<% url = Request.QueryString("name") name = Request.Form("name") gender = Request.Form("gender") age = Request.Form("age") martialstatus = Request.Form("martialstatus") noofissues = Request.Form("issues") profession = Request.Form("profession") street1 = Request.Form("street1") street2 = Request.Form("street2") city = Request.Form("city") state = Request.Form("state") zip = Request.Form("zip") country = Request.Form("country") telephone = Request.Form("telephone") fax = Request.Form("fax") email = Request.Form("email") hereditary=Request.Form("hereditary") bone=Request.Form("bone") thyroid=Request.Form("thyroid") kidney=Request.Form("kidney") diabetes=Request.Form("diabetes") cancer=Request.Form("cancer") stomach=Request.Form("stomach") polio=Request.Form("polio") immune=Request.Form("immune") liver=Request.Form("liver") aids=Request.Form("aids") std=Request.Form("std") neuro=Request.Form("neuro") mental=Request.Form("mental") vision=Request.Form("vision") weight=Request.Form("weight") bleeding=Request.Form("bleeding") bp=Request.Form("bp") tires=Request.Form("tires") chest=Request.Form("chest") heart=Request.Form("heart") heart1=Request.Form("heart1") diet=Request.Form("diet") cold=Request.Form("cold") eye=Request.Form("eye") asthama=Request.Form("asthama") tonsil=Request.Form("tonsil") allergy=Request.Form("allergy") medication=Request.Form("medication") operations=Request.Form("operations") healthcare=Request.Form("healthcare") menstrual=Request.Form("menstrual") pregnant=Request.Form("pregnant") yes = "" dis_name = "" dis_name = dis_name & "" else dis_name = dis_name & "No " end if dis_name = dis_name & "" else dis_name = dis_name & "No " end if dis_name = dis_name & "" else dis_name = dis_name & " No " end if dis_name = dis_name & "" else dis_name = dis_name & "No " end if dis_name = dis_name & "" else dis_name = dis_name & "No " end if dis_name = dis_name & "" else dis_name = dis_name & "No " end if dis_name = dis_name & "" else dis_name = dis_name & " No " end if dis_name = dis_name & "" else dis_name = dis_name & "No " end if dis_name = dis_name & "" else dis_name = dis_name & " No " end if dis_name = dis_name & "" else dis_name = dis_name & "No " end if dis_name = dis_name & "" else dis_name = dis_name & "No " end if dis_name = dis_name & "" else dis_name = dis_name & "No " end if dis_name = dis_name & "" else dis_name = dis_name & "No " end if dis_name = dis_name & "" else dis_name = dis_name & "No " end if dis_name = dis_name & "" else dis_name = dis_name & " No " end if dis_name = dis_name & "" else dis_name = dis_name & " No " end if dis_name = dis_name & "" else dis_name = dis_name & "No " end if dis_name = dis_name & "" else dis_name = dis_name & "No " end if dis_name = dis_name & "" else dis_name = dis_name & " No " end if dis_name = dis_name & "" else dis_name = dis_name & " No " end if dis_name = dis_name & "" else dis_name = dis_name & " No " end if dis_name = dis_name & "" else dis_name = dis_name & " No " end if dis_name = dis_name & "" else dis_name = dis_name & " No " end if dis_name = dis_name & "" else dis_name = dis_name & " No " end if dis_name = dis_name & "" else dis_name = dis_name & " No " end if dis_name = dis_name & "" else dis_name = dis_name & "No " end if dis_name = dis_name & "" else dis_name = dis_name & " No " end if dis_name = dis_name & "" else dis_name = dis_name & " No " end if dis_name = dis_name & "" else dis_name = dis_name & "No " end if dis_name = dis_name & "" else dis_name = dis_name & " No " end if dis_name = dis_name & "" else dis_name = dis_name & "No

" end if dis_name = dis_name & "" else dis_name = dis_name & "No " end if dis_name = dis_name & "" else dis_name = dis_name & "No
Any Hereditary problem or Birth defect: " if not(hereditary = yes) then dis_name = dis_name & hereditary & "
Bone Fractures, any major accidents: " if not(bone = yes) then dis_name = dis_name & bone & "
Endocrine or thyroid problems? " if not(thyroid = yes) then dis_name = dis_name & thyroid & "
Kidney problems? " if not(kidney = yes) then dis_name = dis_name & kidney & "
Do you have Diabetes? " if not(diabetes = yes) then dis_name = dis_name & diabetes & "
Cancer or been treated for a tumor? " if not(cancer = yes) then dis_name = dis_name & cancer & "
Stomach ulcer or hyperacidity? " if not(stomach = yes) then dis_name = dis_name & stomach & "
Polio, mononucleosis, tuberculosis, pneumonia? " if not(polio = yes) then dis_name = dis_name & polio & "
Problems of the immune system? " if not(immune = yes) then dis_name = dis_name & immune & "
Hepatitis, jaundice or liver problem? " if not(liver = yes) then dis_name = dis_name & liver & "
AIDS or HIV Positive? " if not(aids = yes) then dis_name = dis_name & aids & "
Sexually transmitted disease? " if not(std = yes) then dis_name = dis_name & std & "
Fainting spells, seizures, epilepsy or neurologic disease? " if not(neuro = yes) then dis_name = dis_name & neuro & "
Mental health or behavioral problems? " if not(mental = yes) then dis_name = dis_name & mental & "
Vision, hearing, tasting or speech difficulties? " if not(vision = yes) then dis_name = dis_name & vision & "
Loss of weight recently, poor appetite? " if not(weight = yes) then dis_name = dis_name & weight & "
Excessive bleeding, black and blue tendency, anemia or bleeding disorder? " if not(bleeding = yes) then dis_name = dis_name & bleeding & "
High or low blood pressure? " if not(bp = yes) then dis_name = dis_name & bp & "
Tires easily? " if not(tires = yes) then dis_name = dis_name & tires & "
Chest pain, shortness of breath or swelling ankles? " if not(chest = yes) then dis_name = dis_name & chest & "
Damaged heart valves or artificial heart valves, including heart murmur or rheumatic heart disease, scarlet fever, artificial joints? " if not(heart = yes) then dis_name = dis_name & heart & "
Cardiovascular problem (heart trouble, heart attack, angina, coronary insufficiency, arteriosclerosis, stroke?) " if not(heart1 = yes) then dis_name = dis_name & heart1 & "
Does patient have a normal and good diet? " if not(diet = yes) then dis_name = dis_name & diet & "
Frequent headaches, colds or sore throat? " if not(cold = yes) then dis_name = dis_name & cold & "
Eye, ear, nose, throat conditions? " if not(eye = yes) then dis_name = dis_name & eye & "
Hayfever, asthma, sinus trouble, hives? " if not(asthama = yes) then dis_name = dis_name & asthama & "
Tonsil or adenoid conditions? " if not(tonsil = yes) then dis_name = dis_name & tonsil & "
Allergies or drug reactions? If so, what? " if not(allergy = yes) then dis_name = dis_name & allergy & "
Is patient taking medication, nutrient supplements or nonprescription medicine? " if not(medication = yes) then dis_name = dis_name & medication & "
Operations? (surgical procedures)? " if not(operations = yes) then dis_name = dis_name & operations & "
Being treated by another health care professional? " if not(healthcare = yes) then dis_name = dis_name & healthcare & "
Has patient started her menstrual period? If yes, at what age? " if not(menstrual = yes) then dis_name = dis_name & menstrual & "
Is patient pregnant? " if not(pregnant = yes) then dis_name = dis_name & pregnant & "
" end if body = "
" body = body & ">>
Patients Detail
Patient's Name : " & name & "
Patient's Gender : " & gender & "
Age : " & age body = body & "
Marrital Status : " & martialstatus & "
if married no&of issues :" & noofissues & "
Profession : " & profession & "
Street1 : " & street1 & "
Street2 : " & street2 body = body & "
City : " & city & "
State : " & state & "
Zip : " & zip & "
Country :" & country body = body & "
Telephone : " & telephone & "
Fax : " & fax & "
Email :" & email & "

Medical Health History
" & dis_name &"
" if not(name = "") then Set JMail = Server.CreateObject("JMail.SMTPMail") JMail.ServerAddress = "127.0.0.1:25" JMail.Sender = email JMail.Subject = "Patient's Details" JMail.AddRecipient "drrao_md@yahoo.com" JMail.HTMLBody = body JMail.Execute 'Dim ObjSendMail 'Dim iConf 'Dim Flds 'Set ObjSendMail = Server.CreateObject("CDO.Message") 'Set iConf = CreateObject("CDO.Configuration") 'Set Flds = iConf.Fields 'Flds("http://schemas.microsoft.com/cdo/configuration/sendusing") = 1 '**** Path below may need to be changed if it is not correct 'Flds("http://schemas.microsoft.com/cdo/configuration/smtpserverpickupdirectory") = "d:\inetpub\mailroot\pickup" 'Flds.Update 'Set ObjSendMail.Configuration = iConf 'ObjSendMail.To = "rynayak@yahoo.co.in" 'ObjSendMail.Subject = "Patients Details" 'ObjSendMail.From = email ' we are sending a text email.. simply switch the comments around to send an html email instead 'ObjSendMail.HTMLBody = "this is the body" 'ObjSendMail.TextBody = body 'ObjSendMail.Send 'Set ObjSendMail = Nothing 'Dim objCDONTS 'Set objCDONTS = Server.CreateObject("CDONTS.NewMail") 'objCDONTS.From = email 'objCDONTS.To = "rynayak@yahoo.co.in" 'objCDONTS.Subject = "Patients Details" 'objCDONTS.Body = body 'objCDONTS.BodyFormat = 0 'objCDONTS.MailFormat = 0 'objCDONTS.Send 'if err.number<>0 then 'Response.Write err.Description 'end if 'Set objCDONTS = Nothing 'response.Write(body) 'response.End() end if %> Contact to treat incurable illnesses not responding to prescription drugs.DrRaoMD
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