{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=apr3file&nomenu=1" id="fileform" 
					name="fileform" target="upload_iframeapr3" 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_iframeapr3" src="?module=citizen&action=apr3file&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>Central Government Health Scheme<br/>Check List for Reimbursement of Medical Claims</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%">CGHS Token No.:<font color="red">*</font></td>
					<td width="25%"><input class="texts" name="apr3empcode" type="text" value="{APR3EMPCODE}" style="width:150px;"></td>
					<td class="m10" width="25%">Place of issue:<font color="red">*</font></td>
					<td width="25%"><input class="texts" name="apr3empcode" type="text" value="{APR3EMPCODE}" style="width:150px;"></td>
				</tr>
				<tr>
					<td class="m10" colspan="2">Validity of CGH Card (For pensioners)& Entitlement:</td>
					<td colspan="2">From:&nbsp;<input class="texts" name="apr3empcode" id = "datepicker1" type="text" value="{APR3EMPCODE}" style="width:150px;">&nbsp;To:&nbsp;<input class="texts" name="apr3empcode" id = "datepicker2" type="text" value="{APR3EMPCODE}" style="width:150px;"></td>
				</tr>
			    <tr>
					<td class="m10" width="25%">Name of the Card Holder:</td>
					<td width="25%">
						<div id="intro20">
							<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('intro20').style.display = 'none';document.getElementById('intro21').style.display = 'block';document.theform.apr3name.focus();">
						</div>
						<div id="intro21" style="display:none;">
							<input class="texts" type="text" name="apr3name" value="{GLOBALNAME}" style="width:150px;">
						</div>
					</td>
					<td class="m10" width="25%">Status</td>
					<td width="25%"><select name="" type="text" value="" style="width:150px;">
					<option value="">--- Select One ---</option>
					<option value="G">Govt. Servant</option>
					<option value="P">Pensioner</option>
					<option value="O">Other</option>
					</select></td>
				</tr>
				<!-- <tr>
					<td class="m10" width="25%">Employee Code<br>Number:<font color="red">*</font></td>
					<td width="25%"><input class="texts" name="apr3empcode" type="text" value="{APR3EMPCODE}" style="width:150px;"></td>
				</tr> 
				<tr>
					<td class="m10" width="25%">Date of joining:</td>
					<td width="25%"><input class="texts" name="apr3joindt" type="text" value="{APR3JOINDT}" id = "datepicker3" style="width:150px;"></td>
				</tr> 
				<tr>
					<td class="m10" width="25%">Basic pay Rs. per month:</td>
					<td width="25%"><input class="texts" name="apr3pay" type="text" value="{APR3PAY}" 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="apr3id" value="{APR3ID}">
				<input type="hidden" name="documentid" value="{DOCUMENTID}">
				<input type="hidden" name="ref"  value="0"/>		
			</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.apr3name,"Name"))
    return false;

	if(!validRequired(theform.apr3empcode,"Employee Code Number"))
    return false;

	saveapr3();
	return false;
}

$(function() {
	$('#datepicker1').datepicker({
		changeMonth: true,
		changeYear: true
	});
});

$(function() {
	$('#datepicker2').datepicker({
		changeMonth: true,
		changeYear: true
	});
});

function add(idname){
//alert(document.theform.cons.value);
		var	loopval = "";
		loopval = document.theform.ref.value;

		if(loopval >= 0 && loopval < 20){
			document.theform.ref.value = ++loopval;
		}

		 var s = "";
		 for(var i=1;i<=loopval;i++){
			s = document.getElementById(idname+i);
			s.style.display = "";
		 }
			
	}

function add2(idname){
	var loopval = "";
	loopval = document.theform.further.value;

	if(loopval >= 0 && loopval < 20){
		document.theform.further.value = ++loopval;
	}

	var s = "";
	for(var i=1;i<=loopval;i++){
		s = document.getElementById(idname+i);
		s.style.display = "";
	}
}

function remove(idname){		
		 var	loopval = "";

		 if(idname == "ref")
			loopval = document.theform.ref.value;
		 else if(idname == "cons")
			loopval = document.theform.cons.value;
		 else
			loopval = document.theform.further.value;

			
		 if(loopval >=1 && loopval <=20){			
			var s = document.getElementById(idname+loopval);
			s.style.display = "none";
			if(idname == "ref")
				document.theform.ref.value = --loopval;
			else if(idname == "cons")
				document.theform.cons.value = --loopval;
			else
				document.theform.further.value = --loopval;
		}
	}

</script>