uroprosfu.ascx

医疗决策支持系统

<%@ Control Language="c#" AutoEventWireup="false" Codebehind="UroProsFU.ascx.cs" Inherits="Caisis.UI.Modules.Prostate.PaperForms.UroProsFU" TargetSchema="http://schemas.microsoft.com/intellisense/ie5"%>

<link href="../../../StyleSheets/formStyles.css" rel="stylesheet" type="text/css">


<asp:PlaceHolder id="SurveyFormHolder" runat="server"></asp:PlaceHolder>


<div id="PaperFormStart">

<div align="center" >

<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">*U06*</div>
	<div  class="VerticalBarCodeAcctType"><% =BarCodeAcctType %></div>
	<div  class="VerticalBarCodeDate"><% =BarCodeDate %></div>
	</div>
</div>

<font style="font-size: 12px;">CONTAINS PROTECTED  HEALTH INFORMATION - HANDLE ACCORDING TO MSKCC POLICY</font>
  <table width="650"  cellpadding="0" cellspacing="0"  bgcolor="#ffffff">
    <tr> 
      <td colspan="8" class="FormOuterTableTopRow"> <table align="center" border="0" width="100%" cellpadding="0" cellspacing="0" >
          <tr> 
            <td width="50%" 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>
              Urology Prostate Follow- Up Patient</span><br>
            </td>
            <td width="50%" 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  %>
                    &nbsp;&nbsp;&nbsp;</td>
                  <td align="left"><strong> 
                    <% =patientMRN  %>
                    </strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                    <% =patientDOB  %>
                  </td>
                </tr>
                <tr> 
                  <td colspan="1" align="right"> 
                    <% =patientNameLabel  %>
                    &nbsp;&nbsp;&nbsp;</td>
                  <td colspan="1" align="left"><strong> 
                    <% =patientLastName  %>, <% =patientFirstName  %> <% =patientMiddleName  %>
                    </strong></td>
                </tr>
                <tr> 
                  <td align="right" valign="top"> 
                    <% =patientAddressLabel  %>
                    &nbsp;&nbsp;&nbsp;</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 class="FormOuterTableRow"> <table align="center" border="0" width="100%" cellpadding="0" cellspacing="0" >
          <tr> 
            <td class="blackBoldText"><img src="../../Images/shim.gif" border="0" width="4" height="15">Date: 
              <% =apptClinicDate %>
              <img src="../../Images/shim.gif" border="0" width="220" height="1">Physician: 
              <% =apptPhysicianName %>
            </td>
          </tr>
        </table></td>
    </tr>
    <tr> 
      <td 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&nbsp;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 class="FormOuterTableRow"> <table align="center" border="0" width="100%" cellpadding="0" cellspacing="0" >
          <tr> 
            <td height="30" align="left" valign="top" class="blackBoldText"><img src="../../Images/shim.gif" border="0" width="4" height="12">Chief 
              Complaint</td>
          </tr>
        </table></td>
    </tr>
    <tr> 
      <td height="95" valign="top" class="FormOuterTableRow"><img src="../../Images/shim.gif" border="0" width="4" height="12"><span class="blackBoldText">HPI</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:Repeater ID="HpiProstatectomies" runat=server OnItemDataBound="HpiProstatectomiesItemDataBound"> 
                <ItemTemplate> <strong> 
                  <%# DataBinder.Eval(Container.DataItem, "OpType") %>
                  </strong> on 
                  <%# DataBinder.Eval(Container.DataItem, "SurgDateText") %>
                  <asp:Label ID="CaseSurgeonLabel" Runat="server">by 
                    <%# DataBinder.Eval(Container.DataItem, "SurgCaseSurgeon") %>
                  </asp:Label>
                  <br>
                  <asp:Literal ID="StartNextHpiColumn" Runat="server" />
                </ItemTemplate>
              </asp:Repeater> <asp:Label ID="PreTxPot" Runat="server" />
              
              <asp:Repeater ID="hpiProtocols" runat=server OnItemDataBound="appendToHpiItemDataBound"> 
                <ItemTemplate> Protocol 
                  <%# DataBinder.Eval(Container.DataItem, "ProtocolNum") %>  <%# DataBinder.Eval(Container.DataItem, "ProtocolNotes") %> 
                  <%# DataBinder.Eval(Container.DataItem, "PtProtocolStatus") %>
                  <br>
                  <asp:Literal ID="StartNextHpiColumn" Runat="server" />
                </ItemTemplate>
              </asp:Repeater>
              
              <asp:Repeater ID="hpiBiopsies" runat=server > 
                <ItemTemplate> Biopsy:&nbsp; 
                  <%# DataBinder.Eval(Container.DataItem, "BxDateText") %>
                  &nbsp;&nbsp; 
                  <%# DataBinder.Eval(Container.DataItem, "BxType") %>
                  &nbsp;&nbsp;Result:&nbsp; 
                  <%# DataBinder.Eval(Container.DataItem, "BxResult") %>
                  &nbsp;&nbsp; 
                  <%# DataBinder.Eval(Container.DataItem, "bxQuality") %>
                  <br>
                  <asp:Literal ID="StartNextHpiColumn" Runat="server" />
                </ItemTemplate>
              </asp:Repeater> 
              
              
              <asp:Label ID="NVB_Left" Runat="server" /> <asp:Label ID="NVB_Right" Runat="server" /> 
            </td>
          </tr>
        </table></td>
    </tr>
    <tr> 
      <td valign="top" class="FormOuterTableRow"> <table width="650" border="0" cellspacing="0" cellpadding="0">
          <tr> 
            <td width="150" valign="top" class="FormInsideTableTopLeftCell"><span class="blackBoldText"><img src="../../Images/shim.gif" border="0" width="4" height="12">Nomogram 
              Prediction </span></td>
            <td width="70" align="right" class="FormInsideTableTopCell">PreRP:</td>
            <td width="55" class="FormInsideTableTopCell">&nbsp; <asp:Label ID="preRPNomo" Runat=server /></td>
            <td width="70" align="right" class="FormInsideTableTopCell">PreXRT:</td>
            <td width="55" align="right" class="FormInsideTableTopCell">&nbsp; 
              <asp:Label ID="preXRTNomo" Runat=server /></td>
            <td width="70" align="right" class="FormInsideTableTopCell">PreBrachy:</td>
            <td width="55" align="right" class="FormInsideTableTopCell">&nbsp; 
              <asp:Label ID="preBrachyNomo" Runat=server /></td>
            <td width="80" align="right" class="FormInsideTableTopCell">Post RP 
              7 Yr:</td>
            <td width="45" class="FormInsideTableTopCell">&nbsp; <asp:Label ID="postRP7yrNomo" Runat=server /></td>
          </tr>
        </table></td>
    </tr>
    <tr> 
      <td valign="top" class="FormOuterTableRow"> <table align="center" border="0" width="650" cellpadding="0" cellspacing="0" >
          <tr> 
            <td width="360" valign="top"><img src="../../Images/shim.gif" border="0" width="4" height="0"><span class="blackBoldText">Interval 
              History</span><br>
            </td>
            <td width="340" align="left" valign="top"><span class="blackBoldText">Other 
              Treatments:</span> <span class="smallGrayText"> (CHEMO,GENE,HORM,ORCH,XRT,NONE)</span><br> 
              <table align="center" border="0" width="100%" cellpadding="0" cellspacing="0" >
                <tr> 
                  <td align="center" class="FormInsideTableTopLeftCell">Start 
                    Date</td>
                  <td align="center" class="FormInsideTableTopCell">TX<br> <img src="../../Images/shim.gif" border="0" width="90" height="1"></td>
                  <td align="center" class="FormInsideTableTopCell">Notes (Protocol 
                    #)</td>
                  <td align="center" class="FormInsideTableTopCell">Stop Date</td>
                </tr>
                <tr> 
                  <td class="FormInsideTableLeftCell">&nbsp;</td>
                  <td class="FormInsideTableRegCell">&nbsp;</td>