patientsform.ascx

医疗决策支持系统

<%@ Control Language="c#" AutoEventWireup="false" Codebehind="PatientsForm.ascx.cs" Inherits="Caisis.UI.Modules.All.DataEntryForms.PatientsForm" TargetSchema="http://schemas.microsoft.com/intellisense/ie5"%>
<%@ Register TagPrefix="val" TagName="PatientPhoneNumberForm" Src="PatientPhoneNumbersForm.ascx" %>

<%@ 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="6">
	<tr>
		<td class="pdFormFieldLabel" width="150"><val:PDLabel id="PtMRN_PdLabel" Text="MRN:" Field="PtMRN" Required="Yes" runat=server /></td>
		<td><input type="text" id="PtMRN" class="pdFormField" maxlength="50" runat=server NAME="PtMRN"/>
		<img Src="../../Images/shim.gif" width="40" height="1" border="0"><span style="">Institution:</span>
			<asp:Repeater ID="rptInstitutions" Runat=server>
				<ItemTemplate>
					<%# DataBinder.Eval(Container.DataItem, "Institution") %>
				</ItemTemplate>
				<SeparatorTemplate>, </SeparatorTemplate>
		</asp:Repeater></td>
	</tr>
	<input type="hidden" id="PatientId" runat=server NAME="PatientId"/>
	<input type="hidden" id="StoreDoNotContactValue" runat="server"/>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtContactStatus_PdLabel" Text="Contact Status:" Field="PtContactStatus" Required="No" runat=server /></td>
		<td><select id="PtContactStatus" class="pdFormField" runat=server NAME="PtContactStatus"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtTitle_PdLabel" Text="Title:" Field="PtTitle" Required="No" runat=server /></td>
		<td><select id="PtTitle" class="pdFormField" runat=server NAME="PtTitle"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtFirstName_PdLabel" Text="First:" Field="PtFirstName" Required="No" runat=server /></td>
		<td><input type="text" id="PtFirstName" class="pdFormField" maxlength="50" runat=server NAME="PtFirstName"/><img Src="../../Images/shim.gif" width="40" height="1" border="0">
			<div class="patientDataFormDiv" id="AddPatientLinkDiv" runat="server" style="BORDER-RIGHT: #000000 1px; BORDER-TOP: #000000 1px; Z-INDEX: 40; VISIBILITY: visible; OVERFLOW: auto; BORDER-LEFT: #000000 1px; WIDTH: 130; BORDER-BOTTOM: #000000 1px; POSITION: absolute; HEIGHT: 50px;">
				<table width="120" cellpadding="0" cellspacing="0" border="0">
					<tr>
						<td><img  Src="../../Images/ClickHereToAddANewPatient.gif" width="112" height="27" border="0" style="cursor:hand;" onclick="top.navigate('../../Core/Utilities/EmptyContainer.aspx?TaskPage=AddNewPatients.aspx');"></td>	
					</tr>
				</table>
			</div>
		</td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtMiddleName_PdLabel" Text="Middle:" Field="PtMiddleName" Required="No" runat=server /></td>
		<td><input type="text" id="PtMiddleName" class="pdFormField" maxlength="50" runat=server NAME="PtMiddleName"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtLastName_PdLabel" Text="Last:" Field="PtLastName" Required="Yes" runat=server /></td>
		<td><input type="text" id="PtLastName" class="pdFormField" maxlength="50" runat=server NAME="PtLastName"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtSuffix_PdLabel" Text="Suffix:" Field="PtSuffix" Required="No" runat=server /></td>
		<td><select id="PtSuffix" class="pdFormField" runat=server NAME="PtSuffix"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtAlias_PdLabel" Text="Alias:" Field="PtAlias" Required="No" runat=server /></td>
		<td><input type="text" id="PtAlias" class="pdFormField" maxlength="50" runat=server NAME="PtAlias"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtMaidenName_PdLabel" Text="Maiden Name:" Field="PtMaidenName" Required="No" runat=server /></td>
		<td><input type="text" id="PtMaidenName" class="pdFormField" maxlength="50" runat=server NAME="PtMaidenName"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtGender_PdLabel" Text="Gender:" Field="PtGender" Required="No" runat=server /></td>
		<td><select id="PtGender" class="pdFormField" runat=server NAME="PtGender"></select>
		</td>
	</tr>
	<tr>
		<td colspan="2" bgcolor="cccccc"><img Src="../../Images/shim.gif" height="1" width="1" /></td>
	</tr>
	
	<tr>
		<td colspan="2"><b>Phone Numbers</b></td>
	</tr>
	<tr>
		<td colspan="2">
			<val:PatientPhoneNumberForm id=gridForm runat=server></val:PatientPhoneNumberForm>
		</td>
	</tr>
	<tr>
		<td colspan="2" bgcolor="cccccc"><img Src="../../Images/shim.gif" height="1" width="1" /></td>
	</tr>
	<tr>
		<td colspan="2">&nbsp;</td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtBirthDateText_PdLabel" Text="Birth Date:" Field="PtBirthDateText" Required="No" runat=server /></td>
		<td><input type="text" id="PtBirthDateText" class="pdFormField" runat=server NAME="PtBirthDateText"/><img id="PtBirthDateTextCal" Src="../../../Images/Calendar/cal.gif" width="16" height="16" border="0" alt="select date" align="absMiddle" runat="server"/><img Src="../../../Images/shim.gif" height="1" width="30" border="0">Age:<input type="text" readonly style="width:35" id="age" name="age" runat="server" value=""></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtBirthDate_PdLabel" Text="" Field="PtBirthDate" Required="No" readonly runat=server /></td>
		<td><input type="text" id="PtBirthDate" class="pdFormField" runat=server NAME="PtBirthDate" readonly/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtBirthPlace_PdLabel" Text="Birth Place:" Field="PtBirthPlace" Required="No" runat=server /></td>
		<td><input type="text" id="PtBirthPlace" class="pdFormField" maxlength="100" runat=server NAME="PtBirthPlace"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtDeathDateText_PdLabel" Text="Death Date:" Field="PtDeathDateText" Required="No" runat=server /></td>
		<td><input type="text" id="PtDeathDateText" class="pdFormField" runat=server NAME="PtDeathDateText"/><img id="PtDeathDateTextCal" Src="../../../Images/Calendar/cal.gif" width="16" height="16" border="0" alt="select date" align="absMiddle" runat="server"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtDeathDate_PdLabel" Text="" Field="PtDeathDate" Required="No" readonly runat=server /></td>
		<td><input type="text" id="PtDeathDate" class="pdFormField" runat=server NAME="PtDeathDate" readonly/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtDeathType_PdLabel" Text="Death Type:" Field="PtDeathType" Required="No" runat=server /></td>
		<td><select id="PtDeathType" class="pdFormField" runat=server NAME="PtDeathType"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtDeathCause_PdLabel" Text="Death Cause:" Field="PtDeathCause" Required="No" runat=server /></td>
		<td><input type="text" id="PtDeathCause" class="pdFormField" maxlength="255" runat=server NAME="PtDeathCause"/></td>
	</tr>
	<tr>
		<td colspan="2">&nbsp;</td>
	</tr>
	<tr>
		<td colspan="2" bgcolor="cccccc"><img Src="../../Images/shim.gif" height="1" width="1" /></td>
	</tr>
	<tr>
		<td colspan="2">&nbsp;</td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtAddress1_PdLabel" Text="Address Line 1:" Field="PtAddress1" Required="No" runat=server /></td>
		<td><input type="text" id="PtAddress1" class="pdFormField" maxlength="100" runat=server NAME="PtAddress1"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtAddress2_PdLabel" Text="Address Line 2:" Field="PtAddress2" Required="No" runat=server /></td>
		<td><input type="text" id="PtAddress2" class="pdFormField" maxlength="100" runat=server NAME="PtAddress2"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtCity_PdLabel" Text="City:" Field="PtCity" Required="No" runat=server /></td>
		<td><input type="text" id="PtCity" class="pdFormField" maxlength="50" runat=server NAME="PtCity"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtState_PdLabel" Text="State:" Field="PtState" Required="No" runat=server /></td>
		<td><val:ComboBox Id="PtState" RefBy="PtState" runat=server /></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtPostalCode_PdLabel" Text="Postal Code:" Field="PtPostalCode" Required="No" runat=server /></td>
		<td><input type="text" id="PtPostalCode" class="pdFormField" maxlength="50" runat=server NAME="PtPostalCode"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtCountry_PdLabel" Text="Country:" Field="PtCountry" Required="No" runat=server /></td>
		<td><val:ComboBox Id="PtCountry" RefBy="PtCountry" runat=server /></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtEmail_PdLabel" Text="E-mail:" Field="PtEmail" Required="No" runat=server /></td>
		<td><input type="text" id="PtEmail" class="pdFormField" maxlength="50" runat=server NAME="PtEmail"/></td>
	</tr>
	<tr>
		<td colspan="2">&nbsp;</td>
	</tr>
	<tr>
		<td colspan="2" bgcolor="cccccc"><img Src="../../Images/shim.gif" height="1" width="1" /></td>
	</tr>
	<tr>
		<td colspan="2">&nbsp;</td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtCompany_PdLabel" Text="Company:" Field="PtCompany" Required="No" runat=server /></td>
		<td><input type="text" id="PtCompany" class="pdFormField" maxlength="50" runat=server NAME="PtCompany"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtBusinessCity_PdLabel" Text="Bus. City:" Field="PtBusinessCity" Required="No" runat=server /></td>
		<td><input type="text" id="PtBusinessCity" class="pdFormField" maxlength="50" runat=server NAME="PtBusinessCity"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtBusinessState_PdLabel" Text="Bus. State:" Field="PtBusinessState" Required="No" runat=server /></td>
		<td><val:ComboBox Id="PtBusinessState" RefBy="PtBusinessState" runat=server /></td>
	</tr>
	<tr>
		<td colspan="2">&nbsp;</td>
	</tr>
	<tr>
		<td colspan="2" bgcolor="cccccc"><img Src="../../Images/shim.gif" height="1" width="1" /></td>
	</tr>
	<tr>
		<td colspan="2">&nbsp;</td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtContactPerson_PdLabel" Text="Emerg. Contact:" Field="PtContactPerson" Required="No" runat=server /></td>
		<td><input type="text" id="PtContactPerson" class="pdFormField" maxlength="50" runat=server NAME="PtContactPerson"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtContactAddress1_PdLabel" Text="Contact Addr L1:" Field="PtContactAddress1" Required="No" runat=server /></td>
		<td><input type="text" id="PtContactAddress1" class="pdFormField" maxlength="100" runat=server NAME="PtContactAddress1"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtContactAddress2_PdLabel" Text="Contact Addr L2:" Field="PtContactAddress2" Required="No" runat=server /></td>
		<td><input type="text" id="PtContactAddress2" class="pdFormField" maxlength="100" runat=server NAME="PtContactAddress2"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtContactCity_PdLabel" Text="City:" Field="PtContactCity" Required="No" runat=server /></td>
		<td><input type="text" id="PtContactCity" class="pdFormField" maxlength="50" runat=server NAME="PtContactCity"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtContactState_PdLabel" Text="State:" Field="PtContactState" Required="No" runat=server /></td>
		<td><val:ComboBox Id="PtContactState" RefBy="PtContactState" runat=server /></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtContactPostalCode_PdLabel" Text="Postal Code:" Field="PtContactPostalCode" Required="No" runat=server /></td>
		<td><input type="text" id="PtContactPostalCode" class="pdFormField" maxlength="50" runat=server NAME="PtContactPostalCode"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtContactPhone_PdLabel" Text="Phone:" Field="PtContactPhone" Required="No" runat=server /></td>
		<td><input type="text" id="PtContactPhone" class="pdFormField" maxlength="50" runat=server NAME="PtContactPhone"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtSpouse_PdLabel" Text="Spouse:" Field="PtSpouse" Required="No" runat=server /></td>
		<td><input type="text" id="PtSpouse" class="pdFormField" maxlength="50" runat=server NAME="PtSpouse"/></td>
	</tr>
	<tr>
		<td colspan="2">&nbsp;</td>
	</tr>
	<tr>
		<td colspan="2" bgcolor="cccccc"><img Src="../../Images/shim.gif" height="1" width="1" /></td>
	</tr>
	<tr>
		<td colspan="2">&nbsp;</td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtRace_PdLabel" Text="Race:" Field="PtRace" Required="No" runat=server /></td>
		<td><select id="PtRace" class="pdFormField" runat=server NAME="PtRace"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtEthnicity_PdLabel" Text="Ethnicity:" Field="PtEthnicity" Required="No" runat=server /></td>
		<td><val:ComboBox Id="PtEthnicity" RefBy="PtEthnicity" runat=server /></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtLanguage_PdLabel" Text="Language:" Field="PtLanguage" Required="No" runat=server /></td>
		<td><val:ComboBox Id="PtLanguage" RefBy="PtLanguage" runat=server /></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="PtNotes_PdLabel" Text="Notes:" Field="PtNotes" Required="No" runat=server /></td>
		<td><textarea id="PtNotes" class="pdFormNotesField" cols="32" rows="3" maxlength="1000" runat=server NAME="PtNotes"></textarea></td>
	</tr>
	<tr>
		<td colspan="2">&nbsp;</td>
	</tr>
	
 
</table>