Difference between revisions of "Service Provider Integration"

Latest revision as of 13:50, 20 July 2017

This article provides an overview of the process to integrate third party service providers such as transportation and translation services with client copies of SmartSimple that track Independent Medical Assessments(IME) and Rehabilitation services.

For full details, refer to the Service Provider Integration protocol document.

Overview

The objectives of this integration are twofold:

Provide the ability for a SmartSimple client to electronically request services from a third party provider.
Provide the ability for a third party provider to post invoice details related to the services requested back to the SmartSimple client.

Two service types are currently fully defined and supported: Interpretation/Translation and Transportation. Additional service types will be supported in the future.

The general transfer process is illustrated below:

From SmartSimple, information related to the service request is transferred to the service provider's website using a HTTPS post method
Information from the service provider's system is posted back to SmartSimple using a HTTPS post method

Transferring Information from SmartSimple to Service Provider

The information to be transferred from SmartSimple is gathered from a number of linked objects associated to the service.

As illustrated below, information is gathered from the Payor, Client's contact record, Case (Level 1), and the specific assessment or treatment service (Level 2).

The configuration work required to post information to the service provider is performed by SmartSimple or its business partners.

For a complete list of fields transferred from SmartSimple, please refer to Service Provider Integration Fields page.

Transferring Information from Service Provider to SmartSimple

When invoice information is received from the Service Provider, a new record is created under each service called a service billing record (Level 3).

This service billing record contains the details and costs of the services provided.

The configuration work required to post information to SmartSimple is performed by the service provider.

For a complete list of fields transferred by the Service Provider, please refer to Service Provider Integration Fields page.

Transfer Process

For security and auditing purposes, information is not directly passed from the Service Provider system to SmartSimple's client interface. Instead the returned service billing information is managed by SmartSimple's Integration Gateway.

The gateway performs the following:

Manages all incoming service billing information
Each SmartSimple client polls the Integration Gateway and extracts Service Billing records using proprietary protocols
All fields are submitted by http POST parameters
Service URL is https://integration.smartsimple.biz/billingpost/

Sample POST from SmartSimple

The following portion of code is a sample of what SmartSimple will be using within a Web Page View on each client copy to post field data to the service provider.

Note that the naming of the HTML control IDs are the field names specified in the Service Provider Integration Fields page.

The sample page below is sending the following categories of fields:

Insurance Company + Referral Contact
Pickup Details
Claimant Information

<html>
<head>
<title>Transportation Request</title>
</head>

<body>
<form method="POST" action="/ex/ex_post.jsp">
  <input type=hidden name="post_url" value="@system.providerurl@">
  <input type=hidden name="ss_CaseID" value="@parent.opportunityid@">
  <input type=hidden name="ss_ServiceID" value="@eventid@">
  <input type=hidden name="ss_CustomerID" value="ID goes here">
  <input type=hidden name="ss_Source" value="10">
  <div style="border:1px solid #1b409b; max-width:700px; min-width:550px;">
    <table>
      <th colspan="4" align="left" class="titleText001">Insurance company claim referred By:</th>
      </tr>
      <tr>
        <th align="left">Referral Contact First Name </th>
        <td><textarea name=ss_ReferralFirstName readonly>@parent.Referral Contact First Name@</textarea></td>
        <th align="left">Referral Contact Last Name </th>
        <td><textarea name=ss_ReferralLastName readonly>@parent.Referral Contact Last Name@</textarea></td>
      </tr>
      <tr>
        <th align="left"> Address </th>
        <td><textarea name=ss_ReferralAddress readonly>@parent.client.address@</textarea></td>
        <th align="left"> City </th>
        <td><textarea name=ss_ReferralCity readonly>@parent.client.city@</textarea></td>
      </tr>
      <tr>
        <th align="left"> Province </th>
        <td><textarea name=ss_ReferralProvince/State readonly>@parent.client.province@</textarea></td>
        <th align="left"> Postal Code </th>
        <td><textarea name=ss_ReferralPostalCode readonly>@parent.client.postalcode@</textarea></td>
      </tr>
      <tr>
        <th align="left"> Country </th>
        <td><textarea name=ss_ReferralCountry readonly>Canada</textarea></td>
      </tr>
      <tr>
        <th align="left"> Phone </th>
        <td><textarea name=ss_ReferralPhoneNumber readonly>@parent.Referral Contact Phone@</textarea></td>
        <th align="left"> Fax </th>
        <td><textarea name=ss_ReferralFaxNumber readonly>@parent.client.fax@</textarea></td>
      </tr>
      <tr>
        <th align="left">Email </th>
        <td><textarea name=ss_ReferralEmail readonly>@parent.Referral Contact Email@</textarea></td>
        <th align="left"> Company </th>
        <td><textarea name=ss_ReferralCompany readonly>@parent.client.name@</textarea></td>
      </tr>
      <th colspan="4" align="left" class="titleText001"><br /><br />Pickup Details </th>
      </tr>
      <tr>
        <th align="left"> Pickup Time</th>
        <td><textarea name=ss_PickupTime readonly>@apppictime@</textarea></td>
        <th align="left"> Pickup Address</th>
        <td><textarea name=ss_PickupAddress readonly>@picaddress@</textarea></td>
      </tr>
      <tr>
        <th align="left"> Pickup City</th>
        <td><textarea name=ss_PickupCity readonly>@piccity@</textarea></td>
        <th align="left"> Pickup Postal Code</th>
        <td><textarea name=ss_PickupPostalCode readonly>@piczip@</textarea></td>
      </tr>
      <tr>
        <th align="left"> Pickup Province/State</th>
        <td><textarea name=ss_PickupProvince readonly>@picprovince@</textarea></td>
        <th align="left"> Pickup Phone</th>
        <td><textarea name=ss_PickupPhone readonly>@Pickup-Phone@</textarea></td>
      </tr>
      <th colspan="4" align="left" class="titleText001"><br /><br />Claimant Information </th>
      </tr>
      <tr>
        <th align="left"> Claimant First Name </th>
        <td><textarea name=ss_ClaimantFirstName readonly>@parent.Claimant First Name@</textarea></td>
        <th align="left"> Claimant Last Name </th>
        <td><textarea name=ss_ClaimantLastName readonly>@parent.Claimant Last Name@</textarea></td>
      </tr>
      <tr>
        <th align="left"> Address </th>
        <td><textarea name=ss_ClaimantAddress readonly>@parent.Claimant Address@</textarea></td>
        <th align="left"> City </th>
        <td><textarea name=ss_ClaimantCity readonly>@parent.Claimant City@</textarea></td>
      </tr>
      <tr>
        <th align="left"> Province </th>
        <td><textarea name=ss_ClaimantProvince readonly>@parent.Claimant Province@</textarea></td>
        <th align="left"> Postal Code </th>
        <td><textarea name=ss_ClaimantPostalCode readonly>@parent.Claimant Postal Code@</textarea></td>
      </tr>
      <tr>
        <th align="left"> Country </th>
        <td><textarea name=ss_ClaimantCountry readonly>Canada</textarea></td>
            <th align="left">Phone </th>
        <td><textarea name=ss_ClaimantPhone readonly>@parent.Claimant Phone #@</textarea></td>
      <tr>
        <th align="left">Policy #</th>
        <td><textarea name=ss_ClaimantPolicyNumber readonly>@parent.Policy #@</textarea></td>
        <th align="left"> Claim #</th>
        <td><textarea name=ss_ClaimFile readonly>@parent.Claim #@</textarea></td>
      </tr>
      <tr>
        <th align="left"> Date of Loss </th>
        <td><textarea name=ss_DateofLoss readonly>@parent.Date of Loss@</textarea></td>
      </tr>
    </table>
  </div>
</form>
</body>
</html>

Sample POST to SmartSimple

The following code is a sample html post page that Service Providers can use to POST data back to SmartSimple’s Integration Server.

Each form element will need to be populated with information related to the performed service from the Service Provider’s data source.

<HTML>
<HEAD>
<TITLE>Integration Provider Sample Submission</TITLE>
</HEAD>
<BODY>
<form action="http://hcai.smartsimple.biz/ex/provider/billing.jsp" method="POST" target="_blank">
  <table border=1 cellspaing=0 cellpadding=1>
    <tr>
      <td width=400px>Provider Key</td>
      <td><textarea rows=1 cols=25 name=providerkey>xxx key goes here xxx</textarea></td>
    </tr>
    <tr>
      <td width=400px>Test Submission Flag</td>
      <td><textarea rows=1 cols=25 name=isprod>0</textarea></td>
    </tr>
    <tr>
      <td width=400px>Case ID</td>
      <td><textarea rows=1 cols=25 name=caseid>123456</textarea></td>
    </tr>
    <tr>
      <td width=400px>Service ID</td>
      <td><textarea rows=1 cols=25 name=serviceid>88888</textarea></td>
    </tr>
    <tr>
      <td width=400px>Type of Service </td>
      <td><textarea rows=1 cols=25 name=typeofservice>typeofservice</textarea></td>
    </tr>
    <tr>
      <td width=400px>Client Alias </td>
      <td><textarea rows=1 cols=25 name=client>client</textarea></td>
    </tr>
    <tr>
      <td width=400px>Client Type</td>
      <td><textarea rows=1 cols=25 name=source>10</textarea></td>
    </tr>
    <tr>
      <td width=400px>GAP Code </td>
      <td><textarea rows=1 cols=25 name=gapcode>gapcode</textarea></td>
    </tr>
    <tr>
      <td width=400px>Rate for service</td>
      <td><textarea rows=1 cols=25 name=rate>10.00</textarea></td>
    </tr>
    <tr>
      <td width=400px>Unit Measure </td>
      <td><textarea rows=1 cols=25 name=measure>measure</textarea></td>
    </tr>
    <tr>
      <td width=400px>Quantity</td>
      <td><textarea rows=1 cols=25 name=quantity>quantity</textarea></td>
    </tr>
    <tr>
      <td width=400px>Tax</td>
      <td><textarea rows=1 cols=25 name=tax>tax</textarea></td>
    </tr>
    <tr>
      <td width=400px>Tax Type</td>
      <td><textarea rows=1 cols=25 name=taxtype>taxtype</textarea></td>
    </tr>
    <tr>
      <td width=400px>Total</td>
      <td><textarea rows=1 cols=25 name=total>total</textarea></td>
    </tr>
    <tr>
      <td width=400px>Tax Amount</td>
      <td><textarea rows=1 cols=25 name=taxamt>taxamt</textarea></td>
    </tr>
    <tr>
      <td width=400px>Gross Total</td>
      <td><textarea rows=1 cols=25 name=grossamt>grossamt</textarea></td>
    </tr>
    <tr>
      <td width=400px>Reference #</td>
      <td><textarea rows=1 cols=25 name=reference>reference</textarea></td>
    </tr>
    <tr>
      <td width=400px>Confirmation #</td>
      <td><textarea rows=1 cols=25 name=confirmationnum>#12345-eee</textarea></td>
    </tr>
    <tr>
      <td width=400px>Provider Name</td>
      <td><textarea rows=1 cols=25 name=provider>provider</textarea></td>
    </tr>
    <tr>
      <td width=400px>Provider Emailr</td>
      <td><textarea rows=1 cols=25 name=provideremail>provideremail</textarea></td>
    </tr>
    <tr>
      <td width=400px>Notes</td>
      <td><textarea rows=1 cols=25 name=notes>notes</textarea></td>
    </tr>
    <tr>
      <td width=400px><Input type="submit" value="Submit to SmartSimple"></td>
    </tr>
  </table>
</form>
</BODY>
</HTML>

Difference between revisions of "Service Provider Integration"

Latest revision as of 13:50, 20 July 2017

Contents

Overview

Transferring Information from SmartSimple to Service Provider

Transferring Information from Service Provider to SmartSimple

Transfer Process

Sample POST from SmartSimple

Sample POST to SmartSimple

See Also

Navigation menu

Personal tools

Namespaces

Variants

Views

More

Search

Navigation

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@@ Line 1: / Line 1: @@
+This article provides an overview of the process to integrate third party service providers such as transportation and translation services with client copies of SmartSimple that track Independent Medical Assessments(IME) and Rehabilitation services.
+For full details, refer to the Service Provider Integration protocol document.
 ==Overview==
-This article provides an overview of the process to integrate third party service providers such as providers of transportation and translation services with instances of SmartSimple used by clients tracking Independent Medical Assessments(IME) and Rehabilitation services.
 The objectives of this integration are twofold:
 *Provide the ability for a SmartSimple client to electronically request services from a third party provider.
@@ Line 29: / Line 31: @@
-'''For a complete list of fields transferred from SmartSimple, please refer to [[Service Provider Integration Fields]] page.''
+'''For a complete list of fields transferred from SmartSimple, please refer to [[Service Provider Integration Fields]] page.'''
@@ Line 57: / Line 59: @@
 The gateway performs the following:
 *Manages all incoming service billing information
-*Each SmartSimple client instance polls the Integration Gateway and extracts Service Billing records using proprietary protocols
+*Each SmartSimple client polls the Integration Gateway and extracts Service Billing records using proprietary protocols
 *All fields are submitted by http POST parameters
 *Service URL is https://integration.smartsimple.biz/billingpost/
@@ Line 64: / Line 66: @@
 ==Sample POST from SmartSimple==
+The following portion of code is a sample of what SmartSimple will be using within a [[Web Page View]] on each client copy to post field data to the service provider.
+Note that the naming of the HTML control IDs are the field names specified in the [[Service Provider Integration Fields]] page.
+The sample page below is sending the following categories of fields:
+*Insurance Company + Referral Contact
+*Pickup Details
+*Claimant Information
 <pre>
 <html>
 <head>
+<title>Transportation Request</title>
 </head>
-<body bgcolor="#FFFFFF" link=blue vlink=purple class="Normal" lang=EN-US topmargin="25" bottommargin="25" leftmargin="30" rightmargin="30">
-//HTTP Post details
+<body>
 <form method="POST" action="/ex/ex_post.jsp">
-<input type=hidden name="post_url" value="@system. url@">
+  <input type=hidden name="post_url" value="@system.providerurl@">
-<input type=hidden name="codedid" value="@codedid@">
+  <input type=hidden name="ss_CaseID" value="@parent.opportunityid@">
-<input type=hidden name="update_fieldid" value="99999">
+  <input type=hidden name="ss_ServiceID" value="@eventid@">
-<BR>
+  <input type=hidden name="ss_CustomerID" value="ID goes here">
-   <table>
+  <input type=hidden name="ss_Source" value="10">
-<tr><th>Service</th><th><select name=ss_service><option value=2>Transportation</option></select></th>
+  <div style="border:1px solid #1b409b; max-width:700px; min-width:550px;">
-</tr>
+    <table>
-<tr>
+      <th colspan="4" align="left" class="titleText001">Insurance company claim referred By:</th>
+      </tr>
+      <tr>
+        <th align="left">Referral Contact First Name </th>
+        <td><textarea name=ss_ReferralFirstName readonly>@parent.Referral Contact First Name@</textarea></td>
+        <th align="left">Referral Contact Last Name </th>
+        <td><textarea name=ss_ReferralLastName readonly>@parent.Referral Contact Last Name@</textarea></td>
+      </tr>
+      <tr>
+        <th align="left"> Address </th>
+        <td><textarea name=ss_ReferralAddress readonly>@parent.client.address@</textarea></td>
+        <th align="left"> City </th>
+        <td><textarea name=ss_ReferralCity readonly>@parent.client.city@</textarea></td>
+      </tr>
+      <tr>
+        <th align="left"> Province </th>
+        <td><textarea name=ss_ReferralProvince/State readonly>@parent.client.province@</textarea></td>
+        <th align="left"> Postal Code </th>
+        <td><textarea name=ss_ReferralPostalCode readonly>@parent.client.postalcode@</textarea></td>
+      </tr>
+      <tr>
+        <th align="left"> Country </th>
+        <td><textarea name=ss_ReferralCountry readonly>Canada</textarea></td>
+      </tr>
+      <tr>
+        <th align="left"> Phone </th>
+        <td><textarea name=ss_ReferralPhoneNumber readonly>@parent.Referral Contact Phone@</textarea></td>
+        <th align="left"> Fax </th>
+        <td><textarea name=ss_ReferralFaxNumber readonly>@parent.client.fax@</textarea></td>
+      </tr>
+      <tr>
+        <th align="left">Email </th>
+        <td><textarea name=ss_ReferralEmail readonly>@parent.Referral Contact Email@</textarea></td>
+        <th align="left"> Company </th>
+        <td><textarea name=ss_ReferralCompany readonly>@parent.client.name@</textarea></td>
+      </tr>
+      <th colspan="4" align="left" class="titleText001"><br /><br />Pickup Details </th>
+      </tr>
+      <tr>
+        <th align="left"> Pickup Time</th>
+        <td><textarea name=ss_PickupTime readonly>@apppictime@</textarea></td>
+        <th align="left"> Pickup Address</th>
+        <td><textarea name=ss_PickupAddress readonly>@picaddress@</textarea></td>
+      </tr>
+      <tr>
+        <th align="left"> Pickup City</th>
+        <td><textarea name=ss_PickupCity readonly>@piccity@</textarea></td>
+        <th align="left"> Pickup Postal Code</th>
+        <td><textarea name=ss_PickupPostalCode readonly>@piczip@</textarea></td>
+      </tr>
+      <tr>
+        <th align="left"> Pickup Province/State</th>
+        <td><textarea name=ss_PickupProvince readonly>@picprovince@</textarea></td>
+        <th align="left"> Pickup Phone</th>
+        <td><textarea name=ss_PickupPhone readonly>@Pickup-Phone@</textarea></td>
+      </tr>
+      <th colspan="4" align="left" class="titleText001"><br /><br />Claimant Information </th>
+      </tr>
+      <tr>
+        <th align="left"> Claimant First Name </th>
+        <td><textarea name=ss_ClaimantFirstName readonly>@parent.Claimant First Name@</textarea></td>
+        <th align="left"> Claimant Last Name </th>
+        <td><textarea name=ss_ClaimantLastName readonly>@parent.Claimant Last Name@</textarea></td>
+      </tr>
+      <tr>
+        <th align="left"> Address </th>
+        <td><textarea name=ss_ClaimantAddress readonly>@parent.Claimant Address@</textarea></td>
+        <th align="left"> City </th>
+        <td><textarea name=ss_ClaimantCity readonly>@parent.Claimant City@</textarea></td>
+      </tr>
+      <tr>
+        <th align="left"> Province </th>
+        <td><textarea name=ss_ClaimantProvince readonly>@parent.Claimant Province@</textarea></td>
+        <th align="left"> Postal Code </th>
+        <td><textarea name=ss_ClaimantPostalCode readonly>@parent.Claimant Postal Code@</textarea></td>
+      </tr>
+      <tr>
+        <th align="left"> Country </th>
+        <td><textarea name=ss_ClaimantCountry readonly>Canada</textarea></td>
+            <th align="left">Phone </th>
+        <td><textarea name=ss_ClaimantPhone readonly>@parent.Claimant Phone #@</textarea></td>
+      <tr>
+        <th align="left">Policy #</th>
+        <td><textarea name=ss_ClaimantPolicyNumber readonly>@parent.Policy #@</textarea></td>
+        <th align="left"> Claim #</th>
+        <td><textarea name=ss_ClaimFile readonly>@parent.Claim #@</textarea></td>
+      </tr>
+      <tr>
+        <th align="left"> Date of Loss </th>
+        <td><textarea name=ss_DateofLoss readonly>@parent.Date of Loss@</textarea></td>
+      </tr>
+    </table>
+  </div>
+</form>
+</body>
+</html>
-//Referral Information
+</pre>
-<th colspan="6" align="left" class="titleText001">Claim Referred By:</th>  </tr>
+==Sample POST to SmartSimple==
-<tr>  <th align="left"> Address </th><td><textarea name=ss_ReferralAddress readonly>@parent.client.address@</textarea></td>
+The following code is a sample html post page that Service Providers can use to POST data back to SmartSimple’s Integration Server.
-<th align="left"> City </th><td><textarea name=ss_ReferralCity readonly>@parent.client.city@</textarea></td></tr>
-<tr>  <th align="left"> Province </th><td><textarea name=ss_ReferralProvince/State readonly>@parent.client.province@</textarea></td>
-<th align="left"> Postal Code </th><td><textarea name=ss_ReferralPostalCode readonly>@parent.client.postalcode@</textarea></td></tr>
-<tr>  <th align="left"> Phone </th><td><textarea name=ss_ReferralPHoneNumber readonly>@parent.client.phone@</textarea></td>
-<th align="left"> Company </th><td><textarea name=ss_ReferralCompany readonly>@parent.company.name@</textarea></td></tr>
-//File Information
+Each form element will need to be populated with information related to the performed service from the Service Provider’s data source.
-<th colspan="6" align="left" class="titleText001">File  Information    </th></tr>
-<tr> <th align="left">File Number (Referral)</th><td><textarea name=ss_ReferralFileNumber readonly>@parent.File Number@</textarea></td>
-  <th align="left"> Type of File</th><td><textarea name=ss_ClaimFile readonly>@filetype.combovalue@</textarea></td></tr>
-//Appointment Details
+<pre><HTML>
-  <th align="left">Location</th><td><textarea name=ss_AppointmentLocation readonly>@Location@</textarea></td>
+<HEAD>
-<th align="left"> Date & Time </th><td><textarea name=ss_DateandTime readonly>@fullstartdate@</textarea></td></tr>
+<TITLE>Integration Provider Sample Submission</TITLE>
-<th align="left"> Assessment Type</th><th><textarea name=ss_TypeofAssessment readonly>@type@</textarea></th></tr>
+</HEAD>
+<BODY>
-//Claimant Information
+<form action="http://hcai.smartsimple.biz/ex/provider/billing.jsp" method="POST" target="_blank">
-<th colspan="6" align="left" class="titleText001">Claimant Information    </th></tr>
+  <table border=1 cellspaing=0 cellpadding=1>
-<tr>  <th align="left"> Claimant First Name </th><td><textarea name=ss_ClaimantFirstName readonly>@parent.Claimant First Name@</textarea></td>
+    <tr>
-<th align="left"> Claimant Last Name</th><td><textarea name=ss_ClaimantLastName readonly>@parent.Claimant Last Name@</textarea></td></tr>
+      <td width=400px>Provider Key</td>
-<tr><th align="left"> Address </th><td><textarea name=ss_ClaimantAddress readonly>@parent.Claimant Address@</textarea></td>
+      <td><textarea rows=1 cols=25 name=providerkey>xxx key goes here xxx</textarea></td>
-  <th align="left"> City </th><td><textarea name=ss_ClaimantCity readonly>@parent.Claimant City@</textarea></td></tr>
+    </tr>
-<tr><th align="left"> Province </th><td><textarea name=ss_ClaimantProvince/State readonly>@parent.Claimant Province@</textarea></td><th> </th>
+    <tr>
-</tr><tr>  <th align="left"> Postal Code </th><td><textarea name=ss_ClaimantPostalCode readonly>@parent.Claimant Postal Code@</textarea></td>
+      <td width=400px>Test Submission Flag</td>
-<tr>  <th align="left">Phone </th><td><textarea name=ss_ClaimantPhone readonly>@parent.Claimant Phone #@</textarea></td></tr>
+      <td><textarea rows=1 cols=25 name=isprod>0</textarea></td>
+    </tr>
-//Appointment Details
+    <tr>
-<tr>    <th colspan="6" align="left" class="titleText001">Appointment Details    </th></tr>
+      <td width=400px>Case ID</td>
-  <th align="left"> Appointment location same as home address</th><th><textarea name=ss_picsamehome readonly>@picsamehome.combovalue@</textarea></th></tr>
+      <td><textarea rows=1 cols=25 name=caseid>123456</textarea></td>
-  <tr>  <th align="left"> Appointment Date and Time</th><td><textarea name=ss_DateandTime readonly>@fullstartdate@</textarea></td>
+    </tr>
-<th align="left"> Pickup Time</th><td><textarea name=ss_PickupTime readonly>@apppictime@</textarea></td></tr>
+    <tr>
-<tr>  <th align="left"> Return Time</th><td><textarea name=ss_apprettime readonly>@appdate@</textarea></td>
+      <td width=400px>Service ID</td>
-<th align="left"> Duration</th><td><textarea name=ss_Duration readonly>@Assessment Duration@</textarea></td></tr>
+      <td><textarea rows=1 cols=25 name=serviceid>88888</textarea></td>
-<!--@sslogic('@picsamehome@'!='Yes')-->
+    </tr>
-<tr>  <th align="left"> Address</th><td><textarea name=ss_AppointmentLocation readonly>@Location@</textarea></td>
+    <tr>
-  </tr>
+      <td width=400px>Type of Service </td>
-<!--@end-->
+      <td><textarea rows=1 cols=25 name=typeofservice>typeofservice</textarea></td>
+    </tr>
-//Billing Details
+    <tr>
-<tr>  <th colspan="6" align="left" class="titleText001">Billing Details</th>
+      <td width=400px>Client Alias </td>
-</tr><tr>  <th align="left"> Billing same as referral</th>
+      <td><textarea rows=1 cols=25 name=client>client</textarea></td>
-  <td><textarea name=ss_Billingsameasreferral readonly>@billsamereferral.combovalue@</textarea></td>
+    </tr>
-</tr>
+    <tr>
-<!--@sslogic('@billsamereferral@'='No')-->
+      <td width=400px>Client Type</td>
-<tr>  <th align="left"> First Name (Billing)</th><td><textarea name=ss_BillingFirstName readonly>@bilfirstname@</textarea></td>
+      <td><textarea rows=1 cols=25 name=source>10</textarea></td>
-<th align="left"> Last Name (Billing)</th><td><textarea name=ss_BillingLastName readonly>@bilastname@</textarea></td></tr>
+    </tr>
-<tr>  <th align="left"> Company (Billing)</th><td><textarea name=ss_BillingCompany readonly>@bilcompany@</textarea></td>
+    <tr>
-<th align="left"> Address (Billing)</th><td><textarea name=ss_BillingAddress readonly>@biladdress@</textarea></td></tr>
+      <td width=400px>GAP Code </td>
-<tr>  <th align="left"> City (Billing)</th><td><textarea name=ss_BillingCity readonly>@bilcity@</textarea></td>
+      <td><textarea rows=1 cols=25 name=gapcode>gapcode</textarea></td>
-<th align="left"> Province Code/Zip (Billing)</th><td><textarea name=ss_BillingProvince/State readonly>@bilprovince@</textarea></td></tr>
+    </tr>
-<tr>    <th align="left"> Postal Code/Zip (Billing)</th><td><textarea name=ss_BillingPostalCode readonly>@bilzip@</textarea></td>
+    <tr>
-<!--@end-->
+      <td width=400px>Rate for service</td>
+      <td><textarea rows=1 cols=25 name=rate>10.00</textarea></td>
-//Appointment Confirmation
+    </tr>
-<tr>  <th colspan="6" align="left" class="titleText001">Appointment Confirmation</th>
+    <tr>
-</tr><th align="left"> Fax confirmation of appointment</th><th><textarea name=ss_Faxconfirmationofappointment readonly>@faxconf.combovalue@</textarea></th><th> </th>
+      <td width=400px>Unit Measure </td>
- <th align="left"> Phone Confirmation</th><th><textarea name=ss_Phoneconfirmationofappointment readonly>@phoneconf.combovalue@</textarea></th></tr>
+      <td><textarea rows=1 cols=25 name=measure>measure</textarea></td>
-<tr>  <th align="left"> Email confirmation of web referral</th><td><textarea name=ss_Emailconfirmationofappointment readonly>@emailconf.combovalue@</textarea></td></tr>
+    </tr>
-</table>
+    <tr>
-</div>
+      <td width=400px>Quantity</td>
+      <td><textarea rows=1 cols=25 name=quantity>quantity</textarea></td>
+    </tr>
+    <tr>
+      <td width=400px>Tax</td>
+      <td><textarea rows=1 cols=25 name=tax>tax</textarea></td>
+    </tr>
+    <tr>
+      <td width=400px>Tax Type</td>
+      <td><textarea rows=1 cols=25 name=taxtype>taxtype</textarea></td>
+    </tr>
+    <tr>
+      <td width=400px>Total</td>
+      <td><textarea rows=1 cols=25 name=total>total</textarea></td>
+    </tr>
+    <tr>
+      <td width=400px>Tax Amount</td>
+      <td><textarea rows=1 cols=25 name=taxamt>taxamt</textarea></td>
+    </tr>
+    <tr>
+      <td width=400px>Gross Total</td>
+      <td><textarea rows=1 cols=25 name=grossamt>grossamt</textarea></td>
+    </tr>
+    <tr>
+      <td width=400px>Reference #</td>
+      <td><textarea rows=1 cols=25 name=reference>reference</textarea></td>
+    </tr>
+    <tr>
+      <td width=400px>Confirmation #</td>
+      <td><textarea rows=1 cols=25 name=confirmationnum>#12345-eee</textarea></td>
+    </tr>
+    <tr>
+      <td width=400px>Provider Name</td>
+      <td><textarea rows=1 cols=25 name=provider>provider</textarea></td>
+    </tr>
+    <tr>
+      <td width=400px>Provider Emailr</td>
+      <td><textarea rows=1 cols=25 name=provideremail>provideremail</textarea></td>
+    </tr>
+    <tr>
+      <td width=400px>Notes</td>
+      <td><textarea rows=1 cols=25 name=notes>notes</textarea></td>
+    </tr>
+    <tr>
+      <td width=400px><Input type="submit" value="Submit to SmartSimple"></td>
+    </tr>
+  </table>
 </form>
- </body>
+</BODY>
-</html>
+</HTML>
 </pre>
 ==See Also==
 * [[Service Provider Integration Fields]]
+* [[Post to External Server]]
+[[Category:Integration]]
-[[Category:Universal Tracking Application]][[Category:Integration]]
+[[Category:External Services]]