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emailing PDF as attachment - but PDF needs to be 2 pages long

Posted on 2006-07-15
4
499 Views
Last Modified: 2008-03-17
hi - the pdf i'm creating needs to be 2 pages - i'm really just trying to manipulate this code - i didn't write it and i don't have much of a handle on it - anyway, my question is - how do you generate additional pdf pages - my pdf starts at 750 and works its way down when i got to 0 i started using negative numbers (just a clunky guess) - and, of course, my idea isn't working.

the code in question:

<?php

@ require ('var.php');
require ('validation.php');

$company = 'Texas Spine & Joint Hospital';
$companyadd = '3414 Golden Rd. Tyler, TX 75701';
$companyphone = '(903) 597-0601';
$today = date('F d, Y');
$patient = ($personnal[1] . ' ' . $personnal[0]);
$filename = ($personnal[0] . '_' . $personnal[1]);

  //create file
 $pdf = pdf_new();
 
 pdf_open_file($pdf, '');
 
  pdf_set_info($pdf, "Creator", "Bill Hamilton");
  pdf_set_info($pdf, "Author", "Chris Richter");
  pdf_set_info($pdf, "Title", "Texas Spine & Joint Hospital");

  // US letter dimensions at 8 1/2 by 11
  pdf_begin_page($pdf, 8.5*72, 11*72);
 
  pdf_add_bookmark($pdf, ($personnal[1] . ' ' . $personnal[0]), 0, 0);
 
  $font = pdf_findfont($pdf, 'Times-Bold', 'host', 0);//Section Titles
  $font1 = pdf_findfont($pdf, 'Times-Roman', 'host', 0);//User Info
  $font2 = pdf_findfont($pdf, 'Helvetica-Oblique', 'host', 0);//Row Titles

$column1 = 50;
$column2 = 310;
$infocolumn1 = 150;
$infocolumn2 = 410;

$header = 36;

//COMPANY INFORMATION COMPANY INFORMATION
pdf_setfont($pdf, $font, 12);//bold font for company name
pdf_show_xy($pdf, $company, 36, 750);

pdf_setfont($pdf, $font1, 12); //non-bold font
pdf_show_xy($pdf, $today, 450, 750);
pdf_show_xy($pdf, $companyadd, 36, 737);
pdf_show_xy($pdf, $companyphone, 36, 724);

pdf_setfont($pdf, $font, 18);
pdf_show_xy($pdf, 'Patient Pre-Registration Form', 185, 705);

//Begin Column One
pdf_setfont($pdf, $font, 14);
pdf_show_xy($pdf, 'General Information', $header, 680);

//General Information
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Expected Procedure Date', $column1, 665);

//Personal Information H1
pdf_setfont($pdf, $font, 14);
pdf_show_xy($pdf, 'Patient Information', $header, 645);

//Personal Information Headings
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Last Name', $column1, 630);
pdf_show_xy($pdf, 'Maiden Name', $column1, 615);
pdf_show_xy($pdf, 'Address', $column1, 600);
pdf_show_xy($pdf, '-', $column1, 585);
pdf_show_xy($pdf, 'City', $column1, 570);
pdf_show_xy($pdf, 'State', $column1, 555);
pdf_show_xy($pdf, 'Social Security #', $column1, 540);
pdf_show_xy($pdf, 'Home Phone', $column1, 525);

pdf_setfont($pdf, $font, 14);
pdf_show_xy($pdf, 'Patient Employment Information', $header, 505);

pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Employment Status', $column1, 485);
pdf_show_xy($pdf, 'Occupation', $column1, 470);
pdf_show_xy($pdf, 'City', $column1, 455);
pdf_show_xy($pdf, 'Zip Code', $column1, 440);

pdf_setfont($pdf, $font, 14);
pdf_show_xy($pdf, 'Physician Information', $header, 420);

pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Admitting Physician', $column1, 400);

pdf_setfont($pdf, $font, 14);
pdf_show_xy($pdf, 'Guarantor Information (Person Responsible for Billing)', $header, 380);

pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Last Name', $column1, 360);
pdf_show_xy($pdf, 'Relationship', $column1, 345);
pdf_setfont($pdf, $font2, 10); //non-bold font
pdf_show_xy($pdf, 'to patient', $column1, 335);
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Address', $column1, 320);
pdf_show_xy($pdf, ' - ', $column1, 305);

pdf_show_xy($pdf, 'City', $column1, 290);
pdf_show_xy($pdf, 'State', $column1, 275);
pdf_show_xy($pdf, 'Zip', $column1, 260);
pdf_show_xy($pdf, 'Employer', $column1, 245);

//Begin Relative/Next Of Kin
pdf_setfont($pdf, $font, 14);
pdf_show_xy($pdf, 'Relative/Next of Kin', $header, 225);

pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Name', $column1, 205);
pdf_show_xy($pdf, 'Relationship', $column1, 190);
pdf_setfont($pdf, $font2, 10); //non-bold font
pdf_show_xy($pdf, 'to patient', $column1, 180);
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Address', $column1, 165);
pdf_show_xy($pdf, '-', $column1, 150);
pdf_show_xy($pdf, 'City', $column1, 135);
pdf_show_xy($pdf, 'State', $column1, 120);
pdf_show_xy($pdf, 'Zip Code', $column1, 105);
//End Relative/Next Of Kin

//Begin Primary Insurance
pdf_setfont($pdf, $font, 14);
pdf_show_xy($pdf, 'Primary Insurance Information', $header, 85);

pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Insurance Carrier', $column1, 65);
pdf_show_xy($pdf, 'Name of Insured', $column1, 50);
pdf_setfont($pdf, $font2, 10); //non-bold font
pdf_show_xy($pdf, 'if not patient', $column1, 40);
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'SSN', $column1, 25);
pdf_show_xy($pdf, 'Subscriber DOB', $column1, 10);
pdf_show_xy($pdf, 'Group Number', $column1, -5);
pdf_show_xy($pdf, 'Group Name', $column1, -20);
pdf_show_xy($pdf, 'Claims Mailing Address', $column1, -35);
pdf_show_xy($pdf, '-', $column1, -50);
pdf_show_xy($pdf, 'City', $column1, -65);
pdf_show_xy($pdf, 'State', $column1, -80);
pdf_show_xy($pdf, 'Zip Code', $column1, -95);
//End Primary Insurance

//Begin Secondary Insurance
pdf_setfont($pdf, $font, 14);
pdf_show_xy($pdf, 'Secondary Insurance Information', $header, -115);

pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Insurance Carrier', $column1, -135);
pdf_show_xy($pdf, 'Name of Insured', $column1, -150);
pdf_setfont($pdf, $font2, 10); //non-bold font
pdf_show_xy($pdf, 'if not patient', $column1, -160);
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'SSN', $column1, -175);
pdf_show_xy($pdf, 'Subscriber DOB', $column1, -190);
pdf_show_xy($pdf, 'Group Number', $column1, -205);
pdf_show_xy($pdf, 'Group Name', $column1, -220);
pdf_show_xy($pdf, 'Claims Mailing Address', $column1, -235);
pdf_show_xy($pdf, '-', $column1, -250);
pdf_show_xy($pdf, 'City', $column1, -265);
pdf_show_xy($pdf, 'State', $column1, -280);
pdf_show_xy($pdf, 'Zip Code', $column1, -295);
//End Secondary Insurance



//beginning of second column headings

pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'First Name, MI', $column2, 630);
pdf_show_xy($pdf, 'Date of Birth', $column2, 615);
pdf_show_xy($pdf, 'Age', $column2, 600);
pdf_show_xy($pdf, 'Sex', $column2, 585);
pdf_show_xy($pdf, 'Zip Code', $column2, 570);
pdf_show_xy($pdf, 'Martial Status', $column2, 555);
pdf_show_xy($pdf, 'Race/Ethnic Background', $column2, 540);

pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Employer/School Name', $column2, 485);
pdf_show_xy($pdf, 'Work Phone', $column2, 470);
pdf_show_xy($pdf, 'State', $column2, 455);

//physician informaton - craig
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Primary Care Physician', $column2, 400);

//billing information
pdf_show_xy($pdf, 'First Name, MI', $column2, 360);
pdf_show_xy($pdf, 'SSN', $column2, 345);
pdf_show_xy($pdf, 'DOB', $column2, 320);
pdf_show_xy($pdf, 'Home Phone', $column2, 305);
pdf_show_xy($pdf, 'Occupation', $column2, 290);
pdf_show_xy($pdf, 'Employment Status', $column2, 275);
pdf_show_xy($pdf, 'Work Phone', $column2, 260);

//Relative/Next of Kin (col 2)
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Home Phone', $column2, 205);
pdf_show_xy($pdf, 'Marital Status', $column2, 190);
pdf_show_xy($pdf, 'Work Phone', $column2, 165);
pdf_show_xy($pdf, 'Employer', $column2, 150);
//End Relative Next of kin (col 2)

//Begin Primary Insurance (col 2)
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Plan Name', $column2, 65);
pdf_show_xy($pdf, 'Patient Relationship', $column2, 50);
pdf_setfont($pdf, $font2, 10); //non-bold font
pdf_show_xy($pdf, 'to insured', $column2, 40);
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Insured Sex', $column2, 25);
pdf_show_xy($pdf, 'Policy Number', $column2, 10);
pdf_show_xy($pdf, 'Pre-Cert/Auth Phone', $column2, -5);
pdf_show_xy($pdf, 'Benefits Phone', $column2, -20);
//End Primary Insurance (col 2)

//Begin Secondary Insurance (col 2)
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Plan Name', $column2, -135);
pdf_show_xy($pdf, 'Patient Relationship', $column2, -150);
pdf_setfont($pdf, $font2, 10); //non-bold font
pdf_show_xy($pdf, 'to insured', $column2, -160);
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Insured Sex', $column2, -175);
pdf_show_xy($pdf, 'Policy Number', $column2, -190);
pdf_show_xy($pdf, 'Pre-Cert/Auth Phone', $column2, -205);
pdf_show_xy($pdf, 'Benefits Phone', $column2, -220);
//End Primary Insurance (col 2)


//begin user information column 1
pdf_setfont($pdf, $font1, 14); //non-bold font
pdf_show_xy($pdf, $personnal[0],   $infocolumn1, 630);
pdf_show_xy($pdf, $personnal[2],   $infocolumn1, 615);
pdf_show_xy($pdf, $personnal[4],   $infocolumn1, 600);
pdf_show_xy($pdf, $personnal[5],   $infocolumn1, 585);
pdf_show_xy($pdf, $personnal[8],   $infocolumn1, 570);
pdf_show_xy($pdf, $personnal[9],   $infocolumn1, 555);
pdf_show_xy($pdf, $personnal[11],  $infocolumn1, 540);
pdf_show_xy($pdf, $personnal[13],  $infocolumn1, 525);

//begin user information column 2
pdf_show_xy($pdf, $personnal[1],  $infocolumn2, 630);
pdf_show_xy($pdf, $personnal[3],  $infocolumn2, 615);
pdf_show_xy($pdf, $personnal[6],  $infocolumn2, 600);
pdf_show_xy($pdf, $personnal[7],  $infocolumn2, 585);
pdf_show_xy($pdf, $personnal[10], $infocolumn2, 570);
pdf_show_xy($pdf, $personnal[12], $infocolumn2, 555);
pdf_show_xy($pdf, $personnal[14], $infocolumn2, 540);

//begin employment information column 1
pdf_show_xy($pdf, $employment[0],  $infocolumn1, 485);
pdf_show_xy($pdf, $employment[2],  $infocolumn1, 470);
pdf_show_xy($pdf, $employment[4],  $infocolumn1, 455);
pdf_show_xy($pdf, $employment[6],  $infocolumn1, 440);
//begin employment information column 2
pdf_show_xy($pdf, $employment[1], $infocolumn2, 485);
pdf_show_xy($pdf, $employment[3], $infocolumn2, 470);
pdf_show_xy($pdf, $employment[5], $infocolumn2, 455);


//begin physician information column 1
pdf_show_xy($pdf, $physician[0],  $infocolumn1, 400);

//begin physician information column 2
pdf_show_xy($pdf, $physician[1], $infocolumn2, 400);

//begin financial information column 1
pdf_show_xy($pdf, $financial[0],  $infocolumn1, 360);
pdf_show_xy($pdf, $financial[2],  $infocolumn1, 345);
pdf_show_xy($pdf, $financial[4],  $infocolumn1, 320);
pdf_show_xy($pdf, $financial[5],  $infocolumn1, 305);
pdf_show_xy($pdf, $financial[7],  $infocolumn1, 290);
pdf_show_xy($pdf, $financial[9],  $infocolumn1, 275);
pdf_show_xy($pdf, $financial[11], $infocolumn1, 260);
pdf_show_xy($pdf, $financial[13], $infocolumn1, 245);


//begin financial information column 2
pdf_show_xy($pdf, $financial[1],  $infocolumn2, 360);
pdf_show_xy($pdf, $financial[3],  $infocolumn2, 345);
pdf_show_xy($pdf, $financial[6],  $infocolumn2, 320);
pdf_show_xy($pdf, $financial[8],  $infocolumn2, 305);
pdf_show_xy($pdf, $financial[10], $infocolumn2, 275);
pdf_show_xy($pdf, $financial[12], $infocolumn2, 260);
pdf_show_xy($pdf, $financial[14], $infocolumn2, 245);

//begin emergency information column 1
pdf_show_xy($pdf, $emergency[0],  $infocolumn1, 205);
pdf_show_xy($pdf, $emergency[2],  $infocolumn1, 190);
pdf_show_xy($pdf, $emergency[4],  $infocolumn1, 165);
pdf_show_xy($pdf, $emergency[5],  $infocolumn1, 150);
pdf_show_xy($pdf, $emergency[7],  $infocolumn1, 135);
pdf_show_xy($pdf, $emergency[9],  $infocolumn1, 120);
pdf_show_xy($pdf, $emergency[10], $infocolumn1, 105);

//begin emergency information column 2
pdf_show_xy($pdf, $emergency[1],  $infocolumn2, 205);
pdf_show_xy($pdf, $emergency[3],  $infocolumn2, 190);
pdf_show_xy($pdf, $emergency[6],  $infocolumn2, 165);
pdf_show_xy($pdf, $emergency[8],  $infocolumn2, 150);

//begin insurance information column 1
pdf_show_xy($pdf, $insurance[0],  $infocolumn1, 65);
pdf_show_xy($pdf, $insurance[2],  $infocolumn1, 50);
pdf_show_xy($pdf, $insurance[4],  $infocolumn1, 25);
pdf_show_xy($pdf, $insurance[6],  $infocolumn1, 10);
pdf_show_xy($pdf, $insurance[7],  $infocolumn1, -5);
pdf_show_xy($pdf, $insurance[9],  $infocolumn1, -20);
pdf_show_xy($pdf, $insurance[10],  $infocolumn1, -35);
pdf_show_xy($pdf, $insurance[11],  $infocolumn1, -50);
pdf_show_xy($pdf, $insurance[13],  $infocolumn1, -65);
pdf_show_xy($pdf, $insurance[15],  $infocolumn1, -80);
pdf_show_xy($pdf, $insurance[16],  $infocolumn1, -95);

//begin insurance information column 2
pdf_show_xy($pdf, $insurance[1],  $infocolumn2, 65);
pdf_show_xy($pdf, $insurance[3],  $infocolumn2, 50);
pdf_show_xy($pdf, $insurance[5],  $infocolumn2, 25);
pdf_show_xy($pdf, $insurance[8],  $infocolumn2, 10);
pdf_show_xy($pdf, $insurance[12],  $infocolumn2, -5);
pdf_show_xy($pdf, $insurance[14],  $infocolumn2, -20);
//end insurance information column 2

//begin secondary insurance information column 1
pdf_show_xy($pdf, $secondaryinsurance[0],  $infocolumn1, -135);
pdf_show_xy($pdf, $secondaryinsurance[2],  $infocolumn1, -150);
pdf_show_xy($pdf, $secondaryinsurance[4],  $infocolumn1, -175);
pdf_show_xy($pdf, $secondaryinsurance[6],  $infocolumn1, -190);
pdf_show_xy($pdf, $secondaryinsurance[7],  $infocolumn1, -205);
pdf_show_xy($pdf, $secondaryinsurance[9],  $infocolumn1, -220);
pdf_show_xy($pdf, $secondaryinsurance[10],  $infocolumn1, -235);
pdf_show_xy($pdf, $secondaryinsurance[11],  $infocolumn1, -250);
pdf_show_xy($pdf, $secondaryinsurance[13],  $infocolumn1, -265);
pdf_show_xy($pdf, $secondaryinsurance[15],  $infocolumn1, -280);
pdf_show_xy($pdf, $secondaryinsurance[16],  $infocolumn1, -295);

//begin secondary insurance information column 2
pdf_show_xy($pdf, $secondaryinsurance[1],  $infocolumn2, -135);
pdf_show_xy($pdf, $secondaryinsurance[3],  $infocolumn2, -150);
pdf_show_xy($pdf, $secondaryinsurance[5],  $infocolumn2, -175);
pdf_show_xy($pdf, $secondaryinsurance[8],  $infocolumn2, -190);
pdf_show_xy($pdf, $secondaryinsurance[12],  $infocolumn2, -205);
pdf_show_xy($pdf, $secondaryinsurance[14],  $infocolumn2, -220);


  // end the document
  pdf_end_page($pdf);
  pdf_close($pdf);

################################################################################
################################################################################
//output to e-mail
//output to e-mail
 
// create the file to be e-mailed
$data = pdf_get_buffer($pdf);
$file = $filename . '.pdf';
$fp = fopen($file, 'w+');

fwrite($fp, $data);
fclose($fp);

require_once('../register/mail/htmlMimeMail.php');

$mail = new htmlMimeMail();

$mail->setFrom("TSJHPre-Registration");

$mail->setSubject('Pre-Registration Form');

$attachment = $mail->getFile($file);

$mail->setText('You have received this automated
mailing from the Texas Spine & Joint Hospital web site.
Please do not respond to this email. This message
contains an attached pdf registration form for patient '.$patient.'.
Thank-You.... Have a good day!');

      $mail->addAttachment($attachment, $file, 'application/pdf');

$mail->send(array('elkinhimer@sbcglobal.net'));

//destroy the file that was e-mailed
unlink($file);

################################################################################
################################################################################
//output to web browser
//output to web browser

header ('Location: https://www.tsjh.org/contact/thanks.html');


// header  ('Content-Type: Application/pdf');
// header  ('Content-Disposition: inline; filemane=$file');
// header  ('Conten-Length: ' . strlen($data));
   
//echo $data;


?>
0
Comment
Question by:phillystyle123
  • 3
4 Comments
 
LVL 7

Accepted Solution

by:
NetExpert earned 500 total points
ID: 17116267
After pdf_end_page() call pdf_begin_page() again (with reference to your $pdf variable, such as pdf_begin_page($pdf, 8.5*72, 11*72);) to add a new page, and you start writing the new page as with the first one (specifize dimension, font, etc, write content into position).


0
 

Author Comment

by:phillystyle123
ID: 17125141
i think i've got the code in all the right places (according to your instructions but formpdf.php is still not loading - just getting a blank page

http://www.tsjh.org/register/formpdf.php

here's the code - if you look for

"BEGIN 2ND PAGE OF PDF"

you'll see where i've put the code for the 2nd pdf page

thanks for the help!
0
 

Author Comment

by:phillystyle123
ID: 17133666
yikes! forgot to paste the code - once again search for

"BEGIN 2ND PAGE OF PDF"

and you'll see where i added the 2nd page

code:

<?php

@ require ('var.php');
require ('validation.php');

$company = 'Texas Spine & Joint Hospital';
$companyadd = '3414 Golden Rd. Tyler, TX 75701';
$companyphone = '(903) 597-0601';
$today = date('F d, Y');
$patient = ($personnal[1] . ' ' . $personnal[0]);
$filename = ($personnal[0] . '_' . $personnal[1]);

  //create file
 $pdf = pdf_new();
 
 pdf_open_file($pdf, '');
 
  pdf_set_info($pdf, "Creator", "Bill Hamilton");
  pdf_set_info($pdf, "Author", "Chris Richter");
  pdf_set_info($pdf, "Title", "Texas Spine & Joint Hospital");

  // US letter dimensions at 8 1/2 by 11
  pdf_begin_page($pdf, 8.5*72, 11*72);
 
  pdf_add_bookmark($pdf, ($personnal[1] . ' ' . $personnal[0]), 0, 0);
 
  $font = pdf_findfont($pdf, 'Times-Bold', 'host', 0);//Section Titles
  $font1 = pdf_findfont($pdf, 'Times-Roman', 'host', 0);//User Info
  $font2 = pdf_findfont($pdf, 'Helvetica-Oblique', 'host', 0);//Row Titles

$column1 = 50;
$column2 = 310;
$infocolumn1 = 150;
$infocolumn2 = 410;

$header = 36;

//COMPANY INFORMATION COMPANY INFORMATION
pdf_setfont($pdf, $font, 12);//bold font for company name
pdf_show_xy($pdf, $company, 36, 750);

pdf_setfont($pdf, $font1, 12); //non-bold font
pdf_show_xy($pdf, $today, 450, 750);
pdf_show_xy($pdf, $companyadd, 36, 737);
pdf_show_xy($pdf, $companyphone, 36, 724);

pdf_setfont($pdf, $font, 18);
pdf_show_xy($pdf, 'Patient Pre-Registration Form', 185, 705);

//Begin Column One
pdf_setfont($pdf, $font, 14);
pdf_show_xy($pdf, 'General Information', $header, 680);

//General Information
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Expected Procedure Date', $column1, 665);

//Personal Information H1
pdf_setfont($pdf, $font, 14);
pdf_show_xy($pdf, 'Patient Information', $header, 645);

//Personal Information Headings
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Last Name', $column1, 630);
pdf_show_xy($pdf, 'Maiden Name', $column1, 615);
pdf_show_xy($pdf, 'Address', $column1, 600);
pdf_show_xy($pdf, '-', $column1, 585);
pdf_show_xy($pdf, 'City', $column1, 570);
pdf_show_xy($pdf, 'State', $column1, 555);
pdf_show_xy($pdf, 'Social Security #', $column1, 540);
pdf_show_xy($pdf, 'Home Phone', $column1, 525);

pdf_setfont($pdf, $font, 14);
pdf_show_xy($pdf, 'Patient Employment Information', $header, 505);

pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Employment Status', $column1, 485);
pdf_show_xy($pdf, 'Occupation', $column1, 470);
pdf_show_xy($pdf, 'City', $column1, 455);
pdf_show_xy($pdf, 'Zip Code', $column1, 440);

pdf_setfont($pdf, $font, 14);
pdf_show_xy($pdf, 'Physician Information', $header, 420);

pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Admitting Physician', $column1, 400);

pdf_setfont($pdf, $font, 14);
pdf_show_xy($pdf, 'Guarantor Information (Person Responsible for Billing)', $header, 380);

pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Last Name', $column1, 360);
pdf_show_xy($pdf, 'Relationship', $column1, 345);
pdf_setfont($pdf, $font2, 10); //non-bold font
pdf_show_xy($pdf, 'to patient', $column1, 335);
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Address', $column1, 320);
pdf_show_xy($pdf, '-', $column1, 305);

pdf_show_xy($pdf, 'City', $column1, 290);
pdf_show_xy($pdf, 'State', $column1, 275);
pdf_show_xy($pdf, 'Zip', $column1, 260);
pdf_show_xy($pdf, 'Employer', $column1, 245);

//Begin Relative/Next Of Kin
pdf_setfont($pdf, $font, 14);
pdf_show_xy($pdf, 'Relative/Next of Kin', $header, 225);

pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Name', $column1, 205);
pdf_show_xy($pdf, 'Relationship', $column1, 190);
pdf_setfont($pdf, $font2, 10); //non-bold font
pdf_show_xy($pdf, 'to patient', $column1, 180);
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Address', $column1, 165);
pdf_show_xy($pdf, '-', $column1, 150);
pdf_show_xy($pdf, 'City', $column1, 135);
pdf_show_xy($pdf, 'State', $column1, 120);
pdf_show_xy($pdf, 'Zip Code', $column1, 105);
//End Relative/Next Of Kin

//beginning of second column headings

pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'First Name, MI', $column2, 630);
pdf_show_xy($pdf, 'Date of Birth', $column2, 615);
pdf_show_xy($pdf, 'Age', $column2, 600);
pdf_show_xy($pdf, 'Sex', $column2, 585);
pdf_show_xy($pdf, 'Zip Code', $column2, 570);
pdf_show_xy($pdf, 'Martial Status', $column2, 555);
pdf_show_xy($pdf, 'Race/Ethnic Background', $column2, 540);

pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Employer/School Name', $column2, 485);
pdf_show_xy($pdf, 'Work Phone', $column2, 470);
pdf_show_xy($pdf, 'State', $column2, 455);

//physician informaton - craig
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Primary Care Physician', $column2, 400);

//billing information
pdf_show_xy($pdf, 'First Name, MI', $column2, 360);
pdf_show_xy($pdf, 'SSN', $column2, 345);
pdf_show_xy($pdf, 'DOB', $column2, 320);
pdf_show_xy($pdf, 'Home Phone', $column2, 305);
pdf_show_xy($pdf, 'Occupation', $column2, 290);
pdf_show_xy($pdf, 'Employment Status', $column2, 275);
pdf_show_xy($pdf, 'Work Phone', $column2, 260);

//Relative/Next of Kin (col 2)
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Home Phone', $column2, 205);
pdf_show_xy($pdf, 'Marital Status', $column2, 190);
pdf_show_xy($pdf, 'Work Phone', $column2, 165);
pdf_show_xy($pdf, 'Employer', $column2, 150);
//End Relative Next of kin (col 2)

//begin user information column 1
pdf_setfont($pdf, $font1, 14); //non-bold font
pdf_show_xy($pdf, $personnal[0],   $infocolumn1, 630);
pdf_show_xy($pdf, $personnal[2],   $infocolumn1, 615);
pdf_show_xy($pdf, $personnal[4],   $infocolumn1, 600);
pdf_show_xy($pdf, $personnal[5],   $infocolumn1, 585);
pdf_show_xy($pdf, $personnal[8],   $infocolumn1, 570);
pdf_show_xy($pdf, $personnal[9],   $infocolumn1, 555);
pdf_show_xy($pdf, $personnal[11],  $infocolumn1, 540);
pdf_show_xy($pdf, $personnal[13],  $infocolumn1, 525);

//begin user information column 2
pdf_show_xy($pdf, $personnal[1],  $infocolumn2, 630);
pdf_show_xy($pdf, $personnal[3],  $infocolumn2, 615);
pdf_show_xy($pdf, $personnal[6],  $infocolumn2, 600);
pdf_show_xy($pdf, $personnal[7],  $infocolumn2, 585);
pdf_show_xy($pdf, $personnal[10], $infocolumn2, 570);
pdf_show_xy($pdf, $personnal[12], $infocolumn2, 555);
pdf_show_xy($pdf, $personnal[14], $infocolumn2, 540);

//begin employment information column 1
pdf_show_xy($pdf, $employment[0],  $infocolumn1, 485);
pdf_show_xy($pdf, $employment[2],  $infocolumn1, 470);
pdf_show_xy($pdf, $employment[4],  $infocolumn1, 455);
pdf_show_xy($pdf, $employment[6],  $infocolumn1, 440);
//begin employment information column 2
pdf_show_xy($pdf, $employment[1], $infocolumn2, 485);
pdf_show_xy($pdf, $employment[3], $infocolumn2, 470);
pdf_show_xy($pdf, $employment[5], $infocolumn2, 455);


//begin physician information column 1
pdf_show_xy($pdf, $physician[0],  $infocolumn1, 400);

//begin physician information column 2
pdf_show_xy($pdf, $physician[1], $infocolumn2, 400);

//begin financial information column 1
pdf_show_xy($pdf, $financial[0],  $infocolumn1, 360);
pdf_show_xy($pdf, $financial[2],  $infocolumn1, 345);
pdf_show_xy($pdf, $financial[4],  $infocolumn1, 320);
pdf_show_xy($pdf, $financial[5],  $infocolumn1, 305);
pdf_show_xy($pdf, $financial[7],  $infocolumn1, 290);
pdf_show_xy($pdf, $financial[9],  $infocolumn1, 275);
pdf_show_xy($pdf, $financial[11], $infocolumn1, 260);
pdf_show_xy($pdf, $financial[13], $infocolumn1, 245);


//begin financial information column 2
pdf_show_xy($pdf, $financial[1],  $infocolumn2, 360);
pdf_show_xy($pdf, $financial[3],  $infocolumn2, 345);
pdf_show_xy($pdf, $financial[6],  $infocolumn2, 320);
pdf_show_xy($pdf, $financial[8],  $infocolumn2, 305);
pdf_show_xy($pdf, $financial[10], $infocolumn2, 275);
pdf_show_xy($pdf, $financial[12], $infocolumn2, 260);
pdf_show_xy($pdf, $financial[14], $infocolumn2, 245);

//begin emergency information column 1
pdf_show_xy($pdf, $emergency[0],  $infocolumn1, 205);
pdf_show_xy($pdf, $emergency[2],  $infocolumn1, 190);
pdf_show_xy($pdf, $emergency[4],  $infocolumn1, 165);
pdf_show_xy($pdf, $emergency[5],  $infocolumn1, 150);
pdf_show_xy($pdf, $emergency[7],  $infocolumn1, 135);
pdf_show_xy($pdf, $emergency[9],  $infocolumn1, 120);
pdf_show_xy($pdf, $emergency[10], $infocolumn1, 105);

//begin emergency information column 2
pdf_show_xy($pdf, $emergency[1],  $infocolumn2, 205);
pdf_show_xy($pdf, $emergency[3],  $infocolumn2, 190);
pdf_show_xy($pdf, $emergency[6],  $infocolumn2, 165);
pdf_show_xy($pdf, $emergency[8],  $infocolumn2, 150);

  // end the document
  pdf_end_page($pdf);
 
    //BEGIN 2ND PAGE OF PDF
  pdf_begin_page($pdf, 8.5*72, 11*72);
 
  pdf_add_bookmark($pdf, ($personnal[1] . ' ' . $personnal[0]), 0, 0);
 
  $font = pdf_findfont($pdf, 'Times-Bold', 'host', 0);//Section Titles
  $font1 = pdf_findfont($pdf, 'Times-Roman', 'host', 0);//User Info
  $font2 = pdf_findfont($pdf, 'Helvetica-Oblique', 'host', 0);//Row Titles

$column1 = 50;
$column2 = 310;
$infocolumn1 = 150;
$infocolumn2 = 410;

$header = 36;

//COMPANY INFORMATION COMPANY INFORMATION
pdf_setfont($pdf, $font, 12);//bold font for company name
pdf_show_xy($pdf, $company, 36, 750);

pdf_setfont($pdf, $font1, 12); //non-bold font
pdf_show_xy($pdf, $today, 450, 750);
pdf_show_xy($pdf, $companyadd, 36, 737);
pdf_show_xy($pdf, $companyphone, 36, 724);

pdf_setfont($pdf, $font, 18);
pdf_show_xy($pdf, 'Patient Pre-Registration Form - Page 2', 185, 705);

//Begin Primary Insurance
pdf_setfont($pdf, $font, 14);
pdf_show_xy($pdf, 'Primary Insurance Information', $header, 680);

pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Insurance Carrier', $column1, 660);
pdf_show_xy($pdf, 'Name of Insured', $column1, 645);
pdf_setfont($pdf, $font2, 10); //non-bold font
pdf_show_xy($pdf, 'if not patient', $column1, 635);
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'SSN', $column1, 620);
pdf_show_xy($pdf, 'Subscriber DOB', $column1, 605);
pdf_show_xy($pdf, 'Group Number', $column1, 590);
pdf_show_xy($pdf, 'Group Name', $column1, 575);
pdf_show_xy($pdf, 'Claims Mailing Address', $column1, 560);
pdf_show_xy($pdf, '-', $column1, 545);
pdf_show_xy($pdf, 'City', $column1, 530);
pdf_show_xy($pdf, 'State', $column1, 515);
pdf_show_xy($pdf, 'Zip Code', $column1, 500);
//End Primary Insurance

//Begin Secondary Insurance
pdf_setfont($pdf, $font, 14);
pdf_show_xy($pdf, 'Secondary Insurance Information', $header, 480);

pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Insurance Carrier', $column1, 460);
pdf_show_xy($pdf, 'Name of Insured', $column1, 445);
pdf_setfont($pdf, $font2, 10); //non-bold font
pdf_show_xy($pdf, 'if not patient', $column1, 435);
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'SSN', $column1, 420);
pdf_show_xy($pdf, 'Subscriber DOB', $column1, 405);
pdf_show_xy($pdf, 'Group Number', $column1, 390);
pdf_show_xy($pdf, 'Group Name', $column1, 375);
pdf_show_xy($pdf, 'Claims Mailing Address', $column1, 360);
pdf_show_xy($pdf, '-', $column1, 345);
pdf_show_xy($pdf, 'City', $column1, 330);
pdf_show_xy($pdf, 'State', $column1, 315);
pdf_show_xy($pdf, 'Zip Code', $column1, 300);
//End Secondary Insurance

//beginning of second column headings

//Begin Primary Insurance (col 2)
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Plan Name', $column2, 660);
pdf_show_xy($pdf, 'Patient Relationship', $column2, 645);
pdf_setfont($pdf, $font2, 10); //non-bold font
pdf_show_xy($pdf, 'to insured', $column2, 635);
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Insured Sex', $column2, 620);
pdf_show_xy($pdf, 'Policy Number', $column2, 605);
pdf_show_xy($pdf, 'Pre-Cert/Auth Phone', $column2, 590);
pdf_show_xy($pdf, 'Benefits Phone', $column2, 575);
//End Primary Insurance (col 2)

//Begin Secondary Insurance (col 2)
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Plan Name', $column2, 460);
pdf_show_xy($pdf, 'Patient Relationship', $column2, 445);
pdf_setfont($pdf, $font2, 10); //non-bold font
pdf_show_xy($pdf, 'to insured', $column2, 435);
pdf_setfont($pdf, $font2, 12); //non-bold font
pdf_show_xy($pdf, 'Insured Sex', $column2, 420);
pdf_show_xy($pdf, 'Policy Number', $column2, 405);
pdf_show_xy($pdf, 'Pre-Cert/Auth Phone', $column2, 390);
pdf_show_xy($pdf, 'Benefits Phone', $column2, 375);
//End Primary Insurance (col 2)

//begin insurance information column 1
pdf_show_xy($pdf, $insurance[0],  $infocolumn1, 660);
pdf_show_xy($pdf, $insurance[2],  $infocolumn1, 645);
pdf_show_xy($pdf, $insurance[4],  $infocolumn1, 620);
pdf_show_xy($pdf, $insurance[6],  $infocolumn1, 605);
pdf_show_xy($pdf, $insurance[7],  $infocolumn1, 590);
pdf_show_xy($pdf, $insurance[9],  $infocolumn1, 575);
pdf_show_xy($pdf, $insurance[10],  $infocolumn1, 560);
pdf_show_xy($pdf, $insurance[11],  $infocolumn1, 545);
pdf_show_xy($pdf, $insurance[13],  $infocolumn1, 530);
pdf_show_xy($pdf, $insurance[15],  $infocolumn1, 515);
pdf_show_xy($pdf, $insurance[16],  $infocolumn1, 500);

//begin insurance information column 2
pdf_show_xy($pdf, $insurance[1],  $infocolumn2, 660);
pdf_show_xy($pdf, $insurance[3],  $infocolumn2, 645);
pdf_show_xy($pdf, $insurance[5],  $infocolumn2, 620);
pdf_show_xy($pdf, $insurance[8],  $infocolumn2, 605);
pdf_show_xy($pdf, $insurance[12],  $infocolumn2, 590);
pdf_show_xy($pdf, $insurance[14],  $infocolumn2, 575);
//end insurance information column 2

//begin secondary insurance information column 1
pdf_show_xy($pdf, $secondaryinsurance[0],  $infocolumn1, 460);
pdf_show_xy($pdf, $secondaryinsurance[2],  $infocolumn1, 445);
pdf_show_xy($pdf, $secondaryinsurance[4],  $infocolumn1, 420);
pdf_show_xy($pdf, $secondaryinsurance[6],  $infocolumn1, 405);
pdf_show_xy($pdf, $secondaryinsurance[7],  $infocolumn1, 390);
pdf_show_xy($pdf, $secondaryinsurance[9],  $infocolumn1, 375);
pdf_show_xy($pdf, $secondaryinsurance[10],  $infocolumn1, 360);
pdf_show_xy($pdf, $secondaryinsurance[11],  $infocolumn1, 345);
pdf_show_xy($pdf, $secondaryinsurance[13],  $infocolumn1, 330);
pdf_show_xy($pdf, $secondaryinsurance[15],  $infocolumn1, 315);
pdf_show_xy($pdf, $secondaryinsurance[16],  $infocolumn1, 300);

//begin secondary insurance information column 2
pdf_show_xy($pdf, $secondaryinsurance[1],  $infocolumn2, 460);
pdf_show_xy($pdf, $secondaryinsurance[3],  $infocolumn2, 445);
pdf_show_xy($pdf, $secondaryinsurance[5],  $infocolumn2, 420);
pdf_show_xy($pdf, $secondaryinsurance[8],  $infocolumn2, 405);
pdf_show_xy($pdf, $secondaryinsurance[12],  $infocolumn2, 390);
pdf_show_xy($pdf, $secondaryinsurance[14],  $infocolumn2, 375);


  // end the document
  pdf_end_page($pdf);
 
  pdf_close($pdf);

################################################################################
################################################################################
//output to e-mail
//output to e-mail
 
// create the file to be e-mailed
$data = pdf_get_buffer($pdf);
$file = $filename . '.pdf';
$fp = fopen($file, 'w+');

fwrite($fp, $data);
fclose($fp);

require_once('../register/mail/htmlMimeMail.php');

$mail = new htmlMimeMail();

$mail->setFrom("TSJHPre-Registration");

$mail->setSubject('Pre-Registration Form');

$attachment = $mail->getFile($file);

$mail->setText('You have received this automated
mailing from the Texas Spine & Joint Hospital web site.
Please do not respond to this email. This message
contains an attached pdf registration form for patient '.$patient.'.
Thank-You.... Have a good day!');

      $mail->addAttachment($attachment, $file, 'application/pdf');

$mail->send(array('elkinhimer@sbcglobal.net'));

//destroy the file that was e-mailed
unlink($file);

################################################################################
################################################################################
//output to web browser
//output to web browser

header ('Location: https://www.tsjh.org/contact/thanks.html');


// header  ('Content-Type: Application/pdf');
// header  ('Content-Disposition: inline; filemane=$file');
// header  ('Conten-Length: ' . strlen($data));
   
//echo $data;


?>
0
 

Author Comment

by:phillystyle123
ID: 17219043
hey NetExpert -

sorry totally spaced - your code worked great - i was missing a coma somewhere

thanks!
0

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