// JavaScript Document

//Quick Contact Form

function isInteger(s){
	var i;
    for (i = 0; i < s.length; i++){   
        // Check that current character is number.
        var c = s.charAt(i);
        if (((c < "0") || (c > "9"))) return false;
    }
    // All characters are numbers.
    return true;
}

function stripCharsInBag(s, bag){
	var i;
    var returnString = "";
    // Search through string's characters one by one.
    // If character is not in bag, append to returnString.
    for (i = 0; i < s.length; i++){   
        var c = s.charAt(i);
        if (bag.indexOf(c) == -1) returnString += c;
    }
    return returnString;
}

//Phone Number

var digits = "0123456789";
var phoneNumberDelimiters = "()- ";
var validWorldPhoneChars = phoneNumberDelimiters + "+";
var minDigitsInIPhoneNumber = 10;

function trim(s)
{   var i;
    var returnString = "";
    // Search through string's characters one by one.
    // If character is not a whitespace, append to returnString.
    for (i = 0; i < s.length; i++)
    {   
        // Check that current character isn't whitespace.
        var c = s.charAt(i);
        if (c != " ") returnString += c;
    }
    return returnString;
}

function checkIntPhone(strPhone){
var bracket=3
strPhone=trim(strPhone)
if(strPhone.indexOf("+")>1) return false
if(strPhone.indexOf("-")!=-1)bracket=bracket+1
if(strPhone.indexOf("(")!=-1 && strPhone.indexOf("(")>bracket)return false
var brchr=strPhone.indexOf("(")
if(strPhone.indexOf("(")!=-1 && strPhone.charAt(brchr+2)!=")")return false
if(strPhone.indexOf("(")==-1 && strPhone.indexOf(")")!=-1)return false
s=stripCharsInBag(strPhone,validWorldPhoneChars);
return (isInteger(s) && s.length >= minDigitsInIPhoneNumber);
}


function check()
{

if (document.ac.Name.value=="Name")
{alert ("Please enter your Name")
document.ac.Name.focus()
return(0)}
if (document.ac.Email.value=="Email" || document.ac.Email.value.lastIndexOf("@")==-1)
{alert ("Please enter a valid Email ID")
document.ac.Email.focus()
return(0)}
var Phone=document.ac.Phone
if ((Phone.value==null)||(Phone.value=="Telephone"))
{alert("Please Enter your Phone Number")
Phone.focus()
return (0)}

if (checkIntPhone(Phone.value)==false)
{alert("Please Enter a Valid Phone Number")
Phone.value=""
Phone.focus()
return (0)}

if (document.ac.Queries.value=="Query")
{alert ("Please enter your Message")
document.ac.Queries.focus()
return(0)}

if (document.ac.captchacode.value=="Enter Code")
{alert ("Please Enter Verification Code")
document.ac.captchacode.focus()
return(0)}
else
document.ac.submit()
}

function setNameFocus(el)
{
	el.value = '';
}
function lostNameFocus(el)
{
	if (el.value == '')
	{
		el.value = 'Name';
	}
}
function setEmailFocus(el)
	{
		el.value = '';
	}
function lostEmailFocus(el)
{
	if (el.value == '')
	{
		el.value = 'Email';
	}
}
function setPhoneFocus(el)
	{
		el.value = '';
	}
function lostPhoneFocus(el)
{
	if (el.value == '')
	{
		el.value = 'Telephone';
	}
}
function setQueryFocus(el)
	{
		el.value = '';
	}
function lostQueryFocus(el)
{
	if (el.value == '')
	{
		el.value = 'Query';
	}
}

function setVerificationFocus(el)
	{
		el.value = '';
	}
function lostVerificationFocus(el)
{
	if (el.value == '')
	{
		el.value = 'Enter Code';
	}
}


//Validate Date

var dtCh= "/";
var minYear=1900;
var currentTime = new Date()
var maxMonth = currentTime.getMonth() + 1
var maxDay = currentTime.getDate()
var maxYear = currentTime.getFullYear()
//var maxYear=2100;
function isInteger(s){
	var i;
    for (i = 0; i < s.length; i++){   
        // Check that current character is number.
        var c = s.charAt(i);
        if (((c < "0") || (c > "9"))) return false;
    }
    // All characters are numbers.
    return true;
}

function stripCharsInBag(s, bag){
	var i;
    var returnString = "";
    // Search through string's characters one by one.
    // If character is not in bag, append to returnString.
    for (i = 0; i < s.length; i++){   
        var c = s.charAt(i);
        if (bag.indexOf(c) == -1) returnString += c;
    }
    return returnString;
}

function daysInFebruary (year){
	// February has 29 days in any year evenly divisible by four,
    // EXCEPT for centurial years which are not also divisible by 400.
    return (((year % 4 == 0) && ( (!(year % 100 == 0)) || (year % 400 == 0))) ? 29 : 28 );
}
function DaysArray(n) {
	for (var i = 1; i <= n; i++) {
		this[i] = 31
		if (i==4 || i==6 || i==9 || i==11) {this[i] = 30}
		if (i==2) {this[i] = 29}
   } 
   return this
}
function isDate(dtStr){
	var daysInMonth = DaysArray(12)
	var pos1=dtStr.indexOf(dtCh)
	var pos2=dtStr.indexOf(dtCh,pos1+1)
	var strMonth=dtStr.substring(0,pos1)
	var strDay=dtStr.substring(pos1+1,pos2)
	var strYear=dtStr.substring(pos2+1)
	strYr=strYear
	if (strDay.charAt(0)=="0" && strDay.length>1) strDay=strDay.substring(1)
	if (strMonth.charAt(0)=="0" && strMonth.length>1) strMonth=strMonth.substring(1)
	for (var i = 1; i <= 3; i++) {
		if (strYr.charAt(0)=="0" && strYr.length>1) strYr=strYr.substring(1)
	}
	month=parseInt(strMonth)
	day=parseInt(strDay)
	year=parseInt(strYr)
	if (pos1==-1 || pos2==-1){
		alert("Please enter a Valid Date (Format: mm/dd/yyyy)")
		return false
	}
	if (strMonth.length<1 || month<1 || month>12){
		alert("Please enter a valid month")
		return false
	}
	if (strDay.length<1 || day<1 || day>31 || (month==2 && day>daysInFebruary(year)) || day > daysInMonth[month]){
		alert("Please enter a valid day")
		return false
	}
	if (strYear.length != 4 || year==0 || year<minYear || year>maxYear){
		alert("Please enter a valid 4 digit year between "+minYear+" and "+maxYear)
		return false
	}
	if (dtStr.indexOf(dtCh,pos2+1)!=-1 || isInteger(stripCharsInBag(dtStr, dtCh))==false){
		alert("Please enter a valid Date")
		return false
	}
return true
}


//Privacy Form

function PFcheck()
{
	if (document.ac.Name.value=="")
	{alert ("Please enter your Name")
	document.ac.Name.focus()
	return(0)}
	
	if (document.ac.Email.value=="" || document.ac.Email.value.lastIndexOf("@")==-1)
	{alert ("Please enter a valid Email ID")
	document.ac.Email.focus()
	return(0)}
	
	var dt=document.ac.Date
	if (isDate(dt.value)==false)
	{dt.focus()
	return (0)}
	
	if (document.ac.captchacode.value=="")
	{alert ("Please Enter Verification Code")
	document.ac.captchacode.focus()
	return(0)}
	else
	document.ac.submit()
}

//Confidential Information Form

function CIcheck()
{

if (document.ac.Name.value=="")
{alert ("Please enter your Name")
document.ac.Name.focus()
return(0)}

if (document.ac.Email.value=="" || document.ac.Email.value.lastIndexOf("@")==-1)
{alert ("Please enter a valid Email ID")
document.ac.Email.focus()
return(0)}

var Phone=document.ac.Phone_Number
if ((Phone.value==null)||(Phone.value==""))
{alert("Please Enter your Phone Number")
Phone.focus()
return (0)}

if (checkIntPhone(Phone.value)==false)
{alert("Please Enter a Valid Phone Number")
Phone.value=""
Phone.focus()
return (0)}

var dt=document.ac.Birthdate
if (isDate(dt.value)==false)
{dt.focus()
return (0)}

var ds=document.ac.Date_of_last_physical_examination
if (isDate(ds.value)==false)
{ds.focus()
return (0)}

if (document.ac.captchacode.value=="")
{alert ("Please Enter Verification Code")
document.ac.captchacode.focus()
return(0)}
	
else
document.ac.submit()
}

//Acknowledgement Privacy Form

function APcheck()
{
if (document.ac.Name.value=="")
{alert ("Please enter your Name")
document.ac.Name.focus()
return(0)}

if (document.ac.Email.value=="" || document.ac.Email.value.lastIndexOf("@")==-1)
{alert ("Please enter a valid Email ID")
document.ac.Email.focus()
return(0)}

var dt=document.ac.Date
if (isDate(dt.value)==false)
{dt.focus()
return (0)}

if (document.ac.captchacode.value=="")
{alert ("Please Enter Verification Code")
document.ac.captchacode.focus()
return(0)}
else
document.ac.submit()
}

//General Consent Form

function GCcheck()
{
if (document.ac.Name.value=="")
{alert ("Please enter your Name")
document.ac.Name.focus()
return(0)}

if (document.ac.Email.value=="" || document.ac.Email.value.lastIndexOf("@")==-1)
{alert ("Please enter a valid Email ID")
document.ac.Email.focus()
return(0)}
var dt=document.ac.Date
	if (isDate(dt.value)==false)
	{
		dt.focus()
		return (0)
	}
if (document.ac.captchacode.value=="")
{alert ("Please Enter Verification Code")
document.ac.captchacode.focus()
return(0)}
else
document.ac.submit()
}

//Job Injury Accident Form

function Jcheck()
{

if (document.ac.Name.value=="")
{alert ("Please enter your Name")
document.ac.Name.focus()
return(0)}

if (document.ac.Email.value=="" || document.ac.Email.value.lastIndexOf("@")==-1)
{alert ("Please enter a valid Email ID")
document.ac.Email.focus()
return(0)}

var Phone=document.ac.Phone_Number
if ((Phone.value==null)||(Phone.value==""))
{alert("Please Enter your Phone Number")
Phone.focus()
return (0)}

if (checkIntPhone(Phone.value)==false)
{alert("Please Enter a Valid Phone Number")
Phone.value=""
Phone.focus()
return (0)}

var dt=document.ac.Job_Injury_Date
if (isDate(dt.value)==false)
{dt.focus()
return (0)}

var ds=document.ac.Accident_Date
if (isDate(ds.value)==false)
{ds.focus()
return (0)}

if (document.ac.captchacode.value=="")
{alert ("Please Enter Verification Code")
document.ac.captchacode.focus()
return(0)}

else
document.ac.submit()
}


//Release of Records Form

function RRcheck()
{

if (document.ac.Name.value=="")
{alert ("Please enter your Name")
document.ac.Name.focus()
return(0)}

if (document.ac.Email.value=="" || document.ac.Email.value.lastIndexOf("@")==-1)
{alert ("Please enter a valid Email ID")
document.ac.Email.focus()
return(0)}

var Phone=document.ac.Phone_Number
if ((Phone.value==null)||(Phone.value==""))
{alert("Please Enter your Phone Number")
Phone.focus()
return (0)}

if (checkIntPhone(Phone.value)==false)
{alert("Please Enter a Valid Phone Number")
Phone.value=""
Phone.focus()
return (0)}

var dt=document.ac.Date
	if (isDate(dt.value)==false){
		dt.focus()
		return (0)
	}

if (document.ac.captchacode.value=="")
{alert ("Please Enter Verification Code")
document.ac.captchacode.focus()
return(0)}
else
document.ac.submit()
}


//Request For Records Form

function RFRcheck()
{

if (document.ac.Name.value=="")
{alert ("Please enter your Name")
document.ac.Name.focus()
return(0)}

if (document.ac.Email.value=="" || document.ac.Email.value.lastIndexOf("@")==-1)
{alert ("Please enter a valid Email ID")
document.ac.Email.focus()
return(0)}

var Phone=document.ac.Phone_Number
if ((Phone.value==null)||(Phone.value==""))
{alert("Please Enter your Phone Number")
Phone.focus()
return (0)}

if (checkIntPhone(Phone.value)==false)
{alert("Please Enter a Valid Phone Number")
Phone.value=""
Phone.focus()
return (0)}

var dt=document.ac.Date
if (isDate(dt.value)==false)
{dt.focus()
return (0)}

var ds=document.ac.Date_of_Records
if (isDate(ds.value)==false)
{ds.focus()
return (0)}

if (document.ac.captchacode.value=="")
{alert ("Please Enter Verification Code")
document.ac.captchacode.focus()
return(0)}
else
document.ac.submit()
}

//Statement Form

function SFcheck()
{

if (document.ac.Name.value=="")
{alert ("Please enter your Name")
document.ac.Name.focus()
return(0)}

if (document.ac.Email.value=="" || document.ac.Email.value.lastIndexOf("@")==-1)
{alert ("Please enter a valid Email ID")
document.ac.Email.focus()
return(0)}

var Phone=document.ac.Phone_Number
if ((Phone.value==null)||(Phone.value==""))
{alert("Please Enter your Phone Number")
Phone.focus()
return (0)}

if (checkIntPhone(Phone.value)==false)
{alert("Please Enter a Valid Phone Number")
Phone.value=""
Phone.focus()
return (0)}

var dt=document.ac.Dated
	if (isDate(dt.value)==false){
		dt.focus()
		return (0)
	}

if (document.ac.captchacode.value=="")
{alert ("Please Enter Verification Code")
document.ac.captchacode.focus()
return(0)}
else
document.ac.submit()
}

//Contact Form, Symptom Checklist Form

function Ccheck()
{

if (document.ac.Name.value=="")
{alert ("Please enter your Name")
document.ac.Name.focus()
return(0)}

if (document.ac.Email.value=="" || document.ac.Email.value.lastIndexOf("@")==-1)
{alert ("Please enter a valid Email ID")
document.ac.Email.focus()
return(0)}

var Phone=document.ac.Phone_Number
if ((Phone.value==null)||(Phone.value==""))
{alert("Please Enter your Phone Number")
Phone.focus()
return (0)}

if (checkIntPhone(Phone.value)==false)
{alert("Please Enter a Valid Phone Number")
Phone.value=""
Phone.focus()
return (0)}

if (document.ac.captchacode.value=="")
{alert ("Please Enter Verification Code")
document.ac.captchacode.focus()
return(0)}
else
document.ac.submit()
}


//Direct Payment Form

function DPcheck()
{

if (document.ac.Name.value=="")
{alert ("Please enter your Name")
document.ac.Name.focus()
return(0)}

if (document.ac.Email.value=="" || document.ac.Email.value.lastIndexOf("@")==-1)
{alert ("Please enter a valid Email ID")
document.ac.Email.focus()
return(0)}

var Phone=document.ac.Phone_Number
if ((Phone.value==null)||(Phone.value==""))
{alert("Please Enter your Phone Number")
Phone.focus()
return (0)}

if (checkIntPhone(Phone.value)==false)
{alert("Please Enter a Valid Phone Number")
Phone.value=""
Phone.focus()
return (0)}

var dt=document.ac.Dated
	if (isDate(dt.value)==false)
	{
		dt.focus()
		return (0)
	}
if (document.ac.captchacode.value=="")
{alert ("Please Enter Verification Code")
document.ac.captchacode.focus()
return(0)}
else
document.ac.submit()
}