Jason Jordan
448 lines
19 KiB
XML
448 lines
19 KiB
XML
<?xml version="1.0" encoding="UTF-8"?>
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<!-- Created with Jaspersoft Studio version 7.0.3.final using JasperReports Library version 6.1.1 -->
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<jasperReport xmlns="http://jasperreports.sourceforge.net/jasperreports" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://jasperreports.sourceforge.net/jasperreports http://jasperreports.sourceforge.net/xsd/jasperreport.xsd" name="IDCard" pageWidth="243" pageHeight="153" orientation="Landscape" whenNoDataType="AllSectionsNoDetail" columnWidth="243" leftMargin="0" rightMargin="0" topMargin="0" bottomMargin="0" uuid="477346fd-960f-44d2-84f5-bd25202741fc">
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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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<field name="network_provider" class="java.lang.String"/>
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<field name="provider_line_1" class="java.lang.String"/>
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<field name="provider_line_2" class="java.lang.String"/>
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<field name="provider_line_3" class="java.lang.String"/>
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<field name="provider_line_4" class="java.lang.String"/>
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<field name="provider_line_5" class="java.lang.String"/>
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<field name="provider_line_6" class="java.lang.String"/>
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<field name="provider_line_7" class="java.lang.String"/>
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<field name="provider_line_8" class="java.lang.String"/>
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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="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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<field name="claim_to_4" class="java.lang.String"/>
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<field name="claim_to_5" class="java.lang.String"/>
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<field name="claim_to_6" class="java.lang.String"/>
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<field name="claim_to_7" class="java.lang.String"/>
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<field name="claim_to_8" class="java.lang.String"/>
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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="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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<field name="customer_service" class="java.lang.String"/>
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<field name="web_url" class="java.lang.String"/>
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<field name="dependent_1" class="java.lang.String"/>
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<field name="dependent_2" class="java.lang.String"/>
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<field name="dependent_3" class="java.lang.String"/>
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<field name="dependent_4" class="java.lang.String"/>
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<field name="dependent_5" class="java.lang.String"/>
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<field name="dependent_6" class="java.lang.String"/>
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<field name="benefit_desc_1" class="java.lang.String"/>
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<field name="benefit_1" class="java.lang.String"/>
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<field name="benefit_desc_2" class="java.lang.String"/>
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<field name="benefit_2" class="java.lang.String"/>
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<field name="benefit_desc_3" class="java.lang.String"/>
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<field name="benefit_3" class="java.lang.String"/>
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<field name="benefit_desc_4" class="java.lang.String"/>
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<field name="benefit_4" class="java.lang.String"/>
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<field name="benefit_desc_5" class="java.lang.String"/>
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<field name="benefit_5" class="java.lang.String"/>
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<field name="benefit_desc_6" class="java.lang.String"/>
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<field name="benefit_6" class="java.lang.String"/>
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<field name="benefit_desc_7" class="java.lang.String"/>
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<field name="benefit_7" class="java.lang.String"/>
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<field name="benefit_desc_8" class="java.lang.String"/>
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<field name="benefit_8" class="java.lang.String"/>
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<field name="benefit_desc_9" class="java.lang.String"/>
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<field name="benefit_9" class="java.lang.String"/>
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<field name="benefit_desc_10" class="java.lang.String"/>
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<field name="benefit_10" class="java.lang.String"/>
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<field name="benefit_desc_11" class="java.lang.String"/>
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<field name="benefit_11" class="java.lang.String"/>
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<field name="benefit_desc_12" class="java.lang.String"/>
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<field name="benefit_12" class="java.lang.String"/>
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<field name="benefit_desc_13" class="java.lang.String"/>
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<field name="benefit_13" class="java.lang.String"/>
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<field name="benefit_desc_14" class="java.lang.String"/>
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<field name="benefit_14" class="java.lang.String"/>
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<field name="dependent_7" class="java.lang.String"/>
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<field name="dependent_8" class="java.lang.String"/>
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<field name="primary_mb_member_key" class="java.lang.String"/>
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<background>
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<band splitType="Stretch"/>
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</background>
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<title>
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<band splitType="Stretch"/>
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</title>
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<pageHeader>
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<band splitType="Stretch"/>
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</pageHeader>
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<columnHeader>
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<band splitType="Stretch"/>
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</columnHeader>
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<detail>
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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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<property name="com.jaspersoft.studio.unit.width" value="px"/>
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<textElement>
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<font size="6" isBold="true" isUnderline="false"/>
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</textElement>
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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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<textElement>
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<font size="6" isBold="true" isUnderline="false" isPdfEmbedded="false"/>
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</textElement>
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<text><![CDATA[Utilization / Pre-Cert]]></text>
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</staticText>
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<staticText>
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<reportElement x="107" y="1" width="56" height="11" forecolor="#FFFFFF" uuid="5e18e17a-d437-434d-ad97-fe131a7f2850"/>
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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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<text><![CDATA[Claims Submission]]></text>
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</staticText>
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<staticText>
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<reportElement x="1" y="10" width="100" height="17" uuid="75aa6426-2374-4c07-9556-63dab683cb11"/>
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<textElement textAlignment="Center" verticalAlignment="Middle">
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<font size="6" isBold="true" isItalic="false"/>
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</textElement>
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<text><![CDATA[To confirm eligibility, verify benefits, or check claim:
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]]></text>
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</staticText>
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<staticText>
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<reportElement x="1" y="22" width="100" height="17" uuid="8307c61b-9927-4bcc-a825-fec29b5ba605"/>
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<textElement textAlignment="Center" verticalAlignment="Middle">
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<font size="6" isBold="true" isItalic="false"/>
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</textElement>
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<text><![CDATA[Britton Benefit Services, LLC]]></text>
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<staticText>
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<textElement textAlignment="Center" verticalAlignment="Middle">
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<font size="6" isBold="true" isItalic="false"/>
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</textElement>
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<text><![CDATA[Call:
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1.800.676.1182 (8am – 5pm)
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Online:
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www.bbstpa.com (24/7)
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This card does not guarantee
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eligibility or payment
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]]></text>
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</staticText>
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<textField>
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<reportElement x="109" y="11" width="52" height="7" uuid="10b2b729-cb2f-4507-99d4-d3286e5ca8ed"/>
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<textElement verticalAlignment="Middle">
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_1}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="109" y="16" width="52" height="7" uuid="0f23b912-da97-4297-b142-8c47d3332037"/>
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<textElement verticalAlignment="Middle">
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_2}]]></textFieldExpression>
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<textField>
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<textElement verticalAlignment="Middle">
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_3}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="109" y="26" width="52" height="7" uuid="e957833e-54e9-4145-b41b-1a72d0ddadf3"/>
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<textElement verticalAlignment="Middle">
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_4}]]></textFieldExpression>
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<textElement>
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_5}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="109" y="40" width="52" height="7" uuid="0b0c6791-76a7-4a76-9695-59fff6544f8f"/>
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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[$F{claim_to_6}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="109" y="45" width="52" height="7" uuid="f1ce64f0-b5fd-499e-a419-e0ef4b1e32e0"/>
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<textElement>
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_7}]]></textFieldExpression>
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<textField>
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<reportElement x="109" y="50" width="52" height="7" uuid="2abffded-f4c1-4bfd-bf83-95550d8e1aa3"/>
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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[$F{claim_to_8}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="109" y="59" width="52" height="7" uuid="ed2733a7-5906-4544-a4a6-1e4465c94f70"/>
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<textElement>
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_9}]]></textFieldExpression>
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<textElement>
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<font size="5" isBold="true"/>
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<textFieldExpression><![CDATA[$F{claim_to_10}]]></textFieldExpression>
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<textElement>
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_11}]]></textFieldExpression>
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</textField>
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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[$F{provider_line_1}]]></textFieldExpression>
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<textField>
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<font size="5" isBold="true"/>
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<textFieldExpression><![CDATA[$F{provider_line_2}]]></textFieldExpression>
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<font size="5" isBold="true"/>
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<font size="5" isBold="true"/>
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<textFieldExpression><![CDATA[$F{provider_line_7}]]></textFieldExpression>
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<font size="5" isBold="true"/>
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<font size="5" isBold="true"/>
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<font size="5" isBold="true"/>
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<textElement>
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<font size="5" isBold="true"/>
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<textFieldExpression><![CDATA[$F{provider_line_11}]]></textFieldExpression>
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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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<text><![CDATA[Pharmacy Plan]]></text>
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</staticText>
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<image scaleImage="RetainShape">
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<imageExpression><![CDATA["./../../images/FairRxOs.jpg"]]></imageExpression>
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<textElement>
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<font size="5" isBold="true"/>
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<text><![CDATA[RX Bin:]]></text>
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<font size="5" isBold="true"/>
|
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</textElement>
|
||
<text><![CDATA[RX PCN:]]></text>
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<textElement>
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<font size="5" isBold="true"/>
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||
</textElement>
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||
<text><![CDATA[RX GRP:]]></text>
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||
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<staticText>
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<reportElement x="132" y="95" width="27" height="8" uuid="abd7fb37-b19a-4691-869c-28a8c0b326ce"/>
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<textElement>
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||
<font size="5" isBold="true"/>
|
||
</textElement>
|
||
<text><![CDATA[021841]]></text>
|
||
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||
<staticText>
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||
<reportElement x="132" y="105" width="27" height="8" uuid="84e6427e-950d-4c1a-877e-a342ec8009db"/>
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||
<textElement>
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||
<font size="5" isBold="true"/>
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||
</textElement>
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||
<text><![CDATA[18000405]]></text>
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<textField>
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<reportElement x="132" y="115" width="34" height="8" uuid="709713dc-5f48-40dc-957c-9f015b376b41"/>
|
||
<textElement>
|
||
<font size="5" isBold="true"/>
|
||
</textElement>
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||
<textFieldExpression><![CDATA[$F{rx_group}]]></textFieldExpression>
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</textField>
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<staticText>
|
||
<reportElement x="108" y="125" width="51" height="8" uuid="00b86af7-1cba-4c7a-a78b-cb0ffa476f88"/>
|
||
<textElement>
|
||
<font size="5" isBold="true"/>
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||
</textElement>
|
||
<text><![CDATA[Customer Service:]]></text>
|
||
</staticText>
|
||
<textField>
|
||
<reportElement x="166" y="115" width="63" height="8" uuid="0bce3d0c-c01b-4dfd-9638-19b94d75e73e"/>
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<textElement textAlignment="Center">
|
||
<font size="5" isBold="true"/>
|
||
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<textFieldExpression><![CDATA[$F{web_url}]]></textFieldExpression>
|
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<textField>
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<reportElement x="159" y="125" width="70" height="8" uuid="1193b1ef-31e9-4c43-bb51-236b67c21c81"/>
|
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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[$F{customer_service}]]></textFieldExpression>
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||
</textField>
|
||
<staticText>
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<reportElement x="3" y="96" width="93" height="9" uuid="71022051-2ec9-443d-81e2-5f7385ddeb7b"/>
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||
<textElement textAlignment="Center">
|
||
<font fontName="SansSerif" size="6" isBold="true"/>
|
||
</textElement>
|
||
<text><![CDATA[Precertification]]></text>
|
||
</staticText>
|
||
<textField>
|
||
<reportElement x="3" y="105" width="93" height="13" uuid="e414550a-a8d0-4313-9b57-e42ca3bb67ab"/>
|
||
<textElement textAlignment="Center">
|
||
<font fontName="SansSerif" size="6" isBold="true"/>
|
||
</textElement>
|
||
<textFieldExpression><![CDATA["Call Britton Benefit Services, LLC"]]></textFieldExpression>
|
||
</textField>
|
||
<image>
|
||
<reportElement x="159" y="136" width="72" height="8" uuid="7da52da7-1e66-4ba2-ae1c-8ba65b8797c3">
|
||
<printWhenExpression><![CDATA[$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">
|
||
<printWhenExpression><![CDATA[$F{network_provider}.equals("Cigna")]]></printWhenExpression>
|
||
</reportElement>
|
||
<textElement>
|
||
<font size="5.5" isBold="true"/>
|
||
</textElement>
|
||
<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"/>
|
||
<textElement textAlignment="Center">
|
||
<font fontName="SansSerif" size="6" isBold="true"/>
|
||
</textElement>
|
||
<textFieldExpression><![CDATA["1.800.676.1182 (8am-5pm)"]]></textFieldExpression>
|
||
</textField>
|
||
</band>
|
||
</detail>
|
||
<columnFooter>
|
||
<band splitType="Stretch"/>
|
||
</columnFooter>
|
||
<pageFooter>
|
||
<band splitType="Stretch"/>
|
||
</pageFooter>
|
||
<summary>
|
||
<band splitType="Stretch"/>
|
||
</summary>
|
||
</jasperReport>
|