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					obj.style.visibility=(v=='show')?'visible':(v='hide')?'hidden':v; 
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	function DHTMLNavBarRestoreLayers() { 
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				if (obj.style) 
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				if (!aryDHTMLNavBarLayerInfo[args[i]].MOutLayer)
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	{
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		this.defaultVisibility = a[1];
		this.isDefault = true;
		this.MOutLayer = a[2];
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	viz="hide";
	function DHTMLNavBarNavMove()
	{
		if(thisl==DHTMLNavBarMM_findObj("DHTMLNavBarScrollLayer"))
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	  	for(i=0;a&&i<a.length&&(x=a[i])&&x.oSrc;i++) 
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	  	if(d.images)
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			x=DHTML_findObj(n,d.layers[i].document);
	  	if(!x && d.getElementById) 
			x=d.getElementById(n); 
		return x;
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	function DHTML_swapImage() 
	{ //v3.0
		var i,j=0,x,a=DHTML_swapImage.arguments; 
		document.Sliding_sr=new Array; 
		for(i=0;i<(a.length-2);i+=3)
	   		if ((x=DHTML_findObj(a[i]))!=null)
			{
				document.Sliding_sr[j++]=x; 
				if(!x.oSrc) 
					x.oSrc=x.src; 
				x.src=a[i+2];
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                                                                <h1><font color="7c2230" size="4">Your Miracle at Harbor - OB Kit</font></h1>
																
																	
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			<tr class="metadetail">
				<th valign="top" class="metadetail">First Name&nbsp;<span class="required">*</span>&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_1" class="metadetail" size="35" value="">
					<input type="Hidden" name="eformField_1_required" class="metadetail" value="First Name is required.">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Last Name&nbsp;<span class="required">*</span>&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_2" class="metadetail" size="35" value="">
					<input type="Hidden" name="eformField_2_required" class="metadetail" value="Last Name is required.">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Street Address 1&nbsp;<span class="required">*</span>&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_3" class="metadetail" size="35" value="">
					<input type="Hidden" name="eformField_3_required" class="metadetail" value="Street Address 1 is required.">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Street Address 2&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_4" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">City&nbsp;<span class="required">*</span>&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_5" class="metadetail" size="35" value="">
					<input type="Hidden" name="eformField_5_required" class="metadetail" value="City is required.">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">State&nbsp;<span class="required">*</span>&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_6" class="metadetail" size="35" value="Maryland">
					<input type="Hidden" name="eformField_6_required" class="metadetail" value="State is required.">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Zip&nbsp;<span class="required">*</span>&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_7" class="metadetail" size="35" value="">
					<input type="Hidden" name="eformField_7_required" class="metadetail" value="Zip is required.">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Date of Birth (mm/dd/yyyy)&nbsp;<span class="required">*</span>&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_8" class="metadetail" size="35" value="">
					<input type="Hidden" name="eformField_8_required" class="metadetail" value="Date of Birth (mm/dd/yyyy) is required.">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Phone&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_9" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">E-mail&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_10" class="metadetail" size="35" value="">
					  
					<input type="Hidden" name="eformField_10_email" class="metadetail" value="E-mail must be a valid email address.">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Would you like to receive our quarterly magazine?&nbsp;<span class="required">*</span>&nbsp;</th>
				<td class="metadetail">
					<span style="white-space:nowrap;"><input type="radio" name="eformField_11" id="eformField_11_1" style="{border:0;}" value="yes">
					<label for="eformField_11_1" class="metadetail">yes</label></span>
					<span style="white-space:nowrap;"><input type="radio" name="eformField_11" id="eformField_11_2" style="{border:0;}" value="no" checked>
					<label for="eformField_11_2" class="metadetail">no</label></span>
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">How did you hear about us?&nbsp;</th>
				<td class="metadetail">
					<select name="eformField_12" id="eformField_12" class="metadetail" onChange="return smm_eforms_toggle_other(this);">
						<option value="" selected></option>
						<option value="Anne Arundel Guide Book">Anne Arundel Guide Book</option>
						<option value="Baltimore Magazine - Top Doctors">Baltimore Magazine - Top Doctors</option>
						<option value="TV - WMAR - Channel 2">TV - WMAR - Channel 2</option>
						<option value="TV - WJZ - Channel 13">TV - WJZ - Channel 13</option>
						<option value="Web - abc2news.com">Web - abc2news.com</option>
						<option value="Web - wjz.com">Web - wjz.com</option>
						<option value="Web - Harbor Hospital site">Web - Harbor Hospital site</option>
						<option value="Web - other website">Web - other website</option>
						<option value="Web - search engine">Web - search engine</option>
						<option value="Waterfront Magazine">Waterfront Magazine</option>
						<option value="Waterfront Online E-newsletter">Waterfront Online E-newsletter</option>
						<option value="Community Newspaper">Community Newspaper</option>
						<option value="Doctor">Doctor</option>
						<option value="Word of Mouth">Word of Mouth</option>
						<option value=""></option><option value='Other'>Other</option>
					</select>
					<div class="metanew">
						<p class="metanew">
							If Other, please specify:<br>
							<textarea cols="30" rows="3" name="eformField_12_other_txt" disabled class="metadetail"></textarea>
						</p>
					</div>
					<script language="JavaScript" type="text/javascript"><!--
					smm_eforms_toggle_other_to_init[smm_eforms_toggle_other_to_init.length] = "eformField_12";
					//--></script>
					<input type="hidden" name="eformField_12_other_txt_required" value='Please provide further details to your answer: Other.' disabled>
				</td>
			</tr>
			<tr class="metadetail">
				<th class="metadetail">&nbsp;</th>
				<td class="metadetail">
					<input type="submit" name="submit" value="Submit" class="metadetail">
				</td>
			</tr>
			<tr class="metadetail">
				<td class="metadetail" colspan="2"><br><!--####### KEEP THIS FOOTNOTE #####--><br><p class=footnote>As always, Harbor Hospital and its parent company, MedStar Health, respect your privacy. The information you submit is used for internal purposes only to help guide us in developing health information relevant to your needs.</p></td>
			</tr>
		</table>
		</form>
	
	
</td></tr></table>
															</td>
    </tr><tr>
<td colspan="6" align="center"><br></td>
</tr>
<tr>
<td colspan="6" align="center"><span class="footnote1">Harbor Hospital</span><span class="footnote2"> | 3001 S. Hanover St. | Baltimore, MD 21225 | 410.350.3200 | </span>&nbsp;<span class="footnote3"><a href="http://www.medstarhealth.org/" target="_blank">MedStar Health Facilities</a> | <a href="body.cfm?id=555975">Site Map</a> | <a href="body.cfm?id=555795">Contact Us</a> | <a href="body.cfm?id=43">Directions</a> | <a href="http://www.medstarhealth.org/body.cfm?id=385" target="_blank">Privacy Practices</a> | <a href="body.cfm?id=128">Disclaimer</a></span></td>
</tr>
</table>
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