                    <div class="form-group">
                                        <div class="col-md-3">
                                            <select id="select_modality" data-title="Modalidades" data-alt="select_room" data-name="select_modality" class="required form-control selectpicker" data-actions-box="true" data-live-search="true"  data-style="btn-primary">
                                                <optgroup label="Seleccione modalidad">
                                                    <option value="">{{ 'receive.select'|trans([], 'LocalizationBundle') }}</option>
                                                </optgroup>
                                            </select>
                                        </div>
                                    </div>
                                    <div id="modality_st">
                                    <div class="form-group">
                                        <div class="col-md-3">
                                            <select id="select_room" name="select_room" class="required form-control selectpicker" data-actions-box="true" data-live-search="true" data-style="btn-primary" title='Sala'>
                                                <optgroup label="Seleccione sala">
                                                    <option value="">{{ 'receive.select'|trans([], 'LocalizationBundle') }}</option>
                                                </optgroup>
                                            </select>
                                        </div>
                                    </div>
                                    <div class="form-group">
                                        <div class="col-md-3">
                                            <select id="select_studies" data-finalidad="select_finalidad" name="select_studies" class="required select_studies basic form-control selectpicker modality_worklist" data-actions-box="true" data-live-search="true" data-style="btn-primary" title='Estudios'>
                                                <optgroup label="Seleccione estudio">
                                                    <option value="">{{ 'receive.select'|trans([], 'LocalizationBundle') }}</option>
                                                </optgroup>
                                            </select>
                                            <input type="hidden" id="select_studies" class="currencyD"/>
                                            <input type="hidden" id="selectVal" class="required"/>
                                        </div>                                        
                                        <div class="col-sm-2">
                                            <select id="select_finalidad" name="select_finalidad" class="required form-control selectpicker" data-actions-box="true" data-live-search="true" data-style="btn-primary" data-title='Finalidad'>
                                                <optgroup label="Seleccione finalidad">
                                                    <option value="1" selected="selected"> {{ 'receive.diagnostico'|trans([], 'LocalizationBundle') }}</option>
                                                    <option value="2"> {{ 'receive.terapeutico'|trans([], 'LocalizationBundle') }}</option>
                                                    <option value="3"> {{ 'receive.proteccionEsp'|trans([], 'LocalizationBundle') }}</option>
                                                    <option value="4"> {{ 'receive.dteg'|trans([], 'LocalizationBundle') }}</option>
                                                    <option value="5"> {{ 'receive.dtel'|trans([], 'LocalizationBundle') }}</option>
                                                </optgroup>
                                            </select>
                                        </div>
                                    </div>
                                    <button class="btn btn-default add_button" id="plus_modality"><span class="glyphicon glyphicon-plus"></span></button>
                                    <div class="clearfix" style="margin-bottom:10px;"></div>
                                    <div class="panel-body">
                                        <div class="col-md-12 alert alert-success alertModalidad" id="rangoModalidad" role="alert"></div>
                                    </div>
                                    <div class="clearfix"></div>
                                    <div class="form-group">
                                        <div class="col-sm-3">
                                            <input type="checkbox" class="insumos2"  id="insumos" value="0" name="insumos" >
                                            <label for="insumos">
                                                Agregar insumos:
                                            </label>
                                        </div>
                                    </div>
                                    <div id="insumos_st_">
                                                                         
                                    </div>
                                    <div class="clearfix"></div>

                                    </div>
                                </div>
                                <div class="form-group">
                                    <div class="col-sm-6" id="checkRecibo">
                                        <div class="radio radio-success">
                                            <input type="radio" name="check_reciboCaja" id="generar_nuevo" value="0" checked>
                                            <label for="generar_nuevo">
                                            {{ 'Facturacion.CancelarOrdenes.Generar_nuevo_recibo'|trans([], 'LocalizationBundle') }}
                                                
                                            </label>
                                        </div>
                                        <div class="radio radio-success">
                                            <input type="radio" name="check_reciboCaja" id="conservar_recibo" value="1">
                                            <label for="conservar_recibo">
                                            {{ 'Facturacion.CancelarOrdenes.Conservar_recibo'|trans([], 'LocalizationBundle') }}
                                        
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="clearfix"></div>
                                <div class="clearfix"></div>
                                <div class="form-gruop fields_wrap" style="margin-bottom:10px;">
                                    <div class="panel panel-default" id="tarifas_estudios">
                                        <div class="panel-body">
                                            <div class="clearfix" style="margin-bottom:10px;"></div>
                                            <div class="col-md-12">
                                                <div class="form-group" style="margin-bottom:0;">
                                                    <label for="style" class="control-label">Tarifas : </label>

                                                    <label class=" " id="tarifa_estudio">

                                                    </label>
                                                    <input type="hidden" id="valores_estudio" value="">
                                                    <span id="tarifas_estudios"></span>
                                                </div>
                                            </div>
                                            <div class="col-md-12">
                                                <div class="form-group">
                                                    <label for="style" class="control-label">Valores : </label>

                                                    <label class=" " id="valor_total">

                                                    </label>

                                                    <div id="cuotasd" class=" ">

                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                    </div>
                                </div>
                                <div class="clearfix"></div>
                                <div class="panel panel-default" id="tipo_facturar">
                                    <div class="panel-body">
                                        {#tipo Afiliación#}
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label for="style" class="col-sm-6 control-label">Tipo de
                                                    afiliaci&oacute;n: (*)</label>

                                                <div class="col-sm-6">
                                                    <select id="select_tipo_afiliacion"
                                                            name="select_tipo_afiliacion"
                                                            class="form-control select_receive required"
                                                            data-actions-box="true" data-id="selTipoAfiliacion"
                                                            data-style="btn-primary" data-live-search="true"
                                                            title="{{ 'receive.select'|trans([], 'LocalizationBundle') }}">
                                                        <option value="">{{ 'Facturacion.CancelarOrdenes.Seleccione'|trans([], 'LocalizationBundle') }}</option>
                                                        <option value="Ex">{{ 'Facturacion.CancelarOrdenes.Excluido'|trans([], 'LocalizationBundle') }}</option>
                                                        <option value="Ct">{{ 'Facturacion.CancelarOrdenes.Cotizante'|trans([], 'LocalizationBundle') }}</option>
                                                        <option value="Bf">{{ 'Facturacion.CancelarOrdenes.Beneficiario'|trans([], 'LocalizationBundle') }}</option>
                                                    </select>
                                                </div>
                                            </div>
                                        </div>
                                        {#Fin tipo afiliación#}

                                        {#nivel Afiliacion#}
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label for="style" class="col-sm-6 control-label">Nivel de
                                                    afiliaci&oacute;n: (*)</label>

                                                <div class="col-sm-6">
                                                    <select id="select_nivel_afiliacion"
                                                            name="select_nivel_afiliacion"
                                                            class="form-control select_receive required"
                                                            data-actions-box="true" data-id="selNivelAfiliacion"
                                                            data-style="btn-primary" data-live-search="true"
                                                            title="{{ 'receive.select'|trans([], 'LocalizationBundle') }}">
                                                        <option value="">{{ 'Facturacion.CancelarOrdenes.Seleccione'|trans([], 'LocalizationBundle') }}</option>
                                                        <option value="1">{{ 'Facturacion.CancelarOrdenes.Nivel_1'|trans([], 'LocalizationBundle') }}</option>
                                                        <option value="2">{{ 'Facturacion.CancelarOrdenes.Nivel_2'|trans([], 'LocalizationBundle') }}</option>
                                                        <option value="3">{{ 'Facturacion.CancelarOrdenes.Nivel_3'|trans([], 'LocalizationBundle') }}</option>
                                                    </select>
                                                </div>
                                            </div>
                                        </div>
                                        {#Fin nivel afiliacion#}

                                        {#valor Copago-Cuota Moderadora#}
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label for="style" class="col-sm-6 control-label">{{ 'Facturacion.CancelarOrdenes.Valcpcm'|trans([], 'LocalizationBundle') }} (*)</label>

                                                <div class="col-sm-6">
                                                    <input id="valor_Copago_CuotaModeradora"
                                                           name="valor_Copago_CuotaModeradora"
                                                           class="form-control field_receive" type="text"
                                                           required="required">
                                                    <input id="v_cp_cm" type="hidden">
                                                    <input id="v_real" type="hidden">
                                                </div>
                                            </div>
                                        </div>
                                        {#Fin Copago-Cuota Moderadora#}

                                        {#redondedo#}
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label for="style" class="col-sm-6 control-label">{{ 'Facturacion.CancelarOrdenes.Redondeo'|trans([], 'LocalizationBundle') }}:</label>

                                                <div class="col-sm-6">
                                                    <select id="select_redondeo" name="select_redondeo"
                                                            class="form-control select_receive required"
                                                            data-actions-box="true" data-id="selNivelAfiliacion"
                                                            data-style="btn-primary" data-live-search="true"
                                                            title="{{ 'receive.select'|trans([], 'LocalizationBundle') }}">
                                                        <option value="">{{ 'Facturacion.CancelarOrdenes.Seleccione'|trans([], 'LocalizationBundle') }}</option>
                                                    </select>
                                                </div>
                                            </div>
                                        </div>
                                        {#Fin redondeo#}
                                    </div>
                                </div>
                                {# inicio tipo_pago#}
                                <div class="panel panel-default" id="tipo_pago">

                                    <div class="panel-body">
                                        <div class="clearfix" style="margin-bottom:10px;"></div>
                                        <div class="form-group">
                                            <div class="col-md-6" id="div_descuento">
                                                <label class="col-sm-4">{{ 'Facturacion.CancelarOrdenes.descuento'|trans([], 'LocalizationBundle') }}
                                                </label>
                                                <div class="col-sm-8">
                                                    <input id="descuento" maxlength="10" oninput="this.value = this.value.replace(/[^0-9.]/g, ''); this.value = this.value.replace(/(\..*)\./g, '$1');" class="form-control" name="valor_tarjeta" type="text">
                                                </div>
                                            </div>
                                            <div class="col-md-6" id="div_valor_bono">
                                                <label class="col-sm-4">{{ 'Facturacion.CancelarOrdenes.valor_bono'|trans([], 'LocalizationBundle') }}
                                                </label>
                                                <div class="col-sm-8">
                                                    <input id="valor_bono" maxlength="10" oninput="this.value = this.value.replace(/[^0-9.]/g, ''); this.value = this.value.replace(/(\..*)\./g, '$1');" class="form-control" name="valor_efectivo" type="text">
                                                </div>

                                            </div>
                                            <input id="valor_paciente" type="hidden">

                                        </div>
                                        <div class="col-md-12">
                                            <div class="form-group" style="margin-bottom:0;">
                                                <label class="col-sm-2">{{ 'Facturacion.CancelarOrdenes.Tipo_pago'|trans([], 'LocalizationBundle') }}
                                                </label>
                                                <div class="col-sm-4" align="left">
                                                    <input type="radio" name="tipo_pago_d" value="Tarjeta">
                                                    <label>{{ 'Facturacion.CancelarOrdenes.Tarjeta'|trans([], 'LocalizationBundle') }}</label>
                                                    <input type="radio" name="tipo_pago_d" value="Efectivo" checked="checked">
                                                    <label>{{ 'Facturacion.CancelarOrdenes.Efectivo'|trans([], 'LocalizationBundle') }}</label>
                                                    <input type="radio" name="tipo_pago_d" value="Mixto">
                                                    <label>{{ 'Facturacion.CancelarOrdenes.Mixto'|trans([], 'LocalizationBundle') }}</label>
                                                </div>
                                            </div>
                                        </div>
                                        <div class="form-group">
                                            <div class="col-md-6" id="div_valor_tarjeta">
                                                <label class="col-sm-4">{{ 'Facturacion.CancelarOrdenes.Valor_tarjeta'|trans([], 'LocalizationBundle') }}
                                                </label>
                                                <div class="col-sm-8">
                                                    <input id="valor_credito" maxlength="10" oninput="this.value = this.value.replace(/[^0-9.]/g, ''); this.value = this.value.replace(/(\..*)\./g, '$1');" class="form-control" name="valor_tarjeta" type="text">
                                                </div>
                                            </div>
                                            <div class="col-md-6" id="div_valor_efectivo">
                                                <label class="col-sm-4">{{ 'Facturacion.CancelarOrdenes.Valor_efectivo'|trans([], 'LocalizationBundle') }}
                                                </label>
                                                <div class="col-sm-8">
                                                    <input id="valor_efectivo" maxlength="10" oninput="this.value = this.value.replace(/[^0-9.]/g, ''); this.value = this.value.replace(/(\..*)\./g, '$1');" class="form-control" name="valor_efectivo" type="text">
                                                </div>

                                            </div>
                                            <input id="valor_paciente" type="hidden">

                                        </div>
                                    </div>
                                </div>
						{# fin de tipo_pago #}
                                <div class="clearfix"></div>
                                <div class="form-group" style="margin-top:15px;">
                                    <form id="registerReceipt" name="registerReceipt" enctype="multipart/form-data" method="post">
                                        <div class="col-md-6">
                                            <label>{{ 'Facturacion.CancelarOrdenes.Orden_md'|trans([], 'LocalizationBundle') }}</label>
                                            <input id="file_Clinical_Order" class="form-control" name="file_Clinical_Order" type="file">
                                            <input type="hidden" id="contratosD" name="contratosD">
                                        </div>
                                    </form>
                                </div>
                            </div>
                        </div>
                    </div>
                    <div class="modal-footer">
                        <button type="button" class="btn btn-default" id="btn_cancelar" data-dismiss="modal">{{ 'Facturacion.CancelarOrdenes.Cancelar'|trans([], 'LocalizationBundle') }}</button>
                        <button type="button" class="btn btn-primary" id="btn_crear">{{ 'Facturacion.CancelarOrdenes.Crear_orden_hija'|trans([], 'LocalizationBundle') }}</button>
                    </div>
                </div>
            </div>
        </div>
        {# Fin crear orden hija #}
        {# No. Orden Hija #}
        <div class="modal fade" id="num_ordenhija" tabindex="-1" role="dialog">
            <div class="modal-dialog modal-dialog-md" role="document">
                <div class="modal-content">
                    <div class="modal-header">
                        <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">&times;</span></button>
                        <h4 class="modal-title" id="oh_titulo_orden"></h4>
                    </div>
                    <div class="modal-body">
                        <h4>{{ 'Facturacion.CancelarOrdenes.No_original'|trans([], 'LocalizationBundle') }}</h4>
                        <p id="oh_No_original"></p>
                        <h4>{{ 'Facturacion.CancelarOrdenes.Fech_creacion'|trans([], 'LocalizationBundle') }}</h4>
                        <p id="oh_fecha_creacion"></p>
                        <h4>{{ 'Facturacion.CancelarOrdenes.Us_creador'|trans([], 'LocalizationBundle') }}</h4>
                        <p id="oh_usuario_creador"></p>
                    </div>
                    <div class="modal-footer">
                        <button type="button" class="btn btn-default" data-dismiss="modal">{{ 'Facturacion.CancelarOrdenes.Cerrar'|trans([], 'LocalizationBundle') }}</button>
                    </div>
                </div>
            </div>
        </div>
        {# No. Orden Hija #}
        {# Cancelar orden #}
        <div class="modal fade" id="modal_cancelar_orden" tabindex="-1" role="dialog" data-backdrop="static" data-keyboard="false">
            <div class="modal-dialog modal-dialog-md" role="document">
                <div class="modal-content">
                    <div class="modal-header">
                        <h4 class="modal-title" id="titleCancelarOrden"></h4>
                    </div>
                    <div class="modal-body">
                        <div class="row">
                            <div class="col-md-12">
                                <h4>{{ 'Facturacion.CancelarOrdenes.Comentarios'|trans([], 'LocalizationBundle') }}</h4>
                                <textarea id="txt_comentarios" class="form-control" style="min-height:150px;"></textarea>
                                <input id="numero_orden" type="hidden" />
                            </div>
                        </div>
                    </div>
                    <div class="modal-footer">
                        <button type="button" class="btn btn-default" data-dismiss="modal">{{ 'Facturacion.CancelarOrdenes.Cerrar'|trans([], 'LocalizationBundle') }}</button>
                        <button type="button" class="btn btn-danger" id="btn_cancelar_orden">{{ 'Facturacion.CancelarOrdenes.CancelarOrden'|trans([], 'LocalizationBundle') }}</button>
                    </div>
                </div>
            </div>
        </div>
        {# Fin Cancelar orden #}

        {# Modal anular #}
        <div class="modal fade" id="anular" tabindex="-1" role="dialog" data-backdrop="static" data-keyboard="false">
            <input type="hidden" id="codigoFacturaAnulacion" name="codigoFacturaAnulacion" />
            <div class="modal-dialog modal-dialog-md" role="document">
                <div class="modal-content">
                    <div class="modal-header">
                        <h4 class="modal-title">{{ 'Facturacion.CancelarOrdenes.Factura'|trans([], 'LocalizationBundle') }}  <span id="numeroFactura" ></span></h4>
                    </div>
                    <div class="modal-body">

                        <div class="checkbox checkbox-primary checkbox-inline">
                            <input type="checkbox" id="anularorden" value="option">
                            <label>¿{{ 'Facturacion.CancelarOrdenes.Anular_orden'|trans([], 'LocalizationBundle') }}?</label>
                        </div>
                        <h4>{{ 'Facturacion.CancelarOrdenes.Comentarios'|trans([], 'LocalizationBundle') }}</h4><hr>
                        <textarea id='comentarioAnulacion' class="form-control" style="min-height:150px;"></textarea>
                        <h5>Nota: al seleccionar <b>{{ 'Facturacion.CancelarOrdenes.Anular_orden'|trans([], 'LocalizationBundle') }}</b> el comentario de la orden anulada ser&aacute; el mismo de la factura anulada </h5>
                    </div>
                    <div class="modal-footer">
                        <button type="button" class="btn btn-default" data-dismiss="modal">{{ 'Facturacion.CancelarOrdenes.Cancelar'|trans([], 'LocalizationBundle') }}</button>
                        <button id='anularFactura' type="button" class="btn btn-danger">Anular</button>
                    </div>
                </div>
            </div>
        </div>
        {# Fin Modal anular #}

        {# Block anular #}
        <div id="blockanularfactura" style="display:none; cursor: default; padding:20px;">
            <div class="container-fluid">
                <div class="col-md-12">
                    <h3>{{ 'Facturacion.CancelarOrdenes.Seguro'|trans([], 'LocalizationBundle') }}</h3>
                </div>

                <div class="col-md-12" style="margin:0 auto;text-align: center;">
                    <div class="col-md-6">
                        <input type="button"  data-toggle="modal" data-target="#anular" class="btn btn-danger form-control" id="afirmativo" value="Si" />
                    </div>
                    <div class="col-md-6">
                        <input type="button" class="btn btn-default form-control" id="negativo" value="No" />
                    </div>
                </div>
            </div>
        </div>
        {# Fin Block anular #}
    {# Fin ventanas modales #}
    
    {# Scripts #}
        {# Tabla consulta - Tooltip #}
         <script>
            $(function () {
                $('[data-toggle="tooltip"]').tooltip();
                $(".datepicker").datepicker();
            });
        </script>
        {#Modal editar código autorización#}        
         
  <div class="modal fade" id="editCodeModal" role="dialog" aria-hidden="true">
    <div class="modal-dialog modal-dialog-centered" role="document">
    
      <!-- Modal content-->
      <div class="modal-content">
        <div class="modal-header">
          <button type="button" class="close" data-dismiss="modal">&times;</button>
          <h4 class="modal-title">Modal Header</h4>
        </div>
        <div class="modal-body">
         <input  type= "text" value="" id="codigoAutor">
        </div>
        <div class="modal-footer">
          <button type="button" class="btn btn-default" data-dismiss="modal">Close</button>
        </div>
      </div>
      
    </div>
  </div>
  
</div>
{#fin modal codigo#}   
        
        {# Fin Tabla consulta - tooltip #}
        {# Adicionar campos #}
        {#<script>
            $(document).ready(function() {
                $('.selectpicker').selectpicker();
                var max_fields      = 10; 
                var wrapper         = $(".fields_wrap"); 
                var add_button      = $(".add_button"); 

                var x = 1; 
                $(add_button).click(function(e){ 
                    e.preventDefault();
                    if(x < max_fields){ 
                        x++; 
                        $(wrapper).append('<div style="margin-top:10px;"><div class="col-md-3"><select class="form-control selectpicker"><option>Modalidad</option></select></div><div class="col-md-3"><select class="form-control"><option>Sala</option></select></div><div class="col-md-3"><select class="form-control"><option>Estudio</option></select></div><button class="btn btn-default remove_field"><span class="glyphicon glyphicon-minus"></span></button></div><div class="clearfix"></div>'); //add input box
                    }
                });

                $(wrapper).on("click",".remove_field", function(e){ 
                    e.preventDefault(); $(this).parent('div').remove(); x--;
                });
            });
        </script>#}
        {# Fin adicionar campos #}
    {# Fin Scripts #}
{% endblock %}