CICA 1995 August

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/ CICA 1995 August / CICA - The Ultimate Collection of Shareware for Windows (Disc 2) (August 1995).iso / disc2 / programr / vbasic / insure2.exe / FORM3.FRM < prev next >

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Text File | 1993-07-22 | 24KB | 671 lines

VERSION 2.00 Begin Form Form3 BackColor = &H00C0C0C0& BorderStyle = 3 'Fixed Double Caption = "Medical Information" ClientHeight = 5880 ClientLeft = 150 ClientTop = 1290 ClientWidth = 9255 ControlBox = 0 'False Height = 6285 Left = 90 LinkMode = 1 'Source LinkTopic = "Form3" MaxButton = 0 'False MinButton = 0 'False ScaleHeight = 5880 ScaleWidth = 9255 Top = 945 Width = 9375 Begin SSPanel Panel3D1 Alignment = 7 'Center - MIDDLE AutoSize = 0 'None BackColor = &H00C0C0C0& BevelInner = 1 'Inset BevelOuter = 0 'None BevelWidth = 3 BorderWidth = 3 FloodColor = &H00FF0000& FloodShowPct = -1 'True FloodType = 0 'None Font3D = 2 'Raised w/heavy shading ForeColor = &H00000000& Height = 1155 Left = 2370 Outline = 0 'False RoundedCorners = -1 'True ShadowColor = 0 'Dark Grey TabIndex = 35 Top = 5715 Width = 4335 Begin SSCommand Command3D3 AutoSize = 0 'None BevelWidth = 2 Caption = "Return To First Page" Font3D = 3 'Inset w/light shading ForeColor = &H00000000& Height = 855 Left = 1275 Outline = -1 'True Picture = FORM3.FRX:0000 RoundedCorners = -1 'True TabIndex = 36 Top = 150 Width = 1875 End End Begin SSFrame Frame3D5 Alignment = 0 'Left Justify Caption = "Misc. Questions:" Font3D = 1 'Raised w/light shading ForeColor = &H00000000& Height = 1335 Left = 120 ShadowColor = 0 'Dark Grey ShadowStyle = 0 'Inset TabIndex = 23 Top = 4290 Width = 9060 Begin PictureBox Picture6 BackColor = &H00C0C0C0& BorderStyle = 0 'None Height = 180 Left = 7560 ScaleHeight = 180 ScaleWidth = 1215 TabIndex = 43 Top = 1035 Width = 1215 Begin SSOption Option3D8 Alignment = 0 'Text to the Right Caption = "No" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 675 TabIndex = 45 Top = 0 Value = 0 'False Width = 570 End Begin SSOption Option3D7 Alignment = 0 'Text to the Right Caption = "Yes" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 0 TabIndex = 44 Top = 0 Value = 0 'False Width = 630 End End Begin PictureBox Picture7 BackColor = &H00C0C0C0& BorderStyle = 0 'None Height = 180 Left = 7560 ScaleHeight = 180 ScaleWidth = 1215 TabIndex = 46 Top = 810 Width = 1215 Begin SSOption Option3D10 Alignment = 0 'Text to the Right Caption = "No" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 675 TabIndex = 48 Top = 0 Value = 0 'False Width = 570 End Begin SSOption Option3D9 Alignment = 0 'Text to the Right Caption = "Yes" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 0 TabIndex = 47 Top = 0 Value = 0 'False Width = 630 End End Begin PictureBox Picture4 BackColor = &H00C0C0C0& BorderStyle = 0 'None Height = 180 Left = 7560 ScaleHeight = 180 ScaleWidth = 1215 TabIndex = 40 Top = 570 Width = 1215 Begin SSOption Option3D3 Alignment = 0 'Text to the Right Caption = "No" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 675 TabIndex = 42 Top = 0 Value = 0 'False Width = 570 End Begin SSOption Option3D1 Alignment = 0 'Text to the Right Caption = "Yes" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 0 TabIndex = 41 Top = 0 Value = 0 'False Width = 615 End End Begin PictureBox Picture3 BackColor = &H00C0C0C0& BorderStyle = 0 'None Height = 180 Left = 7560 ScaleHeight = 180 ScaleWidth = 1215 TabIndex = 37 Top = 330 Width = 1215 Begin SSOption Option3D2 Alignment = 0 'Text to the Right Caption = "No" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 675 TabIndex = 39 Top = 0 Value = 0 'False Width = 570 End Begin SSOption Option3D4 Alignment = 0 'Text to the Right Caption = "Yes" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 0 TabIndex = 38 Top = 0 Value = 0 'False Width = 630 End End Begin Label Label5 BackColor = &H00C0C0C0& Caption = "Are you currently being treated for or taking medication for any condition or disease?" FontBold = -1 'True FontItalic = 0 'False FontName = "Arial" FontSize = 8.25 FontStrikethru = 0 'False FontUnderline = 0 'False Height = 195 Left = 150 TabIndex = 27 Top = 1005 Width = 7125 End Begin Label Label3 BackColor = &H00C0C0C0& Caption = "Had treatment or counseling for alcohol or drug dependency?" FontBold = -1 'True FontItalic = 0 'False FontName = "Arial" FontSize = 8.25 FontStrikethru = 0 'False FontUnderline = 0 'False Height = 195 Left = 150 TabIndex = 25 Top = 780 Width = 5175 End Begin Label Label4 BackColor = &H00C0C0C0& Caption = "Been a patient in a hospital, sanitarium or other institution?" FontBold = -1 'True FontItalic = 0 'False FontName = "Arial" FontSize = 8.25 FontStrikethru = 0 'False FontUnderline = 0 'False Height = 195 Left = 150 TabIndex = 26 Top = 555 Width = 4950 End Begin Label Label2 BackColor = &H00C0C0C0& Caption = "Had surgery or been advised to have surgery which was not done?" FontBold = -1 'True FontItalic = 0 'False FontName = "Arial" FontSize = 8.25 FontStrikethru = 0 'False FontUnderline = 0 'False Height = 195 Left = 150 TabIndex = 24 Top = 345 Width = 5595 End End Begin SSFrame Frame3D6 Alignment = 0 'Left Justify Caption = "Immune System:" Font3D = 1 'Raised w/light shading ForeColor = &H00000000& Height = 1770 Left = 6285 ShadowColor = 0 'Dark Grey ShadowStyle = 0 'Inset TabIndex = 28 Top = 2430 Width = 3075 Begin SSCheck Check3D22 Alignment = 0 'Text to the Right Caption = "S.T.D (ie. Gonorrhea, Syphilis)" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 33 Top = 1455 Value = 0 'False Width = 2865 End Begin SSCheck Check3D12 Alignment = 0 'Text to the Right Caption = "Cancer" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 32 Top = 1185 Value = 0 'False Width = 885 End Begin SSCheck Check3D11 Alignment = 0 'Text to the Right Caption = "Leukemia" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 31 Top = 915 Value = 0 'False Width = 1110 End Begin SSCheck Check3D9 Alignment = 0 'Text to the Right Caption = "Diabetes" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 30 Top = 630 Value = 0 'False Width = 1035 End Begin SSCheck Check3D10 Alignment = 0 'Text to the Right Caption = "Tumor" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 29 Top = 345 Value = 0 'False Width = 825 End End Begin SSFrame Frame3D3 Alignment = 0 'Left Justify Caption = "Nervous System:" Font3D = 1 'Raised w/light shading ForeColor = &H00000000& Height = 1770 Left = 3105 ShadowColor = 0 'Dark Grey ShadowStyle = 0 'Inset TabIndex = 7 Top = 2430 Width = 3120 Begin SSCheck Check3D18 Alignment = 0 'Text to the Right Caption = "Other Brain Diseases/Disorders" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 15 Top = 1290 Value = 0 'False Width = 2940 End Begin SSCheck Check3D19 Alignment = 0 'Text to the Right Caption = "Mental Disorder" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 14 Top = 990 Value = 0 'False Width = 1635 End Begin SSCheck Check3D20 Alignment = 0 'Text to the Right Caption = "Epilepsy" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 13 Top = 690 Value = 0 'False Width = 975 End Begin SSCheck Check3D21 Alignment = 0 'Text to the Right Caption = "Convulsions" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 12 Top = 375 Value = 0 'False Width = 1305 End End Begin SSFrame Frame3D2 Alignment = 0 'Left Justify Caption = "Respiratory:" Font3D = 1 'Raised w/light shading ForeColor = &H00000000& Height = 1770 Left = 120 ShadowColor = 0 'Dark Grey ShadowStyle = 0 'Inset TabIndex = 6 Top = 2430 Width = 2925 Begin SSCheck Check3D13 Alignment = 0 'Text to the Right Caption = "Other Lung Disease/Disorder" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 11 Top = 1290 Value = 0 'False Width = 2760 End Begin SSCheck Check3D8 Alignment = 0 'Text to the Right Caption = "Tuberculosis" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 10 Top = 975 Value = 0 'False Width = 1350 End Begin SSCheck Check3D7 Alignment = 0 'Text to the Right Caption = "Emphysema" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 9 Top = 660 Value = 0 'False Width = 1260 End Begin SSCheck Check3D6 Alignment = 0 'Text to the Right Caption = "Asthma" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 8 Top = 360 Value = 0 'False Width = 885 End End Begin PictureBox Picture1 AutoSize = -1 'True BackColor = &H00C0C0C0& BorderStyle = 0 'None Height = 2205 Left = 8340 Picture = FORM3.FRX:0302 ScaleHeight = 2205 ScaleWidth = 1440 TabIndex = 34 Top = 600 Width = 1440 Begin PictureBox Picture2 AutoSize = -1 'True BackColor = &H00FFFFFF& BorderStyle = 0 'None Height = 480 Left = 150 Picture = FORM3.FRX:1DBE ScaleHeight = 480 ScaleWidth = 480 TabIndex = 49 Top = 315 Width = 480 End End Begin SSFrame Frame3D4 Alignment = 0 'Left Justify Caption = "Diseases or Disorders of the:" Font3D = 1 'Raised w/light shading ForeColor = &H00000000& Height = 1905 Left = 3570 ShadowColor = 0 'Dark Grey ShadowStyle = 0 'Inset TabIndex = 17 Top = 480 Width = 4710 Begin SSCheck Check3D27 Alignment = 0 'Text to the Right Caption = "Ears, Eyes, Nose or Sinuses" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 22 Top = 1560 Value = 0 'False Width = 2805 End Begin SSCheck Check3D26 Alignment = 0 'Text to the Right Caption = "Blood, Glands or Skin" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 21 Top = 1275 Value = 0 'False Width = 2190 End Begin SSCheck Check3D25 Alignment = 0 'Text to the Right Caption = "Spine, Joints, Skull or other Bones" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 20 Top = 975 Value = 0 'False Width = 3285 End Begin SSCheck Check3D24 Alignment = 0 'Text to the Right Caption = "Kidney, Bladder, Genital Organs or Urinary Tract" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 19 Top = 675 Value = 0 'False Width = 4440 End Begin SSCheck Check3D23 Alignment = 0 'Text to the Right Caption = "Liver, Gallbladder, Stomach, Intestines or Rectum" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 18 Top = 360 Value = 0 'False Width = 4515 End End Begin SSFrame Frame3D1 Alignment = 0 'Left Justify Caption = "Pulmonary:" Font3D = 1 'Raised w/light shading ForeColor = &H00000000& Height = 1905 Left = 120 ShadowColor = 0 'Dark Grey ShadowStyle = 0 'Inset TabIndex = 0 Top = 480 Width = 3390 Begin SSCheck Check3D5 Alignment = 0 'Text to the Right Caption = "Other Heart Diseases/Disorders" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 5 Top = 1575 Value = 0 'False Width = 3030 End Begin SSCheck Check3D4 Alignment = 0 'Text to the Right Caption = "Heart Murmur" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 4 Top = 1275 Value = 0 'False Width = 1425 End Begin SSCheck Check3D3 Alignment = 0 'Text to the Right Caption = "Rheumatic Fever" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 3 Top = 975 Value = 0 'False Width = 1725 End Begin SSCheck Check3D2 Alignment = 0 'Text to the Right Caption = "Chest Pain or Pressure" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 2 Top = 660 Value = 0 'False Width = 2235 End Begin SSCheck Check3D1 Alignment = 0 'Text to the Right Caption = "High Blood Pressure" Font3D = 0 'None ForeColor = &H00000000& Height = 195 Left = 120 TabIndex = 1 Top = 345 Value = 0 'False Width = 2010 End End Begin Label Label1 BackColor = &H00C0C0C0& Caption = "Please Check All Below that Apply:" FontBold = -1 'True FontItalic = 0 'False FontName = "Arial" FontSize = 18 FontStrikethru = 0 'False FontUnderline = 0 'False Height = 450 Left = 1710 TabIndex = 16 Top = 60 Width = 6120 End End Sub Command1_Click () form2.Hide form1.Show End Sub Sub Command3D3_Click () form1.Show form3.Hide End Sub Sub Form_Load () form3.WindowState = 2 picture1.Width = 1020 picture1.Height = 1740 End Sub