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1321 lines
42 KiB
1321 lines
42 KiB
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<html>
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<head>
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<meta name="GENERATOR" content="Microsoft Visual Studio 6.0">
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<script language="javascript1.2">
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function DateCheck(frmMo, frmDy, frmYr)
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{
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var returnCode;
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var cdtStr, fdtStr;
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var cdt = new Date();
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//cdtStr = cdt.getYear().toString() + ZeroPad(cdt.getMonth() + 1, 2).toString() + ZeroPad(cdt.getDate(), 2).toString()
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cdtStr = 20070205
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fdtStr = frmYr + ZeroPad(frmMo, 2) + ZeroPad(frmDy, 2);
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var frmDate = ZeroPad(frmMo, 2) + '/' + ZeroPad(frmDy, 2) + '/' + frmYr;
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compareDate = new Date(frmDate);
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var newDate = ZeroPad(compareDate.getMonth() + 1, 2) + '/' + ZeroPad(compareDate.getDate(), 2) + '/' + frmYr;
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if (frmDate != newDate)
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{
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alert(frmDate + ' is not a valid date!');
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returnCode = false;
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}
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else
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{
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if (fdtStr > cdtStr)
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{
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alert(frmDate + ' is an invalid BirthDate (greater than current date).\n\nYou have entered: ' + frmDate + ' as a birthdate.\n' + cdtStr + ' is the current date.\n');
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returnCode = false;
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}
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else
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returnCode = true;
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}
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return (returnCode);
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}
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function AutoTabCheck(obj, frmObj)
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{
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if (obj.value.length == obj.maxLength)
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{
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start = obj.id.length - 2;
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incre = parseInt(obj.id.substr(start, 2));
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NewIDnum = ZeroPad(incre + 1, 2);
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NewID = obj.id.substr(0, start) + NewIDnum;
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newObj = eval(frmObj.id + "." + NewID);
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newObj.focus();
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}
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}
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function CancelOutWizard()
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{
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var leaving = confirm("Clicking [OK] will exit the wizard without submitting, all data will be lost.\nClick [Cancel] to remain here.");
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if (leaving)
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window.location.replace('http://pacecares.fhsc.com/default.asp');
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}
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function allMoney(num)
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{
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numSet = "0123456789.";
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for (x=0;x<=num.length;x++)
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{
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charX = num.substr(x, 1);
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if (numSet.indexOf(charX) == -1)
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{
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leftS = num.substring(0, x);
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rightS = num.substr(x+1);
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num = leftS + rightS;
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x--;
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}
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}
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return(num);
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}
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function allNum(num)
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{
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numSet = "0123456789";
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for (x=0;x<=num.length;x++)
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{
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charX = num.substr(x, 1);
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if (numSet.indexOf(charX) == -1)
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{
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leftS = num.substring(0, x);
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rightS = num.substr(x+1);
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num = leftS + rightS;
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x--;
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}
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}
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return(num);
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}
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function isAlphaNum(str)
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{
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alphaSet = "ABCDEFGHIJKLMNOPQRSTUVWXYZ0123456789";
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newstr = str.toUpperCase();
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for (x=0; x<newstr.length; x++)
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{
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if (alphaSet.indexOf(newstr.substr(x, 1)) == -1)
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{
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x = newstr.length;
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return false;
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}
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}
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return true;
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}
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function ZeroPad(str, pre)
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{
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var x;
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var workstr;
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for (x=1; x<pre; x++)
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{
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workstr = "0".concat("0");
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}
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return (workstr.concat(str).substr(workstr.concat(str).length-pre));
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}
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function Right(str, retlen)
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{
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if (retlen >= str.length)
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return (str);
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else
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return (str.substr(str.length - retlen));
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}
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function HighlightField(FldStyle)
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{
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FldStyle.borderColor = "blue";
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FldStyle.backgroundColor = "LightSteelBlue";
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}
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function UnHighlightField(FldStyle)
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{
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FldStyle.borderColor = "";
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FldStyle.backgroundColor = "";
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}
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function AddTotalsthenSubmit(j)
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{
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xx = 0, yrvalue = 0, spvalue = 0;
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while (xx<7)
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{
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xx++;
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tot = eval("document.frmPace.Tot_Income" + xx);
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sp = eval("document.frmPace.Sp_Income" + xx);
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yr = eval("document.frmPace.Yr_Income" + xx);
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tvalue = parseFloat(yr.value) + parseFloat(sp.value);
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yrvalue = yrvalue + parseFloat(yr.value);
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spvalue = spvalue + parseFloat(sp.value);
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tot.value = Math.round(tvalue * Math.pow(10, 2)) / Math.pow(10, 2);
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if (xx == 6)
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{
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document.frmPace.Yr_Income7.value = Math.round(yrvalue * Math.pow(10, 2)) / Math.pow(10, 2);
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document.frmPace.Sp_Income7.value = Math.round(spvalue * Math.pow(10, 2)) / Math.pow(10, 2);
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}
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}
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}
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function IndividualEdits(Indv, obj, NoFocus)
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{
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var Status = true;
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frm6Obj = document.frmSect06;
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switch(Indv)
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{
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case "ssn":
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val = obj.value;
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if (isAlphaNum(val))
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{
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obj.value = val;
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if (val.length > 1 && val.length != 9)
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{
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alert('SSN can contain a combination 9 numerics and/or letters.');
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if (!NoFocus)
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obj.focus();
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Status = false;
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}
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}
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else
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{
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Status = false;
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}
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break;
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case "areacode":
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val = obj.value;
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newNum = allNum(val);
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obj.value = newNum;
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if (newNum.length > 1 && newNum.length != 3)
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{
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alert('area code must contain 3 numerics.');
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if (!NoFocus)
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obj.focus();
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Status = false;
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}
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break;
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case "phone":
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val = obj.value;
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newNum = allNum(val);
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obj.value = newNum;
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if (newNum.length > 1 && newNum.length != 7)
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{
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alert('phone trunk must contain 7 numerics.');
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if (!NoFocus)
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obj.focus();
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Status = false;
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}
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break;
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case "zip":
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val = obj.value;
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newNum = allNum(val);
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obj.value = newNum;
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if (newNum.length > 1 && newNum.length != 5)
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{
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alert('zip code must contain 5 numerics.');
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obj.focus();
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Status = false;
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}
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break;
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case "zip4":
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val = obj.value;
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newNum = allNum(val);
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obj.value = newNum;
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if (newNum.length > 1 && newNum.length != 4)
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{
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alert('zip code suffix must contain 4 numerics.');
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obj.focus();
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Status = false;
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}
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break;
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case "money":
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val = obj.value;
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newNum = allMoney(val);
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obj.value = newNum;
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if (newNum.length > 7)
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{
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alert('Money field can contain no more than 7 numerics including decimals.');
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obj.focus();
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Status = false;
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}
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break;
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case "divYear":
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val = obj.value;
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if (frm6Obj.Yr_mstat[0].checked || frm6Obj.Yr_mstat[1].checked)
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{
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obj.value = '';
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}
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break;
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case "marStat":
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if (frm6Obj.Yr_mstat[0].checked || frm6Obj.Yr_mstat[1].checked)
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{
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frm6Obj.DSyear.value = '';
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}
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break;
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default:
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}
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return Status;
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}
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function HelpWindows(Proof)
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{
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switch(Proof)
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{
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case "Age":
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alert("Valid Proofs of Age:\n" +
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"(note: The following examples are acceptable documents but not limited to:)\n\n" +
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"- Birth Certificate/foreign birth certificate\n" +
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"- Baptismal Record\n" +
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"- Valid Driver's License\n" +
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"- Social Security Document\n" +
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"- Insurance Policy (not an insurance application)\n" +
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"- Photocopy of previous PACE/PACENET card\n" +
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"- Passport\n" +
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"- Military Discharge Papers");
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break;
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case "Addr":
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alert("Valid Proofs of Residency:\n" +
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"(note: The following examples are acceptable documents but not limited to:)\n\n" +
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"- Valid Driver's License/Owner's Card\n" +
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"- Utility reciepts\n" +
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"- Pre-printed rent reciepts\n" +
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"- Social Security correspondence\n" +
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"- Nursing Home residents may submit a letter on the facility's stationery stating the admission date and signed by the director or administrator\n" +
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"- Local, state, or federal income tax return with a pre-printed name and address label");
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break;
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case "Income":
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alert("Valid Proofs of Income:\n" +
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"(note: The following examples are acceptable documents but not limited to:)\n\n" +
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"- PA-40 or an IRS 1040 income tax return\n" +
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"- Income tax return schedules (B, C, D, etc.)\n" +
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"- Social Security 1099 form (only document accepted for Social Security income\n" +
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"- Benefit letter stating SSI payments\n" +
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"- RRB-1099 and RRB-1099R forms (Railroad)\n" +
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"- Pension/Annuities/IRA 1099 forms\n" +
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"- W-2 forms (wages)\n" +
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"- Bank statement (last month of previous year)\n" +
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"- Court Order");
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break;
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default:
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}
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}
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function FieldFriendlyDisc(field)
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{
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switch(field)
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{
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case "Yr_lastname":
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FriendlyName = "Applicant Last Name";
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break;
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case "Yr_firstname":
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FriendlyName = "Applicant First Name";
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break;
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case "Yr_address":
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FriendlyName = "Applicant Street Address";
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break;
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case "Yr_City":
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FriendlyName = "Applicant City";
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break;
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case "Yr_State":
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FriendlyName = "Applicant 2-digit State Code";
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break;
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case "Yr_zip01":
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FriendlyName = "Applicant 5-digit Zip Code";
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break;
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case "Yr_zip02":
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FriendlyName = "Applicant 4-digit Zip Code suffix";
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break;
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case "Yr_race":
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FriendlyName = "Applicant Ethnicity Code";
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break;
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case "Yr_rtype":
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FriendlyName = "Applicant Residence Type";
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break;
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case "Yr_Mo":
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FriendlyName = "Applicant Birth Month";
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break;
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case "Yr_Day":
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FriendlyName = "Applicant Birth Day of Month";
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break;
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case "Yr_Year":
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FriendlyName = "Applicant Birth Year";
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break;
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case "Yr_ssn":
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FriendlyName = "Applicant Social Security Number";
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break;
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case "Yr_phone01":
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FriendlyName = "Applicant 3-digit Area Code";
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break;
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case "Yr_phone7":
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FriendlyName = "Applicant 7-digit Telephone Number";
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break;
|
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case "Yr_mstat":
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FriendlyName = "Marital Status";
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break;
|
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case "Sp_lastname":
|
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FriendlyName = "Spouse Last Name";
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break;
|
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case "Sp_firstname":
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FriendlyName = "Spouse First Name";
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break;
|
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case "Sp_address":
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FriendlyName = "Spouse Street Address";
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break;
|
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case "Sp_City":
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FriendlyName = "Spouse City";
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break;
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case "Sp_State":
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FriendlyName = "Spouse 2-digit State Code";
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break;
|
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case "Sp_zip01":
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FriendlyName = "Spouse 5-digit Zip Code";
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break;
|
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case "Sp_zip02":
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FriendlyName = "Spouse 4-digit Zip Code suffix";
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break;
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case "Sp_race":
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FriendlyName = "Spouse Ethnicity Code";
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break;
|
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case "Sp_rtype":
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FriendlyName = "Spouse Residence Type";
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break;
|
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case "Sp_Mo":
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FriendlyName = "Spouse Birth Month";
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break;
|
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case "Sp_Day":
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FriendlyName = "Spouse Birth Day of Month";
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break;
|
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case "Sp_Year":
|
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FriendlyName = "Spouse Birth Year";
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break;
|
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case "Sp_ssn":
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FriendlyName = "Spouse Social Security Number";
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break;
|
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case "Sp_phone01":
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FriendlyName = "Spouse 3-digit Area Code";
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break;
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case "Sp_phone7":
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FriendlyName = "Spouse 7-digit Telephone Number";
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break;
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case "DSyear":
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FriendlyName = "Year of Divorce or Separation";
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break;
|
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case "yrPOA_name":
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FriendlyName = "Applicant Power of Attorney name";
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break;
|
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case "yrPOA_address":
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FriendlyName = "Applicant Power of Attorney address";
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break;
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case "yrPOA_city":
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FriendlyName = "Applicant Power of Attorney city";
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break;
|
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case "yrPOA_state":
|
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FriendlyName = "Applicant Power of Attorney state";
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break;
|
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case "yrPOA_zip01":
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FriendlyName = "Applicant Power of Attorney 5-digit Zip Code";
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break;
|
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case "yrPOA_zip02":
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FriendlyName = "Applicant Power of Attorney 4-digit Zip Code suffix";
|
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break;
|
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case "yrPOA_phone01":
|
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FriendlyName = "Applicant Power of Attorney area code";
|
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break;
|
|
case "yrPOA_phone02":
|
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FriendlyName = "Applicant Power of Attorney 3-digit section of phone number";
|
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break;
|
|
case "yrPOA_phone03":
|
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FriendlyName = "Applicant Power of Attorney 4-digit section of phone number";
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break;
|
|
case "yrPOA_year":
|
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FriendlyName = "Applicant Power of Attorney Year Assigned";
|
|
break;
|
|
case "spPOA_name":
|
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FriendlyName = "Spouse Power of Attorney name";
|
|
break;
|
|
case "spPOA_address":
|
|
FriendlyName = "Spouse Power of Attorney address";
|
|
break;
|
|
case "spPOA_city":
|
|
FriendlyName = "Spouse Power of Attorney city";
|
|
break;
|
|
case "spPOA_state":
|
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FriendlyName = "Spouse Power of Attorney state";
|
|
break;
|
|
case "spPOA_zip01":
|
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FriendlyName = "Spouse Power of Attorney 5-digit Zip Code";
|
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break;
|
|
case "spPOA_zip02":
|
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FriendlyName = "Spouse Power of Attorney 4-digit Zip Code suffix";
|
|
break;
|
|
case "spPOA_phone01":
|
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FriendlyName = "Spouse Power of Attorney area code";
|
|
break;
|
|
case "spPOA_phone02":
|
|
FriendlyName = "Spouse Power of Attorney 3-digit section of phone number";
|
|
break;
|
|
case "spPOA_phone03":
|
|
FriendlyName = "Spouse Power of Attorney 4-digit section of phone number";
|
|
break;
|
|
case "spPOA_year":
|
|
FriendlyName = "Spouse Power of Attorney Year Assigned";
|
|
break;
|
|
case "Scan01":
|
|
FriendlyName = "Valid Proof of Age Image";
|
|
break;
|
|
case "Scan02":
|
|
FriendlyName = "Valid Proof of Residence Image";
|
|
break;
|
|
case "Scan03":
|
|
FriendlyName = "Valid Proof of Income Image";
|
|
break;
|
|
default:
|
|
FriendlyName = field + ' [discription missing]';
|
|
}
|
|
|
|
return (FriendlyName + ' is a required field.');
|
|
}
|
|
|
|
function RequiredFields(page)
|
|
{
|
|
errmsg = "";
|
|
blnReqFlds = false;
|
|
Statchecked = false;
|
|
|
|
switch(page)
|
|
{
|
|
case "002":
|
|
frmObj = document.frmSect02;
|
|
for (i=0; i<frmObj.length; i++)
|
|
{
|
|
switch (frmObj.elements[i].id)
|
|
{
|
|
case "Yr_lastname":
|
|
case "Yr_firstname":
|
|
case "Yr_address":
|
|
case "Yr_City":
|
|
case "Yr_State":
|
|
case "Yr_zip01":
|
|
if (frmObj.elements[i].value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.elements[i].id) + "\n";
|
|
HighlightField(frmObj.elements[i].style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.elements[i].style);
|
|
}
|
|
break;
|
|
default:
|
|
}
|
|
}
|
|
break;
|
|
case "003":
|
|
frmObj = document.frmSect03;
|
|
for (i=0; i<frmObj.length; i++)
|
|
{
|
|
switch (frmObj.elements[i].id)
|
|
{
|
|
case "Yr_Mo":
|
|
case "Yr_Day":
|
|
case "Yr_Year":
|
|
if (frmObj.elements[i].value.length < 1 || frmObj.elements[i].value == 0)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.elements[i].id) + "\n";
|
|
HighlightField(frmObj.elements[i].style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.elements[i].style);
|
|
}
|
|
break;
|
|
case "Yr_BDate":
|
|
if (frmObj.Yr_Mo.value > 0 && frmObj.Yr_Day.value > 0 && frmObj.Yr_Year.value > 0)
|
|
{
|
|
if (DateCheck(frmObj.Yr_Mo.value, frmObj.Yr_Day.value, frmObj.Yr_Year.value) == false)
|
|
blnReqFlds = true;
|
|
}
|
|
break;
|
|
case "Yr_ssn":
|
|
frmObj.elements[i].value = frmObj.Yr_ssn01.value + frmObj.Yr_ssn02.value + frmObj.Yr_ssn03.value;
|
|
if (frmObj.elements[i].value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.elements[i].id) + "\n";
|
|
HighlightField(frmObj.Yr_ssn01.style);
|
|
HighlightField(frmObj.Yr_ssn02.style);
|
|
HighlightField(frmObj.Yr_ssn03.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.Yr_ssn01.style);
|
|
UnHighlightField(frmObj.Yr_ssn02.style);
|
|
UnHighlightField(frmObj.Yr_ssn03.style);
|
|
if (IndividualEdits('ssn', frmObj.elements[i], true) == false)
|
|
{
|
|
frmObj.Yr_ssn01.focus();
|
|
blnReqFlds = true;
|
|
}
|
|
}
|
|
break;
|
|
/* 09/01/2002 - Now, remove requirement on AreaCode and Phone
|
|
case "Yr_phone01":
|
|
if (frmObj.elements[i].value.length < 1 || frmObj.elements[i].value == 0)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.elements[i].id) + "\n";
|
|
HighlightField(frmObj.elements[i].style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.elements[i].style);
|
|
if (IndividualEdits('areacode', frmObj.elements[i], true) == false)
|
|
{
|
|
frmObj.elements[i].focus();
|
|
blnReqFlds = true;
|
|
}
|
|
}
|
|
break;
|
|
*/
|
|
case "Yr_phone7":
|
|
frmObj.elements[i].value = frmObj.Yr_phone02.value + frmObj.Yr_phone03.value;
|
|
if (IndividualEdits('phone', frmObj.elements[i], true) == false)
|
|
{
|
|
frmObj.Yr_phone02.focus();
|
|
blnReqFlds = true;
|
|
}
|
|
break;
|
|
/*
|
|
if (frmObj.elements[i].value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.elements[i].id) + "\n";
|
|
HighlightField(frmObj.Yr_phone02.style);
|
|
HighlightField(frmObj.Yr_phone03.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.Yr_phone02.style);
|
|
UnHighlightField(frmObj.Yr_phone03.style);
|
|
if (IndividualEdits('phone', frmObj.elements[i], true) == false)
|
|
{
|
|
frmObj.Yr_phone02.focus();
|
|
blnReqFlds = true;
|
|
}
|
|
}
|
|
break;
|
|
*/
|
|
default:
|
|
}
|
|
}
|
|
break;
|
|
case "004":
|
|
frmObj = document.frmSect04;
|
|
for (i=0; i<frmObj.length; i++)
|
|
{
|
|
switch (frmObj.elements[i].id)
|
|
{
|
|
case "Sp_lastname":
|
|
case "Sp_firstname":
|
|
case "Sp_address":
|
|
case "Sp_City":
|
|
case "Sp_State":
|
|
case "Sp_zip01":
|
|
if (frmObj.elements[i].value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.elements[i].id) + "\n";
|
|
HighlightField(frmObj.elements[i].style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.elements[i].style);
|
|
}
|
|
break;
|
|
default:
|
|
}
|
|
}
|
|
break;
|
|
case "005":
|
|
frmObj = document.frmSect05;
|
|
for (i=0; i<frmObj.length; i++)
|
|
{
|
|
switch (frmObj.elements[i].id)
|
|
{
|
|
case "Sp_Mo":
|
|
case "Sp_Day":
|
|
case "Sp_Year":
|
|
if (frmObj.elements[i].value.length < 1 || frmObj.elements[i].value == 0)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.elements[i].id) + "\n";
|
|
HighlightField(frmObj.elements[i].style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.elements[i].style);
|
|
}
|
|
break;
|
|
case "Sp_BDate":
|
|
if (frmObj.Sp_Mo.value > 0 && frmObj.Sp_Day.value > 0 && frmObj.Sp_Year.value > 0)
|
|
{
|
|
if (DateCheck(frmObj.Sp_Mo.value, frmObj.Sp_Day.value, frmObj.Sp_Year.value) == false)
|
|
blnReqFlds = true;
|
|
}
|
|
break;
|
|
case "Sp_ssn":
|
|
frmObj.elements[i].value = frmObj.Sp_ssn01.value + frmObj.Sp_ssn02.value + frmObj.Sp_ssn03.value;
|
|
if (frmObj.elements[i].value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.elements[i].id) + "\n";
|
|
HighlightField(frmObj.Sp_ssn01.style);
|
|
HighlightField(frmObj.Sp_ssn02.style);
|
|
HighlightField(frmObj.Sp_ssn03.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.Sp_ssn01.style);
|
|
UnHighlightField(frmObj.Sp_ssn02.style);
|
|
UnHighlightField(frmObj.Sp_ssn03.style);
|
|
if (IndividualEdits('ssn', frmObj.elements[i], true) == false)
|
|
{
|
|
frmObj.Sp_ssn01.focus();
|
|
blnReqFlds = true;
|
|
}
|
|
}
|
|
break;
|
|
/* 09/01/2002 - Now, remove requirement on AreaCode and Phone
|
|
case "Sp_phone01":
|
|
if (frmObj.elements[i].value.length < 1 || frmObj.elements[i].value == 0)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.elements[i].id) + "\n";
|
|
HighlightField(frmObj.elements[i].style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.elements[i].style);
|
|
if (IndividualEdits('areacode', frmObj.elements[i], true) == false)
|
|
{
|
|
frmObj.elements[i].focus();
|
|
blnReqFlds = true;
|
|
}
|
|
}
|
|
break;
|
|
*/
|
|
case "Sp_phone7":
|
|
frmObj.elements[i].value = frmObj.Sp_phone02.value + frmObj.Sp_phone03.value;
|
|
if (IndividualEdits('phone', frmObj.elements[i], true) == false)
|
|
{
|
|
frmObj.Sp_phone02.focus();
|
|
blnReqFlds = true;
|
|
}
|
|
break;
|
|
/*
|
|
if (frmObj.elements[i].value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.elements[i].id) + "\n";
|
|
HighlightField(frmObj.Sp_phone02.style);
|
|
HighlightField(frmObj.Sp_phone03.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.Sp_phone02.style);
|
|
UnHighlightField(frmObj.Sp_phone03.style);
|
|
if (IndividualEdits('phone', frmObj.elements[i], true) == false)
|
|
{
|
|
frmObj.Sp_phone02.focus();
|
|
blnReqFlds = true;
|
|
}
|
|
}
|
|
break;
|
|
*/
|
|
default:
|
|
}
|
|
}
|
|
break;
|
|
|
|
case "006":
|
|
frmObj = document.frmSect06;
|
|
for (i=0; i<frmObj.length; i++)
|
|
{
|
|
switch (frmObj.elements[i].id)
|
|
{
|
|
case "Yr_rtype":
|
|
if (frmObj.elements[i].value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.elements[i].id) + "\n";
|
|
HighlightField(frmObj.elements[i].style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.elements[i].style);
|
|
}
|
|
break;
|
|
default:
|
|
switch (frmObj.elements[i].id)
|
|
{
|
|
case "Yr_mstat":
|
|
if (frmObj.elements[i].value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.elements[i].id) + "\n";
|
|
HighlightField(frmObj.elements[i].style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.elements[i].style);
|
|
}
|
|
break;
|
|
case "DSyear":
|
|
if (frmObj.Yr_mstat.value == '3' || frmObj.Yr_mstat.value == '4')
|
|
{
|
|
if (frmObj.elements[i].value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.elements[i].id) + "\n";
|
|
HighlightField(frmObj.elements[i].style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.elements[i].style);
|
|
}
|
|
}
|
|
default:
|
|
}
|
|
}
|
|
}
|
|
break;
|
|
case "007":
|
|
frmObj = document.frmSect07;
|
|
for (i=0; i<frmObj.length; i++)
|
|
{
|
|
switch (frmObj.elements[i].id)
|
|
{
|
|
case "Sp_rtype":
|
|
if (frmObj.elements[i].value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.elements[i].id) + "\n";
|
|
HighlightField(frmObj.elements[i].style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.elements[i].style);
|
|
}
|
|
break;
|
|
default:
|
|
}
|
|
}
|
|
break;
|
|
case "008":
|
|
frmObj = document.frmSect08;
|
|
Inc01 = frmObj.Tot_Income1;
|
|
Inc02 = frmObj.Tot_Income2;
|
|
Inc03 = frmObj.Tot_Income3;
|
|
Inc04 = frmObj.Tot_Income4;
|
|
Inc05 = frmObj.Tot_Income5;
|
|
Inc06 = frmObj.Tot_Income6;
|
|
spInc01 = frmObj.sp_Tot_Income1;
|
|
spInc02 = frmObj.sp_Tot_Income2;
|
|
spInc03 = frmObj.sp_Tot_Income3;
|
|
spInc04 = frmObj.sp_Tot_Income4;
|
|
spInc05 = frmObj.sp_Tot_Income5;
|
|
spInc06 = frmObj.sp_Tot_Income6;
|
|
tvalue = 0;
|
|
tvalue = tvalue + parseFloat(Inc01.value) + parseFloat(Inc02.value);
|
|
tvalue = tvalue + parseFloat(Inc03.value) + parseFloat(Inc04.value);
|
|
tvalue = tvalue + parseFloat(Inc05.value) + parseFloat(Inc06.value);
|
|
tvalue = tvalue + parseFloat(spInc01.value) + parseFloat(spInc02.value);
|
|
tvalue = tvalue + parseFloat(spInc03.value) + parseFloat(spInc04.value);
|
|
tvalue = tvalue + parseFloat(spInc05.value) + parseFloat(spInc06.value);
|
|
|
|
frmObj.Tot_Income7.value = Math.round(tvalue * Math.pow(10, 2)) / Math.pow(10, 2);
|
|
blnReqFlds = false;
|
|
break;
|
|
|
|
case "888":
|
|
//There is a bug here. Since boolean value can be
|
|
//changed on just either Applicant or spouse being
|
|
//correct, only having one correct can bypass the check.
|
|
//SIW 07.21.2004
|
|
frmObj = document.frmSect888;
|
|
if ((frmObj.CertFirstA.value == frmObj.hdn888AF.value) && (frmObj.CertLastA.value == frmObj.hdn888AL.value) && (frmObj.CertMiA.value == frmObj.hdn888AM.value))
|
|
{
|
|
blnReqFlds = false;
|
|
}
|
|
else
|
|
{
|
|
errmsg = errmsg + "The entered name must exactly match that entered for the Applicant." + "\n";
|
|
blnReqFlds = true;
|
|
}
|
|
|
|
if (frmObj.hdn888SF.value.length > 0)
|
|
{
|
|
if ((frmObj.CertFirstS.value == frmObj.hdn888SF.value) && (frmObj.CertLastS.value == frmObj.hdn888SL.value) && (frmObj.CertMiS.value == frmObj.hdn888SM.value))
|
|
{
|
|
blnReqFlds = false;
|
|
}
|
|
else
|
|
{
|
|
errmsg = errmsg + "The entered name must exactly match that entered for the Spouse." + "\n";
|
|
blnReqFlds = true;
|
|
}
|
|
}
|
|
break;
|
|
|
|
case "009":
|
|
frmObj = document.frmSect09;
|
|
for (i=0; i<frmObj.length; i++)
|
|
{
|
|
switch (frmObj.elements[i].id)
|
|
{
|
|
case "yrPOA_check":
|
|
if (frmObj.yrPOA_check.checked)
|
|
{
|
|
if (frmObj.yrPOA_name.value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.yrPOA_name.id) + "\n";
|
|
HighlightField(frmObj.yrPOA_name.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.yrPOA_name.style);
|
|
}
|
|
if (frmObj.yrPOA_address.value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.yrPOA_address.id) + "\n";
|
|
HighlightField(frmObj.yrPOA_address.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.yrPOA_address.style);
|
|
}
|
|
if (frmObj.yrPOA_city.value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.yrPOA_city.id) + "\n";
|
|
HighlightField(frmObj.yrPOA_city.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.yrPOA_city.style);
|
|
}
|
|
if (frmObj.yrPOA_state.value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.yrPOA_state.id) + "\n";
|
|
HighlightField(frmObj.yrPOA_state.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.yrPOA_state.style);
|
|
}
|
|
if (frmObj.yrPOA_zip01.value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.yrPOA_zip01.id) + "\n";
|
|
HighlightField(frmObj.yrPOA_zip01.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.yrPOA_zip01.style);
|
|
}
|
|
//yrPOAyr = frmObj.yrPOA_year;
|
|
//valYear = yrPOAyr.options[yrPOAyr.selectedIndex].value;
|
|
//if (valYear.length < 1)
|
|
//{
|
|
// errmsg = errmsg + FieldFriendlyDisc(frmObj.yrPOA_year.id) + "\n";
|
|
// HighlightField(frmObj.yrPOA_year.style);
|
|
// blnReqFlds = true;
|
|
//}
|
|
//else
|
|
//{
|
|
// UnHighlightField(frmObj.yrPOA_year.style);
|
|
//}
|
|
/*
|
|
if (frmObj.yrPOA_phone01.value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.yrPOA_phone01.id) + "\n";
|
|
HighlightField(frmObj.yrPOA_phone01.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.yrPOA_phone01.style);
|
|
}
|
|
if (frmObj.yrPOA_phone02.value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.yrPOA_phone02.id) + "\n";
|
|
HighlightField(frmObj.yrPOA_phone02.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.yrPOA_phone02.style);
|
|
}
|
|
if (frmObj.yrPOA_phone03.value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.yrPOA_phone03.id) + "\n";
|
|
HighlightField(frmObj.yrPOA_phone03.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.yrPOA_phone03.style);
|
|
}
|
|
*/
|
|
}
|
|
break;
|
|
case "yrPOA_phone10":
|
|
frmObj.elements[i].value = frmObj.yrPOA_phone01.value;
|
|
if (IndividualEdits('areacode', frmObj.elements[i], true) == false)
|
|
{
|
|
frmObj.yrPOA_phone01.focus();
|
|
blnReqFlds = true;
|
|
}
|
|
frmObj.elements[i].value = frmObj.yrPOA_phone02.value + frmObj.yrPOA_phone03.value;
|
|
if (IndividualEdits('phone', frmObj.elements[i], true) == false)
|
|
{
|
|
frmObj.yrPOA_phone02.focus();
|
|
blnReqFlds = true;
|
|
}
|
|
if (blnReqFlds == false)
|
|
frmObj.elements[i].value = frmObj.yrPOA_phone01.value + frmObj.yrPOA_phone02.value + frmObj.yrPOA_phone03.value;
|
|
break;
|
|
default:
|
|
}
|
|
}
|
|
break;
|
|
case "010":
|
|
frmObj = document.frmSect10;
|
|
for (i=0; i<frmObj.length; i++)
|
|
{
|
|
switch (frmObj.elements[i].id)
|
|
{
|
|
case "spPOA_check":
|
|
if (frmObj.spPOA_check.checked)
|
|
{
|
|
if (frmObj.spPOA_name.value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.spPOA_name.id) + "\n";
|
|
HighlightField(frmObj.spPOA_name.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.spPOA_name.style);
|
|
}
|
|
if (frmObj.spPOA_address.value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.spPOA_address.id) + "\n";
|
|
HighlightField(frmObj.spPOA_address.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.spPOA_address.style);
|
|
}
|
|
if (frmObj.spPOA_city.value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.spPOA_city.id) + "\n";
|
|
HighlightField(frmObj.spPOA_city.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.spPOA_city.style);
|
|
}
|
|
if (frmObj.spPOA_state.value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.spPOA_state.id) + "\n";
|
|
HighlightField(frmObj.spPOA_state.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.spPOA_state.style);
|
|
}
|
|
if (frmObj.spPOA_zip01.value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.spPOA_zip01.id) + "\n";
|
|
HighlightField(frmObj.spPOA_zip01.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.spPOA_zip01.style);
|
|
}
|
|
//spPOAyr = frmObj.spPOA_year;
|
|
//valYear = spPOAyr.options[spPOAyr.selectedIndex].value;
|
|
//if (valYear.length < 1)
|
|
//{
|
|
// errmsg = errmsg + FieldFriendlyDisc(frmObj.spPOA_year.id) + "\n";
|
|
// HighlightField(frmObj.spPOA_year.style);
|
|
// blnReqFlds = true;
|
|
//}
|
|
//else
|
|
//{
|
|
// UnHighlightField(frmObj.spPOA_year.style);
|
|
//}
|
|
/*
|
|
if (frmObj.spPOA_phone01.value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.spPOA_phone01.id) + "\n";
|
|
HighlightField(frmObj.spPOA_phone01.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.spPOA_phone01.style);
|
|
}
|
|
if (frmObj.spPOA_phone02.value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.spPOA_phone02.id) + "\n";
|
|
HighlightField(frmObj.spPOA_phone02.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.spPOA_phone02.style);
|
|
}
|
|
if (frmObj.spPOA_phone03.value.length < 1)
|
|
{
|
|
errmsg = errmsg + FieldFriendlyDisc(frmObj.spPOA_phone03.id) + "\n";
|
|
HighlightField(frmObj.spPOA_phone03.style);
|
|
blnReqFlds = true;
|
|
}
|
|
else
|
|
{
|
|
UnHighlightField(frmObj.spPOA_phone03.style);
|
|
}
|
|
*/
|
|
}
|
|
break;
|
|
case "spPOA_phone10":
|
|
frmObj.elements[i].value = frmObj.spPOA_phone01.value;
|
|
if (IndividualEdits('areacode', frmObj.elements[i], true) == false)
|
|
{
|
|
frmObj.spPOA_phone01.focus();
|
|
blnReqFlds = true;
|
|
}
|
|
frmObj.elements[i].value = frmObj.spPOA_phone02.value + frmObj.spPOA_phone03.value;
|
|
if (IndividualEdits('phone', frmObj.elements[i], true) == false)
|
|
{
|
|
frmObj.spPOA_phone02.focus();
|
|
blnReqFlds = true;
|
|
}
|
|
if (blnReqFlds == false)
|
|
frmObj.elements[i].value = frmObj.spPOA_phone01.value + frmObj.spPOA_phone02.value + frmObj.spPOA_phone03.value;
|
|
break;
|
|
default:
|
|
}
|
|
}
|
|
break;
|
|
case "011":
|
|
frmObj = document.frmSect11;
|
|
for (i=0; i<frmObj.length; i++)
|
|
{
|
|
switch (frmObj.elements[i].id)
|
|
{
|
|
case "yr_prepphone10":
|
|
frmObj.elements[i].value = frmObj.yr_prepphone01.value;
|
|
if (IndividualEdits('areacode', frmObj.elements[i], true) == false)
|
|
{
|
|
frmObj.yr_prepphone01.focus();
|
|
blnReqFlds = true;
|
|
}
|
|
frmObj.elements[i].value = frmObj.yr_prepphone02.value + frmObj.yr_prepphone03.value;
|
|
if (IndividualEdits('phone', frmObj.elements[i], true) == false)
|
|
{
|
|
frmObj.yr_prepphone02.focus();
|
|
blnReqFlds = true;
|
|
}
|
|
if (blnReqFlds == false)
|
|
frmObj.elements[i].value = frmObj.yr_prepphone01.value + frmObj.yr_prepphone02.value + frmObj.yr_prepphone03.value;
|
|
break;
|
|
default:
|
|
}
|
|
}
|
|
break;
|
|
//case "012":
|
|
// frmObj = document.frmSect12;
|
|
// for (i=0; i<frmObj.length; i++)
|
|
// {
|
|
// switch (frmObj.elements[i].id)
|
|
// {
|
|
// case "sp_prepphone10":
|
|
// frmObj.elements[i].value = frmObj.sp_prepphone01.value;
|
|
// if (IndividualEdits('areacode', frmObj.elements[i], true) == false)
|
|
// {
|
|
// frmObj.sp_prepphone01.focus();
|
|
// blnReqFlds = true;
|
|
// }
|
|
// frmObj.elements[i].value = frmObj.sp_prepphone02.value + frmObj.sp_prepphone03.value;
|
|
// if (IndividualEdits('phone', frmObj.elements[i], true) == false)
|
|
// {
|
|
// frmObj.sp_prepphone02.focus();
|
|
// blnReqFlds = true;
|
|
// }
|
|
// if (blnReqFlds == false)
|
|
// frmObj.elements[i].value = frmObj.sp_prepphone01.value + frmObj.sp_prepphone02.value + frmObj.sp_prepphone03.value;
|
|
// break;
|
|
// }
|
|
// }
|
|
// break;
|
|
default:
|
|
}
|
|
|
|
if (blnReqFlds)
|
|
{
|
|
if (errmsg.length > 0)
|
|
alert(errmsg);
|
|
}
|
|
return(blnReqFlds);
|
|
}
|
|
|
|
function GoSubmit(frmObj)
|
|
{
|
|
if (RequiredFields(frmObj.hdnfrm.value) == false)
|
|
{
|
|
frmObj.submit();
|
|
}
|
|
}
|
|
|
|
function popUp(url)
|
|
{
|
|
sealWin=window.open(url,"win",'toolbar=0,location=0,directories=0,status=1,menubar=1,scrollbars=1,resizable=1,width=500,height=450');
|
|
self.name = "mainWin";
|
|
}
|
|
|
|
function AddPrepName(Obj)
|
|
{
|
|
var typeObj = Obj.id;
|
|
var frmObj = Obj.form;
|
|
if (typeObj.substr(0, 2) == "yr")
|
|
{
|
|
frmObj.yr_prepname.value = frmObj.hdnPrepAppFirst.value + ' ' + frmObj.hdnPrepAppLast.value;
|
|
frmObj.yr_prepphone01.value = frmObj.hdnPrepAppAC.value;
|
|
frmObj.yr_prepphone02.value = frmObj.hdnPrepAppPhone.value.substr(0, 3);
|
|
frmObj.yr_prepphone03.value = frmObj.hdnPrepAppPhone.value.substr(3, 4);
|
|
}
|
|
else
|
|
{
|
|
frmObj.sp_prepname.value = frmObj.hdnPrepSpFirst.value + ' ' + frmObj.hdnPrepSpLast.value;
|
|
frmObj.sp_prepphone01.value = frmObj.hdnPrepSpAC.value;
|
|
frmObj.sp_prepphone02.value = frmObj.hdnPrepSpPhone.value.substr(0, 3);
|
|
frmObj.sp_prepphone03.value = frmObj.hdnPrepSpPhone.value.substr(3, 4);
|
|
}
|
|
}
|
|
</script>
|
|
</head>
|
|
<body bgcolor=GhostWhite>
|
|
|
|
<table border=0 cellpadding=0 cellspacing=0 width="600" align=center>
|
|
<tr>
|
|
<td width="50%" align=center>
|
|
<img src="/images/NewColorLogo.gif" border=0
|
|
align=absmiddle alt="First Health Services Corporation logo"
|
|
title="First Health Services Corporation logo">
|
|
</td>
|
|
<td width="50%" align=center valign=middle>
|
|
<img src="/images/PaPACE.gif" border=0
|
|
align=absmiddle alt="Pennsylvania Department of Aging logo"
|
|
title="Pennsylvania Department of Aging logo">
|
|
</td>
|
|
</tr>
|
|
<tr>
|
|
<td width="50%" valign=top nowrap>
|
|
<b><font size=3 face="Arial">
|
|
PACE/PACENET Enrollment</font></b>
|
|
</td>
|
|
<td width="50%" valign=top nowrap>
|
|
<b><font size=2 face="Arial">
|
|
Need Assistance?<br>
|
|
Call: Inside PA <font color="Red">1-800-225-7223</font> Outside PA <font color="Red">717-651-3600</font><br>
|
|
Email: <a href="mailto:PACECares@fhsc.com"
|
|
title="Email: PACECares@fhsc.com">PACECares@fhsc.com</a>
|
|
</font></b>
|
|
</td>
|
|
</tr>
|
|
</table>
|
|
|
|
|
|
<form id="frmSect11" name="frmSect11" method=get
|
|
enctype="multipart/form-data" action="PaceWizardDataSet.asp">
|
|
<table border=2 cellpadding=0 cellspacing=0 width="600" bgcolor="#000066" align=center>
|
|
<tr><td>
|
|
<table border=0 cellpadding=0 cellspacing=0 width="100%" bgcolor="#000066" align=center>
|
|
<tr>
|
|
<td width="100%" colspan=3><br></td>
|
|
</tr>
|
|
<tr bgcolor="LightGrey">
|
|
<td width="100%" colspan=3 valign=top>
|
|
<font size=3><b>
|
|
<input type="checkbox" id="yrprep_check" name="yrprep_check"
|
|
onClick="AddPrepName(this)">Check if same
|
|
as Applicant</b></font>
|
|
</td>
|
|
</tr>
|
|
<tr bgcolor="LightGrey">
|
|
<td width="20%" nowrap><font size=3><b>Preparer's Name</b></font></td>
|
|
<td width="80%" colspan=2 valign=bottom nowrap>
|
|
<input id="yr_prepname" name="yr_prepname" size=30 maxlength=100>
|
|
<font size=3><b>Preparer's Phone</b></font>
|
|
(<input id="yr_prepphone01" name="yr_prepphone01" size=3 maxlength=3
|
|
onKeyUp="AutoTabCheck(this, this.form)">)
|
|
<input id="yr_prepphone02" name="yr_prepphone02" size=3 maxlength=3
|
|
onKeyUp="AutoTabCheck(this, this.form)">-<input
|
|
id="yr_prepphone03" name="yr_prepphone03" size=4 maxlength=4>
|
|
<input type="hidden" id="yr_prepphone10" name="yr_prepphone10">
|
|
<input type="hidden" id="hdnPrepAppLast" name="hdnPrepAppLast" value="Doe">
|
|
<input type="hidden" id="hdnPrepAppFirst" name="hdnPrepAppFirst" value="John">
|
|
<input type="hidden" id="hdnPrepAppAC" name="hdnPrepAppAC" value="215">
|
|
<input type="hidden" id="hdnPrepAppPhone" name="hdnPrepAppPhone" value="5551212">
|
|
</td>
|
|
</tr>
|
|
<tr>
|
|
<td width="100%" align=center nowrap colspan=3><br>
|
|
<font color="white" size=3><b>Please enter the Preparer's Name & Phone #.<br>
|
|
When you are done, click on 'Continue'.<br></b></font>
|
|
</td>
|
|
</tr>
|
|
<tr>
|
|
<td width="100%" align=right nowrap colspan=3><br><br>
|
|
<input type="button" value="Continue" id=button2 name=button2
|
|
onClick="Javascript:GoSubmit(document.frmSect11)">
|
|
<input type="button" value="Cancel" id=button1 name=button1
|
|
onClick="Javascript:CancelOutWizard()">
|
|
<input type="hidden" value="011" id="hdnfrm" name="hdnfrm">
|
|
<br><br>
|
|
</td>
|
|
</tr>
|
|
</table>
|
|
</td></tr>
|
|
</table>
|
|
<!--
|
|
|
|
<input type="hidden" id="hdnSpouse" name="hdnSpouse"
|
|
value="2">
|
|
<input type="hidden" id="hdnRecIDwr" name="hdnRecIDwr"
|
|
value="45791">
|
|
<input type="hidden" id="hdnMiscInfo" name="hdnMiscInfo"
|
|
value="BFC">
|
|
</form>
|
|
</body>
|
|
</html>
|