<%' FP_ASP ASP Automatically generated by a FrontPage Component. Do not Edit.

On Error Resume Next
Session("FP_OldCodePage") = Session.CodePage
Session("FP_OldLCID") = Session.LCID
Session.CodePage = 1252
Session.LCID = 1033
Err.Clear

strErrorUrl = ""

If Request.ServerVariables("REQUEST_METHOD") = "POST" Then
If Request.Form("VTI-GROUP") = "0" Then
	Err.Clear

	Set fp_conn =  Server.CreateObject("ADODB.Connection")
	FP_DumpError strErrorUrl, "Cannot create connection"

	Set fp_rs = Server.CreateObject("ADODB.Recordset")
	FP_DumpError strErrorUrl, "Cannot create record set"

	fp_conn.Open Application("newsouth_rx_form_ConnectionString")
	FP_DumpError strErrorUrl, "Cannot open database"

	fp_rs.Open "Results", fp_conn, 1, 3, 2 ' adOpenKeySet, adLockOptimistic, adCmdTable
	FP_DumpError strErrorUrl, "Cannot open record set"

	fp_rs.AddNew
	FP_DumpError strErrorUrl, "Cannot add new record set to the database"
	Dim arFormFields0(43)
	Dim arFormDBFields0(43)
	Dim arFormValues0(43)

	arFormFields0(0) = "patient_name_first"
	arFormDBFields0(0) = "patient_name_first"
	arFormValues0(0) = Request("patient_name_first")
	arFormFields0(1) = "uncut_shapes"
	arFormDBFields0(1) = "uncut_shapes"
	arFormValues0(1) = Request("uncut_shapes")
	arFormFields0(2) = "frame_eye_size"
	arFormDBFields0(2) = "frame_eye_size"
	arFormValues0(2) = Request("frame_eye_size")
	arFormFields0(3) = "specify_tint_percentate_or_sample_to_come"
	arFormDBFields0(3) = "specify_tint_percentate_or_sample_to_come"
	arFormValues0(3) = Request("specify_tint_percentate_or_sample_to_come")
	arFormFields0(4) = "special_instructions"
	arFormDBFields0(4) = "special_instructions"
	arFormValues0(4) = Request("special_instructions")
	arFormFields0(5) = "progressive_mgf_style"
	arFormDBFields0(5) = "progressive_mgf_style"
	arFormValues0(5) = Request("progressive_mgf_style")
	arFormFields0(6) = "other_coat_specify"
	arFormDBFields0(6) = "other_coat_specify"
	arFormValues0(6) = Request("other_coat_specify")
	arFormFields0(7) = "left_eye_add"
	arFormDBFields0(7) = "left_eye_add"
	arFormValues0(7) = Request("left_eye_add")
	arFormFields0(8) = "lens_color0"
	arFormDBFields0(8) = "lens_color0"
	arFormValues0(8) = Request("lens_color0")
	arFormFields0(9) = "lens_style"
	arFormDBFields0(9) = "lens_style"
	arFormValues0(9) = Request("lens_style")
	arFormFields0(10) = "rteye_oc_ht"
	arFormDBFields0(10) = "rteye_oc_ht"
	arFormValues0(10) = Request("rteye_oc_ht")
	arFormFields0(11) = "lefteye_prismdirection"
	arFormDBFields0(11) = "lefteye_prismdirection"
	arFormValues0(11) = Request("lefteye_prismdirection")
	arFormFields0(12) = "account_number"
	arFormDBFields0(12) = "account_number"
	arFormValues0(12) = Request("account_number")
	arFormFields0(13) = "frame_name"
	arFormDBFields0(13) = "frame_name"
	arFormValues0(13) = Request("frame_name")
	arFormFields0(14) = "date_wanted"
	arFormDBFields0(14) = "date_wanted"
	arFormValues0(14) = Request("date_wanted")
	arFormFields0(15) = "edged_uncut"
	arFormDBFields0(15) = "edged_uncut"
	arFormValues0(15) = Request("edged_uncut")
	arFormFields0(16) = "lens_cm"
	arFormDBFields0(16) = "lens_cm"
	arFormValues0(16) = Request("lens_cm")
	arFormFields0(17) = "rt_eye_sght"
	arFormDBFields0(17) = "rt_eye_sght"
	arFormValues0(17) = Request("rt_eye_sght")
	arFormFields0(18) = "frame_mfg"
	arFormDBFields0(18) = "frame_mfg"
	arFormValues0(18) = Request("frame_mfg")
	arFormFields0(19) = "frame_dbl"
	arFormDBFields0(19) = "frame_dbl"
	arFormValues0(19) = Request("frame_dbl")
	arFormFields0(20) = "rteye_sphere"
	arFormDBFields0(20) = "rteye_sphere"
	arFormValues0(20) = Request("rteye_sphere")
	arFormFields0(21) = "rteye_axis"
	arFormDBFields0(21) = "rteye_axis"
	arFormValues0(21) = Request("rteye_axis")
	arFormFields0(22) = "lefteye_pd"
	arFormDBFields0(22) = "lefteye_pd"
	arFormValues0(22) = Request("lefteye_pd")
	arFormFields0(23) = "account_name"
	arFormDBFields0(23) = "account_name"
	arFormValues0(23) = Request("account_name")
	arFormFields0(24) = "patient_name_last"
	arFormDBFields0(24) = "patient_name_last"
	arFormValues0(24) = Request("patient_name_last")
	arFormFields0(25) = "lens_material"
	arFormDBFields0(25) = "lens_material"
	arFormValues0(25) = Request("lens_material")
	arFormFields0(26) = "rteye_pd"
	arFormDBFields0(26) = "rteye_pd"
	arFormValues0(26) = Request("rteye_pd")
	arFormFields0(27) = "lefteye_prism"
	arFormDBFields0(27) = "lefteye_prism"
	arFormValues0(27) = Request("lefteye_prism")
	arFormFields0(28) = "date_ordered"
	arFormDBFields0(28) = "date_ordered"
	arFormValues0(28) = Request("date_ordered")
	arFormFields0(29) = "ar_coat"
	arFormDBFields0(29) = "ar_coat"
	arFormValues0(29) = Request("ar_coat")
	arFormFields0(30) = "rteye_prism_direction"
	arFormDBFields0(30) = "rteye_prism_direction"
	arFormValues0(30) = Request("rteye_prism_direction")
	arFormFields0(31) = "hard_coat"
	arFormDBFields0(31) = "hard_coat"
	arFormValues0(31) = Request("hard_coat")
	arFormFields0(32) = "rteye_cyl"
	arFormDBFields0(32) = "rteye_cyl"
	arFormValues0(32) = Request("rteye_cyl")
	arFormFields0(33) = "lefteye_cyl"
	arFormDBFields0(33) = "lefteye_cyl"
	arFormValues0(33) = Request("lefteye_cyl")
	arFormFields0(34) = "lefteye_axis"
	arFormDBFields0(34) = "lefteye_axis"
	arFormValues0(34) = Request("lefteye_axis")
	arFormFields0(35) = "lefteye_sphere"
	arFormDBFields0(35) = "lefteye_sphere"
	arFormValues0(35) = Request("lefteye_sphere")
	arFormFields0(36) = "lefteye_ocht"
	arFormDBFields0(36) = "lefteye_ocht"
	arFormValues0(36) = Request("lefteye_ocht")
	arFormFields0(37) = "lefteye_sght"
	arFormDBFields0(37) = "lefteye_sght"
	arFormValues0(37) = Request("lefteye_sght")
	arFormFields0(38) = "frame_style"
	arFormDBFields0(38) = "frame_style"
	arFormValues0(38) = Request("frame_style")
	arFormFields0(39) = "temple"
	arFormDBFields0(39) = "temple"
	arFormValues0(39) = Request("temple")
	arFormFields0(40) = "rt_eye_add"
	arFormDBFields0(40) = "rt_eye_add"
	arFormValues0(40) = Request("rt_eye_add")
	arFormFields0(41) = "rteye_prism"
	arFormDBFields0(41) = "rteye_prism"
	arFormValues0(41) = Request("rteye_prism")
	arFormFields0(42) = "frame_color"
	arFormDBFields0(42) = "frame_color"
	arFormValues0(42) = Request("frame_color")

	FP_SaveFormFields fp_rs, arFormFields0, arFormDBFields0

	If Request.ServerVariables("REMOTE_HOST") <> "" Then
		FP_SaveFieldToDB fp_rs, Request.ServerVariables("REMOTE_HOST"), "Remote_computer_name"
	End If
	If Request.ServerVariables("HTTP_USER_AGENT") <> "" Then
		FP_SaveFieldToDB fp_rs, Request.ServerVariables("HTTP_USER_AGENT"), "Browser_type"
	End If
	FP_SaveFieldToDB fp_rs, Now, "Timestamp"
	If Request.ServerVariables("REMOTE_USER") <> "" Then
		FP_SaveFieldToDB fp_rs, Request.ServerVariables("REMOTE_USER"), "User_name"
	End If

	fp_rs.Update
	FP_DumpError strErrorUrl, "Cannot update the database"

	fp_rs.Close
	fp_conn.Close

	FP_FormConfirmation "text/html; charset=windows-1252",_
						"Form Confirmation",_
						"Thank you for submitting the following information:",_
						"newsouth_rx_form.htm",_
						"Return to the form."

End If
End If

Session.CodePage = Session("FP_OldCodePage")
Session.LCID = Session("FP_OldLCID")

%>
<html>

<head>
<meta http-equiv="Content-Language" content="en-us">
<meta http-equiv="Content-Type" content="text/html; charset=windows-1252">
<title>RX</title>
</head>

<body bgcolor="#FFE1C4">

<!--webbot BOT="GeneratedScript" PREVIEW=" " startspan --><script Language="JavaScript" Type="text/javascript"><!--
function FrontPage_Form1_Validator(theForm)
{

  if (theForm.account_name.value == "")
  {
    alert("Please enter a value for the \"Account Name\" field.");
    theForm.account_name.focus();
    return (false);
  }

  if (theForm.account_name.value.length < 3)
  {
    alert("Please enter at least 3 characters in the \"Account Name\" field.");
    theForm.account_name.focus();
    return (false);
  }

  if (theForm.account_name.value.length > 20)
  {
    alert("Please enter at most 20 characters in the \"Account Name\" field.");
    theForm.account_name.focus();
    return (false);
  }

  if (theForm.account_number.value == "")
  {
    alert("Please enter a value for the \"acct_number\" field.");
    theForm.account_number.focus();
    return (false);
  }

  if (theForm.account_number.value.length < 3)
  {
    alert("Please enter at least 3 characters in the \"acct_number\" field.");
    theForm.account_number.focus();
    return (false);
  }

  if (theForm.account_number.value.length > 7)
  {
    alert("Please enter at most 7 characters in the \"acct_number\" field.");
    theForm.account_number.focus();
    return (false);
  }

  var checkOK = "0123456789-.";
  var checkStr = theForm.account_number.value;
  var allValid = true;
  var validGroups = true;
  var decPoints = 0;
  var allNum = "";
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    if (ch == ".")
    {
      allNum += ".";
      decPoints++;
    }
    else
      allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"acct_number\" field.");
    theForm.account_number.focus();
    return (false);
  }

  if (decPoints > 1 || !validGroups)
  {
    alert("Please enter a valid number in the \"account_number\" field.");
    theForm.account_number.focus();
    return (false);
  }

  if (theForm.patient_name_last.value == "")
  {
    alert("Please enter a value for the \"patient_name_last\" field.");
    theForm.patient_name_last.focus();
    return (false);
  }

  if (theForm.patient_name_last.value.length < 2)
  {
    alert("Please enter at least 2 characters in the \"patient_name_last\" field.");
    theForm.patient_name_last.focus();
    return (false);
  }

  if (theForm.patient_name_last.value.length > 15)
  {
    alert("Please enter at most 15 characters in the \"patient_name_last\" field.");
    theForm.patient_name_last.focus();
    return (false);
  }

  if (theForm.edged_uncut.selectedIndex < 0)
  {
    alert("Please select one of the \"UNCUT/EDGED\" options.");
    theForm.edged_uncut.focus();
    return (false);
  }

  if (theForm.edged_uncut.selectedIndex == 0)
  {
    alert("The first \"UNCUT/EDGED\" option is not a valid selection.  Please choose one of the other options.");
    theForm.edged_uncut.focus();
    return (false);
  }

  var checkOK = "0123456789-.";
  var checkStr = theForm.lens_cm.value;
  var allValid = true;
  var validGroups = true;
  var decPoints = 0;
  var allNum = "";
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    if (ch == ".")
    {
      allNum += ".";
      decPoints++;
    }
    else
      allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"lens_cm\" field.");
    theForm.lens_cm.focus();
    return (false);
  }

  if (decPoints > 1 || !validGroups)
  {
    alert("Please enter a valid number in the \"lens_cm\" field.");
    theForm.lens_cm.focus();
    return (false);
  }

  if (theForm.lens_style.selectedIndex < 0)
  {
    alert("Please select one of the \"LENS STYLE\" options.");
    theForm.lens_style.focus();
    return (false);
  }

  if (theForm.lens_style.selectedIndex == 0)
  {
    alert("The first \"LENS STYLE\" option is not a valid selection.  Please choose one of the other options.");
    theForm.lens_style.focus();
    return (false);
  }

  if (theForm.lens_material.selectedIndex < 0)
  {
    alert("Please select one of the \"LENS MATERIAL\" options.");
    theForm.lens_material.focus();
    return (false);
  }

  if (theForm.lens_material.selectedIndex == 0)
  {
    alert("The first \"LENS MATERIAL\" option is not a valid selection.  Please choose one of the other options.");
    theForm.lens_material.focus();
    return (false);
  }

  if (theForm.lens_color0.selectedIndex < 0)
  {
    alert("Please select one of the \"LENS COLOR\" options.");
    theForm.lens_color0.focus();
    return (false);
  }

  if (theForm.lens_color0.selectedIndex == 0)
  {
    alert("The first \"LENS COLOR\" option is not a valid selection.  Please choose one of the other options.");
    theForm.lens_color0.focus();
    return (false);
  }

  if (theForm.hard_coat.selectedIndex < 0)
  {
    alert("Please select one of the \"HARD COAT\" options.");
    theForm.hard_coat.focus();
    return (false);
  }

  if (theForm.hard_coat.selectedIndex == 0)
  {
    alert("The first \"HARD COAT\" option is not a valid selection.  Please choose one of the other options.");
    theForm.hard_coat.focus();
    return (false);
  }

  if (theForm.ar_coat.selectedIndex < 0)
  {
    alert("Please select one of the \"AR COAT\" options.");
    theForm.ar_coat.focus();
    return (false);
  }

  if (theForm.ar_coat.selectedIndex == 0)
  {
    alert("The first \"AR COAT\" option is not a valid selection.  Please choose one of the other options.");
    theForm.ar_coat.focus();
    return (false);
  }

  if (theForm.rteye_sphere.value == "")
  {
    alert("Please enter a value for the \"rteye_sphere\" field.");
    theForm.rteye_sphere.focus();
    return (false);
  }

  if (theForm.rteye_sphere.value.length < 4)
  {
    alert("Please enter at least 4 characters in the \"rteye_sphere\" field.");
    theForm.rteye_sphere.focus();
    return (false);
  }

  if (theForm.rteye_sphere.value.length > 7)
  {
    alert("Please enter at most 7 characters in the \"rteye_sphere\" field.");
    theForm.rteye_sphere.focus();
    return (false);
  }

  var checkOK = "0123456789-.";
  var checkStr = theForm.rteye_sphere.value;
  var allValid = true;
  var validGroups = true;
  var decPoints = 0;
  var allNum = "";
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    if (ch == ".")
    {
      allNum += ".";
      decPoints++;
    }
    else
      allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"rteye_sphere\" field.");
    theForm.rteye_sphere.focus();
    return (false);
  }

  if (decPoints > 1 || !validGroups)
  {
    alert("Please enter a valid number in the \"rteye_sphere\" field.");
    theForm.rteye_sphere.focus();
    return (false);
  }

  var chkVal = allNum;
  var prsVal = parseFloat(allNum);
  if (chkVal != "" && !(prsVal >= -20.00 && prsVal <= +20.00))
  {
    alert("Please enter a value greater than or equal to \"-20.00\" and less than or equal to \"+20.00\" in the \"rteye_sphere\" field.");
    theForm.rteye_sphere.focus();
    return (false);
  }

  if (theForm.rteye_cyl.value == "")
  {
    alert("Please enter a value for the \"rteye_cyl\" field.");
    theForm.rteye_cyl.focus();
    return (false);
  }

  if (theForm.rteye_cyl.value.length < 4)
  {
    alert("Please enter at least 4 characters in the \"rteye_cyl\" field.");
    theForm.rteye_cyl.focus();
    return (false);
  }

  if (theForm.rteye_cyl.value.length > 8)
  {
    alert("Please enter at most 8 characters in the \"rteye_cyl\" field.");
    theForm.rteye_cyl.focus();
    return (false);
  }

  var checkOK = "0123456789-.";
  var checkStr = theForm.rteye_cyl.value;
  var allValid = true;
  var validGroups = true;
  var decPoints = 0;
  var allNum = "";
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    if (ch == ".")
    {
      allNum += ".";
      decPoints++;
    }
    else
      allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"rteye_cyl\" field.");
    theForm.rteye_cyl.focus();
    return (false);
  }

  if (decPoints > 1 || !validGroups)
  {
    alert("Please enter a valid number in the \"rteye_cyl\" field.");
    theForm.rteye_cyl.focus();
    return (false);
  }

  var chkVal = allNum;
  var prsVal = parseFloat(allNum);
  if (chkVal != "" && !(prsVal >= -10.00 && prsVal <= +10.00))
  {
    alert("Please enter a value greater than or equal to \"-10.00\" and less than or equal to \"+10.00\" in the \"rteye_cyl\" field.");
    theForm.rteye_cyl.focus();
    return (false);
  }

  if (theForm.rteye_axis.value == "")
  {
    alert("Please enter a value for the \"rteye_axis\" field.");
    theForm.rteye_axis.focus();
    return (false);
  }

  if (theForm.rteye_axis.value.length < 1)
  {
    alert("Please enter at least 1 characters in the \"rteye_axis\" field.");
    theForm.rteye_axis.focus();
    return (false);
  }

  if (theForm.rteye_axis.value.length > 3)
  {
    alert("Please enter at most 3 characters in the \"rteye_axis\" field.");
    theForm.rteye_axis.focus();
    return (false);
  }

  var checkOK = "0123456789-.,";
  var checkStr = theForm.rteye_axis.value;
  var allValid = true;
  var validGroups = true;
  var decPoints = 0;
  var allNum = "";
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    if (ch == ".")
    {
      allNum += ".";
      decPoints++;
    }
    else if (ch == "," && decPoints != 0)
    {
      validGroups = false;
      break;
    }
    else if (ch != ",")
      allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"rteye_axis\" field.");
    theForm.rteye_axis.focus();
    return (false);
  }

  if (decPoints > 1 || !validGroups)
  {
    alert("Please enter a valid number in the \"rteye_axis\" field.");
    theForm.rteye_axis.focus();
    return (false);
  }

  var chkVal = allNum;
  var prsVal = parseFloat(allNum);
  if (chkVal != "" && !(prsVal >= 0 && prsVal <= 180))
  {
    alert("Please enter a value greater than or equal to \"0\" and less than or equal to \"180\" in the \"rteye_axis\" field.");
    theForm.rteye_axis.focus();
    return (false);
  }

  var checkOK = "0123456789-.";
  var checkStr = theForm.rteye_pd.value;
  var allValid = true;
  var validGroups = true;
  var decPoints = 0;
  var allNum = "";
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    if (ch == ".")
    {
      allNum += ".";
      decPoints++;
    }
    else
      allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"rteye_pd\" field.");
    theForm.rteye_pd.focus();
    return (false);
  }

  if (decPoints > 1 || !validGroups)
  {
    alert("Please enter a valid number in the \"rteye_pd\" field.");
    theForm.rteye_pd.focus();
    return (false);
  }

  var chkVal = allNum;
  var prsVal = parseFloat(allNum);
  if (chkVal != "" && !(prsVal >= 20 && prsVal <= 80))
  {
    alert("Please enter a value greater than or equal to \"20\" and less than or equal to \"80\" in the \"rteye_pd\" field.");
    theForm.rteye_pd.focus();
    return (false);
  }

  if (theForm.rt_eye_sght.value == "")
  {
    alert("Please enter a value for the \"rt_eye_sght\" field.");
    theForm.rt_eye_sght.focus();
    return (false);
  }

  if (theForm.rt_eye_sght.value.length < 1)
  {
    alert("Please enter at least 1 characters in the \"rt_eye_sght\" field.");
    theForm.rt_eye_sght.focus();
    return (false);
  }

  if (theForm.rt_eye_sght.value.length > 4)
  {
    alert("Please enter at most 4 characters in the \"rt_eye_sght\" field.");
    theForm.rt_eye_sght.focus();
    return (false);
  }

  var checkOK = "0123456789-.";
  var checkStr = theForm.rt_eye_sght.value;
  var allValid = true;
  var validGroups = true;
  var decPoints = 0;
  var allNum = "";
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    if (ch == ".")
    {
      allNum += ".";
      decPoints++;
    }
    else
      allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"rt_eye_sght\" field.");
    theForm.rt_eye_sght.focus();
    return (false);
  }

  if (decPoints > 1 || !validGroups)
  {
    alert("Please enter a valid number in the \"rt_eye_sght\" field.");
    theForm.rt_eye_sght.focus();
    return (false);
  }

  var chkVal = allNum;
  var prsVal = parseFloat(allNum);
  if (chkVal != "" && !(prsVal >= 0 && prsVal <= 33))
  {
    alert("Please enter a value greater than or equal to \"0\" and less than or equal to \"33\" in the \"rt_eye_sght\" field.");
    theForm.rt_eye_sght.focus();
    return (false);
  }

  var checkOK = "0123456789-.";
  var checkStr = theForm.rt_eye_add.value;
  var allValid = true;
  var validGroups = true;
  var decPoints = 0;
  var allNum = "";
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    if (ch == ".")
    {
      allNum += ".";
      decPoints++;
    }
    else
      allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"rt_eye_add\" field.");
    theForm.rt_eye_add.focus();
    return (false);
  }

  if (decPoints > 1 || !validGroups)
  {
    alert("Please enter a valid number in the \"rt_eye_add\" field.");
    theForm.rt_eye_add.focus();
    return (false);
  }

  var chkVal = allNum;
  var prsVal = parseFloat(allNum);
  if (chkVal != "" && !(prsVal >= 0.00 && prsVal <= 6.00))
  {
    alert("Please enter a value greater than or equal to \"0.00\" and less than or equal to \"6.00\" in the \"rt_eye_add\" field.");
    theForm.rt_eye_add.focus();
    return (false);
  }

  if (theForm.lefteye_sphere.value == "")
  {
    alert("Please enter a value for the \"lefteye_sphere\" field.");
    theForm.lefteye_sphere.focus();
    return (false);
  }

  if (theForm.lefteye_sphere.value.length < 1)
  {
    alert("Please enter at least 1 characters in the \"lefteye_sphere\" field.");
    theForm.lefteye_sphere.focus();
    return (false);
  }

  if (theForm.lefteye_sphere.value.length > 8)
  {
    alert("Please enter at most 8 characters in the \"lefteye_sphere\" field.");
    theForm.lefteye_sphere.focus();
    return (false);
  }

  var checkOK = "0123456789-.";
  var checkStr = theForm.lefteye_sphere.value;
  var allValid = true;
  var validGroups = true;
  var decPoints = 0;
  var allNum = "";
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    if (ch == ".")
    {
      allNum += ".";
      decPoints++;
    }
    else
      allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"lefteye_sphere\" field.");
    theForm.lefteye_sphere.focus();
    return (false);
  }

  if (decPoints > 1 || !validGroups)
  {
    alert("Please enter a valid number in the \"lefteye_sphere\" field.");
    theForm.lefteye_sphere.focus();
    return (false);
  }

  var chkVal = allNum;
  var prsVal = parseFloat(allNum);
  if (chkVal != "" && !(prsVal >= -20.00 && prsVal <= +20.00))
  {
    alert("Please enter a value greater than or equal to \"-20.00\" and less than or equal to \"+20.00\" in the \"lefteye_sphere\" field.");
    theForm.lefteye_sphere.focus();
    return (false);
  }

  if (theForm.lefteye_cyl.value == "")
  {
    alert("Please enter a value for the \"lefteye_cyl\" field.");
    theForm.lefteye_cyl.focus();
    return (false);
  }

  if (theForm.lefteye_cyl.value.length < 1)
  {
    alert("Please enter at least 1 characters in the \"lefteye_cyl\" field.");
    theForm.lefteye_cyl.focus();
    return (false);
  }

  if (theForm.lefteye_cyl.value.length > 8)
  {
    alert("Please enter at most 8 characters in the \"lefteye_cyl\" field.");
    theForm.lefteye_cyl.focus();
    return (false);
  }

  var checkOK = "0123456789-.";
  var checkStr = theForm.lefteye_cyl.value;
  var allValid = true;
  var validGroups = true;
  var decPoints = 0;
  var allNum = "";
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    if (ch == ".")
    {
      allNum += ".";
      decPoints++;
    }
    else
      allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"lefteye_cyl\" field.");
    theForm.lefteye_cyl.focus();
    return (false);
  }

  if (decPoints > 1 || !validGroups)
  {
    alert("Please enter a valid number in the \"lefteye_cyl\" field.");
    theForm.lefteye_cyl.focus();
    return (false);
  }

  var chkVal = allNum;
  var prsVal = parseFloat(allNum);
  if (chkVal != "" && !(prsVal >= -10.00 && prsVal <= +10.00))
  {
    alert("Please enter a value greater than or equal to \"-10.00\" and less than or equal to \"+10.00\" in the \"lefteye_cyl\" field.");
    theForm.lefteye_cyl.focus();
    return (false);
  }

  if (theForm.lefteye_axis.value == "")
  {
    alert("Please enter a value for the \"lefteye_axis\" field.");
    theForm.lefteye_axis.focus();
    return (false);
  }

  if (theForm.lefteye_axis.value.length < 1)
  {
    alert("Please enter at least 1 characters in the \"lefteye_axis\" field.");
    theForm.lefteye_axis.focus();
    return (false);
  }

  if (theForm.lefteye_axis.value.length > 3)
  {
    alert("Please enter at most 3 characters in the \"lefteye_axis\" field.");
    theForm.lefteye_axis.focus();
    return (false);
  }

  var checkOK = "0123456789-.";
  var checkStr = theForm.lefteye_axis.value;
  var allValid = true;
  var validGroups = true;
  var decPoints = 0;
  var allNum = "";
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    if (ch == ".")
    {
      allNum += ".";
      decPoints++;
    }
    else
      allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"lefteye_axis\" field.");
    theForm.lefteye_axis.focus();
    return (false);
  }

  if (decPoints > 1 || !validGroups)
  {
    alert("Please enter a valid number in the \"lefteye_axis\" field.");
    theForm.lefteye_axis.focus();
    return (false);
  }

  var chkVal = allNum;
  var prsVal = parseFloat(allNum);
  if (chkVal != "" && !(prsVal >= 0 && prsVal <= 180))
  {
    alert("Please enter a value greater than or equal to \"0\" and less than or equal to \"180\" in the \"lefteye_axis\" field.");
    theForm.lefteye_axis.focus();
    return (false);
  }

  var checkOK = "0123456789-.";
  var checkStr = theForm.lefteye_prism.value;
  var allValid = true;
  var validGroups = true;
  var decPoints = 0;
  var allNum = "";
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    if (ch == ".")
    {
      allNum += ".";
      decPoints++;
    }
    else
      allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"lefteye_prism\" field.");
    theForm.lefteye_prism.focus();
    return (false);
  }

  if (decPoints > 1 || !validGroups)
  {
    alert("Please enter a valid number in the \"lefteye_prism\" field.");
    theForm.lefteye_prism.focus();
    return (false);
  }

  var chkVal = allNum;
  var prsVal = parseFloat(allNum);
  if (chkVal != "" && !(prsVal >= 0 && prsVal <= 18))
  {
    alert("Please enter a value greater than or equal to \"0\" and less than or equal to \"18\" in the \"lefteye_prism\" field.");
    theForm.lefteye_prism.focus();
    return (false);
  }

  var checkOK = "0123456789-.,";
  var checkStr = theForm.lefteye_pd.value;
  var allValid = true;
  var validGroups = true;
  var decPoints = 0;
  var allNum = "";
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    if (ch == ".")
    {
      allNum += ".";
      decPoints++;
    }
    else if (ch == "," && decPoints != 0)
    {
      validGroups = false;
      break;
    }
    else if (ch != ",")
      allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"left eye pd\" field.");
    theForm.lefteye_pd.focus();
    return (false);
  }

  if (decPoints > 1 || !validGroups)
  {
    alert("Please enter a valid number in the \"lefteye_pd\" field.");
    theForm.lefteye_pd.focus();
    return (false);
  }

  if (theForm.lefteye_sght.value == "")
  {
    alert("Please enter a value for the \"left eye pd\" field.");
    theForm.lefteye_sght.focus();
    return (false);
  }

  if (theForm.lefteye_sght.value.length < 1)
  {
    alert("Please enter at least 1 characters in the \"left eye pd\" field.");
    theForm.lefteye_sght.focus();
    return (false);
  }

  var checkOK = "0123456789-.";
  var checkStr = theForm.lefteye_sght.value;
  var allValid = true;
  var validGroups = true;
  var decPoints = 0;
  var allNum = "";
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    if (ch == ".")
    {
      allNum += ".";
      decPoints++;
    }
    else
      allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"left eye pd\" field.");
    theForm.lefteye_sght.focus();
    return (false);
  }

  if (decPoints > 1 || !validGroups)
  {
    alert("Please enter a valid number in the \"lefteye_sght\" field.");
    theForm.lefteye_sght.focus();
    return (false);
  }

  var chkVal = allNum;
  var prsVal = parseFloat(allNum);
  if (chkVal != "" && !(prsVal >= 0 && prsVal <= 80))
  {
    alert("Please enter a value greater than or equal to \"0\" and less than or equal to \"80\" in the \"left eye pd\" field.");
    theForm.lefteye_sght.focus();
    return (false);
  }

  if (theForm.left_eye_add.value == "")
  {
    alert("Please enter a value for the \"left_eye_add\" field.");
    theForm.left_eye_add.focus();
    return (false);
  }

  if (theForm.left_eye_add.value.length < 1)
  {
    alert("Please enter at least 1 characters in the \"left_eye_add\" field.");
    theForm.left_eye_add.focus();
    return (false);
  }

  if (theForm.left_eye_add.value.length > 4)
  {
    alert("Please enter at most 4 characters in the \"left_eye_add\" field.");
    theForm.left_eye_add.focus();
    return (false);
  }

  var checkOK = "0123456789-.";
  var checkStr = theForm.left_eye_add.value;
  var allValid = true;
  var validGroups = true;
  var decPoints = 0;
  var allNum = "";
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    if (ch == ".")
    {
      allNum += ".";
      decPoints++;
    }
    else
      allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"left_eye_add\" field.");
    theForm.left_eye_add.focus();
    return (false);
  }

  if (decPoints > 1 || !validGroups)
  {
    alert("Please enter a valid number in the \"left_eye_add\" field.");
    theForm.left_eye_add.focus();
    return (false);
  }

  var chkVal = allNum;
  var prsVal = parseFloat(allNum);
  if (chkVal != "" && !(prsVal >= 0 && prsVal <= 6.00))
  {
    alert("Please enter a value greater than or equal to \"0\" and less than or equal to \"6.00\" in the \"left_eye_add\" field.");
    theForm.left_eye_add.focus();
    return (false);
  }

  if (theForm.frame_style.selectedIndex < 0)
  {
    alert("Please select one of the \"select_frame_style\" options.");
    theForm.frame_style.focus();
    return (false);
  }

  if (theForm.frame_style.selectedIndex == 0)
  {
    alert("The first \"select_frame_style\" option is not a valid selection.  Please choose one of the other options.");
    theForm.frame_style.focus();
    return (false);
  }
  return (true);
}
//--></script><!--webbot BOT="GeneratedScript" endspan --><form method="POST" action="_derived/nortbots.htm" onsubmit="location.href='_derived/nortbots.htm';return false;" language="JavaScript" name="FrontPage_Form1" webbot-onSubmit="return FrontPage_Form1_Validator(this)" webbot-action="--WEBBOT-SELF--">
	<!--webbot bot="SaveDatabase" startspan SuggestedExt="asp" S-DataConnection="newsouth_rx_form" S-RecordSource="Results" U-Database-URL="fpdb/newsouth_rx_form.mdb" S-Builtin-Fields="REMOTE_HOST HTTP_USER_AGENT Timestamp REMOTE_USER" S-Builtin-DBFields="Remote_computer_name Browser_type Timestamp User_name" S-Form-Fields="patient_name_first uncut_shapes frame_eye_size specify_tint_percentate_or_sample_to_come special_instructions progressive_mgf_style other_coat_specify left_eye_add lens_color0 lens_style rteye_oc_ht lefteye_prismdirection account_number frame_name date_wanted edged_uncut lens_cm rt_eye_sght frame_mfg frame_dbl rteye_sphere rteye_axis lefteye_pd account_name patient_name_last lens_material rteye_pd lefteye_prism date_ordered ar_coat rteye_prism_direction hard_coat rteye_cyl lefteye_cyl lefteye_axis lefteye_sphere lefteye_ocht lefteye_sght frame_style temple rt_eye_add rteye_prism frame_color" S-Form-DBFields="patient_name_first uncut_shapes frame_eye_size specify_tint_percentate_or_sample_to_come special_instructions progressive_mgf_style other_coat_specify left_eye_add lens_color0 lens_style rteye_oc_ht lefteye_prismdirection account_number frame_name date_wanted edged_uncut lens_cm rt_eye_sght frame_mfg frame_dbl rteye_sphere rteye_axis lefteye_pd account_name patient_name_last lens_material rteye_pd lefteye_prism date_ordered ar_coat rteye_prism_direction hard_coat rteye_cyl lefteye_cyl lefteye_axis lefteye_sphere lefteye_ocht lefteye_sght frame_style temple rt_eye_add rteye_prism frame_color" U-ASP-Include-Url="_fpclass/fpdbform.inc" --><input TYPE="hidden" NAME="VTI-GROUP" VALUE="0"><!--webbot bot="SaveDatabase" endspan i-checksum="40548" -->
	<p align="left">
	<font color="#FF0000"><font size="5" face="Bauhaus 93">New South Lab</font><b> 
	<font face="Arial" size="4">RX Order Form&nbsp;&nbsp; This is a test, do not 
	use at this moment</font></b></font></p>
	<table border="1" width="867" height="58" id="table2" bordercolorlight="#FF0000" cellspacing="1" style="font-size: 8pt; font-family: Arial; font-weight: bold">
		<tr>
			<td height="31" width="103" bgcolor="#CCFFCC" align="center">
			<font face="Arial" size="1">&nbsp;</font><font size="1"><!--webbot bot="Validation" s-display-name="Account Name" b-value-required="TRUE" i-minimum-length="3" i-maximum-length="20" --><input name="account_name" size="14" tabindex="1" style="font-family: Arial; font-size:8pt; text-transform:uppercase" maxlength="20"></font></td>
			<td height="31" width="64" bgcolor="#CCFFCC" align="center">
			<font size="1" face="Arial">&nbsp;<font size="1"><!--webbot bot="Validation" s-display-name="acct_number" s-data-type="Number" s-number-separators="x." b-value-required="TRUE" i-minimum-length="3" i-maximum-length="7" --><input type="text" name="account_number" size="5" tabindex="2" maxlength="7" style="font-family: Arial; font-size: 8pt"></font></font></td>
			<td height="31" width="80" bgcolor="#CCFFCC" style="font-family: serif" align="center">
			<font size="1" face="Arial">
			<input type="text" name="date_ordered" size="8" tabindex="3" style="font-family: Arial; font-size: 8pt; font-weight: bold"></font></td>
			<td height="31" width="108" bgcolor="#CCFFCC" align="center">
	<font size="1" face="Arial">
	<input type="text" name="date_wanted" size="9" tabindex="4" style="font-family: Arial; font-size: 8pt; font-weight: bold"></font></td>
			<td height="31" width="106" bgcolor="#CCFFCC" align="center">
	<font size="1" face="Arial">
	&nbsp;<!--webbot bot="Validation" b-value-required="TRUE" i-minimum-length="2" i-maximum-length="15" --><input type="text" name="patient_name_last" size="12" tabindex="4" style="font-size: 8pt; font-family: Arial; font-weight: bold; text-transform: uppercase" maxlength="15"></font></td>
			<td height="31" width="99" bgcolor="#CCFFCC" align="center">
			<font size="1" face="Arial">
			<input type="text" name="patient_name_first" size="10" tabindex="6" style="font-size: 8pt; font-weight: bold; text-transform: uppercase"></font></td>
			<td height="31" width="269" bgcolor="#CCFFCC" align="center">
	<font size="1" face="Arial">
	<input type="text" name="special_instructions" size="41" tabindex="7" style="font-family: Arial; font-size: 8pt"></font></td>
		</tr>
		<tr>
			<td height="21" width="103" align="center"><b>
			<font size="1" face="Arial">ACCOUNT 
			NAME</font></b></td>
			<td height="21" width="64" align="center"><b>
			<font size="1" face="Arial">ACCT #</font></b></td>
			<td height="21" width="80" align="center"><b>
			<font size="1" face="Arial">TODAY'S 
			DATE</font></b></td>
			<td height="21" width="108" align="center"><b>
			<font size="1" face="Arial">DATE 
			WANTED</font></b></td>
			<td height="21" width="106" align="center"><b>
			<font size="1" face="Arial">PAT. 
			NAME LAST</font></b></td>
			<td height="21" width="99" align="center"><b>
			<font size="1" face="Arial">PAT 
			NAME FIRST</font></b></td>
			<td height="21" width="269" align="center"><b>
			<font size="1" face="Arial">SPECIAL 
			INSTRUCTIONS</font></b></td>
		</tr>
	</table>
	<table border="1" width="835" height="1" bordercolorlight="#FF0000">
		<tr>
			<td height="1" width="183" bgcolor="#CCFFCC" align="center">
			<p align="center">
			&nbsp;<!--webbot bot="Validation" s-display-name="UNCUT/EDGED" b-value-required="TRUE" b-disallow-first-item="TRUE" --><select size="1" name="edged_uncut" tabindex="8" style="font-family: Arial; font-size: 8pt; font-weight: bold">
	<option value="SELECT ONE" selected>SELECT ONE UNCUT/EDGED</option>
	<option value="UNCUT">UNCUT</option>
	<option value="EDGE, FRAME TO COME">EDGE, FRAME TO COME</option>
	<option value="EDGE SUPPLY FRAME">EDGE SUPPLY FRAME</option>
	<option value="EDGE SHAPE TO COME">EDGE SHAPE TO COME</option>
	<option value="EDGE DRAWING TO COME">EDGE DRAWING TO COME</option>
	</select></td>
			<td height="1" width="101" bgcolor="#CCFFCC" align="center">
			<p align="center">
			&nbsp;<!--webbot bot="Validation" s-data-type="Number" s-number-separators="x." --><input type="text" name="lens_cm" size="7" tabindex="9"></td>
			<td height="1" width="187" bgcolor="#CCFFCC" align="center">
			&nbsp;<!--webbot bot="Validation" s-display-name="LENS STYLE" b-value-required="TRUE" b-disallow-first-item="TRUE" --><select size="1" name="lens_style" tabindex="10" style="text-transform: uppercase; font-family: Arial; font-size: 8pt">
	<option selected value="LENS STYLE SELECT">LENS STYLE SELECT ONE</option>
	<option value="SINGLE VISION">SINGLE VISION</option>
	<option value="SV ASPHERIC">SV ASPHERIC</option>
	<option value="ST 28">ST 28</option>
	<option value="ST 28 ASPHERIC">ST 28 ASPHERIC</option>
	<option value="ST 35">ST 35</option>
	<option value="ST 45">ST 45</option>
	<option value="EXEC BI">EXEC BI</option>
	<option value="RD SEG 22">RD SEG 22</option>
	<option value="RD SEG 24">RD SEG 24</option>
	<option value="7 X 28">7 X 28</option>
	<option value="8 X 35 ">8 X 35</option>
	<option value="EXEC TRI">EXEC TRI</option>
	<option value="PROGRESSIVE (SPECIFY)">PROGRESSIVE (SPECIFY)</option>
	</select></td>
			<td height="1" width="190" bgcolor="#CCFFCC" align="center">
	<input type="text" name="progressive_mgf_style" size="27" tabindex="11" style="font-family: Arial; font-size: 8pt; text-transform: uppercase"></td>
			<td height="1" width="140" bgcolor="#CCFFCC" align="center">
	&nbsp;<!--webbot bot="Validation" s-display-name="LENS MATERIAL" b-value-required="TRUE" b-disallow-first-item="TRUE" --><select size="1" name="lens_material" tabindex="12" style="font-family: Arial; font-size: 8pt">
	<option value="SELECT ONE" selected>SELECT ONE</option>
	<option value="STD PLASTIC">STD PLASTIC</option>
	<option value="TRIVEX/PHOENIX">TRIVEX/PHOENIX</option>
	<option value="MID INDEX PLASTIC">MID INDEX PLASTIC</option>
	<option value="POLYCARBONATE">POLYCARBONATE</option>
	<option value="1.60 PLASTIC">1.60 PLASTIC</option>
	<option value="1.66/67 PLASTIC">1.66/67 PLASTIC</option>
	<option value="1.70 PLASTIC">1.70 PLASTIC</option>
	<option value="1.74 PLASTIC">1.74 PLASTIC</option>
	<option value="STD GLASS">STD GLASS</option>
	<option value="1.60 GLASS">1.60 GLASS</option>
	<option value="1.70 GLASS">1.70 GLASS</option>
	<option value="1.80 GLASS">1.80 GLASS</option>
	</select></td>
		</tr>
		<tr>
			<td width="183" align="center"><b><font size="1" face="Arial">SELECT UNCUT/EDGED</font></b></td>
			<td width="101" align="center"><b><font size="1" face="Arial">CM FOR LENS ONLY</font></b></td>
			<td width="187" align="center"><b><font size="1" face="Arial">LENS STYLE</font></b></td>
			<td width="190" align="center"><b><font size="1" face="Arial">MFG/PROG/STYLE</font></b></td>
			<td width="140" align="center"><b><font size="1" face="Arial">LENS MATERIAL</font></b></td>
		</tr>
	</table>
	<table border="1" width="820" height="1" bordercolorlight="#FF0000">
		<tr>
			<td height="1" width="148" bgcolor="#CCFFCC" align="center">
			<font size="1">&nbsp;<!--webbot bot="Validation" s-display-name="LENS COLOR" b-value-required="TRUE" b-disallow-first-item="TRUE" --><select size="1" name="lens_color0" tabindex="13" style="font-family: Arial; font-size: 8pt; font-weight: bold">
	<option selected>SELECT LENS COLOR</option>
	<option value="CLEAR">CLEAR</option>
	<option value="TRANSITIONS GRAY">TRANSITIONS GRAY</option>
	<option value="TRANSITIONS BROWN">TRANSITIONS BROWN</option>
	<option value="POLARIZED GRAY">POLARIZED GRAY</option>
	<option value="POLARIZED BROWN">POLARIZED BROWN</option>
	<option value="FASHION SOLID">FASHION SOLID</option>
	<option value="FASHION GRADIENT">FASHION GRADIENT</option>
	<option value="SOLID SUNGLASS">SOLID SUNGLASS</option>
	<option value="GRADIENT SUNGLASS">GRADIENT SUNGLASS</option>
	</select></font></td>
			<td height="1" width="94" bgcolor="#CCFFCC" align="center">
			<font size="1">
			<input type="text" name="specify_tint_percentate_or_sample_to_come" size="12" tabindex="15" style="font-size: 8pt; font-weight: bold"></font></td>
			<td height="1" width="182" bgcolor="#CCFFCC" align="center">
			<font size="1">
			&nbsp;<!--webbot bot="Validation" s-display-name="HARD COAT" b-value-required="TRUE" b-disallow-first-item="TRUE" --><select size="1" name="hard_coat" tabindex="16" style="font-family: Arial; font-size: 8pt; font-weight: bold">
	<option selected value="HARD COAT">HARD COAT SELECT</option>
	<option value="NO COAT">NO COAT</option>
	<option value="SRC ( SCRATCH RESISTANT">SRC ( SCRATCH RESISTANT)</option>
	<option value="SRC AND UV">SRC AND UV</option>
	<option value="UV ONLY">UV ONLY</option>
	<option value="BAR 9">BAR 9</option>
	<option value="BAR 9 AND UV">BAR 9 AND UV</option>
	</select></font></td>
			<td height="1" width="226" bgcolor="#CCFFCC" align="center"> 
			<font size="1">
			&nbsp;<!--webbot bot="Validation" s-display-name="AR COAT" b-value-required="TRUE" b-disallow-first-item="TRUE" --><select size="1" name="ar_coat" tabindex="17" style="font-family: Arial; font-size: 8pt; font-weight: bold">
	<option selected value="Select AR ">Select AR</option>
	<option value="NO AR COAT">NO AR COAT</option>
	<option value="VISION AR COTE">VISION AR COTE</option>
	<option value="NVISION AR">NVISION AR</option>
	<option value="NVISION PLUS AR">NVISION PLUS AR</option>
	<option value="HI VISION AR (1.60 AND 1.70 HOYA)">HI VISION AR (1.60 AND 1.70 HOYA)
	</option>
	<option value="SUPER HI VISION (1.6 AND 1.7 HOYA)">SUPER HI VISION (1.6 AND 1.7 HOYA)
	</option>
	<option value="CRIZAL (DEFINITY AND VARILUX)">CRIZAL (DEFINITY AND VARILUX)
	</option>
	<option value="ALIZE (DEFINITY AND VARILUX)">ALIZE (DEFINITY AND VARILUX)
	</option>
	</select></font></td>
			<td height="1" width="136" bgcolor="#CCFFCC" align="center">
	<font size="1">
	<input type="text" name="other_coat_specify" size="22" tabindex="18" style="font-family: Arial; font-size: 8pt; font-weight: bold"></font></td>
		</tr>
		<tr>
			<td width="148" align="center"><b><font size="1" face="Arial">LENS COLOR</font></b></td>
			<td width="94" align="center"><b><font size="1" face="Arial">SPECIFY TINT &amp; %</font></b></td>
			<td width="182" align="center"><b><font size="1" face="Arial">SELECT HARD COAT</font></b></td>
			<td width="226" align="center"><b><font size="1" face="Arial">AR COATING</font></b></td>
			<td width="136" align="center"><b><font size="1" face="Arial">OTHER COATING/COLOR</font></b></td>
		</tr>
	</table>
	<table border="1" width="65%" id="table1" bordercolorlight="#FF0000">
		<tr>
			<td width="46"><b><font face="Arial" size="1">RX</font></b></td>
			<td width="74" align="center"><b><font face="Arial" size="1">SPHERE</font></b></td>
			<td width="79" align="center"><b><font face="Arial" size="1">CYL</font></b></td>
			<td width="66" align="center"><b><font face="Arial" size="1">AXIS</font></b></td>
			<td width="77" align="center"><b><font face="Arial" size="1">PRISM</font></b></td>
			<td width="65" align="center"><b><font face="Arial" size="1">DIRECTION</font></b></td>
			<td width="71" align="center"><b><font face="Arial" size="1">OC HT</font></b></td>
			<td width="69" align="center"><b><font face="Arial" size="1">PD</font></b></td>
			<td width="51" align="center"><b><font face="Arial" size="1">SEG HT</font></b></td>
			<td align="center" width="73"><b><font face="Arial" size="1">ADD</font></b></td>
		</tr>
		<tr>
			<td width="46" height="29"><b><font face="Arial" size="1">RT</font><font face="Arial" size="1"> EYE</font></b></td>
			<td width="74" bgcolor="#CCFFCC" height="29">
			<p align="center"><font size="1">&nbsp;<!--webbot bot="Validation" s-data-type="Number" s-number-separators="x." b-value-required="TRUE" i-minimum-length="4" i-maximum-length="7" s-validation-constraint="Greater than or equal to" s-validation-value="-20.00" s-validation-constraint="Less than or equal to" s-validation-value="+20.00" --><input type="text" name="rteye_sphere" size="6" tabindex="19" maxlength="7" style="font-family: Arial; font-size: 8pt; font-weight: bold"></font></td>
			<td width="79" bgcolor="#CCFFCC" height="29">
			<p align="center">
			<font size="1">&nbsp;<!--webbot bot="Validation" s-data-type="Number" s-number-separators="x." b-value-required="TRUE" i-minimum-length="4" i-maximum-length="8" s-validation-constraint="Greater than or equal to" s-validation-value="-10.00" s-validation-constraint="Less than or equal to" s-validation-value="+10.00" --><input name="rteye_cyl" size="6" maxlength="8" tabindex="20" style="position: relative; font-family:Arial; font-size:8pt; font-weight:bold"> 
			</font> </td>
			<td width="66" bgcolor="#CCFFCC" height="29">
			<p align="center">
			<font size="1">&nbsp;<!--webbot bot="Validation" s-data-type="Number" s-number-separators=",." b-value-required="TRUE" i-minimum-length="1" i-maximum-length="3" s-validation-constraint="Greater than or equal to" s-validation-value="0" s-validation-constraint="Less than or equal to" s-validation-value="180" --><input type="text" name="rteye_axis" size="5" tabindex="21" maxlength="3" style="font-family: Arial; font-size: 8pt"></font></td>
			<td width="77" bgcolor="#CCFFCC" height="29">
			<p align="center">
			<font size="1">
			<input type="text" name="rteye_prism" size="6" tabindex="22" style="font-family: Arial; font-size: 8pt; font-weight: bold"></font></td>
			<td width="65" bgcolor="#CCFFCC" height="29">
			<p align="center">
			<font size="1">
			<input type="text" name="rteye_prism_direction" size="11" tabindex="23" style="font-family: Arial; font-size: 8pt; font-weight: bold; text-transform: uppercase"></font></td>
			<td width="71" bgcolor="#CCFFCC" height="29">
			<p align="center">
			<font size="1">
			<input type="text" name="rteye_oc_ht" size="6" tabindex="24" style="font-family: Arial; font-size: 8pt; font-weight: bold"></font></td>
			<td width="69" bgcolor="#CCFFCC" height="29">
			<p align="center"><font size="1">&nbsp;<!--webbot bot="Validation" s-data-type="Number" s-number-separators="x." s-validation-constraint="Greater than or equal to" s-validation-value="20" s-validation-constraint="Less than or equal to" s-validation-value="80" --><input type="text" name="rteye_pd" size="5" tabindex="25" style="font-family: Arial; font-size: 8pt; font-weight: bold; text-transform: uppercase"></font></td>
			<td width="51" bgcolor="#CCFFCC" height="29">
			<p align="center"><font size="1">&nbsp;<!--webbot bot="Validation" s-data-type="Number" s-number-separators="x." b-value-required="TRUE" i-minimum-length="1" i-maximum-length="4" s-validation-constraint="Greater than or equal to" s-validation-value="0" s-validation-constraint="Less than or equal to" s-validation-value="33" --><input type="text" name="rt_eye_sght" size="8" maxlength="4" tabindex="26" style="font-family: Arial; font-size: 8pt; text-transform: uppercase; font-weight: bold"></font></td>
			<td bgcolor="#CCFFCC" width="73" height="29">
			<p align="center"><font size="1">&nbsp;<!--webbot bot="Validation" s-data-type="Number" s-number-separators="x." s-validation-constraint="Greater than or equal to" s-validation-value="0.00" s-validation-constraint="Less than or equal to" s-validation-value="6.00" --><input type="text" name="rt_eye_add" size="7" tabindex="27"></font></td>
		</tr>
		<tr>
			<td width="46" height="36"><b><font size="1" face="Arial">LF EYE</font></b></td>
			<td width="74" bgcolor="#CCFFCC" height="36">
			<p align="center"><font size="1">&nbsp;<!--webbot bot="Validation" s-data-type="Number" s-number-separators="x." b-value-required="TRUE" i-minimum-length="1" i-maximum-length="8" s-validation-constraint="Greater than or equal to" s-validation-value="-20.00" s-validation-constraint="Less than or equal to" s-validation-value="+20.00" --><input type="text" name="lefteye_sphere" size="6" tabindex="28" maxlength="8" style="font-family: Arial; font-size: 8pt; font-weight: bold"></font></td>
			<td width="79" bgcolor="#CCFFCC" height="36">
			<p align="center"><font size="1">&nbsp;<!--webbot bot="Validation" s-data-type="Number" s-number-separators="x." b-value-required="TRUE" i-minimum-length="1" i-maximum-length="8" s-validation-constraint="Greater than or equal to" s-validation-value="-10.00" s-validation-constraint="Less than or equal to" s-validation-value="+10.00" --><input name="lefteye_cyl" size="6" tabindex="29" maxlength="8" style="font-family: Arial; font-size: 8pt; font-weight: bold"></font></td>
			<td width="66" bgcolor="#CCFFCC" height="36">
			<p align="center"><font size="1">&nbsp;<!--webbot bot="Validation" s-display-name="lefteye_axis" s-data-type="Number" s-number-separators="x." b-value-required="TRUE" i-minimum-length="1" i-maximum-length="3" s-validation-constraint="Greater than or equal to" s-validation-value="0" s-validation-constraint="Less than or equal to" s-validation-value="180" --><input type="text" name="lefteye_axis" size="5" tabindex="30" maxlength="3" style="font-size: 8pt; font-family: Arial; font-weight: bold"></font></td>
			<td width="77" bgcolor="#CCFFCC" height="36">
			<p align="center"><font size="1">&nbsp;<!--webbot bot="Validation" s-data-type="Number" s-number-separators="x." s-validation-constraint="Greater than or equal to" s-validation-value="0" s-validation-constraint="Less than or equal to" s-validation-value="18" --><input type="text" name="lefteye_prism" size="6" tabindex="31" style="font-family: Arial; font-size: 8pt; font-weight: bold"></font></td>
			<td width="65" bgcolor="#CCFFCC" height="36">
			<p align="center">
			<font size="1">
			<input type="text" name="lefteye_prismdirection" size="11" tabindex="32" style="font-family: Arial; text-transform: uppercase; font-size: 8pt; font-weight: bold"></font></td>
			<td width="71" bgcolor="#CCFFCC" height="36">
			<p align="center">
			<font size="1">
			<input type="text" name="lefteye_ocht" size="7" tabindex="33" style="font-family: Arial; font-size: 8pt; font-weight: bold"></font></td>
			<td width="69" bgcolor="#CCFFCC" height="36">
			<p align="center"><font size="1">&nbsp;<!--webbot bot="Validation" s-display-name="left eye pd" s-data-type="Number" s-number-separators=",." --><input type="text" name="lefteye_pd" size="5" tabindex="34" style="font-family: Arial; text-transform: uppercase; font-size: 8pt; font-weight: bold"></font></td>
			<td width="51" bgcolor="#CCFFCC" height="36">
			<p align="center"><font size="1">&nbsp;<!--webbot bot="Validation" s-display-name="left eye pd" s-data-type="Number" s-number-separators="x." b-value-required="TRUE" i-minimum-length="1" s-validation-constraint="Greater than or equal to" s-validation-value="0" s-validation-constraint="Less than or equal to" s-validation-value="80" --><input type="text" name="lefteye_sght" size="8" tabindex="35" style="font-family: Arial; font-size: 8pt; font-weight: bold"></font></td>
			<td bgcolor="#CCFFCC" width="73" height="36">
			<p align="center"><font size="1">&nbsp;<!--webbot bot="Validation" s-data-type="Number" s-number-separators="x." b-value-required="TRUE" i-minimum-length="1" i-maximum-length="4" s-validation-constraint="Greater than or equal to" s-validation-value="0" s-validation-constraint="Less than or equal to" s-validation-value="6.00" --><input type="text" name="left_eye_add" size="7" maxlength="4" tabindex="36"></font></td>
		</tr>
	</table>
	<table border="1" width="614" height="28" bordercolorlight="#FF0000" cellspacing="4" cellpadding="3">
		<tr>
			<td height="11" width="247" bgcolor="#CCFFCC" bordercolorlight="#CCFFCC" bordercolordark="#CCFFCC" align="center">
			&nbsp;<!--webbot bot="Validation" s-display-name="select_frame_style" b-value-required="TRUE" b-disallow-first-item="TRUE" --><select size="1" name="frame_style" tabindex="36" style="text-transform: uppercase; font-family: Arial; font-size: 8pt; font-weight: bold">
	<option selected>SELECT FRAME STYLE</option>
	<option value="METAL">METAL</option>
	<option value="ZYLE">ZYLE</option>
	<option value="NYLON RIMLESS">NYLON RIMLESS</option>
	<option value="DRILLED RIMLESS">DRILLED RIMLESS</option>
	<option value="METAL GROOVE">METAL GROOVE</option>
	<option value="DRILL AND NOTCH RIMLESS">DRILL AND NOTCH RIMLESS</option>
	<option value="METAL WRAP">METAL WRAP</option>
	<option value="ZYLE WRAP">ZYLE WRAP</option>
	<option value="METAL HALFEYE (UNDER 20 B MEASURE)">METAL HALFEYE (UNDER 20 B MEASURE)
	</option>
	<option>ZYLE HALFEYE (UNDER 20 B MEASURE)</option>
	</select></td>
			<td height="11" width="126" bgcolor="#CCFFCC" bordercolorlight="#CCFFCC" bordercolordark="#CCFFCC" align="center"> 
			<input type="text" name="frame_name" size="18" tabindex="37" style="font-family: Arial; font-size: 8pt; text-transform: uppercase"></td>
			<td height="11" width="183" bgcolor="#CCFFCC" bordercolorlight="#CCFFCC" bordercolordark="#CCFFCC" align="center">
	<select size="1" name="uncut_shapes" tabindex="39" style="font-family: Arial; font-size: 8pt; font-weight: bold">
	<option selected>SELECT UNCUT SHAPE</option>
	<option value="UNCUT SHAPE 1">UNCUT SHAPE 1</option>
	<option value="UNCUT SHAPE 2">UNCUT SHAPE 2</option>
	<option value="UNCUT SHAPE 3">UNCUT SHAPE 3</option>
	<option value="UNCUT SHAPE 4 DEFAULT">UNCUT SHAPE 4 DEFAULT</option>
	<option value="UNCUT SHAPE 5">UNCUT SHAPE 5</option>
	<option value="UNCUT SHAPE 6">UNCUT SHAPE 6</option>
	</select></td>
		</tr>
		<tr>
			<td height="22" width="247" align="center"><b>
			<font size="1" face="Arial">SELECT 
			FRAME STYLE</font></b></td>
			<td height="22" width="126" align="center"><b>
			<font size="1" face="Arial">FRAME 
			NAME</font></b></td>
			<td height="22" width="183" align="center"><b>
			<font size="1" face="Arial">SELECT 
			UNCUT SHAPE</font></b></td>
		</tr>
	</table>
	<table border="1" width="530" height="54" bordercolorlight="#FF0000" cellspacing="3" cellpadding="4">
		<tr>
			<td height="11" width="105" bgcolor="#CCFFCC" bordercolorlight="#CCFFCC" bordercolordark="#CCFFCC" align="center">
	<input type="text" name="frame_mfg" size="12" tabindex="40" style="text-transform: uppercase; font-family: Arial; font-size: 8pt"></td>
			<td height="11" width="100" bgcolor="#CCFFCC" bordercolorlight="#CCFFCC" bordercolordark="#CCFFCC" align="center">
	<input type="text" name="frame_color" size="10" tabindex="41" style="text-transform: uppercase; font-family: Arial; font-size: 8pt; font-weight: bold"></td>
			<td height="11" width="82" bgcolor="#CCFFCC" bordercolorlight="#CCFFCC" bordercolordark="#CCFFCC" align="center">
	<input type="text" name="frame_eye_size" size="6" tabindex="42" style="font-family: Arial; font-size: 8pt; font-weight: bold"></td>
			<td height="11" width="118" bgcolor="#CCFFCC" bordercolorlight="#CCFFCC" bordercolordark="#CCFFCC" align="center">
	<input type="text" name="frame_dbl" size="5" tabindex="42"></td>
			<td height="11" width="91" bordercolor="#CCFFCC" bgcolor="#CCFFCC" bordercolorlight="#CCFFCC" bordercolordark="#CCFFCC" align="center">
	<input type="text" name="temple" size="9" tabindex="44"></td>
		</tr>
		<tr>
			<td height="22" width="105" align="center"><b>
			<font size="1" face="Arial">FRAME 
			MFG</font></b></td>
			<td height="22" width="100" align="center"><b>
			<font size="1" face="Arial">FR. 
			COLOR</font></b></td>
			<td height="22" width="82" align="center"><b>
			<font size="1" face="Arial">EYE</font></b></td>
			<td height="22" width="118" align="center"><b>
			<font size="1" face="Arial">DBL</font></b></td>
			<td height="22" width="91" align="center"><b>
			<font size="1" face="Arial">TEMPLE</font></b></td>
		</tr>
	</table>
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