Spaces:
Sleeping
Sleeping
Commit
·
06675a6
1
Parent(s):
74f57ab
Medical Form Implemented
Browse files- app.py +60 -31
- form_fill.py +51 -0
- models.py +22 -0
- outputs/filled_child_fee_form_e3fba6d8482a476dade270c022cc64e2.pdf +0 -3
- pipeline.py +104 -2
- CHILD FEE REIMBURSEMENT FORM.pdf → templates/CHILD FEE REIMBURSEMENT FORM.pdf +0 -0
- outputs/filled_child_fee_form_6dfe1052f5be4bbc8a78711a456a3cc9.pdf → templates/Medical Reim. Form.pdf +2 -2
- templates/medical_form.html +286 -0
app.py
CHANGED
|
@@ -1,40 +1,40 @@
|
|
| 1 |
import gradio as gr
|
| 2 |
-
from pipeline import
|
| 3 |
-
from
|
|
|
|
|
|
|
| 4 |
|
| 5 |
|
| 6 |
|
| 7 |
with gr.Blocks() as demo:
|
| 8 |
with gr.Tabs():
|
| 9 |
-
with gr.Tab("
|
| 10 |
with gr.Row():
|
| 11 |
with gr.Column(scale=2):
|
| 12 |
-
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 13 |
|
| 14 |
with gr.Column(scale=2):
|
| 15 |
-
|
| 16 |
-
value=""
|
| 17 |
-
|
| 18 |
-
|
| 19 |
-
|
| 20 |
-
|
| 21 |
-
|
| 22 |
-
|
| 23 |
-
|
| 24 |
-
|
| 25 |
-
}
|
| 26 |
-
]
|
| 27 |
-
}
|
| 28 |
-
```""",
|
| 29 |
-
|
| 30 |
-
label="Extracted Info", elem_id="output-box", show_label=False
|
| 31 |
)
|
| 32 |
-
img_input.upload(fn=extract_info, inputs=img_input, outputs=output_box)
|
| 33 |
|
| 34 |
|
| 35 |
|
| 36 |
-
|
| 37 |
-
with gr.Tab("Reimbursement Form"):
|
| 38 |
with gr.Row():
|
| 39 |
with gr.Column(scale=2):
|
| 40 |
img_input = gr.Image(
|
|
@@ -48,17 +48,12 @@ with gr.Blocks() as demo:
|
|
| 48 |
|
| 49 |
with gr.Column(scale=2):
|
| 50 |
# Dropdown for form names
|
| 51 |
-
|
| 52 |
-
choices=["Child Fee Reimbursement", "Medical Reimbursement", "Other Form"],
|
| 53 |
-
label="Select Form",
|
| 54 |
-
value="Child Fee Reimbursement",
|
| 55 |
-
multiselect=False,
|
| 56 |
-
interactive=True,
|
| 57 |
-
)
|
| 58 |
|
| 59 |
# 2x2 grid for info fields
|
| 60 |
with gr.Row():
|
| 61 |
emp_name = gr.Textbox(label="Employee Name")
|
|
|
|
| 62 |
emp_code = gr.Textbox(label="Employee Code")
|
| 63 |
with gr.Row():
|
| 64 |
department = gr.Textbox(label="Department")
|
|
@@ -72,11 +67,45 @@ with gr.Blocks() as demo:
|
|
| 72 |
outputs=preview_output
|
| 73 |
)
|
| 74 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 75 |
# CSS:
|
| 76 |
gr.HTML("""
|
| 77 |
<style>
|
| 78 |
#output-box .prose, #output-box .prose pre, #output-box .prose code {
|
| 79 |
-
font-size:
|
| 80 |
}
|
| 81 |
</style>
|
| 82 |
""")
|
|
|
|
| 1 |
import gradio as gr
|
| 2 |
+
from pipeline import extract_info_batch, extract_child_fee_info,extract_medical_info
|
| 3 |
+
from PIL import Image
|
| 4 |
+
|
| 5 |
+
|
| 6 |
|
| 7 |
|
| 8 |
|
| 9 |
with gr.Blocks() as demo:
|
| 10 |
with gr.Tabs():
|
| 11 |
+
with gr.Tab("Receipts Upload"):
|
| 12 |
with gr.Row():
|
| 13 |
with gr.Column(scale=2):
|
| 14 |
+
batch_img_input = gr.File(
|
| 15 |
+
file_types=["image"],
|
| 16 |
+
label="Batch Image Upload",
|
| 17 |
+
elem_id="batch-upload-img",
|
| 18 |
+
show_label=True,
|
| 19 |
+
file_count="multiple"
|
| 20 |
+
)
|
| 21 |
|
| 22 |
with gr.Column(scale=2):
|
| 23 |
+
batch_output_box = gr.Markdown(
|
| 24 |
+
value="Upload Images to extract information",
|
| 25 |
+
label="Batch Extracted Info",
|
| 26 |
+
elem_id="batch-output-box",
|
| 27 |
+
show_label=True
|
| 28 |
+
)
|
| 29 |
+
batch_img_input.change(
|
| 30 |
+
fn=extract_info_batch,
|
| 31 |
+
inputs=batch_img_input,
|
| 32 |
+
outputs=batch_output_box
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 33 |
)
|
|
|
|
| 34 |
|
| 35 |
|
| 36 |
|
| 37 |
+
with gr.Tab("Child Fee Reimbursement Form"):
|
|
|
|
| 38 |
with gr.Row():
|
| 39 |
with gr.Column(scale=2):
|
| 40 |
img_input = gr.Image(
|
|
|
|
| 48 |
|
| 49 |
with gr.Column(scale=2):
|
| 50 |
# Dropdown for form names
|
| 51 |
+
gr.Markdown("## Child Fee Reimbursement")
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 52 |
|
| 53 |
# 2x2 grid for info fields
|
| 54 |
with gr.Row():
|
| 55 |
emp_name = gr.Textbox(label="Employee Name")
|
| 56 |
+
|
| 57 |
emp_code = gr.Textbox(label="Employee Code")
|
| 58 |
with gr.Row():
|
| 59 |
department = gr.Textbox(label="Department")
|
|
|
|
| 67 |
outputs=preview_output
|
| 68 |
)
|
| 69 |
|
| 70 |
+
|
| 71 |
+
with gr.Tab("Medical Reimbursement Form"):
|
| 72 |
+
with gr.Row():
|
| 73 |
+
with gr.Column(scale=2):
|
| 74 |
+
medical_img_input = gr.Image(
|
| 75 |
+
type="pil",
|
| 76 |
+
label="Image Upload",
|
| 77 |
+
elem_id="upload-img",
|
| 78 |
+
show_label=False,
|
| 79 |
+
height=512,
|
| 80 |
+
width=512
|
| 81 |
+
)
|
| 82 |
+
with gr.Column(scale=2):
|
| 83 |
+
with gr.Row():
|
| 84 |
+
med_company_name = gr.Dropdown(choices=["NetSol Technologies Ltd.","NetSol Innovation Private Ltd."], interactive=True, multiselect=False)
|
| 85 |
+
med_emp_name = gr.Textbox(label="Employee Name")
|
| 86 |
+
med_department = gr.Textbox(label="Department")
|
| 87 |
+
with gr.Row():
|
| 88 |
+
med_designation = gr.Textbox(label="Designation")
|
| 89 |
+
med_ext_code = gr.Textbox(label="Extention No.")
|
| 90 |
+
med_emp_code = gr.Textbox(label="Employee Code")
|
| 91 |
+
medical_upload_btn = gr.Button("Upload and Process")
|
| 92 |
+
preview_medical_output = gr.File(label="Download Filled Form")
|
| 93 |
+
|
| 94 |
+
|
| 95 |
+
medical_upload_btn.click(
|
| 96 |
+
fn=extract_medical_info,
|
| 97 |
+
inputs=[medical_img_input,med_emp_name,med_emp_code,med_department,med_designation,med_company_name,med_ext_code],
|
| 98 |
+
outputs=preview_medical_output
|
| 99 |
+
)
|
| 100 |
+
|
| 101 |
+
|
| 102 |
+
|
| 103 |
+
|
| 104 |
# CSS:
|
| 105 |
gr.HTML("""
|
| 106 |
<style>
|
| 107 |
#output-box .prose, #output-box .prose pre, #output-box .prose code {
|
| 108 |
+
font-size: 30px !important;
|
| 109 |
}
|
| 110 |
</style>
|
| 111 |
""")
|
form_fill.py
CHANGED
|
@@ -40,3 +40,54 @@ def fill_child_fee_pdf(
|
|
| 40 |
annotation.AP = None # Remove old appearance so new value appears
|
| 41 |
PdfWriter().write(output_pdf_path, template_pdf)
|
| 42 |
return output_pdf_path
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 40 |
annotation.AP = None # Remove old appearance so new value appears
|
| 41 |
PdfWriter().write(output_pdf_path, template_pdf)
|
| 42 |
return output_pdf_path
|
| 43 |
+
|
| 44 |
+
|
| 45 |
+
def fill_medical_pdf(
|
| 46 |
+
template_pdf_path,
|
| 47 |
+
output_pdf_path,
|
| 48 |
+
company,
|
| 49 |
+
extension_no,
|
| 50 |
+
employee_name,
|
| 51 |
+
employee_code,
|
| 52 |
+
department,
|
| 53 |
+
date,
|
| 54 |
+
total,
|
| 55 |
+
designation,
|
| 56 |
+
billing_month,
|
| 57 |
+
claims # List of dicts: [{'name': ..., 'relationship': ..., 'category': ..., 'detail': ..., 'amount': ...}]
|
| 58 |
+
):
|
| 59 |
+
data_dict = {
|
| 60 |
+
'company': company,
|
| 61 |
+
'extension_no': extension_no,
|
| 62 |
+
'employee_name': employee_name,
|
| 63 |
+
'employee_code': employee_code,
|
| 64 |
+
'department': department,
|
| 65 |
+
'designation': designation,
|
| 66 |
+
'date': date,
|
| 67 |
+
'billing_month': billing_month,
|
| 68 |
+
'total': str(total),
|
| 69 |
+
'current_date': datetime.now().strftime("%d-%b-%Y"),
|
| 70 |
+
}
|
| 71 |
+
|
| 72 |
+
# Map each row of claims to field names
|
| 73 |
+
for idx, claim in enumerate(claims, start=1):
|
| 74 |
+
data_dict[f'name_{idx}'] = claim.get('name', '')
|
| 75 |
+
data_dict[f'relationship_{idx}'] = claim.get('relationship', '')
|
| 76 |
+
data_dict[f'category_{idx}'] = claim.get('category', '')
|
| 77 |
+
data_dict[f'detail_{idx}'] = claim.get('detail', '')
|
| 78 |
+
data_dict[f'amount_{idx}'] = str(claim.get('amount', ''))
|
| 79 |
+
|
| 80 |
+
# Fill the PDF
|
| 81 |
+
template_pdf = PdfReader(template_pdf_path)
|
| 82 |
+
for page in template_pdf.pages:
|
| 83 |
+
if not hasattr(page, 'Annots') or not page.Annots:
|
| 84 |
+
continue
|
| 85 |
+
for annotation in page.Annots:
|
| 86 |
+
if annotation.T:
|
| 87 |
+
key = annotation.T[1:-1] # Remove parentheses
|
| 88 |
+
if key in data_dict:
|
| 89 |
+
annotation.V = str(data_dict[key])
|
| 90 |
+
annotation.AP = None # Remove old appearance so new value appears
|
| 91 |
+
PdfWriter().write(output_pdf_path, template_pdf)
|
| 92 |
+
return output_pdf_path
|
| 93 |
+
|
models.py
CHANGED
|
@@ -27,3 +27,25 @@ class FeeItem(BaseModel):
|
|
| 27 |
class ChildFeeForm(BaseModel):
|
| 28 |
items: List[FeeItem]
|
| 29 |
total: float # Calculated after parsing
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 27 |
class ChildFeeForm(BaseModel):
|
| 28 |
items: List[FeeItem]
|
| 29 |
total: float # Calculated after parsing
|
| 30 |
+
|
| 31 |
+
|
| 32 |
+
|
| 33 |
+
|
| 34 |
+
class MedicalClaimItem(BaseModel):
|
| 35 |
+
name: str # Patient name
|
| 36 |
+
relationship: str # self, spouse, parent, child
|
| 37 |
+
category: str # in-patient, out-patient, maternity(cesarean), maternity(normal)
|
| 38 |
+
detail: str # doctor's fee, diagnostic tests, medicines, other hospitalization
|
| 39 |
+
amount: float
|
| 40 |
+
|
| 41 |
+
class MedicalReimbursementForm(BaseModel):
|
| 42 |
+
company: Optional[str] = None
|
| 43 |
+
extension_no: Optional[str] = None
|
| 44 |
+
employee_name: str
|
| 45 |
+
employee_code: str
|
| 46 |
+
department: Optional[str] = None
|
| 47 |
+
designation: Optional[str] = None
|
| 48 |
+
date: Optional[str] = None
|
| 49 |
+
billing_month: Optional[str] = None
|
| 50 |
+
claims: List[MedicalClaimItem]
|
| 51 |
+
total: float
|
outputs/filled_child_fee_form_e3fba6d8482a476dade270c022cc64e2.pdf
DELETED
|
@@ -1,3 +0,0 @@
|
|
| 1 |
-
version https://git-lfs.github.com/spec/v1
|
| 2 |
-
oid sha256:fa5b02270d310e55abfdf36281e54e88928ad3b71d19f034b784b1616a2c9eb5
|
| 3 |
-
size 115542
|
|
|
|
|
|
|
|
|
|
|
|
pipeline.py
CHANGED
|
@@ -5,9 +5,11 @@ import os, uuid
|
|
| 5 |
from PIL import Image
|
| 6 |
import base64
|
| 7 |
import json
|
| 8 |
-
from models import ReceiptData, ChildFeeForm
|
| 9 |
-
from form_fill import fill_child_fee_pdf
|
| 10 |
from fraud import process_receipt
|
|
|
|
|
|
|
| 11 |
|
| 12 |
load_dotenv()
|
| 13 |
openai.api_key = os.getenv("OPENAI_API_KEY", "").strip()
|
|
@@ -37,6 +39,7 @@ reciept_system_prompt = (
|
|
| 37 |
"- Do not add any explanation or extra text—only the JSON."
|
| 38 |
)
|
| 39 |
|
|
|
|
| 40 |
fee_bill_system_prompt = (
|
| 41 |
"You are an expert at extracting data from fee bills. "
|
| 42 |
"Read the provided image of a child fee bill and return a JSON object that matches the following Pydantic model:\n"
|
|
@@ -58,6 +61,29 @@ fee_bill_system_prompt = (
|
|
| 58 |
)
|
| 59 |
|
| 60 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 61 |
|
| 62 |
|
| 63 |
def pil_to_bytes(pil_img, quality=70):
|
|
@@ -170,3 +196,79 @@ def extract_child_fee_info(img_input, emp_name, emp_code, department):
|
|
| 170 |
except Exception as e:
|
| 171 |
print("ERROR:", e)
|
| 172 |
return None # or f"Error: {str(e)}"
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 5 |
from PIL import Image
|
| 6 |
import base64
|
| 7 |
import json
|
| 8 |
+
from models import ReceiptData, ChildFeeForm, MedicalReimbursementForm
|
| 9 |
+
from form_fill import fill_child_fee_pdf, fill_medical_pdf
|
| 10 |
from fraud import process_receipt
|
| 11 |
+
from datetime import datetime
|
| 12 |
+
|
| 13 |
|
| 14 |
load_dotenv()
|
| 15 |
openai.api_key = os.getenv("OPENAI_API_KEY", "").strip()
|
|
|
|
| 39 |
"- Do not add any explanation or extra text—only the JSON."
|
| 40 |
)
|
| 41 |
|
| 42 |
+
|
| 43 |
fee_bill_system_prompt = (
|
| 44 |
"You are an expert at extracting data from fee bills. "
|
| 45 |
"Read the provided image of a child fee bill and return a JSON object that matches the following Pydantic model:\n"
|
|
|
|
| 61 |
)
|
| 62 |
|
| 63 |
|
| 64 |
+
medical_form_system_prompt = (
|
| 65 |
+
"You are an expert at extracting structured data from tabular forms containing sample data. "
|
| 66 |
+
"Your task is to read the provided form and return a JSON object that matches the following Pydantic model:\n"
|
| 67 |
+
"class Item(BaseModel):\n"
|
| 68 |
+
" name: str #the patient name\n"
|
| 69 |
+
" relationship: # self, spouse, parent, child\n"
|
| 70 |
+
" category: # in-patient, out-patient, maternity(cesarean), maternity(normal)\n"
|
| 71 |
+
" detail: # doctor's fee, diagnostic tests, medicines, other hospitalization\n"
|
| 72 |
+
" bill_month: Optional[str] = None # Bill Month Field, if not directly stated, find the date and infer the month from that, if not found return null\n"
|
| 73 |
+
" amount: float\n"
|
| 74 |
+
"class Form(BaseModel):\n"
|
| 75 |
+
" claims: List[Item]\n"
|
| 76 |
+
" total: float\n"
|
| 77 |
+
"- Extract only the above information. If a value is missing, set it to null, \"\", or an empty list as appropriate.\n"
|
| 78 |
+
"- For the claims field, provide a list of objects with name, relationship, category, detail, and amount.\n"
|
| 79 |
+
"- The total field must be the sum of all amount values in claims.\n"
|
| 80 |
+
"- Only return a valid JSON object matching the model above.\n"
|
| 81 |
+
"- Do not add any explanation or extra text—only the JSON."
|
| 82 |
+
"- Try your very best to extract this information as it is very important that you do so\n"
|
| 83 |
+
"- If you are unable to extract information, return an empty json in the format requested above, never give a response other than a json"
|
| 84 |
+
)
|
| 85 |
+
|
| 86 |
+
|
| 87 |
|
| 88 |
|
| 89 |
def pil_to_bytes(pil_img, quality=70):
|
|
|
|
| 196 |
except Exception as e:
|
| 197 |
print("ERROR:", e)
|
| 198 |
return None # or f"Error: {str(e)}"
|
| 199 |
+
|
| 200 |
+
|
| 201 |
+
|
| 202 |
+
def extract_info_batch(file_list):
|
| 203 |
+
"""
|
| 204 |
+
Accepts a list of file objects/paths, processes each as a PIL image, and returns results.
|
| 205 |
+
"""
|
| 206 |
+
results = []
|
| 207 |
+
for file in file_list:
|
| 208 |
+
img = Image.open(file)
|
| 209 |
+
results.append(extract_info(img))
|
| 210 |
+
return "\n\n".join(results)
|
| 211 |
+
|
| 212 |
+
|
| 213 |
+
|
| 214 |
+
def extract_medical_info(pil_img, emp_name, emp_code, department, designation, company, extension_no,):
|
| 215 |
+
processed_image = preprocess_image(pil_img)
|
| 216 |
+
img_bytes = pil_to_bytes(processed_image)
|
| 217 |
+
img_base64 = base64.b64encode(img_bytes.getvalue()).decode("utf-8")
|
| 218 |
+
response = openai.chat.completions.create(
|
| 219 |
+
model="gpt-4o",
|
| 220 |
+
messages=[
|
| 221 |
+
{"role": "system", "content": medical_form_system_prompt},
|
| 222 |
+
{"role": "user",
|
| 223 |
+
"content": [
|
| 224 |
+
{"type": "text", "text": "Here is a child fee bill image:"},
|
| 225 |
+
{"type": "image_url", "image_url": {"url": "data:image/png;base64," + img_base64}}
|
| 226 |
+
]}
|
| 227 |
+
]
|
| 228 |
+
)
|
| 229 |
+
raw_output = response.choices[0].message.content
|
| 230 |
+
print(raw_output)
|
| 231 |
+
try:
|
| 232 |
+
if raw_output.startswith("```"):
|
| 233 |
+
raw_output = raw_output.strip("` \n")
|
| 234 |
+
if raw_output.startswith("json"):
|
| 235 |
+
raw_output = raw_output[4:].strip()
|
| 236 |
+
data = json.loads(raw_output)
|
| 237 |
+
print(data)
|
| 238 |
+
# Validate if needed:
|
| 239 |
+
# ChildFeeForm(**data)
|
| 240 |
+
|
| 241 |
+
claims = data.get("claims", [])
|
| 242 |
+
bill_month = ""
|
| 243 |
+
if claims and "bill_month" in claims[0]:
|
| 244 |
+
bill_month = claims[0]["bill_month"]
|
| 245 |
+
|
| 246 |
+
date = datetime.now().strftime("%d-%b-%Y") # e.g., "10-Jun-2024"
|
| 247 |
+
total = data.get("total", 0)
|
| 248 |
+
|
| 249 |
+
print("bill month:",bill_month)
|
| 250 |
+
|
| 251 |
+
print("total:",total)
|
| 252 |
+
os.makedirs("outputs", exist_ok=True)
|
| 253 |
+
output_pdf_path = f"outputs/filled_medical_form_{uuid.uuid4().hex}.pdf"
|
| 254 |
+
|
| 255 |
+
|
| 256 |
+
filled_pdf_path = fill_medical_pdf(
|
| 257 |
+
template_pdf_path="Medical Reim. Form.pdf",
|
| 258 |
+
output_pdf_path=output_pdf_path,
|
| 259 |
+
company=company,
|
| 260 |
+
employee_name=emp_name,
|
| 261 |
+
employee_code=emp_code,
|
| 262 |
+
department=department,
|
| 263 |
+
designation=designation,
|
| 264 |
+
extension_no=extension_no,
|
| 265 |
+
billing_month=bill_month,
|
| 266 |
+
claims=claims,
|
| 267 |
+
date= date,
|
| 268 |
+
total=total
|
| 269 |
+
)
|
| 270 |
+
|
| 271 |
+
return filled_pdf_path # Return path to Gradio for download
|
| 272 |
+
except Exception as e:
|
| 273 |
+
print("ERROR:", e)
|
| 274 |
+
return None # or f"Error: {str(e)}"
|
CHILD FEE REIMBURSEMENT FORM.pdf → templates/CHILD FEE REIMBURSEMENT FORM.pdf
RENAMED
|
File without changes
|
outputs/filled_child_fee_form_6dfe1052f5be4bbc8a78711a456a3cc9.pdf → templates/Medical Reim. Form.pdf
RENAMED
|
@@ -1,3 +1,3 @@
|
|
| 1 |
version https://git-lfs.github.com/spec/v1
|
| 2 |
-
oid sha256:
|
| 3 |
-
size
|
|
|
|
| 1 |
version https://git-lfs.github.com/spec/v1
|
| 2 |
+
oid sha256:c42ef819cd41595124559fb1d5ae4bd290eb5152d477cc0e61ec89f7d13f2380
|
| 3 |
+
size 103497
|
templates/medical_form.html
ADDED
|
@@ -0,0 +1,286 @@
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1 |
+
<!DOCTYPE html>
|
| 2 |
+
<html lang="en">
|
| 3 |
+
<head>
|
| 4 |
+
<meta charset="UTF-8">
|
| 5 |
+
<title>Medical Reimbursement Form (Applicable for Outpatient)</title>
|
| 6 |
+
<style>
|
| 7 |
+
body {
|
| 8 |
+
font-family: 'Times New Roman', Times, serif;
|
| 9 |
+
background: #fff;
|
| 10 |
+
margin: 0;
|
| 11 |
+
padding: 40px 0;
|
| 12 |
+
}
|
| 13 |
+
.form-container {
|
| 14 |
+
width: 900px;
|
| 15 |
+
margin: 0 auto;
|
| 16 |
+
border: 2px solid #000;
|
| 17 |
+
background: #fff;
|
| 18 |
+
}
|
| 19 |
+
.form-header {
|
| 20 |
+
display: flex;
|
| 21 |
+
align-items: flex-start;
|
| 22 |
+
padding: 15px 30px 0 20px;
|
| 23 |
+
}
|
| 24 |
+
.logo-placeholder {
|
| 25 |
+
width: 90px;
|
| 26 |
+
height: 90px;
|
| 27 |
+
background: #f2f2f2;
|
| 28 |
+
border: 1px solid #ddd;
|
| 29 |
+
margin-right: 18px;
|
| 30 |
+
}
|
| 31 |
+
.header-title {
|
| 32 |
+
flex: 1;
|
| 33 |
+
text-align: center;
|
| 34 |
+
}
|
| 35 |
+
.header-title h2 {
|
| 36 |
+
font-size: 24px;
|
| 37 |
+
margin: 0;
|
| 38 |
+
font-weight: bold;
|
| 39 |
+
}
|
| 40 |
+
.header-title h3 {
|
| 41 |
+
font-size: 18px;
|
| 42 |
+
margin: 0;
|
| 43 |
+
font-weight: normal;
|
| 44 |
+
}
|
| 45 |
+
.form-details {
|
| 46 |
+
display: flex;
|
| 47 |
+
flex-wrap: wrap;
|
| 48 |
+
padding: 10px 30px 0 30px;
|
| 49 |
+
font-size: 17px;
|
| 50 |
+
}
|
| 51 |
+
.form-details-col {
|
| 52 |
+
flex: 1 1 50%;
|
| 53 |
+
}
|
| 54 |
+
.form-details-row {
|
| 55 |
+
display: flex;
|
| 56 |
+
align-items: center;
|
| 57 |
+
margin-bottom: 7px;
|
| 58 |
+
}
|
| 59 |
+
.form-details-label {
|
| 60 |
+
width: 140px;
|
| 61 |
+
display: inline-block;
|
| 62 |
+
}
|
| 63 |
+
.form-details-input {
|
| 64 |
+
border: none;
|
| 65 |
+
border-bottom: 1.2px solid #000;
|
| 66 |
+
width: 250px;
|
| 67 |
+
height: 22px;
|
| 68 |
+
font-size: 16px;
|
| 69 |
+
background: none;
|
| 70 |
+
margin-left: 4px;
|
| 71 |
+
margin-right: 4px;
|
| 72 |
+
}
|
| 73 |
+
.form-details-input:focus {
|
| 74 |
+
outline: none;
|
| 75 |
+
background: #eef;
|
| 76 |
+
}
|
| 77 |
+
.form-table-container {
|
| 78 |
+
margin: 25px 20px 0 20px;
|
| 79 |
+
}
|
| 80 |
+
table {
|
| 81 |
+
width: 100%;
|
| 82 |
+
border-collapse: collapse;
|
| 83 |
+
margin-bottom: 0;
|
| 84 |
+
}
|
| 85 |
+
th, td {
|
| 86 |
+
border: 1px solid #000;
|
| 87 |
+
padding: 7px 4px;
|
| 88 |
+
font-size: 16px;
|
| 89 |
+
text-align: center;
|
| 90 |
+
}
|
| 91 |
+
th {
|
| 92 |
+
background: #ddd;
|
| 93 |
+
font-weight: bold;
|
| 94 |
+
}
|
| 95 |
+
.table-title-row th {
|
| 96 |
+
border-bottom: 2px solid #000;
|
| 97 |
+
}
|
| 98 |
+
.table-claim-col {
|
| 99 |
+
width: 120px;
|
| 100 |
+
}
|
| 101 |
+
.table-input {
|
| 102 |
+
width: 95%;
|
| 103 |
+
font-size: 15px;
|
| 104 |
+
border: none;
|
| 105 |
+
border-bottom: 1px solid #555;
|
| 106 |
+
background: none;
|
| 107 |
+
text-align: center;
|
| 108 |
+
}
|
| 109 |
+
.table-input:focus {
|
| 110 |
+
outline: none;
|
| 111 |
+
background: #eef;
|
| 112 |
+
}
|
| 113 |
+
.total-row td {
|
| 114 |
+
border: none;
|
| 115 |
+
text-align: right;
|
| 116 |
+
font-weight: bold;
|
| 117 |
+
font-size: 17px;
|
| 118 |
+
padding-right: 24px;
|
| 119 |
+
}
|
| 120 |
+
.signature-row {
|
| 121 |
+
height: 60px;
|
| 122 |
+
}
|
| 123 |
+
.signature-cell {
|
| 124 |
+
text-align: right;
|
| 125 |
+
padding-right: 90px;
|
| 126 |
+
vertical-align: bottom;
|
| 127 |
+
}
|
| 128 |
+
.notes-section {
|
| 129 |
+
font-size: 14px;
|
| 130 |
+
margin: 8px 22px 10px 24px;
|
| 131 |
+
}
|
| 132 |
+
.notes-section ol,
|
| 133 |
+
.notes-section ul {
|
| 134 |
+
margin-top: 0;
|
| 135 |
+
margin-bottom: 0;
|
| 136 |
+
}
|
| 137 |
+
.notes-section li {
|
| 138 |
+
margin-bottom: 4px;
|
| 139 |
+
}
|
| 140 |
+
.bottom-line {
|
| 141 |
+
border-bottom: 1.5px solid #000;
|
| 142 |
+
margin-top: 30px;
|
| 143 |
+
width: 250px;
|
| 144 |
+
}
|
| 145 |
+
@media (max-width: 950px) {
|
| 146 |
+
.form-container {
|
| 147 |
+
width: 98vw;
|
| 148 |
+
}
|
| 149 |
+
}
|
| 150 |
+
@media (max-width: 650px) {
|
| 151 |
+
.form-header, .form-details, .form-table-container {
|
| 152 |
+
padding-left: 5px !important;
|
| 153 |
+
padding-right: 5px !important;
|
| 154 |
+
}
|
| 155 |
+
.form-container {
|
| 156 |
+
padding: 0 1vw;
|
| 157 |
+
}
|
| 158 |
+
}
|
| 159 |
+
</style>
|
| 160 |
+
</head>
|
| 161 |
+
<body>
|
| 162 |
+
<div class="form-container">
|
| 163 |
+
<div class="form-header">
|
| 164 |
+
<div class="logo-placeholder">
|
| 165 |
+
<!-- Logo goes here -->
|
| 166 |
+
</div>
|
| 167 |
+
<div class="header-title">
|
| 168 |
+
<h2>Medical Reimbursement Form</h2>
|
| 169 |
+
<h3>(Applicable for Outpatient )</h3>
|
| 170 |
+
</div>
|
| 171 |
+
</div>
|
| 172 |
+
<form>
|
| 173 |
+
<div class="form-details">
|
| 174 |
+
<div class="form-details-col">
|
| 175 |
+
<div class="form-details-row">
|
| 176 |
+
<span class="form-details-label">Company:</span>
|
| 177 |
+
<input class="form-details-input" type="text" name="company">
|
| 178 |
+
</div>
|
| 179 |
+
<div class="form-details-row">
|
| 180 |
+
<span class="form-details-label">Name:</span>
|
| 181 |
+
<input class="form-details-input" type="text" name="name">
|
| 182 |
+
</div>
|
| 183 |
+
<div class="form-details-row">
|
| 184 |
+
<span class="form-details-label">Department:</span>
|
| 185 |
+
<input class="form-details-input" type="text" name="department">
|
| 186 |
+
</div>
|
| 187 |
+
<div class="form-details-row">
|
| 188 |
+
<span class="form-details-label">Designation:</span>
|
| 189 |
+
<input class="form-details-input" type="text" name="designation">
|
| 190 |
+
</div>
|
| 191 |
+
</div>
|
| 192 |
+
<div class="form-details-col">
|
| 193 |
+
<div class="form-details-row">
|
| 194 |
+
<span class="form-details-label">Extension No:</span>
|
| 195 |
+
<input class="form-details-input" type="text" name="extension">
|
| 196 |
+
</div>
|
| 197 |
+
<div class="form-details-row">
|
| 198 |
+
<span class="form-details-label">Employee Code:</span>
|
| 199 |
+
<input class="form-details-input" type="text" name="employee_code">
|
| 200 |
+
</div>
|
| 201 |
+
<div class="form-details-row">
|
| 202 |
+
<span class="form-details-label">Date:</span>
|
| 203 |
+
<input class="form-details-input" type="date" name="date" style="width:180px;">
|
| 204 |
+
</div>
|
| 205 |
+
<div class="form-details-row">
|
| 206 |
+
<span class="form-details-label">Billing Month:</span>
|
| 207 |
+
<input class="form-details-input" type="text" name="billing_month" placeholder="mm/yy" style="width:90px;">
|
| 208 |
+
<span style="margin-left:10px;">(mm/yy)</span>
|
| 209 |
+
</div>
|
| 210 |
+
</div>
|
| 211 |
+
</div>
|
| 212 |
+
<div class="form-table-container">
|
| 213 |
+
<table>
|
| 214 |
+
<tr class="table-title-row">
|
| 215 |
+
<th>Name</th>
|
| 216 |
+
<th>Relationship</th>
|
| 217 |
+
<th>Category</th>
|
| 218 |
+
<th class="table-claim-col">Detail</th>
|
| 219 |
+
<th class="table-claim-col">Amount</th>
|
| 220 |
+
</tr>
|
| 221 |
+
<tbody>
|
| 222 |
+
{{claims_rows}}
|
| 223 |
+
</tbody>
|
| 224 |
+
</table>
|
| 225 |
+
<table style="margin-top: 0;">
|
| 226 |
+
<tr class="total-row">
|
| 227 |
+
<td colspan="4" style="border: none;"></td>
|
| 228 |
+
<td style="border-top: none; border-left: 1px solid #000;">Total -
|
| 229 |
+
<input style="width: 80px; border: none; border-bottom: 1px solid #000; font-size: 16px; background: none; text-align: center;" type="number" step="0.01" min="0" name="total" readonly id="total_amount">
|
| 230 |
+
</td>
|
| 231 |
+
</tr>
|
| 232 |
+
<tr class="signature-row">
|
| 233 |
+
<td colspan="5" class="signature-cell">
|
| 234 |
+
<div style="margin-top:20px;">
|
| 235 |
+
________________________________<br>
|
| 236 |
+
Employee's Signature
|
| 237 |
+
</div>
|
| 238 |
+
</td>
|
| 239 |
+
</tr>
|
| 240 |
+
</table>
|
| 241 |
+
</div>
|
| 242 |
+
</form>
|
| 243 |
+
<div class="notes-section">
|
| 244 |
+
<ol>
|
| 245 |
+
<li>No claim will be processed in case:
|
| 246 |
+
<ul style="list-style-type: lower-alpha; margin-left: 20px;">
|
| 247 |
+
<li>Supporting documents are not attached.</li>
|
| 248 |
+
<li>Form is incomplete.</li>
|
| 249 |
+
<li>Claim is time barred <span style="text-decoration:underline;">i.e.</span> not submitted within thirty (30) days after the expense is incurred.</li>
|
| 250 |
+
<li>Any violation of applicable policy and procedure.</li>
|
| 251 |
+
</ul>
|
| 252 |
+
</li>
|
| 253 |
+
<li>
|
| 254 |
+
<span style="text-decoration:underline;">"Category"</span> refers to type of the claim <span style="text-decoration:underline;">i.e.</span> in-patient, out-patient, maternity (cesarean), maternity (normal).
|
| 255 |
+
</li>
|
| 256 |
+
<li>
|
| 257 |
+
<span style="text-decoration:underline;">"Detail"</span> refers to type of the expenditure <span style="text-decoration:underline;">i.e.</span> doctor's fee, diagnostic tests, medicines, other hospitalization charges.
|
| 258 |
+
</li>
|
| 259 |
+
<li>
|
| 260 |
+
Expenses incurred during probation are considered to be time barred if not claimed within thirty days after confirmation.
|
| 261 |
+
</li>
|
| 262 |
+
</ol>
|
| 263 |
+
</div>
|
| 264 |
+
</div>
|
| 265 |
+
<script>
|
| 266 |
+
// Auto sum the Amount columns
|
| 267 |
+
const amountFields = [
|
| 268 |
+
document.querySelector('input[name="claim_amount1"]'),
|
| 269 |
+
document.querySelector('input[name="claim_amount2"]'),
|
| 270 |
+
document.querySelector('input[name="claim_amount3"]'),
|
| 271 |
+
document.querySelector('input[name="claim_amount4"]')
|
| 272 |
+
];
|
| 273 |
+
const totalField = document.getElementById('total_amount');
|
| 274 |
+
amountFields.forEach(f => {
|
| 275 |
+
f.addEventListener('input', () => {
|
| 276 |
+
let total = 0;
|
| 277 |
+
amountFields.forEach(ff => {
|
| 278 |
+
let val = parseFloat(ff.value);
|
| 279 |
+
if (!isNaN(val)) total += val;
|
| 280 |
+
});
|
| 281 |
+
totalField.value = total > 0 ? total.toFixed(2) : '';
|
| 282 |
+
});
|
| 283 |
+
});
|
| 284 |
+
</script>
|
| 285 |
+
</body>
|
| 286 |
+
</html>
|