{AJAXCONTENT}
<div style="display:block;width:100%;align:center;background-color:#C6DEFF;padding-bottom:10px;">
	<table cellpadding="0" cellspacing="0" border="0"  width="800px" bgcolor="#FFFFFF" align="center"> 
	<tr>
		<td class="sleft" colspan="2" width="50%" align="center">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Upload&nbsp;Document:</td>
		<td colspan="2" width="50%" class ="m8" align="center" style="padding-left:15px;font-weight:bold;size:10px;" style="color:#FFFFFF">
		<!-- </form>  -->
		<form action="?module=citizen&action=cghsfile&nomenu=1" id="fileform" 
					name="fileform" target="upload_iframecghs" method="post" 
					 enctype="multipart/form-data">
			<input type="hidden" name="fileframe" value="true"/>
			<input type="file" name="file" id="file" style="width:700px" 
					onChange="jsUploadsd(this);" class="texts"/>
		</td>
	</tr>
	<tr>
		<td colspan="4" align="center" style="padding-bottom:15px;">
		<iframe name="upload_iframecghs" src="?module=citizen&action=cghsfile&nomenu=1"  
		frameborder="0" width="800px" height="400px" style="color:#FFFFFF" scrolling="yes"></iframe>
		</td>
	</tr>
	<tr bgcolor="#cccccc">
		<td	class="sleft" width="830px" colspan="4" height="30px" align="center"><FONT  size="2" COLOR="#000099"><B>CGHS / ECHS Photo Card</B></FONT></td>
	</tr>	
	<tr>
		<td colspan="4">
			<table cellspacing="4" cellpadding="4" border="0" align="center" colspan="4">
				<tr>
					<td class="m10" width="25%">Name:<font color="red">*</font></td>
					<td align="left" width="25%">
						<div id="intro86">
							<input class="texts" disabled="disabled" type="text" value="{GLOBALNAME}" style="width:150px;">
							<img src="{SKINS}images/Edit-icon1.png" align="top" title="Edit" width="20px" height="20px" onclick="document.getElementById('intro86').style.display = 'none';document.getElementById('intro87').style.display = 'block';document.theform.cghsname.focus();">
						</div>
						<div id="intro87" style="display:none;">
							<input class="texts" type="text" name="cghsname" value="{GLOBALNAME}" style="width:150px;">
						</div>
					</td>
				</tr>
				<tr>
					<td class="m10" width="25%">Address:</td>
					<td width="25%">
						<div id="intro88">
							<textarea class="texts" disabled="disabled" cols = "3" type="text" style="width:150px;">c/o {GLOBALCARE_OF},{GLOBALBUILDING},{GLOBALSTREET},{GLOBALLANDMARK},{GLOBALLOCALITY},{GLOBALVILLAGE},{GLOBALTOWN},{GLOBALCITY},{GLOBALDISTRICT},{GLOBALSTATE},Pincode-{GLOBALPINCODE},{GLOBALCOUNTRY}.</textarea>
							<img src="{SKINS}images/Edit-icon1.png" align="top" title="Edit" width="20px" height="20px" onclick="document.getElementById('intro88').style.display = 'none';document.getElementById('intro89').style.display = 'block';document.theform.cghsaddress.focus();">
						</div>
						<div id="intro89" style="display:none;">
							<textarea class="texts" name="cghsaddress" cols = "3" type="text" style="width:150px;">c/o {GLOBALCARE_OF},{GLOBALBUILDING},{GLOBALSTREET},{GLOBALLANDMARK},{GLOBALLOCALITY},{GLOBALVILLAGE},{GLOBALTOWN},{GLOBALCITY},{GLOBALDISTRICT},{GLOBALSTATE},Pincode-{GLOBALPINCODE},{GLOBALCOUNTRY}.</textarea>
						</div>
					</td>
				</tr>
				<tr>
					<td class="m10" width="25%">Card No:<font color="red">*</font></td>
					<td align="left" width="25%"><input class="texts" name="cghscardno" type="text" value="{CGHSCARDNO}" style="width:150px;"></td>
				</tr>
				
				<tr>
				   <td class="m10" width="25%">Validity Period:<font color="red">*</font></td>
				   <td width="25%"><input class="texts" name="cghsvalidity" type="text" id = "datepicker18"  value="{CGHSVALIDITY}" style="width:150px;"></td>
				</tr>
				<tr>
					<td colspan="4" align="center" style="padding-bottom:15px;"><input type="button" value="submit" onclick="return formCheck(theform);"></td>
				</tr>
				<input type="hidden" name="pancardid" value="{PANCARDID}">
				<input type="hidden" name="documentid" value="{DOCUMENTID}">
			</table>
		</td>
	</tr>
</table>
<script>

function jsUploadsd(upload_field) {
		// this is just an example of checking file extensions
		// if you do not need extension checking, remove 
		// everything down to line
		// upload_field.form.submit();
		//var re_text = /\.txt|\.xml|\.zip/i;
		var re_text = /\.jpg|\.jpeg/i;
		var filename = upload_field.value;

		//  Checking file type
		/*if (filename.search(re_text) == -1) {
			alert("File does not have text(jpg, jpeg) extension");
		upload_field.form.reset();
		return false;
		}*/

		//alert("calling");
		//document.getElementById('upload_status').value = "uploading file...";
		// upload_field.disabled = true;
		upload_field.form.submit();
	}

	function formCheck(theform) {
	//alert("sudha");

	if(!validRequired(theform.cghsname,"Name"))
	return false;

	if(!validRequired(theform.cghscardno,"Card No"))
	return false;

	if(!validRequired(theform.cghsvalidity,"Validity Period"))
	return false;

	savedoc();
	return false;
}

$(function() {
	$('#datepicker18').datepicker({
		changeMonth: true,
		changeYear: true
	});
});

</script>