📄 guprosfu.ascx
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<%@ Control CodeBehind="GUProsFU.ascx.cs" Language="c#" AutoEventWireup="false" Inherits="Caisis.UI.Modules.Prostate.PaperForms.GUProsFU" %>
<link href="../StyleSheets/formStyles.css" rel="stylesheet" type="text/css">
<div id="PaperFormStart">
<div align="left">
<div align="center">
<div align="right" class="VerticalBarCodeDiv">
<div class="VerticalBarCodeStatement"><img src="../../Images/FormImages/BarCodeLineStatement.gif" border="0" width="8" height="121"><br/>
<img src="../../Images/FormImages/BarCodeLineStatement.gif" border="0" width="8" height="121" vspace="220"><br/>
<img src="../../Images/FormImages/BarCodeLineStatement.gif" border="0" width="8" height="121"></div>
<div class="VerticalBarCodeMRN"><% =BarCodeMRN %></div>
<div class="VerticalBarCodeDocType">*U19*</div>
<div class="VerticalBarCodeAcctType"><% =BarCodeAcctType %></div>
<div class="VerticalBarCodeDate"><% =BarCodeDate %></div>
</div>
</div>
<div align="center"><font size="-1">CONTAINS PROTECTED HEALTH INFORMATION - HANDLE ACCORDING TO MSKCC POLICY</font></div>
<table width="700" border="0" cellspacing="0" cellpadding="0">
<tr>
<td colspan="8" class="FormOuterTableTopRow">
<table align="center" border="0" width="700" cellpadding="0" cellspacing="0">
<tr>
<td width="325" align="center" valign="middle" class="FormInnerRowRightBorder"><img src="../../Images/FormImages/<%= institutionShortName%>_FormLogo.gif" width="80" alt="" border="0" align="left"><span class="blackBoldText"><%= institutionName%><br/>
GU Prostate Follow-Up Patient<br/>
</span></td>
<td width="325" align="center" valign="bottom">
<table width="340" border="0" cellspacing="1" cellpadding="0" >
<tr>
<td width="65"><img src="../../Images/shim.gif" border="0" width="65" height="1"></td>
<td align="left" width="274"><img src="../../Images/shim.gif" border="0" width="274" height="1"></td>
</tr>
<tr>
<td align="right"><% =patientMRNLabel %> </td>
<td align="left"><strong><% =patientMRN %></strong> <% =patientDOB %></td>
</tr>
<tr>
<td align="right"><% =patientNameLabel %> </td>
<td align="left"><strong><% =patientFirstName %> <% =patientMiddleName %> <% =patientLastName %></strong></td>
</tr>
<tr>
<td align="right" valign="top"><% =patientAddressLabel %> </td>
<td align="left" valign="top"><% =patientAddress1 %><% =patientAddress2 %><% =patientCity %> <% =patientState %> <% =patientPostalCode %></td>
</tr>
<tr>
<td colspan="2"><img src="../../Images/shim.gif" border="0" width="1" height="5"></td>
</tr>
<tr>
<td colspan="2" align="center" valign="bottom" class="blackBoldText">Patient Identification</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td colspan="8" class="FormOuterTableRow">
<table align="center" border="0" width="100%" cellpadding="0" cellspacing="0">
<tr>
<td colspan="8" valign="bottom" class="blackBoldText"><img src="../../Images/shim.gif" border="0" width="4" height="0">Date: <% =apptClinicDate %><img src="../../Images/shim.gif" border="0" width="220" height="1">Physician: <% =apptPhysicianName %></td>
</tr>
</table>
</td>
</tr>
<tr>
<td colspan="8" class="FormOuterTableRow">
<table align="center" border="0" width="100%" cellpadding="0" cellspacing="0">
<tr>
<td align="left" height="22"><img src="../../Images/shim.gif" border="0" width="4" height="0">Referring M.D.:
<asp:Repeater ID="ReferringMD" runat=server >
<ItemTemplate><%# DataBinder.Eval(Container.DataItem, "phFirstName") %> <%# DataBinder.Eval(Container.DataItem, "phLastName") %> (<%# DataBinder.Eval(Container.DataItem, "phInstitution") %>)</ItemTemplate><SeparatorTemplate>, </SeparatorTemplate>
</asp:Repeater>
<asp:Label ID="blankReferrringMD" Runat="server"></asp:Label>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td colspan="8" class="FormOuterTableRow">
<table align="center" border="0" width="700" cellpadding="0" cellspacing="0">
<tr>
<td valign="top" align="left" class="FormInnerRowRightBorder" width="535" height="115"><img src="../../Images/shim.gif" border="0" width="4" height="0"><span class="blackBoldText">HPI / Diagnosis / Stage</span><br/>
<table cellpadding="4" cellspacing="0" border="0">
<tr>
<td class="HPIText" valign="top">
<asp:Repeater ID="hpi" runat=server OnItemDataBound="hpiItemDataBound">
<ItemTemplate>
<%# DataBinder.Eval(Container.DataItem, "patientHPI") %><br/><asp:Literal ID="StartNextHpiColumn" Runat="server" />
</ItemTemplate>
</asp:Repeater>
<asp:Label ID="PreTxPot" Runat="server" />
</td>
</tr>
</table>
</td>
<td valign="top" align="left" width="165"> <span class="blackBoldText"><img src="../../Images/shim.gif" border="0" width="4" height="0">Current Disease State</span><br/>
<table align="right" border="0" width="100%" cellpadding="0" cellspacing="0" >
<tr>
<td align="left"><input type="checkbox" name="Localized" id="Localized" value="Localized" runat="server">
Localized</td>
</tr>
<tr>
<td align="left"><input type="checkbox" name="RisingPSA_NonCastrate" id="RisingPSA_NonCastrate" value="Rising PSA: Non-Castrate" runat="server">
Rising PSA: Non-Castrate</td>
</tr>
<tr>
<td align="left"><input type="checkbox" name="ClinMetsNonCastrate" id="ClinMetsNonCastrate" value="Clin Mets: Non-Castrate" runat="server">
Clin Mets: Non-Castrate</td>
</tr>
<tr>
<td align="left"><input type="checkbox" name="RisingPSA_Castrate" id="RisingPSA_Castrate" value="Rising PSA: Castrate" runat="server">
Rising PSA: Castrate</td>
</tr>
<tr>
<td align="left"><input type="checkbox" name="ClinMetsCastrate" id="ClinMetsCastrate" value="Clin Mets: Castrate" runat="server">
Clin Mets: Castrate</td>
</tr>
<tr>
<td align="left" height="22"><img src="../../Images/shim.gif" border="0" width="12" height="1">Change:<img src="../../Images/shim.gif" border="0" width="12" height="1">Y<img src="../../Images/shim.gif" border="0" width="12" height="1">N</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td colspan="8" class="FormOuterTableRow">
<table align="center" border="0" width="100%" cellpadding="0" cellspacing="0">
<tr >
<td class="FormInsideTableRegCell" align="center" valign="middle" height="20">Current TX</td>
<td class="FormInsideTableRegCell" align="center" valign="middle"><img src="../../Images/shim.gif" border="0" width="70" height="1"></td>
<td class="FormInsideTableRegCell" align="center" valign="middle">Start Date</td>
<td class="FormInsideTableRegCell" align="center" valign="middle"><img src="../../Images/shim.gif" border="0" width="70" height="1"></td>
<td class="FormInsideTableRegCell" align="center" valign="middle">Cycle / Week</td>
<td class="FormInsideTableRegCell" align="center" valign="middle"><img src="../../Images/shim.gif" border="0" width="70" height="1"></td>
<td class="FormInsideTableRegCell" align="center" valign="middle">Protocol # Y<img src="../../Images/shim.gif" border="0" width="6" height="0">N</td>
<td class="FormInsideTableRegCell" align="center" valign="middle"><img src="../../Images/shim.gif" border="0" width="70" height="1"></td>
</tr>
</table>
</td>
</tr>
<tr>
<td colspan="8" valign="top" class="FormOuterTableRow">
<table width="700" border="0" cellspacing="0" cellpadding="0">
<tr>
<td width="330" valign="top" class="FormInnerRowRightBorder">
<table width="350" border="0" cellspacing="0" cellpadding="0">
<tr>
<td valign="top" height="22" colspan="2"><img src="../../Images/shim.gif" border="0" width="4" height="0"><span class="blackBoldText">Interval
History</span></td>
</tr>
<tr>
<td height="22" colspan="2"> </td>
</tr>
</table>
</td>
<td>
<table width="350" border="0" cellspacing="0" cellpadding="0">
<tr>
<td height="22" valign="top"><img src="../../Images/shim.gif" border="0" width="4" height="0"><span class="blackBoldText">Medications</span></td>
<td align="right">Last GnRH: ____\____\____</td>
</tr>
<tr>
<td height="22" align="right" colspan="2">Last Bisphosphonate: ____\____\____</td>
</tr>
<tr>
<td height="90" colspan="2" valign="top">
<table cellpadding="4" cellspacing="0" border="0" width="350">
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