📄 urodynamics.ascx
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<%@ Control Language="c#" AutoEventWireup="false" Codebehind="UroDynamics.ascx.cs" Inherits="Caisis.UI.Modules.All.PaperForms.UroDynamics" TargetSchema="http://schemas.microsoft.com/intellisense/ie5" %>
<link href="../../../StyleSheets/formStyles.css" rel="stylesheet" type="text/css">
<div id="PaperFormStart">
<div align="center">
<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">*U40*</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 <%= institutionShortName%> 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 Urodynamic Study</span><br> </td>
<td width="325" 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 %>
</td>
<td align="left"><strong>
<% =patientMRN %>
</strong>
<% =patientDOB %>
</td>
</tr>
<tr>
<td colspan="1" align="right">
<% =patientNameLabel %>
</td>
<td colspan="1" align="left"><strong>
<% =patientLastName %>, <% =patientFirstName %> <% =patientMiddleName %>
</strong></td>
</tr>
<tr>
<td align="right" valign="top">
<% =patientAddressLabel %>
</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"><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">
<table align="center" border="0" width="100%" cellpadding="1" cellspacing="0">
<tr>
<td width="100" align="left" valign="top" class="FormInnerRowRightBorder"><span class="blackBoldText"><img src="../../Images/shim.gif" border="0" width="4" height="1">Vital Signs</span></td>
<td width="137" height="22" align="left" valign="top" class="FormInnerRowRightBorder"><img src="../../Images/shim.gif" border="0" width="4" height="0">BP:</td>
<td width="137" height="22" align="left" valign="top" class="FormInnerRowRightBorder"><img src="../../Images/shim.gif" border="0" width="4" height="0">Pulse:</td>
<td width="137" height="22" align="left" valign="top" class="FormInnerRowRightBorder"><img src="../../Images/shim.gif" border="0" width="4" height="0">Temp:</td>
<td width="137" height="22" align="left" valign="top"><img src="../../Images/shim.gif" border="0" width="4" height="0">Resp:</td>
</tr>
</table>
</td>
</tr>
<tr>
<td height="32" class="FormOuterTableRow"><table width="650" border="0" cellspacing="0" cellpadding="2">
<tr>
<td width="20" valign="middle"> <input type="checkbox" name="No24322">
</td>
<td width="630" valign="middle">Post instructions reviewed. Fact Cards "Instructions Following Your Urodynamics Study" provided to patient.</td>
</tr>
<tr>
<td colspan="2" valign="middle"><table width="642" border="0" cellspacing="0" cellpadding="2">
<tr>
<td width="70"><span class="blackBoldText">Signature:</span></td>
<td width="380"><span class="blackBoldText">__________________________________________________</span></td>
<td width="192"><span class="blackBoldText">Date:____/____/____</span>
</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td height="32" class="FormOuterTableRow"><span class="blackBoldText"><img src="../../Images/shim.gif" border="0" width="4" height="15">Verification:</span> Patient Identity has been confirmed and agreement of planned procedure with patient and consent ensured.<br>
<img src="../../Images/shim.gif" border="0" width="315" height="10"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13">Yes </td>
</tr>
<tr>
<td class="FormOuterTableRow" height="100" align="left">
<table width="100%" height="100%" cellpadding="0" cellspacing="0" border="0">
<tr>
<td width="55%" valign="top" align="left" class="FormInnerRowRightBorder"><span class="blackBoldText"><img src="../../Images/shim.gif" border="0" width="4" height="1">HPI</span></td>
<td width="45%" align="left" valign="top"><span class="blackBoldText"><img src="../../Images/shim.gif" border="0" width="4" height="1">Medications</span><br/>
<asp:Repeater ID="medications" runat="server" OnItemDataBound="medicationsItemDataBound">
<headertemplate><table cellpadding="0" cellspacing="0" border="0" width="100%"><tr><td style="line-height: 11px;"></headertemplate>
<ItemTemplate>
<asp:Literal ID="StartNextMedColumn" runat="server" /><%# DataBinder.Eval(Container.DataItem, "Medication") %> <%# DataBinder.Eval(Container.DataItem, "MedDose") %> <%# DataBinder.Eval(Container.DataItem, "MedUnits") %> <%# DataBinder.Eval(Container.DataItem, "MedSchedule") %><br/>
</ItemTemplate>
<footertemplate></td></tr></table></footertemplate>
</asp:Repeater>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td class="FormOuterTableRow"><span class="blackBoldText"><img src="../../Images/shim.gif" border="0" width="4" height="1">Previous History / Indication</span>
<table width="100%" border="0" cellspacing="0" cellpadding="1">
<tr>
<td valign="middle" align="center" width="3%" class="FormInsideTableTopLeftCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="1"></td>
<td valign="middle" align="left" class="FormInsideTableTopCell">Post Prostatectomy</td>
<td valign="middle" align="center" width="3%" class="FormInsideTableTopCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="1"></td>
<td valign="middle" align="left" class="FormInsideTableTopCell">Radical Prostatectomy</td>
<td valign="middle" align="center" width="3%" class="FormInsideTableTopCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="1"></td>
<td valign="middle" align="left" class="FormInsideTableTopCell">Laprascopic Prostatectomy</td>
<td valign="middle" align="center" width="3%" class="FormInsideTableTopCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="1"></td>
<td valign="middle" align="left" class="FormInsideTableTopCell">Robot Assisted Prostatectomy</td>
</tr>
<tr>
<td valign="middle" align="center" width="3%" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="1"></td>
<td valign="middle" align="left" class="FormInsideTableRegCell">Post Cystectomy</td>
<td valign="middle" align="center" width="3%" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="1"></td>
<td valign="middle" align="left" class="FormInsideTableRegCell">Neobladder</td>
<td valign="middle" align="center" width="3%" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="1"></td>
<td valign="middle" align="left" class="FormInsideTableRegCell">Ileal-conduit</td>
<td valign="middle" align="center" width="3%" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="1"></td>
<td valign="middle" align="left" class="FormInsideTableRegCell">Cont. Cutaneous Reservoir</td>
</tr>
<tr>
<td valign="middle" align="center" width="3%" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="1"></td>
<td valign="middle" align="left" class="FormInsideTableRegCell">Post Radical GI Surgery</td>
<td valign="middle" align="center" width="3%" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="1"></td>
<td valign="middle" align="left" class="FormInsideTableRegCell">Post Radical GYN Surgery</td>
<td valign="middle" align="center" width="3%" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="1"></td>
<td valign="middle" align="left" class="FormInsideTableRegCell">Post Radiation</td>
<td valign="middle" align="center" width="3%" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="1"></td>
<td valign="middle" align="left" class="FormInsideTableRegCell">Post TURBT</td>
</tr>
<tr>
<td valign="middle" align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="1"></td>
<td valign="middle" align="left" class="FormInsideTableRegCell">Post BCG Therapy</td>
<td valign="middle" align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="1"></td>
<td valign="middle" align="left" class="FormInsideTableRegCell">Urgency</td>
<td valign="middle" align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="1"></td>
<td valign="middle" align="left" class="FormInsideTableRegCell">Retention</td>
<td valign="middle" align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="1"></td>
<td valign="middle" align="left" class="FormInsideTableRegCell">Incontinence</td>
</tr>
<tr>
<td valign="middle" align="center" class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="1"></td>
<td valign="middle" align="left" class="FormInsideTableRegCell">Frequency</td>
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