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$("#sss").hide(); $(function(){ $("#medical_concern").change(function(){ $("#current_medical_concern3722").val(''); var displaycode = $("#medical_concern option:selected").val(); if (displaycode == "") { $("#current_medical_concern3722").val(''); $("#sss").show(); } else if(displaycode == "select_medical_concern"){ $("#sss").hide(); $("#current_medical_concern3722").val(''); } else{ $("#sss").hide(); $("#current_medical_concern3722").val(displaycode); }
});
// $("#medical_concern").change(function(){
// var displaycode = $("#medical_concern option:selected").val();
// if (displaycode == "") {
// $("#sss").show();
// }
// else if(displaycode == "Select Medical Concern"){
// $("#sss").hide();
// $("#medical_concern option:selected").val('');
// }
// else{
// $("#sss").hide();
// }
// $("#current_medical_concern3722").val(displaycode);
// });
});
function SubmitPost() { if (!Validate()) { return false; } } $(function () { $('.date').mask('00-00-0000'); }); function isValidDateText(s) { if (s.length > 0) { var bits = s.split('-'); var d = new Date(bits[2] + '/' + bits[0] + '/' + bits[1]); return !!(d && (d.getMonth() + 1) == bits[0] && d.getDate() == Number(bits[1])); } else return true; } function validatePhoneNumber() { if (isNaN($("#tel1-cell_phone1569871587").val()) || isNaN($("#tel2-cell_phone1569871587").val()) || isNaN($("#tel3-cell_phone1569871587").val()) || ($("#tel1-cell_phone1569871587").val() + $("#tel2-cell_phone1569871587").val() + $("#tel3-cell_phone1569871587").val()).length != 10) { alert('Please enter Phone Number correctly'); return false; } return true; } function validatePharmacyNumber() { if (isNaN($("#tel1-preferred_pharm1570200022").val()) || isNaN($("#tel2-preferred_pharm1570200022").val()) || isNaN($("#tel3-preferred_pharm1570200022").val()) || ($("#tel1-preferred_pharm1570200022").val() + $("#tel2-preferred_pharm1570200022").val() + $("#tel3-preferred_pharm1570200022").val()).length != 10) { alert('Please enter Pharmacy Number correctly'); return false; } return true; } function Validate() { if ((!validatePhoneNumber()) || (!validatePharmacyNumber())) { return false; } if (isNaN($("input[name=zip_personal]").val())) { alert("Zip should be a Number"); $("input[name=zip_personal]").focus(); return false; } if (isNaN($("#height_inches_1569871735").val())) { alert("Height should be a Number"); $("#height_inches_1569871735").focus(); return false; } if (isNaN($("#weight_lbs_1569871748").val())) { alert("Weight should be a Number"); $("#weight_lbs_1569871748").focus(); return false; } if (isNaN($("#body_temperature_f_1569871821").val())) { alert("Temperature should be a Number"); $("#body_temperature_f_1569871821").focus(); return false; } if (!isValidDateText($("#date_of_birth1570200138").val())) { alert('Please enter a valid date'); $("#date_of_birth1570200138").focus(); return false; } if (!isValidDateText($("#date_of_last_ph1570200153").val())) { alert('Please enter a valid date'); $("#date_of_last_ph1570200153").focus(); return false; } return true; } function DisplayHideExistingMemberLink() { $("#existingMemberLink").attr("href", ""); var phoneNumber = $("#tel1-cell_phone1569871587").val() + $("#tel2-cell_phone1569871587").val() + $("#tel3-cell_phone1569871587").val(); if (phoneNumber.length == 10) { $.get("https://member.my24hourphysicians.com/user/MemberExists/?phone=" + phoneNumber, function (data, status) { var obj = JSON.parse(data); if (obj == 1) { $("#existingMemberLink").show(); $("#form_list").hide(); $("#existingMemberLink").show(); $("#existingMemberLink").attr("href", "https://member.my24hourphysicians.com/user/loginExternally/?username=" + phoneNumber); window.location.href = "https://member.my24hourphysicians.com/user/loginExternally/?username=" + phoneNumber;
} else {
$("#existingMemberLink").hide(); $("#form_list").show(); $("#Checkcell").hide();
$("#first_name1569871428").focus(); } }); } else { $("#existingMemberLink").hide(); } }
function SubmitPost() { //$("#overlay").fadeIn(300);
$(".form-group").removeClass("has-error"); $(".help-block").remove(); var formData = { cellphone1:$('input[name=tel1-cell_phone1569871587]').val(), cellphone2:$('input[name=tel2-cell_phone1569871587]').val(), cellphone3:$('input[name=tel3-cell_phone1569871587]').val(), preferred_pharm1:$('input[name=tel1-preferred_pharm1570200022]').val(), preferred_pharm2:$('input[name=tel2-preferred_pharm1570200022]').val(), preferred_pharm3:$('input[name=tel3-preferred_pharm1570200022]').val(), first_name: $("input[name=first_name1569871428]").val(), last_name: $("input[name=last_name1569871443]").val(), middle_name: $("input[name=middle_name1569871434]").val(), member_email_address: $("input[name=inputEmail]").val(), member_sex: $("select[name=patients_sex1569871322] option:selected").val(), member_birthday: $("input[name=date_of_birth1570200138]").val(), memberlast_birthday: $("input[name=date_of_last_ph1570200153]").val(), member_address1: $("input[name=street_personal]").val(), member_address2: $("input[name=suit_personal]").val(), member_city: $("input[name=city_personal]").val(), member_state: $("#zone_id").val(), stateofservice: $("#select_a_state_1593193451").val(), member_country: $("select[name=personal_country] option:selected").val(), member_zip: $("input[name=zip_personal]").val(), signature: $("input[name=signature_type_your_full_name1569871904]").val(), member_current_medical_concern: $("textarea[name=current_medical_concern3722]").val(), member_known_allergies: $("textarea[name=known_allergies1569871703]").val(), member_height_inches: $("input[name=height_inches_1569871735]").val(), member_weight_lbs: $("input[name=weight_lbs_1569871748]").val(), member_smoker: $("select[name= smoker1569871769] option:selected").val(), cfid: $("input[name=cfid]").val(), consultationtype: $("input[name=consultationtype]").val(), currentmedicine:$('textarea[name=please_list_all_current_medications_rx_over_the_counter_home_remedy_1569871841]').val(), anymedicalhistory:$('textarea[name=any_medical_history_not_covered_in_any_of_the_previous_questions1569871857]').val(), cardiovascular:$('select[name=do_you_have_cardiovascular_disease1590091650] option:selected').val(), member_body_temperature: $("input[name=body_temperature_f_1569871821]").val(), call_type: $("select[name=call_type] option:selected").val(), primary_physician_name: $("input[name=primary_physician_name]").val(), primaryphysician1: $('input[name=tel1-cell_phone_physician]').val(), primaryphysician2: $('input[name=tel2-cell_phone_physician]').val(), primaryphysician3: $('input[name=tel3-cell_phone_physician]').val(), captcha: grecaptcha.getResponse()
}; var date_of_last = $('input[name= date_of_last_ph1570200153]').val(); var cellphone1 = $('input[name=tel1-cell_phone1569871587]').val(); var cellphone2 = $('input[name=tel2-cell_phone1569871587]').val(); var cellphone3 = $('input[name=tel3-cell_phone1569871587]').val(); var preferred_pharm1 = $('input[name=tel1-preferred_pharm1570200022]').val(); var preferred_pharm2 = $('input[name=tel2-preferred_pharm1570200022]').val(); var preferred_pharm3 = $('input[name=tel3-preferred_pharm1570200022]').val(); var first_name = $('input[name= first_name1569871428]').val(); var last_name = $('input[name= last_name1569871443]').val(); var middle_name = $('input[name= middle_name1569871434]').val(); var member_email_address = $('input[name= inputEmail]').val(); var member_sex = $('select[name= patients_sex1569871322] option:selected').val(); var member_birthday = $('input[name= date_of_birth1570200138]').val(); var member_address1 = $('input[name= street_personal]').val(); var member_address2 = $('input[name= suit_personal]').val(); var member_city = $('input[name= city_personal]').val(); var member_state = $('select[name= personal_state] option:selected').val(); var member_country = $('select[name= personal_country] option:selected').val(); var member_select_a_state = $('select[name= select_a_state_1593193451] option:selected').val(); var member_zip = $('input[name= zip_personal]').val(); var member_current_medical_concern = $('textarea[name=current_medical_concern3722]').val(); var member_known_allergies = $('textarea[name=known_allergies1569871703]').val(); var member_height_inches = $('input[name= height_inches_1569871735]').val(); var member_weight_lbs = $('input[name= weight_lbs_1569871748]').val(); var member_smoker = $('select[name= smoker1569871769] option:selected').val(); var member_body_temperature = $('input[name= body_temperature_f_1569871821]').val(); var cardiovascular = $('select[name= do_you_have_cardiovascular_disease1590091650] option:selected').val(); var member_signature = $('input[name= signature_type_your_full_name1569871904]').val(); var anymedicalhistory= $('textarea[name=any_medical_history_not_covered_in_any_of_the_previous_questions1569871857]').val(); var currentmedicine= $('textarea[name=please_list_all_current_medications_rx_over_the_counter_home_remedy_1569871841]').val(); var call_type = $('select[name= call_type] option:selected').val();
var nameRegex = /^[a-zA-Z ]{2,30}$/; var emailRegex = /^(([^<>()\[\]\\.,;:\s@"]+(\.[^<>()\[\]\\.,;:\s@"]+)*)|(".+"))@((\[[0-9]{1,3}\.[0-9]{1,3}\.[0-9]{1,3}\.[0-9]{1,3}\])|(([a-zA-Z\-0-9]+\.)+[a-zA-Z]{2,}))$/; if (isNaN(cellphone1) || isNaN(cellphone2) || isNaN(cellphone3) || (cellphone1.toString() + cellphone2.toString()+ cellphone3.toString()).length != 10) { alert('Please enter Phone Number correctly'); return false; } if (!nameRegex.test(first_name)) { alert('Please enter a valid First Name'); $("#first_name1569871428").focus(); return false; }
if (!nameRegex.test(last_name)) { alert('Please enter a valid Last Name'); $("#last_name1569871443").focus(); return false; } if (!emailRegex.test(member_email_address)) { alert('Please enter a valid Email Address'); $("#inputEmail").focus(); return false; } if (member_sex==="") { alert('Please enter a valid Sex'); $("#patients_sex1569871322").focus(); return false; } if (member_birthday==="") { alert("Please enter member birthday."); $('input[name= date_of_birth1570200138]').focus(); return false; } if (member_address1==="") { alert('Please enter a valid Address1'); $("input[name=street_personal]").focus(); return false; } if (member_city==="") { alert('Please enter a valid City'); $("input[name=city_personal]").focus(); return false; } if (member_state=="") { alert('Please enter a valid State'); $("#zone_id").focus(); return false; } if (member_country=="") { alert('Please select a valid Country'); $("#country_id").focus(); return false; } if (member_zip==="" || isNaN(member_zip)) { alert("Please enter zip."); $('input[name= zip_personal]').focus(); return false; } if (member_select_a_state=="") { alert('Please select State of Service'); $("#member_select_a_state").focus(); return false; } if (call_type==="") { alert('Please select call type'); $("#call_type").focus(); return false; } if (isNaN(preferred_pharm1) || isNaN(preferred_pharm2) || isNaN(preferred_pharm3) || (preferred_pharm1.toString() + preferred_pharm2.toString()+ preferred_pharm3.toString()).length != 10) { alert('Please enter Pharmacy Fax No'); return false; } if (member_current_medical_concern.trim()=="") {
alert("Please enter member current medical concern."); if($("#medical_concern").val()=='') { $('#current_medical_concern3722').focus(); } else{ $("#medical_concern").focus(); }
return false; } // if (member_current_medical_concern==="") { // alert("Please enter member current medical concern."); // $('input[name= current_medical_concern3722]').focus(); // return false; // } if (member_known_allergies==="") { alert("Please enter Allergies."); $('textarea[name= known_allergies1569871703]').focus(); return false; } if (member_height_inches==="" || isNaN(member_height_inches)) { alert("Please enter height."); $('input[name= height_inches_1569871735]').focus(); return false; } if (member_weight_lbs==="" || isNaN(member_weight_lbs)) { alert("Please enter weight."); $('input[name= weight_lbs_1569871748]').focus(); return false; } if (member_smoker==="") { alert("Please select Smoker."); $("smoker1569871769").focus(); return false; } if (member_body_temperature==="" || isNaN(member_body_temperature)) { alert("Please enter temp."); $('input[name= body_temperature_f_1569871821]').focus(); return false; } if (currentmedicine==="") { alert("Please enter current medicine."); $('textarea[name= please_list_all_current_medications_rx_over_the_counter_home_remedy_1569871841]').focus(); return false; } if (date_of_last==="") { alert("Date of last Physical is required."); $('input[name= date_of_last_ph1570200153]').focus(); return false; } if (anymedicalhistory==="") { alert("Please enter any medical history."); $('textarea[name= any_medical_history_not_covered_in_any_of_the_previous_questions1569871857]').focus(); return false; }
if (cardiovascular==="") { alert('Please enter a valid cardiovascular'); $("#do_you_have_cardiovascular_disease1590091650").focus(); return false; } if (member_signature==="") { alert('Please enter a Signature'); $("#signature_type_your_full_name1569871904").focus(); return false; }
$.ajax({ type: "POST", url: "https://my24hourphysicians.com/Members/addMember", data: formData, dataType: "json", encode: true, }) .done(function(data) {
if (data.success) {
location.href=data.url;
} else { grecaptcha.reset(); alert(data.error);
//alert(data.errors);
} })
.fail(function(data) { console.log(data);
});
return false;
}