Jason Jordan
590 lines
24 KiB
XML
590 lines
24 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" 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="1150"/>
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<property name="ireport.y" value="0"/>
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<subDataset name="LogoDataset" uuid="5f867a6e-5835-4d64-a042-be4308e843e6">
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<parameter name="LOGO_FILENAME" class="java.lang.String"/>
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<field name="filename" class="java.lang.String"/>
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<field name="image_stream" class="java.io.InputStream"/>
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<field name="aspect_ratio" class="java.lang.Float"/>
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<filterExpression><![CDATA[$F{filename}.equals($P{LOGO_FILENAME})]]></filterExpression>
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</subDataset>
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<parameter name="employerLogosList" class="java.util.List" isForPrompting="false"/>
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<field name="employer_logo_filename" 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="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="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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<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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<rectangle>
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<reportElement x="1" y="10" width="102" height="141" uuid="4a5b91ca-ebdb-45be-8c16-f6ab6529dae7">
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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="10" width="133" height="71" uuid="ad8b04e0-5993-4f1c-b6b1-f2c11320be29"/>
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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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</rectangle>
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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" 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="3" y="12" width="98" height="30" uuid="99f47ca3-1456-4fc7-bb08-a98f460120ce"/>
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<textElement textAlignment="Center" verticalAlignment="Middle">
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<font size="5" isBold="true" isItalic="false"/>
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</textElement>
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<text><![CDATA[Administered by:
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Britton Benefit Services, LLC
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1.800.676.1182]]></text>
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</staticText>
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<textField>
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<reportElement x="112" 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"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_1}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="112" y="16" width="52" height="7" uuid="0f23b912-da97-4297-b142-8c47d3332037"/>
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<textElement verticalAlignment="Middle">
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_2}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="112" y="21" width="52" height="7" uuid="6664081c-30df-4e12-a563-e286fb71935a"/>
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<textElement verticalAlignment="Middle">
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_3}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="112" y="26" width="52" height="7" uuid="e957833e-54e9-4145-b41b-1a72d0ddadf3"/>
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<textElement verticalAlignment="Middle">
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_4}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="112" y="35" width="52" height="7" uuid="a49dbbb0-791e-4930-b99a-dfa39ee3e3d9"/>
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<textElement>
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_5}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="112" y="40" width="52" height="7" uuid="0b0c6791-76a7-4a76-9695-59fff6544f8f"/>
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<textElement>
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_6}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="112" y="45" width="52" height="7" uuid="f1ce64f0-b5fd-499e-a419-e0ef4b1e32e0"/>
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<textElement>
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_7}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="112" y="50" width="52" height="7" uuid="2abffded-f4c1-4bfd-bf83-95550d8e1aa3"/>
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<textElement>
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_8}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="112" y="59" width="52" height="7" uuid="ed2733a7-5906-4544-a4a6-1e4465c94f70"/>
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<textElement>
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_9}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="112" y="65" width="52" height="7" uuid="cc95f964-4572-46b1-b092-964c9f19e7f6"/>
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<textElement>
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_10}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="112" y="71" width="52" height="7" uuid="6becfb6d-cb5b-4262-991d-e8d5bc9153c1"/>
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<textElement>
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_11}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="166" y="11" width="70" height="7" uuid="94749044-5ec6-4eb4-8f6d-e52ce5e215da"/>
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<textElement>
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{provider_line_1}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="166" y="16" width="70" height="7" uuid="25cbc687-a185-4894-97f4-11d57c8ad84c"/>
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<textElement>
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{provider_line_2}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="166" y="21" width="70" height="7" uuid="527837e8-6ecb-4eba-8b3c-c1fee8e58b52"/>
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<textElement>
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{provider_line_3}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="166" y="26" width="70" height="7" uuid="96e1ff12-6c27-4bd9-b706-050a283ea1a8"/>
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<textElement>
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{provider_line_4}]]></textFieldExpression>
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</textField>
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<textField>
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<textElement>
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{provider_line_5}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="166" y="40" width="70" height="7" uuid="22bcf3ce-6edc-4390-9c63-f169623fdf58"/>
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<textElement>
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{provider_line_6}]]></textFieldExpression>
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</textField>
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<textField>
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<textElement>
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{provider_line_7}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="166" y="50" width="70" height="7" uuid="e5d86062-d78f-42b5-b578-cd14dcc071ca"/>
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<textElement>
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{provider_line_8}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="166" y="59" width="70" height="7" uuid="8b542cf4-f0e7-4019-90cf-4b3a826184bf"/>
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<textElement>
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{provider_line_9}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="166" y="64" width="70" height="7" uuid="b154a117-b385-4eac-b53a-51f349d2e9a6"/>
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<textElement>
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{provider_line_10}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="166" y="71" width="70" height="7" uuid="d30067fe-8185-4854-a4da-615d8bb59f4a"/>
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<textElement>
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<font size="5"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{provider_line_11}]]></textFieldExpression>
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</textField>
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<rectangle>
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<reportElement x="1" y="1" width="44" height="8" backcolor="#000000" uuid="4ecd4a82-edd1-4166-abf9-85d66ebb8b37"/>
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<textElement>
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<font size="6" isUnderline="false" isPdfEmbedded="false"/>
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</textElement>
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<text><![CDATA[Medical Plan]]></text>
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</staticText>
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<textElement>
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<font size="6" 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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<componentElement>
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<reportElement x="162" y="95" width="76" height="21" uuid="029a6059-a616-4b4d-87d2-1d84ad9c53c0"/>
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<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">
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<datasetRun subDataset="LogoDataset" uuid="1fed8c49-7871-4654-bedb-a4ffa01cc617">
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<datasetParameter name="LOGO_FILENAME">
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<datasetParameterExpression><![CDATA[$F{employer_logo_filename}]]></datasetParameterExpression>
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</datasetParameter>
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<dataSourceExpression><![CDATA[new net.sf.jasperreports.engine.data.JRBeanCollectionDataSource($P{employerLogosList})]]></dataSourceExpression>
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</datasetRun>
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<jr:listContents height="21" width="76">
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<image scaleImage="RetainShape" hAlign="Center" isUsingCache="true">
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<reportElement x="0" y="0" width="76" height="21" isPrintInFirstWholeBand="true" uuid="7445dc43-933e-4b42-bef0-1772e9b85ba4"/>
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<imageExpression><![CDATA[$F{image_stream}]]></imageExpression>
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</image>
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</jr:listContents>
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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 Bin:]]></text>
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<staticText>
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<reportElement x="108" y="105" width="31" height="8" uuid="cc922142-d87a-4f04-b28b-413ad513e5e0"/>
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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 PCN:]]></text>
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<staticText>
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<reportElement x="108" y="115" width="31" height="8" uuid="4534f9a0-901a-402c-86ba-0b3109370e53"/>
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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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</staticText>
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<staticText>
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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[024144]]></text>
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</staticText>
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<staticText>
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<reportElement x="135" 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[healthbus]]></text>
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</staticText>
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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{rx_group}]]></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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<text><![CDATA[Customer Service:]]></text>
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</staticText>
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<textField>
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<reportElement x="165" y="115" width="73" height="8" uuid="0bce3d0c-c01b-4dfd-9638-19b94d75e73e"/>
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