surgeriesform.ascx

医疗决策支持系统

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          <td  class="loginBorder"><img src="../../images/shim.gif" width="1" height="1"></td>
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        <tr> 
          <td colspan="6"><img src="../../images/SurgicalProceduresTableBottom.gif" width="420" height="3"></td>
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        <tr> 
          <td colspan="6" height="40">&nbsp;</td>
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      </table>












<!---
		<table cellpadding="0" cellspacing="0" border="0" width="450">
				<tr>
					<td height="40" colspan="2">&nbsp;</td>
				</tr>
				<tr>
					<td width="140" valign="top"><span style="font-weight:bold; color: 004159; font-size:12px; line-height:24px;">Procedures Performed:</span></td>
					<td align="left"  valign="top">

						<a href="#" style="font-weight:bold; color: 004159; font-size:12px; line-height:24px;" >Cystectomy<br/></a>
						<select style="width: 150px;" id="proceduresPerformed">
							<option value="">-- None --</option>
							<option value="Prostatectomy">Prostatectomy</option>
						</select> <img src="../../images/ButtonAddSmall.gif" border="0" align="absmiddle" style="cursor:hand;" hspace="4">
					</td>
				</tr>
				<tr>
					<td height="40" colspan="2">&nbsp;</td>
				</tr>
			</table>
		</td>
	</tr>
--->


 End Surgery Design Changes ---%>




	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgAdmitDateText_PdLabel" Text="Admit Date:" Field="SurgAdmitDateText" Required="No" runat=server /></td>
		<td><input type="text" id="SurgAdmitDateText" class="pdFormField" runat=server NAME="SurgAdmitDateText" /><img src="../../../images/Calendar/cal.gif" width="16" height="16" border="0" alt="select date" align="absMiddle" id="SurgAdmitDateTextCal" runat="server" />
		&nbsp;<input type="text" id="SurgAdmitDate" class="pdFormField"  style="width:80; border: 1px gray flat;"   runat=server NAME="SurgAdmitDate" readonly/><val:PDLabel id="SurgAdmitDate_PdLabel" Text="" Field="SurgAdmitDate"  Required="No" runat=server /></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgDischargeDateText_PdLabel" Text="Discharge Date:" Field="SurgDischargeDateText" Required="No" runat=server /></td>
		<td><input type="text" id="SurgDischargeDateText" class="pdFormField" runat=server NAME="SurgDischargeDateText"/><img id="SurgDischargeDateTextCal" runat="server" src="../../../images/Calendar/cal.gif" width="16" height="16" border="0" alt="select date" align="absMiddle"  />
		&nbsp;<input type="text" id="SurgDischargeDate" class="pdFormField" style="width:80; border: 1px gray flat;"  runat=server NAME="SurgDischargeDate" readonly/><val:PDLabel id="SurgDischargeDate_PdLabel" Text="" Field="SurgDischargeDate" Required="No" runat=server /></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgOperatingTime_PdLabel" Text="Operating Time:" Field="SurgOperatingTime" Required="No" runat=server /></td>
		<td><input type="text" id="SurgOperatingTime" class="pdFormField" maxlength="50" runat=server NAME="SurgOperatingTime"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgASA_PdLabel" Text="ASA:" Field="SurgASA" Required="No" runat=server /></td>
		<td><input type="text" id="SurgASA" class="pdFormField" maxlength="50" runat=server NAME="SurgASA"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgAnesthesiaTime_PdLabel" Text="Anesthesia Time:" Field="SurgAnesthesiaTime" Required="No" runat=server /></td>
		<td><input type="text" id="SurgAnesthesiaTime" class="pdFormField" maxlength="50" runat=server NAME="SurgAnesthesiaTime"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgAnesthesiaType_PdLabel" Text="Anesthesia Type:" Field="SurgAnesthesiaType" Required="No" runat=server /></td>
		<td><select id="SurgAnesthesiaType" class="pdFormField" runat=server NAME="SurgAnesthesiaType"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgEstBloodLoss_PdLabel" Text="Est Blood Loss:" Field="SurgEstBloodLoss" Required="No" runat=server /></td>
		<td><input type="text" id="SurgEstBloodLoss" class="pdFormField" maxlength="50" runat=server NAME="SurgEstBloodLoss"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgAutoAvailable_PdLabel" Text="Auto Available:" Field="SurgAutoAvailable" Required="No" runat=server /></td>
		<td><input type="text" id="SurgAutoAvailable" class="pdFormField" maxlength="50" runat=server NAME="SurgAutoAvailable"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgAutoTransfused_PdLabel" Text="Auto Transfused:" Field="SurgAutoTransfused" Required="No" runat=server /></td>
		<td><input type="text" id="SurgAutoTransfused" class="pdFormField" maxlength="50" runat=server NAME="SurgAutoTransfused"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgRBC_Available_PdLabel" Text="RBC Available:" Field="SurgRBC_Available" Required="No" runat=server /></td>
		<td><input type="text" id="SurgRBC_Available" class="pdFormField" maxlength="50" runat=server NAME="SurgRBC_Available"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgRBC_Transfused_PdLabel" Text="RBC Transfused:" Field="SurgRBC_Transfused" Required="No" runat=server /></td>
		<td><input type="text" id="SurgRBC_Transfused" class="pdFormField" maxlength="50" runat=server NAME="SurgRBC_Transfused"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgRBC_IntraOp_PdLabel" Text="RBC Intra-Op:" Field="SurgRBC_IntraOp" Required="No" runat=server /></td>
		<td><input type="text" id="SurgRBC_IntraOp" class="pdFormField" maxlength="50" runat=server NAME="SurgRBC_IntraOp"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgRBC_PostOp_PdLabel" Text="RBC Post-Op:" Field="SurgRBC_PostOp" Required="No" runat=server /></td>
		<td><input type="text" id="SurgRBC_PostOp" class="pdFormField" maxlength="50" runat=server NAME="SurgRBC_PostOp"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgHD_Available_PdLabel" Text="HD Available:" Field="SurgHD_Available" Required="No" runat=server /></td>
		<td><input type="text" id="SurgHD_Available" class="pdFormField" maxlength="50" runat=server NAME="SurgHD_Available"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgHD_Transfused_PdLabel" Text="HD Transfused:" Field="SurgHD_Transfused" Required="No" runat=server /></td>
		<td><input type="text" id="SurgHD_Transfused" class="pdFormField" maxlength="50" runat=server NAME="SurgHD_Transfused"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgHGB_Admit_PdLabel" Text="Admit HGB:" Field="SurgHGB_Admit" Required="No" runat=server /></td>
		<td><input type="text" id="SurgHGB_Admit" class="pdFormField" maxlength="50" runat=server NAME="SurgHGB_Admit"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgHCT_Admit_PdLabel" Text="Admit HCT:" Field="SurgHCT_Admit" Required="No" runat=server /></td>
		<td><input type="text" id="SurgHCT_Admit" class="pdFormField" maxlength="50" runat=server NAME="SurgHCT_Admit"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgHGB_IntraOp_PdLabel" Text="Intra-Op HGB:" Field="SurgHGB_IntraOp" Required="No" runat=server /></td>
		<td><input type="text" id="SurgHGB_IntraOp" class="pdFormField" maxlength="50" runat=server NAME="SurgHGB_IntraOp"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgHCT_IntraOp_PdLabel" Text="Intra-Op HCT:" Field="SurgHCT_IntraOp" Required="No" runat=server /></td>
		<td><input type="text" id="SurgHCT_IntraOp" class="pdFormField" maxlength="50" runat=server NAME="SurgHCT_IntraOp"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgFFP_Transfused_PdLabel" Text="FFP Transfused:" Field="SurgFFP_Transfused" Required="No" runat=server /></td>
		<td><input type="text" id="SurgFFP_Transfused" class="pdFormField" maxlength="50" runat=server NAME="SurgFFP_Transfused"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgPlateletsTransfused_PdLabel" Text="Platelets Transfused:" Field="SurgPlateletsTransfused" Required="No" runat=server /></td>
		<td><input type="text" id="SurgPlateletsTransfused" class="pdFormField" maxlength="50" runat=server NAME="SurgPlateletsTransfused"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgCryoTransfused_PdLabel" Text="Cryo Transfused:" Field="SurgCryoTransfused" Required="No" runat=server /></td>
		<td><input type="text" id="SurgCryoTransfused" class="pdFormField" maxlength="50" runat=server NAME="SurgCryoTransfused"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgPreOpAntibiotics_PdLabel" Text="Pre-Op Antibiotics:" Field="SurgPreOpAntibiotics" Required="No" runat=server /></td>
		<td><select id="SurgPreOpAntibiotics" class="pdFormField" runat=server NAME="SurgPreOpAntibiotics"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgIntraOpAntibiotics_PdLabel" Text="Intra-Op Antibiotics:" Field="SurgIntraOpAntibiotics" Required="No" runat=server /></td>
		<td><select id="SurgIntraOpAntibiotics" class="pdFormField" runat=server NAME="SurgIntraOpAntibiotics"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgPostOpAntibiotics_PdLabel" Text="Post-Op Antibiotics:" Field="SurgPostOpAntibiotics" Required="No" runat=server /></td>
		<td><select id="SurgPostOpAntibiotics" class="pdFormField" runat=server NAME="SurgPostOpAntibiotics"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgNG_Tube_PdLabel" Text="Naso Gastric Tube:" Field="SurgNG_Tube" Required="No" runat=server /></td>
		<td><select id="SurgNG_Tube" class="pdFormField" runat=server NAME="SurgNG_Tube"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgAnticoagulation_PdLabel" Text="Anticoagulation:" Field="SurgAnticoagulation" Required="No" runat=server /></td>
		<td><select id="SurgAnticoagulation" class="pdFormField" runat=server NAME="SurgAnticoagulation"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgPneumatics_PdLabel" Text="Pneumatics:" Field="SurgPneumatics" Required="No" runat=server /></td>
		<td><select id="SurgPneumatics" class="pdFormField" runat=server NAME="SurgPneumatics"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgICU_PostOp_PdLabel" Text="Post-Op ICU:" Field="SurgICU_PostOp" Required="No" runat=server /></td>
		<td><input type="text" id="SurgICU_PostOp" class="pdFormField" maxlength="50" runat=server NAME="SurgICU_PostOp"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgPostOpDayFed_PdLabel" Text="Post-Op Day Fed:" Field="SurgPostOpDayFed" Required="No" runat=server /></td>
		<td><input type="text" id="SurgPostOpDayFed" class="pdFormField" maxlength="50" runat=server NAME="SurgPostOpDayFed"/></td>
	</tr>
	<tr><!-- input type ns in meta data, input text used -->
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgFluids_PdLabel" Text="Fluids:" Field="SurgFluids" Required="No" runat=server /></td>
		<td><input type="text" id="SurgFluids" class="pdFormField" maxlength="50" runat=server NAME="SurgFluids"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgFluidNormosol_PdLabel" Text="Normosol:" Field="SurgFluidNormosol" Required="No" runat=server /></td>
		<td><input type="text" id="SurgFluidNormosol" class="pdFormField" maxlength="50" runat=server NAME="SurgFluidNormosol"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgFluidAlbumin_PdLabel" Text="Albumin:" Field="SurgFluidAlbumin" Required="No" runat=server /></td>
		<td><input type="text" id="SurgFluidAlbumin" class="pdFormField" maxlength="50" runat=server NAME="SurgFluidAlbumin"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgFluidManitol_PdLabel" Text="Manitol:" Field="SurgFluidManitol" Required="No" runat=server /></td>
		<td><input type="text" id="SurgFluidManitol" class="pdFormField" maxlength="50" runat=server NAME="SurgFluidManitol"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgFluidHespan_PdLabel" Text="Hespan:" Field="SurgFluidHespan" Required="No" runat=server /></td>
		<td><input type="text" id="SurgFluidHespan" class="pdFormField" maxlength="50" runat=server NAME="SurgFluidHespan"/></td>
	</tr>
	<tr><!-- input type ns in meta data, input text used -->
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgDifficulty_PdLabel" Text="Difficulty:" Field="SurgDifficulty" Required="No" runat=server /></td>
		<td><select id="SurgDifficulty" class="pdFormField" runat=server NAME="SurgDifficulty"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgNS_ProbeType_PdLabel" Text="Probe Type:" Field="SurgNS_ProbeType" Required="No" runat=server /></td>
		<td><select id="SurgNS_ProbeType" class="pdFormField" runat=server NAME="SurgNS_ProbeType"/></td>
	</tr>
	<tr><!-- input type ns in meta data, input text used -->
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgNS_Notes_PdLabel" Text="NS Notes:" Field="SurgNS_Notes" Required="No" runat=server /></td>
		<td><textarea id="SurgNS_Notes" class="pdFormNotesField" cols="32" rows="3" maxlength="1000" runat=server NAME="SurgNS_Notes"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgNotes_PdLabel" Text="Notes:" Field="SurgNotes" Required="No" runat=server /></td>
		<td><textarea id="SurgNotes" class="pdFormNotesField" cols="32" rows="3" maxlength="1000" runat=server NAME="SurgNotes"></textarea></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgDataSource_PdLabel" Text="Data Source:" Field="SurgDataSource" Required="No" runat=server /></td>
		<td><val:ComboBox Id="SurgDataSource" RefBy="SurgDataSource" runat=server /></td>
	</tr>
	<tr> 
		<td class="pdFormFieldLabel"><val:PDLabel id="SurgQuality_PdLabel" Text="Data Quality:" Field="SurgQuality" Required="No" runat=server /></td>
		<td><select id="SurgQuality" class="pdFormField" runat=server NAME="SurgQuality"/></td>
	</tr>
 
</table>