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09.24.2008 at 07:25PM PDT, ID: 23761138
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8.6

ASP form gives Web Server 500 error

Asked by EricBourland in Active Server Pages (ASP), Programming for ASP.NET

Windows Server 2003
IIS 6
ASP 2.x
MS Access 2003 database

Hi. I've inherited an ASP page from another web site. I'm trying to get this page to work on my Windows 2003 server. The page is here:

http://www.careplanners.net/join_lifeplanner.asp

This page comprises a form that collects user information and adds it to a database -- MS Access 2003. The database is correctly configured as a DSN that ASP can find and understand.

If you fill out the form and attempt to send it, the form gives a web server 500 error, and but offers no other details regarding the error.

The page http://www.careplanners.net/join_lifeplanner.asp comprises several components:

join_lifeplanner.asp ... the main web page
registration_save_inc.asp
directory_form_inc.asp

the code of which pages I append below.

If someone has time, will you take a look at this code and speculate on what could be going wrong? I'm very grateful for any advice.

Thanks and peace,

EricStart Free Trial
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join_lifeplanner.asp:
<%
if request.form("action") = "Submit" then
    %><!-- #include file = "registration_save_inc.asp" --><%
end if
%>
<!-- #include file = "header_inc.asp" -->
<!-- #include file = "menu_inc.asp" -->
 
 
<div id="content">
<h2>Join The Directory</h2>
<p>Please fill out the form to be added the Directory. </p>
</div>
 
<div id="regform"><form name="regform" method="post" action="join_lifeplanner.asp?">
<!-- #include file = "directory_form_inc.asp" -->
							</form>
</div>
<!-- #include file = "footer_inc.asp" -->
<%
function quotestring(s, endchar)
	s = replace(trim(s),"'","''")
   	quotestring = "'" & s & "'" & endchar
end function
 
if (firstname = "" or lastname = "" or company = "" or primaryphone = "" or email = "" or street1 = "" or city1 = "" or state1 = "" or zip1 = "" or country1 = "" or phone1 = "" or chbdegrees = "" or chbcertifications = "" or practice = "" or chbpediatric = "" or chbadult ="" or verify="") and request("action") = "Submit" then
	%><script>alert('You did not fill a required field. All fields marked * are required.')</script><%
end if
%>
 
 
 
 
registration_save_inc.asp:
<%
prefix            = request("prefix")
firstname         = request("firstname")
middleinit        = request("middleinit")
lastname          = request("lastname")
suffix            = request("suffix")
company           = request("company")
region            = request("region")
primaryphone      = request("primaryphone")
email             = request("email")
website           = request("website")
street1           = request("street1")
city1             = request("city1")
state1            = request("state1")
zip1              = request("zip1")
country1          = request("country1")
phone1            = request("phone1")
fax1              = request("fax1")
street2           = request("street2")
city2             = request("city2")
state2            = request("state2")
zip2              = request("zip2")
country2          = request("country2")
phone2            = request("phone2")
fax2              = request("fax2")
chbdegrees        = request("chbdegrees")
chbcertifications = request("chbcertifications")
practice          = request("practice")
chbpediatric      = request("chbpediatric")
chbadult          = request("chbadult")
info              = request("info")
verify 		   = request("verify")
 
if request("sign_up") = "YES" then
	sign_up = true
else
	sign_up = false
end if
if (cstr(request("verify")) <> cstr(session("check_str")) and session("check_str") <> "") then
	verify = ""
end if
 
if firstname = "" or lastname = "" or company = "" or primaryphone = "" or email = "" or street1 = "" or city1 = "" or state1 = "" or zip1 = "" or country1 = "" or phone1 = "" or chbdegrees = "" or chbcertifications = "" or practice = "" or chbpediatric = "" or chbadult ="" or verify="" then
 
else
	Set conn = Server.CreateObject("ADODB.Connection")
	conn.Open session("conn_CarePlanners_db")
	sql = "delete * from directory where firstname = " & quotestring(firstname,"") & " and lastname = " & quotestring(lastname,"")
	conn.execute(sql)
 
	sql = " insert into directory ("
	sql = sql & "prefix,"
	sql = sql & "firstname,"
	sql = sql & "middleinit,"
	sql = sql & "lastname,"
	sql = sql & "suffix,"
	sql = sql & "company,"
	sql = sql & "region,"
	sql = sql & "primaryphone,"
	sql = sql & "email,"
	sql = sql & "website,"
	sql = sql & "street1,"
	sql = sql & "city1,"
	sql = sql & "state1,"
	sql = sql & "zip1,"
	sql = sql & "country1,"
	sql = sql & "phone1,"
	sql = sql & "fax1,"
	sql = sql & "street2,"
	sql = sql & "city2,"
	sql = sql & "state2,"
	sql = sql & "zip2,"
	sql = sql & "country2,"
	sql = sql & "phone2,"
	sql = sql & "fax2,"
	sql = sql & "chbdegrees,"
	sql = sql & "chbcertifications,"
	sql = sql & "practice,"
	sql = sql & "chbpediatric,"
	sql = sql & "chbadult,"
	sql = sql & "sign_up,"
	sql = sql & "info"
	sql = sql & ")values("
	sql = sql & quotestring(prefix,",")
	sql = sql & quotestring(firstname,",")
	sql = sql & quotestring(middleinit,",")
	sql = sql & quotestring(lastname,",")
	sql = sql & quotestring(suffix,",")
	sql = sql & quotestring(company,",")
	sql = sql & quotestring(region,",")
	sql = sql & quotestring(primaryphone,",")
	sql = sql & quotestring(email,",")
	sql = sql & quotestring(website,",")
	sql = sql & quotestring(street1,",")
	sql = sql & quotestring(city1,",")
	sql = sql & quotestring(state1,",")
	sql = sql & quotestring(zip1,",")
	sql = sql & quotestring(country1,",")
	sql = sql & quotestring(phone1,",")
	sql = sql & quotestring(fax1,",")
	sql = sql & quotestring(street2,",")
	sql = sql & quotestring(city2,",")
	sql = sql & quotestring(state2,",")
	sql = sql & quotestring(zip2,",")
	sql = sql & quotestring(country2,",")
	sql = sql & quotestring(phone2,",")
	sql = sql & quotestring(fax2,",")
	sql = sql & quotestring(chbdegrees,",")
	sql = sql & quotestring(chbcertifications,",")
	sql = sql & quotestring(practice,",")
	sql = sql & quotestring(chbpediatric,",")
	sql = sql & quotestring(chbadult,",")
	sql = sql & sign_up & ","
	sql = sql & quotestring(info,"")
	sql = sql & ")"
 
	conn.execute(sql)
	conn.close
	set conn = nothing
 
	BodyText = "There was a new submission for Care Planners Directory" & vbcrlf & "Please visit site maintenance to review it at "&application("website")&"maint/" & vbcrlf
 
	Set Objmail=Server.CreateObject("CDONTS.NewMail")
	Objmail.From = application("notification_email")
	Objmail.To = application("notification_email")
	Objmail.Subject = "** New listing in Care Planners Directory"
	Objmail.Body = BodyText
	Objmail.Send
	Set Objmail = nothing
 
	if sign_up and email<>"" then
Set myMail=CreateObject("CDO.Message")
    			myMail.From = mailfrom
    			myMail.To = "STServ@careplanners.net"
    			myMail.Subject = ""
    			myMail.TextBody = "subscribe lcpforum"
 
myMail.Configuration.Fields.Item("http://schemas.microsoft.com/cdo/configuration/sendusing")=2
myMail.Configuration.Fields.Item("http://schemas.microsoft.com/cdo/configuration/smtpserver") = "mail.careplanners.net"
myMail.Configuration.Fields.Item("http://schemas.microsoft.com/cdo/configuration/smtpserverport") = 25
myMail.Configuration.Fields.Update
mymail.Configuration.Fields.Item ("http://schemas.microsoft.com/cdo/configuration/smtpauthenticate") = 1 'basic (clear-text) authentication
mymail.Configuration.Fields.Item ("http://schemas.microsoft.com/cdo/configuration/sendusername") ="sgrisham"
mymail.Configuration.Fields.Item ("http://schemas.microsoft.com/cdo/configuration/sendpassword") ="susan5"
 
    			myMail.Send
    			Set myMail = Nothing
				    end if
 
 
 
	response.redirect  "thankyou.asp"
	response.end
end if
 
function quotestring (s, endchar)
	quotestring = "'" & replace(cstr(s),"'","''") & "'" & endchar
end function
 
%>
 
 
directory_form_inc.asp:
<table cellSpacing="0" cellPadding="2" border=0>
	<tr>
		<td colSpan="4"><h3>Business Information:</h3></td>
	</tr>
	<tr>
		<td align="right">Prefix:</td>
		<td><select id="select" name="prefix">
               <option <% if prefix = "Mr." then %>selected<%end if%>>Mr.</option>
               <option <% if prefix = "Mrs." then %>selected<%end if%>>Mrs.</option>
               <option <% if prefix = "Miss." then %>selected<%end if%>>Miss.</option>
               <option <% if prefix = "Ms." then %>selected<%end if%>>Ms.</option>
               <option <% if prefix = "Dr." then %>selected<%end if%>>Dr.</option>
               <option <% if prefix = "" then %>selected<%end if%>></option>
               </select>
	  </td>
		<td align="right"><font color="red">* </font>First Name:</td>
	  <td><INPUT id="firstname" type="text" maxLength="40" name="firstname" value="<%=firstname%>"></td>
	</tr>
	<tr>
		<td align="right">Middle Initial:</td>
	  <td><INPUT id="middleinit" type="text" maxLength="10" size="5" name="middleinit" value="<%=middleinit%>"></td>
		<td align="right"><font color="red">* </font>Last Name:</td>
		<td><INPUT id="lastname" type="text" maxLength="40" name="lastname" value="<%=lastname%>"></td>
	</tr>
	<tr>
		<td align="right">Suffix:</td>
		<td><select id="suffix" name="suffix">
               <option <%if suffix = "-" then%>selected<%end if%>>-</option>
               <option <%if suffix = "Jr." then%>selected<%end if%>>Jr.</option>
               <option <%if suffix = "Sr." then%>selected<%end if%>>Sr.</option>
               <option <%if suffix = "II" then%>selected<%end if%>>II</option>
               <option <%if suffix = "III" then%>selected<%end if%>>III</option>
			</select>
	  </td>
	</tr>
	<tr>
		<td align="right" width="50"><font color="red">* </font>Organization / Business Name:</td>
		<td colSpan="3"><INPUT id="company" type="text" maxLength="80" size="50" name="company" value="<%=company%>"></td>
	</tr>
	<tr>
		<td align="right" width="50">Geographic regions served:</td>
		<td><SELECT id="region" name="region">
				<OPTION selected value="">---------------------------------</OPTION>
				<OPTION <%if region="All U.S" then%>selected<%end if%>>All U.S</OPTION>
				<OPTION <%if region="Alabama" then%>selected<%end if%>>Alabama</OPTION>
				<OPTION <%if region="Alaska" then%>selected<%end if%>>Alaska</OPTION>
				<OPTION <%if region="Arizona" then%>selected<%end if%>>Arizona</OPTION>
				<OPTION <%if region="Arkansas" then%>selected<%end if%>>Arkansas</OPTION>
				<OPTION <%if region="California" then%>selected<%end if%>>California</OPTION>
				<OPTION <%if region="Colorado" then%>selected<%end if%>>Colorado</OPTION>
				<OPTION <%if region="Connecticut" then%>selected<%end if%>>Connecticut</OPTION>
				<OPTION <%if region="Delaware" then%>selected<%end if%>>Delaware</OPTION>
				<OPTION <%if region="Florida" then%>selected<%end if%>>Florida</OPTION>
				<OPTION <%if region="Georgia" then%>selected<%end if%>>Georgia</OPTION>
				<OPTION <%if region="Hawaii" then%>selected<%end if%>>Hawaii</OPTION>
				<OPTION <%if region="Idaho" then%>selected<%end if%>>Idaho</OPTION>
				<OPTION <%if region="Illinois" then%>selected<%end if%>>Illinois</OPTION>
				<OPTION <%if region="Indiana" then%>selected<%end if%>>Indiana</OPTION>
				<OPTION <%if region="Iowa" then%>selected<%end if%>>Iowa</OPTION>
				<OPTION <%if region="Kansas" then%>selected<%end if%>>Kansas</OPTION>
				<OPTION <%if region="Kentucky" then%>selected<%end if%>>Kentucky</OPTION>
				<OPTION <%if region="Louisiana" then%>selected<%end if%>>Louisiana</OPTION>
				<OPTION <%if region="Maine" then%>selected<%end if%>>Maine</OPTION>
				<OPTION <%if region="Maryland" then%>selected<%end if%>>Maryland</OPTION>
				<OPTION <%if region="Massachusetts" then%>selected<%end if%>>Massachusetts</OPTION>
				<OPTION <%if region="Michigan" then%>selected<%end if%>>Michigan</OPTION>
				<OPTION <%if region="Minnesota" then%>selected<%end if%>>Minnesota</OPTION>
				<OPTION <%if region="Mississippi" then%>selected<%end if%>>Mississippi</OPTION>
				<OPTION <%if region="Missouri" then%>selected<%end if%>>Missouri</OPTION>
				<OPTION <%if region="Montana" then%>selected<%end if%>>Montana</OPTION>
				<OPTION <%if region="Nebraska" then%>selected<%end if%>>Nebraska</OPTION>
				<OPTION <%if region="Nevada" then%>selected<%end if%>>Nevada</OPTION>
				<OPTION <%if region="New Hampshire" then%>selected<%end if%>>New Hampshire</OPTION>
				<OPTION <%if region="New Jeresy" then%>selected<%end if%>>New Jeresy</OPTION>
				<OPTION <%if region="New Mexico" then%>selected<%end if%>>New Mexico</OPTION>
				<OPTION <%if region="New York" then%>selected<%end if%>>New York</OPTION>
				<OPTION <%if region="North Carolina" then%>selected<%end if%>>North Carolina</OPTION>
				<OPTION <%if region="North Dakota" then%>selected<%end if%>>North Dakota</OPTION>
				<OPTION <%if region="Ohio" then%>selected<%end if%>>Ohio</OPTION>
				<OPTION <%if region="Oklahoma" then%>selected<%end if%>>Oklahoma</OPTION>
				<OPTION <%if region="Oregon" then%>selected<%end if%>>Oregon</OPTION>
				<OPTION <%if region="Pennsylvania" then%>selected<%end if%>>Pennsylvania</OPTION>
				<OPTION <%if region="Rhode Island" then%>selected<%end if%>>Rhode Island</OPTION>
				<OPTION <%if region="South Carolina" then%>selected<%end if%>>South Carolina</OPTION>
				<OPTION <%if region="South Dakota" then%>selected<%end if%>>South Dakota</OPTION>
				<OPTION <%if region="Tennessee" then%>selected<%end if%>>Tennessee</OPTION>
				<OPTION <%if region="Texas" then%>selected<%end if%>>Texas</OPTION>
				<OPTION <%if region="Utah" then%>selected<%end if%>>Utah</OPTION>
				<OPTION <%if region="Vermont" then%>selected<%end if%>>Vermont<OPTION>
				<OPTION <%if region="Virginia" then%>selected<%end if%>>Virginia<OPTION>
				<OPTION <%if region="Washington" then%>selected<%end if%>>Washington<OPTION>
				<OPTION <%if region="Washington D.C." then%>selected<%end if%>>Washington D.C.<OPTION>
				<OPTION <%if region="West Virginia" then%>selected<%end if%>>West Virginia<OPTION>
				<OPTION <%if region="Wisconsin" then%>selected<%end if%>>Wisconsin<OPTION>
				<OPTION <%if region="Wyoming" then%>selected<%end if%>>Wyoming<OPTION>
				<OPTION <%if region="Canada" then%>selected<%end if%>>Canada</OPTION>
				<OPTION <%if region="Argentina" then%>selected<%end if%>>Argentina</OPTION>
				<OPTION <%if region="Australia" then%>selected<%end if%>>Australia</OPTION>
				<OPTION <%if region="Austria" then%>selected<%end if%>>Austria</OPTION>
				<OPTION <%if region="Brazil" then%>selected<%end if%>>Brazil</OPTION>
				<OPTION <%if region="China" then%>selected<%end if%>>China</OPTION>
				<OPTION <%if region="Colombia" then%>selected<%end if%>>Colombia</OPTION>
				<OPTION <%if region="Costa Rica" then%>selected<%end if%>>Costa Rica</OPTION>
				<OPTION <%if region="Czech Republic" then%>selected<%end if%>>Czech Republic</OPTION>
				<OPTION <%if region="Denmark" then%>selected<%end if%>>Denmark</OPTION>
				<OPTION <%if region="Egypt" then%>selected<%end if%>>Egypt</OPTION>
				<OPTION <%if region="France" then%>selected<%end if%>>France</OPTION>
				<OPTION <%if region="Germany" then%>selected<%end if%>>Germany</OPTION>
				<OPTION <%if region="Hong Kong" then%>selected<%end if%>>Hong Kong</OPTION>
				<OPTION <%if region="India" then%>selected<%end if%>>India</OPTION>
				<OPTION <%if region="Indonesia" then%>selected<%end if%>>Indonesia</OPTION>
				<OPTION <%if region="Ireland" then%>selected<%end if%>>Ireland</OPTION>
				<OPTION <%if region="Israel" then%>selected<%end if%>>Israel</OPTION>
				<OPTION <%if region="Italy" then%>selected<%end if%>>Italy</OPTION>
				<OPTION <%if region="Japan" then%>selected<%end if%>>Japan</OPTION>
				<OPTION <%if region="Korea" then%>selected<%end if%>>Korea</OPTION>
				<OPTION <%if region="Malaysia" then%>selected<%end if%>>Malaysia</OPTION>
				<OPTION <%if region="Mexico" then%>selected<%end if%>>Mexico</OPTION>
				<OPTION <%if region="Netherlands" then%>selected<%end if%>>Netherlands</OPTION>
				<OPTION <%if region="New Zealand" then%>selected<%end if%>>New Zealand</OPTION>
				<OPTION <%if region="Philippines" then%>selected<%end if%>>Philippines</OPTION>
				<OPTION <%if region="Poland" then%>selected<%end if%>>Poland</OPTION>
				<OPTION <%if region="Russia" then%>selected<%end if%>>Russia</OPTION>
				<OPTION <%if region="Singapore" then%>selected<%end if%>>Singapore</OPTION>
				<OPTION <%if region="South Africa" then%>selected<%end if%>>South Africa</OPTION>
				<OPTION <%if region="Spain" then%>selected<%end if%>>Spain</OPTION>
				<OPTION <%if region="Sweden" then%>selected<%end if%>>Sweden</OPTION>
				<OPTION <%if region="Taiwan" then%>selected<%end if%>>Taiwan</OPTION>
				<OPTION <%if region="Thailand" then%>selected<%end if%>>Thailand</OPTION>
				<OPTION <%if region="Turkey" then%>selected<%end if%>>Turkey</OPTION>
				<OPTION <%if region="UAE" then%>selected<%end if%>>UAE</OPTION>
				<OPTION <%if region="UK" then%>selected<%end if%>>UK</OPTION>
				<OPTION <%if region="Ukraine" then%>selected<%end if%>>Ukraine</OPTION>
				<OPTION <%if region="Vietnam" then%>selected<%end if%>>Vietnam</OPTION>
			</SELECT>
		</td>
		<td align="right"><font color="red">* </font>Primary Contact Phone:</td>
		<td><INPUT id="primaryphone" type="text" maxLength="20" name="primaryphone" value="<%=primaryphone%>"></td>
		<td width="0"></td>
	</tr>
	<tr>
		<td align="right" style="white-space:nowrap; "><font color="red">* </font>Email Address:</td>
		<td><INPUT id="email" type="text" maxLength="50" name="email" value="<%=email%>"></td>
		<td align=right>Website Address:</td>
		<td><INPUT id="website" type="text" maxLength="80" name="website" value="<%=website%>"></td>
	</tr>
	<tr>
		<td></td>
		<td colspan=4><INPUT id="sign_up" type="checkbox" maxLength="50" name="sign_up" <%if sign_up then %>checked<%end if%> value="YES">Sign Up to Care Planner Network mailing list.</td>
	</tr>
	<tr>
		<td colSpan="4"><h3>Business Address 1:</h3></td>
	</tr>
	<tr>
		<td align=right><font color="red">* </font>Street:</td>
		<td colSpan="3"><INPUT id="street1" type="text" maxLength="80" size="50" name="street1" value="<%=street1%>"></td>
	</tr>
	<tr>
		<td align=right><font color="red">* </font>City:</td>
		<td><INPUT id="city1" type="text" maxLength="40" name="city1" value="<%=city1%>"></td>
		<td align=right><font color="red">* </font>State:</td>
		<td>
			<select name="state1" id="state1">
			<% selected_state  = state1 %>
			<!-- #include file = "state_list_inc.asp" -->
			</select>
		</td>
	</tr>
	<tr>
		<td align="right"><font color="red">* </font>Zip:</td>
		<td><INPUT id="zip1" type="text" maxLength="10" name="zip1" value="<%=zip1%>"></td>
		<td align="right"><font color="red">* </font>Country:</td>
		<td><INPUT id="country1" type="text" maxLength="40" name="country1" value="<%=country1%>"></td>
		
	</tr>
	<tr>
		<td align="right"><font color="red">* </font>Telephone:</td>
		<td><INPUT id="phone1" type="text" maxLength="20" name="phone1" value="<%=phone1%>"></td>
		<td align="right">Fax:</td>
		<td><INPUT id="fax1" type="text" maxLength="20" name="fax1" value="<%=fax1%>"></td>
	</tr>
	<tr>
		<td colSpan="4"><h3>Business Address 2:</h3></td>
	</tr>
	<tr>
		<td align="right">Street:</td>
		<td colSpan="3"><INPUT id="street2" type="text" maxLength="80" size="50" name="street2" value="<%=street2%>"></td>
	</tr>
	<tr>
		<td align="right">City:</td>
		<td><INPUT id="city2" type="text" name="city2" value="<%=city2%>"></td>
		<td align="right">State:</td>
		<td>
			<select name="state2" id="state2">
			<% selected_state  = state2 %>
			<!-- #include file = "state_list_inc.asp" -->
			</select>
		</td>
	</tr>
	<tr>
		<td align="right">Zip:</td>
		<td><INPUT id="zip2" type="text" name="zip2" value="<%=zip2%>"></td>
		<td align="right">Country:</td>
		<td><INPUT id="country2" type="text" name="country2" value="<%=country2%>"></td>
	</tr>
	<tr>
		<td align="right">Telephone:</td>
		<td><INPUT id="phone2" type="text" name="phone2" value="<%=phone2%>"></td>
		<td align="right">Fax:</td>
		<td><INPUT id="fax2" type="text" name="fax2" value="<%=fax2%>"></td>
	</tr>
	<tr>
		<td colSpan="4"><h3><font color="red">* </font>Degrees Earned:</h3></td>
	</tr>
	<tr>
		<td colSpan="4">
			<table cellpadding="2" border=0 width="600">
				<tr>
					<td style="white-space:nowrap "><INPUT name="chbdegrees" type="checkbox" value="Diploma Nursing"  <%=check_check("chbdegrees","Diploma Nursing")%>>Diploma&nbsp;Nursing</td>
					<td><INPUT name="chbdegrees" type="checkbox" value="BSN"			<%=check_check("chbdegrees","BSN")%>>BSN</td>
					<td><INPUT name="chbdegrees" type="checkbox" value="MSN"			<%=check_check("chbdegrees","MSN")%>>MSN</td>
					<td><INPUT name="chbdegrees" type="checkbox" value="MD"			<%=check_check("chbdegrees","MD")%>>MD</td>
				</tr>
				<tr>
					<td><INPUT name="chbdegrees" type="checkbox" value="BA"			<%=check_check("chbdegrees","BA")%>>BA</td>
					<td><INPUT name="chbdegrees" type="checkbox" value="MA"			<%=check_check("chbdegrees","MA")%>>MA</td>
					<td><INPUT name="chbdegrees" type="checkbox" value="BS"			<%=check_check("chbdegrees","BS")%>>BS</td>
					<td><INPUT name="chbdegrees" type="checkbox" value="Ph.D"			<%=check_check("chbdegrees","Ph.D")%>>Ph.D</td>
				</tr>
				<tr>
					<td><INPUT name="chbdegrees" type="checkbox" value="MEd"			<%=check_check("chbdegrees","MEd")%>>MEd</td>
					<td><INPUT name="chbdegrees" type="checkbox" value="EdD"			<%=check_check("chbdegrees","EdD")%>>EdD</td>
					<td><INPUT name="chbdegrees" type="checkbox" value="MS"			<%=check_check("chbdegrees","MS")%>>MS</td>
					<td><INPUT name="chbdegrees" type="checkbox" value="Other"			<%=check_check("chbdegrees","Other")%>>Other</td>
				</tr>
	<tr>
		<td colSpan="4"><h3><font color="red">* </font>Certifications:</h3>
	</tr>
				<tr>
					<td><INPUT name="chbcertifications" type="checkbox" value="ABPP"		<%=check_check("chbcertifications","ABPP")%>>ABPP</td>
					<td><INPUT name="chbcertifications" type="checkbox" value="ACSW"		<%=check_check("chbcertifications","ACSW")%>>ACSW</td>
					<td><INPUT name="chbcertifications" type="checkbox" value="CCM"		<%=check_check("chbcertifications","CCM")%>>CCM</td>
					<td><INPUT name="chbcertifications" type="checkbox" value="CLCP"		<%=check_check("chbcertifications","CLCP")%>>CLCP</td>
				</tr>
				<tr>
					<td><INPUT name="chbcertifications" type="checkbox" value="CRC"		<%=check_check("chbcertifications","CRC")%>>CRC</td>
					<td><INPUT name="chbcertifications" type="checkbox" value="CVE"		<%=check_check("chbcertifications","CVE")%>>CVE</td>
					<td><INPUT name="chbcertifications" type="checkbox" value="NCC"		<%=check_check("chbcertifications","NCC")%>>NCC</td>
					<td><INPUT name="chbcertifications" type="checkbox" value="ABVE"		<%=check_check("chbcertifications","ABVE")%>>ABVE</td>
				</tr>
				<tr>
					<td><INPUT name="chbcertifications" type="checkbox" value="CCC-SLP"	<%=check_check("chbcertifications","CCC-SLP")%>>CCC-SLP</td>
					<td><INPUT name="chbcertifications" type="checkbox" value="CDMS"		<%=check_check("chbcertifications","CDMS")%>>CDMS</td>
					<td><INPUT name="chbcertifications" type="checkbox" value="CNLCP"	<%=check_check("chbcertifications","CNLCP")%>>CNLCP</td>
					<td><INPUT name="chbcertifications" type="checkbox" value="CRRN"		<%=check_check("chbcertifications","CRRN")%>>CRRN</td>
				</tr>
				<tr>
					<td><INPUT name="chbcertifications" type="checkbox" value="LNCC"		<%=check_check("chbcertifications","LNCC")%>>LNCC</td>
					<td><INPUT name="chbcertifications" type="checkbox" value="MSCC"		<%=check_check("chbcertifications","MSCC")%>>MSCC</td>
					<td><INPUT name="chbcertifications" type="checkbox" value="OTHER"	<%=check_check("chbcertifications","OTHER")%>>OTHER</td>
				</tr>
	<tr><td colSpan="4"><h3><font color="red">* </font>Primary Field of Practice:</h3></td></tr>
				<tr>
					<td><input name="practice" type="radio" value="Attorney"			<%=check_check("practice","Attorney")%>>Attorney</td>
					<td><INPUT name="practice" type="radio" value="Nursing"			<%=check_check("practice","Nursing")%>>Nursing</td>
					<td><INPUT name="practice" type="radio" value="Physical Therapy"		<%=check_check("practice","Physical Therapy")%>>Physical Therapy</td>
					<td><INPUT name="practice" type="radio" value="Social Work"			<%=check_check("practice","Social Work")%>>Social Work</td>
				</tr>
				<tr>
					<td><INPUT name="practice" type="radio" value="Counselling"			<%=check_check("practice","Counseling")%>>Counseling</td>
					<td><INPUT name="practice" type="radio" value="Occupational Therapy"	<%=check_check("practice","Occupational Therapy")%>>Occupational Therapy</td>
					<td><INPUT name="practice" type="radio" value="Psychology"			<%=check_check("practice","Psychology")%>>Psychology</td>
					<td><INPUT name="practice" type="radio" value="Medicine"			<%=check_check("practice","Medicine")%>>Medicine</td>
				</tr>
				<tr>
					<td><INPUT name="practice" type="radio" value="Speech Therapy"		<%=check_check("practice","Speech Therapy")%>>Speech Therapy</td>
					<td><INPUT name="practice" type="radio" value="Rehabilitation Counselling"<%=check_check("practice","Rehabilitation Counselling")%>>Rehabilitation&nbsp;Counseling</td>
					<td><INPUT name="practice" type="radio" value="Other"				<%=check_check("practice","Other")%>>Other</td>
				</tr>
	<tr><td colSpan="4"><br />
			<h3>Life Care Planning/Case Management Speciality Area(s):</h3><br /><br />
			<h3><font color="red">* </font>Pediatric</h3>
	</td></tr>
				<tr>
					<td><INPUT name="chbpediatric" type="checkbox" value="Spinal Cord Injury" <%=check_check("chbpediatric","Spinal Cord Injury")%>>Spinal Cord Injury</td>
					<td><INPUT name="chbpediatric" type="checkbox" value="Birth Injury"	<%=check_check("chbpediatric","Birth Injury")%>>Birth Injury</td>
					<td><INPUT name="chbpediatric" type="checkbox" value="Psychiatric"	<%=check_check("chbpediatric","Psychiatric")%>>Psychiatric</td>
					<td><INPUT name="chbpediatric" type="checkbox" value="Chronic Pain"	<%=check_check("chbpediatric","Chronic Pain")%>>Chronic Pain</td>
				</tr>
				<tr>
					<td><INPUT name="chbpediatric" type="checkbox" value="Burns"		<%=check_check("chbpediatric","Burns")%>>Burns</td>
					<td><INPUT name="chbpediatric" type="checkbox" value="Acquired Brain Injury"	<%=check_check("chbpediatric","Acquired Brain Injury")%>>Acquired Brain Injury</td>
					<td><INPUT name="chbpediatric" type="checkbox" value="Multiple Trauma" <%=check_check("chbpediatric","Multiple Trauma")%>>Multiple Trauma</td>
					<td><INPUT name="chbpediatric" type="checkbox" value="All"			<%=check_check("chbpediatric","All")%>>All</td>
				</tr>
				<tr>
					<td><INPUT name="chbpediatric" type="checkbox" value="N/A"			<%=check_check("chbpediatric","N/A")%>>N/A</td>
					<td><INPUT name="chbpediatric" type="checkbox" value="Other"		<%=check_check("chbpediatric","Other")%>>Other</td>
				</tr>
	<tr><td colSpan="5"><h3><font color="red">* </font>Adults</h3></td></tr>
                    <tr>
                         <td><input name="chbadult" type="checkbox" value="Spinal Cord Injury"	<%=check_check("chbadult","Spinal Cord Injury")%>>Spinal&nbsp;Cord&nbsp;Injury</td>
                         <td><input name="chbadult" type="checkbox" value="Multiple Trauma"	<%=check_check("chbadult","Multiple Trauma")%>>Multiple Trauma</td>
					<td><input name="chbadult" type="checkbox" value="Psychiatric"	  	<%=check_check("chbadult","Psychiatric")%>>Psychiatric</td>
                         <td><input name="chbadult" type="checkbox" value="Chronic Pain"		<%=check_check("chbadult","Chronic Pain")%>>Chronic&nbsp;Pain</td>
              </tr>
                         <tr>
                         <td><input name="chbadult" type="checkbox" value="Burns"			<%=check_check("chbadult","Burns")%>>Burns</font></td>
                         <td><input name="chbadult" type="checkbox" value="Acquired Brain Injury" <%=check_check("chbadult","Acquired Brain Injury")%>>Acquired Brain Injury</td>
                         <td><input name="chbadult" type="checkbox" value="All"				<%=check_check("chbadult","All")%>>All </td>
                         <td><input name="chbadult" type="checkbox" value="N/A"				<%=check_check("chbadult","N/A")%>>N/A</font> </td>
                         </tr>
                         <tr>
                         <td><input name="chbadult" type="checkbox" value="Toxic Torts"		<%=check_check("chbadult","Toxic Torts")%>>Toxic Torts</td>
					<td><input name="chbadult" type="checkbox" value="Medicare Set-Asides" <%=check_check("chbadult","Medicare Set-Asides")%>>Medicare Set-Asides</td>
                         <td><input name="chbadult" type="checkbox" value="Workers Comp"		<%=check_check("chbadult","Workers Comp")%>>Workers'&nbsp;Compensation </td>
                         <td><input name="chbadult" type="checkbox" value="Other"			<%=check_check("chbadult","Other")%>>Other</td>
                         </tr>
          </table>
		</td>
	</tr>
	<tr>
		<td colSpan="4"><h3>Professional Information: <em style="font-weight:normal; text-decoration:none; ">(if additional information is desired)</em></h3></td>
	</tr>
	<tr>
		<td colSpan="6"><TEXTAREA id="info" name="info" value=""rows="5" cols="70"><%=info%></TEXTAREA></td>
	</tr>
	<tr><td colSpan="6" height="10"></td></tr>
	<% if maint <> true then %>
	<tr>
		<td colSpan="6" height="10">
			<strong>Please type the numbers displayed in the box.</strong>
			<table border="0" cellspacing="0" cellpadding="0">
			<tr><td>
			<%
			session("check_str") = ""
			dim check_array()
			intUpperBound = 9
			intLowerBound = 0
			redim check_array(4)
			for i = 0 to ubound(check_array)
				Randomize()
				intRangeSize = intUpperBound - intLowerBound + 1
				sngRandomValue = intRangeSize * Rnd()
				check_array(i) = Int(sngRandomValue)
			next
			for i = 0 to ubound(check_array)
				select case check_array(i)
					case 1
						img = "dirt.gif"
					case 2
						img = "musky.gif"
					case 3
						img = "fartwad.gif"
					case 4
						img = "crispy.gif"
					case 5
						img = "noogies.gif"
					case 6
						img = "meinleben.gif"
					case 7
						img = "bungie.gif"
					case 8
						img = "fargle.gif"
					case 9
						img = "jingle.gif"
					case else '0
						img = "sparkle.gif"
				end select
				session("check_str") = session("check_str") & check_array(i)
				response.write "<img src=""/images/ver/" & img & """ />"
			next
			%>
			</td><td>
			&nbsp;<input type="text" name="verify" size="20" />&nbsp;<font color="red">* </font>
			</td></tr>
			</table>
			<br>
		</td>
	</tr>
	<% end if %>
	<tr>
		<td></td>
		<% if record_id = "" or record_id = "0" then %>
		<td><INPUT type="submit" value="Submit" name="action"><INPUT type="reset" value="  Reset  " name="reset"></td>
		<% else %>
		<td>
			Verified:&nbsp;<select name="verified">
			<option value="true" <%if verified then %>selected<%end if%>>Yes</option>
			<option value="false" <%if not verified then %>selected<%end if%>>No</option>
			</select><br><br>
			<INPUT type="submit" value="Update" name="action"><INPUT type="submit" value="Delete" name="action" onClick="return confirm('Are you sure you want to delete this record?')"><INPUT type="button" value="Cancel" onClick="document.location='index.asp'"></td>
		<% end if %>
	</tr>
</table>
<%
function check_check(field_name,field_value)
	compare_value = ""
	found_value = ""
	select case field_name
		case "chbdegrees"
			compare_value = chbdegrees
		case "chbcertifications"
			compare_value = chbcertifications
		case "practice"
			compare_value = practice
		case "chbpediatric"
			compare_value = chbpediatric
		case "chbadult"
			compare_value = chbadult
	end select
 
	compare_array = split(compare_value,",")
	for i = 0 to ubound(compare_array)
		if trim(compare_array(i)) = field_value then
			found_value = "checked"
		end if
	next
	check_check = found_value
end function
%>
[+][-]09.24.2008 at 10:34PM PDT, ID: 22566453

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[+][-]09.25.2008 at 06:40AM PDT, ID: 22568941

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[+][-]09.25.2008 at 11:54AM PDT, ID: 22572668

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[+][-]09.25.2008 at 12:04PM PDT, ID: 22572774

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[+][-]09.25.2008 at 12:29PM PDT, ID: 22572995

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[+][-]09.25.2008 at 01:46PM PDT, ID: 22573704

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About this solution

Zones: Active Server Pages (ASP), Programming for ASP.NET
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Solution Provided By: mkosbie
Participating Experts: 1
Solution Grade: A
 
 
[+][-]09.25.2008 at 01:50PM PDT, ID: 22573730

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[+][-]09.25.2008 at 01:51PM PDT, ID: 22573735

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[+][-]09.25.2008 at 03:16PM PDT, ID: 22574442

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[+][-]09.25.2008 at 03:31PM PDT, ID: 22574584

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[+][-]09.25.2008 at 03:39PM PDT, ID: 22574686

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20081112-EE-VQP-44 - Hierarchy / EE_QW_2_20070628