physicianform.ascx

医疗决策支持系统

<%@ Control Language="c#" AutoEventWireup="false" Codebehind="PhysicianForm.ascx.cs" Inherits="Caisis.UI.Modules.All.DataEntryForms.PhysiciansForm" 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>
	<input type="hidden" id="PhysicianId" runat=server NAME="PhysicianId"/>
<table align="center" class="pdFormTable" width="600" cellpadding="0" cellspacing="0" border="0">
	<tr><td width="290">
	<table align="center" class="pdFormTable" width="290" border="0">
	<tr>
		<td width="70" class="pdFormFieldLabel"><val:PDLabel id="PhSpecialty_PdLabel" Text="Specialty:" Field="PhSpecialty" Required="No" runat="server" /></td>
		<td><val:ComboBox Id="PhSpecialty" RefBy="PhSpecialty" runat="server"  /></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PhLevel_PdLabel" Text="Level:" Field="PhLevel" Required="No" runat=server /></td>
		<td><select id="PhLevel" class="pdFormField" runat=server NAME="PhLevel"/> </td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PhTitle_PdLabel" Text="Title:" Field="PhTitle" Required="No" runat=server /></td>
		<td><select id="PhTitle" class="pdFormField" runat=server NAME="PhTitle"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PhFirstName_PdLabel" Text="First (Given):" Field="PhFirstName" Required="No" runat=server /></td>
		<td><input type="text" id="PhFirstName" class="pdFormField" maxlength="50" runat=server NAME="PhFirstName"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PhMiddleName_PdLabel" Text="Middle:" Field="PhMiddleName" Required="No" runat=server /></td>
		<td><input type="text" id="PhMiddleName" class="pdFormField" maxlength="50" runat=server NAME="PhMiddleName"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PhLastName_PdLabel" Text="Last:" Field="PhLastName" Required="Yes" runat=server /></td>
		<td><input type="text" id="PhLastName" class="pdFormField" maxlength="50" runat=server NAME="PhLastName"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PhSuffix_PdLabel" Text="Suffix:" Field="PhSuffix" Required="No" runat=server /></td>
		<td><select id="PhSuffix" class="pdFormField" runat=server NAME="PhSuffix"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PhAddress1_PdLabel" Text="Address 1:" Field="PhAddress1" Required="No" runat=server /></td>
		<td><input type="text" id="PhAddress1" class="pdFormField" maxlength="100" runat=server NAME="PhAddress1"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PhAddress2_PdLabel" Text="Address 2:" Field="PhAddress2" Required="No" runat=server /></td>
		<td><input type="text" id="PhAddress2" class="pdFormField" maxlength="100" runat=server NAME="PhAddress2"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PhCity_PdLabel" Text="City:" Field="PhCity" Required="No" runat=server /></td>
		<td><input type="text" id="PhCity" class="pdFormField" maxlength="50" runat=server NAME="PhCity"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PhState_PdLabel" Text="State:" Field="PhState" Required="No" runat=server /></td>
		<td><val:ComboBox Id="PhState" RefBy="PhState" runat=server /></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PhPostalCode_PdLabel" Text="Postal Code:" Field="PhPostalCode" Required="No" runat=server /></td>
		<td><input type="text" id="PhPostalCode" class="pdFormField" maxlength="50" runat=server NAME="PhPostalCode"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PhCountry_PdLabel" Text="Country:" Field="PhCountry" Required="No" runat=server /></td>
		<td><input type="text" id="PhCountry" class="pdFormField" maxlength="50" runat=server NAME="PhCountry"/></td>
	</tr>
</table>
	</td>
	<td width="20">&nbsp;</td>
	<td width="290" valign="top">
		<table align="center" class="pdFormTable" width="290">
		<tr>
		<td width="130" class="pdFormFieldLabel"><val:PDLabel id="PhWorkPhone_PdLabel" Text="Work Phone:" Field="PhWorkPhone" Required="No" runat=server /></td>
		<td><input type="text" id="PhWorkPhone" class="pdFormField" maxlength="50" runat=server NAME="PhWorkPhone"/></td>
		</tr>
		<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PhFax_PdLabel" Text="Fax:" Field="PhFax" Required="No" runat=server /></td>
		<td><input type="text" id="PhFax" class="pdFormField" maxlength="50" runat=server NAME="PhFax"/></td>
		</tr>
		<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PhEmail_PdLabel" Text="E-mail:" Field="PhEmail" Required="No" runat=server /></td>
		<td><input type="text" id="PhEmail" class="pdFormField" maxlength="50" runat=server NAME="PhEmail"/></td>
		</tr>
		<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PhInstitution_PdLabel" Text="Institution:" Field="PhInstitution" Required="No" runat=server /></td>
		<td><val:ComboBox Id="PhInstitution" RefBy="PhInstitution" runat=server /></td>
		</tr>
		<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PhDoNotContact_PdLabel" Text="Do Not Contact:" Field="PhDoNotContact" Required="No" runat=server /></td>
		<td><input type="checkbox" id="PhDoNotContact" value="1" runat=server NAME="PhDoNotContact"/></td>
		</tr>
		<tr>
		<td rowspan="5" valign="top" class="pdFormFieldLabel"><val:PDLabel id="PhNotes_PdLabel" Text="Notes:" Field="PhNotes" Required="No" runat=server /></td>
		<td rowspan="5" valign="top"><textarea id="PhNotes" class="pdFormNotesField" cols="24" rows="6" maxlength="1000" runat=server NAME="PhNotes"></textarea></td>
		</tr>
		</table>
		
		
	</td>
	</tr>
</table>