<div id="disp_q1">
	<div class="questionrow">
		<div class="question">1. Is the participant a duplicate enrollment based on fingerprint?</div>
		<div class="answer">
			<input type="hidden" name="partcpnt_id" id="partcpnt_id" value="<?php echo $id; ?>" />
			<input type="hidden" name="tab_id" id="tab_id" value="1" />
			<?php echo $common->generateSelect('q1', $yes_no, $q1, 'onchange="return enb_q1(this.value);"'); ?>
		</div>
	</div>
	<div class="clear_form">
	</div>
</div>
<div id="disp_q1a" style="display: none;">
	<div class="questionrow">
		<div class="question">1a. Participant’s Duplicate Study ID (Copy from Fingerprint Application)</div>
		<div class="answer">
			<input type="text" name="q1a" id="q1a" value="<?php echo $q1a; ?>" style="text-transform: uppercase;" />
		</div>
	</div>
	<div class="clear_form">
	</div>
</div>
<div id="disp_q2">
	<div class="questionrow">
		<div class="question">2. Does the participant have a valid RDS coupon?</div>
		<div class="answer">
			<?php echo $common->generateSelect('q2', $yes_no, $q2, 'onchange="return enb_q2(this.value);"'); ?>
		</div>
	</div>
	<div class="clear_form">
	</div>
</div>
<div id="disp_q3">
	<div class="questionrow">
		<div class="question">3. What is your age in years?</div>
		<div class="answer">
			<input type="text" name="q3" id="q3" value="" maxlength="3" onkeyup="return acceptDigits(this);" /> Years
		</div>
	</div>
	<div class="clear_form">
	</div>
</div>
<div id="disp_q4">
	<div class="questionrow">
		<div class="question">4. How long have you lived where you are living now?</div>
		<div class="answer">
			<input type="text" name="q4" id="q4" value="" maxlength="3" onkeyup="return acceptDigits(this);" /> Years
		</div>
	</div>
	<div class="clear_form">
	</div>
</div>
<div id="disp_q5">
	<div class="questionrow">
		<div class="question">5. Do you have any plans to move from here in the next two years?</div>
		<div class="answer">
			<?php echo $common->generateSelect('q5', $yes_no_dk, $q5); ?>
		</div>
	</div>
	<div class="clear_form">
	</div>
</div>
<div id="disp_q6">
	<div class="questionrow">
		<div class="question">6. In the past 12 months, have you had oral or anal sex with another man?</div>
		<div class="answer">
			<?php echo $common->generateSelect('q6', $yes_no, $q6); ?>
		</div>
	</div>
	<div class="clear_form">
	</div>
</div>
<div id="disp_q7">
	<div class="questionrow">
		<div class="question">7. Have you ever been tested for HIV?</div>
		<div class="answer">
			<?php echo $common->generateSelect('q7', $yes_no, $q7, 'onchange="return enb_q7(this.value);"'); ?>
		</div>
	</div>
	<div class="clear_form">
	</div>
</div>
<div id="disp_q8">
	<div class="questionrow">
		<div class="question">8. What is your biological sex?</div>
		<div class="answer">
			<?php $common->dropdown('gen_code', 'gen_name', 'custom_gender_master', '', 'gen_name', 'q8', $q8, ''); ?>
		</div>
	</div>
	<div class="clear_form">
	</div>
</div>
<div id="disp_q9">
	<div class="questionrow">
		<div class="question">9. How do you self-identify?</div>
		<div class="answer">
			<?php echo $common->generateSelect('q9', $q9, $q9); ?>
		</div>
	</div>
	<div class="clear_form">
	</div>
</div>
<div id="disp_q10">
	<div class="questionrow">
		<div class="question">10. Are you currently employed?</div>
		<div class="answer">
			<?php echo $common->generateSelect('q10', $yes_no_dk, $q10); ?>
		</div>
	</div>
	<div class="clear_form">
	</div>
</div>
<div id="disp_q11">
	<div class="questionrow">
		<div class="question">Participant Eligibility</div>
		<div class="answer">
			<?php echo $common->generateSelect('q11', $yes_no, $q11); ?>
		</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>