// JavaScript Document
function validateForm(form)
{   
	
if(!checkString(form.elements["firstname"], sUSFirstName))
{
 form.elements["firstname"].focus();
 return;
} 
 if(!checkString(form.elements["lastname"],sUSLastName)){
 form.elements["lastname"].focus();
 return;
 } 
 if(!checkString(form.elements["address"], sUSAddress))
 {
 form.elements["address"].focus();
 return;
 }
 if(!checkString(form.elements["city"],sCity))
 {
   form.elements["city"].focus();
   return;
 }
  if(!checkStateCode(form.elements["state"],sStateCode))
  {
  form.elements["state"].focus();
  return;
  }
  
  if(emptyField(form.elements["zipcode"]))
  {
  alert("Zip Code is a required field. Please enter it now.");
  form.elements["zipcode"].focus();
  return;
  }
  
if(emptyField(form.elements["phone"]))
 {
 alert("Phone is a required field. Please enter it now.");
 form.elements["phone"].focus();
 return;
 }

//checkUSPhone(form.elements["Fax"], true) &&
    if(!checkEmail(form.elements["email"],sEmail))
	{
	form.elements["email"].focus();
	return;
	}
	var date=form.elements["dateofbirth"].value;
	var dateAr = date.split("/");
	if( dateAr.length!=3 || !isDate(dateAr[2],dateAr[1],dateAr[0]))
	{
	alert("please enter a valid date of birth like dd/mm/yyyy");
	form.elements["dateofbirth"].focus();
	return;
	}
	
	//date of termination
	var date=form.elements["dateofdiagnosis"].value;
	var dateAr = date.split("/");
	if( dateAr.length!=3 || !isDate(dateAr[2],dateAr[1],dateAr[0]))
	{
	alert("please enter a valid date of dateofdiagnosis like dd/mm/yyyy");
	form.elements["dateofdiagnosis"].focus();
	return;
	}
	
	/*//date of injury
	var date=form.elements["injury_date"].value;
	var dateAr = date.split("/");
	if( dateAr.length!=3 || !isDate(dateAr[2],dateAr[1],dateAr[0]))
	{
	alert("please enter a valid date of injury like dd/mm/yyyy");
	form.elements["injury_date"].focus();
	return;
	}
	*/
	if(!checkStateCode(form.elements["ExposedState"],sStateCode))
  {
  form.elements["ExposedState"].focus();
  return;
  }
  
  if(!checkString(form.elements["casedescription"],sDescription))
  {
  form.elements["casedescription"].focus();
  return;
  }
	
     // checkSSN(form.elements["SSN"], true) &&
     // checkDate(form.elements["BirthYear"], form.elements["BirthMonth"], form.elements["BirthDay"], sDateOfBirth) &&
     // checkCreditCard (form.elements["CreditCardType"], form.elements["CreditCardNumber"]) &&
    //  checkDate(form.elements["ExpirationYear"], form.elements["ExpirationMonth"], form.elements["ExpirationDay"], sExpirationDate, true)
   form.action="sendeaile_beryllium.php";
   form.submit();
}