Cynthia
09-04-2002, 07:13 PM
I am attaching a form (html) in hopes someone can tell me how to validate (with Javascript) the two selection lists within it on submission. I have been able to validate all other fields on the form except these two. The selection lists are named "account" and "market". I have tried until I'm pulling my hair out. If your willing to help me out - I would really appreciate it. Thanks so much.
Cynthia
Dallas, Texas
<HTML>
<HEAD>
<TITLE>Accessibility Survey</TITLE>
<SCRIPT>
function validate() {
mNv=Accessibility.CSRName.value;
if (mNv=='') {
alert('CSR name is required');
event.returnValue=false;
}
mNv=Accessibility.DATE.value;
if (mNv=='') {
alert('Date required');
event.returnValue=false;
}
mNv=Accessibility.PtName.value;
if (mNv=='') {
alert('Pt name required');
event.returnvalue=false;
}
mNv=Accessibility.PtID.value;
if (mNv=='') {
alert('Pt ID required');
event.returnvalue=false;
}
mNv=Accessibility.DOB.value;
if (mNv=='') {
alert('Pt DOB required');
event.returnvalue=false;
}
if (!(Accessibility.TYPE[0].checked || Accessibility.TYPE[1].checked)) {
alert('Select either MD or Therapist.');
event.returnValue=false;
}
if (!(Accessibility.OFFERED[0].checked || Accessibility.OFFERED[1].checked)) {
alert('Was appointment offered?');
event.returnvalue=false;
}
if (!(Accessibility.SATISFIED[0].checked || Accessibility.SATISFIED[1].checked)) {
alert('Was Pt. satisfied?');
event.returnvalue=false;
}
}
</SCRIPT>
</HEAD>
<BODY TEXT="NAVY" BGCOLOR="#C6EFF7">
<H6>MAGELLAN BEHAVIORAL HEALTH<BR>Dallas Regional Service Center<BR>
Accessibility of Services Form</H6>
<CENTER><B><FONT SIZE="4">ACCESSIBILITY OF SERVICES SURVEY TOOL<BR>Please complete <U><FONT COLOR="red">all
</FONT></U> sections then click the submit button.</FONT></B></CENTER>
<FORM NAME="Accessibility" METHOD="post" ENCTYPE="text/plain"
ACTION="mailto:caberry@magellanhealth.com" onsubmit="validate();">
<TABLE WIDTH="100%" BORDER=1 BORDERCOLORDARK="WHITE" BORDERCOLORLIGHT="NAVY" ALIGN="CENTER">
<TR>
<TD WIDTH="60%"><B>CSR Name </B><INPUT TYPE="TEXT" NAME="CSRName" SIZE="45"></TD>
<TD WIDTH="40%"><B>Date (mm/dd/yy)</B> <INPUT TYPE="TEXT" NAME="DATE" SIZE="20"></TD>
</TR>
</TABLE>
<TABLE width="100%" align=center BORDER=1 BORDERCOLORDARK="WHITE" BORDERCOLORLIGHT="NAVY">
<TBODY>
<TR>
<TD VALIGN="TOP"><B>Account:</TD>
<TD><SELECT NAME=Account onBlur="CheckOther();">
<OPTION VALUE="Aetna"><B><FONT SIZE="3">Aetna</B>
<OPTION VALUE="Amcare"><B>Amcare</B>
<OPTION VALUE="BCBSTX"><B>BCBSTX</B>
<OPTION VALUE="BlueLincs"><B>BlueLincs</B>
<OPTION VALUE="CHIP"><B>CHIP</B>
<OPTION VALUE="HMOBlue"><B>HMOBlue</B>
<OPTION VALUE="HMOBlue Medicaid"><B>HMOBlue Medicaid</B>
<OPTION VALUE="Humana"><B>Humana</B>
<OPTION VALUE="Prudential"><B>Prudential</B>
<OPTION VALUE="Superior"><B>Superior</B>
</SELECT></TD>
<TD VALIGN="TOP"><B>Market:</TD>
<TD><SELECT NAME=Market>
<OPTION><B><FONT SIZE="3">N/A</B>
<OPTION><B>All</B>
<OPTION><B>Austin</B>
<OPTION><B>Corpus Christi</B>
<OPTION><B>Dallas</B>
<OPTION><B>Houston</B>
<OPTION><B>Kansas City</B>
<OPTION><B>Oklahoma</B>
<OPTION><B>San Antonio</B>
<OPTION><B>Texas</B>
</TR>
</TR></TBODY></TABLE>
<TABLE width="100%" align=center BORDER=1 BORDERCOLORDARK="WHITE" BORDERCOLORLIGHT="NAVY">
<TR>
<TD><FONT size=2><B>Patient Name: <INPUT name=PtName></B></FONT></TD>
<TD><FONT size=2><B>Patient ID/SS #: <INPUT size=12
name=PtID></B></FONT></TD>
<TD><FONT size=2><B>City: <INPUT size=12 name=City></B></FONT></TD>
<TD><FONT size=2><B>DOB: <INPUT size=13
name=DOB></B></FONT></TD></TR></TABLE>
<TABLE width="100%" align=center BORDER=1 BORDERCOLORDARK="WHITE" BORDERCOLORLIGHT="NAVY"
<TR ALIGN="CENTER">
<TD ALIGN="CENTER"><B>Please Select One: <INPUT TYPE="RADIO" NAME="TYPE" VALUE="MD"><B>M.D.</B>
<INPUT TYPE="RADIO" NAME="TYPE" VALUE="THERAPIST"><B>Therapist</B></TD>
</TR>
<TR>
<TD><FONT SIZE="2"><B>We ask that our Providers offer an appointment within 10 days of your
request for an appointment. Was an appointment offered within 10 days?
<INPUT TYPE=RADIO NAME=OFFERED VALUE=YES>Yes <INPUT TYPE=RADIO NAME=OFFERED
VALUE=NO>No</TD>
</TR>
<TR>
<TD><FONT SIZE="2"><B>Were you satisfied with the time it took for you to get an appointment?
<INPUT TYPE=RADIO NAME=SATISFIED VALUE=YES>Yes <INPUT TYPE=RADIO
NAME=SATISFIED VALUE=NO>No</TD>
</TABLE>
<BR>
<INPUT TYPE="SUBMIT" VALUE="Submit"> <INPUT TYPE="RESET" VALUE="Reset" NAME="RESET">
<A HREF="home page.htm"><IMG SRC="homebutton.gif" BORDER="0"></A>
</FORM>
</BODY>
</HTML>
Cynthia
Dallas, Texas
<HTML>
<HEAD>
<TITLE>Accessibility Survey</TITLE>
<SCRIPT>
function validate() {
mNv=Accessibility.CSRName.value;
if (mNv=='') {
alert('CSR name is required');
event.returnValue=false;
}
mNv=Accessibility.DATE.value;
if (mNv=='') {
alert('Date required');
event.returnValue=false;
}
mNv=Accessibility.PtName.value;
if (mNv=='') {
alert('Pt name required');
event.returnvalue=false;
}
mNv=Accessibility.PtID.value;
if (mNv=='') {
alert('Pt ID required');
event.returnvalue=false;
}
mNv=Accessibility.DOB.value;
if (mNv=='') {
alert('Pt DOB required');
event.returnvalue=false;
}
if (!(Accessibility.TYPE[0].checked || Accessibility.TYPE[1].checked)) {
alert('Select either MD or Therapist.');
event.returnValue=false;
}
if (!(Accessibility.OFFERED[0].checked || Accessibility.OFFERED[1].checked)) {
alert('Was appointment offered?');
event.returnvalue=false;
}
if (!(Accessibility.SATISFIED[0].checked || Accessibility.SATISFIED[1].checked)) {
alert('Was Pt. satisfied?');
event.returnvalue=false;
}
}
</SCRIPT>
</HEAD>
<BODY TEXT="NAVY" BGCOLOR="#C6EFF7">
<H6>MAGELLAN BEHAVIORAL HEALTH<BR>Dallas Regional Service Center<BR>
Accessibility of Services Form</H6>
<CENTER><B><FONT SIZE="4">ACCESSIBILITY OF SERVICES SURVEY TOOL<BR>Please complete <U><FONT COLOR="red">all
</FONT></U> sections then click the submit button.</FONT></B></CENTER>
<FORM NAME="Accessibility" METHOD="post" ENCTYPE="text/plain"
ACTION="mailto:caberry@magellanhealth.com" onsubmit="validate();">
<TABLE WIDTH="100%" BORDER=1 BORDERCOLORDARK="WHITE" BORDERCOLORLIGHT="NAVY" ALIGN="CENTER">
<TR>
<TD WIDTH="60%"><B>CSR Name </B><INPUT TYPE="TEXT" NAME="CSRName" SIZE="45"></TD>
<TD WIDTH="40%"><B>Date (mm/dd/yy)</B> <INPUT TYPE="TEXT" NAME="DATE" SIZE="20"></TD>
</TR>
</TABLE>
<TABLE width="100%" align=center BORDER=1 BORDERCOLORDARK="WHITE" BORDERCOLORLIGHT="NAVY">
<TBODY>
<TR>
<TD VALIGN="TOP"><B>Account:</TD>
<TD><SELECT NAME=Account onBlur="CheckOther();">
<OPTION VALUE="Aetna"><B><FONT SIZE="3">Aetna</B>
<OPTION VALUE="Amcare"><B>Amcare</B>
<OPTION VALUE="BCBSTX"><B>BCBSTX</B>
<OPTION VALUE="BlueLincs"><B>BlueLincs</B>
<OPTION VALUE="CHIP"><B>CHIP</B>
<OPTION VALUE="HMOBlue"><B>HMOBlue</B>
<OPTION VALUE="HMOBlue Medicaid"><B>HMOBlue Medicaid</B>
<OPTION VALUE="Humana"><B>Humana</B>
<OPTION VALUE="Prudential"><B>Prudential</B>
<OPTION VALUE="Superior"><B>Superior</B>
</SELECT></TD>
<TD VALIGN="TOP"><B>Market:</TD>
<TD><SELECT NAME=Market>
<OPTION><B><FONT SIZE="3">N/A</B>
<OPTION><B>All</B>
<OPTION><B>Austin</B>
<OPTION><B>Corpus Christi</B>
<OPTION><B>Dallas</B>
<OPTION><B>Houston</B>
<OPTION><B>Kansas City</B>
<OPTION><B>Oklahoma</B>
<OPTION><B>San Antonio</B>
<OPTION><B>Texas</B>
</TR>
</TR></TBODY></TABLE>
<TABLE width="100%" align=center BORDER=1 BORDERCOLORDARK="WHITE" BORDERCOLORLIGHT="NAVY">
<TR>
<TD><FONT size=2><B>Patient Name: <INPUT name=PtName></B></FONT></TD>
<TD><FONT size=2><B>Patient ID/SS #: <INPUT size=12
name=PtID></B></FONT></TD>
<TD><FONT size=2><B>City: <INPUT size=12 name=City></B></FONT></TD>
<TD><FONT size=2><B>DOB: <INPUT size=13
name=DOB></B></FONT></TD></TR></TABLE>
<TABLE width="100%" align=center BORDER=1 BORDERCOLORDARK="WHITE" BORDERCOLORLIGHT="NAVY"
<TR ALIGN="CENTER">
<TD ALIGN="CENTER"><B>Please Select One: <INPUT TYPE="RADIO" NAME="TYPE" VALUE="MD"><B>M.D.</B>
<INPUT TYPE="RADIO" NAME="TYPE" VALUE="THERAPIST"><B>Therapist</B></TD>
</TR>
<TR>
<TD><FONT SIZE="2"><B>We ask that our Providers offer an appointment within 10 days of your
request for an appointment. Was an appointment offered within 10 days?
<INPUT TYPE=RADIO NAME=OFFERED VALUE=YES>Yes <INPUT TYPE=RADIO NAME=OFFERED
VALUE=NO>No</TD>
</TR>
<TR>
<TD><FONT SIZE="2"><B>Were you satisfied with the time it took for you to get an appointment?
<INPUT TYPE=RADIO NAME=SATISFIED VALUE=YES>Yes <INPUT TYPE=RADIO
NAME=SATISFIED VALUE=NO>No</TD>
</TABLE>
<BR>
<INPUT TYPE="SUBMIT" VALUE="Submit"> <INPUT TYPE="RESET" VALUE="Reset" NAME="RESET">
<A HREF="home page.htm"><IMG SRC="homebutton.gif" BORDER="0"></A>
</FORM>
</BODY>
</HTML>