label {
	font-family: Arial, Helvetica, sans-serif;
	font-size: 1.1em;
	font-weight: bold;
	margin: 0px;
	padding: 0px;
	line-height: 1.1em;
	color: #252525;
}

.row {
	float: left;
	clear: left;
	margin: 0px 0px 19px;
	padding: 0px;
	width: 100%;
}

.columnCity {
	float: left;
	margin: 0px;
	padding: 0px;
	width: 173px;
}

.columnState,.columnDate {
	float: left;
	margin: 0px;
	padding: 0px;
	width: 115px;
}

.columnZip {
	float: left;
	margin: 0px;
	padding: 0px;
	width: 115px;
}

.row input,.row textarea {
	border-style: hidden;
	border-width: 0;
	clear: left;
	color: #000000;
	float: left;
	font-family: Arial, Helvetica, sans-serif;
	font-size: 11px;
	margin: 5px 0 0;
	padding: 5px;
	vertical-align: baseline;
	overflow: hidden;
}

/* override the above rule for these two radio buttons */
#claimant-opioid-y,#claimant-opioid-n {
	clear: none;
	float: none;
}

.row select {
	clear: left;
	color: #000000;
	float: left;
	font-family: Arial, Helvetica, sans-serif;
	font-size: 11px;
	margin: 5px 0 0;
	padding: 5px 5px 5px 0;
	vertical-align: baseline;
	overflow: hidden;
}

#firstName,#lastName,#titlePosition {
	background: transparent url(images/input-bg-207.png) no-repeat scroll 0
		0;
	width: 200px;
	height: 18px;
}

#practiceName,#address1,#address2,#email,#howHeard {
	background: transparent url(images/input-bg-427.png) no-repeat scroll 0
		0;
	width: 419px;
	height: 18px;
}

#city {
	background: transparent url(images/city-bg.png) no-repeat scroll 0 0;
	width: 150px;
	height: 18px;
}

#state,#zipcode,#requestor-state,#requestor-zipcode,#requestor2-state,#requestor2-zipcode,#claimant-state,#claimant-zipcode,#physician-state,#physician-zipcode
	{
	background: transparent url(images/zip-bg.png) no-repeat scroll 0 0;
	width: 92px;
	height: 18px;
}

#areacode,#requestor-areacode,#requestor-areacodeFAX,#requestor2-areacode,#requestor2-areacodeFAX,#claimant-areacode,#claimant-birthMonth,#claimant-birthDay,#claimant-birthYear,#visitMonth,#visitDay,#visitYear,#injuryMonth,#injuryDay,#injuryYear,#physician-areacode,#physician-areacodeFAX
	{
	background: transparent url(images/areacode-bg.png) no-repeat scroll 0 0
		;
	width: 51px;
	height: 18px;
	float: left;
	clear: none;
}

input.date {
	background: transparent url(images/phone2-bg.png) no-repeat scroll 0 0;
	width: 71px;
	height: 18px;
	float: left;
	clear: none;
}

#phone1,#requestor-phone1,#requestor-phone1FAX,#requestor2-phone1,#requestor2-phone1FAX,#claimant-phone1,#physician-phone1,#physician-phone1FAX
	{
	background: transparent url(images/phone1-bg.png) no-repeat scroll 0 0;
	width: 51px;
	height: 18px;
	float: left;
	clear: none;
}

#phone2,#requestor-phone2,#requestor-phone2FAX,#requestor2-phone2,#requestor2-phone2FAX,#claimant-phone2,#physician-phone2,#physician-phone2FAX
	{
	background: transparent url(images/phone2-bg.png) no-repeat scroll 0 0;
	width: 71px;
	height: 18px;
	float: left;
	clear: none;
}

#request {
	background: transparent url(images/request-bg.png) no-repeat scroll 0 0;
	width: 419px;
	height: 113px;
	resize: none;
}

.error {
	color: #ED1C24;
	float: left;
	clear: left;
}

#contactForm {
	margin: 0px;
	padding: 0px;
	float: left;
	clear: left;
}

#contactForm .contact-header {
	margin: 0px;
	padding: 0px;
	float: left;
	height: 45px;
	width: 733px;
}

#contactForm .contact-window {
	margin: 0px;
	padding: 0px;
	clear: left;
	float: left;
	width: 672px;
	background: #FFFFFF;
}

#contactForm .contact-window p {
	font-family: Arial, Helvetica, sans-serif;
	font-size: 1.2em;
	line-height: 15px;
	color: #252525;
	margin: 0px 0px 15px;
	padding: 0px;
	clear: left;
	float: left;
}

#aspmnform {
	margin: 20px 0px 0px;
	padding: 0px;
	clear: both;
	float: left;
	width: 100%;
}

.red {
	color: #ed1c24;
}

#aspmnform .formLeft {
	margin: 0px;
	padding: 0px;
	float: left;
	width: 245px;
}

#aspmnform .formRight {
	margin: 0px;
	padding: 0px;
	clear: none;
	float: right;
	width: 427px;
}

#submit {
	background: transparent url(images/login-submit-button.png) no-repeat
		scroll 0 0;
	border: 0 none;
	cursor: pointer;
	height: 20px;
	margin: 0 5px 0 0;
	padding: 0;
	position: relative;
	text-indent: -1000em;
	vertical-align: baseline;
	width: 57px;
}

.recaptchatable * {
	border: 0 none;
	bottom: auto;
	color: black;
	left: auto;
	margin: 0;
	padding: 0 0 5px;
	position: static;
	right: auto;
	text-align: left !important;
	top: auto;
}

/* UDM Form Styles */
#requestors,#claimant,#physician,#opioid {
	clear: left;
	display: inline;
	float: left;
	margin: 14px 0;
	padding: 0;
	width: 690px;
}

#requestor2 {
	border-top: 1px solid #E1E1E1;
	clear: left;
	display: inline;
	float: left;
	margin: 0;
	padding: 14px 0 0 0;
}

#requestors .top,#claimant .top,#physician .top,#opioid .top {
	background: url("images/udm-top-dark-bg.png") no-repeat scroll 0 0
		transparent;
	display: inline;
	float: left;
	height: 34px;
	margin: 0;
	padding: 0;
	width: 690px;
}

#requestors .top h3,#claimant .top h3,#physician .top h3,#opioid .top h3
	{
	clear: left;
	color: #FFFFFF;
	display: inline;
	float: left;
	font-family: GothamMedium, Arial, Helvetica, sans-serif;
	font-size: 1.3em;
	font-weight: normal;
	letter-spacing: -1px;
	line-height: 18px;
	margin: 8px 0 0;
	padding: 0 0 0 8px;
	text-shadow: 0 0 1px rgba(0, 0, 0, 0.01);
}

#requestor2 h3 {
	clear: left;
	color: #252525;
	display: inline;
	float: left;
	font-family: GothamMedium, Arial, Helvetica, sans-serif;
	font-size: 1.3em;
	font-weight: normal;
	letter-spacing: -1px;
	line-height: normal;
	margin: 0 0 14px 0;
	padding: 0;
	text-shadow: 0 0 1px rgba(0, 0, 0, 0.01);
}

#requestors .middle,#claimant .middle,#physician .middle,#opioid .middle
	{
	background: none repeat scroll 0 0 #FFFFFF;
	border-left: 1px solid #E1E1E1;
	border-right: 1px solid #E1E1E1;
	clear: left;
	display: inline;
	float: left;
	margin: 0;
	padding: 14px 10px 0 10px;
	width: 668px;
}

#requestors .bottom,#claimant .bottom,#physician .bottom,#opioid .bottom
	{
	background: url("images/udm-bottom.png") no-repeat scroll 0 0
		transparent;
	clear: left;
	display: inline;
	float: left;
	height: 5px;
	margin: 0;
	padding: 0;
	width: 690px;
}

#addRequestor {
	float: left;
	clear: left;
	display: inline;
}

.contact-window-udm {
	background: none repeat scroll 0 0 #FFFFFF;
	clear: left;
	float: left;
	margin: 0;
	padding: 0;
	width: 690px;
}

#requestor-firstName,#requestor-lastName,#requestor-titlePosition,#requestor-city,#requestor-clientName,#requestor2-firstName,#requestor2-lastName,#requestor2-titlePosition,#requestor2-city,#claimant-firstName,#claimant-lastName,#claimant-city,#claimNumber,#physician-firstName,#physician-lastName,#physician-city,#physician-npi
	{
	background: transparent url(images/input-bg-180.png) no-repeat scroll 0
		0;
	width: 165px;
	height: 18px;
	margin: 5px 0;
	padding: 5px 10px 5px 5px;
}

#requestor-Organization,#requestor2-Organization,#requestor-address1,#requestor2-address1,#claimant-address1,#physician-address,#physician-practice
	{
	background: url("images/input-bg-367.png") no-repeat scroll 0 0
		transparent;
	height: 18px;
	margin: 5px 16px 5px 0;
	padding: 5px 16px 5px 5px;
	width: 367px;
}

label.width200 {
	width: 200px;
	float: left;
	display: inline;
}

label.width203 {
	display: inline;
	float: left;
	width: 203px;
}

.floatLeft {
	float: left;
	display: inline;
}

#requestor {
	color: #000000;
	float: right;
	font-family: Arial, Helvetica, sans-serif;
	font-size: 11px;
	margin: -9px 0 0 5px;
	overflow: hidden;
	padding: 5px 5px 5px 0;
	vertical-align: baseline;
}

.requestor {
	display: inline;
	float: left;
	margin: 9px 0 0 0;
}

#requestor-email,#requestor2-email {
	background: url("images/input-bg-367.png") no-repeat scroll 0 0
		transparent;
	height: 18px;
	margin: 5px 16px 5px 0;
	padding: 5px 16px 5px 5px;
	width: 367px;
}

/**
 * Additional styles for UDM form
 */
div.success {
	font-size: 1.5em;
}

.placeholder {
	color: #787878 !important;
}

input.phone {
	background: transparent url("images/phone-bg.png") no-repeat scroll 0 0;
	width: 72px;
}

input.ext {
	background: transparent url("images/extension-bg.png") no-repeat scroll 0 0;
	width: 32px;
}

div.phone-with-ext {
	display: inline;
	float: left; /* this doesn't make any sense, because you can't float an inline element, but it's what they have above, so... */
	width: 176px;
}

div.phone-with-ext input {
	float: none; /* to override the above rule for .row input */
}

div.phone-with-ext .error {
	font-weight: bold !important;
	font-size: 1.1em;
}

div.error-summary {
	color: #ed1c24;
	font-weight: bold;
	font-size: 1.1em;
}