3726796.winrxrefill.com
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20.225.77.115
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Submitted URL: https://neorefill.com/
Effective URL: https://3726796.winrxrefill.com/
Submission: On November 10 via api from US — Scanned from DE
Effective URL: https://3726796.winrxrefill.com/
Submission: On November 10 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
Name: frmAnonymousRx — POST /OrderRefill/OrderRefills
<form action="/OrderRefill/OrderRefills" class="form-horizontal" id="frmAnonymousRx" method="post" name="frmAnonymousRx" role="form">
<div id="OrderRefills_Warning" class="warning h4 text-center hidden"></div>
<input id="HashedRxNumbers" name="HashedRxNumbers" type="hidden" value="[]"><input id="IsNursingHome" name="IsNursingHome" type="hidden" value="False">
<div class="dxflFormLayout_WebRefillDefault" id="frmxOrderRefill" style="width:100%;padding-top:0px;padding-bottom:0px;">
<div class="dxflGroup_WebRefillDefault dxflGroupSys dxflAGSys dxflElConSys dxflFloatedElConSys">
<div id="frmxOrderRefill_0" class="dxflFirstChildSys dxflChildInFirstRowSys dxflLastChildSys dxflChildInLastRowSys" style="width:100%;">
<div class="dxflVATSys dxflGroupCell_WebRefillDefault" style="padding-top:0px;padding-bottom:0px;">
<div class="dxflGroup_WebRefillDefault dxflGroupSys dxflAGSys dxflElConSys dxflFloatedElConSys">
<div id="frmxOrderRefill_0_0" class="dxflFirstChildSys dxflChildInFirstRowSys" style="width:100%;">
<div class="dxflGroupCell_WebRefillDefault" style="padding-top:0px;padding-bottom:0px;">
<div class="dxflNestedControlCell_WebRefillDefault dxflCLRSys dxflItemSys dxflTextEditItemSys dxflItem_WebRefillDefault" style="padding-top:0px;padding-bottom:1px;">
<table class="dxeTextBoxSys dxeTextBox_WebRefillDefault dxeTextBoxDefaultWidthSys dxeNullText_WebRefillDefault custom_NullText dxh0" id="LastName" style="width:100%;" savedspellcheck="[object Object]" spellcheck="false">
<tbody>
<tr>
<td class="dxic" style="width:100%;"><input tabindex="1" class="dxeEditArea_WebRefillDefault dxeEditAreaSys dxh0" id="LastName_I" name="LastName" onfocus="ASPx.EGotFocus('LastName')" onblur="ASPx.ELostFocus('LastName')"
onchange="ASPx.EValueChanged('LastName')" value="Last Name" type="text" savedspellcheck="[object Object]" spellcheck="false"></td>
</tr>
</tbody>
</table>
<script id="dxss_693441124" type="text/javascript">
<!--
ASPx.AddDisabledItems('LastName', [
[
['dxeDisabled_WebRefillDefault'],
[''],
['', 'I']
]
]);
var dxo = new ASPxClientTextBox('LastName');
dxo.InitGlobalVariable('LastName');
dxo.SetProperties({
'stateObject': {
'rawValue': ''
},
'nullText': 'Last Name'
});
dxo.InitializeProperties({
'decorationStyles': [{
'key': 'F',
'className': 'dxeFocused_WebRefillDefault',
'cssText': ''
}, {
'key': 'N',
'className': 'dxeNullText_WebRefillDefault custom_NullText',
'cssText': ''
}]
});
dxo.AfterCreate();
//
-->
</script>
</div>
</div>
</div>
<div id="frmxOrderRefill_0_1" class="dxflNotFloatedElSys" style="width:100%;">
<div class="dxflGroupCell_WebRefillDefault" style="padding-top:0px;padding-bottom:0px;">
<div class="dxflCLLSys dxflItemSys dxflTextEditItemSys dxflItem_WebRefillDefault dxflElConSys" style="padding-top:0px;padding-bottom:1px;">
<div class="dxflHALSys dxflVATSys dxflCaptionCell_WebRefillDefault dxflCaptionCellSys" style="width: 89px; min-width: 89px;">
<label class="dxflCaption_WebRefillDefault" for="dateOfBirth_I">Date of Birth:</label>
</div>
<div class="dxflNestedControlCell_WebRefillDefault" style="width:100%;">
<script id="dxss_1634002033" type="text/javascript">
<!--
(function() {
var a = ({
'twoDigitYearMax': 2049,
'percentPattern': 1,
'numPosInf': '∞',
'numNegInf': '-∞'
});
for (var b in a) ASPx.CultureInfo[b] = a[b];
})();
//
-->
</script>
<table class="dxeButtonEditSys dxeButtonEdit_WebRefillDefault" id="dateOfBirth" style="width:100%;">
<tbody>
<tr>
<td class="dxic" onmousedown="return ASPx.DDMC_MD('dateOfBirth', event)" style="width:100%;"><input class="dxeEditArea_WebRefillDefault dxeEditAreaSys" onfocus="ASPx.EGotFocus('dateOfBirth')" value="11/10/2024"
data-val-date="The field Date of Birth must be a date." data-val-required="The Date of Birth field is required." onchange="ASPx.ETextChanged('dateOfBirth')" onblur="ASPx.ELostFocus('dateOfBirth')" name="dateOfBirth"
id="dateOfBirth_I" type="text" data-val="true" autocomplete="off"></td>
<td id="dateOfBirth_B-1" class="dxeButton dxeButtonEditButton_WebRefillDefault" onmousedown="return ASPx.DDDropDown('dateOfBirth', event)" style="-webkit-user-select:none;"><img id="dateOfBirth_B-1Img"
class="dxEditors_edtDropDown_WebRefillDefault" src="/DXR.axd?r=1_35-bA_Bk" alt="v"></td>
</tr>
</tbody>
</table>
<div id="dateOfBirth_DDD_PW-1" class="dxpcDropDown_WebRefillDefault dxpclW dxpc-ddSys" style="cursor:default;z-index:10000;display:none;visibility:hidden;">
<div class="dxpc-mainDiv dxpc-shadow">
<div class="dxpc-contentWrapper">
<div class="dxpc-content" id="dateOfBirth_DDD_PWC-1">
<table style="display:none;">
<tbody>
<tr>
<td id="dateOfBirth_DDD_C_EC_D" class="dxeCalendarDay_WebRefillDefault"></td>
<td id="dateOfBirth_DDD_C_EC_DS" class="dxeCalendarSelected_WebRefillDefault"></td>
<td id="dateOfBirth_DDD_C_EC_DA" class="dxeCalendarOtherMonth_WebRefillDefault"></td>
<td id="dateOfBirth_DDD_C_EC_DW" class="dxeCalendarWeekend_WebRefillDefault"></td>
<td id="dateOfBirth_DDD_C_EC_DO" class="dxeCalendarOutOfRange_WebRefillDefault"></td>
<td id="dateOfBirth_DDD_C_EC_DDD" class="dxeCalendarDayDisabled_WebRefillDefault"></td>
<td id="dateOfBirth_DDD_C_EC_DT" class="dxeCalendarToday_WebRefillDefault"></td>
<td id="dateOfBirth_DDD_C_EC_DD" class="dxeDisabled_WebRefillDefault"></td>
<td id="dateOfBirth_DDD_C_EC_FNM" class="dxeCalendarFastNavMonth_WebRefillDefault"></td>
<td id="dateOfBirth_DDD_C_EC_FNMS" class="dxeCalendarFastNavMonthSelected_WebRefillDefault"></td>
<td id="dateOfBirth_DDD_C_EC_FNY" class="dxeCalendarFastNavYear_WebRefillDefault"></td>
<td id="dateOfBirth_DDD_C_EC_FNYS" class="dxeCalendarFastNavYearSelected_WebRefillDefault"></td>
</tr>
</tbody>
</table>
<table class="dxeCalendar_WebRefillDefault" id="dateOfBirth_DDD_C">
<tbody>
<tr>
<td style="vertical-align:Top;">
<table style="width:100%;border-collapse:collapse;">
<tbody>
<tr>
<td class="dxeCalendarHeader_WebRefillDefault" style="border-top:0;">
<table style="width:100%;border-collapse:collapse;">
<tbody>
<tr>
<td id="dateOfBirth_DDD_C_PYC" class="dxe" onclick="ASPx.CalShiftMonth('dateOfBirth_DDD_C', -12);"><img id="dateOfBirth_DDD_C_PYCImg" class="dxEditors_edtCalendarPrevYear_WebRefillDefault"
src="/DXR.axd?r=1_35-bA_Bk" alt="<<"></td>
<td class="dxeCHS"></td>
<td id="dateOfBirth_DDD_C_PMC" class="dxe" onclick="ASPx.CalShiftMonth('dateOfBirth_DDD_C', -1);"><img id="dateOfBirth_DDD_C_PMCImg" class="dxEditors_edtCalendarPrevMonth_WebRefillDefault"
src="/DXR.axd?r=1_35-bA_Bk" alt="<"></td>
<td id="dateOfBirth_DDD_C_TC" class="dxe" style="width:100%;cursor:default;"><span id="dateOfBirth_DDD_C_T" onclick="ASPx.CalTitleClick('dateOfBirth_DDD_C', 0, 0)" style="cursor:pointer;">November
2024</span></td>
<td id="dateOfBirth_DDD_C_NMC" class="dxe" onclick="ASPx.CalShiftMonth('dateOfBirth_DDD_C', 1);"><img id="dateOfBirth_DDD_C_NMCImg" class="dxEditors_edtCalendarNextMonth_WebRefillDefault"
src="/DXR.axd?r=1_35-bA_Bk" alt=">"></td>
<td class="dxeCHS"></td>
<td id="dateOfBirth_DDD_C_NYC" class="dxe" onclick="ASPx.CalShiftMonth('dateOfBirth_DDD_C', 12);"><img id="dateOfBirth_DDD_C_NYCImg" class="dxEditors_edtCalendarNextYear_WebRefillDefault"
src="/DXR.axd?r=1_35-bA_Bk" alt=">>"></td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td id="dateOfBirth_DDD_C_mc" class="dxMonthGridWithWeekNumbers" style="-webkit-user-select:none;">
<table id="dateOfBirth_DDD_C_mt" style="width:100%;border-collapse:separate;">
<tbody>
<tr class="dx-ac">
<td id="dateOfBirth_DDD_C_AUX_0_0_0"></td>
<td class="dxeCalendarDayHeader_WebRefillDefault" id="dateOfBirth_DDD_C_AUX_0_0_1">Sun</td>
<td class="dxeCalendarDayHeader_WebRefillDefault" id="dateOfBirth_DDD_C_AUX_0_0_2">Mon</td>
<td class="dxeCalendarDayHeader_WebRefillDefault" id="dateOfBirth_DDD_C_AUX_0_0_3">Tue</td>
<td class="dxeCalendarDayHeader_WebRefillDefault" id="dateOfBirth_DDD_C_AUX_0_0_4">Wed</td>
<td class="dxeCalendarDayHeader_WebRefillDefault" id="dateOfBirth_DDD_C_AUX_0_0_5">Thu</td>
<td class="dxeCalendarDayHeader_WebRefillDefault" id="dateOfBirth_DDD_C_AUX_0_0_6">Fri</td>
<td class="dxeCalendarDayHeader_WebRefillDefault" id="dateOfBirth_DDD_C_AUX_0_0_7">Sat</td>
</tr>
<tr>
<td class="dxeCalendarWeekNumber_WebRefillDefault" id="dateOfBirth_DDD_C_AUX_0_0_8">44</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarWeekend_WebRefillDefault dxeCalendarOtherMonth_WebRefillDefault">27</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarOtherMonth_WebRefillDefault">28</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarOtherMonth_WebRefillDefault">29</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarOtherMonth_WebRefillDefault">30</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarOtherMonth_WebRefillDefault">31</td>
<td class="dxeCalendarDay_WebRefillDefault">1</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarWeekend_WebRefillDefault">2</td>
</tr>
<tr>
<td class="dxeCalendarWeekNumber_WebRefillDefault" id="dateOfBirth_DDD_C_AUX_0_0_9">45</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarWeekend_WebRefillDefault">3</td>
<td class="dxeCalendarDay_WebRefillDefault">4</td>
<td class="dxeCalendarDay_WebRefillDefault">5</td>
<td class="dxeCalendarDay_WebRefillDefault">6</td>
<td class="dxeCalendarDay_WebRefillDefault">7</td>
<td class="dxeCalendarDay_WebRefillDefault">8</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarWeekend_WebRefillDefault">9</td>
</tr>
<tr>
<td class="dxeCalendarWeekNumber_WebRefillDefault" id="dateOfBirth_DDD_C_AUX_0_0_10">46</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarWeekend_WebRefillDefault dxeCalendarToday_WebRefillDefault dxeCalendarSelected_WebRefillDefault" style="">10</td>
<td class="dxeCalendarDay_WebRefillDefault">11</td>
<td class="dxeCalendarDay_WebRefillDefault">12</td>
<td class="dxeCalendarDay_WebRefillDefault">13</td>
<td class="dxeCalendarDay_WebRefillDefault">14</td>
<td class="dxeCalendarDay_WebRefillDefault">15</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarWeekend_WebRefillDefault">16</td>
</tr>
<tr>
<td class="dxeCalendarWeekNumber_WebRefillDefault" id="dateOfBirth_DDD_C_AUX_0_0_11">47</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarWeekend_WebRefillDefault">17</td>
<td class="dxeCalendarDay_WebRefillDefault">18</td>
<td class="dxeCalendarDay_WebRefillDefault">19</td>
<td class="dxeCalendarDay_WebRefillDefault">20</td>
<td class="dxeCalendarDay_WebRefillDefault">21</td>
<td class="dxeCalendarDay_WebRefillDefault">22</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarWeekend_WebRefillDefault">23</td>
</tr>
<tr>
<td class="dxeCalendarWeekNumber_WebRefillDefault" id="dateOfBirth_DDD_C_AUX_0_0_12">48</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarWeekend_WebRefillDefault">24</td>
<td class="dxeCalendarDay_WebRefillDefault">25</td>
<td class="dxeCalendarDay_WebRefillDefault">26</td>
<td class="dxeCalendarDay_WebRefillDefault">27</td>
<td class="dxeCalendarDay_WebRefillDefault">28</td>
<td class="dxeCalendarDay_WebRefillDefault">29</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarWeekend_WebRefillDefault">30</td>
</tr>
<tr>
<td class="dxeCalendarWeekNumber_WebRefillDefault" id="dateOfBirth_DDD_C_AUX_0_0_13">49</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarWeekend_WebRefillDefault dxeCalendarOtherMonth_WebRefillDefault">1</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarOtherMonth_WebRefillDefault">2</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarOtherMonth_WebRefillDefault">3</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarOtherMonth_WebRefillDefault">4</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarOtherMonth_WebRefillDefault">5</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarOtherMonth_WebRefillDefault">6</td>
<td class="dxeCalendarDay_WebRefillDefault dxeCalendarWeekend_WebRefillDefault dxeCalendarOtherMonth_WebRefillDefault">7</td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td class="dxeCalendarFooter_WebRefillDefault dx-ac">
<table style="border-collapse:collapse;">
<tbody>
<tr>
<td id="dateOfBirth_DDD_C_BT" class="dxeCalendarButton_WebRefillDefault" onclick="ASPx.CalTodayClick('dateOfBirth_DDD_C');">Today</td>
<td class="dxeCFS"></td>
<td id="dateOfBirth_DDD_C_BC" class="dxeCalendarButton_WebRefillDefault" onclick="ASPx.CalClearClick('dateOfBirth_DDD_C');">Clear</td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
<div id="dateOfBirth_DDD_C_FNP_PW-1" class="dxpcDropDown_WebRefillDefault dxpclW dxpc-ddSys" style="width:0px;cursor:default;z-index:10000;display:none;visibility:hidden;">
<div class="dxpc-mainDiv dxpc-shadow">
<div class="dxpc-contentWrapper">
<div class="dxpc-content" id="dateOfBirth_DDD_C_FNP_PWC-1">
<div class="dxeCalendarFastNav_WebRefillDefault">
<div class="dxeCalendarFastNavMonthArea_WebRefillDefault">
<table id="dateOfBirth_DDD_C_FNP_m" style="width:100%;border-collapse:separate;">
<tbody>
<tr>
<td class="dxeCalendarFastNavMonth_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_M0">Jan</td>
<td class="dxeCalendarFastNavMonth_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_M1">Feb</td>
<td class="dxeCalendarFastNavMonth_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_M2">Mar</td>
<td class="dxeCalendarFastNavMonth_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_M3">Apr</td>
</tr>
<tr>
<td class="dxeCalendarFastNavMonth_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_M4">May</td>
<td class="dxeCalendarFastNavMonth_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_M5">Jun</td>
<td class="dxeCalendarFastNavMonth_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_M6">Jul</td>
<td class="dxeCalendarFastNavMonth_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_M7">Aug</td>
</tr>
<tr>
<td class="dxeCalendarFastNavMonth_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_M8">Sep</td>
<td class="dxeCalendarFastNavMonth_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_M9">Oct</td>
<td class="dxeCalendarFastNavMonth_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_M10">Nov</td>
<td class="dxeCalendarFastNavMonth_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_M11">Dec</td>
</tr>
</tbody>
</table>
</div>
<div class="dxeCalendarFastNavYearArea_WebRefillDefault">
<table id="dateOfBirth_DDD_C_FNP_y" style="width:100%;border-collapse:separate;">
<tbody>
<tr>
<td onclick="ASPx.CalFNYShuffle('dateOfBirth_DDD_C', -10)" rowspan="2" style="cursor:pointer;"><img class="dxEditors_edtCalendarFNPrevYear_WebRefillDefault" src="/DXR.axd?r=1_35-bA_Bk" alt="<"></td>
<td class="dxeCalendarFastNavYear_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_Y0"></td>
<td class="dxeCalendarFastNavYear_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_Y1"></td>
<td class="dxeCalendarFastNavYear_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_Y2"></td>
<td class="dxeCalendarFastNavYear_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_Y3"></td>
<td class="dxeCalendarFastNavYear_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_Y4"></td>
<td onclick="ASPx.CalFNYShuffle('dateOfBirth_DDD_C', 10)" rowspan="2" style="cursor:pointer;"><img class="dxEditors_edtCalendarFNNextYear_WebRefillDefault" src="/DXR.axd?r=1_35-bA_Bk" alt=">"></td>
</tr>
<tr>
<td class="dxeCalendarFastNavYear_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_Y5"></td>
<td class="dxeCalendarFastNavYear_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_Y6"></td>
<td class="dxeCalendarFastNavYear_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_Y7"></td>
<td class="dxeCalendarFastNavYear_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_Y8"></td>
<td class="dxeCalendarFastNavYear_WebRefillDefault" id="dateOfBirth_DDD_C_FNP_Y9"></td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="dxeCalendarFastNavFooter_WebRefillDefault dx-ac">
<table>
<tbody>
<tr>
<td id="dateOfBirth_DDD_C_FNP_BO" class="dxeCalendarButton_WebRefillDefault" onclick="ASPx.CalFNBClick('dateOfBirth_DDD_C', 'ok')">OK</td>
<td class="dxeCFNFS"></td>
<td id="dateOfBirth_DDD_C_FNP_BC" class="dxeCalendarButton_WebRefillDefault" onclick="ASPx.CalFNBClick('dateOfBirth_DDD_C', 'cancel')">Cancel</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</div>
</div>
<script id="dxss_999817998" type="text/javascript">
<!--
ASPx.AddHoverItems('dateOfBirth_DDD_C_FNP', [
[
['dxpc-closeBtnHover'],
[''],
['HCB-1']
]
]);
var dxo = new ASPxClientPopupControl('dateOfBirth_DDD_C_FNP');
dxo.InitGlobalVariable('dateOfBirth_DDD_C_FNP');
dxo.SetProperties({
'uniqueID': 'dateOfBirth$DDD$C$FNP',
'adjustInnerControlsSizeOnShow': false,
'popupAnimationType': 'fade'
});
dxo.AfterCreate();
//
-->
</script>
<script id="dxss_2075100" type="text/javascript">
<!--
ASPx.AddHoverItems('dateOfBirth_DDD_C', [
[
['dxeCalendarButtonHover_WebRefillDefault'],
[''],
['BT', 'BC', 'BO', 'BCN', 'FNP_BO', 'FNP_BC']
],
[
['dxeCalendarFastNavMonthHover_WebRefillDefault'],
[''],
['FNP_M0', 'FNP_M1', 'FNP_M2', 'FNP_M3', 'FNP_M4', 'FNP_M5', 'FNP_M6', 'FNP_M7', 'FNP_M8', 'FNP_M9', 'FNP_M10', 'FNP_M11']
],
[
['dxeCalendarFastNavYearHover_WebRefillDefault'],
[''],
['FNP_Y0', 'FNP_Y1', 'FNP_Y2', 'FNP_Y3', 'FNP_Y4', 'FNP_Y5', 'FNP_Y6', 'FNP_Y7', 'FNP_Y8', 'FNP_Y9']
]
]);
ASPx.AddPressedItems('dateOfBirth_DDD_C', [
[
['dxeCalendarButtonPressed_WebRefillDefault'],
[''],
['BT', 'BC', 'BO', 'BCN', 'FNP_BO', 'FNP_BC']
]
]);
ASPx.AddDisabledItems('dateOfBirth_DDD_C', [
[
['dxeDisabled_WebRefillDefault'],
[''],
['']
],
[
['dxeDisabled_WebRefillDefault dxeButtonDisabled_WebRefillDefault'],
[''],
['BT', 'BC', 'BO', 'BCN', 'FNP_BO', 'FNP_BC']
],
[
[''],
[''],
['PYC', 'PMC', 'NMC', 'NYC'], , [
[{
'spriteCssClass': 'dxEditors_edtCalendarPrevYearDisabled_WebRefillDefault'
}],
[{
'spriteCssClass': 'dxEditors_edtCalendarPrevMonthDisabled_WebRefillDefault'
}],
[{
'spriteCssClass': 'dxEditors_edtCalendarNextMonthDisabled_WebRefillDefault'
}],
[{
'spriteCssClass': 'dxEditors_edtCalendarNextYearDisabled_WebRefillDefault'
}]
],
['Img']
]
]);
var dxo = new MVCxClientCalendar('dateOfBirth_DDD_C');
dxo.InitGlobalVariable('dateOfBirth_DDD_C');
dxo.SetProperties({
'uniqueID': 'dateOfBirth$DDD$C',
'serverCurrentDate': new Date(2024, 10, 10, 0, 0, 0, 0),
'visibleDate': new Date(2024, 10, 10, 0, 0, 0, 0),
'isDateEditCalendar': true
});
dxo.InitializeProperties({
'decorationStyles': [{
'key': 'F',
'className': 'dxeFocused_WebRefillDefault',
'cssText': ''
}],
'selection': [new Date(2024, 10, 10, 0, 0, 0, 0)]
});
dxo.AfterCreate();
//
-->
</script>
</div>
</div>
</div>
</div>
<script id="dxss_1609996168" type="text/javascript">
<!--
ASPx.AddHoverItems('dateOfBirth_DDD', [
[
['dxpc-closeBtnHover'],
[''],
['HCB-1']
]
]);
var dxo = new ASPxClientPopupControl('dateOfBirth_DDD');
dxo.InitGlobalVariable('dateOfBirth_DDD');
dxo.SetProperties({
'uniqueID': 'dateOfBirth$DDD',
'adjustInnerControlsSizeOnShow': false,
'popupAnimationType': 'slide',
'closeAction': 'CloseButton',
'popupHorizontalAlign': 'LeftSides',
'popupVerticalAlign': 'Below'
});
dxo.SetEvents({
'Shown': function(s, e) {
ASPx.DDBPCShown('dateOfBirth', e);
}
});
dxo.AfterCreate();
//
-->
</script>
<script id="dxss_829391349" type="text/javascript">
<!--
ASPx.AddHoverItems('dateOfBirth', [
[
['dxeButtonEditButtonHover_WebRefillDefault'],
[''],
['B-1']
]
]);
ASPx.RemoveHoverItems('dateOfBirth', [
[
['B-100']
]
]);
ASPx.AddPressedItems('dateOfBirth', [
[
['dxeButtonEditButtonPressed_WebRefillDefault'],
[''],
['B-1']
]
]);
ASPx.RemovePressedItems('dateOfBirth', [
[
['B-100']
]
]);
var dxo = new MVCxClientDateEdit('dateOfBirth');
dxo.InitGlobalVariable('dateOfBirth');
dxo.SetProperties({
'stateObject': {
'rawValue': '1731219398155.11'
},
'nullText': 'MM/dd/yyyy',
'autoCompleteAttribute': {
'name': 'autocomplete',
'value': 'off'
},
'outOfRangeWarningClassName': 'dxeOutOfRWarn_WebRefillDefault dxeOutOfRWarnRight_WebRefillDefault',
'outOfRangeWarningMessages': ['The date must be in the range {0}...{1}', 'The date must be greater than or equal to {0}', 'The date must be less than or equal to {0}'],
'date': new Date(2024, 10, 10, 6, 16, 38, 155),
'dateFormatter': ASPx.DateFormatter.Create('MM/dd/yyyy')
});
dxo.InitializeProperties({
'decorationStyles': [{
'key': 'F',
'className': 'dxeFocused_WebRefillDefault',
'cssText': ''
}, {
'key': 'N',
'className': 'dxeNullText_WebRefillDefault',
'cssText': ''
}],
'maskInfo': {
'maskText': 'MM/dd/yyyy',
'dateTimeOnly': true
}
});
dxo.AfterCreate();
//
-->
</script>
</div>
</div>
</div>
</div>
<div id="frmxOrderRefill_0_2" class="dxflNotFloatedElSys" style="width:100%;">
<div class="dxflGroupCell_WebRefillDefault" style="padding-top:0px;padding-bottom:0px;">
<div class="dxflNestedControlCell_WebRefillDefault dxflCLRSys dxflItemSys dxflTextEditItemSys dxflItem_WebRefillDefault" style="padding-top:0px;padding-bottom:1px;">
<table class="dxeButtonEditSys dxeButtonEdit_WebRefillDefault dxeNullText_WebRefillDefault dxh0" id="beAddRxNumber" style="width:100%;" savedspellcheck="[object Object]" spellcheck="false">
<tbody>
<tr>
<td class="dxic" style="width:100%;"><input tabindex="1" class="dxeEditArea_WebRefillDefault dxeEditAreaSys dxh0" id="beAddRxNumber_I" name="beAddRxNumber" onfocus="ASPx.EGotFocus('beAddRxNumber')"
onblur="ASPx.ELostFocus('beAddRxNumber')" onchange="ASPx.EValueChanged('beAddRxNumber')" value="Enter Rx #" type="text" savedspellcheck="[object Object]" spellcheck="false"></td>
<td id="beAddRxNumber_B0" class="dxeButton dxeButtonEditButton_WebRefillDefault" onclick="ASPx.BEClick('beAddRxNumber',0)"><img id="beAddRxNumber_B0Img" class="dxIcon_actions_add_16x16office2013" src="/DXR.axd?r=1_35-bA_Bk"
alt="..."></td>
<td id="beAddRxNumber_B1" class="dxeButton dxeButtonEditButton_WebRefillDefault" onclick="ASPx.BEClick('beAddRxNumber',1)"><img id="beAddRxNumber_B1Img" class="dxIcon_edit_remove_16x16office2013" src="/DXR.axd?r=1_35-bA_Bk"
alt="..."></td>
</tr>
</tbody>
</table>
<script id="dxss_1154378133" type="text/javascript">
<!--
ASPx.AddHoverItems('beAddRxNumber', [
[
['dxeButtonEditButtonHover_WebRefillDefault'],
[''],
['B0', 'B1']
]
]);
ASPx.RemoveHoverItems('beAddRxNumber', [
[
['B-100']
]
]);
ASPx.AddPressedItems('beAddRxNumber', [
[
['dxeButtonEditButtonPressed_WebRefillDefault'],
[''],
['B0', 'B1']
]
]);
ASPx.RemovePressedItems('beAddRxNumber', [
[
['B-100']
]
]);
ASPx.AddDisabledItems('beAddRxNumber', [
[
['dxeDisabled_WebRefillDefault'],
[''],
['', 'I']
],
[
['dxeDisabled_WebRefillDefault dxeButtonDisabled_WebRefillDefault'],
[''],
['B0', 'B1'], , [
[{
'spriteCssClass': 'dxIcon_actions_add_16x16office2013_disabled'
}],
[{
'spriteCssClass': 'dxIcon_edit_remove_16x16office2013_disabled'
}]
],
['Img']
]
]);
ASPx.RemoveDisabledItems('beAddRxNumber', [
[
['B-100'],
]
]);
var dxo = new ASPxClientButtonEdit('beAddRxNumber');
dxo.InitGlobalVariable('beAddRxNumber');
dxo.SetProperties({
'stateObject': {
'rawValue': ''
},
'nullText': 'Enter Rx #',
'buttonCount': 2
});
dxo.SetEvents({
'LostFocus': WinRxRefill.OrderRefill.beAddRxNumber_OnLostFocus,
'KeyDown': WinRxRefill.OrderRefill.beAddRxNumber_OnKeyDown,
'ButtonClick': WinRxRefill.OrderRefill.beAddRxNumber_OnButtonClick
});
dxo.InitializeProperties({
'decorationStyles': [{
'key': 'F',
'className': 'dxeFocused_WebRefillDefault',
'cssText': ''
}, {
'key': 'N',
'className': 'dxeNullText_WebRefillDefault',
'cssText': ''
}]
});
dxo.AfterCreate();
//
-->
</script>
</div>
</div>
</div>
<div id="frmxOrderRefill_0_3" class="dxflNotFloatedElSys" style="width:100%;">
<div class="dxflGroupCell_WebRefillDefault" style="padding-top:0px;padding-bottom:0px;">
<div class="dxflNestedControlCell_WebRefillDefault dxflCLRSys dxflItemSys dxflListBoxItemSys dxflItem_WebRefillDefault" style="padding-top:0px;padding-bottom:1px;">
<table class="dxeListBox_WebRefillDefault" id="RxNumbers" style="border-collapse: separate; width: 100%; display: none; height: 40px;">
<tbody>
<tr>
<td style="vertical-align:Top;">
<div id="RxNumbers_H" class="dxeHD" style="padding-right: 0px;">
<table style="width: 100%; border-collapse: separate; table-layout: fixed !important;">
<tbody>
<tr>
<td class="dxeListBoxItem_WebRefillDefault dxeHFC" style="width:20%;">Rx Number</td>
<td class="dxeListBoxItem_WebRefillDefault dxeHLC" style="width:80%;">Status</td>
</tr>
</tbody>
</table>
</div>
<div id="RxNumbers_D" class="dxlbd" style="overflow: hidden auto; height: 76px;">
<input id="RxNumbers_VI" type="hidden" name="RxNumbers" value="">
<table style="border-collapse:separate;visibility:hidden!important;display:none!important;">
<tbody>
<tr id="RxNumbers_LBI-1" class="dxeListBoxItemRow_WebRefillDefault">
<td id="RxNumbers_LBI-1T0" class="dxeListBoxItem_WebRefillDefault dxeFTM" style="width:20%;"> </td>
<td class="dxeListBoxItem_WebRefillDefault dxeLTM" style="width:80%;" id="RxNumbers_LBI-1T1"> </td>
</tr>
</tbody>
</table>
<table id="RxNumbers_LBT" style="width:100%;border-collapse:separate;table-layout:fixed!important;">
<tbody></tbody>
</table>
</div>
<div class="dxKBSW">
<input id="RxNumbers_KBS" tabindex="2" type="text" readonly="readonly" style="opacity:0;width:0;height:0;position:relative;background-color:transparent;display:block;margin:0;padding:0;border-width:0;" autocomplete="off">
</div>
</td>
</tr>
</tbody>
</table>
<script id="dxss_726636579" type="text/javascript">
<!--
ASPx.AddDisabledItems('RxNumbers', [
[
['dxeDisabled_WebRefillDefault'],
[''],
['']
]
]);
var dxo = new MVCxClientListBox('RxNumbers');
dxo.InitGlobalVariable('RxNumbers');
dxo.SetProperties({
'stateObject': {
'CustomCallback': ''
},
'hasSampleItem': true,
'isHasFakeRow': true,
'columnFieldNames': ['RxNumber', 'Status'],
'textFormatString': '{0}; {1}',
'selectionMode': 1,
'initSelectedIndices': [],
'hoverClasses': ['dxeListBoxItemHover_WebRefillDefault'],
'selectedClasses': ['dxeListBoxItemSelected_WebRefillDefault'],
'disabledClasses': ['dxeDisabled_WebRefillDefault']
});
dxo.SetEvents({
'Init': WinRxRefill.OrderRefill.RxNumber_OnInit,
'KeyDown': WinRxRefill.OrderRefill.RxNumber_OnKeyDown
});
dxo.InitializeProperties({
'decorationStyles': [{
'key': 'F',
'className': 'dxeFocused_WebRefillDefault',
'cssText': ''
}]
});
dxo.AfterCreate();
//
-->
</script>
</div>
</div>
</div>
<div id="frmxOrderRefill_0_4" class="dxflNotFloatedElSys" style="width:100%;">
<div class="dxflHARSys dxflGroupCell_WebRefillDefault" style="padding-top:0px;padding-bottom:0px;">
<div class="dxflNestedControlCell_WebRefillDefault dxflCLRSys dxflItemSys dxflButtonItemSys dxflItem_WebRefillDefault" style="padding-top:0px;padding-bottom:1px;">
<div class="dxflInternalEditorTable_WebRefillDefault dxflElConSys">
<div class="dxflHARSys dxflVATSys dxflLHelpTextSys dxflHelpText_WebRefillDefault">
<span>Only 5 Rx numbers can be submitted per request</span>
</div>
<div style="width:100%;">
<div class="dxbButton_WebRefillDefault DefaultButton dxbButtonSys dxbTSys" id="btnRxNumbersRemoveAll" style="background: transparent; border: none; box-shadow: none; width: 100%; user-select: none; display: none;">
<div class="dxb" id="btnRxNumbersRemoveAll_CD">
<div class="dxb-hbc">
<input id="btnRxNumbersRemoveAll_I" class="dxb-hb" value="Clear List" type="button" name="btnRxNumbersRemoveAll">
</div><img class="dxIcon_actions_clear_16x16office2013 dx-vam" src="/DXR.axd?r=1_35-bA_Bk" alt="" style="margin-right:4px;" id="btnRxNumbersRemoveAllImg"><span class="dx-vam">Clear List</span>
</div>
</div>
<script id="dxss_358933435" type="text/javascript">
<!--
ASPx.AddHoverItems('btnRxNumbersRemoveAll', [
[
['dxbButtonHover_WebRefillDefault DefaultButton_Hovered backgroundPrimary'],
[''],
[''],
['', 'TC']
]
]);
ASPx.AddPressedItems('btnRxNumbersRemoveAll', [
[
['dxbButtonPressed_WebRefillDefault'],
[''],
[''],
['', 'TC']
]
]);
ASPx.AddDisabledItems('btnRxNumbersRemoveAll', [
[
['dxbDisabled_WebRefillDefault'],
[''],
[''],
['', 'TC'],
[
[{
'spriteCssClass': 'dxIcon_actions_clear_16x16office2013_disabled'
}]
],
['Img']
]
]);
ASPx.AddSelectedItems('btnRxNumbersRemoveAll', [
[
['dxbf'],
[''],
['CD']
]
]);
var dxo = new MVCxClientButton('btnRxNumbersRemoveAll');
dxo.InitGlobalVariable('btnRxNumbersRemoveAll');
dxo.SetProperties({
'useSubmitBehavior': false
});
dxo.SetEvents({
'Init': WinRxRefill.OrderRefill.btnRxNumbersRemoveAll_OnInit,
'Click': WinRxRefill.OrderRefill.btnRxNumbersRemoveAll_OnClick
});
dxo.AfterCreate();
//
-->
</script>
</div>
</div>
</div>
</div>
</div>
<div id="frmxOrderRefill_0_5" class="dxflNotFloatedElSys" style="width:100%;">
<div class="dxflGroupCell_WebRefillDefault" style="padding-top:0px;padding-bottom:0px;">
<div class="dxflNestedControlCell_WebRefillDefault dxflCLRSys dxflItemSys dxflMemoItemSys dxflItem_WebRefillDefault" style="padding-top:0px;padding-bottom:1px;">
<table class="dxeMemoSys dxeMemo_WebRefillDefault dxeNullText_WebRefillDefault custom_NullText dxh0" id="OrderRefill_RxNotes" style="height:71px;width:100%;border-collapse:separate;" savedspellcheck="[object Object]"
spellcheck="false">
<tbody>
<tr>
<td style="width:100%;"><textarea tabindex="3" class="dxeMemoEditArea_WebRefillDefault dxeMemoEditAreaSys dxh0" id="OrderRefill_RxNotes_I" name="OrderRefill_RxNotes" onfocus="ASPx.EGotFocus('OrderRefill_RxNotes')"
onblur="ASPx.ELostFocus('OrderRefill_RxNotes')" onchange="ASPx.EValueChanged('OrderRefill_RxNotes')" style="height:71px;width:100%;" savedspellcheck="[object Object]" spellcheck="false"
autocomplete="off">Special Instructions For Order</textarea></td>
</tr>
</tbody>
</table>
<script id="dxss_371043199" type="text/javascript">
<!--
ASPx.AddDisabledItems('OrderRefill_RxNotes', [
[
['dxeDisabled_WebRefillDefault'],
[''],
['', 'I']
]
]);
var dxo = new ASPxClientMemo('OrderRefill_RxNotes');
dxo.InitGlobalVariable('OrderRefill_RxNotes');
dxo.SetProperties({
'stateObject': {
'rawValue': ''
},
'nullText': 'Special Instructions For Order',
'autoCompleteAttribute': {
'name': 'autoComplete',
'value': 'off'
}
});
dxo.SetEvents({
'LostFocus': WinRxRefill.OrderRefill.RxNotesLostFocus,
'KeyDown': WinRxRefill.OrderRefill.RxNotesOnKeyDown
});
dxo.InitializeProperties({
'decorationStyles': [{
'key': 'F',
'className': 'dxeFocused_WebRefillDefault',
'cssText': ''
}, {
'key': 'N',
'className': 'dxeNullText_WebRefillDefault custom_NullText',
'cssText': ''
}]
});
dxo.AfterCreate();
//
-->
</script>
</div>
</div>
</div>
<div id="frmxOrderRefill_0_6" class="dxflNotFloatedElSys" style="width:100%;">
<div class="dxflGroupCell_WebRefillDefault" style="padding-top:0px;padding-bottom:0px;">
<div class="dxflNestedControlCell_WebRefillDefault dxflCLRSys dxflItemSys dxflTextEditItemSys dxflItem_WebRefillDefault" style="padding-top:0px;padding-bottom:1px;">
<table class="dxeButtonEditSys dxeButtonEdit_WebRefillDefault" id="OrderRefill_SelectedPDM" style="width:100%;">
<tbody>
<tr>
<td style="display:none;"><input id="OrderRefill_SelectedPDM_VI" name="OrderRefill_SelectedPDM_VI" type="hidden" value="P"></td>
<td class="dxic" onmousedown="return ASPx.DDDropDown('OrderRefill_SelectedPDM', event)" style="width:100%;"><input tabindex="4" class="dxeEditArea_WebRefillDefault dxeEditAreaSys" id="OrderRefill_SelectedPDM_I"
name="OrderRefill_SelectedPDM" onfocus="ASPx.EGotFocus('OrderRefill_SelectedPDM')" onblur="ASPx.ELostFocus('OrderRefill_SelectedPDM')" onchange="ASPx.ETextChanged('OrderRefill_SelectedPDM')" value="Pickup" type="text"
autocomplete="off"></td>
<td id="OrderRefill_SelectedPDM_B-1" class="dxeButton dxeButtonEditButton_WebRefillDefault" onmousedown="return ASPx.DDDropDown('OrderRefill_SelectedPDM', event)" style="-webkit-user-select:none;"><img
id="OrderRefill_SelectedPDM_B-1Img" class="dxEditors_edtDropDown_WebRefillDefault" src="/DXR.axd?r=1_35-bA_Bk" alt="v"></td>
</tr>
</tbody>
</table>
<div id="OrderRefill_SelectedPDM_DDD_PW-1" class="dxpcDropDown_WebRefillDefault dxpclW dxpc-ddSys" style="cursor:default;z-index:10000;display:none;visibility:hidden;">
<div class="dxpc-mainDiv dxpc-shadow">
<div class="dxpc-contentWrapper">
<div class="dxpc-content" id="OrderRefill_SelectedPDM_DDD_PWC-1">
<table class="dxeListBox_WebRefillDefault" id="OrderRefill_SelectedPDM_DDD_L" style="border-collapse:separate;">
<tbody>
<tr>
<td style="vertical-align:Top;">
<div id="OrderRefill_SelectedPDM_DDD_L_D" class="dxlbd" style="width:100%;overflow-x:hidden;overflow-y:auto;">
<input id="OrderRefill_SelectedPDM_DDD_L_VI" type="hidden" name="OrderRefill_SelectedPDM$DDD$L" value="P">
<table style="border-collapse:separate;visibility:hidden!important;display:none!important;">
<tbody>
<tr id="OrderRefill_SelectedPDM_DDD_L_LBI-1" class="dxeListBoxItemRow_WebRefillDefault">
<td id="OrderRefill_SelectedPDM_DDD_L_LBI-1T0" class="dxeListBoxItem_WebRefillDefault"> </td>
</tr>
</tbody>
</table>
<table id="OrderRefill_SelectedPDM_DDD_L_LBT" style="width:100%;border-collapse:separate;">
<tbody>
<tr class="dxeListBoxItemRow_WebRefillDefault">
<td class="dxeListBoxItem_WebRefillDefault dxeListBoxItemSelected_WebRefillDefault" id="OrderRefill_SelectedPDM_DDD_L_LBI0T0">Pickup</td>
</tr>
<tr class="dxeListBoxItemRow_WebRefillDefault">
<td class="dxeListBoxItem_WebRefillDefault" id="OrderRefill_SelectedPDM_DDD_L_LBI1T0">Mail</td>
</tr>
</tbody>
</table>
</div>
</td>
</tr>
</tbody>
</table>
<script id="dxss_2111103885" type="text/javascript">
<!--
ASPx.AddDisabledItems('OrderRefill_SelectedPDM_DDD_L', [
[
['dxeDisabled_WebRefillDefault'],
[''],
['']
]
]);
var dxo = new MVCxClientListBox('OrderRefill_SelectedPDM_DDD_L');
dxo.InitGlobalVariable('OrderRefill_SelectedPDM_DDD_L');
dxo.SetProperties({
'uniqueID': 'OrderRefill_SelectedPDM$DDD$L',
'stateObject': {
'CustomCallback': ''
},
'savedSelectedIndex': 0,
'itemsValue': ['P', 'M'],
'isComboBoxList': true,
'hasSampleItem': true,
'hoverClasses': ['dxeListBoxItemHover_WebRefillDefault'],
'selectedClasses': ['dxeListBoxItemSelected_WebRefillDefault'],
'disabledClasses': ['dxeDisabled_WebRefillDefault']
});
dxo.SetEvents({
'SelectedIndexChanged': function(s, e) {
ASPx.CBLBSelectedIndexChanged('OrderRefill_SelectedPDM', e);
},
'ItemClick': function(s, e) {
ASPx.CBLBItemMouseUp('OrderRefill_SelectedPDM', e);
}
});
dxo.InitializeProperties({
'decorationStyles': [{
'key': 'F',
'className': 'dxeFocused_WebRefillDefault',
'cssText': ''
}]
});
dxo.AfterCreate();
//
-->
</script>
</div>
</div>
</div>
</div>
<script id="dxss_782717371" type="text/javascript">
<!--
ASPx.AddHoverItems('OrderRefill_SelectedPDM_DDD', [
[
['dxpc-closeBtnHover'],
[''],
['HCB-1']
]
]);
var dxo = new ASPxClientPopupControl('OrderRefill_SelectedPDM_DDD');
dxo.InitGlobalVariable('OrderRefill_SelectedPDM_DDD');
dxo.SetProperties({
'uniqueID': 'OrderRefill_SelectedPDM$DDD',
'adjustInnerControlsSizeOnShow': false,
'popupAnimationType': 'slide',
'closeAction': 'CloseButton',
'popupHorizontalAlign': 'LeftSides',
'popupVerticalAlign': 'Below'
});
dxo.SetEvents({
'Shown': function(s, e) {
ASPx.DDBPCShown('OrderRefill_SelectedPDM', e);
}
});
dxo.AfterCreate();
//
-->
</script>
<script id="dxss_1612126871" type="text/javascript">
<!--
ASPx.AddHoverItems('OrderRefill_SelectedPDM', [
[
['dxeButtonEditButtonHover_WebRefillDefault'],
[''],
['B-1']
]
]);
ASPx.RemoveHoverItems('OrderRefill_SelectedPDM', [
[
['B-100']
]
]);
ASPx.AddPressedItems('OrderRefill_SelectedPDM', [
[
['dxeButtonEditButtonPressed_WebRefillDefault'],
[''],
['B-1']
]
]);
ASPx.RemovePressedItems('OrderRefill_SelectedPDM', [
[
['B-100']
]
]);
ASPx.AddDisabledItems('OrderRefill_SelectedPDM', [
[
['dxeDisabled_WebRefillDefault'],
[''],
['', 'I']
],
[
['dxeDisabled_WebRefillDefault dxeButtonDisabled_WebRefillDefault'],
[''],
['B-1'], , [
[{
'spriteCssClass': 'dxEditors_edtDropDownDisabled_WebRefillDefault'
}]
],
['Img']
]
]);
ASPx.RemoveDisabledItems('OrderRefill_SelectedPDM', [
[
['B-100'],
]
]);
var dxo = new MVCxClientComboBox('OrderRefill_SelectedPDM');
dxo.InitGlobalVariable('PDM_OrderRefill');
dxo.SetProperties({
'autoCompleteAttribute': {
'name': 'autocomplete',
'value': 'off'
},
'lastSuccessValue': 'P',
'islastSuccessValueInit': true
});
dxo.SetEvents({
'Init': WinRxRefill.OrderRefill.PdmListOnInit,
'SelectedIndexChanged': WinRxRefill.OrderRefill.PdmListOnSelectedIndexChanged
});
dxo.InitializeProperties({
'decorationStyles': [{
'key': 'F',
'className': 'dxeFocused_WebRefillDefault',
'cssText': ''
}]
});
dxo.AfterCreate();
//
-->
</script>
</div>
</div>
</div>
<div id="frmxOrderRefill_0_7" class="dxflNotFloatedElSys" style="width:100%;">
<div class="dxflGroupCell_WebRefillDefault" style="padding-top:0px;padding-bottom:0px;">
<div class="dxflNestedControlCell_WebRefillDefault dxflCLRSys dxflItemSys dxflCheckBoxItemSys dxflItem_WebRefillDefault" style="padding-top:0px;padding-bottom:1px;">
<table id="OrderRefill_EmailConfirmation_ET" class="dxeValidStEditorTable dxeRoot_WebRefillDefault" style="width:100%;display:none;" errorframe="errorFrame">
<tbody>
<tr>
<td id="OrderRefill_EmailConfirmation_CC" class="dxeErrorFrame_WebRefillDefault dxeErrorFrameSys dxeNoBorderRight dxeControlsCell_WebRefillDefault" style="width:100%;vertical-align:middle;">
<table class="dxeBase_WebRefillDefault dxeTAR" id="OrderRefill_EmailConfirmation" style="width:100%;display:none;">
<tbody>
<tr>
<td class="dxichCellSys"><span class="dxWeb_edtCheckBoxUnchecked_WebRefillDefault dxICheckBox_WebRefillDefault dxichSys" id="OrderRefill_EmailConfirmation_S_D"><span class="dxKBSW"><input
id="OrderRefill_EmailConfirmation_S" tabindex="6" name="OrderRefill_EmailConfirmation" data-val-required="The OrderRefill_EmailConfirmation field is required." data-val="true" value="U" type="text"
readonly="readonly" style="opacity:0;width:0;height:0;position:relative;background-color:transparent;display:block;margin:0;padding:0;border-width:0;"></span></span></td>
<td class="dxichTextCellSys"><label>Email Confirmation?</label></td>
</tr>
</tbody>
</table>
</td>
<td id="OrderRefill_EmailConfirmation_EC" class="dxeErrorCell_WebRefillDefault dxeErrorFrame_WebRefillDefault dxeErrorFrameSys dxeErrorCellSys dxeNoBorderLeft"
style="vertical-align:middle;visibility:hidden;white-space:nowrap;">
<table style="width:100%;">
<tbody>
<tr>
<td><img id="OrderRefill_EmailConfirmation_EI" title="Invalid value" class="dxEditors_edtError_WebRefillDefault" src="/DXR.axd?r=1_35-bA_Bk" alt="Invalid value"></td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
<script id="dxss_904326404" type="text/javascript">
<!--
ASPx.AddDisabledItems('OrderRefill_EmailConfirmation', [
[
['dxeDisabled_WebRefillDefault'],
[''],
['']
]
]);
var dxo = new ASPxClientCheckBox('OrderRefill_EmailConfirmation');
dxo.InitGlobalVariable('OrderRefill_EmailConfirmation');
dxo.SetProperties({
'clientVisible': false,
'customValidationEnabled': true,
'isValid': true,
'errorText': 'Invalid value',
'isErrorFrameRequired': true,
'errorDisplayMode': 'i',
'errorImageIsAssigned': true,
'imageProperties': {
'4': ['dxWeb_edtCheckBoxChecked_WebRefillDefault', 'dxWeb_edtCheckBoxUnchecked_WebRefillDefault'],
'8': ['dxWeb_edtCheckBoxCheckedDisabled_WebRefillDefault', 'dxWeb_edtCheckBoxUncheckedDisabled_WebRefillDefault']
},
'icbFocusedStyle': ['dxICBFocused_WebRefillDefault', '']
});
dxo.SetEvents({
'Init': WinRxRefill.OrderRefill.EmailConfirmationOnInit,
'CheckedChanged': WinRxRefill.OrderRefill.EmailConfirmationOnCheckChanged
});
dxo.InitializeProperties({
'decorationStyles': [{
'key': 'I',
'className': 'dxeInvalid_WebRefillDefault',
'cssText': ''
}]
});
dxo.AfterCreate();
//
-->
</script>
</div>
</div>
</div>
<div id="frmxOrderRefill_0_8" class="dxflNotFloatedElSys dxflLastChildSys dxflChildInLastRowSys" style="width:100%;">
<div class="dxflGroupCell_WebRefillDefault" style="padding-top:0px;padding-bottom:0px;">
<div class="dxflNestedControlCell_WebRefillDefault dxflCLRSys dxflItemSys dxflButtonItemSys dxflItem_WebRefillDefault" style="padding-top:0px;padding-bottom:1px;">
<div class="dxbButton_WebRefillDefault DefaultButton dxbButtonSys dxbTSys" id="btnOrderRefills" style="width:100%;-webkit-user-select:none;">
<div class="dxb" id="btnOrderRefills_CD">
<div class="dxb-hbc">
<input id="btnOrderRefills_I" tabindex="7" class="dxb-hb" value="Order Refills" type="button" name="btnOrderRefills">
</div><span class="dx-vam">Order Refills</span>
</div>
</div>
<script id="dxss_1304500920" type="text/javascript">
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ASPx.AddHoverItems('btnOrderRefills', [
[
['dxbButtonHover_WebRefillDefault DefaultButton_Hovered backgroundPrimary'],
[''],
[''],
['', 'TC']
]
]);
ASPx.AddPressedItems('btnOrderRefills', [
[
['dxbButtonPressed_WebRefillDefault'],
[''],
[''],
['', 'TC']
]
]);
ASPx.AddDisabledItems('btnOrderRefills', [
[
['dxbDisabled_WebRefillDefault'],
[''],
[''],
['', 'TC']
]
]);
ASPx.AddSelectedItems('btnOrderRefills', [
[
['dxbf'],
[''],
['CD']
]
]);
var dxo = new MVCxClientButton('btnOrderRefills');
dxo.InitGlobalVariable('btnOrderRefills');
dxo.SetProperties({
'useSubmitBehavior': false
});
dxo.SetEvents({
'Click': WinRxRefill.OrderRefill.btnRpOrderRefills_OnClick
});
dxo.AfterCreate();
//
-->
</script>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<script id="dxss_829234093" type="text/javascript">
<!--
var dxo = new MVCxClientFormLayout('frmxOrderRefill');
dxo.InitGlobalVariable('frmxOrderRefill');
dxo.SetProperties({
'adaptivityMode': 'SingleColumnWindowLimit',
'switchToSingleColumnAtWindowInnerWidth': 700
});
dxo.InitializeProperties({
'items': [
['', '0', , , , [
['LastName', '0_0', , , , , ],
['dateOfBirth', '0_1', , , , , ],
['beAddRxNumber', '0_2', , , , , ],
['RxNumbers', '0_3', , , , , ],
['', '0_4', , , , , ],
['OrderRefill_RxNotes', '0_5', , , , , ],
['OrderRefill_SelectedPDM', '0_6', , , , , ],
['OrderRefill_EmailConfirmation', '0_7', , , , , ],
['', '0_8', , , , , ]
]]
]
});
dxo.AfterCreate();
//
-->
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value="{"LastName":null,"dateOfBirth":new Date(2024,10,10,6,16,38,155),"beAddRxNumber":null,"RxNumbers":[],"OrderRefill_RxNotes":null,"OrderRefill_SelectedPDM_DDD_L":["P"],"OrderRefill_SelectedPDM":"P","OrderRefill_EmailConfirmation":false}"><input
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type="hidden" name="DXCss" id="DXCss"
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</form>Text Content
* Order Refills * * Contact Us * * Help * * Register Log in * Home * * Order Refills * * Contact Us * * Help * * Login * * Register * * WELCOME TO WINRXREFILL! Here you'll find quick and easy access to your prescription history and statistics, not to mention multiple tools to help you manage your medication regimen! Login to view and request refills from your prescription history or access your prescription profile. Read the monographs for all of the medications in your prescription history. Find contact information for your pharmacy. Request refills without logging in by typing in the Rx number or scanning the barcode, and you'll receive an immediate response confirming your request. FILL YOUR PRESCRIPTIONS WITHOUT LOGGING IN! Date of Birth: November 2024 SunMonTueWedThuFriSat 44272829303112 453456789 4610111213141516 4717181920212223 4824252627282930 491234567 TodayClear JanFebMarApr MayJunJulAug SepOctNovDec OKCancel Rx NumberStatus Only 5 Rx numbers can be submitted per request Clear List Special Instructions For Order Pickup Mail Email Confirmation? Order Refills Loading… LOGIN TO GAIN ACCESS TO MUCH MORE! * Login to view and request refills from your prescription history. * Access your prescription profile, which is a summary of your prescription, doctor and allergy history. * Read the drug monograph information about all of the drugs in your prescription history. * View linked patient addresses and phone numbers for the pharmacy. Go To Login REQUEST REFILLS ON THE GO USING THE RX2GO APP FOR YOUR MOBILE DEVICE! 2024 ©COPYRIGHT BY COMPUTER-RX NEOHEALTH HULBERT PHARMACY 131 E Main St. Hulbert , OK 74441 918-772-2727 www.neohealth.org/ STORE HOURS Mon-Fri 8:30am-5:00pm Closed 12:30pm-1:00pm Daily WARNING! Your session is about to expire! Click OK to continue your session. Continue Working?