urotestnp.ascx

医疗决策支持系统

            <td valign="middle" class="FormInsideTableTopCell">Seminoma</td>
            <td valign="middle">&nbsp;</td>
            <td valign="middle" class="FormInsideTableTopLeftCell"> <input type="checkbox" name="No243139"></td>
            <td valign="middle" class="FormInsideTableTopCell">Yolk Sac</td>
            <td valign="middle" class="FormInnerRowRightBorder">&nbsp;</td>
            <td valign="middle" class="FormInsideTableTopCell"><input type="checkbox" name="No2431392"></td>
            <td valign="middle" class="FormInsideTableTopCell">Vascular Invation</td>
          </tr>
          <tr> 
            <td width="30" valign="middle" class="FormInsideTableLeftCell"> <input type="checkbox" name="No24310">            </td>
            <td width="180" valign="middle" class="FormInsideTableRegCell">Pure-Seminoma</td>
            <td width="10" valign="middle">&nbsp;</td>
            <td width="30" valign="middle" class="FormInsideTableLeftCell"> <input type="checkbox" name="No2431310">            </td>
            <td width="180" valign="middle" class="FormInsideTableRegCell">Pure-Yolk Sac </td>
            <td width="10" valign="middle" class="FormInnerRowRightBorder">&nbsp;</td>
            <td width="30" valign="middle" class="FormInsideTableRegCell"> <input type="checkbox" name="No24313922">            </td>
            <td width="180" valign="middle" class="FormInsideTableRegCell">Burnt Out / Scar</td>
          </tr>
          <tr> 
            <td valign="middle" class="FormInsideTableLeftCell"> <input type="checkbox" name="No24311"></td>
            <td valign="middle" class="FormInsideTableRegCell">Teratoma</td>
            <td valign="middle">&nbsp;</td>
            <td valign="middle" class="FormInsideTableLeftCell"> <input type="checkbox" name="No2431311"></td>
            <td valign="middle" class="FormInsideTableRegCell">Chorio</td>
            <td valign="middle" class="FormInnerRowRightBorder">&nbsp;</td>
            <td valign="middle" class="FormInsideTableRegCell"><input type="checkbox" name="No243139222"></td>
            <td valign="middle" class="FormInsideTableRegCell">ITGCN</td>
          </tr>
          <tr> 
            <td class="FormInsideTableLeftCell"> <input type="checkbox" name="No2431315"></td>
            <td class="FormInsideTableRegCell">Imm Teratoma</td>
            <td valign="middle">&nbsp;</td>
            <td valign="middle" class="FormInsideTableLeftCell"> <input type="checkbox" name="No2431312"></td>
            <td valign="middle" class="FormInsideTableRegCell">Pure Chorio</td>
            <td valign="middle" class="FormInnerRowRightBorder">&nbsp;</td>
            <td valign="middle" class="FormInsideTableRegCell"><input type="checkbox" name="No243139223"></td>
            <td valign="middle" class="FormInsideTableRegCell">Positive Cord Margin</td>
          </tr>
          <tr> 
            <td class="FormInsideTableLeftCell"> <input type="checkbox" name="No2431316"></td>
            <td class="FormInsideTableRegCell">Malignant Transformation</td>
            <td valign="middle">&nbsp;</td>
            <td valign="middle" class="FormInsideTableLeftCell"> <input type="checkbox" name="No2431313"></td>
            <td valign="middle" class="FormInsideTableRegCell">Leydig Cell</td>
            <td valign="middle" class="FormInnerRowRightBorder">&nbsp;</td>
            <td valign="middle" class="FormInsideTableRegCell"><input type="checkbox" name="No2431392232"></td>
            <td valign="middle" class="FormInsideTableRegCell">Extra-Testicular 
              Extension </td>
          </tr>
          <tr> 
            <td class="FormInsideTableLeftCell"> <input type="checkbox" name="No2431317"></td>
            <td class="FormInsideTableRegCell">Pure-Teratoma</td>
            <td valign="middle">&nbsp;</td>
            <td class="FormInsideTableLeftCell"> <input type="checkbox" name="No2431314"></td>
            <td valign="middle" class="FormInsideTableRegCell">Sertoli Cell</td>
            <td class="FormInnerRowRightBorder">&nbsp;</td>
            <td class="FormInsideTableRegCell"><input type="checkbox" name="No2431392233"></td>
            <td class="FormInsideTableRegCell">LVI</td>
          </tr>
          <tr> 
            <td class="FormInsideTableLeftCell"><input type="checkbox" name="No24313172"></td>
            <td class="FormInsideTableRegCell">Embryonal</td>
            <td valign="middle">&nbsp;</td>
            <td valign="top" class="FormInsideTableLeftCell"> <input type="checkbox" name="No24313142">            </td>
            <td class="FormInsideTableRegCell">Adenocarcinoma</td>
            <td rowspan="2" valign="top" class="FormInnerRowRightBorder">&nbsp;</td>
            <td rowspan="2" valign="top" class="FormInsideTableRegCell">&nbsp;</td>
            <td rowspan="2" valign="top" class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr> 
            <td class="FormInsideTableLeftCell"><input type="checkbox" name="No243131722"></td>
            <td class="FormInsideTableRegCell">Pure-Embryonal</td>
            <td valign="middle">&nbsp;</td>
            <td valign="top" class="FormInsideTableLeftCell"><input type="checkbox" name="No243131422"></td>
            <td class="FormInsideTableRegCell">Other Histology:</td>
          </tr>
        </table></td>
    </tr>
    <tr> 
      <td height="14" align="center" valign="bottom" class="blackBoldText">GU09<img src="../../Images/shim.gif" border="0" width="45" height="1">U13<img src="../../Images/shim.gif" border="0" width="45" height="1">CMIC 
        Approval Date: 6/03<img src="../../Images/shim.gif" border="0" width="45" height="8">rev:08/08/06<img src="../../Images/shim.gif" border="0" width="45" height="1">Page 
        <span id="PageNumber">2</span> of <span id="TotalPages">7</span><img src="../../Images/shim.gif" border="0" width="45" height="1">B/02.070.<span class="blackBoldTextSmall">09</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">*U13*</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>
  <table width="650" border="0" cellspacing="0" cellpadding="0">
    <tr> 
      <td class="FormOuterTableTopRow">
	  	<table align="center" border="0" width="100%" cellpadding="4" cellspacing="0">
          <tr> 
            <td width="50%" 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 Testis New Patient</span></td>
            <td width="50%" align="center" valign="bottom" > 
				<table  width="100%" 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"><img src="../../Images/shim.gif" border="0" width="4" height="11"><span class="blackBoldText">Date: <% =apptClinicDate %></span></td>
    </tr>
    <tr> 
      <td class="FormOuterTableRow"> 
	  <table width="100%" border="0" cellspacing="0" cellpadding="0">
          <tr> 
            <td class="FormInnerRowBottomBorder" ><span class="blackBoldText"><img src="../../Images/shim.gif" border="0" width="4" height="15">Serum Tumor Markers</span> </td>
          </tr>
          <tr  id="LabTestsTrendViewPopTableRow" runat="server"> 
            <td> 
			<table align="center" border="0" width="100%" cellpadding="2" cellspacing="0">
                <tr> 
                  <td width="90" align="center" class="FormInsideTableRegCell"><strong>Test</strong></td>
                  <asp:Repeater ID="LabTestsTrendViewDates" runat=server> 
                    <ItemTemplate> 
                      <td width="80" height="12" class="FormInsideTableRegCell" align="center"><strong> 
                        <%# DataBinder.Eval(Container.DataItem, "LabDates") %>
                        </strong></td>
                    </ItemTemplate>
                  </asp:Repeater>
                  <td width="90" align="left" class="FormInsideTableRegCell"><strong>Date:</strong></td>
                </tr>
                <asp:Repeater ID="LabTestsTrendView" runat=server> 
                  <ItemTemplate> 
                    <tr> 
                      <td align="center" class="FormInsideTableRegCell">&nbsp;<strong> 
                        <%# DataBinder.Eval(Container.DataItem, "[0]") %>
                        </strong>&nbsp;</td>
                      <td  class="FormInsideTableRegCell" align="center">&nbsp;<strong> 
                        <%# DataBinder.Eval(Container.DataItem, "[1]") %>
                        </strong>&nbsp;</td>
                      <td  class="FormInsideTableRegCell" align="center">&nbsp;<strong> 
                        <%# DataBinder.Eval(Container.DataItem, "[2]") %>
                        </strong>&nbsp;</td>
                      <td class="FormInsideTableRegCell" align="center">&nbsp;<strong> 
                        <%# DataBinder.Eval(Container.DataItem, "[3]") %>
                        </strong>&nbsp;</td>
                      <td  class="FormInsideTableRegCell" align="center">&nbsp;<strong> 
                        <%# DataBinder.Eval(Container.DataItem, "[4]") %>
                        </strong>&nbsp;</td>
                      <td  class="FormInsideTableRegCell" align="center">&nbsp;</td>
                    </tr>
                  </ItemTemplate>