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医疗决策支持系统

                </tr>
                <tr> 
                  <td align="right" valign="top"> 
                    <% =patientAddressLabel  %>
                    &nbsp;&nbsp;&nbsp;</td>
                  <td align="left" valign="top"> 
                    <% =patientAddress1  %>
                    <% =patientAddress2  %>
                    <% =patientCity  %>
                    <% =patientState  %>
                    <% =patientPostalCode  %>
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                </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 class="FormOuterTableRow"><img src="../../Images/shim.gif" border="0" width="4" height="15"><span class="blackBoldText">Date: <% =apptClinicDate %>
        <img src="../../Images/shim.gif" border="0" width="220" height="1">Physician: <% =apptPhysicianName %></span></td>
    </tr>
    <tr> 
      <td class="FormOuterTableRow"><span class="blackBoldText"><img src="../../Images/FormImages/shim.gif" border="0" width="4" height="15">Review of Systems</span> &nbsp;&nbsp;&nbsp;<span class="smallGrayText">Clinician Performing Review: 
        <input type="checkbox" name="PA22" value="Yes">
        NP / PA&nbsp;&nbsp;&nbsp; 
        <input type="checkbox" name="Fellow23" value="Yes">
        Fellow&nbsp;&nbsp;&nbsp; 
        <input type="checkbox" name="Attending22" value="Yes">
        Attending</span> <br>
		<table border="0" width="100%" cellpadding="1" cellspacing="0">
          <tr> 
            <td width="70" align="center" class="FormInsideTableTopLeftCell"><strong>System</strong></td>
            <td width="150" align="center" class="FormInsideTableTopCell"><strong>Symptom</strong></td>
            <td width="40" align="center" class="FormInsideTableTopCell"><strong>Not Present</strong></td>
            <td width="40" align="center" class="FormInsideTableTopCell"><strong>Present</strong></td>
            <td width="40" align="center" class="FormInsideTableTopCell"><strong>Disease Related</strong></td>
            <td width="310" align="center" class="FormInsideTableTopCell"><strong>Notes</strong></td>
          </tr>
          <tr> 
            <td rowspan="2" align="left" valign="top" class="FormInsideTableLeftCell">General</td>
            <td align="left" class="FormInsideTableRegCell">Fever</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
            <td rowspan="2" align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td align="left" class="FormInsideTableRegCell">Weight Loss</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td rowspan="2" align="left" valign="top" class="FormInsideTableLeftCell">Neuro</td>
            <td align="left" class="FormInsideTableRegCell">Headaches</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
            <td rowspan="2" align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td align="left" class="FormInsideTableRegCell">Focal Weakness</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td align="left" valign="top" class="FormInsideTableLeftCell">Eyes</td>
            <td align="left" class="FormInsideTableRegCell">Visual Problems</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td rowspan="2" align="left" valign="top" class="FormInsideTableLeftCell">CV</td>
            <td align="left" class="FormInsideTableRegCell">Angina</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
            <td rowspan="2" align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td align="left" class="FormInsideTableRegCell">Palpitations</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td rowspan="3" align="left" valign="top" class="FormInsideTableLeftCell">Respiratory</td>
            <td align="left" class="FormInsideTableRegCell">Cough</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
            <td rowspan="3" align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td align="left" class="FormInsideTableRegCell">Shortness of Breath</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td align="left" class="FormInsideTableRegCell">Hemoptysis</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td rowspan="4" align="left" valign="top" class="FormInsideTableLeftCell">GI</td>
            <td align="left" class="FormInsideTableRegCell">Nausea</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
            <td rowspan="4" align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td align="left" class="FormInsideTableRegCell">Vomiting</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td align="left" class="FormInsideTableRegCell">Abdominal Pain</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td align="left" class="FormInsideTableRegCell">Rectal Bleeding</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td rowspan="3" align="left" valign="top" class="FormInsideTableLeftCell">GU</td>
            <td align="left" class="FormInsideTableRegCell">Dysuria</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
            <td rowspan="3" align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td align="left" class="FormInsideTableRegCell">Frequency</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td align="left" class="FormInsideTableRegCell">Incontinence</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td align="left" valign="top" class="FormInsideTableLeftCell">MS</td>
            <td align="left" class="FormInsideTableRegCell">Joint Pain</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td align="left" valign="top" class="FormInsideTableLeftCell">Psych</td>
            <td align="left" class="FormInsideTableRegCell">Anxiety / Depression</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td rowspan="2" align="left" valign="top" class="FormInsideTableLeftCell">Heme</td>
            <td align="left" class="FormInsideTableRegCell">Anemia</td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="0"></td>
            <td align="center" class="FormInsideTableRegCell">&nbsp;</td>
            <td rowspan="2" align="center" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>