<%@ Page Title="" Language="vb" AutoEventWireup="false" MasterPageFile="Application.master" CodeBehind="MedicalRegistry.aspx.vb" Inherits="Web.MedicalRegistry" %>
<%@ MasterType VirtualPath="Application.Master" %>
<%@ Register Src="~/_include/controls/StatePicker.ascx" TagPrefix="ctrl" TagName="StatePicker" %>
<asp:Content ID="Content1" ContentPlaceHolderID="phContent" runat="server">

    <h1>Current Medical Certificate</h1>

    <ul class="formFields">
        <li class="big">
            <asp:RequiredFieldValidator runat="server" ControlToValidate="txtName"
                Text="required" Display="Dynamic" CssClass="required" />
            <asp:Label runat="server" AssociatedControlID="txtName"
                Text="Medical Examiner Name" />
            <asp:TextBox ID="txtName" runat="server" MaxLength="128" />
        </li>
        <li>
            <asp:RequiredFieldValidator runat="server" ControlToValidate="txtRegistryNumber"
                Text="required" Display="Dynamic" CssClass="required" />
            <asp:Label runat="server" AssociatedControlID="txtRegistryNumber"
                Text="National Registry Number" />
            <asp:TextBox ID="txtRegistryNumber" runat="server" MaxLength="50" />
        </li>
        <li>
            <asp:RequiredFieldValidator runat="server" ControlToValidate="txtExpiration"
                Text="required" Display="Dynamic" CssClass="required" />
            <asp:Label runat="server" AssociatedControlID="txtExpiration"
                Text="Medical Examiner's Certificate Expiration Date" />
            <asp:TextBox ID="txtExpiration" runat="server" MaxLength="50" TextMode="Date" />
        </li>
    </ul>

    <h3>Medical Card</h3>
    <ul class="formFields">
        <li class="big">
            <asp:RegularExpressionValidator runat="server" ControlToValidate="uplFront"
                Text="must be in gif, jpeg, or png format" Display="Dynamic" CssClass="required no-hide"
                ValidationExpression="^.*?\.([Gg][Ii][Ff]|[Jj][Pp][Ee]?[Gg]|[Pp][Nn][Gg])$" />
            <asp:Label runat="server" AssociatedControlID="uplFront"
                Text="Front" />
            <asp:FileUpload ID="uplFront" runat="server" accept=".png,.jpg,.jpeg,.gif" />
        </li>
        <li>
            <label>Preview</label>
            <asp:Image ID="imgFront" runat="server" ImageUrl="#" CssClass="upload-image-preview" />
        </li>
    </ul>

</asp:Content>
