On this prticular form I keep getting the following error message with regards to line 20 and 147. Can't seem to find what the problem is. Need to get this done ASAP
A runtime error has occured
Do you wish to Debug?
Line: 20
Error: 'document.hdoprovidercredf
orm.year' is null or not an object
and
Line:147
Error: 'document.hdoprovidercredf
orm.year' is null or not an object
<html>
<head>
<title>HDO/Organizational Provider Credentialing</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
<link rel="stylesheet" href="base.css" type="text/css">
<!------------------------
----------
----------
------->
<script language="JavaScript">
<!--
function setdate()
{
var thetime=new Date();
var nmonth=thetime.getMonth();
var ntoday=thetime.getDate();
var nyear=thetime.getYear();
nmonth+=1;
if (nyear<=99) nyear= "19"+nyear;
if ((nyear>99) && (nyear<2000)) nyear+=1900;
thedate=nmonth+"/"+ntoday+
"/"+nyear;
document.hdoprovidercredfo
rm.year.va
lue=thedat
e;}
//-->
</script>
<!------------------------
----------
----------
------->
<script>
var area=new Array();
area[0]=["Maine","Connecti
cut","Mass
achusetts"
,"New Hampshire","Northern, NJ","Upstate, NY","Metro, NY","Rhode Island","Vermont"];
area[1]=["Western, PA","Cent./No., PA","Southeast, PA","Southern, NJ","Delaware","N.VA/WA/Li
nth, VA","Hampt. Rds, VA","Roanoke, VA","Richmond, VA","West Virginia"];
area[2]=["Charllote, NC","Raleigh, NC","South Carolina","Georgia","Calif
ornia","Al
abama","Mi
ssippi","T
ampa, FL","Orlando, FL","South, FL","Pensacola, FL","Jacksonville, FL","Louisiana","Arkansas"
,"Nashvill
e, TN","Memphis, TN"];
area[3]=["Illinois","India
na","Kentu
cky","Mich
igan","Cin
cinnati, OH","Richfield, OH","New Albany, OH","Toledo, OH","Wisconsin","Colorado"
,"Kansas City, MO","St.Louis, MO","South Dakota"];
area[4]=["Oklahoma City, OK","Tulsa, OK","Abilene, TX","Amarillo, TX","Austin, TX","Brownwood, TX","Bryan/College Station, TX","Corpus Christi, TX","Dallas, TX","East Texas, TX","El Paso, TX","Hill Country Network, TX","Houston, TX",
,"Houston Cal. Vic., TX","Karnes, TX","Laredo, TX","Lubbock, TX","Midland/Odessa, TX","Rio Grande Valley, TX","San Angelo, TX","San Antontio, TX","West, TX","Witchita Falls, TX"];
area[5]=["Alaska","Arizona
","Califor
nia","Neva
da","South
ern, CA","Northern, CA","San Diego, CA","Utah","Washington","N
ew Mexico"];
function createRegion(opt){
var sel=document.getElementByI
d("area");
for(var j=sel.options.length; j>-1;j--){
sel.options[j]=null;
}
if(opt<0) return false;
for(var i=0; i<area[opt].length;i++){
var optIndex=sel.options.lengt
h;
sel.options[optIndex]=null
;
sel.options[optIndex]=new Option(area[opt][i],area[o
pt][i]);
}
} </script>
<!------------------------
----------
--->
<script type="text/JavaScript">
function concat(one,two,three,four)
{
document.getElementById('m
ailnamesrv
loc').valu
e=""+one+"
"+two+" "+three+" "+four+"";
}
</script>
<!------------------------
----------
--->
<script language="JavaScript">
var prov=new Array(1);
prov[0]=["Hospitals-HO","H
ospitals-C
H","Nursin
g Homes-CF","Nursing Homes-NC","Skilled Nursing-SK",
"Home Care Agencies-HA","Free Standing Surgical Centers-AC","Free Standing Abortion Centers-VIP",
"Free Standing Birthing Centers-BC","Mental Health Hospital-PSH","Chemical Dependency Hospitals-SA",
"Residential Treatment Facilities-RTF","Partial Hospital Programs-PD","Intensive Outpatient Programs and Clinics-IO"
];
prov[1]=["Laboratories-LB"
,"Comprehe
nsive Outpatient Rehab Facilities-AR","Outpatient
Physical Therapy Providers-PT"
,"Outpatient Speech Pathology Providers-ST","Outpatient Speech Pathology Providers-SH","End-Stage Renal Disease Services Providers-DI"
];
prov[2]=["Free Standing Abortion Clinics-VIP",
"Community Mental Health Centers-Other","Diagnostic
Radiology Centers, including MRI and Mobile Units (which includes Mammography, Bone Density and Lithotripsy)-DA",
"Diagnostic Radiology Centers, including MRI and Mobile Units (which includes Mammography, Bone Density and Lithotripsy-MRI",
"Dialysis Centers-DI",
"DME Suppliers-DE",
"Hospice Agencies-HS",
"Infusion Service Centers-IC",
"Oncology Centers-OTC",
"Orthotics and Prosthetics-OF",
"Sleep Diagnostic-SD",
"Urgent Care Centers-UC"];
function createProv(opt){
var sel=document.getElementByI
d("prov");
for(var j=sel.options.length; j>-1;j--){
sel.options[j]=null;
}
if(opt<0) return false;
for(var i=0; i<prov[opt].length;i++){
var optIndex=sel.options.lengt
h;
sel.options[optIndex]=null
;
sel.options[optIndex]=new Option(prov[opt][i],prov[o
pt][i]);
}
}
</script>
<!------------------------
----------
--->
<script type="text/javascript">
<!--
function formatPhoneFax(strField){/
/123-456-7
890
var oLen = strField.value.length;
if(oLen == 3){strField.value += "-";}
if(oLen == 7){strField.value += "-";}
}
// -->
</script>
<script type="text/javascript">
<!--
function formatFax(strField){//123-
456-7890
var oLen = strField.value.length;
if(oLen == 3){strField.value += "-";}
if(oLen == 7){strField.value += "-";}
}
// -->
</script>
<script type="text/javascript">
<!--
function formatProvphone(strField){
//123-456-
7890
var oLen = strField.value.length;
if(oLen == 3){strField.value += "-";}
if(oLen == 7){strField.value += "-";}
}
// -->
</script>
<script type="text/javascript">
<!--
function formatDate(strField){//12-
34-5678
var oLen = strField.value.length;
if(oLen == 2){strField.value += "-";}
if(oLen == 6){strField.value += "-";}
}
// -->
</script>
</head>
<body bgcolor="#FFFFFF" text="#000000" marginheight="0" marginwidth="0" topmargin="0" leftmargin="0" vspace="0" hspace="0" onLoad="setdate(); initOptions(window.documen
t.hdoprovi
dercredfor
m.speca,Sp
ecialty); swapOptions(window.documen
t.hdoprovi
dercredfor
m.speca);"
>
<!-- Begin Top Nav Bar Script -->
<script type='text/javascript'>
function lastmodified()
{
var mdate = new String("Updated: " + document.lastModified);
var mdate = mdate.slice(0,-8);
document.write(mdate);retu
rn (true);
}
function Go(){return}
</script>
<!-- End Top Nav Bar Script -->
<!-- Begin Co-Branding Area -->
<table width="100%" border="0" cellpadding="0" cellspacing="0">
<tr hspace="0">
<!-- LOGO - Your Logo goes here. Maximum size is 375 pixels wide by 55 pixels high -->
<td width="100%" align="center" valign="bottom">
<h2 align="center"><a href="
http://*******.*******.com/">
<img src="*******.gif" alt="*******" border="0" align="left" width="133" height="55"></a></h2>
<h2 align="center"><font face="Times New Roman">HDO/Organizational
Provider Credentialing Application</font></h2>
</td>
<!-- END LOGO -->
</tr>
<!-- End Co-Branding Area -->
</table>
<table width="100%" border="0" cellpadding="0" cellspacing="0" bgcolor="#CCFF33">
<!-- Begin Upper Top Nav -->
<tr bgcolor="#003366">
<td height="28" align="right" width="25%" bgcolor="#99CC33"><nobr>
<p align="left" class="smallerbold"></nobr
></td>
<td width="55%" align="center" valign="center" bgcolor="#99CC33"> </
td>
<td width="20%" height="28" align="right" bgcolor="#99CC33">
</td>
</tr>
</table>
<!-- End Upper Top Nav -->
<table width="100%" border="0" cellpadding="0" cellspacing="0">
<!-- Begin Lower Top Nav -->
<tr bgcolor="#477aae">
<td width="20%" height="25" class="smallerwhite" align="left"><span class="smallerwhite">
<SCRIPT language="JavaScript" src="js/date.js"></SCRIPT>
</span></td>
<td width="80%"><font color="#ffffff"> </fo
nt></td>
</tr>
</table>
<!-- End Lower Top Nav -->
<table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber7">
<!-------hdo/organizationa
l provider credentialing form--------->
<form name="hdoprovidercredform"
method="POST" ACTION="/sharedsvcsMail/Ma
ilServlet?
html_genle
rr_templat
e=mailfail
.tmpl" ENCTYPE="multipart/form-da
ta" onSubmit="">
<INPUT TYPE=HIDDEN NAME="from" VALUE="s029987@*******.com
">
<INPUT TYPE=HIDDEN NAME="to" VALUE="HDOCredentialing2@*
******.com
">
<INPUT TYPE=HIDDEN NAME="html_success_templat
e" VALUE="thankshdoapp.htm">
<INPUT TYPE=HIDDEN NAME="mailmsg_template" VALUE="templatehdoprovapp.
mt">
<INPUT TYPE=HIDDEN NAME="html_editerr_templat
e" VALUE="web-mail_editError.
tmpl">
<INPUT TYPE=HIDDEN NAME="required" VALUE="">
<INPUT TYPE=HIDDEN NAME="subject" VALUE="HDO/Organizational Provider Application Request Form">
<tr>
<td width="100%"> </td>
</tr>
<tr>
<td width="100%">
<p align="center"> </td>
</tr>
</table>
<hr>
<div align="center">
<center>
<table border="1" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="95%" id="AutoNumber6">
<tr>
<td width="7" bgcolor="#0099FF" height="10"> </td>
<td width="95%" bgcolor="#0099FF" height="10">
</td>
<td width="7" bgcolor="#0099FF" height="10"> </td>
</tr>
<tr>
<td width="7" bgcolor="#0099FF"> </
td>
<td width="95%">
<p align="center"><font size="2">An " <font color="#FF0000"><b>*</b></
font>
" indicates a required field. </font></p>
<p> <script language=javascript type="text/javascript">
<!--
//-->
</script><input type="text" name="submitter" size="56" tabindex=1 maxlenght=2>
<b><font color="#FF0000">*</font></
b>Submitte
r name<p> <select name="region" onchange="javascript:creat
eRegion(th
is.selecte
dIndex-1);
" size="1" tabindex="2">
<option>Select a region
<option>Northeast
<option>Mid-Atlantic
<option>Southeast
<option>North Central
<option>Southwest
<option>West
</select>
<select id="area" size="1" tabindex="3" name="site"></select>
<font color="#FF0000"><b>*</b></
font>Site<
p>
</p>
<p> <script language="javascript">
function insertSlash(ele)
{
if ((ele.value.length == 2) || (ele.value.length == 5)) ele.value += "/";
return ele.value;
}
</script><input type="text" name="date" size="20" maxlength="10" onkeypress="this.value=ins
ertSlash(t
his);" onblur="if(this.value=='')
{this.valu
e='mm/dd/y
yyy';}" onfocus="if(this.value=='m
m/dd/yyyy'
){this.val
ue='';}" tabindex="4" />
<b><font color="#FF0000">*</font></
b>Date of Request <font size="2">month,
day, year (ex: '12/15/02')</font><br>
<br>
<select size="1" name="client" tabindex=5 onBlur="">
<option>Please choose client</option>
<option value="Local">Local</optio
n>
<option value="National">National<
/option>
<option value="AWCA">AWCA</option>
<option value="BH">BH</option>
<option value="Medicaid">Medicaid<
/option>
</select> </p>
<p> <b><font color="#FF0000"><select name="provdescr" onchange="javascript:creat
eProv(this
.selectedI
ndex-1);" size="1" tabindex="6">
<option>Select a Provider Type
<option>******* RECOGNIZED HDO PROVIDERS TYPES
<option>MEDICARE PRODUCT FACILITIES
<option>ADDITIONAL FACILITIES ONLY CREDENTIALED IN TX
</select>
*</font></b>HDO/Organizati
onal Provider Type <b><font color="#FF0000">
<br>
<select id="prov" name="provdetails" size="1" tabindex="7"></select>
</font></b><font size="2">  
; &nb
sp; &
nbsp; 
; &nb
sp; &
nbsp; 
; &nb
sp; &
nbsp; 
; &nb
sp; &
nbsp; 
; &nb
sp; &
nbsp; 
; &nb
sp; &
nbsp; 
; &nb
sp; &
nbsp; 
; &nb
sp; &
nbsp; 
; &nb
sp; &
nbsp; 
; &nb
sp;
(*Applies to Medicare Product Only- **State Mandated-Requires Comment)<br>
&n
bsp;
&nbs
p; &n
bsp;
&nbs
p; &n
bsp;
&nbs
p; &n
bsp;
&nbs
p; &n
bsp;
&nbs
p; &n
bsp;
&nbs
p; &n
bsp;
&nbs
p; &n
bsp;
</font></p>
<p> <input type="text" name="HdoProvName" size="39" tabindex=8> <b><font color="#FF0000">
*</font></b>HDO/Organizati
onal Provider Name</p>
<p><font size="2"> </font><inp
ut type="text" name="servicelocation" size="24" tabindex=9 onBlur="">
<b><font color="#FF0000">
*</font></b>List Primary Service Location and ALL additional service
locations</p>
<p> <input type="text" name="street" size="44" tabindex=10 onBlur="">
<font color="#FF0000"><b>*</b></
font>Stree
t</p>
<p> <input type="text" name="suite" size="5" tabindex=11 onBlur="">
<font color="#FF0000"><b>*</b></
font>Suite
<br>
<br>
<input type="text" name="city" size="44" tabindex=12 onBlur=""><b><font color="#FF0000">
*</font></b>City: <font size="2">(Anytown)</font><
/p>
<p>
<select size="1" name="state" tabindex=13 onBlur="">
<option></option>
<option value="AL">Alabama</option
>
<option value="AK">Alaska</option>
<option value="AR">Arkansas</optio
n>
<option value="AZ">Arizona</option
>
<option value="CA">California</opt
ion>
<option value="CO">Colorado</optio
n>
<option value="CT">Connecticut</op
tion>
<option value="DC">Dist.of Colum.</option>
<option value="DE">Delaware</optio
n>
<option value="FL">Florida</option
>
<option value="GA">Georgia</option
>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</optio
n>
<option value="IN">Indiana</option
>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</optio
n>
<option value="LA">Louisiana</opti
on>
<option value="MA">Massachusetts</
option>
<option value="MD">Maryland</optio
n>
<option value="ME">Maine</option>
<option value="MI">Michigan</optio
n>
<option value="MN">Minnesota</opti
on>
<option value="MS">Mississippi</op
tion>
<option value="MO">Missouri</optio
n>
<option value="MT">Montana</option
>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="NE">Nebraska</optio
n>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NV">Nevada</option>
<option value="NY">New York</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</optio
n>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</o
ption>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</opti
on>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VA">Virginia</optio
n>
<option value="VT">Vermont</option
>
<option value="WA">Washington</opt
ion>
<option value="WI">Wisconsin</opti
on>
<option value="WV">West Virginia</option>
<option value="WY">Wyoming</option
>
</select> <b><font color="#FF0000">*</font></
b>Please Select
State</p>
<p>
<input type="text" name="zip1" size="7" tabindex=14 onBlur="">
-
<input type="text" name="zip2" size="6" tabindex=15 onBlur=""><font color="#FF0000"> <b>
*</b></font>ZIP<p>
<input type="text" name="phone1" maxlength="12" size="12" onkeypress="formatPhoneFax
(this)" tabindex="16" />
<b><font color="#FF0000">*</font></
b>Phone<p>
<input type="text" name="fax1" maxlength="12" size="12" onkeypress="formatFax(this
)" tabindex="17" />
<b><font color="#FF0000">
*</font></b>Fax<p> <s
elect size="1" name="taxid_lett" tabindex=18>
<option></option>
<option>E</option>
<option>S</option>
</select> - <input type="text" name="taxid" size="9" tabindex=19><b><font color="#FF0000">
*</font></b>Providers Tax ID Number<font size="2"> <font color="#FF0000"><b>
DO NOT INCLUDE SPACES OR DASHES </b></font></font></p>
<p> <input type="text" name="ProvContactName" size="24" tabindex=20>
<b><font color="#FF0000">
*</font></b>Provider Contact Name</p>
<p> <input type="text" name="ProvContactPhone1" maxlength="12" size="12" onkeypress="formatProvphon
e(this)" tabindex="21" />
<b><font color="#FF0000">
*</font></b>Provider Contact Phone </p><b> Comments:</b>
<p>
<textarea rows="4" name="comments" cols="66" tabindex=22></textarea><p>
</p>
</td>
<td width="7" bgcolor="#0099FF"> </
td>
</tr>
</table>
</center>
</div>
<hr>
<p align="center">
<input type="submit" value="Submit" name="B1" tabindex=23 style="font-weight: bold">
<input type="reset" value="Reset" name="B2" tabindex=24 style="font-weight: bold"><b><br>
******* Credentialing - One Team One Process One Standard - Excellence</b></p>
<hr>
<p align="left">
<font class="footer">
<a href="
http://www.*******.com">
<img src="aelogo_s.gif" border="0" alt="******* logo" align="right" width="150" height="47"></a>
Owner: Credentialing | Contact: Jeff Coddington |
<a href="mailto:?subject=Feed
back from the Credentialing Web Site">Feedback</a>
<BR>
<script>lastmodified
();</scrip
t> | ©2002 ******* Inc. | <a href="/">
******* home</a>
</font>
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</p>
</body>
</html>
