<div class="questionrow">
    <div class="question">Particpant ID</div>
    <div class="answer">
		<input type="hidden" name="id" id="id" value="<?php echo $id; ?>"/>
		<input type="text" name="partcpnt_id" id="partcpnt_id" value="<?php echo $partcpnt_id; ?>" readonly />
		<img src="includes/images/search_img.png" style="vertical-align: middle;" onclick="open_frame('autocomplete.php?from=reimbursement_payments');">
    </div>
</div>
<div class="clear_form">
</div>
<div class="questionrow">
    <div class="question">Survey</div>
    <div class="answer">
		<input type="hidden" name="tab_id" id="tab_id" value="" />
        <?php
            $common->dropdown('sur_code', 'sur_title', 'custom_survey_master', '', 'sur_title', 'survey_id', $survey_id, 'class="required" onchange="return specimen_data(this.value);"');
        ?>
    </div>
    <script>
        $("#survey_id option").each(function(){
			if(this.value != '<?php echo $survey_id; ?>')
				$(this).remove();
        });
        //specimen_data('<?php echo $survey_id; ?>', 'edit');
		$('#partcpnt_id').attr("readonly", true);
		$("#div_submit").show();
		$("#print").hide();
    </script>
</div>
<div class="clear_form">
</div>
<br />
<div class="questionrow">
    <table border="0" cellpadding="0" cellspacing="0" style="width: 100%; line-height: 40px;" id="dataTable" align="center">
		<tr>
			<td class="question_title" style="width: 30%;">Voucher Number</td>
			<td class="question_title" style="width: 20%;">Voucher Date</td>
			<td class="question_title" style="width: 20%;">Amount</td>
			<td class="question_title" style="width: 30%;">Pay Amount</td>
		</tr>
		<tr>
			<td class="question" style="width: 30%;">
				&nbsp;<?php echo $vchr_no; ?>
				<input type="hidden" name="vchr_no" id="vchr_no" value="<?php echo $vchr_no; ?>" />
			</td>
			<td class="question" style="width: 20%;">
				&nbsp;<?php echo $vchr_dt; ?>
				<input type="hidden" name="vchr_dt" id="vchr_dt" value="<?php echo $vchr_dt; ?>" />
			</td>
			<td class="question" style="width: 20%;">
				&nbsp;<?php echo $vchr_amt; ?>
				<input type="hidden" name="vchr_amt" id="vchr_amt" value="<?php echo $vchr_amt; ?>" />
			</td>
			<td class="question" style="width: 30%;">
				&nbsp;<input type="text" name="vchr_pay_amt" id="vchr_pay_amt" value="<?php echo $vchr_amt; ?>" style="text-align: right; width: 125px;" />
			</td>
		</tr>
    </table>
</div>
<div class="clear_form">
</div>
<div class="questionrow">
    <div style="padding: 5px; display: none;" align="center" id="div_submit">
        <!--<input type="submit" name="Submit" value="Save & Print" />-->
		<input type="button" id="save" name="save" value="Save & Print" onclick="return frm_validation('1');" />
		<input type="button" id="print" name="print" value="Print" onclick="return frm_validation('2');" />
    </div>
</div>