Card updates
This commit is contained in:
@@ -7,11 +7,11 @@
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maxActive="100"
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maxIdle="20"
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maxWait="50"
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name="jdbc/BrittonConnect"
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name="jdbc/Baclight"
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password="BSTIBOY"
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removeAbandonedTimeout="60"
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type="javax.sql.DataSource"
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url="jdbc:jtds:sqlserver://10.41.82.73:1433/BrittonConnect"
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url="jdbc:jtds:sqlserver://10.41.82.73:1433/Baclight"
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username="BSTI"
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validationQuery="select 1"/>
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@@ -4,13 +4,6 @@
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<property name="ireport.zoom" value="5.0"/>
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<property name="ireport.x" value="1955"/>
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<property name="ireport.y" value="0"/>
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<!-- <parameter name="sample_key" class="java.lang.String"/>
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<parameter name="dynamic_where" class="java.lang.String">
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<defaultValueExpression><![CDATA[$P{sample_key} == null ? "family_id = '" + $P{family_id} + "'" : "sample_key = '" + $P{sample_key} + "'"]]></defaultValueExpression>
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</parameter>
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<queryString>
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<![CDATA[Select * From id_card_print_data Where $P!{dynamic_where}]]>
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</queryString> -->
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<field name="employer_name" class="java.lang.String"/>
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<field name="full_name" class="java.lang.String"/>
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<field name="medical_eff_date" class="java.lang.String"/>
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@@ -26,6 +19,7 @@
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<field name="provider_line_9" class="java.lang.String"/>
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<field name="provider_line_10" class="java.lang.String"/>
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<field name="provider_line_11" class="java.lang.String"/>
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<field name="provider_line_12" class="java.lang.String"/>
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<field name="claim_to_1" class="java.lang.String"/>
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<field name="claim_to_2" class="java.lang.String"/>
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<field name="claim_to_3" class="java.lang.String"/>
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@@ -37,6 +31,7 @@
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<field name="claim_to_9" class="java.lang.String"/>
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<field name="claim_to_10" class="java.lang.String"/>
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<field name="claim_to_11" class="java.lang.String"/>
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<field name="claim_to_12" class="java.lang.String"/>
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<field name="family_id" class="java.lang.String"/>
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<field name="group_number" class="java.lang.String"/>
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<field name="rx_group" class="java.lang.String"/>
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@@ -95,13 +90,17 @@
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<band height="153" splitType="Immediate">
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<property name="com.jaspersoft.studio.unit.height" value="px"/>
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<rectangle>
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<reportElement x="1" y="10" width="100" height="71" uuid="e762ee84-c013-417b-a78f-54f6f1f6a1a3"/>
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<reportElement x="1" y="10" width="100" height="73" uuid="e762ee84-c013-417b-a78f-54f6f1f6a1a3">
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<property name="com.jaspersoft.studio.unit.height" value="px"/>
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</reportElement>
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</rectangle>
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<rectangle>
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<reportElement x="1" y="92" width="100" height="42" uuid="66e1721c-c7fd-40cf-8f45-10b5f6b4c22d"/>
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<reportElement x="1" y="94" width="100" height="42" uuid="66e1721c-c7fd-40cf-8f45-10b5f6b4c22d"/>
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</rectangle>
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<rectangle>
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<reportElement x="106" y="10" width="125" height="71" uuid="ad8b04e0-5993-4f1c-b6b1-f2c11320be29"/>
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<reportElement x="106" y="10" width="125" height="73" uuid="ad8b04e0-5993-4f1c-b6b1-f2c11320be29">
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<property name="com.jaspersoft.studio.unit.height" value="px"/>
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</reportElement>
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</rectangle>
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<rectangle>
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<reportElement x="106" y="1" width="58" height="8" backcolor="#000000" uuid="5c229560-d2d4-4752-95a0-b562e786d29e"/>
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@@ -110,7 +109,7 @@
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<reportElement x="1" y="1" width="60" height="8" backcolor="#000000" uuid="014fd155-bf62-4aa6-8a1a-894c0b5855ac"/>
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</rectangle>
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<rectangle>
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<reportElement x="1" y="84" width="62" height="8" backcolor="#000000" uuid="2a360f63-7815-4b72-9ff1-9339cc530b94">
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<reportElement x="1" y="86" width="62" height="8" backcolor="#000000" uuid="2a360f63-7815-4b72-9ff1-9339cc530b94">
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<property name="com.jaspersoft.studio.unit.width" value="px"/>
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</reportElement>
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</rectangle>
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@@ -122,7 +121,7 @@
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<text><![CDATA[Eligibility]]></text>
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</staticText>
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<staticText>
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<reportElement x="3" y="84" width="58" height="11" forecolor="#FFFFFF" uuid="393d9b02-933b-46d8-850b-4d69d148aa86"/>
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<reportElement x="3" y="86" width="58" height="11" forecolor="#FFFFFF" uuid="393d9b02-933b-46d8-850b-4d69d148aa86"/>
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<textElement>
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<font size="6" isBold="true" isUnderline="false" isPdfEmbedded="false"/>
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</textElement>
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@@ -241,184 +240,208 @@ eligibility or payment
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<textFieldExpression><![CDATA[$F{claim_to_11}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="163" y="11" width="67" height="7" uuid="94749044-5ec6-4eb4-8f6d-e52ce5e215da"/>
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<reportElement x="162" y="11" width="67" height="7" uuid="94749044-5ec6-4eb4-8f6d-e52ce5e215da"/>
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<textElement>
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{provider_line_1}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="163" y="16" width="67" height="7" uuid="25cbc687-a185-4894-97f4-11d57c8ad84c"/>
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<reportElement x="162" y="16" width="67" height="7" uuid="25cbc687-a185-4894-97f4-11d57c8ad84c"/>
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<textElement>
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{provider_line_2}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="163" y="21" width="67" height="7" uuid="527837e8-6ecb-4eba-8b3c-c1fee8e58b52"/>
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||||
<reportElement x="162" y="21" width="71" height="7" uuid="527837e8-6ecb-4eba-8b3c-c1fee8e58b52">
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<property name="com.jaspersoft.studio.unit.width" value="px"/>
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</reportElement>
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<textElement>
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{provider_line_3}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="163" y="26" width="67" height="7" uuid="96e1ff12-6c27-4bd9-b706-050a283ea1a8"/>
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||||
<reportElement x="162" y="26" width="67" height="7" uuid="96e1ff12-6c27-4bd9-b706-050a283ea1a8"/>
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<textElement>
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{provider_line_4}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="163" y="35" width="67" height="7" uuid="c209866f-c8db-455d-8118-ae0aa51204a8"/>
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||||
<reportElement x="162" y="35" width="67" height="7" uuid="c209866f-c8db-455d-8118-ae0aa51204a8"/>
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||||
<textElement>
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{provider_line_5}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="163" y="40" width="67" height="7" uuid="22bcf3ce-6edc-4390-9c63-f169623fdf58"/>
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||||
<reportElement x="162" y="40" width="67" height="7" uuid="22bcf3ce-6edc-4390-9c63-f169623fdf58"/>
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<textElement>
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{provider_line_6}]]></textFieldExpression>
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</textField>
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<textField>
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||||
<reportElement x="163" y="45" width="67" height="7" uuid="b8bd2df8-9ad2-4cde-9c67-b0e32425c00b"/>
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||||
<reportElement x="162" y="45" width="67" height="7" uuid="b8bd2df8-9ad2-4cde-9c67-b0e32425c00b"/>
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||||
<textElement>
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||||
<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{provider_line_7}]]></textFieldExpression>
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</textField>
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<textField>
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||||
<reportElement x="163" y="50" width="67" height="7" uuid="e5d86062-d78f-42b5-b578-cd14dcc071ca"/>
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||||
<reportElement x="162" y="50" width="67" height="7" uuid="e5d86062-d78f-42b5-b578-cd14dcc071ca"/>
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||||
<textElement>
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||||
<font size="5" isBold="true"/>
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||||
</textElement>
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||||
<textFieldExpression><![CDATA[$F{provider_line_8}]]></textFieldExpression>
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||||
</textField>
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||||
<textField>
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||||
<reportElement x="163" y="59" width="67" height="7" uuid="8b542cf4-f0e7-4019-90cf-4b3a826184bf"/>
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||||
<reportElement x="162" y="59" width="67" height="7" uuid="8b542cf4-f0e7-4019-90cf-4b3a826184bf"/>
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||||
<textElement>
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||||
<font size="5" isBold="true"/>
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||||
</textElement>
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<textFieldExpression><![CDATA[$F{provider_line_9}]]></textFieldExpression>
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||||
</textField>
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||||
<textField>
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||||
<reportElement x="163" y="64" width="67" height="7" uuid="b154a117-b385-4eac-b53a-51f349d2e9a6"/>
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||||
<reportElement x="162" y="64" width="67" height="7" uuid="b154a117-b385-4eac-b53a-51f349d2e9a6"/>
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||||
<textElement>
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||||
<font size="5" isBold="true"/>
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||||
</textElement>
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||||
<textFieldExpression><![CDATA[$F{provider_line_10}]]></textFieldExpression>
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||||
</textField>
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||||
<textField>
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||||
<reportElement x="163" y="71" width="67" height="7" uuid="d30067fe-8185-4854-a4da-615d8bb59f4a"/>
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||||
<reportElement x="162" y="70" width="71" height="7" uuid="d30067fe-8185-4854-a4da-615d8bb59f4a">
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||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
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||||
</reportElement>
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||||
<textElement>
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||||
<font size="5" isBold="true"/>
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||||
</textElement>
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||||
<textFieldExpression><![CDATA[$F{provider_line_11}]]></textFieldExpression>
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||||
</textField>
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||||
<rectangle>
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||||
<reportElement x="106" y="92" width="125" height="42" uuid="1b74e177-da54-47c1-a801-ac0331d2cd11"/>
|
||||
<reportElement x="106" y="94" width="125" height="42" uuid="1b74e177-da54-47c1-a801-ac0331d2cd11"/>
|
||||
</rectangle>
|
||||
<rectangle>
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||||
<reportElement x="106" y="84" width="53" height="8" backcolor="#000000" uuid="6a6d5769-ee7e-439f-8d65-7de67cdcb16b"/>
|
||||
<reportElement x="106" y="86" width="53" height="8" backcolor="#000000" uuid="6a6d5769-ee7e-439f-8d65-7de67cdcb16b"/>
|
||||
</rectangle>
|
||||
<staticText>
|
||||
<reportElement x="109" y="84" width="50" height="11" forecolor="#FFFFFF" uuid="fa26d6b7-51d2-4f9e-9d05-9a4513c66eed"/>
|
||||
<reportElement x="109" y="86" width="50" height="11" forecolor="#FFFFFF" uuid="fa26d6b7-51d2-4f9e-9d05-9a4513c66eed"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Pharmacy Plan]]></text>
|
||||
</staticText>
|
||||
<image scaleImage="RetainShape">
|
||||
<reportElement x="160" y="95" width="69" height="21" uuid="36c204c6-c2f7-4613-863f-332cf50ff6cc"/>
|
||||
<reportElement x="160" y="97" width="69" height="21" uuid="36c204c6-c2f7-4613-863f-332cf50ff6cc"/>
|
||||
<imageExpression><![CDATA["./../../images/FairRxOs.jpg"]]></imageExpression>
|
||||
</image>
|
||||
<staticText>
|
||||
<reportElement x="108" y="95" width="21" height="8" uuid="40b57f3b-eeeb-4e38-857b-6bf290bb5ba5"/>
|
||||
<reportElement x="108" y="97" width="21" height="8" uuid="40b57f3b-eeeb-4e38-857b-6bf290bb5ba5"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[RX Bin:]]></text>
|
||||
</staticText>
|
||||
<staticText>
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||||
<reportElement x="108" y="105" width="21" height="8" uuid="cc922142-d87a-4f04-b28b-413ad513e5e0"/>
|
||||
<reportElement x="108" y="107" width="25" height="8" uuid="cc922142-d87a-4f04-b28b-413ad513e5e0">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[RX PCN:]]></text>
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||||
</staticText>
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||||
<staticText>
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||||
<reportElement x="108" y="115" width="21" height="8" uuid="4534f9a0-901a-402c-86ba-0b3109370e53"/>
|
||||
<reportElement x="108" y="117" width="25" height="8" uuid="4534f9a0-901a-402c-86ba-0b3109370e53">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[RX GRP:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="132" y="95" width="27" height="8" uuid="abd7fb37-b19a-4691-869c-28a8c0b326ce"/>
|
||||
<reportElement x="132" y="97" width="27" height="8" uuid="abd7fb37-b19a-4691-869c-28a8c0b326ce"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[021841]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="132" y="105" width="27" height="8" uuid="84e6427e-950d-4c1a-877e-a342ec8009db"/>
|
||||
<reportElement x="132" y="107" width="27" height="8" uuid="84e6427e-950d-4c1a-877e-a342ec8009db"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[18000405]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement x="132" y="115" width="34" height="8" uuid="709713dc-5f48-40dc-957c-9f015b376b41"/>
|
||||
<reportElement x="132" y="117" width="34" height="8" uuid="709713dc-5f48-40dc-957c-9f015b376b41"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{rx_group}]]></textFieldExpression>
|
||||
</textField>
|
||||
<staticText>
|
||||
<reportElement x="108" y="125" width="51" height="8" uuid="00b86af7-1cba-4c7a-a78b-cb0ffa476f88"/>
|
||||
<reportElement x="108" y="127" width="54" height="8" uuid="00b86af7-1cba-4c7a-a78b-cb0ffa476f88">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Customer Service:]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement x="166" y="115" width="63" height="8" uuid="0bce3d0c-c01b-4dfd-9638-19b94d75e73e"/>
|
||||
<reportElement x="166" y="117" width="63" height="8" uuid="0bce3d0c-c01b-4dfd-9638-19b94d75e73e"/>
|
||||
<textElement textAlignment="Center">
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{web_url}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="159" y="125" width="70" height="8" uuid="1193b1ef-31e9-4c43-bb51-236b67c21c81"/>
|
||||
<reportElement x="159" y="127" width="70" height="8" uuid="1193b1ef-31e9-4c43-bb51-236b67c21c81"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{customer_service}]]></textFieldExpression>
|
||||
</textField>
|
||||
<staticText>
|
||||
<reportElement x="3" y="96" width="93" height="9" uuid="71022051-2ec9-443d-81e2-5f7385ddeb7b"/>
|
||||
<reportElement x="3" y="98" width="93" height="9" uuid="71022051-2ec9-443d-81e2-5f7385ddeb7b"/>
|
||||
<textElement textAlignment="Center">
|
||||
<font fontName="SansSerif" size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Precertification]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement x="3" y="105" width="93" height="13" uuid="e414550a-a8d0-4313-9b57-e42ca3bb67ab"/>
|
||||
<reportElement x="3" y="107" width="93" height="13" uuid="e414550a-a8d0-4313-9b57-e42ca3bb67ab">
|
||||
<printWhenExpression><![CDATA[!$F{network_provider}.equals("MedCost")]]></printWhenExpression>
|
||||
</reportElement>
|
||||
<textElement textAlignment="Center">
|
||||
<font fontName="SansSerif" size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA["Call Britton Benefit Services, LLC"]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="3" y="107" width="93" height="13" uuid="da2ecd13-2381-494c-9d69-745b2496587e">
|
||||
<printWhenExpression><![CDATA[$F{network_provider}.equals("MedCost")]]></printWhenExpression>
|
||||
</reportElement>
|
||||
<textElement textAlignment="Center">
|
||||
<font fontName="SansSerif" size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA["Call MedCost"]]></textFieldExpression>
|
||||
</textField>
|
||||
<image>
|
||||
<reportElement x="159" y="136" width="72" height="8" uuid="7da52da7-1e66-4ba2-ae1c-8ba65b8797c3">
|
||||
<reportElement x="159" y="138" width="72" height="8" uuid="7da52da7-1e66-4ba2-ae1c-8ba65b8797c3">
|
||||
<property name="com.jaspersoft.studio.unit.y" value="px"/>
|
||||
<printWhenExpression><![CDATA[$F{network_provider}.equals("Cigna")]]></printWhenExpression>
|
||||
</reportElement>
|
||||
<imageExpression><![CDATA["./../../images/LOGO - AFHC.jpg"]]></imageExpression>
|
||||
</image>
|
||||
<staticText>
|
||||
<reportElement x="1" y="135" width="154" height="8" uuid="4da0cb27-87c4-4f6c-8cde-4078ad224da6">
|
||||
<reportElement x="1" y="137" width="160" height="8" uuid="4da0cb27-87c4-4f6c-8cde-4078ad224da6">
|
||||
<property name="com.jaspersoft.studio.unit.y" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
<printWhenExpression><![CDATA[$F{network_provider}.equals("Cigna")]]></printWhenExpression>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
@@ -427,12 +450,37 @@ eligibility or payment
|
||||
<text><![CDATA[Benefits are not insured by Cigna Healthcare or affiliates]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement x="3" y="115" width="93" height="13" uuid="1d9c4616-e0bc-41e0-836d-8614c195b304"/>
|
||||
<reportElement x="3" y="117" width="93" height="13" uuid="1d9c4616-e0bc-41e0-836d-8614c195b304">
|
||||
<printWhenExpression><![CDATA[!$F{network_provider}.equals("MedCost")]]></printWhenExpression>
|
||||
</reportElement>
|
||||
<textElement textAlignment="Center">
|
||||
<font fontName="SansSerif" size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA["1.800.676.1182 (8am-5pm)"]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="3" y="117" width="93" height="13" uuid="8c0fbf41-d7b6-482b-996d-0b48ee2b0ff7">
|
||||
<printWhenExpression><![CDATA[$F{network_provider}.equals("MedCost")]]></printWhenExpression>
|
||||
</reportElement>
|
||||
<textElement textAlignment="Center">
|
||||
<font fontName="SansSerif" size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA["1.800.722.2157"]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="109" y="77" width="52" height="7" uuid="76608777-7f33-451c-a12a-83883683fbee"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_12}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="162" y="77" width="67" height="7" uuid="179e8a66-f23e-408d-84ce-043aae18de5b"/>
|
||||
<textElement>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_12}]]></textFieldExpression>
|
||||
</textField>
|
||||
</band>
|
||||
</detail>
|
||||
<columnFooter>
|
||||
|
||||
@@ -121,17 +121,9 @@
|
||||
</datasetRun>
|
||||
<jr:listContents height="27" width="88">
|
||||
<image scaleImage="RetainShape" hAlign="Center" isUsingCache="true">
|
||||
<reportElement x="0" y="0" width="88" height="27" isPrintInFirstWholeBand="true" uuid="7445dc43-933e-4b42-bef0-1772e9b85ba4">
|
||||
<!-- <printWhenExpression><![CDATA[$F{aspect_ratio} >= 1.20f]]></printWhenExpression> -->
|
||||
</reportElement>
|
||||
<reportElement x="0" y="0" width="88" height="27" isPrintInFirstWholeBand="true" uuid="7445dc43-933e-4b42-bef0-1772e9b85ba4"/>
|
||||
<imageExpression><![CDATA[$F{image_stream}]]></imageExpression>
|
||||
</image>
|
||||
<!-- <image scaleImage="FillFrame" isUsingCache="true">
|
||||
<reportElement x="20" y="0" width="45" height="27" isPrintInFirstWholeBand="true" uuid="7445dc43-933e-4b42-bef0-1772e9b85ba4">
|
||||
<printWhenExpression><![CDATA[$F{aspect_ratio} < 1.20f]]></printWhenExpression>
|
||||
</reportElement>
|
||||
<imageExpression><![CDATA[$F{image_stream}]]></imageExpression>
|
||||
</image> -->
|
||||
</jr:listContents>
|
||||
</jr:list>
|
||||
</componentElement>
|
||||
@@ -171,63 +163,83 @@ Britton Benefit Services, LLC
|
||||
<text><![CDATA[Group #/ID:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="3" y="18" width="19" height="8" uuid="26d1f156-d150-4837-9bba-1390a8199fb4"/>
|
||||
<reportElement x="3" y="18" width="24" height="8" uuid="26d1f156-d150-4837-9bba-1390a8199fb4">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Name:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="3" y="25" width="32" height="8" uuid="8c0fbf41-d7b6-482b-996d-0b48ee2b0ff7"/>
|
||||
<reportElement x="3" y="25" width="38" height="8" uuid="8c0fbf41-d7b6-482b-996d-0b48ee2b0ff7">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Member #:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="3" y="32" width="50" height="8" uuid="da2ecd13-2381-494c-9d69-745b2496587e"/>
|
||||
<reportElement x="3" y="32" width="53" height="8" uuid="da2ecd13-2381-494c-9d69-745b2496587e">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Effective Date:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="3" y="39" width="30" height="8" uuid="58ce6f59-01b7-457a-aee6-0be9d7ae868e"/>
|
||||
<reportElement x="3" y="39" width="37" height="8" uuid="58ce6f59-01b7-457a-aee6-0be9d7ae868e">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Employer:]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement x="45" y="11" width="88" height="8" uuid="1361e8b7-6ea2-4f2b-a6fd-781b1fa521e8"/>
|
||||
<reportElement x="48" y="11" width="84" height="8" uuid="1361e8b7-6ea2-4f2b-a6fd-781b1fa521e8">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{group_number}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="22" y="18" width="111" height="8" uuid="c2877613-bc27-4175-b080-5ab67f1d781c"/>
|
||||
<reportElement x="48" y="18" width="84" height="8" uuid="c2877613-bc27-4175-b080-5ab67f1d781c">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{full_name}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="35" y="25" width="98" height="8" uuid="acea13af-f269-47da-b9cc-ba0ea22df29f"/>
|
||||
<reportElement x="48" y="25" width="84" height="8" uuid="acea13af-f269-47da-b9cc-ba0ea22df29f">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{primary_mb_member_key}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="45" y="32" width="88" height="8" uuid="eaa738bf-1ced-4c86-8a31-9acc09a88abe"/>
|
||||
<reportElement x="48" y="32" width="84" height="8" uuid="eaa738bf-1ced-4c86-8a31-9acc09a88abe">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{medical_eff_date}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="33" y="39" width="100" height="15" uuid="f559a5a0-cd09-46e5-9a6c-0b4458ddd8b2"/>
|
||||
<reportElement x="48" y="39" width="84" height="15" uuid="f559a5a0-cd09-46e5-9a6c-0b4458ddd8b2">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
|
||||
@@ -50,18 +50,22 @@
|
||||
<detail>
|
||||
<band height="153" splitType="Immediate">
|
||||
<rectangle>
|
||||
<reportElement x="1" y="10" width="122" height="90" uuid="e762ee84-c013-417b-a78f-54f6f1f6a1a3"/>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement x="1" y="112" width="122" height="34" uuid="66e1721c-c7fd-40cf-8f45-10b5f6b4c22d"/>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement x="128" y="10" width="106" height="136" uuid="ad8b04e0-5993-4f1c-b6b1-f2c11320be29">
|
||||
<reportElement x="1" y="10" width="120" height="90" uuid="e762ee84-c013-417b-a78f-54f6f1f6a1a3">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement x="128" y="1" width="62" height="8" backcolor="#000000" uuid="5c229560-d2d4-4752-95a0-b562e786d29e">
|
||||
<reportElement x="1" y="112" width="120" height="34" uuid="66e1721c-c7fd-40cf-8f45-10b5f6b4c22d">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement x="126" y="10" width="106" height="136" uuid="ad8b04e0-5993-4f1c-b6b1-f2c11320be29">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement x="126" y="1" width="62" height="8" backcolor="#000000" uuid="5c229560-d2d4-4752-95a0-b562e786d29e">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
</rectangle>
|
||||
@@ -90,7 +94,7 @@
|
||||
<text><![CDATA[Utilization / Pre-Cert]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="130" y="1" width="62" height="11" forecolor="#FFFFFF" uuid="5e18e17a-d437-434d-ad97-fe131a7f2850">
|
||||
<reportElement x="128" y="1" width="62" height="11" forecolor="#FFFFFF" uuid="5e18e17a-d437-434d-ad97-fe131a7f2850">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
@@ -99,25 +103,31 @@
|
||||
<text><![CDATA[Claims Submission]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="1" y="11" width="122" height="17" uuid="75aa6426-2374-4c07-9556-63dab683cb11"/>
|
||||
<reportElement x="1" y="11" width="120" height="17" uuid="75aa6426-2374-4c07-9556-63dab683cb11">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement textAlignment="Center" verticalAlignment="Middle">
|
||||
<font size="6" isBold="false" isItalic="false"/>
|
||||
<font size="6" isBold="true" isItalic="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[To confirm eligibility, verify benefits,
|
||||
or check claim:
|
||||
]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="1" y="28" width="122" height="17" uuid="8307c61b-9927-4bcc-a825-fec29b5ba605"/>
|
||||
<reportElement x="1" y="28" width="120" height="17" uuid="8307c61b-9927-4bcc-a825-fec29b5ba605">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement textAlignment="Center" verticalAlignment="Middle">
|
||||
<font size="6" isBold="false" isItalic="false"/>
|
||||
<font size="6" isBold="true" isItalic="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Britton Benefit Services, LLC]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="1" y="45" width="122" height="50" uuid="46c394a4-7df2-4f23-b17e-d8e186e99f5e"/>
|
||||
<reportElement x="1" y="45" width="120" height="50" uuid="46c394a4-7df2-4f23-b17e-d8e186e99f5e">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement textAlignment="Center" verticalAlignment="Middle">
|
||||
<font size="6" isBold="false" isItalic="false"/>
|
||||
<font size="6" isBold="true" isItalic="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Call:
|
||||
1.800.676.1182 (8am – 5pm)
|
||||
@@ -128,86 +138,86 @@ eligibility or payment
|
||||
]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement x="130" y="11" width="37" height="7" uuid="10b2b729-cb2f-4507-99d4-d3286e5ca8ed"/>
|
||||
<reportElement x="128" y="11" width="37" height="7" uuid="10b2b729-cb2f-4507-99d4-d3286e5ca8ed"/>
|
||||
<textElement verticalAlignment="Middle">
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="130" y="16" width="37" height="7" uuid="0f23b912-da97-4297-b142-8c47d3332037"/>
|
||||
<reportElement x="128" y="16" width="37" height="7" uuid="0f23b912-da97-4297-b142-8c47d3332037"/>
|
||||
<textElement verticalAlignment="Middle">
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="130" y="21" width="37" height="7" uuid="6664081c-30df-4e12-a563-e286fb71935a"/>
|
||||
<reportElement x="128" y="21" width="37" height="7" uuid="6664081c-30df-4e12-a563-e286fb71935a"/>
|
||||
<textElement verticalAlignment="Middle">
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="130" y="26" width="37" height="7" uuid="e957833e-54e9-4145-b41b-1a72d0ddadf3"/>
|
||||
<reportElement x="128" y="26" width="37" height="7" uuid="e957833e-54e9-4145-b41b-1a72d0ddadf3"/>
|
||||
<textElement verticalAlignment="Middle">
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="130" y="35" width="37" height="7" uuid="a49dbbb0-791e-4930-b99a-dfa39ee3e3d9"/>
|
||||
<reportElement x="128" y="35" width="37" height="7" uuid="a49dbbb0-791e-4930-b99a-dfa39ee3e3d9"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="130" y="40" width="37" height="7" uuid="0b0c6791-76a7-4a76-9695-59fff6544f8f"/>
|
||||
<reportElement x="128" y="40" width="37" height="7" uuid="0b0c6791-76a7-4a76-9695-59fff6544f8f"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="130" y="45" width="37" height="7" uuid="f1ce64f0-b5fd-499e-a419-e0ef4b1e32e0"/>
|
||||
<reportElement x="128" y="45" width="37" height="7" uuid="f1ce64f0-b5fd-499e-a419-e0ef4b1e32e0"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="130" y="50" width="37" height="7" uuid="2abffded-f4c1-4bfd-bf83-95550d8e1aa3"/>
|
||||
<reportElement x="128" y="50" width="37" height="7" uuid="2abffded-f4c1-4bfd-bf83-95550d8e1aa3"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_8}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="130" y="59" width="37" height="7" uuid="ed2733a7-5906-4544-a4a6-1e4465c94f70">
|
||||
<reportElement x="128" y="59" width="37" height="7" uuid="ed2733a7-5906-4544-a4a6-1e4465c94f70">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_9}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="130" y="65" width="37" height="7" uuid="cc95f964-4572-46b1-b092-964c9f19e7f6"/>
|
||||
<reportElement x="128" y="65" width="37" height="7" uuid="cc95f964-4572-46b1-b092-964c9f19e7f6"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_10}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="130" y="71" width="37" height="7" uuid="6becfb6d-cb5b-4262-991d-e8d5bc9153c1"/>
|
||||
<reportElement x="128" y="71" width="37" height="7" uuid="6becfb6d-cb5b-4262-991d-e8d5bc9153c1"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_11}]]></textFieldExpression>
|
||||
</textField>
|
||||
<componentElement>
|
||||
<reportElement x="130" y="96" width="100" height="49" uuid="68346dc5-8ea0-4119-846b-af63da9dc653"/>
|
||||
<reportElement x="128" y="96" width="100" height="49" uuid="68346dc5-8ea0-4119-846b-af63da9dc653"/>
|
||||
<jr:list xmlns:jr="http://jasperreports.sourceforge.net/jasperreports/components" xsi:schemaLocation="http://jasperreports.sourceforge.net/jasperreports/components http://jasperreports.sourceforge.net/xsd/components.xsd" printOrder="Vertical">
|
||||
<datasetRun subDataset="LogoDataset" uuid="f9c33856-e20c-4c2f-a9fe-8a2bbef32985">
|
||||
<datasetParameter name="LOGO_FILENAME">
|
||||
@@ -224,119 +234,121 @@ eligibility or payment
|
||||
</jr:list>
|
||||
</componentElement>
|
||||
<textField>
|
||||
<reportElement x="168" y="11" width="64" height="7" uuid="94749044-5ec6-4eb4-8f6d-e52ce5e215da">
|
||||
<reportElement x="166" y="11" width="64" height="7" uuid="94749044-5ec6-4eb4-8f6d-e52ce5e215da">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="168" y="16" width="64" height="7" uuid="25cbc687-a185-4894-97f4-11d57c8ad84c">
|
||||
<reportElement x="166" y="16" width="64" height="7" uuid="25cbc687-a185-4894-97f4-11d57c8ad84c">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="168" y="21" width="64" height="7" uuid="527837e8-6ecb-4eba-8b3c-c1fee8e58b52">
|
||||
<reportElement x="166" y="21" width="64" height="7" uuid="527837e8-6ecb-4eba-8b3c-c1fee8e58b52">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="168" y="26" width="64" height="7" uuid="96e1ff12-6c27-4bd9-b706-050a283ea1a8">
|
||||
<reportElement x="166" y="26" width="64" height="7" uuid="96e1ff12-6c27-4bd9-b706-050a283ea1a8">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="168" y="35" width="64" height="7" uuid="c209866f-c8db-455d-8118-ae0aa51204a8">
|
||||
<reportElement x="166" y="35" width="64" height="7" uuid="c209866f-c8db-455d-8118-ae0aa51204a8">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="168" y="40" width="64" height="7" uuid="22bcf3ce-6edc-4390-9c63-f169623fdf58">
|
||||
<reportElement x="166" y="40" width="64" height="7" uuid="22bcf3ce-6edc-4390-9c63-f169623fdf58">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="168" y="45" width="64" height="7" uuid="b8bd2df8-9ad2-4cde-9c67-b0e32425c00b">
|
||||
<reportElement x="166" y="45" width="64" height="7" uuid="b8bd2df8-9ad2-4cde-9c67-b0e32425c00b">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="168" y="50" width="64" height="7" uuid="e5d86062-d78f-42b5-b578-cd14dcc071ca">
|
||||
<reportElement x="166" y="50" width="70" height="7" uuid="e5d86062-d78f-42b5-b578-cd14dcc071ca">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_8}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="168" y="59" width="64" height="7" uuid="8b542cf4-f0e7-4019-90cf-4b3a826184bf">
|
||||
<reportElement x="166" y="59" width="64" height="7" uuid="8b542cf4-f0e7-4019-90cf-4b3a826184bf">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_9}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="168" y="64" width="64" height="7" uuid="b154a117-b385-4eac-b53a-51f349d2e9a6">
|
||||
<reportElement x="166" y="64" width="64" height="7" uuid="b154a117-b385-4eac-b53a-51f349d2e9a6">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_10}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="168" y="71" width="64" height="7" uuid="d30067fe-8185-4854-a4da-615d8bb59f4a">
|
||||
<reportElement x="166" y="71" width="64" height="7" uuid="d30067fe-8185-4854-a4da-615d8bb59f4a">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_11}]]></textFieldExpression>
|
||||
</textField>
|
||||
<staticText>
|
||||
<reportElement x="3" y="114" width="120" height="33" uuid="3c43b93c-3234-4df3-8deb-cd743c45bee5"/>
|
||||
<reportElement x="1" y="114" width="120" height="33" uuid="3c43b93c-3234-4df3-8deb-cd743c45bee5">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement textAlignment="Center">
|
||||
<font size="6"/>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Pre-certification is required for
|
||||
Inpatient Hospitalization
|
||||
@@ -344,11 +356,11 @@ Call MedCost 1.800.722.2157
|
||||
]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="130" y="82" width="100" height="20" uuid="92607fc5-eae8-472b-95ce-fa64bf7f19fb">
|
||||
<reportElement x="128" y="82" width="100" height="20" uuid="92607fc5-eae8-472b-95ce-fa64bf7f19fb">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement textAlignment="Center">
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[(800-824-7406) for provider look-up
|
||||
www.medcost.com]]></text>
|
||||
|
||||
@@ -75,7 +75,7 @@
|
||||
</jr:list>
|
||||
</componentElement>
|
||||
<staticText>
|
||||
<reportElement x="138" y="62" width="92" height="34" uuid="99f47ca3-1456-4fc7-bb08-a98f460120ce"/>
|
||||
<reportElement x="139" y="62" width="92" height="34" uuid="99f47ca3-1456-4fc7-bb08-a98f460120ce"/>
|
||||
<textElement textAlignment="Center" verticalAlignment="Middle">
|
||||
<font size="6" isBold="true" isItalic="false"/>
|
||||
</textElement>
|
||||
@@ -141,14 +141,16 @@ Kinston, NC 28502
|
||||
<text><![CDATA[Name:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="3" y="25" width="24" height="8" uuid="8c0fbf41-d7b6-482b-996d-0b48ee2b0ff7"/>
|
||||
<reportElement x="3" y="25" width="42" height="8" uuid="8c0fbf41-d7b6-482b-996d-0b48ee2b0ff7"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Member Id:]]></text>
|
||||
<text><![CDATA[Member ID:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="3" y="32" width="44" height="8" uuid="da2ecd13-2381-494c-9d69-745b2496587e"/>
|
||||
<reportElement x="3" y="32" width="53" height="8" uuid="da2ecd13-2381-494c-9d69-745b2496587e">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
@@ -162,42 +164,54 @@ Kinston, NC 28502
|
||||
<text><![CDATA[Division:]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement x="45" y="11" width="82" height="8" uuid="1361e8b7-6ea2-4f2b-a6fd-781b1fa521e8"/>
|
||||
<reportElement x="50" y="11" width="80" height="8" uuid="1361e8b7-6ea2-4f2b-a6fd-781b1fa521e8">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{group_number}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="45" y="18" width="82" height="8" uuid="c2877613-bc27-4175-b080-5ab67f1d781c"/>
|
||||
<reportElement x="50" y="18" width="80" height="8" uuid="c2877613-bc27-4175-b080-5ab67f1d781c">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{full_name}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="45" y="25" width="82" height="8" uuid="acea13af-f269-47da-b9cc-ba0ea22df29f"/>
|
||||
<reportElement x="50" y="25" width="80" height="8" uuid="acea13af-f269-47da-b9cc-ba0ea22df29f">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{primary_mb_member_key}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="45" y="32" width="82" height="8" uuid="eaa738bf-1ced-4c86-8a31-9acc09a88abe"/>
|
||||
<reportElement x="50" y="32" width="80" height="8" uuid="eaa738bf-1ced-4c86-8a31-9acc09a88abe">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{medical_eff_date}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="45" y="39" width="82" height="18" uuid="f559a5a0-cd09-46e5-9a6c-0b4458ddd8b2"/>
|
||||
<reportElement x="50" y="39" width="80" height="18" uuid="f559a5a0-cd09-46e5-9a6c-0b4458ddd8b2">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{employer_name}]]></textFieldExpression>
|
||||
</textField>
|
||||
<staticText>
|
||||
<reportElement x="3" y="56" width="70" height="8" uuid="cf1ce1ca-5cef-436c-b2d6-26bd3e1015b4"/>
|
||||
<reportElement x="3" y="55" width="76" height="8" uuid="cf1ce1ca-5cef-436c-b2d6-26bd3e1015b4">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
@@ -208,42 +222,42 @@ Kinston, NC 28502
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dependent_1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="4" y="69" width="62" height="7" uuid="adee7873-b80c-4be4-9568-533471bab640"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dependent_2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="4" y="76" width="62" height="7" uuid="53ed1fe8-89ed-42a2-98bb-9ad75418f543"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dependent_3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="68" y="62" width="62" height="7" uuid="07c29443-8589-4e0f-a758-b69a34f38b07"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dependent_4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="68" y="69" width="62" height="7" uuid="f906328d-53c5-4bb7-b4d4-4eba2261adfb"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dependent_5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="68" y="76" width="62" height="7" uuid="a15671c2-f677-4def-9d42-1e0553d43010"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dependent_6}]]></textFieldExpression>
|
||||
</textField>
|
||||
@@ -338,7 +352,7 @@ Kinston, NC 28502
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="7"/>
|
||||
<font size="7" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dental_coverage}]]></textFieldExpression>
|
||||
</textField>
|
||||
|
||||
@@ -53,12 +53,12 @@
|
||||
<reportElement x="1" y="10" width="111" height="90" uuid="e762ee84-c013-417b-a78f-54f6f1f6a1a3"/>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement x="1" y="112" width="111" height="37" uuid="66e1721c-c7fd-40cf-8f45-10b5f6b4c22d">
|
||||
<reportElement x="1" y="112" width="111" height="32" uuid="66e1721c-c7fd-40cf-8f45-10b5f6b4c22d">
|
||||
<property name="com.jaspersoft.studio.unit.height" value="px"/>
|
||||
</reportElement>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement x="125" y="10" width="106" height="140" uuid="ad8b04e0-5993-4f1c-b6b1-f2c11320be29">
|
||||
<reportElement x="125" y="10" width="106" height="134" uuid="ad8b04e0-5993-4f1c-b6b1-f2c11320be29">
|
||||
<property name="com.jaspersoft.studio.unit.height" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
@@ -103,7 +103,7 @@
|
||||
<staticText>
|
||||
<reportElement x="1" y="11" width="111" height="17" uuid="75aa6426-2374-4c07-9556-63dab683cb11"/>
|
||||
<textElement textAlignment="Center" verticalAlignment="Middle">
|
||||
<font size="6" isBold="false" isItalic="false"/>
|
||||
<font size="6" isBold="true" isItalic="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[To confirm eligibility, verify benefits,
|
||||
or check claim:
|
||||
@@ -112,14 +112,14 @@ or check claim:
|
||||
<staticText>
|
||||
<reportElement x="1" y="28" width="111" height="17" uuid="8307c61b-9927-4bcc-a825-fec29b5ba605"/>
|
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<textElement textAlignment="Center" verticalAlignment="Middle">
|
||||
<font size="6" isBold="false" isItalic="false"/>
|
||||
<font size="6" isBold="true" isItalic="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Britton Benefit Services, LLC]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="1" y="45" width="111" height="50" uuid="46c394a4-7df2-4f23-b17e-d8e186e99f5e"/>
|
||||
<textElement textAlignment="Center" verticalAlignment="Middle">
|
||||
<font size="6" isBold="false" isItalic="false"/>
|
||||
<font size="6" isBold="true" isItalic="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Call:
|
||||
1.800.676.1182 (8am – 5pm)
|
||||
@@ -132,49 +132,49 @@ eligibility or payment
|
||||
<textField>
|
||||
<reportElement x="127" y="11" width="37" height="7" uuid="10b2b729-cb2f-4507-99d4-d3286e5ca8ed"/>
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||||
<textElement verticalAlignment="Middle">
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="127" y="16" width="37" height="7" uuid="0f23b912-da97-4297-b142-8c47d3332037"/>
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||||
<textElement verticalAlignment="Middle">
|
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<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="127" y="21" width="37" height="7" uuid="6664081c-30df-4e12-a563-e286fb71935a"/>
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<textElement verticalAlignment="Middle">
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<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="127" y="26" width="37" height="7" uuid="e957833e-54e9-4145-b41b-1a72d0ddadf3"/>
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<textElement verticalAlignment="Middle">
|
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<font size="5"/>
|
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<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="127" y="35" width="37" height="7" uuid="a49dbbb0-791e-4930-b99a-dfa39ee3e3d9"/>
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<textElement>
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<font size="5"/>
|
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<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="127" y="40" width="37" height="7" uuid="0b0c6791-76a7-4a76-9695-59fff6544f8f"/>
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<textElement>
|
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<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="127" y="45" width="37" height="7" uuid="f1ce64f0-b5fd-499e-a419-e0ef4b1e32e0"/>
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<textElement>
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<font size="5"/>
|
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<font size="5" isBold="true"/>
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||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_7}]]></textFieldExpression>
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</textField>
|
||||
@@ -183,28 +183,28 @@ eligibility or payment
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
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</reportElement>
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<textElement>
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<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_8}]]></textFieldExpression>
|
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</textField>
|
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<textField>
|
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<reportElement x="127" y="59" width="37" height="7" uuid="ed2733a7-5906-4544-a4a6-1e4465c94f70"/>
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<textElement>
|
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<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_9}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="127" y="65" width="37" height="7" uuid="cc95f964-4572-46b1-b092-964c9f19e7f6"/>
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<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_10}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="127" y="71" width="37" height="7" uuid="6becfb6d-cb5b-4262-991d-e8d5bc9153c1"/>
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<textElement>
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<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{claim_to_11}]]></textFieldExpression>
|
||||
</textField>
|
||||
@@ -231,7 +231,7 @@ eligibility or payment
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
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||||
</reportElement>
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||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_1}]]></textFieldExpression>
|
||||
</textField>
|
||||
@@ -241,7 +241,7 @@ eligibility or payment
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
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||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_2}]]></textFieldExpression>
|
||||
</textField>
|
||||
@@ -251,7 +251,7 @@ eligibility or payment
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_3}]]></textFieldExpression>
|
||||
</textField>
|
||||
@@ -261,7 +261,7 @@ eligibility or payment
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_4}]]></textFieldExpression>
|
||||
</textField>
|
||||
@@ -271,7 +271,7 @@ eligibility or payment
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_5}]]></textFieldExpression>
|
||||
</textField>
|
||||
@@ -281,17 +281,17 @@ eligibility or payment
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="166" y="45" width="64" height="7" uuid="b8bd2df8-9ad2-4cde-9c67-b0e32425c00b">
|
||||
<reportElement x="166" y="45" width="68" height="7" uuid="b8bd2df8-9ad2-4cde-9c67-b0e32425c00b">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
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||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_7}]]></textFieldExpression>
|
||||
</textField>
|
||||
@@ -301,7 +301,7 @@ eligibility or payment
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_8}]]></textFieldExpression>
|
||||
</textField>
|
||||
@@ -311,7 +311,7 @@ eligibility or payment
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_9}]]></textFieldExpression>
|
||||
</textField>
|
||||
@@ -321,17 +321,17 @@ eligibility or payment
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_10}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="166" y="71" width="64" height="7" uuid="d30067fe-8185-4854-a4da-615d8bb59f4a">
|
||||
<reportElement x="166" y="71" width="70" height="7" uuid="d30067fe-8185-4854-a4da-615d8bb59f4a">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{provider_line_11}]]></textFieldExpression>
|
||||
</textField>
|
||||
@@ -340,7 +340,7 @@ eligibility or payment
|
||||
<property name="com.jaspersoft.studio.unit.height" value="px"/>
|
||||
</reportElement>
|
||||
<textElement textAlignment="Center">
|
||||
<font size="6"/>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Pre-certification is required for
|
||||
Inpatient Hospitalization.
|
||||
|
||||
@@ -59,7 +59,9 @@
|
||||
<detail>
|
||||
<band height="153" splitType="Immediate">
|
||||
<rectangle>
|
||||
<reportElement x="136" y="10" width="96" height="109" uuid="4a5b91ca-ebdb-45be-8c16-f6ab6529dae7"/>
|
||||
<reportElement x="132" y="10" width="100" height="109" uuid="4a5b91ca-ebdb-45be-8c16-f6ab6529dae7">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
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|
||||
<rectangle>
|
||||
<reportElement x="1" y="10" width="127" height="74" uuid="777f7302-b52c-48fd-9cf7-6bce02846f86"/>
|
||||
@@ -70,7 +72,7 @@
|
||||
</reportElement>
|
||||
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|
||||
<componentElement>
|
||||
<reportElement x="139" y="12" width="88" height="27" uuid="029a6059-a616-4b4d-87d2-1d84ad9c53c0"/>
|
||||
<reportElement x="138" y="12" width="88" height="27" uuid="029a6059-a616-4b4d-87d2-1d84ad9c53c0"/>
|
||||
<jr:list xmlns:jr="http://jasperreports.sourceforge.net/jasperreports/components" xsi:schemaLocation="http://jasperreports.sourceforge.net/jasperreports/components http://jasperreports.sourceforge.net/xsd/components.xsd" printOrder="Vertical">
|
||||
<datasetRun subDataset="LogoDataset" uuid="1fed8c49-7871-4654-bedb-a4ffa01cc617">
|
||||
<datasetParameter name="LOGO_FILENAME">
|
||||
@@ -87,7 +89,7 @@
|
||||
</jr:list>
|
||||
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|
||||
<staticText>
|
||||
<reportElement x="138" y="35" width="92" height="34" uuid="99f47ca3-1456-4fc7-bb08-a98f460120ce"/>
|
||||
<reportElement x="136" y="35" width="92" height="34" uuid="99f47ca3-1456-4fc7-bb08-a98f460120ce"/>
|
||||
<textElement textAlignment="Center" verticalAlignment="Middle">
|
||||
<font size="6" isBold="true" isItalic="false"/>
|
||||
</textElement>
|
||||
@@ -134,77 +136,84 @@ Britton Benefit Services, LLC
|
||||
<text><![CDATA[Pharmacy Plan]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="3" y="11" width="34" height="8" uuid="5c39d2a5-fb6b-427a-ade9-f09c04c1144c"/>
|
||||
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|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
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|
||||
<text><![CDATA[Group #/ID:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="3" y="18" width="24" height="8" uuid="26d1f156-d150-4837-9bba-1390a8199fb4"/>
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||||
<reportElement x="3" y="18" width="34" height="8" uuid="26d1f156-d150-4837-9bba-1390a8199fb4"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Name:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="3" y="25" width="24" height="8" uuid="8c0fbf41-d7b6-482b-996d-0b48ee2b0ff7"/>
|
||||
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|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
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|
||||
<text><![CDATA[Policy #:]]></text>
|
||||
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|
||||
<staticText>
|
||||
<reportElement x="3" y="32" width="44" height="8" uuid="da2ecd13-2381-494c-9d69-745b2496587e"/>
|
||||
<reportElement x="3" y="32" width="53" height="8" uuid="da2ecd13-2381-494c-9d69-745b2496587e">
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<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
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|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Effective Date:]]></text>
|
||||
</staticText>
|
||||
<staticText>
|
||||
<reportElement x="3" y="39" width="34" height="8" uuid="58ce6f59-01b7-457a-aee6-0be9d7ae868e"/>
|
||||
<reportElement x="3" y="39" width="42" height="8" uuid="58ce6f59-01b7-457a-aee6-0be9d7ae868e"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Employer:]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement x="45" y="11" width="82" height="8" uuid="1361e8b7-6ea2-4f2b-a6fd-781b1fa521e8"/>
|
||||
<reportElement x="48" y="11" width="80" height="8" uuid="1361e8b7-6ea2-4f2b-a6fd-781b1fa521e8">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{group_number}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="45" y="18" width="82" height="8" uuid="c2877613-bc27-4175-b080-5ab67f1d781c"/>
|
||||
<reportElement x="48" y="18" width="80" height="8" uuid="c2877613-bc27-4175-b080-5ab67f1d781c"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{full_name}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="45" y="25" width="82" height="8" uuid="acea13af-f269-47da-b9cc-ba0ea22df29f"/>
|
||||
<reportElement x="48" y="25" width="80" height="8" uuid="acea13af-f269-47da-b9cc-ba0ea22df29f"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{primary_mb_member_key}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="45" y="32" width="82" height="8" uuid="eaa738bf-1ced-4c86-8a31-9acc09a88abe"/>
|
||||
<reportElement x="48" y="32" width="80" height="8" uuid="eaa738bf-1ced-4c86-8a31-9acc09a88abe"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{medical_eff_date}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="45" y="39" width="82" height="18" uuid="f559a5a0-cd09-46e5-9a6c-0b4458ddd8b2"/>
|
||||
<reportElement x="48" y="39" width="80" height="18" uuid="f559a5a0-cd09-46e5-9a6c-0b4458ddd8b2"/>
|
||||
<textElement>
|
||||
<font size="6"/>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{employer_name}]]></textFieldExpression>
|
||||
</textField>
|
||||
<staticText>
|
||||
<reportElement x="3" y="56" width="70" height="8" uuid="cf1ce1ca-5cef-436c-b2d6-26bd3e1015b4"/>
|
||||
<reportElement x="3" y="55" width="76" height="8" uuid="cf1ce1ca-5cef-436c-b2d6-26bd3e1015b4">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="6" isBold="true"/>
|
||||
</textElement>
|
||||
@@ -213,42 +222,42 @@ Britton Benefit Services, LLC
|
||||
<textField>
|
||||
<reportElement x="4" y="62" width="57" height="7" uuid="848389f8-98f1-41da-962e-cc29aeac91d1"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dependent_1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="4" y="69" width="57" height="7" uuid="adee7873-b80c-4be4-9568-533471bab640"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dependent_2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="4" y="76" width="57" height="7" uuid="53ed1fe8-89ed-42a2-98bb-9ad75418f543"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dependent_3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="70" y="62" width="57" height="7" uuid="07c29443-8589-4e0f-a758-b69a34f38b07"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dependent_4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="70" y="69" width="57" height="7" uuid="f906328d-53c5-4bb7-b4d4-4eba2261adfb"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dependent_5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="70" y="76" width="57" height="7" uuid="a15671c2-f677-4def-9d42-1e0553d43010"/>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{dependent_6}]]></textFieldExpression>
|
||||
</textField>
|
||||
@@ -327,132 +336,170 @@ Britton Benefit Services, LLC
|
||||
<textFieldExpression><![CDATA[$F{customer_service}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="138" y="68" width="46" height="7" uuid="ded7012f-9a8d-4e97-876b-e34bc59241ef"/>
|
||||
<reportElement x="133" y="68" width="48" height="7" uuid="ded7012f-9a8d-4e97-876b-e34bc59241ef">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="184" y="68" width="46" height="7" uuid="2a63ebda-6cf8-4f7a-927b-7cfa892e196d"/>
|
||||
<reportElement x="181" y="68" width="56" height="7" uuid="2a63ebda-6cf8-4f7a-927b-7cfa892e196d">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_1}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="138" y="74" width="46" height="7" uuid="aa510ad0-1a1e-4f24-b692-505794f4f159"/>
|
||||
<reportElement x="133" y="74" width="48" height="7" uuid="aa510ad0-1a1e-4f24-b692-505794f4f159">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="184" y="74" width="46" height="7" uuid="f501005d-ba2b-4747-92f4-1b3288d52f3a"/>
|
||||
<reportElement x="181" y="74" width="56" height="7" uuid="f501005d-ba2b-4747-92f4-1b3288d52f3a">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_2}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="138" y="80" width="46" height="7" uuid="fae8e590-1ffe-4e48-aef6-26a7e01c88af"/>
|
||||
<reportElement x="133" y="80" width="48" height="7" uuid="fae8e590-1ffe-4e48-aef6-26a7e01c88af">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="138" y="86" width="46" height="7" uuid="693746af-9ba2-4992-a270-397eaac04653"/>
|
||||
<reportElement x="133" y="86" width="48" height="7" uuid="693746af-9ba2-4992-a270-397eaac04653">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="184" y="80" width="46" height="7" uuid="27282b06-831e-40e5-93ee-ca77e3190dd5"/>
|
||||
<reportElement x="181" y="80" width="56" height="7" uuid="27282b06-831e-40e5-93ee-ca77e3190dd5">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_3}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="184" y="86" width="46" height="7" uuid="fb423834-c0e0-4e68-8dd9-baa62eaa79a2"/>
|
||||
<reportElement x="181" y="86" width="56" height="7" uuid="fb423834-c0e0-4e68-8dd9-baa62eaa79a2">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_4}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="138" y="92" width="46" height="7" uuid="b0e3223c-1930-42db-82cc-d059e9b699b9"/>
|
||||
<reportElement x="133" y="92" width="48" height="7" uuid="b0e3223c-1930-42db-82cc-d059e9b699b9">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="184" y="110" width="46" height="7" uuid="bae3a6b6-1ca2-4ca6-9ba1-dd5fb9d1153f"/>
|
||||
<reportElement x="181" y="110" width="56" height="7" uuid="bae3a6b6-1ca2-4ca6-9ba1-dd5fb9d1153f">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_8}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="138" y="110" width="46" height="7" uuid="8afd99dc-91b9-4416-806a-5f0e7eb83b1c"/>
|
||||
<reportElement x="133" y="110" width="48" height="7" uuid="8afd99dc-91b9-4416-806a-5f0e7eb83b1c">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_8}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="138" y="104" width="46" height="7" uuid="c88d8d15-070c-42ad-999c-2e013f399992"/>
|
||||
<reportElement x="133" y="104" width="52" height="7" uuid="c88d8d15-070c-42ad-999c-2e013f399992">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="138" y="98" width="46" height="7" uuid="8bfb12fe-aef3-4397-a026-1fe43ebce05e"/>
|
||||
<reportElement x="133" y="98" width="48" height="7" uuid="8bfb12fe-aef3-4397-a026-1fe43ebce05e">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_desc_6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="184" y="98" width="46" height="7" uuid="43a569a5-7de5-427a-986f-bc4af746be06"/>
|
||||
<reportElement x="181" y="98" width="56" height="7" uuid="43a569a5-7de5-427a-986f-bc4af746be06">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_6}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="184" y="104" width="46" height="7" uuid="a26646b1-152c-44f2-9486-1bd1590683c3"/>
|
||||
<reportElement x="181" y="104" width="60" height="7" uuid="a26646b1-152c-44f2-9486-1bd1590683c3">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_7}]]></textFieldExpression>
|
||||
</textField>
|
||||
<textField>
|
||||
<reportElement x="184" y="92" width="46" height="7" uuid="b572b49b-7b9a-4f68-b7ef-11dfadd2dae4"/>
|
||||
<reportElement x="181" y="92" width="56" height="7" uuid="b572b49b-7b9a-4f68-b7ef-11dfadd2dae4">
|
||||
<property name="com.jaspersoft.studio.unit.x" value="px"/>
|
||||
</reportElement>
|
||||
<textElement>
|
||||
<font size="5"/>
|
||||
<font size="5" isBold="true"/>
|
||||
</textElement>
|
||||
<textFieldExpression><![CDATA[$F{benefit_5}]]></textFieldExpression>
|
||||
</textField>
|
||||
<rectangle>
|
||||
<reportElement x="136" y="130" width="96" height="16" uuid="002ddfe1-3306-4180-a53f-2e73a62166bd"/>
|
||||
<reportElement x="132" y="130" width="100" height="16" uuid="002ddfe1-3306-4180-a53f-2e73a62166bd">
|
||||
<property name="com.jaspersoft.studio.unit.width" value="px"/>
|
||||
</reportElement>
|
||||
</rectangle>
|
||||
<rectangle>
|
||||
<reportElement x="136" y="122" width="47" height="8" backcolor="#000000" uuid="db5ddcca-b080-4f85-a149-213bfee625b1"/>
|
||||
<reportElement x="132" y="122" width="47" height="8" backcolor="#000000" uuid="db5ddcca-b080-4f85-a149-213bfee625b1"/>
|
||||
</rectangle>
|
||||
<staticText>
|
||||
<reportElement x="138" y="122" width="44" height="11" forecolor="#FFFFFF" uuid="f453b523-e229-4fde-9a39-7a3d8bea048a"/>
|
||||
<reportElement x="134" y="122" width="44" height="11" forecolor="#FFFFFF" uuid="f453b523-e229-4fde-9a39-7a3d8bea048a"/>
|
||||
<textElement>
|
||||
<font size="6" isBold="true" isUnderline="false" isPdfEmbedded="false"/>
|
||||
</textElement>
|
||||
<text><![CDATA[Dental Plan]]></text>
|
||||
</staticText>
|
||||
<textField>
|
||||
<reportElement x="138" y="131" width="92" height="13" uuid="065b6096-3261-4ea9-aedd-51c5d7687cc0"/>
|
||||
<reportElement x="134" y="131" width="92" height="13" uuid="065b6096-3261-4ea9-aedd-51c5d7687cc0"/>
|
||||
<textElement>
|
||||
<font size="7"/>
|
||||
</textElement>
|
||||
|
||||
Reference in New Issue
Block a user