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<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">


 
	





 
	

























<meta name="description" content="">
<meta name="keywords" content=",">
<link href="default.css" rel="stylesheet" type="text/css" />

   <title>Prayer Request - Provena Mercy Medical Center</title>

<style type="text/css">
	@import url(default.css);
</style>


            <script language="JavaScript" type="text/javascript">
            <!--//
                  var ns4 = (document.layers);
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                  var ie5 = (ie && document.getElementById);
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							this.HTMLname = arg[0];
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							this.OriginalSrc = '';
							return true;
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						function BillzImagePreload() {
						// 0) html image name 1) mo image src 2)image Name for rollover key (rollover may have multiple mos for one html Image) 
							var arg = BillzImagePreload.arguments;
							nbImagePreload(arg[0], arg[1], arg[2]);
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								aryMoImages[imageKey] = new MOImage(img_name, mo_img_src);
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						function BillzMouseover() {
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								arg = BillzMouseover.arguments; //args 0)ImageName 1)OriginalSrc 2)array index (caller imagename)		
								nbMouseover(arg[0], arg[1], arg[2]);
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							return true;
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                  // args 1) ImageName 2) OriginalSrc 3) array index (caller imagename)
                  function nbMouseover(img_name, orig_src, img_key)
                  {
							var imageKey = null;
							var o = null;
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                     {				
								imageKey = (img_key.length > 0) ? img_key : img_name;
								if (!(aryMoImages[imageKey].ptrImage)) {
									aryMoImages[imageKey].ptrImage = BillzNavBarMM_findObj(img_name);
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                        {
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							return true;
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						var NavBarTempOnload = null;
						if (window.onload && window.onload != null){
							NavBarTempOnload = window.onload;
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						function FullyLoaded() {
							if (NavBarTempOnload != null){
								NavBarTempOnload();
							}
							runMouseOvers = true;
							return true;
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						function BillzMouseOutTimer() {
							return nbMouseOutTimer();
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                  function nbMouseOutTimer() 
                  {
							if (TimerID) {
								clearTimeout(TimerID);
							}
							TimerID = setTimeout("nbLayerRestore()",5000);
							return true;
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						function RestoreAll() {
							nbMouseoverRestore();
							nbLayerRestore();
							return true;
						}
                  
						function BillzMouseoverRestore() {
							return nbMouseoverRestore();
						}
                  function nbMouseoverRestore() 
                  {
							var i = 0;
							var o = null;
							if (runMouseOvers) 
                     {
								for (i = 0; i < imageList.length; i++) 
                        {
									if (aryMoImages[imageList[i]].Moused && (o = aryMoImages[imageList[i]].ptrImage)) 
                           {
										o.src = aryMoImages[imageList[i]].OriginalSrc;
										aryMoImages[imageList[i]].Moused = false;
									}
								}
							}
							return true;
						}
                  
						function BillzLayerRestore() {
							return nbLayerRestore();
						}
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                  {
							var i = 0;
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                     {
								if (!aryNavBarLayerInfo[aryLayerNames[i]].isDefault) {
									BillzNavBarRestoreLayers(aryLayerNames[i]);
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							return true;
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						function BillzArrayPushUnique(aryArray, varNewElement) { //only pushes if unique value
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							var i = 0;
							for (i = 0; i < aryArray.length && pushIt; i++) {
								pushIt = (varNewElement != aryArray[i]);
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							if (pushIt) {
								BillzArrayPush(aryArray, varNewElement);
							}
							return pushIt;
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						function BillzArrayPush(aryArray, varNewElement) { //Implement Array Push 'cause IE cant handle it
							aryArray[aryArray.length] = varNewElement;
							return true;
						}
						function BillzArrayPop(aryArray) { //Implement Array Pop 'cause IE cant handle it before 5.5
							var varItemToPop = null;
							if (aryArray[aryArray.length - 1]) {
								varItemToPop = aryArray[aryArray.length - 1];
								aryArray[aryArray.length] = null;
							}
							return varItemToPop;
						}
			                 
                  //v3.0 name changed to avoid clash with possible other JS in content, this function complements of MM Dreamweaver
						function BillzNavBarMM_findObj(n, d) {
						  	var p,i,x;
						
							if (registeredObjects[n]) {
								return registeredObjects[n];
							}
							if (!(d)) {
								d = document;
							}
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                        p = n.indexOf("?");
                     }
                     catch(e) {
                        p = 0;
                     }
							if (p > 0 && parent.frames.length) {
								d = parent.frames[n.substring(p+1)].document;
								n = n.substring(0,p);
							}
						  	if (!(x = d[n]) && d.all) {
								x = d.all[n];
							}
							for (i = 0; !x && i < d.forms.length; i++) {
								x = d.forms[i][n];
							}
						  	for (i=0; !x && d.layers && i < d.layers.length; i++) {
								if (d.layers[i].id.indexOf("external_") == -1) {
						  			x = BillzNavBarMM_findObj(n, d.layers[i].document);
								}
							}
							registeredObjects[n] = x;
						
						 	return x;
						}
						function BillzArrayContains() {
							var arg = BillzArrayContains.arguments;
							var foundit = false;
							var i = 0;
							for (i = 0; i < arg[0].length && !foundit; i++) {
								foundit = (arg[1] == arg[0][i]);
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							return foundit;
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						function NavBarRegisterLayer() {
							var arg = NavBarRegisterLayer.arguments;
							var n = arg[0];
							var d = arg[1];
							var mo = false;
							var o = null;
							if (arg[2] && arg[2] == 'MOutLayer') {
								mo = true;
							} else {
								mo = false;
							}
							if (!(BillzArrayContains(aryLayerNames, n))) {
								if (o = BillzNavBarMM_findObj(n)) {
									aryNavBarLayers[n] = o;
									BillzArrayPushUnique(aryLayerNames, n);
									aryNavBarLayerInfo[n] = new NavBarLayer(n, d, mo);
								}
							}
							return true;
						}
						function BillzNavBarMM_showHideLayers() {
						//v3.0 name changed, this function complements of MM Dreamweaver with customizations by Bill Heller
							var i = 0;
							var x = "";
							var obj = null;
							var v = null;
							var p = null;
							var args = BillzNavBarMM_showHideLayers.arguments;

							if (args[args.length - 1] != "menu") {
								nbMouseOutTimer();
							}
						  	for (i = 0; i < (args.length - 2); i += 3) {
								if (!aryNavBarLayers[args[i]]) {
									x = (args[i + 2] == 'show') ? 'hide' : 'show';
									NavBarRegisterLayer(args[i], x);
								}
						  		if ((obj = aryNavBarLayers[args[i]]) != null) {
									v = args[i + 2];
									aryNavBarLayerInfo[args[i]].isDefault = false;
						  			if (args[args.length - 1] == "restore") {
										v = (v == 'show') ? 'hide' : 'show';
									}
									if (obj.style) {
										obj.style.visibility = (v == 'show') ? 'visible' : ((v == 'hide') ? 'hidden' : v);
									} else {
										obj.visibility = v;
									}
								}
							}
							return true;
						}
                  
						function BillzNavBarRestoreLayers() {
							var i = 0;
							var x = "";
							var obj = null;
							var v = null;
							var p = null;
							var args = BillzNavBarRestoreLayers.arguments;
						  	for (i = 0; i < (args.length); i++) {
						  		if (obj = aryNavBarLayers[args[i]]) {
									v = aryNavBarLayerInfo[args[i]].defaultVisibility;
									if (obj.style) {
										obj = obj.style;
										v = (v == 'show' ) ? 'visible' : ((v == 'hide') ? 'hidden' : v);
									}
									obj.visibility = v;
									if (!aryNavBarLayerInfo[args[i]].MOutLayer) {
										aryNavBarLayerInfo[args[i]].isDefault = true;
									}
								}
							}
							return true;
						}
						function NavBarLayer() {
							var arg = NavBarLayer.arguments;
							this.defaultVisibility = arg[1];
							this.isDefault = true;
							this.MOutLayer = arg[2];
							return true;
						}
						function BillzNavMove() {
							return nbNavMove();
						}
                  function nbNavMove() 
                  {
							var thisl = null;
							var otherl = null;
							if (thisl = BillzNavBarMM_findObj("nbScrollLayer")) 
                     {
								if (thisl.style) {
									thisl = thisl.style;
									viz = "hidden";
								} 
								thisl.top = nbThisLoc -= 3;
								if (nbThisLoc < -750) {
									nbThisLoc = 325;
									nbTimes--;
								}
							}
							if (nbTimes <= 0) 
                     {
								otherl = BillzNavBarMM_findObj("BillzLayer");
								otherl.visibility = viz;
							} else {
								setTimeout("nbNavMove()", nbTime);
							}
							
							return true;
						}
						function NavBar_openadmin() {
							window.open('admin/', 'SiteAdmin', 'height=screen.availheight,width=screen.availwidth,scrollbars=1,toolbar=0,directories=0,status=0,menubar=0,resizable=1');
							return true;
						}
						window.onload = FullyLoaded;
					//-->
				</script>
				
	    <style type="text/css">
	    <!--
	    @import url("module.css");
	    -->
	    </style>
	</head>




	
	<body style="background-color:#75ACD5;">
	<div align="center">
	<table align="center" width="768">
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			<td background="images/bkg_leftgradient.jpg" width="8"></td>
			<td valign="top" align="left" style="background-color:#fff;">
				
				
					
				
				<table style="border-bottom:10pt solid #FFFFFF;">
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						<td align="left" valign="top">
							<a href="homepage.cfm?id=1&amp;oTopId=0">
							
								
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						</td>
						<td background="images/bkg_top.jpg" width="552" height="85" style="background-repeat:repeat-x;" align="right">
						
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<style name="text/css" class="search">		
td.search {background-color: transparent; background-image: URL(images/clear.gif); font-family: Helvetica; font-weight: 
700; font-size: 8pt; color: 666666; }
				
	</style>

		<table border="0" cellpadding="0" cellspacing="0" background="" align= "top" class="search">		
		<form action="body.cfm?id=109" method="POST">		
		<input type="hidden" name="action" value="list">	
		<input type="hidden" name="search_areas_id" value="">	
		<input type="hidden" name="includewhat" value="">
			
			<tr class="search">							
				
					<td class="search" style="padding-left: 10px; ">Search</td>
				
				
					<td class="search"><input type="text" name="keywords" size="15" style="color: #3300FF; " value="Search Intranet"></td>
							
				
					<td class="search"><input type="IMAGE" src="images/go_button.gif" border="0" width="32" height="24" style="border: 0px; "></td>
				
			</tr>
		</form>
			<tr class="search"><td class="search" colspan="3" align="right">
				<a href="body.cfm?id=109">Advanced Search...</a>
			</td></tr>
		</table>
	 


									</td>
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							</table>
						</td>
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				</table>
				
				<table>
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						<td align="left" valign="top">
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var sm_reEuroDate = /^((((0?[1-9]|[12]\d|3[01])[\.\-\/](0?[13578]|1[02])[\.\-\/]((1[6-9]|[2-9]\d)?\d{2}))|((0?[1-9]|[12]\d|30)[\.\-\/](0?[13456789]|1[012])[\.\-\/]((1[6-9]|[2-9]\d)?\d{2}))|((0?[1-9]|1\d|2[0-8])[\.\-\/]0?2[\.\-\/]((1[6-9]|[2-9]\d)?\d{2}))|(29[\.\-\/]0?2[\.\-\/]((1[6-9]|[2-9]\d)?(0[48]|[2468][048]|[13579][26])|((16|[2468][048]|[3579][26])00)|00)))|(((0[1-9]|[12]\d|3[01])(0[13578]|1[02])((1[6-9]|[2-9]\d)?\d{2}))|((0[1-9]|[12]\d|30)(0[13456789]|1[012])((1[6-9]|[2-9]\d)?\d{2}))|((0[1-9]|1\d|2[0-8])02((1[6-9]|[2-9]\d)?\d{2}))|(2902((1[6-9]|[2-9]\d)?(0[48]|[2468][048]|[13579][26])|((16|[2468][048]|[3579][26])00)|00))))$/;
function sm_Trim(s) {
	var mystr = s;
	var myArr = sm_reEmpty.exec(mystr);
	if (myArr != null) {
		return "";
	}
	var myArr = sm_reLeading.exec(mystr);
	if (myArr != null) {
		if (RegExp.rightContext) {
			mystr = RegExp.rightContext;
		} else {
			mystr = mystr.substring(RegExp.$1.length, mystr.length);
		}
	}
	myArr = sm_reEnding.exec(mystr);
	if (myArr != null) {
		if (RegExp.leftContext) {
			mystr = RegExp.leftContext;
		} else {
			mystr = mystr.substring(0, (mystr.length - RegExp.$1.length));
		}
	}
	return mystr;
}
function sm_StripCRLF(s) {
	return s.replace(sm_reCRLF, " ");
}
function sm_IsArray(o) {
	return (typeof(o) == "object" && typeof(o.length) == "number");
}
function sm_IsRadio(o) {
	return (o.type == "radio");
}
function sm_IsCheckBox(o) {
	return (o.type == "checkbox");
}
function sm_IsFileUpload(o) {
	return (o.type == 'file');
}
function sm_IsSelectMulti(o) {
	return (o.type == "select-multiple");
}
function sm_IsSelectOne(o) {
	return (o.type == "select-one");
}
function sm_IsSelect(o) {
	return (sm_IsSelectMulti(o) || sm_IsSelectOne(o));
}
function sm_IsHidden(o) {
	return (o.type == "hidden");
}
function sm_IsInputText(o) {
	return (o.type == "text");
}
function sm_IsTextarea(o) {
	return (o.type == "textarea");
}
function sm_IsPassword(o) {
	return (o.type == "password");
}
function sm_IsSubmit(o) {
	return (o.type == "submit");
}
function sm_IsDate(s) {
	if (sm_reDate.test(s))
	{
		var oDate = Date.parse(s);
		if (isNaN(oDate)) {
			return false;
		}
		oDate = new Date(s);
		if (oDate.getFullYear() < 1900) {
			return false;
		}
		return true;
	}
	return false;
}
function sm_IsEuroDate(s) {
	if (sm_reEuroDate.test(s))
	{
		return true;
	}
	return false;
}
function sm_IsTime(s) {
	var dtToday = new Date();
	var strToday = (dtToday.getMonth()+1) + "/" + dtToday.getDate() + "/" + dtToday.getFullYear();

	var lgnTest = Date.parse(strToday+" "+s);
	if (isNaN(lgnTest)) return false;
	var datTest = new Date();
	datTest.setTime(lgnTest);
	if (datTest.getFullYear() < 1900) return false;
	return true;
}
function sm_IsFloat(s) {
	return (!isNaN(parseFloat(s)));
}
function sm_IsInt(s) {
	return (sm_reInteger.test(s));
}
function sm_IsWithinRange(n, lower, upper) {
	var f = parseFloat(n);
	if (isNaN(f)) return true;
	var isOK = true;
	var l = parseFloat(lower);
	if (!isNaN(l) && (l > f)) {
		isOK = false;
	}
	var u = parseFloat(upper);
	if (!isNaN(u) && (f > u)) {
		isOK = false;
	}
	return isOK;
}
function sm_IsEmail(s) {
	return (sm_reEmail.test(s));
}
function sm_IsMultiEmails(s) {
	return (sm_reMultiEmails.test(s));
}
function sm_IsACheckObj(o, re) {
	if (!o.name) return false;
	return re.test(o.name);
}
function sm_IsRequired(o) {
	return sm_IsACheckObj(o, sm_reIsRequired);
}
function sm_IsIntegerObj(o) {
	return sm_IsACheckObj(o, sm_reIsInteger);
}
function sm_IsFloatObj(o) {
	return sm_IsACheckObj(o, sm_reIsFloat);
}
function sm_IsDateObj(o) {
	return sm_IsACheckObj(o, sm_reIsDate);
}
function sm_IsEuroDateObj(o) {
	return sm_IsACheckObj(o, sm_reIsEuroDate);
}
function sm_IsTimeObj(o) {
	return sm_IsACheckObj(o, sm_reIsTime);
}
function sm_IsRangeObj(o) {
	return sm_IsACheckObj(o, sm_reIsRange);
}
function sm_IsEmailObj(o) {
	return sm_IsACheckObj(o, sm_reIsEmail);
}
function sm_IsMultiEmailsObj(o) {
	return sm_IsACheckObj(o, sm_reIsMultiEmails);
}
function sm_GetAnObjToCheck(o, re) {
	if (!sm_IsACheckObj(o, re)) return null;
	var arrName = re.exec(o.name);
	if (arrName == null) return null;
	return (o.form[arrName[1]]);
}
function sm_GetRequiredObj(o) {
	return sm_GetAnObjToCheck(o, sm_reIsRequired);
}
function sm_GetIntegerObj(o) {
	return sm_GetAnObjToCheck(o, sm_reIsInteger);
}
function sm_GetFloatObj(o) {
	return sm_GetAnObjToCheck(o, sm_reIsFloat);
}
function sm_GetDateObj(o) {
	return sm_GetAnObjToCheck(o, sm_reIsDate);
}
function sm_GetEuroDateObj(o) {
	return sm_GetAnObjToCheck(o, sm_reIsEuroDate);
}
function sm_GetTimeObj(o) {
	return sm_GetAnObjToCheck(o, sm_reIsTime);
}
function sm_GetRangeObj(o) {
	return sm_GetAnObjToCheck(o, sm_reIsRange);
}
function sm_GetEmailObj(o) {
	return sm_GetAnObjToCheck(o, sm_reIsEmail);
}
function sm_GetMultiEmailsObj(o) {
	return sm_GetAnObjToCheck(o, sm_reIsMultiEmails);
}
function sm_CheckRequiredElement(o) {
	if (typeof(o) != "object") return false;
	if (sm_IsSelectOne(o)) {
		if (o.selectedIndex < 0) return false;
		var objoption = o.options[o.selectedIndex];
		return (objoption.value.length > 0);
	} else if (sm_IsSelectMulti(o)) {
		if (o.selectedIndex < 0) return false;
		var x;
		var isOK = false;
		for (x = 0; x < o.length && !isOK; x++) {
			isOK = o.options[x].selected && o.options[x].value.length > 0;
		}
		return isOK;
	} else if (sm_IsRadio(o) || sm_IsCheckBox(o)) {
		return o.checked;
	} else if (sm_IsHidden(o) || sm_IsInputText(o) || sm_IsTextarea(o) || sm_IsPassword(o)) {
		var strValue = sm_Trim(o.value);
		return (strValue.length > 0);
	} else if (sm_IsSubmit(o)) {
		return true;
	} else if (sm_IsArray(o)) {
		var x;
		var isOK = false;
		for (x = 0; x < o.length && !isOK; x++) {
			isOK = sm_CheckRequiredElement(o[x]);
		}
		return isOK;
	} else if (sm_IsFileUpload(o)) {
		// we don't know for sure due to client-side security.
		// depend on server side checks.
		return true;
	} else {
		return false;
	}
}
function sm_IsThisRequired(ho, re) {
	var arrName = re.exec(ho.name);
	if (arrName == null) return null;
	var strName = arrName[1];
	if (ho.form[strName+"_required"]) {
		return true;
	} else {
		return false;
	}
}
function sm_CheckValueTypeElement(o, fn, breq) {
	if (typeof(o) != "object") return true;
	if (sm_IsSelectOne(o)) {
		if (o.selectedIndex < 0) return true;
		var objoption = o.options[o.selectedIndex];
		if (fn(objoption.value)) {
			return true;
		} else if (breq) {
			return false;
		} else {
			// Not required but it is not of this type.
			return (objoption.value.length == 0);
		}
	} else if (sm_IsSelectMulti(o)) {
		if (o.selectedIndex < 0) return true;
		var x;
		var isOK = true;
		for (x = 0; x < o.length && isOK; x++) {
			if (o.options[x].selected) {
				isOK = fn(o.options[x].value);
				if (!(isOK || breq)) {
					isOK = (o.options[x].value.length == 0);
				}
			}
		}
		return isOK;
	} else if (sm_IsRadio(o) || sm_IsCheckBox(o)) {
		if (o.checked) {
			if (fn(o.value)) {
				return true;
			} else if (breq) {
				return false;
			} else {
				// Not required but it is not of this type.
				return (o.value.length == 0);
			}
		} else {
			return true;
		}
	} else if (sm_IsHidden(o) || sm_IsInputText(o) || sm_IsTextarea(o) || sm_IsPassword(o)) {
		if (fn(o.value)) {
			return true;
		} else if (breq) {
			return false;
		} else {
			// Not required but it is not of this type.
			return (o.value.length == 0);
		}
	} else if (sm_IsArray(o)) {
		var x;
		var isOK = true;
		for (x = 0; x < o.length && isOK; x++) {
			// Possible Recursion
			isOK = sm_CheckValueTypeElement(o[x], fn, breq);
		}
		return isOK;
	} else {
		return true;
	}
}
function sm_CheckIntegerElement(ho, fn) {
	var o = fn(ho);
	o.value = sm_Trim(o.value);
	var breq = sm_IsThisRequired(ho, sm_reIsInteger);
	return sm_CheckValueTypeElement(o, sm_IsInt, breq);
}
function sm_CheckFloatElement(ho, fn) {
	var o = fn(ho);
	o.value = sm_Trim(o.value);
	var breq = sm_IsThisRequired(ho, sm_reIsFloat);
	return sm_CheckValueTypeElement(o, sm_IsFloat, breq);
}
function sm_CheckDateElement(ho, fn) {
	var o = fn(ho);
	o.value = sm_Trim(o.value);
	var breq = sm_IsThisRequired(ho, sm_reIsDate);
	return sm_CheckValueTypeElement(o, sm_IsDate, breq);
}
function sm_CheckEuroDateElement(ho, fn) {
	var o = fn(ho);
	o.value = sm_Trim(o.value);
	var breq = sm_IsThisRequired(ho, sm_reIsEuroDate);
	return sm_CheckValueTypeElement(o, sm_IsEuroDate, breq);
}
function sm_CheckTimeElement(ho, fn) {
	var o = fn(ho);
	o.value = sm_Trim(o.value);
	var breq = sm_IsThisRequired(ho, sm_reIsTime);
	return sm_CheckValueTypeElement(o, sm_IsTime, breq);
}
function sm_CheckRangeElement(ho, fn) {
	var r = ho.value;
	var o = fn(ho);
	var breq = sm_IsThisRequired(ho, sm_reIsRange);
	var lower = "null";
	var upper = "null";
	var arrRange;
	arrRange = sm_reMinRange.exec(r);
	if (arrRange != null) {
		lower = parseFloat(arrRange[1]);
	}
	arrRange = sm_reMaxRange.exec(r);
	if (arrRange != null) {
		upper = parseFloat(arrRange[1]);
	}

	var fnBody = "return sm_IsWithinRange(n,"+lower+","+upper+");";

	var rfn = new Function("n", fnBody);
	return sm_CheckValueTypeElement(o, rfn, breq);
}
function sm_CheckEmailElement(ho, fn) {
	var o = fn(ho);
	var breq = sm_IsThisRequired(ho, sm_reIsEmail);
	return sm_CheckValueTypeElement(o, sm_IsEmail, breq);
}
function sm_CheckMultiEmailsElement(ho, fn) {
	var o = fn(ho);
	var breq = sm_IsThisRequired(ho, sm_reIsMultiEmails);
	return sm_CheckValueTypeElement(o, sm_IsMultiEmails, breq);
}
// Takes care of checkboxes, radio buttons, and hidden forms
function sm_IsDeleteActionForm(f) {
	var i = 0;
	var o = null;
	for (i = 0; i < f.elements.length; i++) {
		o = f.elements[i];
		if (o.name.toLowerCase() == "action" && (o.value.toLowerCase() == "postdelete")) {
			if (sm_IsRadio(o) || sm_IsCheckBox(o)) {
				return o.checked;
			} else if (sm_IsHidden(o)) {
				return true;
			}
		}
	}
	return false;
}
var sm_DisabledHiddenFieldNameSuffix = "_smdisabled";
function sm_removeALLrequiredhiddenfields(f) {
	var i = 0;
	var o = null;
	for (i = 0; i < f.elements.length; i++) {
		o = f.elements[i];
		if (	sm_IsHidden(o)
			&&	(	sm_IsRequired(o)
				||	sm_IsIntegerObj(o)
				||	sm_IsFloatObj(o)
				||	sm_IsDateObj(o)
				||	sm_IsEuroDateObj(o)
				||	sm_IsTimeObj(o)
				||	sm_IsRangeObj(o)
				||	sm_IsEmailObj(o)
				||	sm_IsMultiEmailsObj(o)
				)
		)
		{
			o.name += sm_DisabledHiddenFieldNameSuffix;
		}
	}
	return true;
}
var sm_DeleteConfirmationPromptText = "Are you sure you want to delete this record?\nClick 'OK' to delete, or click 'Cancel' otherwise.";
function sm_ValidateForm(f, confirmDelete) {
	var obj = f.elements;
	var x, o;
	var errmsg = "";
	var confDel = (confirmDelete == undefined || confirmDelete == null) ? false : confirmDelete;
	var bDeleteConfirmed = false;
	
	if (confDel && sm_IsDeleteActionForm(f)) {
		bDeleteConfirmed = window.confirm(sm_DeleteConfirmationPromptText);
		if (bDeleteConfirmed) {
			sm_removeALLrequiredhiddenfields(f);
		}
		return bDeleteConfirmed;
	}
	
	for (x = 0; x < obj.length; x++) {
		o = obj[x];
		if (sm_IsHidden(o)) {
			if (sm_IsRequired(o)) {
				var oreq = sm_GetRequiredObj(o);
				if (!sm_CheckRequiredElement(oreq)) {
					errmsg += "* " + o.value + "\n";
				}
			} else if (sm_IsIntegerObj(o)) {
				if (!sm_CheckIntegerElement(o, sm_GetIntegerObj)) {
					errmsg += "* " + o.value + "\n";
				}
			} else if (sm_IsFloatObj(o)) {
				if (!sm_CheckFloatElement(o, sm_GetFloatObj)) {
					errmsg += "* " + o.value + "\n";
				}
			} else if (sm_IsDateObj(o)) {
				if (!sm_CheckDateElement(o, sm_GetDateObj)) {
					errmsg += "* " + o.value + "\n";
				}
			} else if (sm_IsEuroDateObj(o)) {
				if (!sm_CheckEuroDateElement(o, sm_GetEuroDateObj)) {
					errmsg += "* " + o.value + "\n";
				}
			} else if (sm_IsTimeObj(o)) {
				if (document.getElementById(o.name.replace(/_time$/,""))){
					document.getElementById(o.name.replace(/_time$/,"")).value = document.getElementById(o.name.replace(/_time$/,"")).value.replace(/\./g,"");
				}
				if (!sm_CheckTimeElement(o, sm_GetTimeObj)) {
					errmsg += "* " + o.value + "\n";
				}
			} else if (sm_IsRangeObj(o)) {
				if (!sm_CheckRangeElement(o, sm_GetRangeObj)) {
					errmsg += "* " + o.name + " is restricted to " + sm_StripCRLF(o.value) + "\n";
				}
			} else if (sm_IsEmailObj(o)) {
				if (!sm_CheckEmailElement(o, sm_GetEmailObj)) {
					errmsg += "* " + o.value + "\n";
				}
			} else if (sm_IsMultiEmailsObj(o)) {
				if (!sm_CheckMultiEmailsElement(o, sm_GetMultiEmailsObj)) {
					errmsg += "* " + o.value + "\n";
				}
			}
		}
	}
	if (errmsg.length > 0) {
		window.alert(errmsg);
		return false;
	}
	return true;
}
//-->
</script>

		<form name="eform" method="post" action="http://www.provena.org/mercy/body.cfm?xyzpdqabc=0&amp;id=270&amp;action=submiteform" onSubmit="return (sm_ValidateForm(this) && sm_removeALLrequiredhiddenfields(this));" class="metadetail">
		<table class="metadetail">
			<tr class="metadetail">
				<td class="metadetail" colspan="2">Please write your request in the message box below. Prayer requests will be placed in the chapel, where pastoral staff will pray over them daily. <br><br><br></td>
			</tr>
			<tr class="metadetail">
				<td class="metadetail" colspan="2"><span class="required">
				* Indicates required information</span></td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Your First Name:&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_1" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Last Name:&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_2" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Telephone:&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_3" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Email:&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_4" class="metadetail" size="35" value="">
					  
					<input type="Hidden" name="eformField_4_email" class="metadetail" value="Email: must be a valid email address.">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Message:&nbsp;<span class="required">*</span>&nbsp;</th>
				<td class="metadetail">
					<textarea name="eformField_5" class="metadetail" cols="40" rows="5"></textarea>
					<input type="Hidden" name="eformField_5_required" class="metadetail" value="Message: is required.">
				</td>
			</tr>
			<tr>
				<th class="metadetail">&nbsp;</th>
				<td class="metadetail">
				
					
				
				<script type="text/javascript"
				   src="http://api.recaptcha.net/challenge?k=6LdOTwIAAAAAAFshosIOqJ9EA29aod8uED-zLmEm">
				</script>
				<noscript>
				   <iframe src="http://api.recaptcha.net/noscript?k=6LdOTwIAAAAAAFshosIOqJ9EA29aod8uED-zLmEm"
				       height="300" width="500" frameborder="0"></iframe><br>
				   <textarea name="recaptcha_challenge_field" rows="3" cols="40">
				   </textarea>
				   <input type="hidden" name="recaptcha_response_field" 
				       value="manual_challenge">
				</noscript>
				</td>
			</tr>
			<tr class="metadetail">
				<th class="metadetail">&nbsp;</th>
				<td class="metadetail">
					<input type="submit" name="submit" value="Submit" class="metadetail">
				</td>
			</tr>
		</table>
		</form>
	
	

 

	
 

				
			
			
			
			
			</td>
			
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