inptnonlinkedfu.ascx

医疗决策支持系统

<%@ Control Language="c#" AutoEventWireup="false" Codebehind="InptNonLinkedFU.ascx.cs" Inherits="Caisis.UI.Modules.All.PaperForms.InptNonLinkedFU" TargetSchema="http://schemas.microsoft.com/intellisense/ie5"%>
<link href="../../../StyleSheets/formStyles.css" rel="stylesheet" type="text/css">


<div id="PaperFormStart">


<div id="LastPageInForm" runat="server" align="left" >
  
<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">*U34*</div>
	<div  class="VerticalBarCodeAcctType"><% =BarCodeAcctType %></div>
	<div  class="VerticalBarCodeDate"></div>
	</div>
</div>

<div align="center">
<font style="font-size: 12px;">CONTAINS PROTECTED  HEALTH INFORMATION - HANDLE ACCORDING TO MSKCC POLICY</font></div>
  <table width="700" border="0" cellspacing="0" cellpadding="0">
    <tr> 
      <td class="FormOuterTableTopRow"><table align="center" border="0" width="700" cellpadding="4" cellspacing="0">
          <tr> 
            <td width="350" 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>
              Genitourinary / Head and Neck Service<br>
			  Attending Inpatient Progress Note:<br>Non-Linked</span></td>
            <td width="350" align="center" valign="bottom"> <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 class="FormOuterTableRow">
	  		<table width="100%" border="0" cellspacing="0" cellpadding="0">
				<tr>
				  <td align="left" colspan="3" class="FormInnerRowBottomBorder"><img src="../../Images/shim.gif" border="0" width="4" height="1"><span class="blackBoldText">Date:</span><img src="../../Images/shim.gif" border="0" width="4" height="1"><span class="blackBoldText"><% =apptClinicDate %></span></td>
				</tr>
				<tr>
				  <td><img src="../../Images/shim.gif" border="0" width="4" height="1"><span class="blackBoldText">Non-Linked Follow-up Note</span></td>
				  <td align="right"><span class="blackBoldText">Admit Date:</span></td>
				  <td width="15%">&nbsp;<span class="blackBoldText"><% =InPatientAdmitDate  %></span></td>
				  <!--<td align="right"><span class="blackBoldText">Room #:</span></td>-->
				  <!--<td width="15%">&nbsp;<span class="blackBoldText"><% =InPatientRoomNumber  %></span></td>-->
				</tr>
			</table>
		</td>
    </tr>
    <tr> 
      <td height="40" valign="top" align="left" class="FormOuterTableRow"><img src="../../Images/shim.gif" border="0" width="4" height="1"><span class="blackBoldText">Cancer Diagnosis, Cell Type, EOD:</span></td>
    </tr>
    <tr> 
      <td height="20" valign="middle" align="left" class="FormOuterTableRow"><img src="../../Images/shim.gif" border="0" width="4" height="1"><span class="blackBoldText">Current Problem(s):</span>&nbsp;&nbsp;&nbsp;<!--<% =InPatientAdmitReason  %>--></td>
    </tr>
    <tr> 
      <td class="FormOuterTableRow"> <table width="700" border="0" cellspacing="0" cellpadding="0">
          <tr> 
            <td height="25" class="FormInnerRowBottomBorder"><img src="../../Images/shim.gif" border="0" width="4" height="1"><span class="blackBoldText">Interval History \ Symptoms:</span><img src="../../Images/shim.gif" border="0" width="6" height="1"><img src="../../Images/icon_checkBoxBlank.gif" align="absmiddle" width="18" height="14" alt="" border="0"><span class="blackBoldTextSmall">History is unchanged from note dated ____/____/____.</span></td>
          </tr>
          <tr> 
            <td height="25" class="FormInnerRowBottomBorder">&nbsp;</td>
          </tr>
          <tr> 
            <td height="23" class="FormInnerRowBottomBorder">&nbsp;</td>
          </tr>
          <tr> 
            <td height="25" class="FormInnerRowBottomBorder" align="right" valign="bottom"><span class="blackBoldTextSmall"><img src="../../Images/icon_checkBoxBlank.gif" align="absmiddle" width="18" height="14" alt="" border="0">The remainder of the history is unremarkable.</span></td>
          </tr>
        </table>
	  </td>
    </tr>
    <tr> 
      <td class="FormOuterTableRow"> <table width="700" border="0" cellspacing="0" cellpadding="0">
          <tr> 
            <td height="25" class="FormInnerRowBottomBorder"><img src="../../Images/shim.gif" border="0" width="4" height="1"><span class="blackBoldText">Review of Systems:</span><img src="../../Images/shim.gif" border="0" width="6" height="1"><img src="../../Images/icon_checkBoxBlank.gif" align="absmiddle" width="18" height="14" alt="" border="0"><span class="blackBoldTextSmall">Review of systems is unchanged from note dated ____/____/____.</span></td>
          </tr>
          <tr> 
            <td height="25" class="FormInnerRowBottomBorder">&nbsp;</td>
          </tr>
          <tr> 
            <td height="25" class="FormInnerRowBottomBorder" align="right" valign="bottom"><img src="../../Images/icon_checkBoxBlank.gif" align="absmiddle" width="18" height="14" alt="" border="0"><span class="blackBoldTextSmall">All other review of systems are unremarkable.</span></td>
          </tr>
        </table>
	  </td>
    </tr>
	<tr> 
      <td class="FormOuterTableRow"><table align="center" border="0" width="100%" cellpadding="4" cellspacing="0">
          <tr> 
            <td width="10%" rowspan="2" align="left" valign="top" class="FormInnerRowRightBorder"><span class="blackBoldText">Vital 
              Signs</span></td>
            <td height="22" align="left" valign="top" class="FormInsideTableRegCell"><img src="../../Images/shim.gif" border="0" width="4" height="0">BP:</td>