<div id="recertstep1" style="display:block;">
	<cfform name="formstep1" id="formstep1">
		<div class="form-body">
			<div class="margin-top-10 text-center">
				<ul class="pagination nav_pagination" style="margin:0;">
					<cfloop index=ind from="1" to="9">
						<cfoutput>
							<li class="nav_recertstep#ind# <cfif ind eq 1>active</cfif>" onClick="$('##recertstep1').hide(); $('##recertstep#ind#').show(); $('.pagination li').removeClass('active'); $('.nav_recertstep#ind#').addClass('active');">
								<a href="javascript:;">#ind#</a>
							</li>
						</cfoutput>
					</cfloop>
				</ul>

				<div class="dashboard-stat2 progress_div" style="margin: 0px auto; padding-top: 0px; max-width: 320px;">
					<div class="progress-info">
						<div class="progress" style="height: 9px">
							<span class="progress-bar progress-bar-success green-sharp">
								<span class="sr-only ">0% progress</span>
							</span>
						</div>
						<div class="status">
							<div class="status-title"> progress </div>
							<div class="status-number"> <span class="progressBar">0%</span> </div>
						</div>
					</div>
				</div>
			</div>
			<div class="well">
			<input type="hidden" name="M0230Diagnosisid" id="M0230Diagnosisid"/>
			<input type="hidden" name="hdnmedssearch" id="hdnmedssearch"/>
			<input type="hidden" name="hdnmedssearch2" id="hdnmedssearch2"/>
			<input type="hidden" name="tradeid" id="tradeid"/>
			<input type="hidden" name="doseid" id="doseid">
			<input type="hidden" name="TypeOwn1" id="TypeOwn1">
			<input type="hidden" name="hdnPatientMedsID" id="hdnPatientMedsID">
			<input type="hidden" name="hdnPatientMedsInsert" id="hdnPatientMedsInsert">
			<input type="hidden" name="hdnPatientMedsUpdate" id="hdnPatientMedsUpdate">
			<input type="hidden" name="codetype" id="codetype">
			<textarea name="txtAssId" style="display:none"></textarea>
			<div class="form-group">
				<div class="label-stable">
					<label>M0110 Episode Timing - Is this assessment for an "early" or "later" episode in this sequence of Medicare episodes?</label>
					<div id="radM0110d" class="radio-list">
						<label>
						<input type="radio" name="radM0110" value="1 - Early"<cfif Recertform.M0110 EQ "1 - Early">checked </cfif>> 1 - Early</label>
						<label>
						<input type="radio" name="radM0110" value="2 - Later"<cfif Recertform.M0110 EQ "2 - Later">checked </cfif>> 2 - Later</label>
						<label>
						<input type="radio" name="radM0110" value="UK - Unknown"<cfif Recertform.M0110 EQ "UK - Unknown">checked </cfif>> UK - Unknown</label>
						<label>
						<input type="radio" name="radM0110" value="NA - Not Applicable:no medicare case mix group to be defined"<cfif Recertform.M0110 EQ "NA - Not Applicable:no medicare case mix group to be defined">checked </cfif>> NA - Not Applicable:no Medicare case mix group to be defined</label>
					</div>
				</div>
			</div>
			<div class="form-group">
				<label>
					M1021/3/5 ICD and Severity Index: List up to 6 ICDs for which the patient is receiving home care and rate them using the severity index.
					<img name="ImgM1020Add" id="ImgM1020Add" src="../../images/icon_add.png" style="cursor:pointer;" />
				</label>
			</div>
			<div class="well" id="DivM1020SubPage" style="display:none;">
				<div class="form-group">
					<label>Diagnosis Search</label>
					<input type='hidden' name='commId' value='#url.Id#' />
					<textarea name="M0230txtsearch" type="text" value="" class="form-control"></textarea>
				</div>
				<input class="btn btn-sm blue" name="btnM0230" type="button" value="Search" onclick="SearchClickM0230()" />
				<input class="btn btn-sm blue" name="btnSev" type="button" value="Redo Find" />
				<input class="btn btn-sm default" name="btnM1020cancel" id="btnM1020cancel" type="button" value="Cancel" />
			</div>
			<cfinput name="tinput4" type="text" style="display:none" value="Test">
			<cfdiv bind="url:#Application.siteURL#/patientadmin_new/M0230Grid.cfm?InputText={tinput4}" ID="M0230Div"style="height:100"></cfdiv>
			<div class="form-group">
				<label>
					New treatments/interventions for this assessment
					<img src="../../images/icon_add.png" onclick="addRow('dataTable')" style="cursor:pointer;" />
				</label>
				<button type="button" class="btn btn-sm red" style="cursor:pointer;float:right;" onclick="deleteRow('dataTable')">Delete Selected</button>
			</div>
			<div style="height:120px;border:1px solid #CCCCCC;overflow-y:scroll;margin-bottom:15px;">
				<table style="width:100%;" id="dataTable" cellpadding="0" cellspacing="0" border="0">
					<tr>
						<td><INPUT class="form-control" type="text"/></td>
						<td>
							<SELECT class="form-control">
								<OPTION VALUE="HHA">HHA</OPTION>
								<OPTION VALUE="MSW">MSW</OPTION>
								<OPTION VALUE="OT">OT</OPTION>
								<OPTION VALUE="PT">PT</OPTION>
								<OPTION VALUE="SN">SN</OPTION>
								<OPTION VALUE="ST">ST</OPTION>
							</SELECT>
						</td>
						<td style="text-align:center;vertical-align:middle;">
							<div class="form-group" style="margin:0;">
								<div class="checkbox-list">
									<label>
									<INPUT type="checkbox" name="chk"/></label>
								</div>
							</div>
						</td>
					</tr>
				</table>
			</div>
			
			<div class="hidden">
			<div class="form-group">
				<div class="label-stable">
					<label>Use Coding Expert?</label>
					<div id="chkM1010YesColor1" class="checkbox-list">
						<label>
						<input type="checkbox" name="chkM1010Yes"onclick="chkReflect('1')" value="1"> Yes <img src="../../images/icon_help.png" alt="top" style="cursor:pointer" onclick="help();" /></label>
					</div>
				</div>
			</div>
			<div class="form-group">
				<label>new/changed medications <img name="Imgbtn5New" style="cursor:pointer;" id="Imgbtn5New" onclick="ColdFusion.Window.show('MedicationWindow');" src="../../images/icon_add.png" /></label>
			</div>
			<div class="form-group">
				<label>Why are we <img src="../../images/icon_help.png" alt="top" style="cursor:pointer" onclick="medicationalert();" /></label>
				<p>asking this?</p>
			</div>
			</div>
			
			<div class="form-group">
				<label>Comments</label>
				<textarea class="form-control" name="txtComment" id="txtComment" onblur="CommentChangeBlur('formstep1')" rows="3"><cfoutput>#Recertform.Assessment_note#</cfoutput></textarea>
			</div>
			<div class="form-group">
				<label>Add Vital <img name="imgbtnaddvital" id="imgbtnaddvital" src="../../images/icon_add.png" style="cursor:pointer" onclick="$('#Vitaldiv').modal('show');"/></label>
				<input type="hidden" name="AssTrackID" id="AssTrackID" value="<cfoutput>#Recertform.Assessment_Tracker_ID#</cfoutput>">
			</div>
		</div>
		</div>
		
		<div class="form-actions">
			<input class="btn green" type="button" value="Next" onClick="return shownextwindow('1','');">
            <input class="btn btn-default" type="button" value="Cancel" onclick="shownextwindow('1','close');">
		</div>
	</cfform>
</div>