<div class="questionrow">
	<div class="question">Survey</div>
	<div class="answer">
		<input type="hidden" name="dt_fmt" id="dt_fmt" value="<?php echo DT_FMT; ?>" />
		<?php
			if($survey_id == "")
				$survey_id = SURVY;
			
			if(SURVYFXD == 'Y')
			{
				echo '<input type="hidden" name="survey_id" id="survey_id" value="'.SURVY.'" />';
				echo SURVYTITLE;
				echo '<script>get_location("'.SURVY.'", \'location_coupon\', true);</script>';
			}
			else
			{
				$common->dropdown('sur_code', 'sur_title', 'custom_survey_master', 'status = "Y"', 'sur_title', 'survey_id', $survey_id, 'class="required" onchange="return get_survey_location(this.value, \'location_sel\', \'\');"');
			}
		?>
	</div>
</div>
<div class="clear_form">
</div>
<div class="questionrow">
	<div class="question">Date of Interview</div>
	<div class="answer">
		<?php
		echo '<span id="dor_span">' . $doi . '</span>';
		?>
		<input type="hidden" name="id" id="id" value="<?php echo $id ?>" />
		<!--<input type="hidden" name="survey_id" id="survey_id" value="<?php echo $survey_id ?>" />-->
		<input type="hidden" name="tab_id" id="tab_id" value="1" />
		<input type="hidden" name="doi" id="doi" value="<?php echo $mem_intr_doi; ?>" />
	</div>
</div>
<div class="clear_form">
</div>
<div class="questionrow">
	<div class="question">Interview's Initial's</div>
	<div class="answer">
		<input type="text" name="interview_initial" id="interview_initial" value="<?php echo $interview_initial; ?>" maxlength="3" onkeyup="return acceptDigits(this);" style="text-transform: uppercase;" size="7" />
	</div>
</div>
<div class="clear_form">
</div>
<div class="questionrow">
	<div class="question">Which Location do you belong to?</div>
	<div class="answer">
		<input type="hidden" name="location" id="location" value="" />
		<input type="hidden" name="location_fxd" id="location_fxd" value="" />
		<span id="loc_row">
		<?php 
			$common->dropdown('loc_code', 'loc_name', 'custom_location', '', 'loc_name', 'location_sel', $location, '');
			echo '<script>get_survey_location("'.$survey_id.'", \'location_sel\', "'.$location.'");</script>';
		?>
		</span>
		<?php 
			/*$common->dropdown('loc_code', 'loc_name', 'custom_location', '', 'loc_name', 'location_sel', $location, '');
			echo '<script>get_location("'.$survey_id.'", \'location_coupon\', true);</script>';*/
		?>
	</div>
</div>
<div class="clear_form">
</div>
<div class="questionrow">
	<div class="question">Participant Type</div>
	<div class="answer">
		<select name="participant_type" id="participant_type">
			<option value="">Select</option>
			<option value="S">Seed</option>
			<option value="W">Recruit</option>
		</select>
	</div>
</div>
<div class="clear_form">
</div>
<?php if(COUPONFXD == 'Y'): ?>
    <div class="questionrow">
        <div class="question">Participant ID</div>
        <div class="answer">
            <input type="text" name="participant_id" id="participant_id" value="<?php echo $participant_id; ?>" maxlength="6" />
        </div>
    </div>
    <div class="clear_form">
    </div>
<?php else: ?>
    <div class="questionrow">
        <div class="question">Coupon ID</div>
        <div class="answer">
            <input type="text" name="coupon_id" id="coupon_id" value="<?php echo $participant_id; ?>" maxlength="6" />
        </div>
    </div>
    <div class="clear_form">
    </div>
<?php endif; ?>
  <div style="display: none;">		
    <div class="questionrow">
                        <div class="question">Recruitment Location</div>
                        <div class="answer">
                            <select name="recruitment_loc" id="recruitment_loc">
                                <option value="">Select</option>
                                <option value=1>Transport (A'Mandi)</option>
                                <option value=2>Gorakhnath-10</option>
                            </select>
                        </div>
                    </div>
					<div class="clear_form">
                    </div>
			</div>
<div class="questionrow">
	<div style="padding: 5px;" align="center">
		<input type="submit" name="Submit" value="Submit" />
	</div>
</div>
<?php
	echo '<script>
		select_checked("participant_type", "'.$participant_type.'", "");
        select_checked("recruitment_loc", "'.$recruitment_loc.'", "");		
	</script>';
?>
