socialhistoriesform.ascx

医疗决策支持系统

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

<%@ Register TagPrefix="uc1" TagName="helpToolTip" Src="../../../Core/Help/helpToolTip.ascx" %>
<%@ Register TagPrefix="val" TagName="DataEntryCommonFields" Src="../../../Core/DataEntryForms/DataEntryCommonFields.ascx" %>
<%@ Register TagPrefix="val" Namespace="Caisis.UI.Core.Classes" Assembly="Caisis.UI" %>
 
<val:DataEntryCommonFields id="commonFields" runat=server></val:DataEntryCommonFields>

<table align="center" class="pdFormTable" width="440" cellpadding="0" cellspacing="2">

	<input type="hidden" id="PatientId" runat=server NAME="PatientId"/>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SocHxOccupation_PdLabel" Text="Occupation:" Field="SocHxOccupation" Required="No" runat=server /></td>
		<td><input type="text" id="SocHxOccupation" class="pdFormField" maxlength="50" runat=server NAME="SocHxOccupation"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SocHxMaritalStatus_PdLabel" Text="Marital Status:" Field="SocHxMaritalStatus" Required="No" runat=server /></td>
		<td><select id="SocHxMaritalStatus" class="pdFormField" runat=server NAME="SocHxMaritalStatus"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SocHxChildren_PdLabel" Text="# Children:" Field="SocHxChildren" Required="No" runat=server /></td>
		<td><input type="text" id="SocHxChildren" class="pdFormField" maxlength="50" runat=server NAME="SocHxChildren"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SocHxTobaccoType_PdLabel" Text="Tobacco Usage:" Field="SocHxTobaccoType" Required="No" runat=server /></td>
		<td><select id="SocHxTobaccoType" class="pdFormField" runat=server NAME="SocHxTobaccoType"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SocHxTobaccoPacksPerDay_PdLabel" Text="Packs per Day:" Field="SocHxTobaccoPacksPerDay" Required="No" runat=server /></td>
		<td><input type="text" id="SocHxTobaccoPacksPerDay" class="pdFormField" maxlength="50" runat=server NAME="SocHxTobaccoPacksPerDay"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SocHxTobaccoPacksPerYear_PdLabel" Text="Packs per Year:" Field="SocHxTobaccoPacksPerYear" Required="No" runat=server /></td>
		<td><input type="text" id="SocHxTobaccoPacksPerYear" class="pdFormField" maxlength="50" runat=server NAME="SocHxTobaccoPacksPerYear"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SocHxTobaccoYears_PdLabel" Text="Tobacco Usage (Yrs):" Field="SocHxTobaccoYears" Required="No" runat=server /></td>
		<td><input type="text" id="SocHxTobaccoYears" class="pdFormField" maxlength="50" runat=server NAME="SocHxTobaccoYears"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SocHxTobaccoQuitYear_PdLabel" Text="Tobacco Year Quit:" Field="SocHxTobaccoQuitYear" Required="No" runat=server /></td>
		<td><input type="text" id="SocHxTobaccoQuitYear" class="pdFormField" maxlength="50" runat=server NAME="SocHxTobaccoQuitYear"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SocHxAlcohol_PdLabel" Text="Alcohol Usage:" Field="SocHxAlcohol" Required="No" runat=server /></td>
		<td><val:ComboBox Id="SocHxAlcohol" RefBy="SocHxAlcohol" runat=server /></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SocHxCarcinogen_PdLabel" Text="Carcinogen Exposure:" Field="SocHxCarcinogen" Required="No" runat=server /></td>
		<td><input type="text" id="SocHxCarcinogen" class="pdFormField" maxlength="50" runat=server NAME="SocHxCarcinogen"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SocHxOther_PdLabel" Text="Other:" Field="SocHxOther" Required="No" runat=server /></td>
		<td><input type="text" id="SocHxOther" class="pdFormField" maxlength="255" runat=server NAME="SocHxOther"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SocHxDataSource_PdLabel" Text="Data Source:" Field="SocHxDataSource" Required="No" runat=server /></td>
		<td><val:ComboBox Id="SocHxDataSource" RefBy="SocHxDataSource" runat=server /></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SocHxQuality_PdLabel" Text="Data Quality:" Field="SocHxQuality" Required="No" runat=server /></td>
		<td><select id="SocHxQuality" class="pdFormField" runat=server NAME="SocHxQuality"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SocHxNotes_PdLabel" Text="Notes:" Field="SocHxNotes" Required="No" runat=server /></td>
		<td><textarea id="SocHxNotes" class="pdFormField" style="width:240;height:60" maxlength="1000" runat=server NAME="SocHxNotes"/></textarea></td>
	</tr>
 
</table>