General Edit

{** * X12 Partner edit * * @package OpenEMR * @link https://www.open-emr.org * @author Brady Miller * @copyright Copyright (c) 2017 Brady Miller * @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3 * Modified by Daniel Pflieger at GrowlingFlea Software to handle submitters *} {xlt t='Partner Name'}

{xlt t='Submitter Name (3rd Party Submitter Only)'} {html_options options=$partner->get_x12_submitter_array() selected=$partner->get_x12_submitter_id()}

{xlt t='ID Number (ETIN)'}

{xlt t='User logon Required Indicator (ISA01~ use 00 or 03)'}

{xlt t='User Logon (If 03 above, else leave spaces) (ISA02)'}

{xlt t='User password required Indicator (ISA03~ use 00 or 01)'}

{xlt t='User Password (ISA04~ if 01 above, else leave spaces)'}

{xlt t='Sender ID Qualifier (ISA05)'} {html_options options=$partner->get_idqual_array() selected=$partner->get_x12_isa05()}

{xlt t='Sender ID (ISA06)'}

{xlt t='Receiver ID Qualifier (ISA07)'} {html_options options=$partner->get_idqual_array() selected=$partner->get_x12_isa07()}

{xlt t='Receiver ID (ISA08)'}

{xlt t='Acknowledgment Requested (ISA14)'} {html_options options=$partner->get_x12_isa14_array() selected=$partner->get_x12_isa14()}

{xlt t='Usage Indicator (ISA15)'} {html_options options=$partner->get_x12_isa15_array() selected=$partner->get_x12_isa15()}

{xlt t='Application Sender Code (GS02)'}

{xlt t='Eligibility Service Date (270 DTP03)'} {html_options options=$partner->get_x12_dtp03_type_array() selected=$partner->get_x12_dtp03()}

{xlt t='Submitter EDI Access Number (PER06)'}

{xlt t='Version'} {html_options options=$partner->get_x12_version_array() selected=$partner->get_x12_version()}

{xlt t='Processing format'} {html_options options=$partner->get_processing_format_array() selected=$partner->get_processing_format()}

{xlt t='Application Receiver Code (GS03 - If blank ISA08 will be used)'}

{xlt t='SFTP or Eligibility Login Credentials'}

{xlt t='SFTP or Eligibility Pass Credentials'}

{xlt t='SFTP Host'}

{xlt t='SFTP Port'}

{xlt t='SFTP Local Directory'}

{xlt t='SFTP Remote Directory'}

{xlt t='Client ID'}

{xlt t='Client Secret'}

{xlt t='Token Endpoint'}

{xlt t='Eligibility Endpoint'}

{xlt t='Claim Status Endpoint'}

{xlt t='Attachment Endpoint'}

{xlt t='Save'}{xlt t='Cancel'}