[[static_app_header.html]]

<script language="JavaScript" type="text/JavaScript">
	


function orderbynumbervalidation()
{
	var ValidChars = "0123456789.";
	var IsNumber=true;
	var Char;
	var telephone = document.frm.telephone.value;
	if(telephone == "")
	{
		alert("Telephone Number must be filled in and match a phone number on file at the store for each prescription");		
		return false;
	} 
	else 
	{
	 for (i = 0; i < telephone.length && IsNumber == true; i++) 
      { 
      Char = telephone.charAt(i); 
      if (ValidChars.indexOf(Char) == -1) 
         {
		   isnumber=false;	 
		   alert("Invalid Characters in Phone Number only use 0123456789");	 
           return false;
         }
      }
	  if (telephone.length!=10)
	  {
		 alert("Invalid Phone Number format shoud be 9999999999 10 digits including areacode ");
		  return false;
	  }
	}
	
	if (validaterxs() == false)
	{
		return false;
	}
		
			
	return true;
	
	
}
function validaterxs()
{
	var j =0;
	var k =0;
	var m =0;
	var txt = "";
	var storeshort ="";
	var pos=-1;
	for(i=0; i<document.forms[0].elements.length;i++)
	{

		if(document.forms[0].elements[i].type == "text")
			{
				if (document.forms[0].elements[i].name == "rxnums[]")
					{
						if (document.forms[0].elements[i].value!="") 
							{
				   			j=j+1;
				   			txt=document.forms[0].elements[i].value;
							pos=txt.indexOf("-");
							if (pos==-1)
							{
				   					k=k+1;
				   			}
							else
							{
							 if (storeshort=="")	
							 {
								 storeshort=txt.substr(pos+1);
							 }
							 if (storeshort!=txt.substr(pos+1))
							 {
								 m=m+1;
							 }
							}
							}
					}
			}
	}
	if (j==0) 
	{
		alert("please fill in at least one prescription number to refill "		);
		return false;
	}
	if (k>=1) 
	{
		alert("missing - Store on at least one prescription "		);
		return false;
	}
	if (m>=1) 
	{
		alert("please order from one store at a time "		);
		return false;
	}
	
	return true;
}





</script>





<!-- Content Area Start -->
<form id="frm" name="frm" method="post" action="orderrefillsbynumber.php" onsubmit="return orderbynumbervalidation()">
      <table border="0" width="98%" cellspacing="0" cellpadding="0">
<tr>
    <td> Rx1 </td>
    <td>  <input type="text" name="rxnums[]" id="Rxnum1" tabindex="1" /> </td>
</tr>
<tr>
    
     <td>  Rx2 </td>
     <td>   <input type="text" name="rxnums[]" id="Rxnum2" /></td>
</tr>
<tr>
   <td> Rx3</td>
      <td>  <input type="text" name="rxnums[]" id="Rxnum3" /></td>

</tr>
<tr>
      
     <td> Telephone</td>
      <td>  <input type="text" name="telephone" id="telephone" /></td>
</tr>
<tr>
  
    <td> Note</td>
    <td> <textarea name="note" id="note" cols="45" rows="5"></textarea></td>
</tr>     
<tr>
<td><input type="submit" name="submitBtn" id="submitBtn" value="Submit" /></td>

</table>
<!-- Content Area End -->
    </td>
  </tr>
  <tr>
    <td width="100%" class="row3" colspan="2">
    
</form>
    
[[static_footer.html]]

<<store>> 
<tr>
          <td width="5%" class="top right" align="center" valign="top">
          <input type="checkbox" name="store[]" value="$store_storeidentifier" checked class="no-border"> </td>


          <td width="40%" class="top right" valign="top">
            <table border="0" width="100%" cellspacing="0" cellpadding="4">
              <tr>
              
              
                <td width="100%" class="blue-txta"><b>$store_name</b><br>
                  $store_address <br>
                  $store_city, $store_province<br>
                  $store_postal</td>
              </tr>
              <tr>
                <td width="100%" class="blue-txta"><b>Store ID: </b> $store_storeidentifier</td>
              </tr>
              <tr>
                <td class="blue-txta"><a href="#"><img border="0" src="$staticimages_http_prefix/but-map.gif" width="69" height="33"><img border="0" src="$staticimages_http_prefix/but-flyer.gif" width="71" height="33"></a></td>
              </tr>
            </table>          </td>
          <td width="15%" class="top right blue-txtb" valign="top">
          <b>$store_phone</b>          </td>
          <td width="40%" class="top" valign="top">
            <table border="0" width="100%" cellspacing="0" cellpadding="4">
              <tr>
                <td width="100%" class="blue-txta"><b>
                
                $store_eventdesc{$store_eventdesc{<br />
<a href="$special_url">more...</a>}}{!$store_eventdesc{&nbsp;}}
                
                
                </td>
              </tr>
              
            </table>          </td>
</tr>
<</store>>