<!--#include virtual ="/script/StripHTML.asp" -->
<%
sub showemail()
action = Server.URLEncode(StripHTML(TRIM(Request.QueryString("action"))))
Response.Write "<div class=""subheader""><strong>" & UCASE(SubSectTitle) & "</strong></div>"
if action = "" then
errmsg = StripHTML(TRIM(Request.Querystring("errmsg")))
if errmsg = "1" then
PrintMe = "<strong style='color:red;'>You are not allowed to insert those characters!</strong>"
end if
%>
<!-- email a patient form -->
<p>some description here</p>
<% if PrintMe <> "" then %><div style="padding:10px 0 10px 0;"><%=PrintMe %></div><% end if %>
<div align="center">
<form method="post" action="/eservices/sendemail.asp" name="EmailPatients" id="EmailPatients" class="cmxform">
<fieldset>
<div class="itemheader"><strong>MESSAGE DETAILS</strong></div>
<div class="emailwrapper">
<label for="sender_name" class="styleme"><span style="color: #ff0000">*</span> <strong>Your Name

/strong></label>
<div class="fieldme"><input type="text" name="sender_name" size="40" maxlength="50" class="forms" /></div>
</div>
<div class="emailwrapper">
<label for="fromWho" class="styleme"><span style="color: #ff0000">*</span> <strong>Your Email Address

/strong></label>
<div class="fieldme"><input type="text" name="fromWho" size="25" maxlength="20" class="forms" /></div>
</div>
<div class="emailwrapper">
<label for="patient" class="styleme"><span style="color: #ff0000">*</span> <strong>Patient´s Name

/strong></label>
<div class="fieldme"><input type="text" name="patient" size="40" maxlength="50" class="forms" /></div>
</div>
<div class="emailwrapper">
<label for="room" class="styleme"><strong>Patient´s room number

/strong></label>
<div class="fieldme"><input type="text" name="room" size="10" maxlength="10" class="forms" style="width:75px;" /></div>
</div>
<div class="emailwrapper">
<label for="comments" class="styleme">
<span style="color: #ff0000">*</span> <strong>Your Message

/strong>
</label>
<div class="fieldme">
<textarea name="comments" rows="8" cols="50" class="forms" onKeyDown="textCounter(this.form.comments,this.form.details,300);" onKeyUp="textCounter(this.form.comments,this.form.details,300);"></textarea> <br />
<input readonly type="text" name="details" size="3" maxlength="3" value="300" class="forms" style="width:30px" /> Max. number of characters
<label style="display:none;" for="comments" class="warning" style="float:left;">Required</label>
</div>
</div>
<!-- ecard selection -->
<div class="ecardform">
<label for="ecard" class="styleme"><span style="color: #ff0000">*</span><strong>Tick the circle to choose an ecard template. Click image for preview.</strong></label><br /><br />
<div align="center">
<input type="radio" name="radio" id="temp1" value="temp1" />
<a href="images/ecard/jpeg/temp1.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp1.jpg" /></a>
<input type="radio" name="radio" id="temp2" value="temp2" />
<a href="images/ecard/jpeg/temp2.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp2.jpg" /></a>
<input type="radio" name="radio" id="temp3" value="temp3" />
<a href="images/ecard/jpeg/temp3.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp3.jpg" /></a><br /><br />
<input type="radio" name="radio" id="temp4" value="temp4" />
<a href="images/ecard/jpeg/temp4.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp4.jpg" /></a>
<input type="radio" name="radio" id="temp5" value="temp5" />
<a href="images/ecard/jpeg/temp5.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp5.jpg" /></a>
<input type="radio" name="radio" id="temp6" value="temp6" />
<a href="images/ecard/jpeg/temp6.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp6.jpg" /></a><br /><br />
<input type="radio" name="radio" id="temp7" value="temp7" />
<a href="images/ecard/jpeg/temp7.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp7.jpg" /></a>
<input type="radio" name="radio" id="temp8" value="temp8" />
<a href="images/ecard/jpeg/temp8.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp8.jpg" /></a>
<input type="radio" name="radio" id="temp9" value="temp9" />
<a href="images/ecard/jpeg/temp9.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp9.jpg" /></a><br /><br />
<input type="radio" name="radio" id="temp10" value="temp10" />
<a href="images/ecard/jpeg/temp10.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp10.jpg" /></a>
<input type="radio" name="radio" id="temp11" value="temp11" />
<a href="images/ecard/jpeg/temp11.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp11.jpg" /></a>
<input type="radio" name="radio" id="temp12" value="temp12" />
<a href="images/ecard/jpeg/temp12.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp12.jpg" /></a><br /><br />
<input type="radio" name="radio" id="temp13" value="temp13" />
<a href="images/ecard/jpeg/temp13.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp13.jpg" /></a>
<input type="radio" name="radio" id="temp14" value="temp14" />
<a href="images/ecard/jpeg/temp14.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp14.jpg" /></a>
<input type="radio" name="radio" id="temp15" value="temp15" />
<a href="images/ecard/jpeg/temp15.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp15.jpg" /></a><br /><br />
<input type="radio" name="radio" id="temp16" value="temp16" />
<a href="jpeg/temp16.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp16.jpg" /></a>
<input type="radio" name="radio" id="temp17" value="temp17" />
<a href="images/ecard/jpeg/temp17.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp17.jpg" /></a>
<input type="radio" name="radio" id="temp18" value="temp18" />
<a href="images/ecard/jpeg/temp18.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp18.jpg" /></a><br /><br />
<input type="radio" name="radio" id="temp19" value="temp19" />
<a href="images/ecard/jpeg/temp19.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp19.jpg" /></a>
<input type="radio" name="radio" id="temp20" value="temp20" />
<a href="images/ecard/jpeg/temp20.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp20.jpg" /></a>
<input type="radio" name="radio" id="temp21" value="temp21" />
<a href="images/ecard/jpeg/temp21.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp21.jpg" /></a><br /><br />
<input type="radio" name="radio" id="temp22" value="temp22" />
<a href="images/ecard/jpeg/temp22.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp22.jpg" /></a>
<input type="radio" name="radio" id="temp23" value="temp23" />
<a href="images/ecard/jpeg/temp23.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp23.jpg" /></a>
<input type="radio" name="radio" id="temp24" value="temp24" />
<a href="images/ecard/jpeg/temp24.jpg" rel="shadowbox"><img src="images/ecard/thumb/temp24.jpg" /></a>
</div>
<br /><br />
<div class="itemheader"><strong>VERIFICATION CODE</strong></div>
<div class="emailwrapper" style="text-align:left;">
<p>By entering the code you see below, you help us prevent automated programs from using this service. This ensures better performance for delivering messages and greetings to patients. Please type the code the way it appears or else an error will occur.</p>
</div>
<div class="emailwrapper">
<label for="VerifyMe" class="styleme"><span style="color: #ff0000">*</span> <strong>Enter the code shown

/strong></label>
<div class="fieldme">
<div style="float:left; width:120px;"><input type="text" name="verifycode" maxlength="6" class="verifyme" /></div>
<div style="background:url('/helpers/vercode/bg.gif'); width:40%; float:left; text-align:center;">
<%
For intWriteDigitLoopCount = 1 to Len(randnum)
'Display the graphical hit count
Response.Write("<img src=""/helpers/vercode/")
Response.Write(Mid(randnum, intWriteDigitLoopCount, 1) & ".gif""")
Response.Write("alt=""" & Mid(randnum, intWriteDigitLoopCount, 1) & """>")
Next
%>
</div>
<input type="hidden" id="generatedcode" name="generatedcode" value="<%=randnum%>" />
</div>
</div>
<div align="right" style="padding:5px;">
<input type="submit" name="MySend" value="send email" class="button" style="width:75px;" />
<input type="reset" name="reset" value="clear" class="button" style="width:50px;" />
</div>
</fieldset>
</form>
</div>
<p style="margin-top:20px"><a name="details"></a><b>Email a Patient Details</b><br />
<p>Please note the service is setup only to receive messages. We cannot send outgoing replies. We respect message confidentiality. If you are going to be a patient and would like information on how your loved ones and friends can email you, read our <a href="#" id="create-user">Patient Q&A</a>.</p>
<!-- end of email a patient form -->
<div id="dialog" title="EMAIL A PATIENT - Q & A"><!-- #include virtual = "/dox/emailpatientQA.asp" --></div>
<% else %>
<p><strong>YOU HAVE SENT AN EMAIL TO A PATIENT</strong></p>
<p>Thank you for using "Email a Patient" to send a greeting to a friend or family member who may be a patient in our hospital.</p>
<%
end if
end sub
%>
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