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

    <div class="container">
        <h1>Request Drug Test</h1>

<asp:PlaceHolder ID="phSubmitted" runat="server" Visible="false">
            <p class="alert alert-success">The test has been submitted</p>
</asp:PlaceHolder>
        <asp:Literal ID="txttest" runat="server" />

<asp:PlaceHolder ID="phForm" runat="server">

        <section>
            <h2>Order Information</h2>
            <asp:Label runat="server" AssociatedControlID="ddlTestType" Text="Test Type" />
            <div class="form-group">
                <asp:DropDownList ID="ddlTestType" runat="server" CssClass="form-control">
                    <asp:ListItem Text="Federal DOT Drug Screen" Value="TCDOTU" />
                    <asp:ListItem Text="Forensic Non-DOT Drug Screen" Value="TC5UDOTLIKE" />
                </asp:DropDownList>
                <asp:RequiredFieldValidator runat="server" ControlToValidate="ddlTestType"
                    Text="required" Display="Dynamic" CssClass="text-danger" />
            </div>
            <div class="form-group">
                <asp:Label runat="server" AssociatedControlID="ddlReason" Text="Reason for Test" />
                <asp:DropDownList ID="ddlReason" runat="server" CssClass="form-control" />
                <asp:RequiredFieldValidator runat="server" ControlToValidate="ddlReason"
                    Text="required" Display="Dynamic" CssClass="text-danger" />
            </div>
        </section>

        <section>
            <h2>Participant Information</h2>
            <section>
                <h3>Participant</h3>
                <div class="row">
                    <div class="form-group col">
                        <asp:Label runat="server" AssociatedControlID="txtNameFirst" Text="First Name" />
                        <asp:TextBox ID="txtNameFirst" runat="server" MaxLength="50" ValidationGroup="AccountInfo" CssClass="form-control" />
                        <asp:RequiredFieldValidator runat="server" ValidationGroup="AccountInfo" ControlToValidate="txtNameFirst"
                            Text="required" Display="Dynamic" CssClass="text-danger" />
                    </div>
                    <div class="form-group col">
                        <asp:Label runat="server" AssociatedControlID="txtNameMiddle" Text="Middle Name" />
                        <asp:TextBox ID="txtNameMiddle" runat="server" MaxLength="50" ValidationGroup="AccountInfo" CssClass="form-control" />
                    </div>
                    <div class="form-group col">
                        <asp:Label runat="server" AssociatedControlID="txtNameLast" Text="Last Name" />
                        <asp:TextBox ID="txtNameLast" runat="server" MaxLength="50" ValidationGroup="AccountInfo" CssClass="form-control" />
                        <asp:RequiredFieldValidator runat="server" ValidationGroup="AccountInfo" ControlToValidate="txtNameLast"
                            Text="required" Display="Dynamic" CssClass="text-danger" />
                    </div>
                </div>
                <div class="row">
                    <div class="form-group col">
                        <asp:Label runat="server" AssociatedControlID="txtDLNumber" Text="DL Number" />
                        <asp:TextBox ID="txtDLNumber" runat="server" MaxLength="50" CssClass="form-control" />
                        <asp:RequiredFieldValidator runat="server" ControlToValidate="txtDLNumber"
                            Text="required" Display="Dynamic" CssClass="text-danger" />
                    </div>
                    <div class="form-group col">
                        <asp:Label runat="server" AssociatedControlID="ddlDLState" Text="DL State" />
                        <ctrl:StatePicker ID="ddlDLState" runat="server" />
                        <asp:RequiredFieldValidator runat="server" ControlToValidate="ddlDLState"
                            Text="required" Display="Dynamic" CssClass="text-danger" />
                    </div>
                </div>
                <div class="form-group w-25">
                    <asp:Label runat="server" AssociatedControlID="txtDateBirth" Text="Date of Birth" />
                    <asp:TextBox ID="txtDateBirth" runat="server" MaxLength="50" TextMode="Date" CssClass="form-control" />
                    <ctrl:RequiredDependentFieldValidator runat="server" ControlToValidate="txtDateBirth"
                        DependencyControl="ddlFederalAgency" WhenValue="FMCSA"
                        Text="required when Federal Agency is FMCSA" Display="Dynamic" CssClass="text-danger" />
                </div>
                <div class="form-group w-25">
                    <asp:Label runat="server" AssociatedControlID="txtPhone" Text="Phone" />
                    <asp:TextBox ID="txtPhone" runat="server" MaxLength="50" TextMode="Phone" placeholder="(###)###-####" CssClass="form-control" />
                    <asp:RequiredFieldValidator runat="server" ControlToValidate="txtPhone"
                        Text="required" Display="Dynamic" CssClass="text-danger" />
                </div>
                <div class="form-group w-25">
                    <asp:Label runat="server" AssociatedControlID="txtPhone" Text="Phone 2" />
                    <asp:TextBox ID="txtPhone2" runat="server" MaxLength="50" TextMode="Phone" placeholder="(###)###-####" CssClass="form-control" />
                </div>
                <div class="form-group">
                    <asp:Label runat="server" AssociatedControlID="txtEmail" Text="Email" />
                    <asp:TextBox ID="txtEmail" runat="server" MaxLength="128" CssClass="form-control" />
                </div>
                <div class="form-group">
                    <asp:Label runat="server" AssociatedControlID="txtEmailCC" Text="Email CC" />
                    <asp:TextBox ID="txtEmailCC" runat="server" MaxLength="128" CssClass="form-control" />
                </div>
                <div class="form-group w-25">
                    <asp:Label runat="server" AssociatedControlID="txtOrderExpires" Text="Order Expires" />
                    <asp:TextBox ID="txtOrderExpires" runat="server" MaxLength="50" TextMode="Date" CssClass="form-control" />
                </div>
                <div class="form-group w-25">
                    <asp:Label runat="server" AssociatedControlID="ddlFederalAgency" Text="Federal Agency" />
                    <asp:DropDownList ID="ddlFederalAgency" runat="server" CssClass="form-control">
                        <asp:ListItem Text="" />
                        <asp:ListItem Text="FAA" />
                        <asp:ListItem Text="FMCSA" />
                        <asp:ListItem Text="FRA" />
                        <asp:ListItem Text="FTA" />
                        <asp:ListItem Text="PHMSA" />
                        <asp:ListItem Text="USCG" />
                    </asp:DropDownList>
                    <ctrl:RequiredDependentFieldValidator runat="server" ControlToValidate="ddlFederalAgency"
                        DependencyControl="ddlTestType" WhenValue="TCDOTU"
                        Text="required when test type is Federal DOT Drug Screen" Display="Dynamic" CssClass="text-danger" />
                </div>
                <div class="form-group">
                    <asp:Label runat="server" AssociatedControlID="ddlObservedCollectionRequired" Text="Observed Collection Required" />
                    <asp:DropDownList ID="ddlObservedCollectionRequired" runat="server" CssClass="form-control w-25">
                        <asp:ListItem Text="" Value="" />
                        <asp:ListItem Text="Yes" Value="1" />
                        <asp:ListItem Text="No" Value="0" />
                    </asp:DropDownList>
                    <asp:RequiredFieldValidator runat="server" ControlToValidate="ddlObservedCollectionRequired"
                        Text="required" Display="Dynamic" CssClass="text-danger" />
                </div>
            </section>
            <section>
                <h3>Participant Address</h3>
                <div class="form-group">
                    <asp:Label runat="server" AssociatedControlID="txtAddress" Text="Address" />
                    <asp:TextBox ID="txtAddress" runat="server" MaxLength="128" CssClass="form-control" />
                    <asp:RequiredFieldValidator runat="server" ControlToValidate="txtAddress"
                        Text="required" Display="Dynamic" CssClass="text-danger" />
                </div>
                <div class="form-group">
                    <asp:Label runat="server" AssociatedControlID="txtAddress2" Text="Address" />
                    <asp:TextBox ID="txtAddress2" runat="server" MaxLength="128" CssClass="form-control" />
                </div>
                <div class="row">
                    <div class="form-group col">
                        <asp:Label runat="server" AssociatedControlID="txtCity" Text="City" />
                        <asp:TextBox ID="txtCity" runat="server" MaxLength="50" CssClass="form-control" />
                        <asp:RequiredFieldValidator runat="server" ControlToValidate="txtCity"
                            Text="required" Display="Dynamic" CssClass="text-danger" />
                    </div>
                    <div class="form-group col">
                        <asp:Label runat="server" AssociatedControlID="ddlState" Text="State" />
                        <ctrl:StatePicker ID="ddlState" runat="server" />
                        <asp:RequiredFieldValidator runat="server" ControlToValidate="ddlState"
                            Text="required" Display="Dynamic" CssClass="text-danger" />
                    </div>
                    <div class="form-group col">
                        <asp:Label runat="server" AssociatedControlID="txtZip" Text="Zip" />
                        <asp:TextBox ID="txtZip" runat="server" MaxLength="50" CssClass="form-control" />
                        <asp:RequiredFieldValidator runat="server" ControlToValidate="txtZip"
                            Text="required" Display="Dynamic" CssClass="text-danger" />
                    </div>
                </div>
                <div class="form-group">
                    <asp:Label runat="server" AssociatedControlID="txtNotes" Text="Notes" />
                    <asp:TextBox ID="txtNotes" runat="server" TextMode="MultiLine" MaxLength="1000" CssClass="form-control" />
                </div>
            </section>
        </section>

        <section>
            <h2>Schedule Test Date</h2>
            <div class="form-group w-25">
                <asp:Label runat="server" AssociatedControlID="txtTestDate" Text="Test Date" />
                <asp:TextBox ID="txtTestDate" runat="server" TextMode="Date" CssClass="form-control" />
                <asp:RequiredFieldValidator runat="server" ControlToValidate="txtTestDate"
                    Text="required" Display="Dynamic" CssClass="text-danger" />
            </div>
        </section>

        <div class="row">
            <div class="col">
                <asp:Button ID="btnCancel" runat="server" CssClass="btn btn-secondary" Text="Cancel" CausesValidation="false" />
            </div>
            <div class="col text-right">
                <asp:Button ID="btnSubmit" runat="server" CssClass="btn btn-primary" Text="Submit" />
            </div>
        </div>

</asp:PlaceHolder>

</asp:Content>
