// ADDED A VARIABLE TO DISPLAY THE RESPECTIVE MESSAGE FOR ENGLISH AS WELL AS LATINO SITE-ANAND FOR // LINE ADDED TO DISPLAY MSG FOR LATINO-2B.

var emailAlertMsg = "Must be a valid Email address."; 

// MODIFICATION END FOR LATINO_2B

function contactUsInfo(form)  {
	var type = form.type.value;
	var domaintype = form.DomainType.value;	
	//audience var is created for Provider Nomination
	var audience = form.Audience.value;
	if(type == 'Menopause')
	{
		if (Trim(form.firstName.value) == "") 	{
		  alert("Please enter your first name.");
		  form.firstName.focus();
		  return (false);
		}

		if (Trim(form.lastName.value) == "") 	{
		  alert("Please enter your last name.");
		  form.lastName.focus();
		  return (false);
		}
		
		if (Trim(form.member_number.value) == "") 	{
		  alert("Please enter your member ID number, as it appears on your membership card.");
		  form.member_number.focus();
		  return (false);
		}


		if (Trim(form.mailingAddress.value) == "") 	{
		 alert("Please enter your street address.");
		  form.mailingAddress.focus();
		  return (false);
		}

		if (Trim(form.city.value) == "") 	{
		  alert("Please enter your city.");
		  form.city.focus();
		  return (false);
		}		

		if (Trim(form.zip.value) == "") 	{
		 alert("Please enter your zip code.");
		  form.zip.focus();
		  return (false);
		}
		
		if (Trim(form.emailAddress.value) == "") 	{
		 // Make Sure it's not empty
		 alert("Please enter your email address.");
		 form.emailAddress.focus();
		 return (false);
		}
		else
		{
			if(!isValidEmail(form.emailAddress))
			{
				form.emailAddress.focus();
				return false;
			}
		}


		if (Trim(form.areaCode.value) == "") 	{
		  alert("Please enter your area code.");
		  form.areaCode.focus();
		  return (false);
		}

		if (Trim(form.phone_prefix.value) == "") 	{
		  alert("Please enter your phone number prefix.");
		  form.phone_prefix.focus();
		  return (false);
		}
		if (Trim(form.phone_suffix.value) == "") 	{
		  alert("Please enter your phone number suffix.");
		  form.phone_suffix.focus();
		  return (false);
		}
		if (Trim(form.dob.value) == "") 	{
		  alert("Please enter your date of birth.");
		  form.dob.focus();
		  return (false);
		}
			
	}
	//Added by Kuljeet Enrollment Form For PHS Employer Portal 16th Nov 2006 Start
	else if(type == 'MemberEnrollmentAdd')
	{
	 	if (Trim(form.authContactName.value) == "")
		{
			alert("Please enter the Benefits Administrator's Name.");
			form.authContactName.focus();
			return(false);
		}
		if (Trim(form.authAreaCode.value) == "")
		{
			alert("Please enter the Benefits Administrator's Phone Number.");
			form.authAreaCode.focus();
			return(false);
		}
		if (Trim(form.authPhoneNumber.value) == "")
		{
			alert("Please enter the Benefits Administrator's Phone Number.");
			form.authPhoneNumber.focus();
			return(false);
		}
		if (Trim(form.emailAddress.value) == "") 	
		{
			 alert("Please enter the Benefits Administrator's E-mail Address.");
			 form.emailAddress.focus();
			return (false);
		}
		else
		{
			if(!isValidEmail(form.emailAddress))
			{
				form.emailAddress.focus();
				return false;
			}
		}
		if (Trim(form.groupNumber.value) == "") 	{
		  alert("Please enter your Group Number.");
		  form.groupNumber.focus();
		  return (false);
		}
		if (Trim(form.groupName.value) == "") 	{
		  alert("Please enter your Group Name.");
		  form.groupName.focus();
		  return (false);
		}
		if (Trim(form.ssn1.value) == "")
		{
		  alert("Please enter your Social Security Number.");
		  form.ssn1.focus();
		  return (false);
		}
		if (Trim(form.ssn2.value) == "")
		{
		  alert("Please enter your Social Security Number.");
		  form.ssn2.focus();
		  return (false);
		}
		if (Trim(form.ssn3.value) == "")
		{
		  alert("Please enter your Social Security Number.");
		  form.ssn3.focus();
		  return (false);
		}
		if (Trim(form.subscriberLastName.value) == "") 	{
		  alert("Please enter your Last Name.");
		  form.subscriberLastName.focus();
		  return (false);
		}
		if (Trim(form.subscriberFirstName.value) == "") 	{
		  alert("Please enter your First Name.");
		  form.subscriberFirstName.focus();
		  return (false);
		}
		if (Trim(form.hireDate.value) == "") 	
		{
		  alert("Please select the Hire Date by clicking on the Calendar button.");
		  form.hireDate.focus();
		  return (false);
		}
		else if( isDateEntered( form.hireDate ) == null )
		{
	          alert("Hire date should be in [MM/DD/YYYY], please select the Hire Date by clicking on the Calendar button.");
		  form.hireDate.focus();
		  return (false);
		}
		if (Trim(form.effectiveDate.value) == "") 	
		{
		  alert("Please select the Effective Date by clicking on the Calendar button.");
		  form.effectiveDate.focus();
		  return (false);
		}
		else if( isDateEntered( form.effectiveDate ) == null )
		{
		  alert("Effective date should be in [MM/DD/YYYY], please select the Effective Date by clicking on the Calendar button.");
		  form.effectiveDate.focus();
		  return (false);
		}
		if (Trim(form.dob.value) == "") 	
		{
		  alert("Please enter the Date of Birth value.");
		  form.dob.focus();
		  return (false);
		}
		else if( isDateEntered( form.dob ) == null )
		{
		  alert("Date of Birth should be in [MM/DD/YYYY], Please enter the Date of Birth value in [MM/DD/YYYY] format.");
		  form.dob.focus();
		  return (false);
		}
		
		if (Trim(form.plansRequested.value) == "") 	{
		  alert("Please select the Product Requested.");
		  form.plansRequested.focus();
		  return (false);
		}
		
		// if(form.productsRequested.value == null){
		//	  alert("Please select the Plan Requested.");
		//	  form.productsRequested.focus();
		//	  return (false);
		// }
		
		if(form.productsRequested.value != null){
		if (Trim(form.productsRequested.value) == "") 	{
		  alert("Please select the Plans Requested.");
		  form.productsRequested.focus();
		  return (false);
		}
		}
		
	//Added by Sekar for Enrollment changes
	if (form.plansRequested.value == "PPOCA" 
		|| form.plansRequested.value == "EPOCA" 
		|| form.plansRequested.value == "SDHPCA" 
		|| form.plansRequested.value == "PPOOR" 
		|| form.plansRequested.value == "EPOOR" 
		|| form.plansRequested.value == "SDHPOR" 
		|| form.plansRequested.value == "PPOWA" 
		|| form.plansRequested.value == "EPOWA"
		|| form.plansRequested.value == "SDHPWA" 
		|| form.plansRequested.value == "PPOAZ"
		|| form.plansRequested.value == "EPOAZ"
		|| form.plansRequested.value == "SDHPAZ"
		|| form.plansRequested.value == "PPONV"
		|| form.plansRequested.value == "EPONV"
		|| form.plansRequested.value == "SDHPNV"
		|| form.plansRequested.value == "PPOCO"
		|| form.plansRequested.value == "EPOCO"
		|| form.plansRequested.value == "SDHPCO"
		|| form.plansRequested.value == "PPOTX"
		|| form.plansRequested.value == "SDHPTX"
		|| form.plansRequested.value == "EPOTX"
		|| form.plansRequested.value == "PPOOK"
		|| form.plansRequested.value == "EPOOK"
		|| form.plansRequested.value == "SDHPOK"
		)
	{
		if (Trim(form.priorCoverageFlag.value) == "") 	{
		  alert("Please select whether you had prior coverage or NO( Y/N).");
		  form.priorCoverageFlag.focus();
		  return (false);
		}
	
		if (Trim(form.priorCoverageFlag.value) == "Y")	{
		
		    if (form.CoverageEndDate.value == ""){
		  	alert("Please Enter the Coverage End Date");  
		  	form.CoverageEndDate.focus();
		  	return (false);
		    }
		    // alert("inside full time");
		    if((form.CoverageEndDate.value != "") &&  (Trim(form.priorCoverageFlag.value) == "Y")){
				if(isDateEntered (form.CoverageEndDate) == null ) {
		    	alert("Coverage End date should be in [MM/DD/YYYY].");
		    	form.CoverageEndDate.focus();
		    	return (false);
				}
			}
		    
		}
		
	}
		if (Trim(form.lifeCoverageIncluded.value) == "") 	{
		  alert("Please select the Life Coverage Included.");
		  form.lifeCoverageIncluded.focus();
		  return (false);
		}
		
		if (Trim(form.subQualifyingEvent.value) == "") 	{
		  alert("Please select the Qualifying Event.");
		  form.subQualifyingEvent.focus();
		  return (false);
		}
		if (Trim(form.subQualifyingEvent.value) == "Full Time")	{
		
		    if (form.fulltimedate.value == ""){
		  	alert("Please Enter the Date of Hire");  
		  	form.fulltimedate.focus();
		  	return (false);
		    }
		    // alert("inside full time");
		    if( isDateEntered (form.fulltimedate) == null ) {
		    	alert("Hire date should be in [MM/DD/YYYY], please select the Hire Date by clicking on the Calendar button.");
		    	form.fulltimedate.focus();
		    	return (false);
		    }
		    
		}
		
		
		else if(Trim(form.subQualifyingEvent.value) == "Other" 
			&& Trim(form.subSpecify.value) == "")	
			{
				alert("Please specify the Qualifying Event.");
				form.subSpecify.focus();
				return(false);
		
		}
		if (form.plansRequested.value == "HMOPOSCA" 
		|| form.plansRequested.value == "HMOPOSOR" 
		|| form.plansRequested.value == "MCOPOSWA" 
		|| form.plansRequested.value == "HMOCA" 
		|| form.plansRequested.value == "HMOOR" 
		|| form.plansRequested.value == "HMOWA" 
		|| form.plansRequested.value == "POSOR" 
		|| form.plansRequested.value == "POSWA" 
		|| form.plansRequested.value == "POSCA" 
		|| form.plansRequested.value == "HMOAZ" 
		|| form.plansRequested.value == "HMOCO" 
		|| form.plansRequested.value == "HMOOK" )
		{
			if (Trim(form.primaryCarePhysicianNum.value) == "") 	{
			  alert("Please enter your Primary Care Physician Number.");
			  form.primaryCarePhysicianNum.focus();
		  return (false);
		}
		}
		
		// alert("form value-----"+form.plansRequested.value);
		if (form.plansRequested.value == "PPOCA" 
		|| form.plansRequested.value == "EPOCA" 
		|| form.plansRequested.value == "IndemnityCA" 
		|| form.plansRequested.value == "QHDHPCA"
		|| form.plansRequested.value == "PPOOR" 
		|| form.plansRequested.value == "EPOOR" 
		|| form.plansRequested.value == "IndemnityOR" 
		|| form.plansRequested.value == "QHDHPOR" 
		|| form.plansRequested.value == "PPOWA" 
		|| form.plansRequested.value == "EPOWA" 
		|| form.plansRequested.value == "IndemnityWA" 
		|| form.plansRequested.value == "QHDHPWA" )
		{
		if (Trim(form.locationCode.value) == "") 	{
		  //alert("Please enter the Location Code.");
		  //form.locationCode.focus();
		  //return (false);
		}
		}
		if (Trim(form.subscribersStreetAddress.value) == "") 	{
		  alert("Please enter your Street Address.");
		  form.subscribersStreetAddress.focus();
		  return (false);
		}
		if (Trim(form.subscribersCity.value) == "") 	{
		  alert("Please enter your City.");
		  form.subscribersCity.focus();
		  return (false);
		}
		if (Trim(form.state.value) == "") 	{
		  alert("Please select your State.");
		  form.state.focus();
		  return (false);
		}
		if (Trim(form.subscribersZipCode.value) == "") 	{
		  alert("Please enter your Zip Code.");
		  form.subscribersZipCode.focus();
		  return (false);
		}
	
				
		// Dependent block validations
		if(form.noOfDependent.value >0)
		{
			for(var t=1; t <= form.noOfDependent.value; t++)
			{
				var relationshipId = document.getElementById("relationship"+t);
				if(Trim(relationshipId.value) == "")
				{
					alert("Please select your Relationship to the Dependent");
					relationshipId.focus();
					return (false);
				}
				
				var dssn1 = document.getElementById("dssn1"+t);
				if (Trim(dssn1.value) == "")
				{
				  alert("Please enter your Social Security Number.");
				  dssn1.focus();
				  return (false);
				}
				var dssn2 = document.getElementById("dssn2"+t);
				if (Trim(dssn2.value) == "")
				{
				  alert("Please enter your Social Security Number.");
				  dssn2.focus();
				  return (false);
				}
				var dssn3 = document.getElementById("dssn3"+t);
				if (Trim(dssn3.value) == "")
				{
				  alert("Please enter your Social Security Number.");
				  dssn3.focus();
				  return (false);
				}

				if (Trim(dssn1.value) == "" || dssn1.value.length < 3)
				{
				  alert("Please enter your Social Security Number.");
				  dssn1.focus();
				  return (false);
				}
				if (Trim(dssn2.value) == "" || dssn2.value.length < 2)
				{
				  alert("Please enter your Social Security Number.");
				  dssn2.focus();
				  return (false);
				}
				if (Trim(dssn3.value) == "" || dssn3.value.length < 4)
				{
				  alert("Please enter your Social Security Number.");
				  dssn3.focus();
				  return (false);
				}

				
				var dLastNameId = document.getElementById("dLastName"+t);
				if(Trim(dLastNameId.value) == "")
				{
					alert("Please enter Dependents Last Name.");
					dLastNameId.focus();
					return (false);
				}

				var dFirstNameId = document.getElementById("dFirstName"+t);
				if(Trim(dFirstNameId.value) == "")
				{
					alert("Please enter Dependents First Name.");
					dFirstNameId.focus();
					return (false);
				}
				
				var dDateofBirthId = document.getElementById("dDateofBirth"+t);
				if(Trim(dDateofBirthId.value) == "")
				{
					alert("Please Enter the Dependents Date of Birth.");
					dDateofBirthId.focus();
					return (false);
				}
				else if( isDateEntered( dDateofBirthId ) == null )
				{
				  
				  alert("please Enter the Dependents Date of Birth in [MM/DD/YYYY] format.");
				  dDateofBirthId.focus();
				  return (false);
				}
				
				
				// anand annamalai----------
				var fulltimetextId = document.getElementById("fulltimetext"+t);
				
				var qualifyingEventId = document.getElementById("qualifyingEvent" + t);
				var qualifyingEventVal = qualifyingEventId.value;
				if(qualifyingEventVal == "Full Time"){		
				if(Trim(fulltimetextId.value) == "")
				{
					alert("Please Enter the Hire Date.");
					fulltimetextId.focus();
					return (false);
				}
				else if( isDateEntered( fulltimetextId ) == null )
				{
				  
				  alert("Please Enter the Date of Hire in [MM/DD/YYYY] format.");
				  fulltimetextId.focus();
				  return (false);
				}
				}
				


				var plansRequestedId = document.getElementById("plansRequested"+t);
				if(Trim(plansRequestedId.value) == "")
				{
					alert("Please enter Dependents Products Requested.");
					plansRequestedId.focus();
					return (false);
				}
				
								
				// 7777777777777
				var productsRequestedId = document.getElementById("productsRequested2"+t);
				// alert("dependents plan value*****"+productsRequestedId.value);						   
				
				if(Trim(productsRequestedId.value) == "")
				{
					alert("Please enter Dependents Plans Requested.");
					productsRequestedId.focus();
					return (false);
				}
				

				var qualifyingEventId = document.getElementById("qualifyingEvent"+t);
				if(Trim(qualifyingEventId.value) == "")
				{
					alert("Please select Dependents Qualifying Event.");
					qualifyingEventId.focus();
					return (false);
				}
				else if(Trim(qualifyingEventId.value) == "Other")
				{
					var specifyId = document.getElementById("specify"+t);
					if(Trim(specifyId.value) == "")
					{
						alert("Please specify Dependents Qualifying Event.");
						specifyId.focus();
						return (false);
					}
				}
				
				
				// 88888888
				// alert("dependent2222.."+plansRequestedId.value);
				if (plansRequestedId.value =="HMOPOSCA"
				|| plansRequestedId.value =="HMOOR"
				|| plansRequestedId.value =="HMOPOSOR"
				|| plansRequestedId.value =="HMOCA"
				|| plansRequestedId.value =="HMOWA"
				|| plansRequestedId.value =="MCOPOSWA"
				|| plansRequestedId.value =="HMOAZ"
				|| plansRequestedId.value =="HMOCO"
				|| plansRequestedId.value =="HMOOK" )
				
				{
					var primaryCarePhysicianNumId = document.getElementById("primaryCarePhysicianNum"+t);
					if (Trim(primaryCarePhysicianNumId.value) == "") 	{
					  alert("Please enter your Primary Care Physician Number.");
					  primaryCarePhysicianNumId.focus();
					  return (false);
					}
				
				}
				
				
				
				
				if (productsRequestedId.value == "Signature Value High Option" 
				|| productsRequestedId.value == "Signature Value Low Option" 
				|| productsRequestedId.value == "Signature Value Advantage" 
				|| productsRequestedId.value == "HMO - (AZ, CO, NV only)"  )
				{
					var primaryCarePhysicianNumId = document.getElementById("primaryCarePhysicianNum"+t);
					if (Trim(primaryCarePhysicianNumId.value) == "") 	{
					  alert("Please enter your Primary Care Physician Number.");
					  primaryCarePhysicianNumId.focus();
					  return (false);
					}
				}
				var dGenderId = document.getElementById("dGender"+t);
				if(Trim(dGenderId.value) == "")
				{
					alert("Please select Dependents Gender.");
					dGenderId.focus();
					return (false);
				}
			}
		}
		
	}
	else if(type == 'MemberEnrollmentTerminate')
	{
		//For Termination Form
		if (Trim(form.authContactName.value) == "")
		{
			alert("Please enter the Benefits Administrator's Name.");
			form.authContactName.focus();
			return(false);
		}
		if (Trim(form.authAreaCode.value) == "")
		{
			alert("Please enter the Benefits Administrator's Phone Number.");
			form.authAreaCode.focus();
			return(false);
		}
		if (Trim(form.authPhoneNumber.value) == "")
		{
			alert("Please enter the Benefits Administrator's Phone Number.");
			form.authPhoneNumber.focus();
			return(false);
		}
		if (Trim(form.emailAddress.value) == "") 	
		{
			 alert("Please enter the Benefits Administrator's E-mail Address.");
			 form.emailAddress.focus();
			return (false);
		}
		else
		{
			if(!isValidEmail(form.emailAddress))
			{
				form.emailAddress.focus();
				return false;
			}
		}
		if (Trim(form.groupNumber.value) == "") 	
		{
		  alert("Please enter your Group Number.");
		  form.groupNumber.focus();
		  return (false);
		}
		if (Trim(form.groupName.value) == "") 	
		{
		  alert("Please enter your Group Name.");
		  form.groupName.focus();
		  return (false);
		}
		if (Trim(form.ssn1.value) == "" || form.ssn1.value.length < 3)
		{
		  alert("Please enter your Social Security Number.");
		  form.ssn1.focus();
		  return (false);
		}
		if (Trim(form.ssn2.value) == "" || form.ssn2.value.length < 2)
		{
		  alert("Please enter your Social Security Number.");
		  form.ssn2.focus();
		  return (false);
		}
		if (Trim(form.ssn3.value) == "" || form.ssn3.value.length < 4)
		{
		  alert("Please enter your Social Security Number.");
		  form.ssn3.focus();
		  return (false);
		}
		if (Trim(form.subscriberLastName.value) == "") 	
		{
		  alert("Please enter your Last Name.");
		  form.subscriberLastName.focus();
		  return (false);
		}
		if (Trim(form.subscriberFirstName.value) == "") 	
		{
		  alert("Please enter your First Name.");
		  form.subscriberFirstName.focus();
		  return (false);
		}
		if (Trim(form.terminationDate.value) == "") 	
		{
		  alert("Please select the Termination Date by clicking on the Calendar button.");
		  form.terminationDate.focus();
		  return (false);
		}
		else if( isDateEntered( form.terminationDate ) == null )
		{
		  alert("Termination Date should be in [MM/DD/YYYY], please select the Termination Date by clicking on the Calendar button.");
		  form.terminationDate.focus();
		  return (false);
		}
		
		if(form.noOfDependent.value >0)
		{
			for(var t=1; t <= form.noOfDependent.value; t++)
			{
				var depNameId = document.getElementById("dName"+t);
				if(depNameId.value == "")
				{
					alert("Please enter your Dependent to be termed");
					depNameId.focus();
					return (false);
				}
			}
		}
	}else if(type == 'MemberEnrollmentChange')
	{
		//For Change Request Form
		if (Trim(form.authContactName.value) == "")
		{
			alert("Please enter the Benefits Administrator's Name.");
			form.authContactName.focus();
			return(false);
		}
		if (Trim(form.authAreaCode.value) == "")
		{
			alert("Please enter the Benefits Administrator's Phone Number.");
			form.authAreaCode.focus();
			return(false);
		}
		if (Trim(form.authPhoneNumber.value) == "")
		{
			alert("Please enter the Benefits Administrator's Phone Number.");
			form.authPhoneNumber.focus();
			return(false);
		}
		if (Trim(form.emailAddress.value) == "") 	
		{
			 alert("Please enter the Benefits Administrator's E-mail Address.");
			 form.emailAddress.focus();
			return (false);
		}
		else
		{
			if(!isValidEmail(form.emailAddress))
			{
				form.emailAddress.focus();
				return false;
			}
		}
		if (Trim(form.groupNumber.value) == "") 	{
		  alert("Please enter your Group Number.");
		  form.groupNumber.focus();
		  return (false);
		}
		if (Trim(form.groupName.value) == "") 	{
		  alert("Please enter your Group Name.");
		  form.groupName.focus();
		  return (false);
		}
		if (Trim(form.ssn1.value) == "" || form.ssn1.value.length < 3)
		{
		  alert("Please enter your Social Security Number.");
		  form.ssn1.focus();
		  return (false);
		}
		if (Trim(form.ssn2.value) == "" || form.ssn2.value.length < 2)
		{
		  alert("Please enter your Social Security Number.");
		  form.ssn2.focus();
		  return (false);
		}
		if (Trim(form.ssn3.value) == "" || form.ssn3.value.length < 4)
		{
		  alert("Please enter your Social Security Number.");
		  form.ssn3.focus();
		  return (false);
		}
		if (Trim(form.subscriberLastName.value) == "") 	
		{
		  alert("Please enter your Last Name.");
		  form.subscriberLastName.focus();
		  return (false);
		}
		if (Trim(form.subscriberFirstName.value) == "") 	
		{
		  alert("Please enter your First Name.");
		  form.subscriberFirstName.focus();
		  return (false);
		}
		if (form.requestedChange.value != "Address Change"
			&& form.requestedChange.value != "PCP"
			&& form.requestedChange.value != "SSN"
			&& form.requestedChange.value != "Group Transfer"
			&& form.requestedChange.value != "Other")
		{
			alert("Please select the Requested Change.");
			form.requestedChange.focus();
			return(false);
		}
		else
		{
			if (form.requestedChange.value == "Address Change")
			{
				if (Trim(form.subscribersStreetAddress.value) == "") 	
				{
				  alert("Please enter your Street Address.");
				  form.subscribersStreetAddress.focus();
				  return (false);
				}
				if (Trim(form.subscribersCity.value) == "") 	
				{
				  alert("Please enter your City.");
				  form.subscribersCity.focus();
				  return (false);
				}
				if (Trim(form.state.value) == "") 	
				{
				  alert("Please select your State.");
				  form.state.focus();
				  return (false);
				}
				if (Trim(form.subscribersZipCode.value) == "") 	
				{
				  alert("Please enter your Zip Code.");
				  form.subscribersZipCode.focus();
				  return (false);
				}
			}
			else if (form.requestedChange.value == "Group Transfer")
			{
				if(Trim(form.groupnumbertext.value) =="")
				{
					alert("Please enter your Current Group Number.");
					form.groupnumbertext.focus();
					return(false);
				}
				if(Trim(form.newgrouptext.value) =="")
				{
					alert("Please enter your New Group Number.");
					form.newgrouptext.focus();
					return(false);
				}
				if(Trim(form.newgroupdatetext.value) =="")
				{
					alert("Please enter your New Group Number Effective Date.");
					form.newgroupdatetext.focus();
					return(false);
				}
				if(isDateEntered( form.newgroupdatetext ) == null)
				{
					alert("New Group date should be in [MM/DD/YYYY], please select the New Group Date by clicking on the Calendar button.");
					form.newgroupdatetext.focus();
					return(false);
				}
				
				
			}
			else if (form.requestedChange.value == "PCP")
			{
				if(Trim(form.primaryCarePhysicianNum.value) =="")
				{
					alert("Please enter your Primary Care Physician Number.");
					form.primaryCarePhysicianNum.focus();
					return(false);
				}
			}
			else if (form.requestedChange.value == "Other" )
			{
				if(Trim(form.changesReq.value) =="")
				{
					alert("Please describe your Requested Change.");
					form.changesReq.focus();
					return(false);
				}
			}
		else if (form.requestedChange.value == "SSN" ){
		if(form.noOfSubscriber.value >0)
		{
			for(var t=1; t <= form.noOfSubscriber.value; t++)
			{
				var dLastNameId = document.getElementById("dLastName"+t);
				if(Trim(dLastNameId.value) == "")
				{
					alert("Please enter Member Last Name.");
					dLastNameId.focus();
					return (false);
				}
				var dFirstNameId = document.getElementById("dFirstName"+t);
				if(Trim(dFirstNameId.value) == "")
				{
					alert("Please enter Member First Name.");
					dFirstNameId.focus();
					return (false);
				}
				var dssn1 = document.getElementById("dssn1"+t);
				if (Trim(dssn1.value) == "")
				{
				  alert("Please enter Member Social Security Number.");
				  dssn1.focus();
				  return (false);
				}
				var dssn2 = document.getElementById("dssn2"+t);
				if (Trim(dssn2.value) == "")
				{
				  alert("Please enter Member Social Security Number.");
				  dssn2.focus();
				  return (false);
				}
				var dssn3 = document.getElementById("dssn3"+t);
				if (Trim(dssn3.value) == "")
				{
				  alert("Please enter Member Social Security Number.");
				  dssn3.focus();
				  return (false);
				}

				if (Trim(dssn1.value) == "" || dssn1.value.length < 3)
				{
				  alert("Please enter Member Social Security Number.");
				  dssn1.focus();
				  return (false);
				}
				if (Trim(dssn2.value) == "" || dssn2.value.length < 2)
				{
				  alert("Please enter Member Social Security Number.");
				  dssn2.focus();
				  return (false);
				}
				if (Trim(dssn3.value) == "" || dssn3.value.length < 4)
				{
				  alert("Please enter Member Social Security Number.");
				  dssn3.focus();
				  return (false);
				}				
				
			}
		}

			
		}
		}
		
	}
	//Added by Kuljeet Enrollment Form For PHS Employer Portal 13th Nov 2006 End
	else if(type == 'pregnancy_to_preschool')
	{
		if (Trim(form.firstName.value) == "") 	{
		  alert("Please enter your first name.");
		  form.firstName.focus();
		  return (false);
		}

		if (Trim(form.lastName.value) == "") 	{
		  alert("Please enter your last name.");
		  form.lastName.focus();
		  return (false);
		}
		
		if (Trim(form.member_number.value) == "") 	{
		  alert("Please enter your member ID number, as it appears on your membership card.");
		  form.member_number.focus();
		  return (false);
		}


		if (Trim(form.mailingAddress.value) == "") 	{
		 alert("Please enter your street address.");
		  form.mailingAddress.focus();
		  return (false);
		}

		if (Trim(form.city.value) == "") 	{
		  alert("Please enter your city.");
		  form.city.focus();
		  return (false);
		}		

		if (Trim(form.zip.value) == "") 	{
		 alert("Please enter your zip code.");
		  form.zip.focus();
		  return (false);
		}
		
		if (Trim(form.emailAddress.value) == "") 	{
		 // Make Sure it's not empty
		 alert("Please enter your email address.");
		 form.emailAddress.focus();
		 return (false);
		}
		else
		{
			if(!isValidEmail(form.emailAddress))
			{
				form.emailAddress.focus();
				return false;
			}
		}


		if (Trim(form.areaCode.value) == "") 	{
		  alert("Please enter your area code.");
		  form.areaCode.focus();
		  return (false);
		}

		if (Trim(form.phone_prefix.value) == "") 	{
		  alert("Please enter your phone number prefix.");
		  form.phone_prefix.focus();
		  return (false);
		}
		if (Trim(form.phone_suffix.value) == "") 	{
		  alert("Please enter your phone number suffix.");
		  form.phone_suffix.focus();
		  return (false);
		}
		if (Trim(form.dob.value) == "") 	{
		  alert("Please enter your date of birth.");
		  form.dob.focus();
		  return (false);
		}		
	}
	else if(type == 'ProviderNomination'){					
		  if (Trim(form.firstName.value) == ""){
			  alert("Please enter your first name.");
			  form.firstName.focus();					 
			  return (false);
			}

		  if (Trim(form.lastName.value) == ""){
			  alert("Please enter your last name.");
			  form.lastName.focus();
			  return (false);
			}
		   if(audience  == 'Provider-Before-Logon'){

			   /*  if (Trim(form.suffix.value) == ""){
					  alert("Suffix is required.  22222222");
					  form.suffix.focus();
					  return (false);
				}
				*/

			     if (Trim(form.degree.value) == ""){
					  alert("Degree is required.");
					  form.degree.focus();
					  return (false);
				}

				if (Trim(form.Specialty.selectedIndex) == 0){		
				  alert("Primary  Specialty is required.");
				  form.Specialty.focus();
				  return (false);		
			   }
			   }

				/*  if (Trim(form.Specialty.selectedIndex) == 0){		
				  alert("Primary Specialty is required.");
				  form.Specialty.focus();
				  return (false);		
			   }
			   */

                  //area code removed in this release
                  /*
if (Trim(form.areaCode.value) == "") 	{
		  alert("Area code is required. ");
		  form.areaCode.focus();
		  return (false);
		}else{
		if(!isNum(form.areaCode.value))
			{
				form.areaCode.focus();
				alert("Please enter numbers only");
				return false;
			}
		
		}*/


		    if (Trim(form.emailAddress.value) == "") 	{
					 // Make Sure it's not empty
					 alert("Please enter your email address.");
					 form.emailAddress.focus();
					 return (false);
					}
					else
					{
						if(!isValidEmail(form.emailAddress))
						{
							form.emailAddress.focus();
							return false;
						}
			   }

		if (Trim(form.providerGrpName.value) == "") 	{
		 // Make Sure it's not empty
		 alert("Please enter the Provider Group Name.");
		 form.providerGrpName.focus();
		 return (false);
		}			   
			   
		if (Trim(form.phoneNumber.value) == "") 	{
		  alert("Phone Number is required.");
		  form.phoneNumber.focus();
		  return (false);
		}else{
		if(!isNum(form.phoneNumber.value))
			{				alert("Please enter numbers only");
				form.phoneNumber.focus();

				return false;
			}
		
		}
		  /*if (Trim(form.taxid.value) == ""){
					  alert("Tax ID# is required.");
					  form.taxid.focus();
					  return (false);
			}*/
				   
	}
	//Edited for UHCGeneration
	
	else if(type=='UHCGContactUS')
	{
		if (Trim(form.firstName.value) == ""){
			  alert("Please enter your first name.");
			  form.firstName.focus();					 
			  return (false);
			}

		  if (Trim(form.lastName.value) == ""){
			  alert("Please enter your last name.");
			  form.lastName.focus();
			  return (false);
			}
		if (Trim(form.mailingAddress.value) == "") 	{
		 alert("Please enter your e-mail ID");
		  form.mailingAddress.focus();
		  return (false);
		}
		else
		{
			if(!isValidEmail(form.mailingAddress))
			{
				form.emailAddress.focus();
				return false;
			}
		}

	if (Trim(form.subject.value) == "") 	{
		 alert("Please enter the Subject.");
		  form.subject.focus();
		  return (false);
		}
	if (Trim(form.Message.value) == "") 	{
		 alert("Please enter the message you want to send.");
		  form.Message.focus();
		  return (false);
		}

	}
	//Edited for AAHS
	else if (type =='AASContactUS')
	{

		if (Trim(form.firstName.value) == ""){
			  alert("Please enter your first name.");
			  form.firstName.focus();					 
			  return (false);
			}

		  if (Trim(form.lastName.value) == ""){
			  alert("Please enter your last name.");
			  form.lastName.focus();
			  return (false);
			}
		if (Trim(form.mailingAddress.value) == "") 	{
		 alert("Please enter your street address.");
		  form.mailingAddress.focus();
		  return (false);
		}

		if (Trim(form.city.value) == "") 	{
		  alert("Please enter your city.");
		  form.city.focus();
		  return (false);
		}		

		if (Trim(form.state.value) == "") 	{
		  alert("State is required.");
		  form.state.focus();
		  return (false);
		}

		if (Trim(form.zip.value) == "") 	{
		 alert("Please enter your zip code.");
		  form.zip.focus();
		  return (false);
		}
		if (Trim(form.areaCode.value) == "") 	{
		  alert("Area code is required. ");
		  form.areaCode.focus();
		  return (false);
		}else{
		if(!isNum(form.areaCode.value))
			{
				form.areaCode.focus();
				alert("Please enter numbers only");
				return false;
			}
		
		}

		if (Trim(form.phoneNumber.value) == "") 	{
		  alert("Phone Number is required.");
		  form.phoneNumber.focus();
		  return (false);
		}else{
		if(!isNum(form.phoneNumber.value))
			{				alert("Please enter numbers only");
				form.phoneNumber.focus();

				return false;
			}
		
		}
		
		if (Trim(form.emailAddress.value) == "") 	{
		 // Make Sure it's not empty
		 alert("Please enter your email address.");
		 form.emailAddress.focus();
		 return (false);
		}
		else
		{
			if(!isValidEmail(form.emailAddress))
			{
				form.emailAddress.focus();
				return false;
			}
		}
		if (Trim(form.race_ethnicity.value) == "") 	{
		  alert("Race/Ethnicity is required. ");
		  form.race_ethnicity.focus();
		  return (false);
		}
			myOptionCurrMember = -1;
			myOptionOtherPerson = -1;

			for (i=0; i<form.currentMember.length; i++)
			{
				if (form.currentMember[i].checked)
				{
					myOptionCurrMember = i;
					break;
				}

			}

			if (myOptionCurrMember == -1)
			{
				alert("Please select are you currently a member of Secure Horizons");
				return false;
			}

			if(form.currentMember[myOptionCurrMember].value == "Yes" &&	Trim(form.member_number.value) == "")
			{
				alert("Plese enter Member ID");
				form.member_number.focus();
				return false;
			}

			for (i=0; i<form.otherPerson.length; i++)
			{
				if (form.otherPerson[i].checked)
				{
					myOptionOtherPerson = i;
				}

			}

			if (myOptionOtherPerson == -1)
			{
				alert("Please select  are you inquiring about Secure Horizons for someone other than yourself ");
				return false;
			}

			//alert(form.otherPerson[myOptionOtherPerson].value);
			if(form.otherPerson[myOptionOtherPerson].value == 'Yes' &&
					Trim(form.otherPersonName.value) == "")
			{
				alert("Please enter the person's name");
				form.otherPersonName.focus();
				return false;
			}

	}
	//Validation for AAHS Ends here
	// VALIDATION FOR LATINO-2B - START Merged by Soumya on 25-feb-04 Start
		else if(domaintype == 'Pacificarelatino')
		{
			// This is to set different alert message based on
			// latino site while validating the email field value
			emailAlertMsg = "Debe ser una direccin Correo electrnico vlida.";
	
	
			if (Trim(form.firstName.value) == "")
			{
				alert("Por favor proporcione su Nombre.");
				form.firstName.focus();
				return (false);
			}
			if (Trim(form.lastName.value) == "")
			{
				alert("Por favor proporcione su Apellido Paterno.");
				form.lastName.focus();
				return (false);
			}
			if (Trim(form.mailingAddress.value) == "")
			{
				alert("Por favor proporcione su Domicilio.");
				form.mailingAddress.focus();
				return (false);
			}
			if (Trim(form.city.value) == "")
			{
				alert("Por favor proporcione su Ciudad.");
				form.city.focus();
				return (false);
			}
		
			if (Trim(form.state.value) == "")
			{
				alert("Por favor proporcione su Estado.");
				form.state.focus();
				return (false);
			}
			if (Trim(form.zip.value) == "")
			{
				alert("Por favor proporcione su Cdigo Postal.");
				form.zip.focus();
				return (false);
			}
			if (Trim(form.areaCode.value) == "") 	
			{
				  alert("Por favor proporcione su el rea cdigo.");
				  form.areaCode.focus();
				  return (false);
			}
			if (Trim(form.phoneNumber.value) == "")
			{
				alert("Por favor proporcione su Telfono.");
				form.phoneNumber.focus();
				return (false);
			}
			if (Trim(form.emailAddress.value) == "")
			{
				// Make Sure it's not empty
				alert("Por favor proporcione su Direccin de Correo Electrnico.");
				form.emailAddress.focus();
				return (false);
			}
			else
			{
				if(!isValidEmail(form.emailAddress))
				{
					form.emailAddress.focus();
					return false;
				}
			}
	
			if (Trim(form.product.value) == "")
			{
			  alert("Por favor proporcione su Plan de Salud / Tipo de Producto.");
			  form.product.focus();
			  return (false);
			}
	
			if(type == 'LatinoMembers')
			{
				if (Trim(form.member_number.value) == "")
				{
				  alert("Por favor proporcione su Nmero de Membresa");
				  form.member_number.focus();
				  return (false);
				}
			}
	
			if (Trim(form.comments.value) == "")
			{
				alert("Por favor proporcione su comenta.");
				form.comments.focus();
				return (false);
			}
	
		}
   // VALIDATION FOR LATINO-2B ENDS HERE Merged by Soumya 25Feb04 End
	// Validation for ASolutionForCaregivers - START
	else if(type == 'CaregiverContactUs')
	{
		if (Trim(form.firstName.value) == "")
		{
			alert("Please enter your first name.");
			form.firstName.focus();
			return (false);
		}
		if (Trim(form.lastName.value) == "")
		{
			alert("Please enter your last name.");
			form.lastName.focus();
			return (false);
		}
		if (Trim(form.mailingAddress.value) == "")
		{
			alert("Mailing address is required.");
			form.mailingAddress.focus();
			return (false);
		}
		if (Trim(form.city.value) == "")
		{
			alert("City is required.");
			form.city.focus();
			return (false);
		}

		if (Trim(form.state.value) == "")
		{
			alert("State is required.");
			form.state.focus();
			return (false);
		}
		if (Trim(form.zip.value) == "")
		{
			alert("Zip code is required.");
			form.zip.focus();
			return (false);
		}
		if (Trim(form.phoneNumber.value) == "")
		{
			alert("Phone Number is required.");
			form.phoneNumber.focus();
			return (false);
		}
		if (Trim(form.emailAddress.value) == "")
		{
			// Make Sure it's not empty
			alert("Please enter your email address.");
			form.emailAddress.focus();
			return (false);
		}
		else
		{
			if(!isValidEmail(form.emailAddress))
			{
				form.emailAddress.focus();
				return false;
			}
		}

		if (Trim(form.comments.value) == "")
		{
			alert("Please enter your comments.");
			form.comments.focus();
			return (false);
		}


		if (Trim(form.company_name.value) != "")
		{
			if (Trim(form.industry.value) == "")
			{
				alert("Please select an Industry");
				form.industry.focus();
				return (false);
			}
			if (Trim(form.employeeNumber.value) == "")
			{
				alert("Please select # of Employees");
				form.employeeNumber.focus();
				return (false);
			}
			if (form.radIsPacificareProd(0).checked == false && form.radIsPacificareProd(1).checked == false)
			{
				alert("Please select Radio Button for using Pacificare Health Provider");
				form.radIsPacificareProd(0).focus();
				return (false);
			}
		}
	}
	// Validation for ASolutionForCaregivers - END

/*Changes made by Vivek for II6631-E1206-Change to Broker submission at PHS site-Ron Pukszta-041124 on Dec 17 Starts*/

	else if(type == 'IfBroker')
	{
		if (Trim(form.firstName.value) == "") 	{
		  alert("First name is required.");
		  form.firstName.focus();
		  return (false);
		}

		if (Trim(form.lastName.value) == "") 	{
		  alert("Last name is required.");
		  form.lastName.focus();
		  return (false);
		}

		if (Trim(form.emailAddress.value) == "") 	{
		 // Make Sure it's not empty
		 alert("Email address is required.");
		 form.emailAddress.focus();
		 return (false);
		}
		else
		{
			if(!isValidEmail(form.emailAddress))
			{
				form.emailAddress.focus();
				return false;
			}
		}
		if (Trim(form.state.value) == "") 	{
		  alert("State is required.");
		  form.state.focus();
		  return (false);
		}
		if (Trim(form.company_name.value) == "")
				{
					alert("Please enter your company name.");
					form.company_name.focus();
					return false;
				}
				if (Trim(form.comments.value) == "")
				{
					alert("Please enter your comments.");
					form.comments.focus();
					return (false);
				}

	}

/*Changes made by Vivek for II6631-E1206-Change to Broker submission at PHS site-Ron Pukszta-041124 on Dec 17 Ends*/
//Added by Sajesh on 05/March/2005 for the CCR SR7452-E1130-New Page for Provider Portal iEXCHANGE-Joanne Ennis RD040913 - Starts
 
	else if(type == 'iEXCHANGE_Info_CD_Req_Form'){
	
		if (Trim(form.firstName.value) == ""){
		  alert("First name is required.");
		  form.firstName.focus();
		  return (false);
		}else if (!isNaN(form.firstName.value)){
		  alert("First name should not be numeric.");
		  form.firstName.focus();
		  form.firstName.select();
		  return (false);
		}
		

		if (Trim(form.lastName.value) == "") 	{
		  alert("Last name is required.");
		  form.lastName.focus();
		  return (false);
		}else if (!isNaN(form.lastName.value)){
		  alert("Last name should not be numeric.");
		  form.lastName.focus();
		  form.lastName.select();
		  return (false);
		}

		if (Trim(form.mailingAddress.value) == "") 	{
		  alert("Mailing address is required.");
		  form.mailingAddress.focus();
		  return (false);
		}

		if (Trim(form.city.value) == "") 	{
		  alert("City is required.");
		  form.city.focus();
		  return (false);
		}

		if (Trim(form.state.value) == "") 	{
		  alert("State is required.");
		  form.state.focus();
		  return (false);
		}

		if (Trim(form.zip.value) == "") 	{
		  alert("Zip code is required.");
		  form.zip.focus();
		  return (false);
		}
		return (true);
	}
	
	else if(type == 'iEXCHANGE_Web_Prof_Form'){

		//alert("Do The Validations for iEXCHANGE_Web_Prof_Form here!!");
		if(!form.notifHospAdmission.checked && !form.reqAuthAndReferrels.checked && !form.notifAuthReffStatus.checked){
		    alert("Please select the type of Transaction");
		    form.notifHospAdmission.focus();
		    return (false);
		 }

		if (Trim(form.firstName.value) == ""){
		  alert("Name is required.");
		  form.firstName.focus();
		  return (false);
		}else if (!isNaN(form.firstName.value)){
		  alert("Name should not be numeric.");
		  form.firstName.focus();
		  form.firstName.select();
		  return (false);
		}

		if (Trim(form.phone_prefix.value) == "") 	{
		  alert("Please enter your phone number prefix.");
		  form.phone_prefix.focus();
		  return (false);
		}
		if (Trim(form.phone_suffix.value) == "") 	{
		  alert("Please enter your phone number suffix.");
		  form.phone_suffix.focus();
		  return (false);
		}

		if (Trim(form.phone_extension.value) == "") 	{
		  alert("Please enter your extension.");
		  form.phone_extension.focus();
		  return (false);
		}

		if (Trim(form.officeName.value) == "") 	{
		  alert("Please enter Office / Group name.");
		  form.officeName.focus();
		  return (false);
		}else if (!isNaN(form.officeName.value)){
		  alert("Office / Group name should not be numeric.");
		  form.officeName.focus();
		  form.officeName.select();
		  return (false);
		}

	}
//Added by Sajesh on 05/March/2005 for the CCR SR7452-E1130-New Page for Provider Portal iEXCHANGE-Joanne Ennis RD040913 - Ends

	else
	{
		if (Trim(form.firstName.value) == "") 	{
		  alert("First name is required.");
		  form.firstName.focus();
		  return (false);
		}

		if (Trim(form.lastName.value) == "") 	{
		  alert("Last name is required.");
		  form.lastName.focus();
		  return (false);
		}


		if (Trim(form.mailingAddress.value) == "") 	{
		  alert("Mailing address is required.");
		  form.mailingAddress.focus();
		  return (false);
		}

		if (Trim(form.city.value) == "") 	{
		  alert("City is required.");
		  form.city.focus();
		  return (false);
		}

		if (Trim(form.state.value) == "") 	{
		  alert("State is required.");
		  form.state.focus();
		  return (false);
		}

		if (Trim(form.zip.value) == "") 	{
		  alert("Zip code is required.");
		  form.zip.focus();
		  return (false);
		}


		if (Trim(form.areaCode.value) == "") 	{
		  alert("Area code is required.");
		  form.areaCode.focus();
		  return (false);
		}

		if (Trim(form.phoneNumber.value) == "") 	{
		  alert("Phone Number is required.");
		  form.phoneNumber.focus();
		  return (false);
		}


		if (Trim(form.emailAddress.value) == "") 	{
		 // Make Sure it's not empty
		 alert("Email address is required.");
		 form.emailAddress.focus();
		 return (false);
		}
		else
		{
			if(!isValidEmail(form.emailAddress))
			{
				form.emailAddress.focus();
				return false;
			}
		}
		if(domaintype == 'PacificCare')
		{
			if(type == 'Member' || type == 'NonMember' || type == 'WHSContactUs')
			{
				if (Trim(form.product.value) == "")
				{
					  alert("Plan/Product Type is required.");
					  form.product.focus();
					  return (false);
				}
			}

			if(type == 'Member')
			{
				if (Trim(form.member_number.value) == "")
				{
				  alert("Please enter your member number");
				  form.member_number.focus();
				  return (false);
				}

			}
			<!--Edited by vivek for  changes in broker Removed type==IFBroker->
			if( type == 'BecomingBroker')
			{
				if (Trim(form.ssn1.value) == "")
				{
				  alert("Please enter your Social Security Number.");
				  form.ssn1.focus();
				  return (false);
				}
				if (Trim(form.ssn2.value) == "")
				{
				  alert("Please enter your Social Security Number.");
				  form.ssn2.focus();
				  return (false);
				}
				if (Trim(form.ssn3.value) == "")
				{
				  alert("Please enter your Social Security Number.");
				  form.ssn3.focus();
				  return (false);
				}
				if (Trim(form.broker_id.value) == "")
				{
					alert("Please enter your Broker License Number.");
					form.broker_id.focus();
					return false;
				}
				if (form.broker_state.value == "")
				{
					alert("Please select your Broker State.");
					form.broker_id.focus();
					return false;
				}
				if (Trim(form.company_name.value) == "")
				{
					alert("Please enter your company name.");
					form.company_name.focus();
					return false;
				}
//Added By Soumya For making the comments field Mandatory--Changes made by Soumya is removed by Vivek for II6631-E1206-Change to Broker submission at PHS site-Ron Pukszta-041124 on Dec 17 Starts and Ends*/


			}
			if(type == 'GroupInsurance')
			{
				if (Trim(form.company_name.value) == "")
				{
				  alert("Please enter your company name");
				  form.company_name.focus();
				  return (false);
				}
				if (Trim(form.industry.value) == "")
				{
				  alert("Please enter your industry name");
				  form.industry.focus();
				  return (false);
				}
				myOptionEmployeesIn2States = -1;
				for (i=0; i<form.hasEmployeesIn2States.length; i++)
				{
					if (form.hasEmployeesIn2States[i].checked)
					{
						myOptionEmployeesIn2States = i;
					}
				}
				myOptionHealthInsurance = -1;
				for (i=0; i<form.hasHealthInsurance.length; i++)
				{
					if (form.hasHealthInsurance[i].checked)
					{
						myOptionHealthInsurance = i;
					}
				}
				myOptionSelfFunded = -1;
				for (i=0; i<form.isSelfFunded.length; i++)
				{
					if (form.isSelfFunded[i].checked)
					{
						myOptionSelfFunded = i;
					}
				}
				if (myOptionEmployeesIn2States == -1)
				{
					alert("Please select whether or not your employees reside in 2 or more states.");
					return (false);
				}
				if (myOptionHealthInsurance == -1)
				{
					alert("Please select whether or not you are currently using another health care provider");
					return (false);
				}
				if (myOptionSelfFunded == -1)
				{
					alert("Please select whether or not you are self funded")
					return (false);
				}			

			}

			/* Added by srikanth on 09\09\05 for 7575-E1380 Update member portal sales contact forms Michelle Bywater-RDO50506 start*/
			if(type == 'GroupInsuranceCALargeGroup')
			{
				if (Trim(form.company_name.value) == "")
				{
				  alert("Please enter your company name");
				  form.company_name.focus();
				  return (false);
				}
				if (Trim(form.industry.value) == "")
				{
				  alert("Please enter your industry name");
				  form.industry.focus();
				  return (false);
				}
				myOptionEmployeesIn2States = -1;
				for (i=0; i<form.hasEmployeesIn2States.length; i++)
				{
					if (form.hasEmployeesIn2States[i].checked)
					{
						myOptionEmployeesIn2States = i;
					}
				}
				myOptionHealthInsurance = -1;
				for (i=0; i<form.hasHealthInsurance.length; i++)
				{
					if (form.hasHealthInsurance[i].checked)
					{
						myOptionHealthInsurance = i;
					}
				}
				myOptionSelfFunded = -1;
				for (i=0; i<form.isSelfFunded.length; i++)
				{
					if (form.isSelfFunded[i].checked)
					{
						myOptionSelfFunded = i;
					}
				}
				if (myOptionEmployeesIn2States == -1)
				{
					alert("Please select whether or not your employees reside in 2 or more states.");
					return (false);
				}
				if (myOptionHealthInsurance == -1)
				{
					alert("Please select whether or not you are currently using another health care provider");
					return (false);
				}
				if (myOptionSelfFunded == -1)
				{
					alert("Please select whether or not you are self funded")
					return (false);
				}			

			}
		/* Added by srikanth on 09\09\05 for 7575-E1380 Update member portal sales contact forms Michelle Bywater-RDO50506 end*/
			if(type == 'IndividualPlan')
			{			
				myOptionhealth_ins = -1;
				for (i=0; i<form.health_ins.length; i++)
				{
					if (form.health_ins[i].checked)
					{
						myOptionhealth_ins = i;
					}
				}			
				if (myOptionhealth_ins == -1)
				{
					alert("Please fill in whether or not you have health insurance.");
					return (false);
				}
				/*
				* Changed the IF condition. There is no column like "ind_pos" in the form.
				* Fix is for e-Manage id 858, 05-Apr-2004
				*/
				//if (!form.ind_hmo.checked && !form.ind_pos.checked)
				if (!form.ind_hmo.checked)
				{
					alert("Please check which plan you would like information about.");
					return (false);
				}
				if (Trim(form.job.value) == "")
				{
					alert("Please enter your occupation.");
					form.job.focus();
					return (false);
				}

				if (Trim(form.younger_spouse_age.value) == "")
				{
					alert("Please enter your age (if single) or age of younger spouse applying for coverage (if married).");
					form.younger_spouse_age.focus();
					return (false);
				}
				if (form.call_info.checked || form.mail_info.checked)
				{
					if (form.call_info.checked)
					{
						if (Trim(form.contact_area_code.value) == "" || Trim(form.contact_phone.value) == "" || Trim(form.best_time_to_call.value) == "")
						{
							alert("Please enter your phone number and the best time to call you.");
							form.contact_area_code.focus();
							return (false);
						}
					}

				}
				else
				{
					alert("Please check either to have information mailed to you or to be called.");
					return (false);
				}
			}
			if(type == 'SecureHorizons')
			{
				/*				
				*	Modified for 008633-E2124-WA 07 July -08 by Gopichand Start
				*/
				/*
				if (!form.hmo.checked && !form.pos.checked)
				{
					alert("Please select which MediCare Risk plan you would like information about.");
					return (false);
				}
				*/
				/*				
				*	Modified for 008633-E2124-WA 07 July -08 by Gopichand Ends
				*/

				myOptionmedicare = -1;
				for (i=0; i<form.medicare.length; i++)
				{
					if (form.medicare[i].checked)
					{
						myOptionmedicare = i;
					}
				}			
				if (myOptionmedicare == -1)
				{
					alert("Please select whether or not you have MediCare.");
					return (false);
				}
				if (form.call_info.checked || form.mail_info.checked)
				{
					if (form.call_info.checked)
					{
						if (Trim(form.contact_area_code.value) == "" || Trim(form.contact_phone.value) == "" || Trim(form.best_time_to_call.value) == "")
						{
							alert("Please enter your phone number and the best time to call you.");
							form.contact_area_code.focus();
							return (false);
						}
					}

				}
				else
				{
					alert("Please check either to have information mailed to you or to be called.");
					return (false);
				}
			}
		}else
		{
			myOptionCurrMember = -1;
			myOptionOtherPerson = -1;
			for (i=0; i<form.currentMember.length; i++)
			{
				if (form.currentMember[i].checked)
				{
					myOptionCurrMember = i;
					break;
				}

			}

			if (myOptionCurrMember == -1)
			{
				alert("Please select are you currently a member of Secure Horizons");
				return false;
			}

			if(form.currentMember[myOptionCurrMember].value == "Yes" &&	Trim(form.member_number.value) == "")
			{
				alert("Plese enter Member ID");
				form.member_number.focus();
				return false;
			}

			for (i=0; i<form.otherPerson.length; i++)
			{
				if (form.otherPerson[i].checked)
				{
					myOptionOtherPerson = i;
				}

			}

			if (myOptionOtherPerson == -1)
			{
				alert("Please select  are you inquiring about Secure Horizons for someone other than yourself ");
				return false;
			}

			//alert(form.otherPerson[myOptionOtherPerson].value);
			if(form.otherPerson[myOptionOtherPerson].value == 'Yes' &&
					Trim(form.otherPersonName.value) == "")
			{
				alert("Please enter the person's name");
				form.otherPersonName.focus();
				return false;
			}


		}
/* Added by srikanth on 09\09\05 for 7575-E1380 Update member portal sales contact forms Michelle Bywater-RDO50506 start*/
		if(type != 'BecomingBroker' && type !='GroupInsurance' && type !='IndividualPlan' && type == 'SecureHorizons' && type =='AASContactUS' && type !='GroupInsuranceCALargeGroup')
		{
			if (Trim(form.comments.value) == "")
			{
			  alert("Please enter your comments.");
			  form.comments.focus();
			  return (false);
			}
		}		
/* Added by srikanth on 09\09\05 for 7575-E1380 Update member portal sales contact forms Michelle Bywater-RDO50506 END*/	
		if(type == 'WHSContactUs' || type == 'AboutOurWebSite' || type == 'TechnicalProblems')
		{
			if (Trim(form.comments.value) == "")
			{
			  alert("Please enter your comments.");
			  form.comments.focus();
			  return (false);
			}
		}
	}
	return (true);
}

function Trim(str)
{
        return RTrim(LTrim(str));
}


function LTrim(str)
{
	var whitespace = new String(" \t\n\r");
        var s = new String(str);

        if (whitespace.indexOf(s.charAt(0)) != -1)
        {
		// We have a string with leading blank(s)...

		var j=0, i = s.length;
		// Iterate from the far left of string until we
		// don't have any more whitespace...
		while (j < i && whitespace.indexOf(s.charAt(j)) != -1)
			j++;


		// Get the substring from the first non-whitespace
		// character to the end of the string...
		s = s.substring(j, i);
	}

	return s;
}



function RTrim(str)
{
	// We don't want to trip JUST spaces, but also tabs,
	// line feeds, etc.  Add anything else you want to
	// "trim" here in Whitespace
	var whitespace = new String(" \t\n\r");

	var s = new String(str);

	if (whitespace.indexOf(s.charAt(s.length-1)) != -1)
	{
        	// We have a string with trailing blank(s)...

        	var i = s.length - 1;       // Get length of string

        	// Iterate from the far right of string until we
        	// don't have any more whitespace...
        	while (i >= 0 && whitespace.indexOf(s.charAt(i)) != -1)
        		i--;

		// Get the substring from the front of the string to
		// where the last non-whitespace character is...
		s = s.substring(0, i+1);
	}
	return s;
}
//Added for uhc generation

function CheckCharinTextBox(str){
var maxchars = 500; // Change number to maximum characters.
if (str.value.length > maxchars) 
str.value = str.value.substring(0,maxchars);
}

// CHANGED FOR LATINO-2B TO DISPLAY SPANISH AS WELL AS ENGLISH MSGS.
// CURRENTLY ONLY ENGLISH MESSAGES WERE DISPLAYED.-ANAND
function isValidEmail(emailStr)
{
	var emailVar=emailStr.value
	if (emailVar.length > 0)
	{
		/* The following pattern is used to check if the entered e-mail address
		   fits the user@domain format.  It also is used to separate the username
		   from the domain. */
		var emailPat=/^(.+)@(.+)$/
		/* The following string represents the pattern for matching all special
		   characters.  We don't want to allow special characters in the address.
		   These characters include ( ) < > @ , ; : \ " . [ ]    */
		var specialChars="\\(\\)<>@,;:\\\\\\\"\\.\\[\\]\'"
		/* The following string represents the range of characters allowed in a
		   username or domainname.  It really states which chars aren't allowed. */
		var validChars="\[^\\s" + specialChars + "\]"
		/* The following pattern applies if the "user" is a quoted string (in
		   which case, there are no rules about which characters are allowed
		   and which aren't; anything goes).  E.g. "jiminy cricket"@disney.com
		   is a legal e-mail address. */
		var quotedUser="(\"[^\"]*\")"
		/* The following pattern applies for domains that are IP addresses,
		   rather than symbolic names.  E.g. joe@[123.124.233.4] is a legal
		   e-mail address. NOTE: The square brackets are required. */
		var ipDomainPat=/^\[(\d{1,3})\.(\d{1,3})\.(\d{1,3})\.(\d{1,3})\]$/
		/* The following string represents an atom (basically a series of
		   non-special characters.) */
		var atom=validChars + '+'
		/* The following string represents one word in the typical username.
		   For example, in john.doe@somewhere.com, john and doe are words.
		   Basically, a word is either an atom or quoted string. */
		var word="(" + atom + "|" + quotedUser + ")"
		// The following pattern describes the structure of the user
		var userPat=new RegExp("^" + word + "(\\." + word + ")*$")
		/* The following pattern describes the structure of a normal symbolic
		   domain, as opposed to ipDomainPat, shown above. */
		var domainPat=new RegExp("^" + atom + "(\\." + atom +")*$")


		/* Finally, let's start trying to figure out if the supplied address is
		   valid. */

		/* Begin with the coarse pattern to simply break up user@domain into
		   different pieces that are easy to analyze. */
		var matchArray=emailVar.match(emailPat)
		if (matchArray==null)
		{
			/* Too many/few @'s or something; basically, this address doesn't
			   even fit the general mould of a valid e-mail address. */
			// alert("Must be a valid Email address."); LINE COMMENTED FOR LATINO-2B
			alert(emailAlertMsg); // LINE ADDED TO DISPLAY MSG FOR LATINO-2B
			return false
		}
		var user=matchArray[1]
		var domain=matchArray[2]

		// See if "user" is valid
		if (user.match(userPat)==null)
		{
			// user is not valid
    			// alert("Must be a valid Email address."); LINE COMMENTED FOR LATINO-2B
			alert(emailAlertMsg); // LINE ADDED TO DISPLAY MSG FOR LATINO-2B
    			return false
		}

	/* if the e-mail address is at an IP address (as opposed to a symbolic
	   host name) make sure the IP address is valid. */
	var IPArray=domain.match(ipDomainPat)
	if (IPArray!=null)
	{
    		// this is an IP address
		for (var i=1;i<=4;i++)
		{
	    		if (IPArray[i]>255)
	    		{
	        		// alert("Must be a valid Email address."); LINE COMMENTED FOR LATINO-2B
	        		alert(emailAlertMsg); // LINE ADDED TO DISPLAY MSG FOR LATINO-2B
				return false
	    		}
    		}
    		return false
	}

	// Domain is symbolic name
	var domainArray=domain.match(domainPat)
	if (domainArray==null) {
	// alert("Must be a valid Email address."); LINE COMMENTED FOR LATINO-2B
	alert(emailAlertMsg); // LINE ADDED TO DISPLAY MSG FOR LATINO-2B
	return false
	}

	/* domain name seems valid, but now make sure that it ends in a
	   three-letter word (like com, edu, gov) or a two-letter word,
	   representing country (uk, nl), and that there's a hostname preceding
	   the domain or country. */

	/* Now we need to break up the domain to get a count of how many atoms
	   it consists of. */
	var atomPat=new RegExp(atom,"g")
	var domArr=domain.match(atomPat)
	var len=domArr.length
	if (domArr[domArr.length-1].length<2 || domArr[domArr.length-1].length>4)
	{
   		// the address must end in a two letter or three letter word.
   		// alert("Must be a valid Email address."); LINE COMMENTED FOR LATINO-2B
   		alert(emailAlertMsg); // LINE ADDED TO DISPLAY MSG FOR LATINO-2B
   		return false
	}

	// Make sure there's a host name preceding the domain.
	if (len<2)
	{
  		var errStr="Please enter email address correctly. e.g. abc@xyz.com"
  		// alert("Must be a valid Email address."); LINE COMMENTED FOR LATINO-2B
  		alert(emailAlertMsg); // LINE ADDED TO DISPLAY MSG FOR LATINO-2B
  		return false
	}

	// If we've gotten this far, everything's valid!
	return true;

	}
	return true;
}

//================================================================
// This Function checks whether the input is numeric or not
function isDigit(c)
{
	return ((c>="0") && (c<="9"));
}

// This Function checks whether the input is alphabetic or not
function isAlphabetic(c)
{
	//alert("return = " +  return ( ((c >= "a") && (c <= "z")) || ((c >= "A") && (c <= "Z")) ));
	return ( ((c >= "a") && (c <= "z")) || ((c >= "A") && (c <= "Z")) );
}

// This Function checks whether the input is numeric or not
function isNum(s)
{
	var i=0;
	var count  = 0;
	var count1 = 0;

	var spass = s;
 	for(i=0;i<spass.length;i++)
	{
		var c = spass.charAt(i)
		if (isDigit(c))
			count++;
		if (isAlphabetic(c))
			count1++;
	}
	//if ((count >1) && (count1 >= 1))
	if(count1>=1)
	return false;
	else
		 return true;
}


//  Added code for ASolutionForCaregivers - START

function companyname_Onchange(form)
{
	if( form.type.value == 'CaregiverContactUs' )
	{
		if(Trim(form.company_name.value) != "" )
		{
			document.all.lbl1.innerText = "*";
			document.all.lbl2.innerText = "*";
			document.all.lbl3.innerText = "*";
		}
		else
		{
			document.all.lbl1.innerText = "";
			document.all.lbl2.innerText = "";
			document.all.lbl3.innerText = "";
		}
	}
}

//  Added code for ASolutionForCaregivers - END

//Code Added for Validation of integers in Phone Numbers by Vivek 23 Dec-04 -Starts

function isDigit (c)
{
    return ((c >= "0") && (c <= "9"))
}

/*function checkForLength( s1,type,length ){

	var s = s1.value;
	if( s.length != 0 && s.length < length ){
		if( type == 0 )
			alert("Area Code should be length of 3 digits");
		else		
			alert("Phone number should be length of 7 or 8 digits");
		s1.focus();
		return false;
	}
	return true;

	// use this in XSL
	onblur="javascript:checkForLength(this,0,3);"

}*/

function isDigitEntered (s1)
{
	var i;
	var s = s1.value;
	var s2 = "";
	

    for (i = 0; i < s.length; i++)
    {
      var c = s.charAt(i);
      if (!isDigit(c)){ 
		  s1.value = s2;
		  s1.focus();
		  return false; 
	  }
	  s2+=c;
    }

	return true;
}
//Code Added for Validation of integers in Phone Numbers by Vivek 23 Dec-04 -Ends

// Added by Kuljeet Enrollment Form For PHS Employer Portal 13th Nov 2006 Start
function subValidateQualifyingEvent(form)
{
	
	if(form.subQualifyingEvent.value == "Other")
	{
		 showLayer("subOtherSelected");
	}
	else
	{
		hideLayer("subOtherSelected");
	}
	alert("after");
}

function subQualifyingEventChange(form)
{
	if (form.subQualifyingEvent.value == "Full Time"){
		// alert("inside full time selected....");
		showLayer("fulltimedivlabel");
		showLayer("fulltimeDiv");
	}
	if (form.subQualifyingEvent.value == ""){
		hideLayer("fulltimedivlabel");
		hideLayer("fulltimeDiv");
	}
	if (form.subQualifyingEvent.value == "New Hire"){
		hideLayer("fulltimedivlabel");
		hideLayer("fulltimeDiv");
	}
	if (form.subQualifyingEvent.value == "Open Enrollment"){
		hideLayer("fulltimedivlabel");
		hideLayer("fulltimeDiv");
	}
	if (form.subQualifyingEvent.value == "Loss of Other Coverage"){
		hideLayer("fulltimedivlabel");
		hideLayer("fulltimeDiv");
	}
	if (form.subQualifyingEvent.value == "Court Ordered Dependent"){
		hideLayer("fulltimedivlabel");
		hideLayer("fulltimeDiv");
	}
	if (form.subQualifyingEvent.value == "New Group"){
		hideLayer("fulltimedivlabel");
		hideLayer("fulltimeDiv");
	}
	if (form.subQualifyingEvent.value == "Other"){
		hideLayer("fulltimedivlabel");
		hideLayer("fulltimeDiv");
	}
	
}

// Added by Sekar Ponnusamy for enrollment changes
function priorCoverageChange(form)
{
	var priorCoverFlag = form.priorCoverageFlag.value;
	var region = form.plansRequested.value;

	var innerID = document.getElementById("priorCoverage");
	var innerID1 = document.getElementById("priorCoverage1");
	var innerHtml = "";
	var innerHtml1 = "";
	
   	if (form.plansRequested.value == "PPOCA" 
		|| form.plansRequested.value == "EPOCA" 
		|| form.plansRequested.value == "SDHPCA" 
		|| form.plansRequested.value == "PPOOR" 
		|| form.plansRequested.value == "EPOOR" 
		|| form.plansRequested.value == "SDHPOR" 
		|| form.plansRequested.value == "PPOWA" 
		|| form.plansRequested.value == "EPOWA"
		|| form.plansRequested.value == "SDHPWA" 
		|| form.plansRequested.value == "PPOAZ"
		|| form.plansRequested.value == "EPOAZ"
		|| form.plansRequested.value == "SDHPAZ"
		|| form.plansRequested.value == "PPONV"
		|| form.plansRequested.value == "EPONV"
		|| form.plansRequested.value == "SDHPNV"
		|| form.plansRequested.value == "PPOCO"
		|| form.plansRequested.value == "EPOCO"
		|| form.plansRequested.value == "SDHPCO"
		|| form.plansRequested.value == "PPOTX"
		|| form.plansRequested.value == "SDHPTX"
		|| form.plansRequested.value == "EPOTX"
		|| form.plansRequested.value == "PPOOK"
		|| form.plansRequested.value == "EPOOK"
		|| form.plansRequested.value == "SDHPOK"
		)
	
	{
	if ( priorCoverFlag == "Y"){
		
		innerHtml += '<tr><br><td>Other Provider name:</td>';
		innerHtml1 += '<br><td><input maxlength="40" size="22" name="Otherprovidername" type="text"/></td>';
		innerHtml1 += '</tr>';
	
		innerHtml += '<br><tr><td>Coverage Start Date :</td>';
		innerHtml1 += '<br><td>';
		innerHtml1 += '<input maxlength="40" size="14" name="CoverageStartDate" type="text"/></td></tr>';
		
		innerHtml += '<br><tr><td>Coverage End Date :</td>';
		innerHtml1 += '<br><td>';
		innerHtml1 += '<input maxlength="40" size="14" name="CoverageEndDate" type="text"/></td></tr>';
		innerHtml1 += '<font color="#ff0000"><B>*</B></font>';

		innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}else
	{
		innerID.innerHTML = "";;
	    innerID1.innerHTML = "";
			
	}
	}


}

// anand annamalai
function plansRequestedChange(form)
{
	var region = form.plansRequested.value;
	var innerHtml = "";
	var innerID = document.getElementById("innerProduct");
	var innerID1 = document.getElementById("innerProduct1");
	var innerHtml1 = "";
	
	var innerCovHtml = "";
	var innerCovID = document.getElementById("CoverageQuestion");
	var innerCovID1 = document.getElementById("CoverageQuestion1");
	var innerCovHtml1 = "";
	
	var innerPriID = document.getElementById("priorCoverage");
	var innerPriID1 = document.getElementById("priorCoverage1");
	var innerPriHtml = "";
	var innerPriHtml1 = "";

	// alert("plans request "+region);
	
        //Added be Sekar for Enrollment changes
	if (form.plansRequested.value == "PPOCA" 
		|| form.plansRequested.value == "EPOCA" 
		|| form.plansRequested.value == "SDHPCA" 
		|| form.plansRequested.value == "PPOOR" 
		|| form.plansRequested.value == "EPOOR" 
		|| form.plansRequested.value == "SDHPOR" 
		|| form.plansRequested.value == "PPOWA" 
		|| form.plansRequested.value == "EPOWA"
		|| form.plansRequested.value == "SDHPWA" 
		|| form.plansRequested.value == "PPOAZ"
		|| form.plansRequested.value == "EPOAZ"
		|| form.plansRequested.value == "SDHPAZ"
		|| form.plansRequested.value == "PPONV"
		|| form.plansRequested.value == "EPONV"
		|| form.plansRequested.value == "SDHPNV"
		|| form.plansRequested.value == "PPOCO"
		|| form.plansRequested.value == "EPOCO"
		|| form.plansRequested.value == "SDHPCO"
		|| form.plansRequested.value == "PPOTX"
		|| form.plansRequested.value == "SDHPTX"
		|| form.plansRequested.value == "EPOTX"
		|| form.plansRequested.value == "PPOOK"
		|| form.plansRequested.value == "EPOOK"
		|| form.plansRequested.value == "SDHPOK"
		)
	
	{
		innerCovHtml1 += 'Have you had /have other coverage?:';
	    innerCovHtml += '<SELECT onChange="priorCoverageChange(this.form)" name="priorCoverageFlag">';
	    innerCovHtml += '<option value=" ">[Choose]</option>';
	    innerCovHtml += '<option value="Y">Yes</option>';
	    innerCovHtml += '<option value="N">No</option>';
	    innerCovHtml += '</SELECT>';
	    
	    innerCovHtml += '<font color="#ff0000"><B>*</B></font>';
	 
		innerCovID.innerHTML = innerCovHtml;
	    innerCovID1.innerHTML = innerCovHtml1;	
	}
	else{
		innerCovID.innerHTML = '';
	    innerCovID1.innerHTML = '';
		innerPriID.innerHTML = "";
		innerPriID1.innerHTML = "";

	}

	if ( region == "PPOCA"){
	    //hideLayer("defaultProdReq");
	    
	    innerHtml1 += 'Plans Requested:';
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="Signature Options">Signature Options</option>';
	    innerHtml += '<option value="Signature Independence">Signature Independence</option>';
	    innerHtml += '<option value="PPO">PPO</option>';
	    innerHtml += '</SELECT>';
	    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    
	    innerID1.innerHTML = innerHtml1;
	}
	

	if ( region == "HMOPOSCA"){
	    // hideLayer("defaultProdReq");
	    
	    innerHtml1 += 'Plans Requested:';
	    innerHtml += '<SELECT name="productsRequested" >';
	    
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="SignatureValue">SignatureValue</option>';
	    innerHtml += '<option value="SignatureValue Advantage">SignatureValue Advantage</option>';
	    innerHtml += '<option value="Signature POS">Signature POS</option>';
	    innerHtml += '</SELECT>';
	    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}


	if ( region == "HDHPCA"){
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="Signature Options">Signature Options</option>';
	    innerHtml += '</SELECT>';
	    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}
	
	
	if ( region == "EPOCA"){
	    // hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="EPO">EPO</option>';
	    innerHtml += '</SELECT>';
	    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}
	
	if ( region == "SDHPCA"){
	
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="Signature Freedom">Signature Freedom</option>';
	    innerHtml += '<option value="SignatureFreedomwdental">SignatureFreedom- w/dental</option>';
	    innerHtml += '<option value="SDHP">SDHP</option>';
	    innerHtml += '</SELECT>';
	    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;	    
	}	
	
	if ( region == "IndemnityCA"){
	
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="Indemnity">Indemnity</option>';
	    innerHtml += '</SELECT>';
	    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}	
	
	if ( region == "QHDHPCA"){
	
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="QHDHP">QHDHP</option>';
	    innerHtml += '</SELECT>';
		    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}	
	
	// for tx fixes - anand
	if ( region == "PPOTX"){
	
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="PPO">PPO</option>';
	    innerHtml += '</SELECT>';
		    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}	

	

	if ( region == "SDHPTX"){
	
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="PacifiCare Signature Freedom">PacifiCare Signature Freedom</option>';
	    innerHtml += '</SELECT>';
		    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}	
		
	if ( region == "IndemnityTX"){
	
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="PacifiCare Signature Independence">PacifiCare Signature Independence</option>';
	    innerHtml += '</SELECT>';
		    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}	
		
	if ( region == "EPOTX"){
	
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="PacifiCare Signature Value Access">PacifiCare Signature Value Access</option>';
	    innerHtml += '</SELECT>';
		    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}	

	if ( region == "HMOOK"){
	
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="Pacificare Signature Value">Pacificare Signature Value</option>';
	    innerHtml += '<option value="Pacificare Signature Value- High">Pacificare Signature Value- High</option>';
	    innerHtml += '<option value="Pacificare Signature Value- Low">Pacificare Signature Value- Low</option>';
	    innerHtml += '</SELECT>';
		    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}	
				
	if ( region == "PPOOK"){
	
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="Pacificare Signature Options">Pacificare Signature Options</option>';
	    innerHtml += '<option value="Pacificare Signature Options- High">Pacificare Signature Options- High</option>';
	    innerHtml += '<option value="Pacificare Signature Options- Low">Pacificare Signature Options- Low</option>';
	    innerHtml += '</SELECT>';
		    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}	
		
if ( region == "SDHPOK"){
	
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="Pacificare Signature Freedom">Pacificare Signature Freedom</option>';
	    innerHtml += '</SELECT>';
		    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}	
		
if ( region == "IndemnityOK"){
	
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="Pacificare Signature Independence">Pacificare Signature Independence</option>';
	    innerHtml += '</SELECT>';
		    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}	
		
		
		
		
	if ( region == "HMOAZ"){
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="HMO">HMO</option>';
	    innerHtml += '<option value="POS">POS</option>';
	    innerHtml += '<option value="Open Access">Open Access</option>';
	    innerHtml += '</SELECT>';
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}	
		
	if ( region == "PPOAZ"){
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="PPO">PPO</option>';
	    innerHtml += '<option value="Indemnity">Indemnity</option>';
	    innerHtml += '</SELECT>';
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}	
		
	
	if ( region == "SDHPAZ"){
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="SDHP">SDHP</option>';
	    innerHtml += '</SELECT>';
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}	
		
	
	
	
	if ( region == "HMONV"){
	
	    innerHtml1 += 'Plans Requested:';
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="PacifiCare Signature Value - High">PacifiCare Signature Value - High</option>';
	    innerHtml += '<option value="PacifiCare Signature Value - Low">PacifiCare Signature Value - Low</option>';
	    innerHtml += '<option value="PacifiCare Signature Value direct">PacifiCare Signature Value direct</option>';
	    innerHtml += '<option value="PacifiCare Signature POS">PacifiCare Signature POS</option>';
	    innerHtml += '<option value="PacifiCare Signature Value">PacifiCare Signature Value </option>';
	    innerHtml += '</SELECT>';
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}	
		
	if ( region == "PPONV"){
	
	    // alert("ppo nv selected");
	    innerHtml1 += 'Plans Requested:';
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="PacifiCare Signature Options - High">PacifiCare Signature Options - High</option>';
	    innerHtml += '<option value="PacifiCare Signature Options - Low">PacifiCare Signature Options - Low</option>';
	    innerHtml += '</SELECT>';
    	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}	
		
	if ( region == "HDHPNV"){
	
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="PacifiCare Signature Options">PacifiCare Signature Options</option>';
	    innerHtml += '</SELECT>';
		    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}
	if ( region == "SDHPNV"){
	
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="PacifiCare Signature Freedom">PacifiCare Signature Freedom</option>';
	    innerHtml += '</SELECT>';
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}	
	
	if ( region == "IndemnityNV"){
	    innerHtml1 += 'Plans Requested:';
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="PacifiCare Signature Independence">PacifiCare Signature Independence</option>';
	    innerHtml += '</SELECT>';
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}
	




	if ( region == "HMOCO"){
	
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="PacifiCare Signature Value -High">PacifiCare Signature Value -High</option>';
	    innerHtml += '<option value="PacifiCare Signature Value -Low">PacifiCare Signature Value -Low</option>';
	    innerHtml += '<option value="PacifiCare Signature POS">PacifiCare Signature POS</option>';
	    innerHtml += '</SELECT>';
		    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}	
		
	if ( region == "PPOCO"){
	
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="PacifiCare Signature Options - High">PacifiCare Signature Options - High</option>';
	    innerHtml += '<option value="PacifiCare Signature Options - Low">PacifiCare Signature Options - Low</option>';
	    innerHtml += '</SELECT>';
		    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}
	if ( region == "IndemnityCO"){
	
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="PacifiCare Signature Independence">PacifiCare Signature Independence</option>';
	    innerHtml += '</SELECT>';
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}	
	
	if ( region == "SDHPCO"){
	    innerHtml1 += 'Plans Requested:';
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="PacifiCare Signature Freedom">PacifiCare Signature Freedom</option>';
	    innerHtml += '</SELECT>';
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}


	
	//  This is for oragon state
	
	if ( region == "PPOOR"){
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="Signature Options">Signature Options</option>';
	    innerHtml += '<option value="Signature Independence">Signature Independence</option>';
	    innerHtml += '</SELECT>';
	    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}
	

	if ( region == "HMOPOSOR"){
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="SignatureValue">SignatureValue</option>';
	    innerHtml += '<option value="SignaturePOS">Signature POS</option>';
	    innerHtml += '<option value="Oregon OOA">Oregon OOA</option>';
	    innerHtml += '<option value="Oregon POS OOA">Oregon POS OOA</option>';
	    innerHtml += '<option value="National Out-of-Area">National Out-of-Area</option>';
	    innerHtml += '</SELECT>';
	    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;	    
	}


	if ( region == "HDHPOR"){
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="Signature Options">Signature Options</option>';
	    innerHtml += '</SELECT>';
	    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
 	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}
	
	
	if ( region == "EPOOR"){
	    //hideLayer("defaultProdReq");
	    
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="SignatureValue-Direct">SignatureValue-Direct</option>';
	    innerHtml += '</SELECT>';

	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}
	
	if ( region == "SDHPOR"){
	
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
	    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
		innerHtml += '<option value="Signature Freedom">Signature Freedom</option>';
	    innerHtml += '<option value="Signature Independence">Signature Independence</option>';
	    innerHtml += '<option value="SignatureValue-Direct">SignatureValue-Direct</option>';
	    innerHtml += '</SELECT>';

		innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}		
	
	// end of oragan state
	
	// this is for wa state

	if ( region == "PPOWA"){
	    //hideLayer("defaultProdReq");
	    innerHtml1 += 'Plans Requested:';
		    
	    innerHtml += '<SELECT name="productsRequested" >';
	    innerHtml += '<option value="">[Choose Plans]</option>';
	    innerHtml += '<option value="Signature Options">Signature Options</option>';
	    innerHtml += '</SELECT>';

	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}
	
	if ( region == "SDHPWA"){
		
		    //hideLayer("defaultProdReq");
		    innerHtml1 += 'Plans Requested:';
		    innerHtml += '<SELECT name="productsRequested" >';
		    innerHtml += '<option value="">[Choose Plans]</option>';
		    innerHtml += '<option value="Signature Options">Signature Options</option>';
		    innerHtml += '<option value="Signature Freedom">Signature Freedom</option>';
		    innerHtml += '<option value="Signature Independence">Signature Independence</option>';
		    innerHtml += '</SELECT>';

	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}
	
	if ( region == "MCOPOSWA"){
		    //hideLayer("defaultProdReq");
		    innerHtml1 += 'Plans Requested:';
		    
		    innerHtml += '<SELECT name="productsRequested" >';
		    innerHtml += '<option value="">[Choose Plans]</option>';
		    innerHtml += '<option value="Signature Value">SignatureValue</option>';
		    innerHtml += '<option value="DUAL MC">DUAL MC</option>';
		    innerHtml += '<option value="SignaturePOS">Signature POS</option>';
		    innerHtml += '<option value="Dual POS">Dual POS</option>';
		    innerHtml += '<option value="Seattle OOA">Seattle OOA</option>';
		    innerHtml += '<option value="Seattle POS OOA">Seattle POS OOA</option>';
		    innerHtml += '<option value="Dual MC">Dual MC</option>';
		    innerHtml += '<option value="SignatureValue - MH3-SEA">SignatureValue - MH3-SEA</option>';
		    innerHtml += '<option value="SignatureValue - MH3-CLARK">SignatureValue - MH3-CLARK</option>';
		    innerHtml += '<option value="SignatureValue - MH3-CLK">SignatureValue - MH3-CLK</option>';
		    innerHtml += '<option value="SignatureValue -SEA- MH5">SignatureValue -SEA- MH5</option>';
		    innerHtml += '<option value="SignatureValue - SEA- MH6">SignatureValue - SEA- MH6</option>';
		    innerHtml += '</SELECT>';
		    
	    innerHtml += '<font color="#ff0000"><B>*</B></font>';
	    innerID.innerHTML = innerHtml;
	    innerID1.innerHTML = innerHtml1;
	}
	
	
	// end of wa state
	
	if ( region == ""){
			
		    innerHtml += '<SELECT name="productsRequested" disabled="true" >';
		    innerHtml += '<option value="">[Choose Plans]</option></SELECT>';
		    innerID.innerHTML = innerHtml;
		    // showLayer("innerID");
	}
	
	
	if (form.plansRequested.value == "HMOPOSCA" 
		|| form.plansRequested.value == "HMOOR" 
		|| form.plansRequested.value == "HMOPOSOR"
		|| form.plansRequested.value == "HMOCA"
		|| form.plansRequested.value == "HMOWA"
		|| form.plansRequested.value == "MCOPOSWA"
		|| form.plansRequested.value == "HMOAZ"
		|| form.plansRequested.value == "HMOCO"
		|| form.plansRequested.value == "HMOOK"
		)
	{
		showLayer("HMOSelected");		
		hideLayer("nonHMOSelected");
		
	}
	
	if (form.plansRequested.value == "PPOCA" 
		|| form.plansRequested.value == "EPOCA" 
		|| form.plansRequested.value == "SDHPCA" 
		|| form.plansRequested.value == "QHDHPCA" 
		|| form.plansRequested.value == "HDHPCA"
		|| form.plansRequested.value == "PPOOR" 
		|| form.plansRequested.value == "EPOOR" 
		|| form.plansRequested.value == "SDHPOR" 
		|| form.plansRequested.value == "HDHPOR" 
		|| form.plansRequested.value == "PPOWA" 
		|| form.plansRequested.value == "SDHPWA" 
		|| form.plansRequested.value == "IndemnityCA"  
		|| form.plansRequested.value == "PPOAZ"
		|| form.plansRequested.value == "SDHPAZ"
		|| form.plansRequested.value == "PPONV"
		|| form.plansRequested.value == "SDHPNV"
		|| form.plansRequested.value == "IndemnityNV"
		|| form.plansRequested.value == "PPOCO"
		|| form.plansRequested.value == "IndemnityCO"
		|| form.plansRequested.value == "SDHPCO"
		|| form.plansRequested.value == "PPOTX"
		|| form.plansRequested.value == "SDHPTX"
		|| form.plansRequested.value == "IndemnityTX"
		|| form.plansRequested.value == "EPOTX"
		|| form.plansRequested.value == "PPOOK"
		|| form.plansRequested.value == "SDHPOK"
		|| form.plansRequested.value == "IndemnityOK"
		)
	{
		
		// showLayer("nonHMOSelected");		
		hideLayer("HMOSelected");
	}
}


function productsRequestedChange(form)
{
	if (form.productsRequested.value == "Signature Value High Option" 
		|| form.productsRequested.value == "Signature Value Low Option" 
		|| form.productsRequested.value == "Signature Value Advantage" 
		|| form.productsRequested.value == "HMO - (AZ, CO, NV only)"  )
	{
		showLayer("HMOSelected");		
		hideLayer("nonHMOSelected");
		
	}
	if (form.productsRequested.value == "Signature Options" 
		|| form.productsRequested.value == "Signature Independence" 
		|| form.productsRequested.value == "Signature Freedom - SDHP" 
		|| form.productsRequested.value == "Signature Value Option - EPO"  )
	{
		showLayer("nonHMOSelected");		
		hideLayer("HMOSelected");
	}
}

function productsRequestedDependentChange2(i)
{   
	var productsRequestedId2 = document.getElementById("productsRequested2"+i);
	
	// alert("product val2222..."+productsRequestedId2.value);

}

function qualifyingEventChange(i){
	var qualifyingEventId = document.getElementById("qualifyingEvent" + i);
	var qualifyingEventVal = qualifyingEventId.value;
	
	if(qualifyingEventVal == "Full Time"){
	    showLayer("fulltimedivlabel"+i);
	    showLayer("fulltimeDiv"+i);
	} else if (qualifyingEventVal != "Full Time"){
            hideLayer("fulltimedivlabel"+i);
            hideLayer("fulltimeDiv"+i);
	
	}
}


function productsRequestedDependentChange(i)
{
	
	// 7777
 	var retValueID = document
 	var plansRequestedId = document.getElementById("plansRequested"+i);
	
	var productsRequestedId = document.getElementById("productsRequested"+i);
	innerHtml = "";
	
	var primaryCarePhysicianNumId = document.getElementById("primaryCarePhysicianNum"+i);
	
	var plansVal = plansRequestedId.value;
	innerHtml1 = "";

	// note: change id-productsRequested2 value to all the state and plans
	if (plansVal == "PPOCA"){
	
	hideLayer("HMOSelected"+i);
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="SignatureOptions">Signature Options</option>';
	innerHtml += '<option value="SignatureIndependence">Signature Independence</option>';
	innerHtml += '<option value="PPO">PPO</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	
	}
	
	if (plansVal == "HMOPOSCA"){
	
	showLayer("HMOSelected"+i);
	
	innerHtml += "<td>Plans Requested: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</td><td>";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";

	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="SignatureValue">SignatureValue</option>';
	innerHtml += '<option value="SignatureValue Advantage">SignatureValue Advantage</option>';
	innerHtml += '<option value="Signature POS">Signature POS</option>';
	
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font></td><br><br>";
	}
	
	if (plansVal == "HDHPCA"){
	hideLayer("HMOSelected"+i);
	innerHtml += "<td>Plans Requested: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</td><td>";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";

	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="Signature Options">Signature Options</option>';

	innerHtml += "</SELECT></td><br><br>";
	// innerHtml += "<font color='#ff0000'><B>*</B></font></td><br><br>";
	}
	
	if (plansVal == "EPOCA"){
	hideLayer("HMOSelected"+i);
	innerHtml += "<td>Plans Requested: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</td><td>";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="EPO">EPO</option>';

	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font></td><br><br>";
	}
	
	if (plansVal == "SDHPCA"){
	hideLayer("HMOSelected"+i);
	innerHtml += "<td>Plans Requested: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</td><td>";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";

	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="Signature Freedom">Signature Freedom</option>';
	innerHtml += '<option value="SignatureFreedom w dental">SignatureFreedom- w/dental</option>';
	innerHtml += '<option value="SDHP">SDHP</option>';
	
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font></td><br><br>";
	}

	if (plansVal == "IndemnityCA"){
	hideLayer("HMOSelected"+i);
	innerHtml += "<td>Plans Requested: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</td><td>";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="Indemnity">Indemnity</option>';
	
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font></td><br><br>";
	}
	
	if (plansVal == "QHDHPCA"){
	hideLayer("HMOSelected"+i);
	innerHtml += "<td>Plans Requested: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</td><td>";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";

	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="QHDHP">QHDHP</option>';
	
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font></td><br><br>";
	}	
	

	if (plansVal == "HMOCO"){
	showLayer("HMOSelected"+i);
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="PacifiCare Signature Value -High">PacifiCare Signature Value -High</option>';
	innerHtml += '<option value="PacifiCare Signature Value -Low">PacifiCare Signature Value -Low</option>';
	innerHtml += '<option value="PacifiCare Signature POS">PacifiCare Signature POS</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	}

	if (plansVal == "PPOCO"){
	hideLayer("HMOSelected"+i);
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="PacifiCare Signature Options - High">PacifiCare Signature Options - High</option>';
	innerHtml += '<option value="PacifiCare Signature Options - Low">PacifiCare Signature Options - Low</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	}

	if (plansVal == "IndemnityCO"){
	hideLayer("HMOSelected"+i);
	
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="PacifiCare Signature Independence">PacifiCare Signature Independence</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	}
	
	if (plansVal == "SDHPCO"){
	hideLayer("HMOSelected"+i);
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="PacifiCare Signature Freedom">PacifiCare Signature Freedom</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	}
	

	if (plansVal == "PPONV"){
	hideLayer("HMOSelected"+i);
	
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="PacifiCare Signature Options - High">PacifiCare Signature Options - High</option>';
	innerHtml += '<option value="PacifiCare Signature Options - Low">PacifiCare Signature Options - Low</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	}
	
	if (plansVal == "HMONV"){
	showLayer("HMOSelected"+i);
	
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="PacifiCare Signature Value - High">PacifiCare Signature Value - High</option>';
	innerHtml += '<option value="PacifiCare Signature Value - Low">PacifiCare Signature Value - Low</option>';
	innerHtml += '<option value="PacifiCare Signature Value direct">PacifiCare Signature Value direct</option>';
	innerHtml += '<option value="PacifiCare Signature POS">PacifiCare Signature POS</option>';
	innerHtml += '<option value="PacifiCare Signature Value ">PacifiCare Signature Value </option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	}
	

	if (plansVal == "HDHPNV"){
	hideLayer("HMOSelected"+i);
	
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="PacifiCare Signature Options">PacifiCare Signature Options</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	
	}
	
	if (plansVal == "SDHPNV"){
	hideLayer("HMOSelected"+i);
	
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="PacifiCare Signature Freedom">PacifiCare Signature Freedom</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	
	}
	
	if (plansVal == "IndemnityNV"){
	hideLayer("HMOSelected"+i);
	
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="PacifiCare Signature Independence">PacifiCare Signature Independence</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	
	}	
	
	if (plansVal == "HMOAZ"){
	showLayer("HMOSelected"+i);
	
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="HMO">HMO</option>';
	innerHtml += '<option value="POS">POS</option>';
	innerHtml += '<option value="Open Access">Open Access</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	}

	if (plansVal == "PPOAZ"){
	hideLayer("HMOSelected"+i);
	
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="PPO">PPO</option>';
	innerHtml += '<option value="Indemnity">Indemnity</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	}

	if (plansVal == "SDHPAZ"){
	hideLayer("HMOSelected"+i);
	
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="SDHP">SDHP</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	
	}
	
	if (plansVal == "HMOOK"){
	showLayer("HMOSelected"+i);
	
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="Pacificare Signature Value">Pacificare Signature Value</option>';
	innerHtml += '<option value="Pacificare Signature Value- High">Pacificare Signature Value- High</option>';
	innerHtml += '<option value="Pacificare Signature Value- Low">Pacificare Signature Value- Low</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	
	}	
	
	if (plansVal == "PPOOK"){
	hideLayer("HMOSelected"+i);
	
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="Pacificare Signature Options">Pacificare Signature Options</option>';
	innerHtml += '<option value="Pacificare Signature Options- High">Pacificare Signature Options- High</option>';
	innerHtml += '<option value="Pacificare Signature Options- Low">Pacificare Signature Options- Low</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	
	}
	
	if (plansVal == "SDHPOK"){
	hideLayer("HMOSelected"+i);
	
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="Pacificare Signature Freedom">Pacificare Signature Freedom</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	
	}
	
	if (plansVal == "IndemnityOK"){
	hideLayer("HMOSelected"+i);
	
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="Pacificare Signature Independence">Pacificare Signature Independence</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	
	}
	
	// this is TX fix - anand
	
	if (plansVal == "PPOTX"){
	hideLayer("HMOSelected"+i);

	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="PPO">PPO</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";

	}
	
	
	if (plansVal == "SDHPTX"){
	hideLayer("HMOSelected"+i);
	
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="PacifiCare Signature Freedom">PacifiCare Signature Freedom</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	
	}	
	
	if (plansVal == "IndemnityTX"){
	hideLayer("HMOSelected"+i);
	
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="PacifiCare Signature Independence">PacifiCare Signature Independence</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	
	}	

	if (plansVal == "EPOTX"){
	hideLayer("HMOSelected"+i);
	
	innerHtml += "Plans Requested:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="PacifiCare Signature Value Access">PacifiCare Signature Value Access</option>';
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font><br><br>";
	
	}	
	
	if (plansVal == "PPOOR"){
	hideLayer("HMOSelected"+i);
	
	innerHtml += "<td>Plans Requested: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</td><td>";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="Signature Options">Signature Options</option>';
	innerHtml += '<option value="Signature Independence">Signature Independence</option>';
	
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font></td><br><br>";
	}
	
	if (plansVal == "HMOPOSOR"){
	showLayer("HMOSelected"+i);
	
	innerHtml += "<td>Plans Requested: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</td><td>";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";

	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="SignatureValue">SignatureValue</option>';
	innerHtml += '<option value="SignaturePOS">Signature POS</option>';
	innerHtml += '<option value="Oregon OOA">Oregon OOA</option>';
	innerHtml += '<option value="Oregon POS OOA">Oregon POS OOA</option>';
	innerHtml += '<option value="National Out-of-Area">National Out-of-Area</option>';	
	
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font></td><br><br>";
	}		


	if (plansVal == "HDHPOR"){
	hideLayer("HMOSelected"+i);
	
	innerHtml += "<td>Plans Requested: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</td><td>";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";

	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="Signature Options">Signature Options</option>';
	
	innerHtml += "</SELECT></td><br><br>";
	// innerHtml += "<font color='#ff0000'><B>*</B></font></td><br><br>";
	}	
	
	if (plansVal == "EPOOR"){
	hideLayer("HMOSelected"+i);
	
	innerHtml += "<td>Plans Requested: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</td><td>";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="SignatureValue-Direct">SignatureValue-Direct</option>';
	
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font></td><br><br>";
	}
	
	if (plansVal == "SDHPOR"){
	hideLayer("HMOSelected"+i);
	
	innerHtml += "<td>Plans Requested: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</td><td>";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";

	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="Signature Freedom">Signature Freedom</option>';
	innerHtml += '<option value="Signature Independence">Signature Independence</option>';
	innerHtml += '<option value="SignatureValue-Direct">SignatureValue-Direct</option>';
		
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font></td><br><br>";
	}	


	if (plansVal == "PPOWA"){
	hideLayer("HMOSelected"+i);
	
	innerHtml += "<td>Plans Requested: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</td><td>";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";

	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="Signature Options">Signature Options</option>';
	
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font></td><br><br>";
	}	
	
	if (plansVal == "SDHPWA"){
	hideLayer("HMOSelected"+i);
	
	innerHtml += "<td>Plans Requested: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</td><td>";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";
	
	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="Signature Options">Signature Options</option>';
	innerHtml += '<option value="Signature Freedom">Signature Freedom</option>';
	innerHtml += '<option value="Signature Independence">Signature Independence</option>';
	
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font></td><br><br>";
	}
	
	if (plansVal == "MCOPOSWA"){
	showLayer("HMOSelected"+i);
	
	innerHtml += "<td>Plans Requested: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</td><td>";
	innerHtml += "<SELECT name='productsRequested' id='productsRequested2" + i + "' onChange='productsRequestedDependentChange2("+i+")'>";

	innerHtml += '<option value="">[Choose Plans]</option>';
	innerHtml += '<option value="Signature Value">SignatureValue</option>';
	innerHtml += '<option value="DUAL MC">DUAL MC</option>';
	innerHtml += '<option value="SignaturePOS">Signature POS</option>';
	innerHtml += '<option value="Dual POS">Dual POS</option>';
	innerHtml += '<option value="Seattle OOA">Seattle OOA</option>';
	innerHtml += '<option value="Seattle POS OOA">Seattle POS OOA</option>';
	innerHtml += '<option value="Dual MC">Dual MC</option>';
	innerHtml += '<option value="SignatureValue - MH3-SEA">SignatureValue - MH3-SEA</option>';
	innerHtml += '<option value="SignatureValue - MH3-CLARK">SignatureValue - MH3-CLARK</option>';
	innerHtml += '<option value="SignatureValue - MH3-CLK">SignatureValue - MH3-CLK</option>';
	innerHtml += '<option value="SignatureValue -SEA- MH5">SignatureValue -SEA- MH5</option>';
	innerHtml += '<option value="SignatureValue - SEA- MH6">SignatureValue - SEA- MH6</option>';
		
	innerHtml += "</SELECT>";
	innerHtml += "<font color='#ff0000'><B>*</B></font></td><br><br>";
	}	



	
	productsRequestedId.innerHTML = innerHtml;
	
}

function addSubscriberMemberAdd(form)
{
	var subscriberArr= new Array();
	var dssn1Arr= new Array();
	var dssn2Arr= new Array();
	var dssn3Arr= new Array();
	var dLastNameArr= new Array();
	var dFirstNameArr= new Array();

	for(var t=1; t<=form.prevTotalSubcriber.value; t++)
	{
		var subscriberId = document.getElementById("noOfSubscriber");
		subscriberArr[t] = subscriberId.value;

		var dssn1Id = document.getElementById("dssn1"+t);
		dssn1Arr[t] = dssn1Id.value;

		var dssn2Id = document.getElementById("dssn2"+t);
		dssn2Arr[t] = dssn2Id.value;

		var dssn3Id = document.getElementById("dssn3"+t);
		dssn3Arr[t] = dssn3Id.value;

		var dLastNameId = document.getElementById("dLastName"+t);
		dLastNameArr[t] = dLastNameId.value;

		var dFirstNameId = document.getElementById("dFirstName"+t);
		dFirstNameArr[t] = dFirstNameId.value;
	}
	var noOfSubscriberObj = document.getElementById("noOfSubscriber");	
	var	noOfSubscriber=noOfSubscriberObj.value;
		showLayer("HeadingText");		
		showLayer("selectDivText");
		showLayer("selectDiv");
	for(var i=1; i <=noOfSubscriber; i++){		
		showLayer("dTr"+i+"1");
		showLayer("dTr"+i+"2");
		showLayer("dTr"+i+"3");
		}
		hideSubscriberMember(form, noOfSubscriber);				
		if(noOfSubscriber==1){
		var subscriberId = document.getElementById("noOfSubscriber");
				subscriberId.value = noOfSubscriber;
		}
		for(t=1;t<=noOfSubscriber && t<=form.prevTotalSubcriber.value;t++){		
		var subscriberId = document.getElementById("noOfSubscriber");
		subscriberId.value = noOfSubscriber;

		var dssn1Id = document.getElementById("dssn1"+t);
		dssn1Id.value = dssn1Arr[t];

		var dssn2Id = document.getElementById("dssn2"+t);
		dssn2Id.value = dssn2Arr[t];

		var dssn3Id = document.getElementById("dssn3"+t);
		dssn3Id.value = dssn3Arr[t];

		var dLastNameId = document.getElementById("dLastName"+t);
		dLastNameId.value = dLastNameArr[t];

		var dFirstNameId = document.getElementById("dFirstName"+t);
		dFirstNameId.value = dFirstNameArr[t];
	}	
	form.prevTotalSubcriber.value=noOfSubscriber;
}

function hideSubscriberMember(form, noOfSubscriber){
	var noOfSubscriberHide=noOfSubscriber;	
	if(noOfSubscriber==-1){
		hideLayer("HeadingText");		
		hideLayer("selectDivText");
		hideLayer("selectDiv");
	}
	if(noOfSubscriber==-1){
	noOfSubscriberHide=0;
	}	
	if(form.prevTotalSubcriber.value!=""){	
	for(var i=++noOfSubscriberHide; i <=form.prevTotalSubcriber.value; i++){	
		hideLayer("dTr"+i+"1");
		hideLayer("dTr"+i+"2");
		hideLayer("dTr"+i+"3");
		resetValue(i);
	}
}
}
function resetValue( no ){
		var dssn1Id = document.getElementById("dssn1"+no);
		dssn1Id.value = "";
		var dssn2Id = document.getElementById("dssn2"+no);
		dssn2Id.value = "";
		var dssn3Id = document.getElementById("dssn3"+no);
		dssn3Id.value = "";
		var dLastNameId = document.getElementById("dLastName"+no);
		dLastNameId.value = "";
		var dFirstNameId = document.getElementById("dFirstName"+no);
		dFirstNameId.value = "";
}


function memberEnrollmentRequestedChange(form)
{
	if(form.requestedChange.value != "SSN"){
	var noOfSubscriber=document.getElementById("noOfSubscriber");		
	noOfSubscriber.value=0;	
	hideSubscriberMember(form, -1);	
	var prevTotalSubcriber=document.getElementById("prevTotalSubcriber");
	prevTotalSubcriber.value="";	
	}
	if (form.requestedChange.value == "Group Transfer"){
		
		showLayer("currentgroupnumberid");
		showLayer("currentgroupnumber");
		showLayer("newgroupnumberid");
		showLayer("newgroupnumber");
		showLayer("newgroupdateid");
		showLayer("newgroupdate");
		showLayer("newgroupdate2");
		showLayer("newgroupdate3");
		
		hideLayer("AddressSelected1");
		hideLayer("AddressSelected2");
		hideLayer("AddressSelected3");
		hideLayer("AddressSelected4");
		hideLayer("PcpSelected");
		
	}
	
	
	if (form.requestedChange.value == "Address Change")
	{
		showLayer("AddressSelected1");
		showLayer("AddressSelected2");
		showLayer("AddressSelected3");
		showLayer("AddressSelected4");
		hideLayer("PcpSelected");
		hideLayer("OtherSelected");
		hideLayer("currentGroupID");
		
		hideLayer("currentgroupnumberid");
		hideLayer("currentgroupnumber");
		hideLayer("newgroupnumberid");
		hideLayer("newgroupnumber");
		hideLayer("newgroupdateid");
		hideLayer("newgroupdate");
		hideLayer("newgroupdate2");
		hideLayer("newgroupdate3");

		
		
		
	}
	else if(form.requestedChange.value == "PCP")
	{
		hideLayer("AddressSelected1");
		hideLayer("AddressSelected2");
		hideLayer("AddressSelected3");
		hideLayer("AddressSelected4");
		showLayer("PcpSelected");
		hideLayer("OtherSelected");
		
		hideLayer("currentgroupnumberid");
		hideLayer("currentgroupnumber");
		hideLayer("newgroupnumberid");
		hideLayer("newgroupnumber");
		hideLayer("newgroupdateid");
		hideLayer("newgroupdate");
		hideLayer("newgroupdate2");
		hideLayer("newgroupdate3");
	}
	else if(form.requestedChange.value == "SSN")
	{	
		addSubscriberMemberAdd(form);	
		hideLayer("AddressSelected1");
		hideLayer("AddressSelected2");
		hideLayer("AddressSelected3");
		hideLayer("AddressSelected4");
		hideLayer("PcpSelected");
		hideLayer("OtherSelected");
		
		hideLayer("currentgroupnumberid");
		hideLayer("currentgroupnumber");
		hideLayer("newgroupnumberid");
		hideLayer("newgroupnumber");
		hideLayer("newgroupdateid");
		hideLayer("newgroupdate");
		hideLayer("newgroupdate2");
		hideLayer("newgroupdate3");
	}
	else if(form.requestedChange.value == "Other")
	{
		hideLayer("AddressSelected1");
		hideLayer("AddressSelected2");
		hideLayer("AddressSelected3");
		hideLayer("AddressSelected4");
		hideLayer("PcpSelected");
		showLayer("OtherSelected");
		
		hideLayer("currentgroupnumberid");
		hideLayer("currentgroupnumber");
		hideLayer("newgroupnumberid");
		hideLayer("newgroupnumber");
		hideLayer("newgroupdateid");
		hideLayer("newgroupdate");
		hideLayer("newgroupdate2");
		hideLayer("newgroupdate3");
	}
}
function showLayer( id ){
	var sl_id = document.getElementById(id);
	if( sl_id != null ){
		sl_id.style.visibility='visible';
		if( getBrowser() == "IE" )
			sl_id.style.display='block';
		else
			sl_id.style.display='';
	}
	return sl_id;
}
function getBrowser( ){
	var browserName=navigator.appName;
	if (browserName=="Microsoft Internet Explorer"){
		return "IE";
	}
	return "ALL";
}
function hideLayer( id ){
	var hl_id = document.getElementById(id);
	if( hl_id != null ){
		hl_id.style.visibility='hidden';
		hl_id.style.display='none';
	}
	return hl_id;
}
function addDependentTerminated(form)
{
	
	var id = document.getElementById("inner");
	var depNameArr= new Array();
	for(var t=1; t<=form.prevTotalDependent.value; t++)
	{
		var depNameId = document.getElementById("dName"+t);
		depNameArr[t] = depNameId.value;
	}

	var innerHtml = "";

	for(var i=1; i <=form.noOfDependent.value; i++)
	{
		innerHtml += "<tr><td>Dependent to be Termed:&nbsp;</td>";
		innerHtml += "<td>";
		innerHtml += "<input type=text name='dName' id='dName" + i + "' size=22 maxlength=40/>";
		innerHtml += "&nbsp;<font color='#ff0000'><B>*</B></font></td>";
		innerHtml += "</tr>";
		innerHtml += "<br>";
	}
	id.innerHTML = innerHtml;

	for(t=1;t<=form.noOfDependent.value && t<=form.prevTotalDependent.value;t++)
	{
		var depNameId = document.getElementById("dName"+t);
		depNameId.value = depNameArr[t];
	}
	form.prevTotalDependent.value=form.noOfDependent.value;
}
function isDateEntered (s1)
{
	trimSpaces( s1 );
	var dateStr = s1.value;
	var datePat = /^(\d{1,2})(\/)(\d{1,2})(\/)(\d{2,4})$/; // dd-mm-yy
	var matchArray = dosValidation(dateStr,datePat);
	if( matchArray == null ){
		return null;
	}
	s1.value = matchArray[1] >= 10 ? matchArray[1] : "0" + (matchArray[1]%10);
	s1.value += "/" + ( matchArray[3] >= 10 ? matchArray[3] : "0" + (matchArray[3]%10) ) + "/";
	var year = matchArray[5];
	if( year.length <= 2 ){
		if( year > 75 )
			year = ( year.length == 1 ) ? ( "190" + year ) : ( "19" + year );
		else
			year = ( year.length == 1 ) ? ( "200" + year ) : ( "20" + year );
	}else if( year.length == 1 ){
		year = "200" + year;
	}else if( year.length == 3 ){
		year = "2" + year;
	}
	s1.value += year;
	return matchArray;
}
function dosValidation(dosStr,dosPattern){
	var datePat = /^(\d{2})(\/)(\d{2})(\/)(\d{4})$/; // dd-mm-yyyy
	if( dosPattern != "" )
		datePat = dosPattern;
	var matchArray = dosStr.match(datePat); // check the format
	var monthArray = new Array(31,28,31,30,31,30,31,31,30,31,30,31);
	if( matchArray == null ){
		return null;
	}
	var month = matchArray[1]; // month extract
	var day = matchArray[3];   // day extract
	var year = matchArray[5];  // year
	if( year.length <= 2 ){
		if( year > 75 )
			year = ( year.length == 1 ) ? ( "190" + year ) : ( "19" + year );
		else
			year = ( year.length == 1 ) ? ( "200" + year ) : ( "20" + year );
	}
	month = month >= 10 ? month : month % 10;
	if (month < 1 || month > 12) { // check month range
		return null;
	}
	day = day >= 10 ? day : day % 10;
	if (day < 1 || day > 31) {
		return null;
	}

	var dayOfMonth = monthArray[month-1];
	if ( month != 2 ) {
		return day > dayOfMonth ? null : matchArray;
	}else{
		return (year % 4 == 0 && (year % 100 != 0 || year % 400 == 0)) ? day <= 29 ? matchArray : null : day < 29 ? matchArray : null;
	}
}
function trimSpaces( object ){

	/* For Removing spaces before and after */
	var str = object.value;
	str = str.replace(/^\s+/, '');
	str = str.replace(/\s+$/, '');
	object.value = str;
}
function selectDepDate(i)
{
	show_calendar("contactus.dDateofBirth"+i);
}

	
// for Add form dependent
function addDependentAdd(form)
{

	var id = document.getElementById("inner");

	var relationshipArr= new Array();
	var dssn1Arr= new Array();
	var dssn2Arr= new Array();
	var dssn3Arr= new Array();
	var dLastNameArr= new Array();
	var dFirstNameArr= new Array();
	var dMiddleInitialArr= new Array();
	var dDateofBirthArr= new Array();
	
	// anand annamalai
	var fulltimedateArr= new Array();
	
	var productsRequestedArr= new Array();
	var qualifyingEventArr= new Array();
	var specifyArr= new Array();
	var primaryCarePhysicianArr= new Array();
	var primaryCarePhysicianNumArr= new Array();
	var dGenderArr= new Array();

	for(var t=1; t<=form.prevTotalDependent.value; t++)
	{
		var relationshipId = document.getElementById("relationship"+t);
		relationshipArr[t] = relationshipId.value;

		var dssn1Id = document.getElementById("dssn1"+t);
		dssn1Arr[t] = dssn1Id.value;

		var dssn2Id = document.getElementById("dssn2"+t);
		dssn2Arr[t] = dssn2Id.value;

		var dssn3Id = document.getElementById("dssn3"+t);
		dssn3Arr[t] = dssn3Id.value;

		var dLastNameId = document.getElementById("dLastName"+t);
		dLastNameArr[t] = dLastNameId.value;

		var dFirstNameId = document.getElementById("dFirstName"+t);
		dFirstNameArr[t] = dFirstNameId.value;

		var dMiddleInitialId = document.getElementById("dMiddleInitial"+t);
		dMiddleInitialArr[t] = dMiddleInitialId.value;

		var dDateofBirthId = document.getElementById("dDateofBirth"+t);
		dDateofBirthArr[t] = dDateofBirthId.value;
		
		// anand annamalai change 
		var fulltimetextId = document.getElementById("fulltimetext"+t);
		fulltimedateArr[t] = fulltimetextId.value;
		

		var productsRequestedId = document.getElementById("productsRequested"+t);
		productsRequestedArr[t] = productsRequestedId.value;

		var qualifyingEventId = document.getElementById("qualifyingEvent"+t);
		qualifyingEventArr[t] = qualifyingEventId.value;

		var specifyId = document.getElementById("specify"+t);
		specifyArr[t] = specifyId.value;

		var primaryCarePhysicianId = document.getElementById("primaryCarePhysician"+t);
		primaryCarePhysicianArr[t] = primaryCarePhysicianId.value;

		var primaryCarePhysicianNumId = document.getElementById("primaryCarePhysicianNum"+t);
		primaryCarePhysicianNumArr[t] = primaryCarePhysicianNumId.value;

		var dGenderId = document.getElementById("dGender"+t);
		dGenderArr[t] = dGenderId.value;
	}

	var innerHtml = "";
	var JSRegion = form.JSRegion.value;
	// alert("JSRegion......"+JSRegion);
	for(var i=1; i <=form.noOfDependent.value; i++)
	{
		innerHtml += "<br>Enter Details for Dependent No. " + i + "<br>";


		innerHtml += "<tr><td>Relationship to: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
		innerHtml += "<SELECT name='relationship' id='relationship" + i + "'>";
		innerHtml += "<option value=''>[Choose]</option>";
		innerHtml += "<option value='Spouse'>Spouse</option>";
		innerHtml += "<option value='Dependent Child'>Dependent Child</option>";
		innerHtml += "<option value='Domestic Partner'>Domestic Partner</option>";
		innerHtml += "</SELECT>";
		innerHtml += "<font color='#ff0000'><B>*</B></font><br>Subscriber</td></tr><br>";

		innerHtml += "<tr><td>Dependents Social<br>";
		innerHtml += "Security Number: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
		innerHtml += "<input type='text' name='dssn1' id='dssn1" + i + "' size='3' maxlength='3' /> - ";
		innerHtml += "<input type='text' name='dssn2' id='dssn2" + i + "' size='2' maxlength='2' /> - ";
		innerHtml += "<input type='text' name='dssn3' id='dssn3" + i + "' size='4' maxlength='4' />";
		innerHtml += "<font color='#ff0000'><B>*</B></font><br>(If no SSN please enter<br>000-00-0000)</td></tr><br>";

		innerHtml += "<tr><td>Dependents Last &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input type='text' name='dLastName' id='dLastName" + i + "' size='22' ";
		innerHtml += "maxlength='40'/><font color='#ff0000'><B>*</B></font><br>Name:</td></tr><br>";

		innerHtml += "<tr><td>Dependents First &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input type='text' name='dFirstName' id='dFirstName" + i + "' size='22' ";
		innerHtml += "maxlength='40'/><font color='#ff0000'><B>*</B></font><br>Name:</td></tr><br>";

		innerHtml += "<tr><td>Dependents Middle &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input type='text' name='dMiddleInitial' id='dMiddleInitial" + i + "' size='1' ";
		innerHtml += "maxlength='1'/><br>Initial:</td></tr><br>";

		innerHtml += "<tr><td>Dependents Date of: &nbsp;&nbsp;&nbsp;<input type='text' name='dDateofBirth' id='dDateofBirth" + i + "' size='14' ";
		innerHtml += "maxlength='40'/><font color='#ff0000'>";
		innerHtml += "<B>*</B></font><br>Birth (enter as mm/dd/yyyy)</td></tr><br>";
		
		if (JSRegion == "CAJS"){
		innerHtml += "<tr><td>Products Requested: &nbsp;&nbsp;&nbsp;</td><td>";
		
		var retValue = "plansRequested" + i;
		innerHtml += "<SELECT name='plansRequested' id=" + retValue + " onChange='productsRequestedDependentChange("+i+")'>";
		innerHtml += "<option value=''>[Choose Products]</option>";
		innerHtml += "<option value='PPOCA'>PPO</option>";
		innerHtml += "<option value='HMOPOSCA'>HMO / POS</option>";
		innerHtml += "<option value='EPOCA'>EPO</option>";
		innerHtml += "<option value='HDHPCA'>HDHP</option>";
		innerHtml += "<option value='SDHPCA'>SDHP</option>";
		innerHtml += "<option value='IndemnityCA'>Indemnity</option>";
		innerHtml += "<option value='QHDHPCA'>QHDHP</option>";
		innerHtml += "</SELECT>";
		innerHtml += "<font color='#ff0000'><B>*</B></font></td></tr><br><br>";
		}
		
		
		if (JSRegion == "TXJS"){
		innerHtml += "<tr><td>Products Requested: &nbsp;&nbsp;&nbsp;</td><td>";
		var retValue = "plansRequested" + i;
		innerHtml += "<SELECT name='plansRequested' id=" + retValue + " onChange='productsRequestedDependentChange("+i+")'>";
		innerHtml += "<option value=''>[Choose Products]</option>";
		innerHtml += "<option value='PPOTX'>PPO</option>";
		innerHtml += "<option value='SDHPTX'>SDHP</option>";
		innerHtml += "<option value='IndemnityTX'>Indemnity</option>";
		innerHtml += "<option value='EPOTX'>EPO</option>";
		innerHtml += "</SELECT>";
		innerHtml += "<font color='#ff0000'><B>*</B></font></td></tr><br><br>";
		}		
		
		if (JSRegion == "OKJS"){
		innerHtml += "<tr><td>Products Requested: &nbsp;&nbsp;&nbsp;</td><td>";
		var retValue = "plansRequested" + i;
		innerHtml += "<SELECT name='plansRequested' id=" + retValue + " onChange='productsRequestedDependentChange("+i+")'>";
		innerHtml += "<option value=''>[Choose Products]</option>";
		innerHtml += "<option value='HMOOK'>HMO</option>";
		innerHtml += "<option value='PPOOK'>PPO</option>";
		innerHtml += "<option value='SDHPOK'>SDHP</option>";
		innerHtml += "<option value='IndemnityOK'>Indemnity</option>";
		innerHtml += "</SELECT>";
		innerHtml += "<font color='#ff0000'><B>*</B></font></td></tr><br><br>";
		}		
		
		if (JSRegion == "AZJS"){
		innerHtml += "<tr><td>Products Requested: &nbsp;&nbsp;&nbsp;</td><td>";
		
		var retValue = "plansRequested" + i;
		innerHtml += "<SELECT name='plansRequested' id=" + retValue + " onChange='productsRequestedDependentChange("+i+")'>";
		innerHtml += "<option value=''>[Choose Products]</option>";
		innerHtml += "<option value='HMOAZ'>HMO</option>";
		innerHtml += "<option value='PPOAZ'>PPO</option>";
		innerHtml += "<option value='SDHPAZ'>SDHP</option>";
		innerHtml += "</SELECT>";
		innerHtml += "<font color='#ff0000'><B>*</B></font></td></tr><br><br>";
		}		
		
		if (JSRegion == "NVJS"){
		
		innerHtml += "<tr><td>Products Requested: &nbsp;&nbsp;&nbsp;</td><td>";
		var retValue = "plansRequested" + i;
		innerHtml += "<SELECT name='plansRequested' id=" + retValue + " onChange='productsRequestedDependentChange("+i+")'>";
		innerHtml += "<option value=''>[Choose Products]</option>";
		innerHtml += "<option value='HMONV'>HMO</option>";
		innerHtml += "<option value='PPONV'>PPO</option>";
		innerHtml += "<option value='HDHPNV'>HDHP</option>";
		innerHtml += "<option value='SDHPNV'>SDHP</option>";
		innerHtml += "<option value='IndemnityNV'>Indemnity</option>";
		innerHtml += "</SELECT>";
		innerHtml += "<font color='#ff0000'><B>*</B></font></td></tr><br><br>";
		}		
		
		if (JSRegion == "COJS"){
		innerHtml += "<tr><td>Products Requested: &nbsp;&nbsp;&nbsp;</td><td>";
		var retValue = "plansRequested" + i;
		innerHtml += "<SELECT name='plansRequested' id=" + retValue + " onChange='productsRequestedDependentChange("+i+")'>";
		innerHtml += "<option value=''>[Choose Products]</option>";
		innerHtml += "<option value='HMOCO'>HMO</option>";
		innerHtml += "<option value='PPOCO'>PPO</option>";
		innerHtml += "<option value='IndemnityCO'>Indemnity</option>";
		innerHtml += "<option value='SDHPCO'>SDHP</option>";
		innerHtml += "</SELECT>";
		innerHtml += "<font color='#ff0000'><B>*</B></font></td></tr><br><br>";
		}		
		
	
		
		if (JSRegion == "ORJS"){
		innerHtml += "<tr><td>Products Requested: &nbsp;&nbsp;&nbsp;</td><td>";
		innerHtml += "<SELECT name='plansRequested' id='plansRequested" + i + "' onChange='productsRequestedDependentChange("+i+")'>";
		innerHtml += "<option value=''>[Choose Products]</option>";
		innerHtml += "<option value='PPOOR'>PPO</option>";
		innerHtml += "<option value='HMOPOSOR'>HMO / POS</option>";
		innerHtml += "<option value='HDHPOR'>HDHP</option>";
		innerHtml += "<option value='EPOOR'>EPO</option>";
		innerHtml += "<option value='SDHPOR'>SDHP</option>";
		
		innerHtml += "</SELECT>";
		innerHtml += "<font color='#ff0000'><B>*</B></font></td></tr><br><br>";
		}
		
		if (JSRegion == "WAJS"){
		innerHtml += "<tr><td>Products Requested: &nbsp;&nbsp;&nbsp;</td><td>";
		innerHtml += "<SELECT name='plansRequested' id='plansRequested" + i + "' onChange='productsRequestedDependentChange("+i+")'>";
		innerHtml += "<option value=''>[Choose Products]</option>";
		innerHtml += "<option value='PPOWA'>PPO</option>";
		innerHtml += "<option value='SDHPWA'>SDHP</option>";
		innerHtml += "<option value='MCOPOSWA'>MCO / POS</option>";
		innerHtml += "</SELECT>";
		innerHtml += "<font color='#ff0000'><B>*</B></font></td></tr><br><br>";
		}
		
		innerHtml += "<tr>";
		
		innerHtml += "<div id='productsRequested" + i + "' onChange='productsRequestedDependentChange("+i+")'>";
		innerHtml += "</div>"
		
		innerHtml += "</tr>";
		
		innerHtml += "<tr><td>Qualifying Event: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
		innerHtml += "<SELECT name='qualifyingEvent' id='qualifyingEvent" + i + "' onChange='qualifyingEventChange("+i+")' >";
		innerHtml += "<option value=''>[Choose]</option>";
		innerHtml += "<option value='New Hire'>New Hire</option>";
		innerHtml += "<option value='Open Enrollment'>Open Enrollment</option>";
		innerHtml += "<option value='Loss of Other Coverage'>Loss of Other Coverage</option>";
		innerHtml += "<option value='Court Ordered Dependent'>Court Ordered Dependent</option>";
		innerHtml += "<option value='New Group'>New Group</option>";
		innerHtml += "<option value='Full Time'>Full Time</option>";
		innerHtml += "<option value='Other'>Other</option>";
		innerHtml += "</SELECT>";
		innerHtml += "<font color='#ff0000'><B>*</B></font></td>";
		innerHtml += "<td>Specify:<input type='text' name='specify' id='specify" + i + "' size='22' maxlength='40'/>";
		innerHtml += "(Reason for Enrollment)</td></tr><br>";
		
		innerHtml += "<table width='70%'><tr><td><div id='fulltimedivlabel"+ i +"' style='visibility:hidden;display:none'>Hire Date(enter<br>as mm/dd/yyyy)</div></td>";
		
		innerHtml += "<td><div id='fulltimeDiv"+i+"' style='visibility:hidden;display:none'>";
		innerHtml += "<input type='text' name='fulltimetext' id='fulltimetext" + i + "' size='22' maxlength='40' />";
		innerHtml += "<font color='#ff0000'><B>*</B></font></div>";
		
		innerHtml += "</td></tr></table>";
				
		innerHtml += "<tr><td>Primary Care <br> Physician Number:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input type='text' name='primaryCarePhysicianNum' id='primaryCarePhysicianNum" + i + "' size='22' maxlength='40'/></td>";
		//innerHtml += "<br>(for HMO/POS plans only)</td></tr>";
		innerHtml += "<br>(for HMO/MCO/POS plans only)";
		innerHtml += "<div id='HMOSelected" + i + "' style='visibility:hidden' ><font color='#ff0000'><B>*</B></font></div>";
	
	        innerHtml += "<br><tr><td>Primary Care <br> Physician Name:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input type='text' name='primaryCarePhysician'  id='primaryCarePhysician" + i + "'  size='22' maxlength='40'/>";
		innerHtml += "<br>(for HMO/MCO/POS plans only)</td></tr><br>";
		innerHtml += "</tr>";

		innerHtml += "<br><tr><td>Dependents Gender: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;";
		innerHtml += "<SELECT name='dGender' id='dGender" + i + "'>";
		innerHtml += "<option value='Male'>Male</option>";
		innerHtml += "<option value='Female'>Female</option>";
		innerHtml += "</SELECT>";
		innerHtml += "<font color='#ff0000'>";
		innerHtml += "	<B>*</B>";
		innerHtml += "</font>";
		innerHtml += "</td>";
		innerHtml += "</tr><br>";
	}
	id.innerHTML = innerHtml;
	for(t=1;t<=form.noOfDependent.value && t<=form.prevTotalDependent.value;t++)
	{
		var relationshipId = document.getElementById("relationship"+t);
		relationshipId.value = relationshipArr[t];

		var dssn1Id = document.getElementById("dssn1"+t);
		dssn1Id.value = dssn1Arr[t];

		var dssn2Id = document.getElementById("dssn2"+t);
		dssn2Id.value = dssn2Arr[t];

		var dssn3Id = document.getElementById("dssn3"+t);
		dssn3Id.value = dssn3Arr[t];

		var dLastNameId = document.getElementById("dLastName"+t);
		dLastNameId.value = dLastNameArr[t];

		var dFirstNameId = document.getElementById("dFirstName"+t);
		dFirstNameId.value = dFirstNameArr[t];

		var dMiddleInitialId = document.getElementById("dMiddleInitial"+t);
		dMiddleInitialId.value = dMiddleInitialArr[t];

		var dDateofBirthId = document.getElementById("dDateofBirth"+t);
		dDateofBirthId.value = dDateofBirthArr[t];
		
		// anand annamalai 
		var fulltimetextId = document.getElementById("fulltimetext"+t);
		fulltimetextId.value = fulltimedateArr[t];

		var productsRequestedId = document.getElementById("productsRequested"+t);
		productsRequestedId.value = productsRequestedArr[t];

		var qualifyingEventId = document.getElementById("qualifyingEvent"+t);
		qualifyingEventId.value = qualifyingEventArr[t];

		var specifyId = document.getElementById("specify"+t);
		specifyId.value = specifyArr[t];

		var primaryCarePhysicianId = document.getElementById("primaryCarePhysician"+t);
		primaryCarePhysicianId.value = primaryCarePhysicianArr[t];

		var primaryCarePhysicianNumId = document.getElementById("primaryCarePhysicianNum"+t);
		primaryCarePhysicianNumId.value = primaryCarePhysicianNumArr[t];

		var dGenderId = document.getElementById("dGender"+t);
		dGenderId.value = dGenderArr[t];
	}
	form.prevTotalDependent.value=form.noOfDependent.value;
}
// Added by Kuljeet Enrollment Form For PHS Employer Portal 10th Nov 2006 End

//Added for Calender Popup
var weekend = [0,6]; 
var weekendColor = "#e0e0e0"; 
var fontface = "Verdana"; 
var fontsize = 2; 

var gNow = new Date(); 
var ggWinCal; 
isNav = (navigator.appName.indexOf("Netscape") != -1) ? true : false; 
isIE = (navigator.appName.indexOf("Microsoft") != -1) ? true : false; 

Calendar.Months = ["January", "February", "March", "April", "May", "June", 
"July", "August", "September", "October", "November", "December"]; 

// Non-Leap year Month days.. 
Calendar.DOMonth = [31, 28, 31, 30, 31, 30, 31, 31, 30, 31, 30, 31]; 
// Leap year Month days.. 
Calendar.lDOMonth = [31, 29, 31, 30, 31, 30, 31, 31, 30, 31, 30, 31]; 

function Calendar(p_item, p_WinCal, p_month, p_year, p_format) { 
    if ((p_month == null) && (p_year == null))    return; 

    if (p_WinCal == null) 
        this.gWinCal = ggWinCal; 
    else 
        this.gWinCal = p_WinCal; 
    
    if (p_month == null) { 
        this.gMonthName = null; 
        this.gMonth = null; 
        this.gYearly = true; 
    } else { 
        this.gMonthName = Calendar.get_month(p_month); 
        this.gMonth = new Number(p_month); 
        this.gYearly = false; 
    } 

    this.gYear = p_year; 
    this.gFormat = p_format; 
    this.gBGColor = "white"; 
    this.gFGColor = "black"; 
    this.gTextColor = "black"; 
    this.gHeaderColor = "black"; 
    this.gReturnItem = p_item; 
} 

Calendar.get_month = Calendar_get_month; 
Calendar.get_daysofmonth = Calendar_get_daysofmonth; 
Calendar.calc_month_year = Calendar_calc_month_year; 
Calendar.print = Calendar_print; 

function Calendar_get_month(monthNo) { 
    return Calendar.Months[monthNo]; 
} 

function Calendar_get_daysofmonth(monthNo, p_year) { 
    /* 
    Check for leap year .. 
    1.Years evenly divisible by four are normally leap years, except for... 
    2.Years also evenly divisible by 100 are not leap years, except for... 
    3.Years also evenly divisible by 400 are leap years. 
    */ 
    if ((p_year % 4) == 0) { 
        if ((p_year % 100) == 0 && (p_year % 400) != 0) 
            return Calendar.DOMonth[monthNo]; 
    
        return Calendar.lDOMonth[monthNo]; 
    } else 
        return Calendar.DOMonth[monthNo]; 
} 

function Calendar_calc_month_year(p_Month, p_Year, incr) { 
    /* 
    Will return an 1-D array with 1st element being the calculated month 
    and second being the calculated year 
    after applying the month increment/decrement as specified by 'incr' parameter. 
    'incr' will normally have 1/-1 to navigate thru the months. 
    */ 
    var ret_arr = new Array(); 
    
    if (incr == -1) { 
        // B A C K W A R D 
        if (p_Month == 0) { 
            ret_arr[0] = 11; 
            ret_arr[1] = parseInt(p_Year) - 1; 
        } 
        else { 
            ret_arr[0] = parseInt(p_Month) - 1; 
            ret_arr[1] = parseInt(p_Year); 
        } 
    } else if (incr == 1) { 
        // F O R W A R D 
        if (p_Month == 11) { 
            ret_arr[0] = 0; 
            ret_arr[1] = parseInt(p_Year) + 1; 
        } 
        else { 
            ret_arr[0] = parseInt(p_Month) + 1; 
            ret_arr[1] = parseInt(p_Year); 
        } 
    } 
    
    return ret_arr; 
} 

function Calendar_print() { 
    ggWinCal.print(); 
} 

function Calendar_calc_month_year(p_Month, p_Year, incr) { 
    /* 
    Will return an 1-D array with 1st element being the calculated month 
    and second being the calculated year 
    after applying the month increment/decrement as specified by 'incr' parameter. 
    'incr' will normally have 1/-1 to navigate thru the months. 
    */ 
    var ret_arr = new Array(); 
    
    if (incr == -1) { 
        // B A C K W A R D 
        if (p_Month == 0) { 
            ret_arr[0] = 11; 
            ret_arr[1] = parseInt(p_Year) - 1; 
        } 
        else { 
            ret_arr[0] = parseInt(p_Month) - 1; 
            ret_arr[1] = parseInt(p_Year); 
        } 
    } else if (incr == 1) { 
        // F O R W A R D 
        if (p_Month == 11) { 
            ret_arr[0] = 0; 
            ret_arr[1] = parseInt(p_Year) + 1; 
        } 
        else { 
            ret_arr[0] = parseInt(p_Month) + 1; 
            ret_arr[1] = parseInt(p_Year); 
        } 
    } 
    
    return ret_arr; 
} 

// This is for compatibility with Navigator 3, we have to create and discard one object before the prototype object exists. 
new Calendar(); 

Calendar.prototype.getMonthlyCalendarCode = function() { 
    var vCode = ""; 
    var vHeader_Code = ""; 
    var vData_Code = ""; 
    
    // Begin Table Drawing code here.. 
    vCode = vCode + "<TABLE BORDER=1 BGCOLOR=\"" + this.gBGColor + "\">"; 
    
    vHeader_Code = this.cal_header(); 
    vData_Code = this.cal_data(); 
    vCode = vCode + vHeader_Code + vData_Code; 
    
    vCode = vCode + "</TABLE>"; 
    
    return vCode; 
} 

Calendar.prototype.show = function() { 
    var vCode = ""; 
    
    this.gWinCal.document.open(); 

    // Setup the page... 
    this.wwrite("<html>"); 
    this.wwrite("<head><title>Calendar</title>"); 
    this.wwrite("</head>"); 

    this.wwrite("<body " + 
        "link=\"" + this.gLinkColor + "\" " + 
        "vlink=\"" + this.gLinkColor + "\" " + 
        "alink=\"" + this.gLinkColor + "\" " + 
        "text=\"" + this.gTextColor + "\">"); 
    this.wwriteA("<FONT FACE='" + fontface + "' SIZE=2><B>"); 
    this.wwriteA(this.gMonthName + " " + this.gYear); 
    this.wwriteA("</B><BR>"); 

    // Show navigation buttons 
    var prevMMYYYY = Calendar.calc_month_year(this.gMonth, this.gYear, -1); 
    var prevMM = prevMMYYYY[0]; 
    var prevYYYY = prevMMYYYY[1]; 

    var nextMMYYYY = Calendar.calc_month_year(this.gMonth, this.gYear, 1); 
    var nextMM = nextMMYYYY[0]; 
    var nextYYYY = nextMMYYYY[1]; 
    
    this.wwrite("<TABLE WIDTH='100%' BORDER=1 CELLSPACING=0 CELLPADDING=0 BGCOLOR='#e0e0e0'><TR><TD ALIGN=center>"); 
    this.wwrite("[<A HREF=\"" + 
        "javascript:window.opener.Build(" + 
        "'" + this.gReturnItem + "', '" + this.gMonth + "', '" + (parseInt(this.gYear)-1) + "', '" + this.gFormat + "'" + 
        ");" + 
        "\"><<<\/A>]</TD><TD ALIGN=center>"); 
    this.wwrite("[<A HREF=\"" + 
        "javascript:window.opener.Build(" + 
        "'" + this.gReturnItem + "', '" + prevMM + "', '" + prevYYYY + "', '" + this.gFormat + "'" + 
        ");" + 
        "\"><<\/A>]</TD><TD ALIGN=center>"); 
    this.wwrite("[<A HREF=\"javascript:window.print();\">Print</A>]</TD><TD ALIGN=center>"); 
    this.wwrite("[<A HREF=\"" + 
        "javascript:window.opener.Build(" + 
        "'" + this.gReturnItem + "', '" + nextMM + "', '" + nextYYYY + "', '" + this.gFormat + "'" + 
        ");" + 
        "\">><\/A>]</TD><TD ALIGN=center>"); 
    this.wwrite("[<A HREF=\"" + 
        "javascript:window.opener.Build(" + 
        "'" + this.gReturnItem + "', '" + this.gMonth + "', '" + (parseInt(this.gYear)+1) + "', '" + this.gFormat + "'" + 
        ");" + 
        "\">>><\/A>]</TD></TR></TABLE><BR>"); 

    // Get the complete calendar code for the month.. 
    vCode = this.getMonthlyCalendarCode(); 
    this.wwrite(vCode); 

    this.wwrite("</font></body></html>"); 
    this.gWinCal.document.close(); 
} 

Calendar.prototype.showY = function() { 
    var vCode = ""; 
    var i; 
    var vr, vc, vx, vy;        // Row, Column, X-coord, Y-coord 
    var vxf = 285;            // X-Factor 
    var vyf = 200;            // Y-Factor 
    var vxm = 10;            // X-margin 
    var vym;                // Y-margin 
    if (isIE)    vym = 75; 
    else if (isNav)    vym = 25; 
    
    this.gWinCal.document.open(); 

    this.wwrite("<html>"); 
    this.wwrite("<head><title>Calendar</title>"); 
    this.wwrite("<style type='text/css'>\n<!--"); 
    for (i=0; i<12; i++) { 
        vc = i % 3; 
        if (i>=0 && i<= 2)    vr = 0; 
        if (i>=3 && i<= 5)    vr = 1; 
        if (i>=6 && i<= 8)    vr = 2; 
        if (i>=9 && i<= 11)    vr = 3; 
        
        vx = parseInt(vxf * vc) + vxm; 
        vy = parseInt(vyf * vr) + vym; 

        this.wwrite(".lclass" + i + " {position:absolute;top:" + vy + ";left:" + vx + ";}"); 
    } 
    this.wwrite("-->\n</style>"); 
    this.wwrite("</head>"); 

    this.wwrite("<body " + 
        "link=\"" + this.gLinkColor + "\" " + 
        "vlink=\"" + this.gLinkColor + "\" " + 
        "alink=\"" + this.gLinkColor + "\" " + 
        "text=\"" + this.gTextColor + "\">"); 
    this.wwrite("<FONT FACE='" + fontface + "' SIZE=2><B>"); 
    this.wwrite("Year : " + this.gYear); 
    this.wwrite("</B><BR>"); 

    // Show navigation buttons 
    var prevYYYY = parseInt(this.gYear) - 1; 
    var nextYYYY = parseInt(this.gYear) + 1; 
    
    this.wwrite("<TABLE WIDTH='100%' BORDER=1 CELLSPACING=0 CELLPADDING=0 BGCOLOR='#e0e0e0'><TR><TD ALIGN=center>"); 
    this.wwrite("[<A HREF=\"" + 
        "javascript:window.opener.Build(" + 
        "'" + this.gReturnItem + "', null, '" + prevYYYY + "', '" + this.gFormat + "'" + 
        ");" + 
        "\" alt='Prev Year'><<<\/A>]</TD><TD ALIGN=center>"); 
    this.wwrite("[<A HREF=\"javascript:window.print();\">Print</A>]</TD><TD ALIGN=center>"); 
    this.wwrite("[<A HREF=\"" + 
        "javascript:window.opener.Build(" + 
        "'" + this.gReturnItem + "', null, '" + nextYYYY + "', '" + this.gFormat + "'" + 
        ");" + 
        "\">>><\/A>]</TD></TR></TABLE><BR>"); 

    // Get the complete calendar code for each month.. 
    var j; 
    for (i=11; i>=0; i--) { 
        if (isIE) 
            this.wwrite("<DIV ID=\"layer" + i + "\" CLASS=\"lclass" + i + "\">"); 
        else if (isNav) 
            this.wwrite("<LAYER ID=\"layer" + i + "\" CLASS=\"lclass" + i + "\">"); 

        this.gMonth = i; 
        this.gMonthName = Calendar.get_month(this.gMonth); 
        vCode = this.getMonthlyCalendarCode(); 
        this.wwrite(this.gMonthName + "/" + this.gYear + "<BR>"); 
        this.wwrite(vCode); 

        if (isIE) 
            this.wwrite("</DIV>"); 
        else if (isNav) 
            this.wwrite("</LAYER>"); 
    } 

    this.wwrite("</font><BR></body></html>"); 
    this.gWinCal.document.close(); 
} 

Calendar.prototype.wwrite = function(wtext) { 
    this.gWinCal.document.writeln(wtext); 
} 

Calendar.prototype.wwriteA = function(wtext) { 
    this.gWinCal.document.write(wtext); 
} 

Calendar.prototype.cal_header = function() { 
    var vCode = ""; 
    
    vCode = vCode + "<TR>"; 
    vCode = vCode + "<TD WIDTH='14%'><FONT SIZE='2' FACE='" + fontface + "' COLOR='" + this.gHeaderColor + "'><B>Sun</B></FONT></TD>"; 
    vCode = vCode + "<TD WIDTH='14%'><FONT SIZE='2' FACE='" + fontface + "' COLOR='" + this.gHeaderColor + "'><B>Mon</B></FONT></TD>"; 
    vCode = vCode + "<TD WIDTH='14%'><FONT SIZE='2' FACE='" + fontface + "' COLOR='" + this.gHeaderColor + "'><B>Tue</B></FONT></TD>"; 
    vCode = vCode + "<TD WIDTH='14%'><FONT SIZE='2' FACE='" + fontface + "' COLOR='" + this.gHeaderColor + "'><B>Wed</B></FONT></TD>"; 
    vCode = vCode + "<TD WIDTH='14%'><FONT SIZE='2' FACE='" + fontface + "' COLOR='" + this.gHeaderColor + "'><B>Thu</B></FONT></TD>"; 
    vCode = vCode + "<TD WIDTH='14%'><FONT SIZE='2' FACE='" + fontface + "' COLOR='" + this.gHeaderColor + "'><B>Fri</B></FONT></TD>"; 
    vCode = vCode + "<TD WIDTH='16%'><FONT SIZE='2' FACE='" + fontface + "' COLOR='" + this.gHeaderColor + "'><B>Sat</B></FONT></TD>"; 
    vCode = vCode + "</TR>"; 
    
    return vCode; 
} 

Calendar.prototype.cal_data = function() { 
    var vDate = new Date(); 
    vDate.setDate(1); 
    vDate.setMonth(this.gMonth); 
    vDate.setFullYear(this.gYear); 

    var vFirstDay=vDate.getDay(); 
    var vDay=1; 
    var vLastDay=Calendar.get_daysofmonth(this.gMonth, this.gYear); 
    var vOnLastDay=0; 
    var vCode = ""; 

    /* 
    Get day for the 1st of the requested month/year.. 
    Place as many blank cells before the 1st day of the month as necessary. 
    */ 

    vCode = vCode + "<TR>"; 
    for (i=0; i<vFirstDay; i++) { 
        vCode = vCode + "<TD WIDTH='14%'" + this.write_weekend_string(i) + "><FONT SIZE='2' FACE='" + fontface + "'> </FONT></TD>"; 
    } 

    // Write rest of the 1st week 
    for (j=vFirstDay; j<7; j++) { 
        vCode = vCode + "<TD WIDTH='14%'" + this.write_weekend_string(j) + "><FONT SIZE='2' FACE='" + fontface + "'>" + 
            "<A HREF='#' " + 
                "onClick=\"self.opener.document." + this.gReturnItem + ".value='" + 
                this.format_data(vDay) + 
                "';window.close();\">" + 
                this.format_day(vDay) + 
            "</A>" + 
            "</FONT></TD>"; 
        vDay=vDay + 1; 
    } 
    vCode = vCode + "</TR>"; 

    // Write the rest of the weeks 
    for (k=2; k<7; k++) { 
        vCode = vCode + "<TR>"; 

        for (j=0; j<7; j++) { 
            vCode = vCode + "<TD WIDTH='14%'" + this.write_weekend_string(j) + "><FONT SIZE='2' FACE='" + fontface + "'>" + 
                "<A HREF='#' " + 
                    "onClick=\"self.opener.document." + this.gReturnItem + ".value='" + 
                    this.format_data(vDay) + 
                    "';window.close();\">" + 
                this.format_day(vDay) + 
                "</A>" + 
                "</FONT></TD>"; 
            vDay=vDay + 1; 

            if (vDay > vLastDay) { 
                vOnLastDay = 1; 
                break; 
            } 
        } 

        if (j == 6) 
            vCode = vCode + "</TR>"; 
        if (vOnLastDay == 1) 
            break; 
    } 
    
    // Fill up the rest of last week with proper blanks, so that we get proper square blocks 
    for (m=1; m<(7-j); m++) { 
        if (this.gYearly) 
            vCode = vCode + "<TD WIDTH='14%'" + this.write_weekend_string(j+m) + 
            "><FONT SIZE='2' FACE='" + fontface + "' COLOR='gray'> </FONT></TD>"; 
        else 
            vCode = vCode + "<TD WIDTH='14%'" + this.write_weekend_string(j+m) + 
            "><FONT SIZE='2' FACE='" + fontface + "' COLOR='gray'>" + m + "</FONT></TD>"; 
    } 
    
    return vCode; 
} 

Calendar.prototype.format_day = function(vday) { 
    var vNowDay = gNow.getDate(); 
    var vNowMonth = gNow.getMonth(); 
    var vNowYear = gNow.getFullYear(); 

    if (vday == vNowDay && this.gMonth == vNowMonth && this.gYear == vNowYear) 
        return ("<FONT COLOR=\"RED\"><B>" + vday + "</B></FONT>"); 
    else 
        return (vday); 
} 

Calendar.prototype.write_weekend_string = function(vday) { 
    var i; 

    // Return special formatting for the weekend day. 
    for (i=0; i<weekend.length; i++) { 
        if (vday == weekend[i]) 
            return (" BGCOLOR=\"" + weekendColor + "\""); 
    } 
    
    return ""; 
} 

Calendar.prototype.format_data = function(p_day) { 
    var vData; 
    var vMonth = 1 + this.gMonth; 
    vMonth = (vMonth.toString().length < 2) ? "0" + vMonth : vMonth; 
    var vMon = Calendar.get_month(this.gMonth).substr(0,3).toUpperCase(); 
    var vFMon = Calendar.get_month(this.gMonth).toUpperCase(); 
    var vY4 = new String(this.gYear); 
    var vY2 = new String(this.gYear.substr(2,2)); 
    var vDD = (p_day.toString().length < 2) ? "0" + p_day : p_day; 

    switch (this.gFormat) { 
        case "MM\/DD\/YYYY" : 
            vData = vMonth + "\/" + vDD + "\/" + vY4; 
            break; 
        case "MM\/DD\/YY" : 
            vData = vMonth + "\/" + vDD + "\/" + vY2; 
            break; 
        case "MM-DD-YYYY" : 
            vData = vMonth + "-" + vDD + "-" + vY4; 
            break; 
        case "MM-DD-YY" : 
            vData = vMonth + "-" + vDD + "-" + vY2; 
            break; 

        case "DD\/MON\/YYYY" : 
            vData = vDD + "\/" + vMon + "\/" + vY4; 
            break; 
        case "DD\/MON\/YY" : 
            vData = vDD + "\/" + vMon + "\/" + vY2; 
            break; 
        case "DD-MON-YYYY" : 
            vData = vDD + "-" + vMon + "-" + vY4; 
            break; 
        case "DD-MON-YY" : 
            vData = vDD + "-" + vMon + "-" + vY2; 
            break; 

        case "DD\/MONTH\/YYYY" : 
            vData = vDD + "\/" + vFMon + "\/" + vY4; 
            break; 
        case "DD\/MONTH\/YY" : 
            vData = vDD + "\/" + vFMon + "\/" + vY2; 
            break; 
        case "DD-MONTH-YYYY" : 
            vData = vDD + "-" + vFMon + "-" + vY4; 
            break; 
        case "DD-MONTH-YY" : 
            vData = vDD + "-" + vFMon + "-" + vY2; 
            break; 

        case "DD\/MM\/YYYY" : 
            vData = vDD + "\/" + vMonth + "\/" + vY4; 
            break; 
        case "DD\/MM\/YY" : 
            vData = vDD + "\/" + vMonth + "\/" + vY2; 
            break; 
        case "DD-MM-YYYY" : 
            vData = vDD + "-" + vMonth + "-" + vY4; 
            break; 
        case "DD-MM-YY" : 
            vData = vDD + "-" + vMonth + "-" + vY2; 
            break; 

        default : 
            vData = vMonth + "\/" + vDD + "\/" + vY4; 
    } 

    return vData; 
} 

function Build(p_item, p_month, p_year, p_format) { 
    var p_WinCal = ggWinCal; 
    gCal = new Calendar(p_item, p_WinCal, p_month, p_year, p_format); 

    // Customize your Calendar here.. 
    gCal.gBGColor="white"; 
    gCal.gLinkColor="black"; 
    gCal.gTextColor="black"; 
    gCal.gHeaderColor="darkgreen"; 

    // Choose appropriate show function 
    if (gCal.gYearly)    gCal.showY(); 
    else    gCal.show(); 
} 

function show_calendar() { 
    /* 
        p_month : 0-11 for Jan-Dec; 12 for All Months. 
        p_year    : 4-digit year 
        p_format: Date format (mm/dd/yyyy, dd/mm/yy, ...) 
        p_item    : Return Item. 
    */ 

    p_item = arguments[0]; 
    if (arguments[1] == null) 
        p_month = new String(gNow.getMonth()); 
    else 
        p_month = arguments[1]; 
    if (arguments[2] == "" || arguments[2] == null) 
        p_year = new String(gNow.getFullYear().toString()); 
    else 
        p_year = arguments[2]; 
    if (arguments[3] == null) 
        p_format = "MM/DD/YYYY"; 
    else 
        p_format = arguments[3]; 

    vWinCal = window.open("", "Calendar", 
        "width=250,height=250,status=no,resizable=no,top=200,left=200"); 
    vWinCal.opener = self; 
    ggWinCal = vWinCal; 

    Build(p_item, p_month, p_year, p_format); 
} 
/* 
Yearly Calendar Code Starts here 
*/ 
function show_yearly_calendar(p_item, p_year, p_format) { 
    // Load the defaults.. 
    if (p_year == null || p_year == "") 
        p_year = new String(gNow.getFullYear().toString()); 
    if (p_format == null || p_format == "") 
        p_format = "MM/DD/YYYY"; 

    var vWinCal = window.open("", "Calendar", "scrollbars=yes"); 
    vWinCal.opener = self; 
    ggWinCal = vWinCal; 

    Build(p_item, null, p_year, p_format); 
}