urogennp.ascx

医疗决策支持系统

                <input type="checkbox" name="Digitized22223" />
                Pipe</asp:Label>
              <br />
              <br />
              <img src="../../Images/shim.gif" border="0" width="75" height="1" />
              <input type="checkbox" name="Digitized222" />
              ______ packs / day for ______years<br />
              <img src="../../Images/shim.gif" border="0" width="75" height="1" />
              <input type="checkbox" name="Digitized23" />
              Quit: ______ years ago<br />
              <br />
              <br />
              Alcohol Use: <br />
              <br />
              Carcinogen Exposure: <br />
            </p></td>
          </tr>
      </table></td>
    </tr>
    <tr > 
      <td height="14" align="center" valign="bottom" class="blackBoldText">GU17<img src="../../Images/shim.gif" border="0" width="45" height="1">U21<img src="../../Images/shim.gif" border="0" width="45" height="1">CMIC 
        Approval Date: 6/04<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">2</span> of <span id="TotalPages">6</span><img src="../../Images/shim.gif" border="0" width="45" height="1">B/02.070.<span class="blackBoldTextSmall">17</span></td>
    </tr>
  </table>
</div>
<div align="center" style="page-break-before:always">
<div align="center">
	<div align="right" class="VerticalBarCodeDiv">
	  <div  class="VerticalBarCodeStatement"><img src="../../Images/FormImages/BarCodeLineStatement.gif" border="0" width="8" height="121"><br/>
        <img src="../../Images/FormImages/BarCodeLineStatement.gif" border="0" width="8" height="121" vspace="220"><br/>
        <img src="../../Images/FormImages/BarCodeLineStatement.gif" border="0" width="8" height="121"></div>
	<div  class="VerticalBarCodeMRN"><% =BarCodeMRN %></div>
	<div  class="VerticalBarCodeDocType">*U21*</div>
	<div  class="VerticalBarCodeAcctType"><% =BarCodeAcctType %></div>
	<div  class="VerticalBarCodeDate"><% =BarCodeDate %></div>
	</div>
</div>

<font style="font-size: 12px;">CONTAINS PROTECTED  HEALTH INFORMATION - HANDLE ACCORDING TO MSKCC POLICY</font> <br>
  <table width="650" border="0" cellspacing="0" cellpadding="0">
    <tr> 
      <td class="FormOuterTableTopRow"><table align="center" border="0" width="650" cellpadding="4" cellspacing="0">
          <tr> 
            <td width="325" align="center" valign="middle" class="FormInnerRowRightBorder"><img src="../../Images/FormImages/<%= institutionShortName%>_FormLogo.gif" width="90" alt="" border="0" align="left"><span class="blackBoldText"><%= institutionName%><br>
              Urology General Patient</span></td>
            <td width="325" align="center" valign="bottom" class="blackBoldText"> 
              <table  width="325" border="0" cellspacing="1" cellpadding="0" >
                <tr> 
                  <td width="65"><img src="../../Images/shim.gif" border="0" width="65" height="1"></td>
                  <td align="left" width="260"><img src="../../Images/shim.gif" border="0" width="260" height="1"></td>
                </tr>
                <tr> 
                  <td align="right"> 
                    <% =patientMRNLabel  %>
                    &nbsp;&nbsp;&nbsp;</td>
                  <td align="left"><strong> 
                    <% =patientMRN  %>
                    </strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                    <% =patientDOB  %>
                  </td>
                </tr>
                <tr> 
                  <td colspan="1" align="right"> 
                    <% =patientNameLabel  %>
                    &nbsp;&nbsp;&nbsp;</td>
                  <td colspan="1" align="left"><strong> 
                    <% =patientLastName  %>, <% =patientFirstName  %> <% =patientMiddleName  %>
                    </strong></td>
                </tr>
                <tr> 
                  <td align="right" valign="top"> 
                    <% =patientAddressLabel  %>
                    &nbsp;&nbsp;&nbsp;</td>
                  <td align="left" valign="top"> 
                    <% =patientAddress1  %>
                    <% =patientAddress2  %>
                    <% =patientCity  %>
                    <% =patientState  %>
                    <% =patientPostalCode  %>
                  </td>
                </tr>
                <tr> 
                  <td colspan="2"><img src="../../Images/shim.gif" border="0" width="1" height="5"></td>
                </tr>
                <tr> 
                  <td colspan="2" align="center" valign="bottom" class="blackBoldText">Patient 
                    Identification</td>
                </tr>
              </table></td>
          </tr>
        </table></td>
    </tr>
    <tr> 
      <td height="20" class="FormOuterTableRow"><img src="../../Images/shim.gif" border="0" width="4" height="11"><span class="blackBoldText">Date: 
        <% =apptClinicDate %>
        </span></td>
    </tr>
    <tr> 
      <td class="FormOuterTableRow"><span class="blackBoldText"><img src="../../Images/shim.gif" border="0" width="4" height="15">Lab 
        Tests</span><br> <table align="center" border="0" width="650" cellpadding="4" cellspacing="0">
          <tr> 
            <td colspan="2" class="FormInsideTableTopCell"><strong>Date:</strong></td>
            <td colspan="2" class="FormInsideTableTopCell"><strong>Date:</strong></td>
            <td colspan="2" class="FormInsideTableTopCell"><strong>Date:</strong></td>
            <td colspan="2" class="FormInsideTableTopCell"><strong>Date:</strong></td>
          </tr>
          <tr align="center"> 
            <td width="85" class="FormInsideTableRegCell"><strong>Test</strong></td>
            <td width="85" height="12" class="FormInsideTableRegCell"><strong>Result</strong></td>
            <td width="85" class="FormInsideTableLeftCell"><strong>Test</strong></td>
            <td width="85" class="FormInsideTableRegCell"><strong>Result</strong></td>
            <td width="85" class="FormInsideTableLeftCell"><strong>Test</strong></td>
            <td width="85" class="FormInsideTableRegCell"><strong>Result</strong></td>
            <td width="85" height="12" class="FormInsideTableLeftCell"><strong>Test</strong></td>
            <td width="85" class="FormInsideTableRegCell"><strong>Result</strong></td>
          </tr>
          <tr class="FormInsideTableRegCell"> 
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td height="12" class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr class="FormInsideTableRegCell"> 
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td height="12" class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td height="12" class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr class="FormInsideTableRegCell"> 
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td height="12" class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td height="12" class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr class="FormInsideTableRegCell"> 
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td height="12" class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td height="12" class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr class="FormInsideTableRegCell"> 
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td height="12" class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td height="12" class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr class="FormInsideTableRegCell"> 
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td height="12" class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td height="12" class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
        </table></td>
    </tr>
    <tr> 
      <td class="FormOuterTableRow"><span class="blackBoldText"><img src="../../Images/shim.gif" border="0" width="4" height="0">Imaging</span><span><img src="../../Images/shim.gif" border="0" width="12" height="1"> 
        <input type="checkbox" name="Films Reviewed">
        Films Reviewed<br>
        </span> <table align="center" border="0" width="650" cellpadding="2" cellspacing="0">
          <tr> 
            <td width="100" align="center" valign="middle" class="FormInsideTableTopCell">Date</td>
            <td width="100" align="center" valign="middle" class="FormInsideTableTopCell">Study</td>
            <td width="225" align="center" valign="middle" class="FormInsideTableTopCell">Results</td>
            <td width="225" align="center" valign="middle" class="FormInsideTableTopCell">Notes</td>
          </tr>
          <tr> 
            <td height="36" class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td height="36" class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td height="36" class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>