function Is() {
    var agent   = navigator.userAgent.toLowerCase();

    this.major  = parseInt(navigator.appVersion);
    this.minor  = parseFloat(navigator.appVersion);

    this.ns     = ((agent.indexOf('mozilla')   != -1) &&
                  (agent.indexOf('spoofer')    == -1) &&
                  (agent.indexOf('compatible') == -1) &&
                  (agent.indexOf('opera')      == -1) &&
                  (agent.indexOf('webtv')      == -1));
    this.ns2    = (this.ns && (this.major      ==  2));
    this.ns3    = (this.ns && (this.major      ==  3));
    this.ns4    = (this.ns && (this.major      ==  4));
    this.ns6    = (this.ns && (this.major      >=  5));
    this.ie     = (agent.indexOf("msie")       != -1);
    this.ie3    = (this.ie && (this.major      <   4));
    this.ie4    = (this.ie && (this.major      ==  4) &&
                  (agent.indexOf("msie 5.0")   == -1));
    this.ie5    = (this.ie && (this.major      ==  4) &&
                  (agent.indexOf("msie 5.0")   != -1));
    this.ie6    = (this.ie && (this.major      ==  4) &&
                  (agent.indexOf("msie 6.0")   != -1));
    this.ieX    = (this.ie && !this.ie3 && !this.ie4);
	this.opera  = (agent.indexOf('opera')      == 0) 
}

var is = new Is();
function ucw(str){
re = /_/gi;
str = str.replace(re,' ');
strArray = str.split(' ');
for(j=0; j<strArray.length; j++){
	strArray[j] = strArray[j].charAt(0).toUpperCase() + strArray[j].substring(1);
}
return strArray.join(' ');
}
function validate(){
var errors;
var focus_el;
for(i=0; i<document.theform.elements.length; i++){
	test = document.theform.elements[i].value;
	name = document.theform.elements[i].name;

	if(document.theform.elements[i].type !='hidden' && test == '' &&  (name=='company_name' ||  name=='email')){
		alert(ucw(document.theform.elements[i].name)+' is required');
		document.theform.elements[i].focus();
		return false;
	}
	if(name=='email'){
		var filter=/^([\w-]+(?:\.[\w-]+)*)@((?:[\w-]+\.)*\w[\w-]{0,66})\.([a-z]{2,6}(?:\.[a-z]{2})?)$/i;
		if(!filter.test(test)){
			alert('Please enter a valid email');
			document.theform.elements[i].focus();
			errors = true;
		}
	}
}
for(j=0; j<document.theform.number_of_eligible_employees.value; j++){
	if(document.theform['employee['+j+'][full_name]'].value == ''){
		alert('Please enter all eligible employees information');
		document.theform['employee['+j+'][full_name]'].focus();
		errors = true;
		return false;
	}
	if(document.theform['employee['+j+'][age]'].value == ''){
		alert('Please enter all eligible employees information');
		document.theform['employee['+j+'][age]'].focus();
		errors = true;
		return false;
	}
}
if(errors){
	return false;
}else{
	return true;
}
}
function trapint(event) {
if(is.ns4||is.ns6||is.opera) {
	if (event.which>46 && event.which<58) {
		return true;
	} else {
		event.preventDefault();
	}
}else{
	if (event.keyCode>46 && event.keyCode<58) {
		return true;
	} else {
		event.returnValue = false;
		return false;
	}
}
}
function show_ees(){
	var content;
	var number_of_eligible_employees = document.theform.number_of_eligible_employees.value;
	var full_name_value = '';
	var sex_value = '';
	var sex_m_selected = '';
	var sex_f_selected = '';
	var age_value = '';
	var ssn_value = '';
	var monthly_salary_value = '';
	var hours_per_week_value = '';
	var hire_date_value = '';
	var job_title_value = '';
	var spouse_value = '';
	var spouse_y_selected = '';
	var spouse_n_selected = '';
	var dependents_value = '';
	var home_zipcode_value = '';
	if(number_of_eligible_employees>=1){
		if(number_of_eligible_employees>50){
			number_of_eligible_employees=50;
			alert('This form only allows for 50 eligible employees');
		}
		document.theform.number_of_eligible_employees.value = number_of_eligible_employees;
		document.getElementById('comments').style.display='block';
		document.getElementById('ee').style.display='block';
		content = '<table BORDER=0 width=760px cellspacing=0><tr><td colspan=11><b>Eligible Employees</b></td></tr>';
		content += '<tr><td ALIGN=CENTER valign=top>1</td><td ALIGN=CENTER valign=top>2</td><td ALIGN=CENTER valign=top>3</td><td ALIGN=CENTER valign=top>4</td><td ALIGN=CENTER valign=top>5</td><td ALIGN=CENTER valign=top>6</td><td ALIGN=CENTER valign=top>7</td><td ALIGN=CENTER valign=top>8</td><td ALIGN=CENTER valign=top>9</td><td ALIGN=CENTER valign=top>10</td></tr>';
		content += '<tr><td ALIGN=CENTER valign=top><span style="color:red">* </span><span style=font-size:11px>Full Name</span></font></td><td ALIGN=CENTER valign=top><span style=font-size:11px>Sex</span></td><td ALIGN=CENTER valign=top><span style="color:red">* </span><span style=font-size:11px>Age</span></td><td ALIGN=CENTER valign=top><span style=font-size:11px>SS#</span></td><td ALIGN=CENTER valign=top><span style=font-size:11px>Monthly<br>Salary</span></td><td ALIGN=CENTER valign=top><span style=font-size:11px>Hours /<br>Week</span></td><td ALIGN=CENTER valign=top><span style=font-size:11px>Hire Date<br>00-00-00</span></td><td ALIGN=CENTER valign=top><span style=font-size:11px>Job Title</span></td><td ALIGN=CENTER valign=top><span style=font-size:11px>Spouse</span></td><td ALIGN=CENTER valign=top><span style=font-size:11px>Dependents</span></td><td ALIGN=CENTER valign=top><span style=font-size:11px>Home<br>Zipcode</span></td></tr>';
		for(i=0; i<number_of_eligible_employees; i++){
			full_name = 'employee['+i+'][full_name]';
			sex = 'employee['+i+'][sex]';
			age = 'employee['+i+'][age]';
			ssn = 'employee['+i+'][ss#]';
			monthly_salary = 'employee['+i+'][monthly_salary]';
			hours_per_week = 'employee['+i+'][hours_per_week]';
			hire_date = 'employee['+i+'][hire_date]';
			job_title = 'employee['+i+'][job_title]';
			spouse = 'employee['+i+'][spouse]';
			dependents = 'employee['+i+'][dependents]';
			home_zipcode = 'employee['+i+'][home_zipcode]';
			try{
				full_name_value = document.theform(full_name).value;
				sex_value = document.theform(sex).value;
				if(sex_value == 'M'){
					sex_m_selected = 'selected';
				}else if(sex_value == 'M'){
					sex_f_selected = 'selected';
				}
				age_value = document.theform(age).value;
				ssn_value = document.theform(ssn).value;
				monthly_salary_value = document.theform(monthly_salary).value;
				hours_per_week_value = document.theform(hours_per_week).value;
				hire_date_value = document.theform(hire_date).value;
				job_title_value = document.theform(job_title).value;
				spouse_value = document.theform(spouse).value;
				if(spouse_value == 'N'){
					spouse_n_selected = 'selected';
				}else if(spouse_value == 'Y'){
					spouse_y_selected = 'selected';
				}
				dependents_value = document.theform(dependents).value;
				home_zipcode_value = document.theform(home_zipcode).value;
			}catch(e){
			}
			content += '<tr><td><input type=text '; 
			content += 'name="employee['+i+'][full_name]" value="'+full_name_value+'" size=19></td><td nowrap><SELECT ';  
			content += 'name="employee['+i+'][sex]"><OPTION value=></OPTION><OPTION value=M '+sex_m_selected+'>M</OPTION><OPTION value=F '+sex_f_selected+'>F</OPTION></SELECT></td><td><input type=text ';  
			content += 'name="employee['+i+'][age]" value="'+age_value+'" size=1 maxlength=2></td><td><input type=text ';  
			content += 'name="employee['+i+'][ss#]" value="'+ssn_value+'" size=9 maxlength=11></td><td><input type=text '; 
			content += 'name="employee['+i+'][monthly_salary]" value="'+monthly_salary_value+'" value=$ size=6 maxlength=8></td><td><input type=text '; 
			content += 'name="employee['+i+'][hours_per_week]" value="'+hours_per_week_value+'" size=3 maxlength=3></td><td><input type=text '; 
			content += 'name="employee['+i+'][hire_date]" value="'+hire_date_value+'" size=6 maxlength=8></td><td><input type=text '; 
			content += 'name="employee['+i+'][job_title]" value="'+job_title_value+'" size=20></td><td><SELECT '; 
			content += 'name="employee['+i+'][spouse]"><OPTION value=></OPTION><OPTION value=Y '+spouse_y_selected+'>Y</OPTION><OPTION value=N '+spouse_n_selected+'>N</OPTION></SELECT></td><td><input type=text ';  
			content += 'name="employee['+i+'][dependents]" value="'+dependents_value+'" size=6></td><td><input type=text ';  
			content += 'name="employee['+i+'][home_zipcode]" value="'+home_zipcode_value+'" size=6 maxlength=10></td></tr>';
			full_name_value = '';
			sex_value = '';
			sex_m_selected = '';
			sex_f_selected = '';
			age_value = '';
			ssn_value = '';
			monthly_salary_value = '';
			hours_per_week_value = '';
			hire_date_value = '';
			job_title_value = '';
			spouse_value = '';
			spouse_y_selected = '';
			spouse_n_selected = '';
			dependents_value = '';
			home_zipcode_value = '';
		}
		content += '</table>';
		content += '<p align=center><input type=submit name=Submit value="Submit Census"></p><hr color=#000000>';
		document.getElementById('ee').innerHTML=content;
	}else{
		document.getElementById('ee').innerHTML='';
	}
	return true;
}
function show_cobra(){
var content;
var number_of_cobra_employees = document.theform['risk_appraisal_questionnaire[number_of_cobra_participants]'].value;
if(number_of_cobra_employees>=1){
	document.getElementById('cobra').style.display='block';
	content = '<table BORDER=1 WIDTH=760px><tr><td nowrap colspan=5> 3. Employee Name,Date of Qualifying Event & Reason For Each COBRA participant:</td></tr>';
	content += '<tr><td nowrap width=70px>&nbsp;</td><td ALIGN=CENTER valign=top WIDTH=245px>Name</td><td ALIGN=CENTER valign=top WIDTH=83px>Date</td><td ALIGN=CENTER valign=top WIDTH=250px>Reason</td></tr>';
	for(i=0; i<number_of_cobra_employees; i++){
		content += '<tr><td nowrap width=70px>&nbsp;</td><td><input type=text '; 
		content += 'name="risk_appraisal_questionnaire[cobra_participants]['+i+'][name]" size=36 maxlength=100></td><td><input type=text ';  
		content += 'name="risk_appraisal_questionnaire[cobra_participants]['+i+'][date]" size=9 maxlength=9></td><td nowrap><input type=text ';  
		content += 'name="risk_appraisal_questionnaire[cobra_participants]['+i+'][reason]" size=51 maxlength=100></td></tr>';
	}
	content += '</table>';
	document.getElementById('cobra').innerHTML=content;
}else{
	document.getElementById('cobra').innerHTML='';
}
return true;
}
function show_hmp_block(){
var content;
var k;
var number_pregnant = document.theform['number_pregnant'].value;
if(number_pregnant>=1){
	document.getElementById('hmp_block').style.display='block';
	content = '<table BORDER=1 WIDTH=760px>';
	for(i=0; i<number_pregnant; i++){
		k = i+1;
		content += '<tr><td nowrap width=70px>&nbsp;</td><td nowrap width=243px>Due Date ('+k+'):</td><td><input type=text '; 
		content += 'name="risk_appraisal_questionnaire[number_pregnant]['+i+'][due_date]" size=9 maxlength=10></td></tr>';
	}
	content += '</table>';
	document.getElementById('hmp_block').innerHTML=content;
}else{
	document.getElementById('hmp_block').innerHTML='';
}
return true;
}
function show_unable_block(){
var content;
var k;
var number_unable_to_work_due_to_injury_or_illness = document.theform['number_unable_to_work_due_to_injury_or_illness'].value;
if(number_unable_to_work_due_to_injury_or_illness>=1){
	document.getElementById('unable_block').style.display='block';
	content = '<table BORDER=1 WIDTH=760px>';
	for(i=0; i<number_unable_to_work_due_to_injury_or_illness; i++){
		k = i+1;
		content += '<tr><td nowrap width=70px>&nbsp;</td><td nowrap width=243px>Condition ('+k+'):</td><td><input type=text '; 
		content += 'name="risk_appraisal_questionnaire[unable_to_work_due_to_injury_or_illness]['+i+'][condition]" size=9 maxlength=100></td></tr>';
	}
	content += '</table>';
	document.getElementById('unable_block').innerHTML=content;
}else{
	document.getElementById('unable_block').innerHTML='';
}
return true;
}
function show_unable_perform_block(){
var content;
var k;
var number_unable_to_perform_their_normal_work_duties = document.theform['number_unable_to_perform_their_normal_work_duties'].value;
if(number_unable_to_perform_their_normal_work_duties>=1){
	document.getElementById('unable_perform_block').style.display='block';
	content = '<table BORDER=1 WIDTH=760px>';
	for(i=0; i<number_unable_to_perform_their_normal_work_duties; i++){
		k = i+1;
		content += '<tr><td nowrap width=70px>&nbsp;</td><td nowrap width=243px>Explaination ('+k+'):</td><td><input type=text '; 
		content += 'name="risk_appraisal_questionnaire[unable_to_perform_normal_work_duties]['+i+'][explaination]" size=9 maxlength=100></td></tr>';
	}
	content += '</table>';
	document.getElementById('unable_perform_block').innerHTML=content;
}else{
	document.getElementById('unable_perform_block').innerHTML='';
}
return true;
}
function show_dependent_children_block(){
var content;
var k;
var number_dependent_children = document.theform['number_dependent_children'].value;
if(number_dependent_children>=1){
	document.getElementById('dependent_children_block').style.display='block';
	content = '<table BORDER=1 WIDTH=760px>';
	for(i=0; i<number_dependent_children; i++){
		k = i+1;
		content += '<tr><td nowrap width=70px>&nbsp;</td><td nowrap width=243px>Explaination ('+k+'):</td><td><input type=text '; 
		content += 'name="risk_appraisal_questionnaire[dependent_children_with_physical_or_mental_disability]['+i+'][explaination]" size=9 maxlength=100></td></tr>';
	}
	content += '</table>';
	document.getElementById('dependent_children_block').innerHTML=content;
}else{
	document.getElementById('dependent_children_block').innerHTML='';
}
return true;
}
function show_workers_compensation_block(){
var content;
var number_employees_not_covered_by_workers_compensation = document.theform['number_employees_not_covered_by_workers_compensation'].value;
if(number_employees_not_covered_by_workers_compensation>=1){
	document.getElementById('workers_compensation_block').style.display='block';
	content = '<table BORDER=1 WIDTH=760px>';
	content += '<tr><td nowrap width=70px>&nbsp;</td><td ALIGN=CENTER valign=top WIDTH=245px>Name</td><td ALIGN=CENTER valign=top WIDTH=83px>&nbsp;</td><td ALIGN=CENTER valign=top WIDTH=250px>Title</td></tr>';
	for(i=0; i<number_employees_not_covered_by_workers_compensation; i++){
		content += '<tr><td nowrap width=70px>&nbsp;</td><td><input type=text '; 
		content += 'name="risk_appraisal_questionnaire[employees_not_covered_by_workers_compensation]['+i+'][name]" size=36 maxlength=100></td><td>';  
		content += '&nbsp;</td><td nowrap><input type=text ';  
		content += 'name="risk_appraisal_questionnaire[employees_not_covered_by_workers_compensation]['+i+'][title]" size=51 maxlength=100></td></tr>';
	}
	content += '</table>';
	document.getElementById('workers_compensation_block').innerHTML=content;
}else{
	document.getElementById('workers_compensation_block').innerHTML='';
}
return true;
}
function show_withholding_block(){
var content;
var k;
var number_employees_not_subject_to_withholding = document.theform['number_employees_not_subject_to_withholding'].value;
if(number_employees_not_subject_to_withholding>=1){
	document.getElementById('withholding_block').style.display='block';
	content = '<table BORDER=1 WIDTH=760px>';
	for(i=0; i<number_employees_not_subject_to_withholding; i++){
		k = i+1;
		content += '<tr><td nowrap width=70px>&nbsp;</td><td nowrap width=243px>Explaination ('+k+'):</td><td><input type=text '; 
		content += 'name="risk_appraisal_questionnaire[employees_not_subject_to_w-2_withholding]['+i+'][explaination]" size=9 maxlength=100></td></tr>';
	}
	content += '</table>';
	document.getElementById('withholding_block').innerHTML=content;
}else{
	document.getElementById('withholding_block').innerHTML='';
}
return true;
}
function show_chronic_block(){
var content;
var k;
var number_employees_chronic = document.theform['number_employees_chronic'].value;
if(number_employees_chronic>=1){
	document.getElementById('chronic_block').style.display='block';
	content = '<table BORDER=1 WIDTH=760px>';
	content += '<tr><td nowrap width=70px>&nbsp;</td><td ALIGN=CENTER valign=top>Name</td><td ALIGN=CENTER valign=top>Condition</td><td ALIGN=CENTER valign=top>Date of Onset</td><td ALIGN=CENTER valign=top>Diagnosis</td><td ALIGN=CENTER valign=top>Status</td></tr>';
	for(i=0; i<number_employees_chronic; i++){
		content += '<tr><td nowrap width=70px>&nbsp;</td><td><input type=text '; 
		content += 'name="risk_appraisal_questionnaire[employees_chronic]['+i+'][name]" size=20 maxlength=100></td><td><input type=text ';
		content += 'name="risk_appraisal_questionnaire[employees_chronic]['+i+'][condition]" size=20 maxlength=100></td><td><input type=text ';  
		content += 'name="risk_appraisal_questionnaire[employees_chronic]['+i+'][date_of_onset]" size=11 maxlength=9></td><td><input type=text ';
		content += 'name="risk_appraisal_questionnaire[employees_chronic]['+i+'][diagnosis]" size=20 maxlength=100></td><td><input type=radio  ';  
		content += 'name="risk_appraisal_questionnaire[employees_chronic]['+i+'][status]" value=Stable>Stable<input type=radio  ';
		content += 'name="risk_appraisal_questionnaire[employees_chronic]['+i+'][status]" value=Treatment>Treatment</td></tr>';

	}
	content += '</table>';
	document.getElementById('chronic_block').innerHTML=content;
}else{
	document.getElementById('chronic_block').innerHTML='';
}
return true;
}
function show_12_block(){
var content;
var k;
var number_employees_12 = document.theform['number_employees_12'].value;
if(number_employees_12>=1){
	document.getElementById('12_block').style.display='block';
	content = '<table BORDER=1 WIDTH=760px>';
	content += '<tr><td nowrap width=70px>&nbsp;</td><td ALIGN=CENTER valign=top>Name</td><td ALIGN=CENTER valign=top>Condition</td><td ALIGN=CENTER valign=top>Date of Onset</td><td ALIGN=CENTER valign=top>Diagnosis</td><td ALIGN=CENTER valign=top>Status</td></tr>';
	for(i=0; i<number_employees_12; i++){
		content += '<tr><td nowrap width=70px>&nbsp;</td><td><input type=text '; 
		content += 'name="risk_appraisal_questionnaire[employees_12]['+i+'][name]" size=20 maxlength=100></td><td><input type=text ';
		content += 'name="risk_appraisal_questionnaire[employees_12]['+i+'][condition]" size=20 maxlength=100></td><td><input type=text ';  
		content += 'name="risk_appraisal_questionnaire[employees_12]['+i+'][date_of_onset]" size=11 maxlength=9></td><td><input type=text ';
		content += 'name="risk_appraisal_questionnaire[employees_12]['+i+'][diagnosis]" size=20 maxlength=100></td><td><input type=radio  ';  
		content += 'name="risk_appraisal_questionnaire[employees_12]['+i+'][status]" value=Stable>Stable<input type=radio  ';
		content += 'name="risk_appraisal_questionnaire[employees_12]['+i+'][status]" value=Treatment>Treatment</td></tr>';

	}
	content += '</table>';
	document.getElementById('12_block').innerHTML=content;
}else{
	document.getElementById('12_block').innerHTML='';
}
return true;
}
function show_24_block(){
var content;
var k;
var number_employees_24 = document.theform['number_employees_24'].value;
if(number_employees_24>=1){
	document.getElementById('24_block').style.display='block';
	content = '<table BORDER=1 WIDTH=760px>';
	content += '<tr><td nowrap width=70px>&nbsp;</td><td ALIGN=CENTER valign=top>Name</td><td ALIGN=CENTER valign=top>Condition</td><td ALIGN=CENTER valign=top>Date of Onset</td><td ALIGN=CENTER valign=top>Diagnosis</td><td ALIGN=CENTER valign=top>Status</td></tr>';
	for(i=0; i<number_employees_24; i++){
		content += '<tr><td nowrap width=70px>&nbsp;</td><td><input type=text '; 
		content += 'name="risk_appraisal_questionnaire[employees_24]['+i+'][name]" size=20 maxlength=100></td><td><input type=text ';
		content += 'name="risk_appraisal_questionnaire[employees_24]['+i+'][condition]" size=20 maxlength=100></td><td><input type=text ';  
		content += 'name="risk_appraisal_questionnaire[employees_24]['+i+'][date_of_onset]" size=11 maxlength=9></td><td><input type=text ';
		content += 'name="risk_appraisal_questionnaire[employees_24]['+i+'][diagnosis]" size=20 maxlength=100></td><td><input type=radio  ';  
		content += 'name="risk_appraisal_questionnaire[employees_24]['+i+'][status]" value=Stable>Stable<input type=radio  ';
		content += 'name="risk_appraisal_questionnaire[employees_24]['+i+'][status]" value=Treatment>Treatment</td></tr>';

	}
	content += '</table>';
	document.getElementById('24_block').innerHTML=content;
}else{
	document.getElementById('24_block').innerHTML='';
}
return true;
}
function show_dependency_block(){
var content;
var k;
var number_employees_dependency = document.theform['number_employees_dependency'].value;
if(number_employees_dependency>=1){
	document.getElementById('24_block').style.display='block';
	content = '<table BORDER=1 WIDTH=760px>';
	content += '<tr><td nowrap width=70px>&nbsp;</td><td ALIGN=CENTER valign=top>Name</td><td ALIGN=CENTER valign=top>Condition</td><td ALIGN=CENTER valign=top>Date of Onset</td><td ALIGN=CENTER valign=top>Diagnosis</td><td ALIGN=CENTER valign=top>Status</td></tr>';
	for(i=0; i<number_employees_dependency; i++){
		content += '<tr><td nowrap width=70px>&nbsp;</td><td><input type=text '; 
		content += 'name="risk_appraisal_questionnaire[employees_dependency]['+i+'][name]" size=20 maxlength=100></td><td><input type=text ';
		content += 'name="risk_appraisal_questionnaire[employees_dependency]['+i+'][condition]" size=20 maxlength=100></td><td><input type=text ';  
		content += 'name="risk_appraisal_questionnaire[employees_dependency]['+i+'][date_of_onset]" size=11 maxlength=9></td><td><input type=text ';
		content += 'name="risk_appraisal_questionnaire[employees_dependency]['+i+'][diagnosis]" size=20 maxlength=100></td><td><input type=radio  ';  
		content += 'name="risk_appraisal_questionnaire[employees_dependency]['+i+'][status]" value=Stable>Stable<input type=radio  ';
		content += 'name="risk_appraisal_questionnaire[employees_dependency]['+i+'][status]" value=Treatment>Treatment</td></tr>';

	}
	content += '</table>';
	document.getElementById('dependency_block').innerHTML=content;
}else{
	document.getElementById('dependency_block').innerHTML='';
}
return true;
}
function show_hospitalized_block(){
var content;
var k;
var number_employees_hospitalized = document.theform['number_employees_hospitalized'].value;
if(number_employees_hospitalized>=1){
	document.getElementById('hospitalized_block').style.display='block';
	content = '<table BORDER=1 WIDTH=760px>';
	content += '<tr><td nowrap width=70px>&nbsp;</td><td ALIGN=CENTER valign=top>Name</td><td ALIGN=CENTER valign=top>Condition</td><td ALIGN=CENTER valign=top>Date of Onset</td><td ALIGN=CENTER valign=top>Diagnosis</td><td ALIGN=CENTER valign=top>Status</td></tr>';
	for(i=0; i<number_employees_hospitalized; i++){
		content += '<tr><td nowrap width=70px>&nbsp;</td><td><input type=text '; 
		content += 'name="risk_appraisal_questionnaire[employees_hospitalized]['+i+'][name]" size=20 maxlength=100></td><td><input type=text ';
		content += 'name="risk_appraisal_questionnaire[employees_hospitalized]['+i+'][condition]" size=20 maxlength=100></td><td><input type=text ';  
		content += 'name="risk_appraisal_questionnaire[employees_hospitalized]['+i+'][date_of_onset]" size=11 maxlength=9></td><td><input type=text ';
		content += 'name="risk_appraisal_questionnaire[employees_hospitalized]['+i+'][diagnosis]" size=20 maxlength=100></td><td><input type=radio  ';  
		content += 'name="risk_appraisal_questionnaire[employees_hospitalized]['+i+'][status]" value=Stable>Stable<input type=radio  ';
		content += 'name="risk_appraisal_questionnaire[employees_hospitalized]['+i+'][status]" value=Treatment>Treatment</td></tr>';

	}
	content += '</table>';
	document.getElementById('hospitalized_block').innerHTML=content;
}else{
	document.getElementById('hospitalized_block').innerHTML='';
}
return true;
}