@if (!WebSecurity.IsAuthenticated) {
Response.Redirect("~/Account/Login");
}
@{
Layout = "~/_SiteLayout.cshtml";
PageData["Title"] = "Permitted Users Only";
}
@if ( Roles.IsUserInRole("power")) {
<span> Welcome <b>@WebSecurity.CurrentUserName</b>! </span>
}
else {
Response.Redirect("~/UnAuthorized");
}
@{
var db = Database.Open("snakeConnection");
var FName = Request["FName"];
var MName = Request["MName"];
var LName = Request["LName"];
var RefBy = Request["RefBy"];
var Age = Request["Age"];
var Gender = Request["Gender"];
var Street = Request["Street"];
var City = Request["City"];
var State = Request["State"];
var Zip = Request["Zip"];
var Phone1 = Request["Phone1"];
var Phone2 = Request["Phone2"];
var Email = Request["Email"];
var DateVisit = Request["DateVisit"];
var HABenefit = Request["HABenefit"];
var BenefitYN = Request["BenefitYN"];
var HABenWhom = Request["HABenWhom"];
var IPA = Request["IPA"];
var HMO = Request["HMO"];
var CPTCode = Request["CPTCode"];
var ICD9Code = Request["ICD9Code"];
var GrossSale = Request["GrossSale"];
var COGS = Request["COGS"];
var TDate = Request["TDate"];
var Brand = Request["Brand"];
var Model = Request["Model"];
var PayMethod = Request["PayMethod"];
var PayPocketAmt = Request["PayPocketAmt"];
var PayInsAmt = Request["PayInsAmt"];
var WDamageB = Request["WDamageB"];
var WDamageE = Request["WDamageE"];
var WRepairB = Request["WRepairB"];
var WRepairE = Request["WRepairE"];
if (IsPost) {
// Read product name.
FName = Request["FName"];
if (FName.IsEmpty()) {
ModelState.AddError("FName", "First name is required.");
}
MName = Request["MName"];
if (MName.IsEmpty())
{
ModelState.AddError("MName", "Middle name is required.");
}
// Read product description.
LName = Request["LName"];
if (LName.IsEmpty()) {
ModelState.AddError("LName",
"Last Name is required.");
}
// Read product price
RefBy = Request["RefBy"];
if (RefBy.IsEmpty()) {
ModelState.AddError("RefBy", "Referred by is required.");
}
// Define the insert query. The values to assign to the
// columns in the Product table are defined as parameters
// with the VALUES keyword.
if(ModelState.IsValid) {
var insertQuery1 = "INSERT INTO dbo.Patients (FName, MName, LName, RefBy, Age, Gender, Street, City, State, Zip, Phone1, Phone2, Email) " +
"VALUES (@0, @1, @2, @3, @4, @5, @6, @7, @8, @9, @10, @11, @12)";
db.Execute(insertQuery1, FName, MName, LName, RefBy, Age, Gender, Street, City, State, Zip, Phone1, Phone2, Email);
var insertQuery2 = "INSERT INTO dbo.Referrals (LName, RefBy, DateVisit, HABenefit, HABenWhom, IPA, HMO, CPTCode, ICD9Code) " +
"VALUES (@0, @1, @2, @3, @4, @5, @6, @7, @8)";
db.Execute(insertQuery2, LName, RefBy, DateVisit, HABenefit, HABenWhom, IPA, HMO, CPTCode, ICD9Code);
var insertQuery3 = "INSERT INTO dbo.financials (LName, GrossSale, COGS, TDate, Brand, Model, PayMethod, PayPocketAmt, PayInsAmt, WDamageB, WDamageE, WRepairB, WRepairE) " + "VALUES (@0, @1, @2, @3, @4, @5, @6, @7, @8, @9, @10, @11, @12)";
db.Execute(insertQuery3, LName, GrossSale, COGS, TDate, Brand, Model, PayMethod, PayPocketAmt, PayInsAmt, WDamageB, WDamageE, WRepairB, WRepairE);
}
}
}
<form method="post" action="">
<table width="900" border="1">
<tr>
<td width="225"><h3 align="center">Patient</h3></td>
<td width="225">
<h3 align="center"><input type="submit" value="Submit" class="submit" style="color: Blue; width: 75; height: 35;"/></h3></td>
<td width="225"><h3 align="center">Insurance</h3></td>
<td width="225"><h3 align="center">Financials</h3></td>
</tr>
</table>
<table width="900" border="1">
<tr>
<td width="150px">First Name</td>
<td width="150px">
<input type="text" name="FName" value="" />
</td>
<td width="150px">Date of Visit</td>
<td width="150px"> <input type="text" name="DateVisit" value="" /></td>
<td width="150px">Transaction Date</td>
<td width="150px"><input type="text" name="TDate" value="" /></td>
</tr>
<tr>
<td width="150px">Middle Name</td>
<td width="150px"><input type="text" name="MName" value="" /></td>
<td width="150px">Hearing Aid Benefit</td>
<td width="150px"><input type="text" name="HABenefit" value="" /></td>
<td width="150px">Gross Sale</td>
<td width="150px"><input type="text" name="GrossSale" value="" /></td>
</tr>
<tr>
<td width="150px">Last Name</td>
<td width="150px"><input type="text" name="LName" value="" /></td>
<td width="150px">Benefit By Whom</td>
<td width="150px"> <input type="text" name="HABenWhom" value="" /></td>
<td width="150px">COGS</td>
<td width="150px"><input type="text" name="COGS" value="" /></td>
</tr>
<tr>
<td width="150px">Referred By</td>
<td width="150px"><input type="text" name="RefBy" value="" /></td>
<td width="150px">Insurer</td>
<td width="150px"><input type="text" name="HMO" value="" /></td>
<td width="150px">Brand</td>
<td width="150px"><input type="text" name="Brand" value="" /></td>
</tr>
<tr>
<td width="150px">Birth Date</td>
<td width="150px"><input type="text" name="Age" value="" /></td>
<td width="150px">IPA</td>
<td width="150px"><input type="text" name="IPA" value="" /></td>
<td width="150px">Model</td>
<td width="150px"><input type="text" name="Model" value="" /></td>
</tr>
<tr>
<td width="150px">Gender</td>
<td width="150px"><input type="text" name="Gender" value="" /></td>
<td width="150px">CPT Code</td>
<td width="150px"><input type="text" name="CPTCode" value="" /></td>
<td width="150px">Payment Method</td>
<td width="150px"><input type="text" name="PayMethod" value="" /></td>
</tr>
<tr>
<td width="150px">Street</td>
<td width="150px"><input type="text" name="Street" value="" /></td>
<td width="150px">ICD9/10 Code</td>
<td width="150px"><input type="text" name="ICD9Code" value="" /></td>
<td width="150px">Out of Pocket</td>
<td width="150px"><input type="text" name="PayPocketAmt" value="" /></td>
</tr>
<tr>
<td width="150px">City</td>
<td width="150px"><input type="text" name="City" value="" /></td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px">Insurance Portion</td>
<td width="150px"><input type="text" name="PayInsAmt" value="" /></td>
</tr>
<tr>
<td width="150px">State</td>
<td width="150px"><input type="text" name="State" value="" /></td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px">WarrantyD Begin</td>
<td width="150px"><input type="text" name="WDamageB" value="" /></td>
</tr>
<tr>
<td width="150px">Zip</td>
<td width="150px"><input type="text" name="Zip" value="" /></td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px">WarrantyD End</td>
<td width="150px"><input type="text" name="WDamageE" value="" /></td>
</tr>
<tr>
<td width="150px">Phone1</td>
<td width="150px"><input type="text" name="Phone1" value="" /></td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px">WarrantyR Begin</td>
<td width="150px"><input type="text" name="WRepairB" value="" /></td>
</tr>
<tr>
<td width="150px">Phone2</td>
<td width="150px"><input type="text" name="Phone2" value="" /></td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px">WarrantyR End</td>
<td width="150px"><input type="text" name="WRepairE" value="" /></td>
</tr>
<tr>
<td width="150px">Email</td>
<td width="150px"><input type="text" name="Email" value="" /></td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
</tr>
<tr>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
</tr>
<tr>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
</tr>
<tr>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
</tr>
<tr>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
</tr>
<tr>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
</tr>
<tr>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
<td width="150px"> </td>
</tr>
</table>
</form>
