{global_header_before_title}
{preload_replace:widget_bundle="frontpage"}
{embed="embeds/global_header" page="person_update"}

 
 <div id="columns"> 
        <div class="psd-registration psd-registration-dcnz"> 
            <div class="box-wrap">
                  <h1 class="title underline">Request Change to practitioner type</h1>
                  <p>Practitioner Types are aligned with your registration. If your practitioner
                  type is incorrect, please indicate your correct practitioner type below.
                  Your request will be validated within 24hours.
                  </p>
                                    
                  <div class="box-wrap-content" >
                       <p class="alert" id="message"></p>
                       <form name="psd_registration_dba" method="post" action="{site_url}">
                           <input type="hidden" name="ACT" value="[##AID##]"/>
                           <input type="hidden" name="cmd" id="cmd" value="" />
                           <input type="hidden" name="sub_cmd" id="sub_cmd" value="" />
                           <div class="container">
                                <div class="item main-item clearer">
                                    <div class="first"><label>Current Practitioner Type</label></div>
                                    <div class="second"><span class="email">[##pract_type_nz##]</span></div>
                                </div>
                                <div class="item main-item clearer">
                                    <div class="first"><label>Registration Domain</label></div>
                                    <div class="second"><span class="email">[##rego_domain##]</span></div>            
                                </div>
                           
                                <div class="item main-item clearer">
                                    <div class="first">
                                        <label>
                                            New Practitioner Type<em>*</em> <br/>
                                            Hold down the Control key <br/>
                                            to select more than one Type.
                                        </label>
                                    </div>
                                    <div class="second">
                                        <select id="pract_type_nz" name="pract_type_nz[]" multiple="true" size="6" class="required">
                                            [##pract_type_nz_html##]
                                        </select>
                                    </div> 
                                </div>
                                
                                <div class="item main-item clearer">
                                    <div class="first"><label>DCNZ Registration Number<em>*</em></label></div>
                                    <div class="second">
                                        <select name="rego_no_nz_prefix" id="rego_no_nz_prefix">
                                            [##rego_no_nz_html##]
                                        </select>
                                        <input type="text" name="rego_no_nz" id="rego_no_nz" value="[##rego_no_nz##]" maxlength="4" size="5">
                                    </div>
                                </div>
                                
                                <div class="item actions clearer">
                                    <span class="f-right">
                                        <input type="button" class="btn-cancel" onclick="javascript:jQuery('#cmd').val('cancel');$('#sub_cmd').val('dcnz');jQuery('form').submit();" name="cancel" id="cancel" value="">
                                        &nbsp;&nbsp;
                                        <input type="submit" class="btn-confirm" name="confirm" id="confirm" value="">
                                    </span>
                                </div>
                           </div>    
                       </form>
                       <script type="text/javascript">
                       
                       jQuery(document).ready(function($){                           
                           var alertObj = $('#message');
                           alertObj.hide();

                           $('#confirm').click(function(){
                              
                              if ($('#pract_type_nz').val() == null){
                                    alertObj.html('ERROR: Please select a New Practitioner Type');
                                    alertObj.show();
                                    return false;
                              }
                                   
                              var pattern = new RegExp(/^[0-9]{4}$/i);
                              var rego_no = $('#rego_no_nz').val();
                              
                              if(rego_no == '' || !pattern.test(rego_no)){
                                  alertObj.html("Your Registration Number must contain 4 digits.");
                                  alertObj.show();
                                  return false;
                              } 
                               
                              $('#cmd').val('do_update_registration');
                              $('#sub_cmd').val('dcnz');
                              $('form').submit();
                           });
                       });
                       </script>
                  </div>
                  
            </div>
 
        </div> <!--/col1--> 
 
{global_footer}