Authorization to Release Protected Health Information

<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd"> <html lang="en"> <head> <meta http-equiv="X-UA-Compatible" content="IE=edge"/>  <meta name="google" content="notranslate"/> <meta name="robots" content="none"/> <meta http-equiv='Content-Type' content='text/html; charset=UTF-8'/> <meta name="viewport" content="width=device-width, initial-scale=1.0, maximum-scale=1.0, user-scalable=0, viewport-fit=cover" > <title> Authorization to Release Protected Health Information</title> <script type="text/javascript"> var ksConfig = {"isDevMode":false,"isEform":false,"isOffline":false,"modulePath":"","moduleType":"MAIN","msig":"df90747eca7328b90f382623fe6532c1","serverTimeZoneOffset":"-480"}; </script> <script language='JavaScript' type='text/javascript' charset='UTF-8'> var currentPosition=1; </script> <script type="text/javascript" language="javascript" src="/js/vendor/ks.libs.js?version=549532" charset="UTF-8"></script> <script type="text/javascript" language="javascript" src="/js/metaUtil.js?version=549532" charset="UTF-8"></script> <script type="text/javascript" language="javascript" src="/survdata/form/js?id=156625&localeAnswerId=0&pwd=4e76" charset="UTF-8"></script> <script type="text/javascript" language="javascript" src="/Member/Voting/JSAPI/JSAPI.js?version=549532" charset="UTF-8"></script> <script language='JavaScript' type='text/javascript'> var mySurvey = null; var myQuestionSectionHeader = null; var myQuestionPickOneWithoutOther = null; var myQuestionPickOneWithOther = null; var myQuestionPickOneWithComment = null; var myQuestionCheckAllThatApplyWithoutOther= null; var myQuestionCheckAllThatApplyWithOther= null; var myQuestionDropDownBox= null; var myQuestionListBox= null; var myQuestionSingleLine= null; var myQuestionLookup = null; var myQuestionMulLookup = null; var myQuestionMultiLine= null; var myQuestionRateDifferent=null; var myQuestionCompareOneByOne=null; var myQuestion3dMatrix=null; var myQuestionNumericAllocation=null; var myColumnRadioForRateDifferent=null; var myAnswer=null; var myColumn=null; mySurvey = new Survey(156625,"Authorization to Release Protected Health Information","",null,"Voting",true,true,false); myQuestionPickOneWithoutOther=new QuestionPickOneWithoutOther(3147683,"<span class=\"required\" style=\"color: #ff0000;\">*<\u002fspan>Are you the patient?",false,"Q1"); myAnswer=new AnswerRadio(13105780,"<div>Yes<\u002fdiv>",false,"Q1.A1"); myQuestionPickOneWithoutOther.addAnswerRadio(myAnswer); myAnswer=new AnswerRadio(13105781,"No, I\'m the patient\'s personal representative.",false,"Q1.A2"); myQuestionPickOneWithoutOther.addAnswerRadio(myAnswer); mySurvey.addQuestion(myQuestionPickOneWithoutOther); </script> <script type="text/javascript"> ; var commonVotingModule = (function (window, $) { "use strict"; var commonVModule = {}; commonVModule.allDataRestored = $.Deferred(); commonVModule.resolveAllDataRestored = function () { eventsModuleProvider.getModule(true); pipingModuleProvider.getModule({}); commonVModule.allDataRestored.resolve(); }; commonVModule.surveyOpensFirstTime = $.Deferred(); commonVModule.resolveSurveyOpensFirstTime = function () { commonVModule.surveyOpensFirstTime.resolve(); }; return commonVModule; })(window, jQuery); (function ($) { 'use strict'; var actionType_SET = "SET_VALUE"; var actionType_RESET = "CLEAR_VALUE"; var actionType_SET_AND_RESET = "SET_AND_CLEAR_VALUE"; var setValue_CALC_NUMERIC="CALC_NUMERIC"; var setValue_CALC_TEXT="CALC_TEXT"; //set value static part var fnSetValue = function (questionId, answerId, columnNumOrId, result1, actionType, oldLogicResult, jsInlineFuncName,jsCalcFuncName,calculationType,hasPiping, loopInitiator, eventData) { if (window.votingWaitModule.getWaitingQuestionById(questionId)) { window.votingWaitModule.addWaitingSetValue(questionId,answerId,columnNumOrId); setTimeout(function () { fnSetValue(questionId, answerId, columnNumOrId, result1, actionType, oldLogicResult, jsInlineFuncName,jsCalcFuncName,calculationType,hasPiping, loopInitiator,eventData); }, 1); return false ; } window.votingWaitModule.removeWaitingSetValue(questionId,answerId,columnNumOrId); try { if (eventData && eventData.ignoreListeners) { return false; } var setValueInlineFunc = window.survData.setValueInlineFuncs[jsInlineFuncName]; var setValueCalcFunc = window.survData.setValueCalcInlineFuncs[jsCalcFuncName]; if (oldLogicResult) { oldLogicResult=!votingWaitModule.isSomeResultChange(jsInlineFuncName); } var result=result1; if (setValueCalcFunc && typeof setValueCalcFunc === 'function') { result=setValueCalcFunc(); if (setValue_CALC_TEXT == calculationType ) { if (result == null) { result = ""; } else if (hasPiping) { result = pipingModuleProvider.getModule().replacePipingText(result,false,true); result = KS_Utils.decodeHtmlEntities(result); } } else { if (result == null || !isFinite(result)) { result = ""; } else { result = "" + result; var vt = calculationModule.getValueType(questionId, answerId, columnNumOrId); if (vt) { var vtNative = new ValueType(vt.valType, vt.decimals, vt.decimalDivider, vt.thousendDivider, vt.format, vt.preffix, vt.suffix); result = "" + KS_ValueType.convertValue(vtNative, result); } } } } var logicResult = setValueInlineFunc(); if (logicResult) { votingWaitModule.refreshQuestionState(); } if (window.votingSubmitModule.debugMode && window.logOffline) { window.logOffline.info("do SetValue : queId = " + questionId + ", ansId = " + answerId + ", columnNumOrId = " + columnNumOrId + ", result = " + result + ", actionType = " + actionType + ", oldLogicResult = " + oldLogicResult + ", jsInlineFuncName = " + jsInlineFuncName + ", loopInitiator = " + loopInitiator + ", logicResult: " + logicResult + ", setValueInlineFunc: " + setValueInlineFunc); } var reset = false; if (actionType_RESET == actionType) { reset = true; } if (logicResult) { if (oldLogicResult == false) { oldLogicResult = true; votingResultsModule.setVotingResult(questionId, answerId, columnNumOrId, result, reset, loopInitiator,undefined,true); } } else { if (actionType_SET_AND_RESET == actionType) { reset = true; votingResultsModule.setVotingResult(questionId, answerId, columnNumOrId, result, reset, loopInitiator,undefined,true); } oldLogicResult = logicResult; } } catch(ex) { window.logOffline.error("SetValue Exception: queId = " + questionId + ", ansId = " + answerId + ", columnNumOrId = " + columnNumOrId + ", result = " + result + ", actionType = " + actionType + ", oldLogicResult = " + oldLogicResult + ", jsInlineFuncName = " + jsInlineFuncName + ", loopInitiator = " + loopInitiator + ", logicResult: " + logicResult + ", exception: " + ex); } return oldLogicResult; }; var beforeSetValue; window.commonVotingModule.setBeforeSetValueFunction = function (code) { beforeSetValue = code; }; window.commonVotingModule.allDataRestored.done(function () { if (beforeSetValue) { try { beforeSetValue(); } catch (e) { window.logOffline.error("BeforeSetValue could not be executed. Error: " + e); } } _.each(window.survData.setValues, function (setValue) { var oldLogicResult = false; var executeOnFirstOpen = setValue.executeOnFirstOpen && window.survData.setValueInlineFuncs[setValue.jsInlineFuncName](); if (executeOnFirstOpen === true) { commonVotingModule.surveyOpensFirstTime.done(function () { oldLogicResult = fnSetValue(setValue.questionId, setValue.answerId, setValue.columnNumOrId, setValue.result, setValue.actionType, false, setValue.jsInlineFuncName,setValue.jsInlineCalcFuncName,setValue.calculationType,setValue.calculationHasPiping, null); }); } else if (!setValue.executeOnFirstOpen) { window.logOffline.info("Blocked SetValue execution: questionId = " + setValue.questionId + ", answerId = " + setValue.answerId + ", columnNumOrId = " + setValue.columnNumOrId + ", result = " + setValue.result + ", actionType = " + setValue.actionType); } eventsModuleProvider.getModule().addEventHandlerToManyTokens(setValue.tokens, function(loopInitiator, eventData) { oldLogicResult = fnSetValue(setValue.questionId, setValue.answerId, setValue.columnNumOrId, setValue.result, setValue.actionType, oldLogicResult, setValue.jsInlineFuncName, setValue.jsInlineCalcFuncName,setValue.calculationType,setValue.calculationHasPiping, loopInitiator, eventData); }); eventsModuleProvider.getModule().addEventHandlerToManyTokens(setValue.calculatedTokens, function(loopInitiator, eventData) { oldLogicResult = fnSetValue(setValue.questionId, setValue.answerId, setValue.columnNumOrId, setValue.result, setValue.actionType, false, setValue.jsInlineFuncName, setValue.jsInlineCalcFuncName,setValue.calculationType,setValue.calculationHasPiping, loopInitiator, eventData); }); }); _.each(window.survData.setValues, function (setValue) { votingWaitModule.initQuestionDependency(setValue.jsInlineFuncName, setValue.tokens, setValue.answerId); }); }); //set value static part end //calc value static part var fnCalcValue = function(questionId, answerId, jsInlineFuncName, loopInitiator, calculationType, hasPiping) { try { var calcResult; try { var calcValueInlineFunc = window.survData.calcValueInlineFuncs[jsInlineFuncName]; calcResult = calcValueInlineFunc(); } catch (ex) { calcResult = ""; window.logOffline.error("Result calculation exception: queId = " + questionId + ", ansId = " + answerId + ", jsInlineFuncName = " + jsInlineFuncName + ", loopInitiator = " + loopInitiator + ", calculationType = " + calculationType + ", hasPiping = " + hasPiping + ", exception: " + ex); } if (calculationType == "TEXT") { if (calcResult == null) { calcResult = ""; } else if (hasPiping) { calcResult = pipingModuleProvider.getModule().replacePipingText(calcResult); calcResult = KS_Utils.decodeHtmlEntities(calcResult); } } else { if (calcResult == null || !isFinite(calcResult)) { calcResult = ""; } else { calcResult = "" + calcResult; var vt = calculationModule.getValueType(questionId, answerId, null); if (vt) { var vtNative = new ValueType(vt.valType, vt.decimals, vt.decimalDivider, vt.thousendDivider, vt.format, vt.preffix, vt.suffix); calcResult = "" + KS_ValueType.convertValue(vtNative, calcResult); } } } if (window.votingSubmitModule.debugMode && window.logOffline) { window.logOffline.info("do CalcValue: queId = " + questionId + ", ansId = " + answerId + ", jsInlineFuncName = " + jsInlineFuncName + ", loopInitiator = " + loopInitiator + ", calculationType = " + calculationType + ", hasPiping = " + hasPiping + ", calcResult: " + calcResult + ", calcValueInlineFunc:" + calcValueInlineFunc); } votingResultsModule.setVotingResult(questionId, answerId, null, calcResult, false, loopInitiator); } catch(ex) { window.logOffline.error("CalcValue Exception: queId = " + questionId + ", ansId = " + answerId + ", jsInlineFuncName = " + jsInlineFuncName + ", loopInitiator = " + loopInitiator + ", calculationType = " + calculationType + ", hasPiping = " + hasPiping + ", exception: " + ex); } }; window.commonVotingModule.allDataRestored.done(function () { _.each(window.survData.calculatedValues, function (calcValue) { eventsModuleProvider.getModule().addEventHandlerToManyTokens(calcValue.tokens, function(loopInitiator) { fnCalcValue(calcValue.questionId, calcValue.answerId, calcValue.jsInlineFuncName, loopInitiator, calcValue.calculationType, calcValue.hasPiping); }); commonVotingModule.surveyOpensFirstTime.done(function () { fnCalcValue(calcValue.questionId, calcValue.answerId, calcValue.jsInlineFuncName, null, calcValue.calculationType, calcValue.hasPiping); }); }); }); window.commonVotingModule.recalculateCalcValues = function() { _.each(window.survData.calculatedValues, function (calcValue) { fnCalcValue(calcValue.questionId, calcValue.answerId, calcValue.jsInlineFuncName, null, calcValue.calculationType, calcValue.hasPiping); }); }; //calc value static part end //ShowHide static part var fnShowHide = function(questionId, answerId, columnId, humanFormula, hideParam, clearParam, jsInlineFuncName, isAlways, loopInitiator, initialization) { if(!isPreviewSingleQuestion) { try { if (isPreviewMode && showHide && !showHide.getToggleStatus()) { return false; } if (window.votingWaitModule.getWaitingQuestionById(questionId)) { setTimeout(function () { fnShowHide(questionId, answerId, columnId, humanFormula, hideParam, clearParam, jsInlineFuncName, isAlways, loopInitiator, initialization); }, 10); return false; } var hide = !hideParam; var clear = !hideParam && clearParam && !isAlways; var showHideInlineFunc = window.survData.showHideInlineFuncs[jsInlineFuncName]; var logicResult = showHideInlineFunc(); if (logicResult) { hide = hideParam; clear = hideParam && clearParam && !isAlways; } window.showHideModule.setAnswerColumnVisibility(humanFormula, questionId, answerId, columnId, hide); //if clear and not always if (!initialization && clear && votingResultsModule.getVotingResult(questionId, answerId, columnId, null) != null) { votingResultsModule.setVotingResult(questionId, answerId, columnId, "", true, loopInitiator); } if (window.votingSubmitModule.debugMode && window.logOffline) { window.logOffline.info("do ShowHide : queId = " + questionId + ", ansId = " + answerId + ", columnId = " + columnId + ", answerHumanFormula = " + humanFormula + ", hideParam = " + hideParam + ", clearParam = " + clearParam + ", jsInlineFuncName = " + jsInlineFuncName + ", isAlways = " + isAlways + ", loopInitiator = " + loopInitiator + ", logicResult: " + logicResult + ", hide = " + hide + ", clear = " + clear + ", showHideInlineFunc = " + showHideInlineFunc); } } catch (ex) { window.logOffline.error("ShowHide exception: queId = " + questionId + ", ansId = " + answerId + ", isAlways = " + isAlways + ", hideParam = " + hideParam + ", clearParam = " + clearParam + ", answerHumanFormula = " + humanFormula + ", jsInlineFuncName = " + jsInlineFuncName + ", loopInitiator: " + loopInitiator + ", exception: " + ex); vpHide(humanFormula, false); } } }; var fnPredefinedFilter = function (questionId, loopInitiator, eventData) { window.logOffline.info("do prdefined filter change : queId = " + questionId); $.when(votingResultsModule.refreshLookupResultForFilter(questionId, loopInitiator, eventData)) .always(function () { window.LQ_Core.predefinedFilterChangedDropBox(questionId, null); }); }; window.commonVotingModule.allDataRestored.done(function () { _.each(window.survData.showHides, function (showHide) { eventsModuleProvider.getModule().addEventHandlerToManyTokens(showHide.tokens, function(loopInitiator) { fnShowHide(showHide.answerToken.questionId, showHide.answerToken.answerId, showHide.answerToken.columnId, showHide.answerHumanFormula, showHide.hide, showHide.clear, showHide.jsInlineFuncName, showHide.isAlways, loopInitiator, false); }); fnShowHide(showHide.answerToken.questionId, showHide.answerToken.answerId, showHide.answerToken.columnId, showHide.answerHumanFormula, showHide.hide, showHide.clear, showHide.jsInlineFuncName, showHide.isAlways, null, true); }); }); //ShowHide static part end //Predefined filter for lookup or multiple lookup window.commonVotingModule.allDataRestored.done(function () { var predefinedLookupFilter = {}; _.each(window.survData.questionsMap, function (que) { if (que.type && que.type === 'LOOKUP') { var tokens = LQ_Core.getTokensForFilters(que.questionId); eventsModuleProvider.getModule().addEventHandlerToManyTokens(tokens, function (loopInitiator, eventData) { fnPredefinedFilter(que.questionId, loopInitiator, eventData); }); } else if (que.type && que.type === 'MULTIPLE_LOOKUP') { LQ_Core.initPredefinedFilters(que.questionId); } }) }); }).call(window, jQuery); </script><script type="text/javascript"> var votingSubmitModule = (function (window, $, commonVotingModule) { "use strict"; var exports = {}; exports.debugMode = true; exports.isOfflineVoting = function () { return false; }; exports.submitCallback = undefined; exports.calculateBackPage = function () { var responsePageLink; if (exports.taskId) { responsePageLink = "index.html#tasks!" + exports.taskDefinitionId + "/" + exports.taskId; } else if (votingSubmitModule.customAnchor) { responsePageLink = "index.html#" + votingSubmitModule.customAnchor; } else { responsePageLink = "index.html#responses!" + getSurveyId(); } return '/portal/' + responsePageLink; }; var isLastPage = function() { return j$('#goSubmitPage').length > 0; }; var visitedPages = [{page : 1, passed : true, encountered: true},{page : 2, passed : true, encountered: true},{page : 3, passed : true, encountered: true},{page : 4, passed : true, encountered: true},{page : 5, passed : true, encountered: true},{page : 6, passed : true, encountered: true},{page : 7, passed : true, encountered: true},{page : 8, passed : true, encountered: true},{page : 9, passed : true, encountered: true},{page : 10, passed : true, encountered: true}]; exports.getResponseTrace = function() { return visitedPages; }; exports.responseId = null; function setCurrentResult($input, result) { if ($input.attr("type") === "hidden") { $input.val(result); } else { $input.attr("checked", "checked"); } } function getSurveyId() { return 156625; } exports.getPageNumber = function() { return 1; }; exports.submit = function (formForSubmit, dir) { formForSubmit.submit(); }; function getCurrentRespondentId() { return exports.responseId; } $(document).ready(function () { exports.survData = window.survData; commonVotingModule.resolveAllDataRestored(); commonVotingModule.resolveSurveyOpensFirstTime(); }); return exports; })(window, jQuery, commonVotingModule); if(!window.logOffline) { window.logOffline = { info: function (text) {if (window.console) console.log(text);}, error: function (text) {if (window.console) console.log(text);}, debug: function (text) {if (window.console) console.log(text);} }; } </script><script language='JavaScript' type='text/javascript' src='/js/CombinedJavascript.js?version=549532'> alert('Error! VoteLibJavascript Script was not loaded'); </script> <link rel='stylesheet' type='text/css' href='/js/pipingCallout/pipingCallout.css?version=549532'> <script language='JavaScript' type='text/javascript' charset='UTF-8'> var beforeSubmitMsg = "Before submitting you must first complete this question: \n"; var answerOtherMissingTextMsg = "missing text." var pleaseAnswerAllRowsMsg = "Please answer all rows in question: \n"; var pleaseAnswerMsg = "Please answer the following question: \n"; var pleaseAnswerAllMatrixFieldsMsg = "Please answer all matrix fields: \n"; var atLeastMsg = "Please answer at least"; var rowsMsg = "rows"; var oneRowMsg = "1 row"; var inQueMsg = "in question: \n"; var inTheQueMsg = "In the question: \n"; var youCanChooseMsg = "You can use each column only once."; var exclusiveAlert="The combination selected in question \"{0}\" is not valid.\n Please check your answers"; var mayCheckFullMsg = "You may select only up to {0} answer options in this question: \n {1} "; var chooseAtLeastFullMsg = "Please choose at least {0} answers to this question: \n {1}"; var exactlyFullMsg = "Please choose exactly {0} answers to this question: \n {1}"; var checkFromFullMsg = "You may only check from {0} to {1} answers to this question: \n {2}"; var inTheQue = "In the question: \n"; var summLess = "Sum total is less than {0}"; var summExceeds = "Sum total exceeds {0}"; var notAnsweredButPreferredMsg = "You did not answer the question(s):\n"; var isItOkMsg = "\nPress ok to continue with the survey submission, or cancel to go back and correct."; var pleaseRespondToTheFollowingItems = "Please respond to all of the following:\n"; var fileUploadTranslations = { confirmDeleteFileLabel: "Are you sure you want to delete this file?", closeImageGalleryLabel: "Close", clientFileSizeNotAllowed: "Uploaded file size ({0}) exceeds the maximum allowed size ({1}).", fileTooLarge: "This file is too large to edit from your mobile device.", clientFileTypeNotAllowed: "The type of file ({0}) you are trying to upload is not allowed.", rotateButton: "Rotate", deleteButton: "Delete", downloadButton: "Download", markupButton: "Markup", markupText: "Markup.", markupHint: "Highlight important areas", markupSaveButton: "Markup", markupCancelButton: "Cancel", markupClearButton: "Clear", pickColor: "Pick a color", cropButton: "Crop", cropText: "Image crop.", cropHint: "Select area to crop", cropSaveButton: "Crop", cropCancelButton: "Cancel", cropPreviewButton: "Crop", cropUndoButton: "Undo", saveButton: "Save", closeGalleryConfirm: "You have made changes, closing gallery will discard these changes. Are you sure you want to discard these changes?", galleryArrowNext: "Next", galleryArrowPrev: "Previous", questionIsNotSupportedAndroid: "This question is not supported in your current version of Android, please upgrade Android to 5.0 or greater", questionIsNotSupportedIOS: "This question is not supported in your current version of iOS, please upgrade iOS to 9.0 or greater", appAndServerDoesNotMatch: "Application and server versions do not match", connectToInternetToDownloadFile: "Connect to Internet to download file", downloadFileFromServer: "Download file from server", deleteDialogTitle: "Delete", worldappOfflineTitle: "Worldapp offline", editImageTooLarge: "The image you are trying to edit is too large. Maximum allowed size is 4 Mb.", deviceOfflineAlert: "Your device is currently offline. Connect to Internet to download file.", okButton: "OK", cancelButton: "Cancel", confirmFileTooLarge: "Image is too large for Crop\u002fRotate\u002fMarkup on mobile device", insertingFile: "Insert from...", insertFromCameraLabel: "Take Photo", chooseFileLabel: "Choose File", noFilesAttachedLabel: "No file attached" }; var ASMTranslations = { autosave: "Autosave:", status: "Status:", saved: "Saved", notsaved: "Not saved", on: "On", off: "Off", enable: "Enable", disable: "Disable" }; var printerFriendlyTranslations = { nothingSelected: "Nothing Selected" }; jQuery(function(){ /*POST_LOAD*/ }); document.onkeypress = stopFormEnter; var isPreviewMode=false; var isPreviewSingleQuestion=false; var doubleclick1=false; var arr_other=new Array(0,0); var arrtext_other=new Array("",""); var profileCodes=new Array("0"); // array of possible answers to link question that links to Profile Survey var dispNameValues=new Array(0); // array of used display name values var verifyPlugins = []; var beforeSubmitPlugins = []; var verifyShowHide = []; var prefAnsweredQue=[]; var prefAnsweredQueTexts=[]; var prefAnsweredQueBackup=[]; var prefAnsweredQueTextsBackup=[]; var preview="/servlet/survey.VotingSurvey?i_n_f=survey156625_pg0_totpg50_rid38934882_lqid3147683_SurveyLook&msig=df90747eca7328b90f382623fe6532c1&linkNumber=58_AllInOne&signature=904b3fa8970d86aaccde790a7938c823"; var advancedPreviewTestMode=false; var isOffline = false; //WINDOW_ONUNLOAD_COMMENT //window.onunload=onunloadSaving; var votingStartDateTime='0d162829313e3f42454647495b5c5f626382898a969a9ea9aababcc3c7d2dff13c211c19000a077a707e767c69901d2468388dbbd7ed6fc62e08e4e7bf'; var submit_time=0; var timeUp=0; function checkTimeOut() { for(var i=0; i<document.theForm.elements.length; i++) { var elem = document.theForm.elements[i]; if (elem!=null && elem.name!=null && elem.name.indexOf("other")==0) elem.onblur=null; } document.theForm.target="_self"; document.theForm.startTime.value=votingStartDateTime; doSubmit(true,"",preview); } if (submit_time>0) setTimeout('checkTimeOut();',submit_time); var timeout=submit_time-5*60*1000; document.sessionExpires=new Date(new Date().getTime()+submit_time); function sessionWillExpire() { if (submit_time==0) return; var exp=document.sessionExpires; var mins=Math.round((exp.getTime()-new Date().getTime())/(60*1000.0)); if (mins<1) return; var when=exp.getHours()+':'+((exp.getMinutes()<10?"0":"")+exp.getMinutes()); focus(); if (submit_time>300000-5) alert("Your session will expire in {0} minutes at {1}".replace(/\{0\}/,mins).replace(/\{1\}/,when)); } if (submit_time>0) setTimeout('sessionWillExpire()',timeout); //remain time var tf=0; var timeLeft=0; var tcount=0; if (submit_time>0) tf=window.setTimeout("TimerFunc();",1000); function TimerFunc() { tf=window.setTimeout("TimerFunc();",1000); tcount++; var exp=document.sessionExpires; timeLeft=Math.round((exp.getTime()-new Date().getTime())/1000); var min_left=Math.round((timeLeft-30)/60); var msg=''; if (min_left>1) msg=min_left+" minutes "; else if (min_left==1) msg=min_left+" minute "; var sec_left=timeLeft-min_left*60; window.status=msg+sec_left+" seconds remaining"; if (timeLeft<5) { window.clearTimeout(tf); timeUp=1; } } function setRefreshCookie(value) { document.cookie="refresh=" + value + "; path=/servlet"; } setRefreshCookie("true"); var imageElement=null; function moveRadioAndCheck(qid,aid,name,fromOther,isRadio,checkit,other_element,obj,eventSource) { moveRadio("Question"+qid,name,aid,fromOther,isRadio,other_element, eventSource); if (name!=null && aid!=null) { var frm=findForm(""+qid); for( var i=0; i<frm.length; i++ ) { if (frm[i]!=null && frm[i].name!=null && frm[i].name.indexOf(name)==0 && frm[i].value==aid) { imageElement=frm[i]; } } } answerRequiredModule.check(qid,checkit,imageElement,other_element); } function validateAnswerText() { var i=1; while (i<arr_other.length) { if (arr_other[i]<=0) {i++; continue;} if (!validateOtherState(arr_other[i],arrtext_other[i])) return false; i++; } return true; } function questionVisible( questionId ) { var pageNumber = getPage( questionId ); if ( votingSubmitModule.getPageNumber() === pageNumber ) { return true; } return ( votingSubmitModule.isPageSelectorPluginInstalled() || pageEncountered( pageNumber ) ) && votingSubmitModule.pageVisible( pageNumber ); } function pageEncountered( pageNumber ) { var trace = votingSubmitModule.getResponseTrace(); if ( !trace ) { return pageNumber === 1; } for ( var index in trace ) { if ( trace[index].page === pageNumber ) { return trace[index].passed; } } return false; } function getPage( questionId ) { for ( var page in survData.questionsByVP ) { if ( survData.questionsByVP[page].indexOf(questionId) >= 0 ) { return parseInt(page, 10); } } } //the next line is replaced with Javascript function calls in SurveyLook //(one call for each question needing validation): function validate_full() { var res = true; if(!validateRequiredGeneral(3147683,"* Are you the patient?",false,"")) { if (_current_form == null) return false; res = false; } var allForms=document.forms; var formSum = allForms.length; var cf = ''; var cfsufix = ''; window.removeAlert = false; window.isDevice = false; return res; } window.resultHasBeenSaved=false; function showRespondentInfo(){} function doSubmit(kip_validate, dir, formAction) { disableButtons(); if (valBlurModule.focusCantBeMoved()) { enableButtons(); return false; } setTimeout(function () { doSubmitByTime(kip_validate, dir, formAction); }, 100); return false; } function doSubmitByTime(kip_validate, dir, formAction) { if (window.votingWaitModule.isEmptyAll()) { return _doSubmit(kip_validate, dir, formAction); } else { setTimeout(function () { doSubmit(kip_validate, dir, formAction); }, 100); } return false; } function _doSubmit(skip_validate, dir, formAction) { try { if (window.isNavigationButtonEnable && !window.isNavigationButtonEnable()) { enableButtons(); return; } setRefreshCookie("false"); window.dirSubmit = dir; window.onbeforeunload = null; window.onunload = null; var beginTime = new Date().getTime(); var theForm = document.theForm; if (!validatePlugin(skip_validate, dir, formAction)) { enableButtons(); return; } if (!validateProfileCode()) { enableButtons(); return; } if (!validateDisplayName()) { enableButtons(); return; } if (!validateAnswerText()) { enableButtons(); return; } if (!skip_validate && !advancedPreviewTestMode) { if (!validate_full()) { enableButtons(); return; } } if (window.LQ_Multiple && window.LQ_Multiple.validateMustCheck && window.LQ_Multiple.appendResultsToForm) { if (!window.LQ_Multiple.validateMustCheck() || !window.LQ_Multiple.appendResultsToForm(theForm)) { enableButtons(); return; } } runBeforeSubmitPlugins(skip_validate, dir, formAction); if (dir === "") { //BEFORE_EXECUTE_VOTING } if (theForm.validateTime != null) { theForm.validateTime.value = "" + (new Date().getTime() - beginTime); } theForm.onunload.value = 0; theForm.Dir.value = dir; if (formAction != null && formAction.length > 0) { theForm.action = formAction; } j$("secureReviewIdParam").val(dir !== "Review" ? "" : j$("holderSecureReviewIdParam").val()); var hiddenOptionsForDelete = ksAPI.createHiddenOptions(theForm); if (dir !== "Save") { votingSubmitModule.submit(theForm, dir, function () { enableButtons(); }); return; } theForm.Dir.value = "Next"; if (!j$("#saveButtonMsg")) { j$("#SaveAndExit").before('<div class="SaveMSG"><div id=\"saveButtonMsg\"></div></div>'); } j$("#saveButtonMsg").html("<b></b>").show(); if (isOffline) { votingSubmitModule.submit(document.theForm, "Save", function () { j$("#saveButtonMsg").show(0).delay(100).hide(0); ksAPI.deleteHiddenOptions(hiddenOptionsForDelete); if (window.autoSaveModule && window.autoSaveModule.saved) { window.autoSaveModule.saved(); } enableButtons(); }); return; } if (hasFormRespondentFiles()) { theForm.Dir.value = "Save"; votingSubmitModule.submit(theForm, dir, function () { ksAPI.deleteHiddenOptions(hiddenOptionsForDelete); enableButtons(); }); return; } j$("input[type='file']").attr("disabled", "disabled"); var submitData = j$('form[name="theForm"]').serialize() + "&SaveAndExit=SaveAndExit&disallowRedirect=true&GlobalFormId=new"; return j$.ajax({ type: "POST", url: formAction, data: submitData, success: function (data) { window.resultHasBeenSaved = true; if (data) { var result = JSON.parse(data); if (result.globalFormId) { theForm.globalFormID.value = result.globalFormId; if (result.respondentId) { theForm.RID.value = result.respondentId; } if (result.ARGS) theForm.ARGS.value = result.ARGS; } else { theForm.globalFormID.value = data; } } j$("#saveButtonMsg").show(0).delay(100).hide(0); enableButtons(); if (votingSubmitModule.submitCallback) { votingSubmitModule.submitCallback(); } }, error: function (XMLHttpRequest, textStatus, errorThrown) { if (XMLHttpRequest.status === 409) { blockResubmit(submitData); return; } j$("#saveButtonMsg").hide(); alert("Your data has not been saved"); enableButtons(); window.resultHasBeenSaved = false; }, complete: function () { j$("input[type='file']").removeAttr("disabled"); ksAPI.deleteHiddenOptions(hiddenOptionsForDelete); setRefreshCookie("true"); } }); } catch (er) { if (isOffline) { alert("Internal JavaScript Error occurred. Please, try again or contact your Administrator." +"\n(" + er + ")"); } } } var blockResubmit = function(submitData) { j$.ajax( { type: 'POST', url: '/servlet/voting/BlockResubmit', data: submitData, success: function() { location.reload(); }, error: function() { alert("Your data has not been saved"); } } ); }; var hasFormRespondentFiles = function() { var form = j$('form[name=theForm]'); var inputFilesEl = form.find('input[type=file]'); for(var i = 0; i < inputFilesEl.length; i++) { if (j$(inputFilesEl[i]).val()) { return true; } } return false; }; // there 3 functions return whether browser should submit form, // returns 'false' if form already successfully submitted by script. // If last click was within 5 seconds, then survey is submitted without // scripts - in case respondent is having trouble (or doesn't see alert) // and tries to click again. window.scriptsOk=window.doSubmit && window.validate_full && window.validateRequiredGeneral; window.lastClick=0; var twoSeconds=2000; var lastSave = 0; function pressedBack(){ showBeforeAlert=false; document.theForm.target="_self"; if (!window.scriptsOk) return true; if (new Date().getTime()-window.lastClick<twoSeconds) return false; window.lastClick=new Date().getTime(); doSubmit(true,"Back",""); return false; } function pressedNext(){ showBeforeAlert=false; document.theForm.target="_self"; if (!window.scriptsOk) return true; if (new Date().getTime()-window.lastClick<twoSeconds) return false; window.lastClick=new Date().getTime(); doSubmit(false,"Next",""); return false; } function pressedVote() { showBeforeAlert=false; document.theForm.target="_self"; if (!window.scriptsOk) return true; if (new Date().getTime()-window.lastClick<twoSeconds) return false; window.lastClick=new Date().getTime(); doSubmit(false,"",preview); return false; } function pressedSave( fileUpload){ if(!fileUpload) { //BEFORE_EXECUTE_VOTING } showBeforeAlert=false; document.theForm.target="_self"; if (!window.scriptsOk){ return true; } if (new Date().getTime()-lastSave<twoSeconds){ return false; } lastSave = new Date().getTime(); if (!isOffline) { window.formChanges = false; } if (fileUpload) return _doSubmit(true,"Save",preview); else { doSubmit(true,"Save",preview); return false; } } function pressedReview() { if (window.votingWaitModule.isEmptyAll()) { return _pressedReview(); } else { setTimeout(function () { _pressedReview(); }, 10); } return false; } function _pressedReview(){ document.theForm.target="_blank"; _doSubmit(false,"Review",""); j$("#goSubmitPage").removeAttr("disabled"); document.theForm.target = "_self"; } function onbeforeAlert() { if (getShowBeforeAlert() && onunloadSaving(false,true)) { return "Are you sure you want to navigate away from this page?\n Your responses on this page will not be saved!"; } // else no alert will popup } //WINDOW_ONUNLOAD_COMMENT window.onbeforeunload=onbeforeAlert; //validate ProfileCode for Profile Poll function validateProfileCode() { var forCheckField=null; if (forCheckField==null) return true; for (var i=1; i<=profileCodes.length; i++) { if (profileCodes[i]==forCheckField.value) return true; } alert("The password you have entered is not valid. \n\nPlease enter a valid password."); forCheckField.focus(); return false; } //validate originality of Display Name function validateDisplayName() { var ret=true; var dispNameField=null; if (dispNameField==null) return ret; dispNameField.value=Trim(dispNameField.value); var validateDispNameMsg=''; for (var i=1; i<=dispNameValues.length; i++) { if (dispNameValues[i]==dispNameField.value || Trim(dispNameField.value)=='') {ret=false; break;} } if (!ret) { //alert(<UNIQUE1/>+' '+validateDispNameMsg+' '+<UNIQUE2/>+' '+validateDispNameMsg+' '+<UNIQUE3/>+' '+validateDispNameMsg+'!'); alert("The value of {0} is used as a Display Name in the chat room and must be unique. This Display Name, {1}, has been taken.\nPlease specify another Display Name {2}".replace(/\{0\}/,validateDispNameMsg).replace(/\{1\}/,validateDispNameMsg).replace(/\{2\}/,validateDispNameMsg)); dispNameField.focus(); } return ret; } function runBeforeSubmitPlugins(skip_validate, dir, formAction) { beforeSubmitPlugins.forEach(function(plugin) { if (window[plugin] && typeof window[plugin].process === 'function') { window[plugin].process.apply(window, [skip_validate, dir, formAction]); } }); } //valueTypeOnBlurFunctions function validatePlugin(skip_validate,dir,formAction){ for(var i = 0; i < verifyPlugins.length; i++){ var res = runValidatePlugin(verifyPlugins[i],[skip_validate,dir,formAction]) if(!res){ return false; } } return true; } function runValidatePlugin(name, arguments){ if(!name){ return true; } var fn = window[name].validate; if(typeof fn !== 'function'){ return true; } return fn.apply(window, arguments); } function validateShowHide(prefixParam, hide){ for(var i = 0; i < verifyShowHide.length; i++){ var res = runValidateShowHide(verifyShowHide[i], [prefixParam, hide]); if(!res){ return false; } } return true; } function runValidateShowHide(name, arguments){ var fn = window[name].validateShowHide; if(typeof fn !== 'function'){ return true; } return fn.apply(window, arguments); } function disableButtons() { jQuery(".HBUTTONS").children("input").attr("disabled", "disabled"); } function enableButtons() { jQuery(".HBUTTONS").children("input").removeAttr("disabled"); }var showHide = initializeShowHideToggle(function(toggle) { window.commonVotingModule.allDataRestored.done(function () { _.each(window.survData.showHides, function (showHide) { var showHideInlineFunc = window.survData.showHideInlineFuncs[showHide.jsInlineFuncName]; var hide = !toggle ? false : (showHideInlineFunc() ? showHide.hide : !showHide.hide); window.showHideModule.setAnswerColumnVisibility(showHide.answerHumanFormula, showHide.answerToken.questionId, showHide.answerToken.answerId, showHide.answerToken.columnId, hide); }); }); }); function initializeShowHideToggle(callback) { var toggleStatus = true; return { getToggleStatus : function() { return toggleStatus; }, setToggleStatus : function(p) { toggleStatus = p; callback(toggleStatus);} }; }//; var thisRatingsMatrix360 = []; var thisAverageMatrix360 = []; function processKeyPress(a, event, is360) { if (a.type == 'radio' && a.className == 'cRadio') { checkRadioInGrid(a); } is360 && changeForm(a); } function processFocus(a, event, is360){ if (is360){ if ((a.tagName=="INPUT" && a.type=="text") || a.tagName=="TEXTAREA"){ currentFocusedElem=a; } } processKeyPress(a,event); } function processClick(a, event, is360) { processRadio(a, true, true); if (a.className == 'cRadio') checkRadioInGrid(a); if (is360) { changeForm(a); if (thisRatingsMatrix360[a.id] != null && a.tagName != 'SELECT'){ getRetingData(a, thisRatingsMatrix360[a.id]); } if (thisAverageMatrix360[a.id] != null && a.tagName != 'SELECT'){ var thisAverageMatrix360Inner = thisAverageMatrix360[a.id]; getAverageData(a, thisAverageMatrix360Inner[0], thisAverageMatrix360Inner[1], thisAverageMatrix360Inner[2], thisAverageMatrix360Inner[3]); } } } function processInputTextChange(elem, event){ changeForm(elem); } function processChange(a, event, is360) { if (is360) { if (thisRatingsMatrix360[a.id] != null) { getRetingData(a, thisRatingsMatrix360[a.id]); } if (thisAverageMatrix360[a.id] != null) { var thisAverageMatrix360Inner = thisAverageMatrix360[a.id]; getAverageData(a, thisAverageMatrix360Inner[0], thisAverageMatrix360Inner[1], thisAverageMatrix360Inner[2], thisAverageMatrix360Inner[3]); } } ksAPI.resetPreviouslySelectedOptions(event); } var j$ = jQuery.noConflict(); function initPageSelectorError(){ if(j$(".ERROR_MESSAGE").length > 0){ var errorObject = j$(".ERROR_MESSAGE")[0]; if(errorObject !=null && errorObject.style.display == 'none') return; var labelObject = document.getElementById("QuestionLabel"+errorObject.title); var questionText = ""; if(labelObject!=null){ questionText = removeHTMLTags(labelObject.innerHTML); var labelObjLength = questionText.length; if(labelObjLength > 50) questionText = questionText.substring(0,50)+"..."; } alert(' ' + removeHTMLTags(errorObject.innerHTML) + (questionText.length == 0 ? '' : (':\n' + questionText))); scrollToQuestion = '#Q' + errorObject.title; window.setTimeout(scrollToSomeQuestion, 250); } } function closeThis(obj){ if(obj!=null){ obj.style.display='none'; } } function removeHTMLTags(string){ string = string.replace(/&(lt|gt);/g, function (strMatch, p1){ return (p1 == "lt")? "<" : ">"; }); string = string.replace(/ /g, ' '); string = string.replace(/<\/?[^>]+(>|$)/g, ""); return string; } function initRadio() { j$('input[type="radio"]').each(function() { var elem = j$(this); elem.data('tallinn', elem.is(':checked')); }); } function setEvents(is360) { initRadio(); j$(document).on('keypress', 'input', function(e) {processFocus(e.target, e, is360); }); j$(document).on('click', 'input', function(e) {processClick(e.target, e, is360); }); j$(document).on('keypress', 'select', function(e) {processFocus(e.target, e, is360); }); j$(document).on('click', 'select', function(e) {processClick(e.target, e, is360); }); j$(document).on('keypress', 'textarea', function(e) {processFocus(e.target, e, is360); }); j$(document).on('click', 'textarea', function(e) {processClick(e.target, e, is360); }); if(is360){ j$(document).on('change', 'input', function(e) {processInputTextChange(e.target, e); }); j$(document).on('change', 'textarea', function(e) {changeForm(e.target); }); } if(j$.browser.msie) { j$('select').bind('change', function(e) {processChange(e.target, e, is360); }); } else { j$(document).on('change', 'select', function(e) {processChange(e.target, e, is360); }); } } //checks whether one element is chosen only in a column var checkRadioInGridArray = []; function isSetPressedEnter(event) { if (isPressedEnter(event)) { return false; } } function checkRadioInGrid(rb) { var currentForm = rb.form; var el_id = new String(rb.id); var first_idx = el_id.indexOf("R"); var last_idx = el_id.indexOf("_"); var QID = el_id.substring(first_idx + 1, last_idx); if (!checkRadioInGridArray[QID]) return false; var frm = findQuestionElementsOnForm(QID, currentForm); var l = frm.length; var m = 0; var arr = rb.parentNode.parentNode.childNodes; var arrSize = arr.length; for (var i = 0; i < arrSize; i++) { var s = new String(arr[i].className); if (s.indexOf("HRG3D") > -1) { m++; } } var n = l / m; var res = false; var isShowErrorString = false; for (var i = 0; i < m; i++) { var buf = []; var count = 0; for (var j = 0; j < n; j++) { var elem = frm[i + j * m]; if (elem == null) break; var ename = elem.name; if (ename == null) break; if (ename.indexOf("R" + QID) == 0) { if (elem.checked) { count++; buf[j] = elem; } else { buf[j] = null; } } } isShowErrorString = (isShowErrorString || count > 1); for (var j = 0; j < n; j++) { var be = frm[i + j * m]; if (buf[j] == null || count < 2) { be.parentNode.className = "HRG3D"; } else { be.parentNode.className = "HRG3D absrankAlert"; } } res = true; } return res; } // function bodyOnload(){ KS_Utils.disableBrowserAutocomplete() enableNavigationButton(); MM_HideLayer('wait_div',true);MM_HideLayer('Layer0',false); window.formChanges = false; if (window.opener && !window.opener.closed && window.opener.length > 0 && window.opener['focusPreview']) {window.opener.focusPreview(window);}setTimeout('setEvents(false)', 5);if (window.setHeader) setTimeout('setHeader()', 5);if (window.initPageSelectorError) setTimeout('initPageSelectorError()', 5); } window.onbeforeunload = function() {onbeforeAlert();if (window.bodyOnUnLoad) window.bodyOnUnLoad();} </script> <meta http-equiv="Content-type" content="text/html;charset=UTF-8"> <meta name='robots' content='noindex, follow'> <link rel='stylesheet' type='text/css' href='/css/defaultSurveyStyle.css?version=549532'><link rel='stylesheet' type='text/css' href='/js/jcrop/css/jquery.Jcrop.min.css?version=549532'><link rel='stylesheet' type='text/css' href='/css/defaultSurveyPrintStyle.css?version=549532'><link rel='stylesheet' type='text/css' href='/user-data/65/65166/156625/style_156625.css?v=3492'><script type="text/javascript" language="javascript" src="https://cdnjs.cloudflare.com/ajax/libs/moment.js/2.24.0/moment.min.js"></script><script type="text/javascript" language="javascript">$=jQuery; jQuery(document).ready(function(){ //alert('hello'); //Restore first name if (document.getElementById("inputtextother3147699_13105953")) { $("#inputtextother3147699_13105953").val(sessionStorage.getItem("firstname")); }; if (document.getElementById("inputtextother3147693_13105887")) { $("#inputtextother3147693_13105885").val(sessionStorage.getItem("firstname")); }; //Update patient checkbox label if(document.getElementById("RC3147714_13106001")) { $('label[for="RC3147714_13106001"]').text('Check this box if records will go to the patient only. No further action required on this page.'); } //Expiration +15days jQuery("#inputtextother3147729_13106030").prop('type', 'date'); jQuery("#inputtextother3147729_13106030").prop('min', new Date().toISOString().split('T')[0]).prop('min', new Date(new Date().setDate(new Date().getDate() +15)).toISOString().split('T')[0]); jQuery("#inputtextother3147729_13106030").on ("focus", function () { jQuery("#inputtextother3147729_13106030").prop('type', 'date'); jQuery("#inputtextother3147729_13106030").prop('max', new Date(new Date().setDate(new Date().getDate() + 365)).toISOString().split('T')[0]); }) let mygoNextPage = $("<input type='submit' name='mygoNextPage' value='Next >' id='mygoNextPage' class='votingNavigation htmlButton' disableForInit='true' tabIndex='1' title='Next page' aria-label='Next page' ></div></td></tr>"); let fax = $('<tr><td colspan="2"><input type="text" name="dynamicInput" id="faxNumber" placeholder="Enter fax number here">' + ' <input type="checkbox" name="primary" id="faxPrimary" value="Fax"><label for="faxPrimary">(Check this box if this option should be your primary delivery method)</label></td></tr>'); let email = $('<tr><td colspan="2"><input type="text" name="dynamicInput" id="emailAddress" placeholder="Enter recipient\'s email here">' + '<select id="encryption"><option value="Encrypted" selected>Encrypted</option><option value="Unencrypted">Unencrypted</option></select>' + ' <input type="checkbox" name="primary" id="emailPrimary" value="Email"><label for="emailPrimary">(Check this box if this option should be your primary delivery method)</label></td></tr>'); let usb = $('<tr><td colspan="2"><label id="xyz">Choose delivery method:</label><select id="usbMail"><option value="Mail" selected>Mail</option>' + //'<option value="Pickup">Pickup</option></select><input type="text" name="dynamicInput" id="usb_mailAddress" placeholder="Enter postal address, if new">' + '<option value="Pickup">Pickup</option></select><input type="text" name="dynamicInput" id="usb_mailAddress" placeholder="Enter postal address here">' + '<input type="text" name="dynamicInput" id="usb_pickupName" placeholder="Enter name here">' + ' <input type="checkbox" name="primary" id="usbPrimary" value="USB"><label id="xyz">(Check this box if this option should be your primary delivery method)</label></td></tr>'); let cd = $('<tr><td colspan="2"><label id="xyz">Choose delivery method:</label><select id="cdMail"><option value="Mail" selected>Mail</option>' + //'<option value="Pickup">Pickup</option></select><input type="text" name="dynamicInput" id="cd_mailAddress" placeholder="Enter postal address, if new">' + '<option value="Pickup">Pickup</option></select><input type="text" name="dynamicInput" id="cd_mailAddress" placeholder="Postal address here, if new">' + '<input type="text" name="dynamicInput" id="cd_pickupName" placeholder="Enter name here"> <input type="checkbox" name="primary" id="cdPrimary" value="CD">' + '<label id="xyz">(Check this box if this option should be your primary delivery method)</label></td></tr>'); let paper = $('<tr><td colspan="2"><label id="xyz">Choose delivery method:</label><select id="paperMail"><option value="Mail" selected>Mail</option>' + // '<option value="Pickup">Pickup</option></select><input type="text" name="dynamicInput" id="paper_mailAddress" placeholder="Enter postal address, if new">' + '<option value="Pickup">Pickup</option></select><input type="text" name="dynamicInput" id="paper_mailAddress" placeholder="Enter postal address here">' + '<input type="text" name="dynamicInput" id="paper_pickupName" placeholder="Enter name here"> <input type="checkbox" name="primary" id="paperPrimary" value="Paper">' + '<label id="xyz">(Check this box if this option should be your primary delivery method)</label></td></tr>'); let portal = $('<tr><td colspan="2">      <input type="checkbox" name="primary" id="portalPrimary" value="Patient Portal"><label id="xyz">(Check this box if this option should be your primary delivery method)</label></td></tr>'); let dynamicInput = "#inputtextother3147713_13112201"; let primary = ""; let count = 0; $("#AnswerTr3147706_13105977").css("position","absolute"); $("#AnswerTr3147706_13105977").css("left","-1000px"); $("#AnswerTr3147713_13112201").css("position","absolute"); $("#AnswerTr3147713_13112201").css("left","-1000px"); $("#questionFieldsetId3147716").css("position","absolute"); $("#questionFieldsetId3147716").css("left","-1000px"); $("#RC3147691_13105825").css("position","absolute"); $("#RC3147691_13105825").css("left","-1000px"); $("#RC3147713_13112201").css('display','none'); $("#AnswerElementTd3147722_13106020").css("position","absolute"); $("#AnswerElementTd3147722_13106020").css("left","-1000px"); //Add dynamic inputs $(portal).appendTo(document.theForm); $(portal).detach().insertAfter($("#AnswerTr3147713_13105995")); portal.hide(); $(fax).appendTo(document.theForm); $(fax).detach().insertAfter($("#AnswerTr3147713_13105998")); fax.hide(); $(email).appendTo(document.theForm); $(email).detach().insertAfter($("#AnswerTr3147713_13105996")); email.hide(); $(usb).appendTo(document.theForm); $(usb).detach().insertAfter($("#AnswerTr3147713_13106000")); usb.hide(); $(paper).appendTo(document.theForm); $(paper).detach().insertAfter($("#AnswerTr3147713_13105999")); paper.hide(); $(cd).appendTo(document.theForm); $(cd).detach().insertAfter($("#AnswerTr3147713_13105997")); cd.hide(); //Restore dynamic Inputs if (document.getElementById("questionDivEntireId3147683") != null) sessionStorage.clear(); if (document.getElementById("inputtextother3147713_13112201") || document.getElementById("inputtextother3147699_13105955") || document.getElementById("inputtextother3147693_13105887")) { $(mygoNextPage).appendTo(document.theForm); $(mygoNextPage).detach().insertAfter($("#goPrevPage")); $("#goNextPage").css("position","absolute"); $("#goNextPage").css("left","-1000px"); } if (document.getElementById("inputtextother3147713_13112201")) { //restore doctor's name if ($("#RC3147706_13105976").is(":checked")) { $("#inputtextother3147706_13105986").val(sessionStorage.getItem("doctor")); } //restore other detail if ($("#RC3147706_13108317").is(":checked")) { $("#inputtextother3148284_13108343").val(sessionStorage.getItem("record-other")); } $("#inputtextother3147716_13106008").val(""); let prime = (sessionStorage.getItem("primary") != null ? sessionStorage.getItem("primary") : ""); let portalRes = (sessionStorage.getItem("portal") != null ? sessionStorage.getItem("portal") : ""); let emailRes = (sessionStorage.getItem("email") != null ? sessionStorage.getItem("email") : ""); let faxRes = (sessionStorage.getItem("fax") != null ? sessionStorage.getItem("fax") : ""); let cdRes = (sessionStorage.getItem("cd") != null ? sessionStorage.getItem("cd") : ""); let paperRes = (sessionStorage.getItem("paper") != null ? sessionStorage.getItem("paper") : ""); let usbRes = (sessionStorage.getItem("usb") != null ? sessionStorage.getItem("usb") : ""); primary = prime; if (prime == "Patient Portal") { $(portal).show(); $(portalPrimary).prop("checked",true);} if (prime == "Email") { $(email).show(); $(emailPrimary).prop("checked",true); } if (prime == "CD") { $(cd).show(); $(cdPrimary).prop("checked",true);} if (prime == "Paper") {$(paper).show(); $(paperPrimary).prop("checked",true);} if (prime == "Fax") { $(fax).show(); $(faxPrimary).prop("checked",true);} if (prime == "USB") { $(usb).show(); $(usbPrimary).prop("checked",true); } if (sessionStorage.getItem("dynamicInput") != null) { $("#dynamicInput").val(sessionStorage.getItem("dynamicInput")); } if (portalRes != "") { count = count + 1; } else { $("#RC3147713_13105995").prop("checked", false); } if (emailRes != "") { count = count + 1; let index = emailRes.indexOf (":"); $(email).show(); $("#emailAddress").val(emailRes.substring(index+1)); $("#encryption").val(emailRes.substring(0, index)); } else { $("#RC3147713_13105996").prop("checked", false); } if (faxRes != "") { count = count + 1; $(fax).show(); $("#faxNumber").val(faxRes); } else { $("#RC3147713_13105998").prop("checked", false); } if (cdRes != "") { count = count + 1; $(cd).show(); let index = cdRes.indexOf (":"); $("#cdMail").val(cdRes.substring(0, index)); if ($("#cdMail").val() == "Mail") { $("#cd_mailAddress").val(cdRes.substring(index+1)); $("#cd_pickupName").hide(); } else { $("#cd_pickupName").val(cdRes.substring(index+1)); $("#cd_mailAddress").hide(); } } else { $("#RC3147713_13105997").prop("checked", false); } if (paperRes != "") { count = count + 1; $(paper).show(); let index = paperRes.indexOf (":"); $("#paperMail").val(paperRes.substring(0, index)); if ($("#paperMail").val() == "Mail") { $("#paper_mailAddress").val(paperRes.substring(index+1)); $("#paper_pickupName").hide(); } else { $("#paper_pickupName").val(paperRes.substring(index+1)); $("#paper_mailAddress").hide(); } //$("#RC3147713_1315999").prop("checked", tru); } else { $("#RC3147713_13105999").prop("checked", false); } if (usbRes != "") { count = count + 1; $(usb).show(); let index = usbRes.indexOf (":"); $("#usbMail").val(usbRes.substring(0, index)); if ($("#usbMail").val() == "Mail") { $("#usb_mailAddress").val(usbRes.substring(index+1)); $("#usb_pickupName").hide(); } else { $("#usb_pickupName").val(usbRes.substring(index+1)); $("#usb_mailAddress").hide(); } //$("#RC3147713_13106000").prop("checked", tru); } else { $("#RC3147713_13106000").prop("checked", false); } //alert("*****************"+count); } //Patient portal $("#RC3147713_13105995").change(function(){ if($("#RC3147713_13105995").is(':checked')){ if (count>=2) { alert ("At most two 2 delivery methods allowed"); jQuery("#RC3147713_13105995").prop("checked", false); return false; } count = count +1; portal.show(); sessionStorage.setItem("portal","checked"); } else{ count = count - 1; portal.hide(); if($("#portalPrimary").is(':checked')){ $("#portalPrimary").prop("checked",false); primary = ""; } sessionStorage.setItem("portal",""); } }); //fax $("#RC3147713_13105998").change(function(){ if($("#RC3147713_13105998").is(':checked')){ if (count>=2) { alert ("At most two 2 delivery methods allowed"); jQuery("#RC3147713_13105998").prop("checked", false); return false; } count = count +1; $(fax).show(); } else{ count = count - 1; $("#faxNumber").val(""); sessionStorage.setItem("fax",""); $(fax).hide(); if($("#faxPrimary").is(':checked')){ $("#faxPrimary").prop("checked",false); primary = ""; } } }); $("#RC3147713_13105996").change(function(){ if($("#RC3147713_13105996").is(':checked')){ if (count>=2) { alert ("At most two 2 delivery methods allowed"); jQuery("#RC3147713_13105996").prop("checked", false);return false; } count = count +1; $(email).show(); } else{ count = count - 1; $("#emailAddress").val(""); sessionStorage.setItem("email",""); $(email).hide(); if($("#emailPrimary").is(':checked')){ $("#emailPrimary").prop("checked",false); primary = ""; } } }); $("#RC3147713_13106000").change(function(){ if($("#RC3147713_13106000").is(':checked')){ if (count>=2) { alert ("At most two 2 delivery methods allowed"); jQuery("#RC3147713_13106000").prop("checked", false);return false; } count = count +1; $(usb).show(); $("#usbMail").val("Mail"); $("#usb_mailAddress").show(); $("#usb_pickupName").hide(); } else{ count = count - 1; $("#usb_mailAddress").val(""); $("#usb_pickupName").val(""); sessionStorage.setItem("usb",""); $(usb).hide(); if($("#usbPrimary").is(':checked')){ $("#usbPrimary").prop("checked",false); primary = ""; } } }); //Paper $("#RC3147713_13105999").change(function(){ if($("#RC3147713_13105999").is(':checked')){ if (count>=2) { alert ("At most two 2 delivery methods allowed"); jQuery("#RC3147713_13105999").prop("checked", false); return false; } count = count +1; $(paper).show(); $("#paperMail").val("Mail"); $("#paper_mailAddress").show(); $("#paper_pickupName").hide(); } else{ count = count - 1; $("#paper_mailAddress").val(""); $("#paper_pickupName").val(""); sessionStorage.setItem("paper",""); $(paper).hide(); if($("#paperPrimary").is(':checked')){ $("#paperPrimary").prop("checked",false); primary = ""; } } }); //CD $("#RC3147713_13105997").change(function(){ if($("#RC3147713_13105997").is(':checked')){ if (count>=2) { alert ("At most two 2 delivery methods allowed"); jQuery("#RC3147713_13105997").prop("checked", false); return false; } count = count +1; $(cd).show(); $("#cdMail").val("Mail"); $("#cd_mailAddress").show(); $("#cd_pickupName").hide(); } else{ count = count - 1; $("#cd_mailAddress").val(""); $("#cd_pickupName").val(""); sessionStorage.setItem("cd",""); $(cd).hide(); if($("#cdPrimary").is(':checked')){ $("#cdPrimary").prop("checked",false); primary = ""; } } }); $("#faxNumber").on ("focusout", function(){ sessionStorage.setItem("fax",$(this).val()); return true; }); $("#emailAddress").on ("focusout", function(){ sessionStorage.setItem("email",$("#encryption").children("option:selected").val()+":"+$(this).val()); return true; }); $("#encryption").change(function(){ let val = $(this).children("option:selected").val(); sessionStorage.setItem("email", $(this).children("option:selected").val()+":"+$("#emailAddress").val()); }); $("#usbMail").change(function(){ let val = $(this).children("option:selected").val(); if (val == "Mail") { $("#usb_mailAddress").css("display","inline-block"); $("#usb_pickupName").css("display","none"); usb_pickupName = ""; } else{ $("#usb_mailAddress").css("display","none"); usb_mailAddress = ""; $("#usb_pickupName").css("display","inline-block"); } sessionStorage.setItem("usb", ""); }); $("#usb_mailAddress").on ("focusout", function(){ sessionStorage.setItem("usb", "Mail:" + $("#usb_mailAddress").val()); return true; }); $("#usb_pickupName").on ("focusout", function(){ sessionStorage.setItem("usb", "Pickup:" + $("#usb_pickupName").val()); return true; }); $("#paperMail").change(function(){ let val = $(this).children("option:selected").val(); if (val == "Mail") { $("#paper_mailAddress").css("display","inline-block"); $("#paper_pickupName").css("display","none"); paper_pickupName = ""; } else{ $("#paper_mailAddress").css("display","none"); paper_mailAddress = ""; $("#paper_pickupName").css("display","inline-block"); } sessionStorage.setItem("paper", ""); }); $("#paper_mailAddress").on ("focusout", function(){ sessionStorage.setItem("paper", "Mail:" + $("#paper_mailAddress").val()); return true; }); $("#paper_pickupName").on ("focusout", function(){ sessionStorage.setItem("paper", "Pickup:" + $("#paper_pickupName").val()); return true; }); $("#cdMail").change(function(){ let val = $(this).children("option:selected").val(); if (val == "Mail") { $("#cd_mailAddress").css("display","inline-block"); $("#cd_pickupName").css("display","none"); } else{ $("#cd_mailAddress").css("display","none"); $("#cd_pickupName").css("display","inline-block"); } sessionStorage.setItem("cd", ""); }); $("#cd_mailAddress").on ("focusout", function(){ sessionStorage.setItem("cd", "Mail:" + $("#cd_mailAddress").val()); return true; }); $("#cd_pickupName").on ("focusout", function(){ let val = $(this).children("option:selected").val(); sessionStorage.setItem("cd", "Pickup:" + $("#cd_pickupName").val()); return true; }); $("#portalPrimary, #faxPrimary, #emailPrimary, #cdPrimary, #paperPrimary, #usbPrimary").change(function(){ if($(this).is(':checked')){ if (primary != "") { alert("Only one primary can be selected"); $(this).prop("checked", false);return false; } primary = $(this).val(); } else { primary = ""; } sessionStorage.setItem("primary",primary); }); // move the date inputs to the left a bit jQuery("label:contains('YYYY')").parent().css('width','50%'); // remove green bar between q15 and q16 jQuery("#QuestionLabelTd3036571").detach(); // Office visit Please enter doctors name reposition jQuery("#AnswerTr3036574_12713204, #AnswerTr2957878_12572754").hide(); jQuery("#RC3036574_12713204, #RC2957878_12572754").addClass('sr-only'); jQuery("#AnswerTr3036574_12713204").detach().insertAfter(jQuery("#AnswerTr3036574_12713195")); // BEGIN Office visit Please enter doctors name reposition jQuery("#RC3147706_13105986, #RC3147706_13105976").addClass('sr-only'); jQuery("#AnswerTr3147706_13105986").detach().insertAfter("#AnswerTr3147706_13105976"); jQuery("#AnswerTr3147706_13105986").hide(); if (jQuery("#RC3147706_13105976").is(":checked")) { $("#AnswerTr3147706_13105986").show(); $("#RC3147706_13105986").css('visibility','hidden'); } jQuery("#AnswerTr3147706_13105976").on('click', function(e){ //alert('Hi'); jQuery("#AnswerTr3147706_13105986").toggle(); jQuery("#RC3147706_13105986").css('visibility','hidden'); if (!jQuery("#RC3147706_13105976").is(":checked")) { $("#inputtextother3147706_13105986").val(""); } }); // END Office visit Please enter doctors name reposition if (jQuery("#RC3036574_12713195").is(":checked")) { jQuery("#AnswerTr3036574_12713204").show(); } jQuery("#RC3036574_12713195").on('click', function(e){ console.log('clicked'); jQuery("#AnswerTr3RC3147036574_12713204").toggle(); jQuery("#RC3036574_12713204").prop('checked', jQuery("#AnswerTr3036574_12713204").is(":visible")); }); // check if doctors name is populated when first office visit is checked jQuery("#mygoNextPage").click(function(e){ if (document.getElementById("inputtextother3147699_13105955")) { if ($("#inputtextother3147699_13105955").val().length>0 && $("#inputtextother3147699_13105953").val().indexOf("Alias:") < 0) { sessionStorage.setItem("firstname",$("#inputtextother3147699_13105953").val()); let alias = ($("#inputtextother3147699_13105953").val() + " (Alias: " + $("#inputtextother3147699_13105955").val() + ")"); $("#inputtextother3147699_13105953").val(alias); } $("#goNextPage").click(); }; if (document.getElementById("inputtextother3147693_13105887")) { if ($("#inputtextother3147693_13105887").val().length>0 && $("#inputtextother3147693_13105885").val().indexOf("Alias:") < 0) { sessionStorage.setItem("firstname",$("#inputtextother3147693_13105885").val()); let alias = ($("#inputtextother3147693_13105885").val() + " (Alias: " + $("#inputtextother3147693_13105887").val() + ")"); $("#inputtextother3147693_13105885").val(alias); } $("#goNextPage").click(); } //verify and set dynamic input if (document.getElementById("inputtextother3147713_13112201")) { let correct = 0; if( $("#RC3147713_13105995").prop('checked') ) { //Portal correct = correct + 1; } if( $("#RC3147713_13105996").prop('checked') ) { //Email if( $("#emailAddress").val().length == 0 ){ alert("Email address is required"); $("#emailAddress").focus(); return false; } else correct = correct + 1; } if( $("#RC3147713_13105998").prop('checked') ) { //Fax if( $("#faxNumber").val().length == 0 ){ alert("Fax number is required"); $("#faxNumber").focus(); return false; } else correct = correct + 1; } if( $("#RC3147713_13105997").prop('checked') && $("#cdMail").val() == "Mail") { //CD Mail //if( $("#cd_mailAddress").val().length == 0 ){ //alert("Postal address is required"); //$("#cd_mailAddress").focus(); //return false; //} else correct = correct + 1; } if( $("#RC3147713_13105997").prop('checked') && $("#cdMail").val() == "Pickup") { //CD Pickup if (sessionStorage.getItem("location") == "PAMF") { alert("Please be aware that the sole pick-up location for Palo Alto Medical Foundation (PAMF) records is in Soquel, Santa Cruz County. If this location is inconvenient for you, kindly go back and choose an alternative delivery method."); } if($("#cd_pickupName").val().length == 0 ){ alert("Pickup person name is required"); $("#cd_pickupName").focus(); return false; } else correct = correct + 1; } if( $("#RC3147713_13105999").prop('checked') && $("#paperMail").val() == "Mail") { //Paper Mail if($("#paper_mailAddress").val().length == 0 ){ alert("Postal address is required"); $("#paper_mailAddress").focus(); return false; } else correct = correct + 1; } if( $("#RC3147713_13105999").prop('checked') && $("#paperMail").val() == "Pickup") { //Paper Pickup if (sessionStorage.getItem("location") == "PAMF") { alert("Please be aware that the sole pick-up location for Palo Alto Medical Foundation (PAMF) records is in Soquel, Santa Cruz County. If this location is inconvenient for you, kindly go back and choose an alternative delivery method."); } if($("#paper_pickupName").val().length == 0 ){ alert("Pickup person name is required"); $("#paper_pickupName").focus(); return false; } else correct = correct + 1; } if( $("#RC3147713_13106000").prop('checked') && $("#usbMail").val() == "Mail") { //USB Mail if($("#usb_mailAddress").val().length == 0 ){ alert("Postal address is required"); $("#usb_mailAddress").focus(); return false; } else correct = correct + 1; } if( $("#RC3147713_13106000").prop('checked') && $("#usbMail").val() == "Pickup") { //USB Pickup if (sessionStorage.getItem("location") == "PAMF") { alert("Please be aware that the sole pick-up location for Palo Alto Medical Foundation (PAMF) records is in Soquel, Santa Cruz County. If this location is inconvenient for you, kindly go back and choose an alternative delivery method."); } if($("#usb_pickupName").val().length == 0 ){ alert("Pickup person name is required"); $("#usb_pickupName").focus(); return false; } else correct = correct + 1; } //if (sessionStorage.getItem("release") == "cd" && (primary != "CD" || primary != "checked")) { alert ("Images can only be released on CD. Please select CD as the primary or alternate delivery method"); return false;} if (sessionStorage.getItem("release") == "cd" && primary != "CD") { alert ("Images can only be released on CD. Please select CD as the primary delivery method"); return false;} //if (sessionStorage.getItem("release") == "cd" && !$("#RC3147706_13105983") is 'checked')) { alert ("CD must be selected as one of the delivery methods as Images can only be released on CD"); return false;} if (count <2 || primary == "") { alert ("Please select one primary and one alternate delivery methods"); return false;} let portal = (sessionStorage.getItem("portal") == "checked" ? (primary == "Patient Portal" ? ("Primary: Patient Portal") + " " : ("Alternate: Patient Portal")) + " ": ""); let email = ($("#emailAddress").val() != "" ? (primary == "Email" ? ("Primary: Email(" + $("#emailAddress").val() + "-" + $("#encryption").children("option:selected").val() + ") ") : ("Alternate: Email(" + $("#emailAddress").val() + "-" + $("#encryption").children("option:selected").val() + ") ")): ""); let faxN = ($("#faxNumber").val() != "" ? (primary == "Fax" ? ("Primary: Fax(" + $("#faxNumber").val() + ") ") : ("Alternate: Fax(" + $("#faxNumber").val() + ") " )): ""); let cd = ($("#cd_mailAddress").val() != "" ? (primary == "CD" ? ("Primary: CD-Mail (" + $("#cd_mailAddress").val() + ") ") : ("Alternate: CD-Mail(" + $("#cd_mailAddress").val() + ") ")): ""); cd = cd + ($("#cd_pickupName").val() != "" ? (primary == "CD" ? ("Primary: CD-Pickup (" + $("#cd_pickupName").val() + ") ") : ("Alternate: CD-Pickup(" + $("#cd_pickupName").val() + ") ")): ""); let paper = ($("#paper_mailAddress").val() != "" ? (primary == "Paper" ? ("Primary: paper-Mail (" + $("#paper_mailAddress").val() + ") ") : ("Alternate: paper-Mail(" + $("#paper_mailAddress").val() + ") ")): ""); paper = paper + ($("#paper_pickupName").val() != "" ? (primary == "paper" ? ("Primary: paper-Pickup (" + $("#paper_pickupName").val() + ") ") : ("Alternate: paper-Pickup(" + $("#paper_pickupName").val() + ") ")): ""); let usb = ($("#usb_mailAddress").val() != "" ? (primary == "USB" ? ("Primary: usb-Mail (" + $("#usb_mailAddress").val() + ") ") : ("Alternate: usb-Mail(" + $("#usb_mailAddress").val() + ") ")): ""); usb = usb + ($("#usb_pickupName").val() != "" ? (primary == "USB" ? ("Primary: usb-Pickup (" + $("#usb_pickupName").val() + ") ") : ("Alternate: usb-Pickup(" + $("#usb_pickupName").val() + ") ")): ""); $(dynamicInput).val(portal+email+faxN+cd+paper+usb); if (primary == "Patient Portal") {$(dynamicInput).val(portal + "; " + faxN+email+usb+cd+paper);} if (primary == "Email") {$(dynamicInput).val(email + "; " + portal+faxN+usb+cd+paper);} if (primary == "Fax") {$(dynamicInput).val(faxN + "; " + portal+email+usb+cd+paper);} if (primary == "CD") {$(dynamicInput).val(cd + "; " + portal+email+usb+faxN+paper);} if (primary == "Paper") {$(dynamicInput).val(paper + "; " + portal+email+usb+cd+faxN);} if (primary == "USB") {$(dynamicInput).val(usb + "; " + portal+email+faxN+cd+paper);} sessionStorage.setItem("dynamicInput", $(dynamicInput).val()); //alert(sessionStorage.getItem("dynamicInput")); //doctor's name if (jQuery("#RC3147706_13105976").is(":checked")) { if ($("#inputtextother3147706_13105986").val().indexOf("Doctor's name:") < 0) { sessionStorage.setItem("doctor",$("#inputtextother3147706_13105986").val()); $("#inputtextother3147706_13105986").val("Doctor's name: "+$("#inputtextother3147706_13105986").val()); } } else { sessionStorage.setItem("doctor",""); $("#inputtextother3147706_13105986").val(""); } //other if (jQuery("#RC3147706_13108317").is(":checked")) { if ($("#inputtextother3148284_13108343").val().indexOf("Other detail:") < 0) { sessionStorage.setItem("record-other",$("#inputtextother3148284_13108343").val()); $("#inputtextother3148284_13108343").val("Other detail: "+$("#inputtextother3148284_13108343").val()); } } else { sessionStorage.setItem("record-other",""); $("#inputtextother3148284_13108343").val(""); } if (correct == 2) { $("#goNextPage").click(); } } }); // check if doctors name is populated when first office visit is checked jQuery("#goNextPage, #goPrevPage, #goSubmitPage").click(function(e){ if( jQuery("#RC3036574_12713204").prop('checked') ) { if( jQuery("#inputtextother3036574_12713204").val().length == 0 ){ alert("Please enter all doctor's name"); setTimeout(function(){ jQuery("#inputtextother3036574_12713204").focus(); },1000); } } }); //Reason to hide //moving or switching doctors jQuery("#RC3146278_13095253").hide(); jQuery("#AnswerLabel3146278_13095253").hide(); //Getting a second opinion jQuery("#RC3146278_13095254").hide(); jQuery("#AnswerLabel3146278_13095254").hide(); //Location--hide-other jQuery("#RC3147691_13105825").show(); jQuery("#AnswerLabel3147691_13105825").show(); //confirm email hide jQuery("#AAnswerLabel3147716_13106009").hide(); // relationship jQuery("#AnswerTr3036584_12713233").hide(); jQuery("#RC3036584_12713233").addClass('sr-only'); if (jQuery("#RC3036584_12713232").is(":checked")) { jQuery("#AnswerTr3036584_12713233").show(); } jQuery("#RC3036584_12713232").on('click', function(e){ jQuery("#AnswerTr3036584_12713233").toggle(); jQuery("#RC3036584_12713232").prop('checked', jQuery("#AnswerTr3036584_12713233").is(":visible")); jQuery("#RC3036584_12713231").prop('checked', false); }); jQuery("#RC3036584_12713231").on('click', function(e){ jQuery("#RC3036584_12713232").prop('checked', false); jQuery("#AnswerTr3036584_12713233").hide(); }); //Behavior if ( jQuery("#RC3146281_13095276").is(":checked") ) { jQuery("#RC3146284_13095280, #RC3146284_13095281").prop('checked', true); } // not applicable if ( jQuery("#RC3036577_12713210").is(":checked") ) { jQuery("#RC3036577_12713206, #RC3036577_12713207, #RC3036577_12713208, #RC3036577_12713209").prop('checked', false); } jQuery("#RC3036577_12713210").on('click', function(){ if ( jQuery("#RC3036577_12713210").is(":checked") ) { jQuery("#RC3036577_12713206, #RC3036577_12713207, #RC3036577_12713208, #RC3036577_12713209").prop('checked', false); } }); jQuery("#RC3036577_12713206, #RC3036577_12713207, #RC3036577_12713208, #RC3036577_12713209").on('click', function(){ if ( jQuery("#RC3036577_12713206, #RC3036577_12713207, #RC3036577_12713208, #RC3036577_12713209").is(":checked") ) { jQuery("#RC3036577_12713210").prop('checked', false); } }); // upload file jQuery("#AnswerTr3036586_12713236, #AnswerTr3036589_12713242").removeClass("mobileFriendControl FUIT"); // chooose file jQuery("#AnswerTr3036586_12713236, #AnswerTr3036589_12713242") .find(".labelCFUInput.htmlButton") .css({"border":"solid 1px lightgray", "padding":".5em 1.5em", "font-family":"Helvetica"}); // expiry date jQuery("#inputtextother3036591_12713243").on('change', function(){ if (jQuery("#inputtextother3036591_12713243").val().length) { var now = moment(); var then = now.add(15, "days"); var dateInput = moment(jQuery("#inputtextother3036591_12713243").val()); if (dateInput < then) { alert('Expiration Date must be at least 15 days from today'); jQuery("#goNextPage").prop('disabled', true); } else { jQuery("#goNextPage").prop('disabled', false); } } else { jQuery("#goNextPage").prop('disabled', false); } }); // radiology /*jQuery("#RC3036574_12713201").on("click", function(){ if (jQuery("#RC3036574_12713201").is(":checked")) { alert("To request copies of radiology imaging records or films, please contact the Imaging Department at the location where you had your test."); } });*/ // birthday jQuery("#inputtextother3036561_12713116").on('change', function(){ var age = moment().diff(jQuery(this).val(), 'years'); if (age < 12) { alert('Please check your date of birth'); jQuery("#goNextPage").prop('disabled', true); } else { jQuery("#goNextPage").prop('disabled', false); } }); // dependent birthday jQuery("#inputtextother3036569_12713178").on('change', function(){ var isValidDate = moment().isSameOrAfter(jQuery(this).val(), 'day'); if (!isValidDate) { alert('Please check your date of birth'); jQuery("#goNextPage").prop('disabled', true); } else { jQuery("#goNextPage").prop('disabled', false); } }); // timeframe jQuery("#inputtextother3036573_12713193, #inputtextother3036573_12713194").on('change', function(){ var start = jQuery("#inputtextother3036573_12713193").val(); var to = jQuery("#inputtextother3036573_12713194").val(); var fail = moment(to).isBefore(start); if (start.length && to.length && fail) { alert('Start Date must be before To Date'); jQuery("#goNextPage").prop('disabled', true); } else { jQuery("#goNextPage").prop('disabled', false); } }); // date needed jQuery("#inputtextother3036580_12713213").on('change', function(){ var now = moment(); var needed = jQuery(this).val(); var fail = moment(needed).isBefore(now, 'day'); if (jQuery(this).length && fail) { alert('Please enter today\'s date or future date'); jQuery("#goNextPage, #goPrevPage").prop('disabled', true); } else { jQuery("#goNextPage, #goPrevPage").prop('disabled', false); } }); // limit maxlength of 'other' field on reason for requesting records jQuery("#inputtextother3036572_12713192").attr('maxlength', 50); // limit maxlength of text area for the specific records description jQuery("#inputtextother3036576_12713205").attr('maxlength', 250); // third party stop here if (sessionStorage.getItem("3rd-party") == "true") { $("#goNextPage").hide(); sessionStorage.setItem("3rd-party",""); } else $("#goNextPage").show(); //jQuery("#QuestionHeaderTableId3139676").parent().siblings(".HBUTTONS").find("#goNextPage").hide(); //jQuery("#QuestionHeaderTableId3146263").parent().siblings(".HBUTTONS").find("#goNextPage").hide(); //my-Parent or guardian of a minor between the ages of 12-17 (adolescent)-no next //jQuery("#QuestionHeaderTableId3146260").parent().siblings(".HBUTTONS").find("#goNextPage").hide(); // military enlistment--updated jQuery("#RC3147703_13105965").on("click", function(){ if (jQuery("#RC3147703_13105965").is(":checked")) { alert("If you are a military recruiter, please stop here and have the patient or their guardian sign and submit the authorization as we will otherwise not be able to fulfill your request."); } }); // military enlistment jQuery("#RC3146278_13095256").on("click", function(){ if (jQuery("#RC3146278_13095256").is(":checked")) { alert("If you are a military recruiter, please stop here and have the patient or their guardian sign and submit the authorization as we will otherwise not be able to fulfill your request."); } }); // behavior if ( jQuery("#hidden_RC3138269_13073654").length ){ jQuery("#RC3138272_13067623").prop('checked', true); } //check date //date range-no furture date allowed jQuery("#inputtextother3146280_13095266").prop('type', 'date'); jQuery("#inputtextother3146280_13095266").prop('max',(new Date().toISOString()).split('T')[0]); jQuery("#inputtextother3146280_13095266").on ("focus", function () { $("#inputtextother3146280_13095266").type='date'; $("#inputtextother3146280_13095266").setAttribute('min',new Date());}); //start date range-no furture date allowed jQuery("#inputtextother3146280_13095265").prop('type', 'date'); jQuery("#inputtextother3146280_13095265").prop('max',(new Date().toISOString()).split('T')[0]); jQuery("#inputtextother3146280_13095265").on ("focus", function () { $("#inputtextother3146280_13095265").type='date'; $("#inputtextother3146280_13095265").setAttribute('min',new Date());}); //What date do you need the recordes by jQuery("#inputtextother3146287_13095285").prop('type', 'date'); // jQuery("#inputtextother3146287_13095285").prop('min',(new Date().toISOString()).split('T')[0]); // jQuery("#inputtextother3146287_13095285").prop('max', new Date(new Date().setDate(new Date().getDate() + 15)).toISOString().split('T')[0]); jQuery("#inputtextother3146287_13095285").prop('min', new Date().toISOString().split('T')[0]).prop('max', new Date(new Date().setDate(new Date().getDate() + 100)).toISOString().split('T')[0]); jQuery("#inputtextother3146287_13095285").on ("focus", function () { $("#inputtextother3146287_13095285").type='date'; $("#inputtextother3146287_13095285").setAttribute('max',new Date());}); //Types of records with hover over jQuery("#AnswerLabelTd3147691_13125739").attr('title', 'Do not use to request records from outside of Sutter Health. Only enter Sutter Health locations.'); jQuery("#AnswerLabel3147691_13105825").attr('title', 'Do not use to request records from outside of Sutter Health. Only enter Sutter Health locations.'); jQuery("#AnswerLabelTd3147706_13105976").attr('title', 'Outpatient visit notes\nPhysician office notes\nPrimary care visit notes\nSpecialists visit notes\nFollow-up visit notes\nVideo visit notes (Telehealth)'); jQuery("#AnswerLabel3147706_13105986").attr('title', 'Doctor\'s name'); jQuery("#AnswerLabel3147706_13105976_13095267").attr('title', 'This is testing Hover text'); jQuery("#AnswerLabel3147706_13105977").attr('title', 'Outpatient visit notes\nPhysician office notes\nPrimary care visit notes\nSpecialists visit notes\nFollow-up visit notes\nVideo visit notes (Telehealth)'); jQuery("#AnswerLabel3147706_13105978").attr('title', 'Discharge Summary\nEmergency Department Provider Note\nHistory \& Physical\nConsult\nOperative reports\nProcedure notes\nRadiology reports\nLabs and other diagnostic testing'); jQuery("#AnswerLabel3147706_13105979").attr('title', 'Home Health Records (Sutter Care At Home)'); jQuery("#AnswerLabel3147706_13105980").attr('title', 'Immunizations'); jQuery("#AnswerLabel3147706_13105981").attr('title', 'Lab Test Results'); jQuery("#AnswerLabel3147706_13105982").attr('title', 'Radiology Reports (CT, MRI, X-ray, etc.)'); jQuery("#AnswerLabel3147706_13105983").attr('title', 'NOTE: Images can only be released in CD format'); jQuery("#AnswerLabel3147706_13105984").attr('title', 'Surgeon\鈥檚 report (does not include anesthesia records or implant information)'); jQuery("#AnswerLabel3147706_13108317").attr('title', 'Examples (please specify clearly):\nComplete medical records (includes medication administration record (MAR), flowsheets, progress notes, nurse notes, orders, anesthesia records, consent forms, photographs, etc.)\nFetal monitor strips\nImplant Data\nRadiation Oncology Treatment records'); jQuery("#QuestionLabel3148284").attr('title', 'Please specify Hover'); }); jQuery(document).ready(function(){ // move the date inputs to the left a bit jQuery("label:contains('YYYY')").parent().css('width','50%'); // remove green bar between q15 and q16 jQuery("#QuestionLabelTd3036571").detach(); // Office visit Please enter doctors name reposition jQuery("#AnswerTr3036574_12713204, #AnswerTr2957878_12572754").hide(); jQuery("#RC3036574_12713204, #RC2957878_12572754").addClass('sr-only'); jQuery("#AnswerTr3036574_12713204").detach().insertAfter(jQuery("#AnswerTr3036574_12713195")); if (jQuery("#RC3036574_12713195").is(":checked")) { jQuery("#AnswerTr3036574_12713204").show(); } jQuery("#RC3036574_12713195").on('click', function(e){ console.log('clicked'); jQuery("#AnswerTr3036574_12713204").toggle(); jQuery("#RC3036574_12713204").prop('checked', jQuery("#AnswerTr3036574_12713204").is(":visible")); }); //Sensitive to hide //jQuery("#RC3147709_13105991").hide(); //jQuery("#AnswerLabel3147709_13105991").hide(); // relationship jQuery("#AnswerTr3036584_12713233").hide(); jQuery("#RC3036584_12713233").addClass('sr-only'); if (jQuery("#RC3036584_12713232").is(":checked")) { jQuery("#AnswerTr3036584_12713233").show(); } jQuery("#RC3036584_12713232").on('click', function(e){ jQuery("#AnswerTr3036584_12713233").toggle(); jQuery("#RC3036584_12713232").prop('checked', jQuery("#AnswerTr3036584_12713233").is(":visible")); jQuery("#RC3036584_12713231").prop('checked', false); }); jQuery("#RC3036584_12713231").on('click', function(e){ jQuery("#RC3036584_12713232").prop('checked', false); jQuery("#AnswerTr3036584_12713233").hide(); }); // not applicable if ( jQuery("#RC3036577_12713210").is(":checked") ) { jQuery("#RC3036577_12713206, #RC3036577_12713207, #RC3036577_12713208, #RC3036577_12713209").prop('checked', false); } jQuery("#RC3036577_12713210").on('click', function(){ if ( jQuery("#RC3036577_12713210").is(":checked") ) { jQuery("#RC3036577_12713206, #RC3036577_12713207, #RC3036577_12713208, #RC3036577_12713209").prop('checked', false); } }); jQuery("#RC3036577_12713206, #RC3036577_12713207, #RC3036577_12713208, #RC3036577_12713209").on('click', function(){ if ( jQuery("#RC3036577_12713206, #RC3036577_12713207, #RC3036577_12713208, #RC3036577_12713209").is(":checked") ) { jQuery("#RC3036577_12713210").prop('checked', false); } }); // upload file jQuery("#AnswerTr3036586_12713236, #AnswerTr3036589_12713242").removeClass("mobileFriendControl FUIT"); // chooose file jQuery("#AnswerTr3036586_12713236, #AnswerTr3036589_12713242") .find(".labelCFUInput.htmlButton") .css({"border":"solid 1px lightgray", "padding":".5em 1.5em", "font-family":"Helvetica"}); // expiry date jQuery("#inputtextother3036591_12713243").on('change', function(){ if (jQuery("#inputtextother3036591_12713243").val().length) { var now = moment(); var then = now.add(15, "days"); var dateInput = moment(jQuery("#inputtextother3036591_12713243").val()); if (dateInput < then) { alert('Expiration Date must be at least 15 days from today'); jQuery("#goNextPage").prop('disabled', true); } else { jQuery("#goNextPage").prop('disabled', false); } } else { jQuery("#goNextPage").prop('disabled', false); } }); jQuery("#goPrevPage").on("click", function() { jQuery("#inputtextother3036591_12713243").val(""); }); // radiology /*jQuery("#RC3036574_12713201").on("click", function(){ if (jQuery("#RC3036574_12713201").is(":checked")) { alert("To request copies of radiology imaging records or films, please contact the Imaging Department at the location where you had your test."); } });*/ //relationship // if (document.getElementById("inputtextother3147722_13106020") != null && $("#inputtextother3147722_13106020").val().length==0) { // alert("Please elaborate your specific relationship to the patient."); return false; // } // birthday jQuery("#inputtextother3036561_12713116").on('change', function(){ var age = moment().diff(jQuery(this).val(), 'years'); if (age < 12) { alert('Please check your date of birth'); jQuery("#goNextPage").prop('disabled', true); } else { jQuery("#goNextPage").prop('disabled', false); } }); // dependent birthday jQuery("#inputtextother3036569_12713178").on('change', function(){ var isValidDate = moment().isSameOrAfter(jQuery(this).val(), 'day'); if (!isValidDate) { alert('Please check your date of birth'); jQuery("#goNextPage").prop('disabled', true); } else { jQuery("#goNextPage").prop('disabled', false); } }); // timeframe jQuery("#inputtextother3036573_12713193, #inputtextother3036573_12713194").on('change', function(){ var start = jQuery("#inputtextother3036573_12713193").val(); var to = jQuery("#inputtextother3036573_12713194").val(); var fail = moment(to).isBefore(start); if (start.length && to.length && fail) { alert('Start Date must be before To Date'); jQuery("#goNextPage").prop('disabled', true); } else { jQuery("#goNextPage").prop('disabled', false); } }); // date needed jQuery("#inputtextother3036580_12713213").on('change', function(){ var now = moment(); var needed = jQuery(this).val(); var fail = moment(needed).isBefore(now, 'day'); if (jQuery(this).length && fail) { alert('Please enter today\'s date or future date'); jQuery("#goNextPage, #goPrevPage").prop('disabled', true); } else { jQuery("#goNextPage, #goPrevPage").prop('disabled', false); } }); // limit maxlength of 'other' field on reason for requesting records jQuery("#inputtextother3036572_12713192").attr('maxlength', 50); // limit maxlength of text area for the specific records description jQuery("#inputtextother3036576_12713205").attr('maxlength', 250); // third party stop here //jQuery("#QuestionHeaderTableId3147688").parent().siblings(".HBUTTONS").find("#goNextPage").hide(); // military enlistment jQuery("#RC3138267_13067605").on("click", function(){ if (jQuery("#RC3138267_13067605").is(":checked")) { alert("If you are a military recruiter, please stop here and have the patient or their guardian sign and submit the authorization as we will otherwise not be able to fulfill your request."); } }); // behavior if ( jQuery("#hidden_RC3138269_13073654").length ){ jQuery("#RC3138272_13067623").prop('checked', true); } //check date //date range-no furture date allowed jQuery("#inputtextother3147705_13105975").prop('type', 'date'); jQuery("#inputtextother3147705_13105975").prop('max',(new Date().toISOString()).split('T')[0]); jQuery("#inputtextother3147705_13105975").on ("focus", function () { $("# inputtextother3147705_13105975").type='date'; $("# inputtextother3147705_13105975").setAttribute('min',new Date());}); //start date range-no furture date allowed jQuery("#inputtextother3147705_13105974").prop('type', 'date'); jQuery("#inputtextother3147705_13105974").prop('max',(new Date().toISOString()).split('T')[0]); jQuery("#inputtextother3147705_13105974").on ("focus", function () { $("# inputtextother3147705_13105974").type='date'; $("# inputtextother3147705_13105974").setAttribute('min',new Date());}); //What date do you need the recordes by: jQuery("#inputtextother3147712_13105994").prop('type', 'date'); // jQuery("#inputtextother3146287_13095285").prop('min',(new Date().toISOString()).split('T')[0]); // jQuery("#inputtextother3146287_13095285").prop('max', new Date(new Date().setDate(new Date().getDate() + 15)).toISOString().split('T')[0]); jQuery("#inputtextother3147712_13105994").prop('min', new Date().toISOString().split('T')[0]).prop('max', new Date(new Date().setDate(new Date().getDate() + 100)).toISOString().split('T')[0]); jQuery("#inputtextother3147712_13105994").on ("focus", function () { $("# inputtextother3147712_13105994").type='date'; $("# inputtextother3147712_13105994 ").setAttribute('max',new Date());}); //Expiration +15days jQuery("#inputtextother3147729_13106030").prop('type', 'date'); jQuery("#inputtextother3147729_13106030").prop('min', new Date().toISOString().split('T')[0]).prop('min', new Date(new Date().setDate(new Date().getDate() +15)).toISOString().split('T')[0]); jQuery("#inputtextother3147729_13106030").on ("focus", function () { jQuery("#inputtextother3147729_13106030").prop('type', 'date'); jQuery("#inputtextother3147729_13106030").prop('max', new Date(new Date().setDate(new Date().getDate() + 365)).toISOString().split('T')[0]); }); //*** //Adding new lines from down here //added sensitive alert //added sensitive alert //alert("Hi") jQuery(document).ready (function() { if(jQuery("#RC3147706_13105985").is(":checked")) { jQuery("#RC3147709_13105990").prop("checked", true); } jQuery("#RC3147709_13105990").on('change',function(){ //if( !jQuery("#RC3147709_13105990").is(":checked")) { //if(jQuery(sessionStorage.getItem("location").length > 0)) { //if(!jQuery("#RC3147709_13105990").is(":checked") && (sessionStorage.getItem("location").length > 0)) { if(!jQuery("#RC3147709_13105990").is(":checked") && ((sessionStorage.getItem("location") == "Sutter Center for Psychiatry, Sacramento") || (sessionStorage.getItem("location") == "Kahi Mohala Ewa Beach, HI"))) { alert( "Behavioral/Mental Health records need special authorization for release. If not provided, we cannot release the requested sensitive, protected health information."); //alert( "In the state of California, it is required to give special authorization. If not provided, we cannot release the requested sensitive, protected health information."); jQuery("#RC3147709_13105990").prop("checked", true); return false; } }); }); //add sensitive alert--behav //alert("Hi") jQuery(document).ready (function() { jQuery("#RC3147706_13105985").on('change',function(){ //if( !jQuery("#RC3147706_13105985").is(":checked") && sessionStorage.getItem("location").length > 0) { if( !jQuery("#RC3147706_13105985").is(":checked") && ((sessionStorage.getItem("location") == "Sutter Center for Psychiatry, Sacramento") || (sessionStorage.getItem("location") == "Kahi Mohala Ewa Beach, HI"))) { alert( "Required for " + sessionStorage.getItem("location")); jQuery("#RC3147706_13105985").prop("checked", true); return false; } }); }); //added CD-images alert // jQuery(document).ready (function() { // jQuery("#RC3147706_13105983").on('change',function(){ //jQuery("#RC3147713_13106000").on('change',function(){ $('input[name="RC3147713XXX"]').change(function() { if($("#RC3147713_13105997").is(":checked") && sessionStorage.getItem("release") == "cd") { alert( "Images can only be released on CD"); $("#RC3147713_13105997").prop("checked", true); return false; } }); $('input[name="R3147684"]').change(function(){ if($("#RC3147684_13105786").is(":checked")) sessionStorage.setItem("3rd-party", "true"); else sessionStorage.setItem("3rd-party", ""); if (sessionStorage.getItem("3rd-party") == "") $("#goNextPage").show(); }); $('input[name="R3147706"]').change(function() { if(jQuery("#RC3147706_13105983").is(":checked")) { //alert("Image"); sessionStorage.setItem("release","cd"); //$("#RC3147713_13105997").prop("checked", true); $(cd).show(); $(cdPrimary).prop("checked",true); } else { //alert("Not image"); sessionStorage.setItem("release",""); //$("#RC3147713_13105997").prop("checked", false); $(cd).hide(); $(cdPrimary).prop("checked",false); } }); $('input[name="R3147691"]').change(function() { if(jQuery("#RC3147691_13105802").is(":checked")) { sessionStorage.setItem("location","Sutter Center for Psychiatry, Sacramento"); } else if ($("#RC3147691_13106040").is(":checked")) { sessionStorage.setItem("location","Kahi Mohala Ewa Beach, HI"); } else if ($("#RC3147691_13105815").is(":checked")) { sessionStorage.setItem("location","PAMF"); } else { sessionStorage.setItem("location",""); } }); }); //updates //alert("Sutter") jQuery(document).ready (function() { if(jQuery("#RC3147691_13105824").is(":checked")) { jQuery("#RC3147706_13105979").prop("checked", true); } jQuery("#RC3147706_13105979").on('change',function(){ // alert("Sutter") if( !jQuery("#RC3147706_13105979").is(":checked")) { alert( "Location Home Health already selected in the \"Select a location page\""); jQuery("#RC3147706_13105979").prop("checked", true); return false; } }); })</script><script type="text/javascript" language="javascript" src="/js/fileupload/boxQueries.js?version=549532" charset="UTF-8"></script> <script type="text/javascript" language="javascript" 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name=R3147683 value=13105781 id='RC3147683_13105781' class='cRadio' tabIndex='1' onClick='javascript:answerRequiredModule.check(3147683,false,this,null);'></td><td id="AnswerLabelTd3147683_13105781" class='H3' ><label id="AnswerLabel3147683_13105781" onclick="" for='RC3147683_13105781'>No, I'm the patient's personal representative.</label> </td></tr> </table> </td> </tr> </table> </td></tr> </table> </fieldset> </div> </div> <div align='center' class='HBUTTONS'> <input type='submit' name='goNextPage' value='Next >' id='goNextPage' class='votingNavigation htmlButton' disableForInit='true' tabIndex='1' onClick='javascript:try{if (!isPressedTab(event) && window.pressedNext) return window.pressedNext();}catch(ex){console.log(ex);};' onKeyPress='javascript:try{if (!isPressedTab(event) && window.pressedNext) return window.pressedNext();}catch(ex){console.log(ex);};' title='Next page' aria-label="Next page" ></div></td></tr> <tr><td id='Footer' class='HFooter'><span style="font-weight: 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vpGetElements(reference); if (objByRef && objByRef[0]) { objByRef[0].value = value; $("#"+objByRef[0].id).change(); } } }; var clearField = function (reference) { captureImgData(reference, ""); }; var getSignatureDateForRbr = function () { if (vpIsEditResponse() || vpIsRbr()) { return '<div class="H2 signatureDate" style="float:left;position:absolute;left:10px;bottom:10px"><b>' + signaturePluginDateRbr + '</b></div>'; } return signaturePluginDate; }; var createSignature = function (j, q, h, w, lColor, lWidth, isNeedErasing, bgColor, borderColor, baseLineColor, dateColor, showDate) { //default parameters h = h || 500; w = w || 500; lColor = lColor || '#000'; bgColor = bgColor || "#f0f0f0"; borderColor = borderColor || '#000'; baseLineColor = baseLineColor || '#000'; dateColor = dateColor || '#000'; lWidth = lWidth || 3; isNeedErasing = isNeedErasing === 'true'; var displayDate = showDate === 'false' ? "none" : "block"; for (var x in q) { var currentQuestion = q[x]; var qObj = vpFindQuestion(currentQuestion); if (!qObj) continue; var ansRef = currentQuestion + ".A1", qId = qObj.id, qFieldSetId = "#questionFieldsetId" + qId, qFSObj = $(qFieldSetId), sigId = "signature" + qId, clearId = "clear" + qId, textField = vpGetElements(ansRef)[0], jqTextField = $(textField), field_Top = jqTextField.offset().top, field_Left = jqTextField.offset().left, field_zIndex = jqTextField.parent().css('z-index') ? jqTextField.parent().css('z-index') : 999, fieldVal = textField.value, signatureDateId = "signatureDate" + qId, signerName = qFSObj.find('signature').text(), signerId = "signerName" + qId, construct = '<input class="htmlButton clearSignature" type="button" value="Clear" id="' + clearId + '" data="#' + sigId + '" style="margin:4px"/>' + '<span id="' + signatureDateId + '" class="signatureDate" style="color:' + dateColor + '; display:' + displayDate + '">' + (vpIsEditResponse() ? signaturePluginDateRbr : signaturePluginDate) + '</span>' + '<div id=' + sigId + ' class="signature" data="' + ansRef + '" style="width:' + w + 'px;border:1px solid ' + borderColor + '; margin:4px;z-index:' + field_zIndex + ';background-color:' + bgColor + '">' + '<span id="' + signerId + '" class="signerName">' + signerName + '</span>' + '</div>'; jqTextField.hide(); jqTextField.addClass('hidden'); $(construct).appendTo($("#" + vpGetElements(ansRef)[0].id).parent()); var sig = $('#' + sigId), clearButton = $('#' + clearId); sig.jSignature({ color: lColor, lineWidth: lWidth, width: w, height: h, cssclass: "sigPad", "decor-color": baseLineColor, 'signatureLine': true }); if (fieldVal != "") { if (!isNeedErasing || vpIsViewMode()) { try { sig.jSignature("setData", fieldVal); } catch(e) { // it means that there previously was text result window.logOffline.error( e + ' For field value: ' + fieldVal ) } } else { vpResetResults(currentQuestion); } } sig.bind('change', function (e) { var $self = $(this); captureImgData($self.attr('data'), $self.jSignature("getData")); }); var dy = 0, dx = 0; if (( h > 80 ) && ( w > 80 )) { dy = h - Math.round(h / 5) + 30; dx = Math.round(w / 2) - 40; } else { dx = 5; dy = 0 } $('#' + signatureDateId).css({ 'position': 'relative', 'top': dy + "px", 'left': dx + "px", 'max-width': '100px' }); $('#' + signerId).css({ 'position': 'relative', 'top': h - 30 + "px", 'left': '57%' }); $(sig).closest('.aDivEntireQuestion').addClass(pluginClassName); } $('.clearSignature').bind('click', function () { var sigId = $(this).attr('data'); var $signature = $(sigId); $signature.jSignature("clear"); clearField($signature.attr('data')); }); }; var getSig = function (q, h, w) { //default parameters h = h || 500; w = w || 500; for (var x in q) { if (!isEform) { var qx = vpFindQuestion(q[x]); if (!qx) continue; var qxid = qx.id, qxAnswerid = qx.answers[0].id, qxAnsLabId = "#AnswerLabel" + qxid + "_" + qxAnswerid, qxAnsLabJqObj = $(qxAnsLabId), src = qxAnsLabJqObj.text(), fieldSet = $("#questionFieldsetId" + qxid), signatureDateId = "signatureDate" + qxid, signatureImageHolderId = "imageHolder" + qxid; qxAnsLabJqObj.hide(); qxAnsLabJqObj.css({ "opacity": "0", "position": "absolute", "width": "0px", "height": "0px", "overflow": "hidden" }); var divSig = "<div id=\"" + signatureImageHolderId + "\" class=\"signature\"><img class=\"imported\" src=\"" + src + "\">" + getSignatureDateForRbr() + "</div>"; $(divSig).appendTo(qxAnsLabJqObj.parent()); $('#' + signatureImageHolderId).css({ 'width': w + "px", 'height': h + "px", 'border': '1px solid black', 'position': 'relative' }); } else { var fieldObj; if (vpIsRbr()) { var question = vpFindQuestion(q[x]); var answer = vpFindAnswer(q[x] + '.A1'); fieldObj = $('#AnswerLabel' + question.id + '_' + answer.id); } else { fieldObj = vpGetElements(q[x] + ".A1")[0]; } var jqObj = $(fieldObj); var signatureImageHolderId = "imageHolder" + fieldObj.id; var field_Top = jqObj.offset().top; var field_Left = jqObj.offset().left; var src = jqObj.text(); var signImage = (!src || src.trim().length === 0) ? "" : "<img class=\"imported\" src=\"" + src + "\">"; var sigDIV = "<div id=\"" + signatureImageHolderId + "\" class=\"signature\" style='position: relative'>" + signImage + getSignatureDateForRbr() + "</div>"; jqObj.hide(); jqObj.after(sigDIV); jqObj.css({ "opacity": "0", "position": "absolute", "width": "0px", "height": "0px", "overflow": "hidden" }); var sig = $('#' + signatureImageHolderId); sig.css({ 'width': w + "px", 'height': h + "px", 'border': '1px solid black' }); moveBottomNavPixels = moveBottomNavPixels >= h ? moveBottomNavPixels : h; } } }; var fixRbrLayout = function () { $('hr').remove(); $('#DivMainBottomMenuNavigation').css('top', moveBottomNavPixels + 'px'); }; return { Run: function () { for (var x = 0; ; x++) { try { var q = eval("SIG_Q" + x), h = eval("SIG_H" + x), w = eval("SIG_W" + x), lineColor = eval("SIG_LC" + x), lineWidth = eval("SIG_LW" + x), keep = eval("KEEP_SIG" + x), showDate = eval("window.SHOW_DATE" + x), bgColor = eval("window.SIG_BG_COLOR" + x), borderColor = eval("window.SIG_BORDER_COLOR" + x), baseLineColor = eval("window.SIG_LC" + x), //using SIG_LC instead of SIG_BASELINE_COLOR due to "1px offset" bug in jSignature/ dateColor = eval("window.SIG_DATE_COLOR" + x); if (q == null) { return; } if (!vpIsRbr()) { createSignature(x, q, h, w, lineColor, lineWidth, keep, bgColor, borderColor, baseLineColor, dateColor, showDate); } else { getSig(q, h, w); } } catch (ex) { fixRbrLayout(); return; } } }, clearArea: function (qId) { $("#clear" + qId).trigger("click"); } } })(jQuery); jQuery(document).ready(function () { if (typeof commonVotingModule != "undefined") { commonVotingModule.allDataRestored.done(function () { signatureMain.Run(); }); } else { signatureMain.Run(); } }); </script> <script type="text/javascript" > var compareValuesPlugin = (function ($) { var regQNumber = new RegExp("Q(\\d+)(\\.A(\\d+))?(\\.C(\\d+))?", "ig"), array = [], compare = function () { var result = true; for (var i = 0; i < array.length; i++) { var field1Collection = vpGetResults(array[i].field1), field2Collection = vpGetResults(array[i].field2), value1 = getValueFromResultCollection(field1Collection, array[i].field1), value2 = getValueFromResultCollection(field2Collection, array[i].field2), lastObject = vpGetElements(array[i].lastField); if (!isNaN(parseFloat(value1))) { value1 = parseFloat(value1); } if (!isNaN(parseFloat(value2))) { value2 = parseFloat(value2); } var isLast = lastObject != null; if (isLast) { if (lastObject instanceof Array) { isLast = lastObject.length > 0; } } if (value1 !== value2 && isLast) { if (array[i].allow) { if (confirm(array[i].message + "\nDo you want to skip the check?")) { result = true; } else { result = false; break } } else { alert(array[i].message); result = false; break; } } } return result; }, createModel = function (i, field1, field2, allow, message) { var model = {}; model.field1 = field1; model.field2 = field2; model.allow = allow; model.message = message; model.lastField = parseInt(field1.replace(regQNumber, "$1")) > parseInt(field2.replace(regQNumber, "$1")) ? field1 : field2; array[i] = model; }, getValueFromResultCollection = function (collection, field) { if (collection != null) { for (var i = 0; i < collection.length; i++) { var result = collection[i]; var expr = result.expression; if (result.isMultiLine()) { if (expr.length > 0 && expr.indexOf(".") > -1) { expr = expr.substring(0, expr.indexOf(".")); } } if (expr == field) { if (result.valueType.valType == "PERCENT" || result.valueType.valType == "AMOUNT" || result.valueType.valType == "NUMBER" || result.valueType.valType == "NUMBER_NATURAL") { return result.value.replace(/[^-0-9\.]/gim, ""); } else { return result.value; } } } } return ""; }; return { Run: function () { for (var i = 0; ; i++) { try { var field1 = eval("COMPAREVALUEFIRST" + i), field2 = eval("COMPAREVALUESECOND" + i), allow = eval("COMPAREVALUEALLOWTOPROCEED" + i), message = eval("COMPAREVALUEWARNINGMESSAGE" + i); if (field1 == null || field1 == null || allow == null || message == null) { return; } createModel(i, vpReplaceSurveyVars(field1), vpReplaceSurveyVars(field2), (allow == "Yes"), message); } catch (ex) { return; } } }, validate: function (skip_validate, dir, formAction) { if (dir != "Next" && dir != "") { return true; } return compare(); } } })(jQuery); jQuery(document).ready(function () { compareValuesPlugin.Run(); verifyPlugins.push("compareValuesPlugin"); }); </script></div> </body> </html>

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