5010 Checklist

Complete this form to receive a 5010 checklist. This document will help guide you through your implementation of the Version 005010 (5010) HIPAA electronic administrative transactions.

#mc_embed_signup{background:#fff; clear:left; font:14px Helvetica,Arial,sans-serif; }
/* Add your own MailChimp form style overrides in your site stylesheet or in this style block.
We recommend moving this block and the preceding CSS link to the HEAD of your HTML file. */

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var fnames = new Array();var ftypes = new Array();fnames[1]=’FNAME’;ftypes[1]=’text’;fnames[2]=’LNAME’;ftypes[2]=’text’;fnames[0]=’EMAIL’;ftypes[0]=’email’;fnames[4]=’MMERGE4′;ftypes[4]=’radio’;
try {
var jqueryLoaded=jQuery;
jqueryLoaded=true;
} catch(err) {
var jqueryLoaded=false;
}
var head= document.getElementsByTagName(‘head’)[0];
if (!jqueryLoaded) {
var script = document.createElement(‘script’);
script.type = ‘text/javascript’;
script.src = ‘http://ajax.googleapis.com/ajax/libs/jquery/1.4.4/jquery.min.js’;
head.appendChild(script);
if (script.readyState && script.onload!==null){
script.onreadystatechange= function () {
if (this.readyState == ‘complete’) mce_preload_check();
}
}
}
var script = document.createElement(‘script’);
script.type = ‘text/javascript’;
script.src = ‘http://downloads.mailchimp.com/js/jquery.form-n-validate.js’;
head.appendChild(script);
var err_style = ”;
try{
err_style = mc_custom_error_style;
} catch(e){
err_style = ‘#mc_embed_signup input.mce_inline_error{border-color:#6B0505;} #mc_embed_signup div.mce_inline_error{margin: 0 0 1em 0; padding: 5px 10px; background-color:#6B0505; font-weight: bold; z-index: 1; color:#fff;}’;
}
var head= document.getElementsByTagName(‘head’)[0];
var style= document.createElement(‘style’);
style.type= ‘text/css’;
if (style.styleSheet) {
style.styleSheet.cssText = err_style;
} else {
style.appendChild(document.createTextNode(err_style));
}
head.appendChild(style);
setTimeout(‘mce_preload_check();’, 250);

var mce_preload_checks = 0;
function mce_preload_check(){
if (mce_preload_checks>40) return;
mce_preload_checks++;
try {
var jqueryLoaded=jQuery;
} catch(err) {
setTimeout(‘mce_preload_check();’, 250);
return;
}
try {
var validatorLoaded=jQuery(“#fake-form”).validate({});
} catch(err) {
setTimeout(‘mce_preload_check();’, 250);
return;
}
mce_init_form();
}
function mce_init_form(){
jQuery(document).ready( function($) {
var options = { errorClass: ‘mce_inline_error’, errorElement: ‘div’, onkeyup: function(){}, onfocusout:function(){}, onblur:function(){} };
var mce_validator = $(“#mc-embedded-subscribe-form”).validate(options);
$(“#mc-embedded-subscribe-form”).unbind(‘submit’);//remove the validator so we can get into beforeSubmit on the ajaxform, which then calls the validator
options = { url: ‘http://apexedi.us2.list-manage.com/subscribe/post-json?u=a7e98f00cecb6dfcae853f97a&id=302ae24f22&c=?’, type: ‘GET’, dataType: ‘json’, contentType: “application/json; charset=utf-8″,
beforeSubmit: function(){
$(‘#mce_tmp_error_msg’).remove();
$(‘.datefield’,’#mc_embed_signup’).each(
function(){
var txt = ‘filled’;
var fields = new Array();
var i = 0;
$(‘:text’, this).each(
function(){
fields[i] = this;
i++;
});
$(‘:hidden’, this).each(
function(){
var bday = false;
if (fields.length == 2){
bday = true;
fields[2] = {‘value’:1970};//trick birthdays into having years
}
if ( fields[0].value==’MM’ && fields[1].value==’DD’ && (fields[2].value==’YYYY’ || (bday && fields[2].value==1970) ) ){
this.value = ”;
} else if ( fields[0].value==” && fields[1].value==” && (fields[2].value==” || (bday && fields[2].value==1970) ) ){
this.value = ”;
} else {
this.value = fields[0].value+’/’+fields[1].value+’/’+fields[2].value;
}
});
});
return mce_validator.form();
},
success: mce_success_cb
};
$(‘#mc-embedded-subscribe-form’).ajaxForm(options);

});
}
function mce_success_cb(resp){
$(‘#mce-success-response’).hide();
$(‘#mce-error-response’).hide();
if (resp.result==”success”){
$(‘#mce-’+resp.result+’-response’).show();
$(‘#mce-’+resp.result+’-response’).html(resp.msg);
$(‘#mc-embedded-subscribe-form’).each(function(){
this.reset();
});
} else {
var index = -1;
var msg;
try {
var parts = resp.msg.split(‘ – ‘,2);
if (parts[1]==undefined){
msg = resp.msg;
} else {
i = parseInt(parts[0]);
if (i.toString() == parts[0]){
index = parts[0];
msg = parts[1];
} else {
index = -1;
msg = resp.msg;
}
}
} catch(e){
index = -1;
msg = resp.msg;
}
try{
if (index== -1){
$(‘#mce-’+resp.result+’-response’).show();
$(‘#mce-’+resp.result+’-response’).html(msg);
} else {
err_id = ‘mce_tmp_error_msg’;
html = ‘

‘+msg+’

‘;

var input_id = ‘#mc_embed_signup’;
var f = $(input_id);
if (ftypes[index]==’address’){
input_id = ‘#mce-’+fnames[index]+’-addr1′;
f = $(input_id).parent().parent().get(0);
} else if (ftypes[index]==’date’){
input_id = ‘#mce-’+fnames[index]+’-month’;
f = $(input_id).parent().parent().get(0);
} else {
input_id = ‘#mce-’+fnames[index];
f = $().parent(input_id).get(0);
}
if (f){
$(f).append(html);
$(input_id).focus();
} else {
$(‘#mce-’+resp.result+’-response’).show();
$(‘#mce-’+resp.result+’-response’).html(msg);
}
}
} catch(e){
$(‘#mce-’+resp.result+’-response’).show();
$(‘#mce-’+resp.result+’-response’).html(msg);
}
}
}