📄 uroprossurvivor.ascx
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<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:
<%# DataBinder.Eval(Container.DataItem, "BxDateText") %>
<%# DataBinder.Eval(Container.DataItem, "BxType") %>
Result:
<%# DataBinder.Eval(Container.DataItem, "BxResult") %>
<%# 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"> <asp:Label ID="preRPNomo" Runat=server /></td>
<td width="70" align="right" class="FormInsideTableTopCell">PreXRT:</td>
<td width="55" align="right" class="FormInsideTableTopCell">
<asp:Label ID="preXRTNomo" Runat=server /></td>
<td width="70" align="right" class="FormInsideTableTopCell">PreBrachy:</td>
<td width="55" align="right" class="FormInsideTableTopCell">
<asp:Label ID="preBrachyNomo" Runat=server /></td>
<td width="80" align="right" class="FormInsideTableTopCell">Post RP
7 Yr:</td>
<td width="45" class="FormInsideTableTopCell"> <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="50%" valign="top" class="FormInsideTableTopCell"><img src="../../images/shim.gif" border="0" width="4" height="0"><span class="blackBoldText">Interval History</span><br></td>
<td colspan="2" 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"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInnerRowBottomBorder"> </td>
</tr>
<tr>
<td class="FormInsideTableLeftCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInnerRowBottomBorder"> </td>
</tr>
<tr>
<td class="FormInsideTableLeftCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInnerRowBottomBorder"> </td>
</tr>
</table>
</td>
</tr>
<tr>
<td align="left" valign="top" height="30"><img src="../../images/shim.gif" border="0" width="4" height="0">Late Complications: <input type="checkbox" name="No"> No <input type="checkbox" name="Yes"> Yes (specify):
<asp:Repeater ID="complications" runat=server>
<ItemTemplate>
<%# DataBinder.Eval(Container.DataItem, "ROS_DateText") %>
<%# DataBinder.Eval(Container.DataItem, "ROS_Result") %>
</ItemTemplate>
<SeparatorTemplate>, </SeparatorTemplate>
</asp:Repeater> </td>
<td> <img src="../../images/FormImages/WinCheckbox.gif" width="13" height="13">
Peyronies<br/> <img src="../../images/FormImages/WinCheckbox.gif" width="13" height="13">
Hernia Side:________________<br/> <img src="../../images/FormImages/WinCheckbox.gif" width="13" height="13">
Stricture<br/> <img src="../../images/FormImages/WinCheckbox.gif" width="13" height="13">
Depression<br></td>
<td valign="top"><img src="../../images/FormImages/WinCheckbox.gif" width="13" height="13">
Marital Discord<br/> <img src="../../images/FormImages/WinCheckbox.gif" width="13" height="13">
Other:<br></td>
</tr>
</table>
</td>
</tr>
<tr>
<td valign="top" class="FormOuterTableRow">
<table width="650" border="0" cellspacing="0" cellpadding="0">
<tr>
<td width="335" class="FormInnerRowRightBorder" valign="top">
<table width="100%" border="0" cellspacing="0" cellpadding="0">
<tr>
<td colspan="3"><span class="blackBoldText"><img src="../../images/shim.gif" border="0" width="4" height="0">Medications / Devices</span> <img src="../../images/FormImages/WinCheckbox.gif" width="13" height="13"> Yes <img src="../../images/FormImages/WinCheckbox.gif" width="13" height="13"> No <span><img src="../../images/shim.gif" border="0" width="30" height="1"><input name="DateLastGnRH4" type="checkbox" id="DateLastGnRH4" value="yes"> Unchanged</span></td>
</tr>
<tr align="center">
<td width="195" class="FormInsideTableTopCell">Agent</td>
<td width="60" class="FormInsideTableTopCell">Dose</td>
<td width="70" class="FormInsideTableTopCell">Schedule</td>
</tr>
<asp:Repeater ID="medications" runat=server>
<ItemTemplate>
<tr>
<td class="FormInsideTableRegCell">
<%# DataBinder.Eval(Container.DataItem, "Medication") %>
</td>
<td class="FormInsideTableRegCell">
<%# DataBinder.Eval(Container.DataItem, "MedDose") %>
</td>
<td class="FormInsideTableRegCell">
<%# DataBinder.Eval(Container.DataItem, "MedSchedule") %>
</td>
</tr>
</ItemTemplate>
</asp:Repeater>
</table>
</td>
<td width="315" valign="top">
<table width="100%" border="0" cellspacing="0" cellpadding="0">
<tr>
<td height="20" colspan="3"> </td>
</tr>
<tr align="center">
<td width="195" class="FormInsideTableTopCell">Agent</td>
<td width="60" class="FormInsideTableTopCell">Dose</td>
<td width="70" class="FormInsideTableTopCell">Schedule</td>
</tr>
<tr align="center">
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
</tr>
<tr align="center">
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
</tr>
<tr align="center">
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </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 align="left" valign="top" height="90"><img src="../../images/shim.gif" border="0" width="4" height="0"><span class="blackBoldText">Medical
& Surgical History / Comorbidities</span><br/> <img src="../../images/shim.gif" border="0" width="1" height="14">
<asp:Repeater ID="comorbidities" runat=server>
<ItemTemplate>
<%# DataBinder.Eval(Container.DataItem, "ComorbDateText") %>
-
<strong><%# DataBinder.Eval(Container.DataItem, "Comorbidity") %></strong>
</ItemTemplate>
<SeparatorTemplate><br> </SeparatorTemplate>
</asp:Repeater> </td>
<td width="400" align="right" valign="top">
<table width="400" border="0" cellspacing="0" cellpadding="0">
<tr>
<td colspan="2"><img src="../../images/shim.gif" border="0" width="10" height="5"></td>
</tr>
<tr>
<td> <img src="../../images/FormImages/WinCheckbox.gif" width="13" height="13">
Coronary Artery Disease / MI<br/> <img src="../../images/FormImages/WinCheckbox.gif" width="13" height="13">
Other Cardiac Disease __________<br/> <img src="../../images/FormImages/WinCheckbox.gif" width="13" height="13">
Hypertension<br/> <img src="../../images/FormImages/WinCheckbox.gif" width="13" height="13">
CVA<br> <img src="../../images/FormImages/WinCheckbox.gif" width="13" height="13">
Thromboembolic Events / DVT <br/> </td>
<td valign="top"> <img src="../../images/FormImages/WinCheckbox.gif" width="13" height="13">
Pulmonary Disease / Asthma / COPD<br/> <img src="../../images/FormImages/WinCheckbox.gif" width="13" height="13">
Diabetes (IDDM/NIDDM)<br> <img src="../../images/FormImages/WinCheckbox.gif" width="13" height="13">
Hypercholesterolemia<br/> <img src="../../images/FormImages/WinCheckbox.gif" width="13" height="13">
Back Pain / DJD <br/></td>
</tr>
</table></td>
</tr>
</table></td>
</tr>
<tr>
<td height="14" align="center" valign="bottom" class="blackBoldText">GU34<img src="../../Images/shim.gif" border="0" width="45" height="1">U38<img src="../../Images/shim.gif" border="0" width="45" height="1">CMIC
Approval Date: 6/05<img src="../../Images/shim.gif" border="0" width="45" height="8">rev:09/08/06<img src="../../Images/shim.gif" border="0" width="45" height="1">Page <span id="PageNumber">1</span> of <span id="TotalPages">4</span><img src="../../Images/shim.gif" border="0" width="45" height="1">B/02.070.<span class="blackBoldTextSmall">34</span></td>
</tr>
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