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<td> <table align="center" border="0" width="100%" cellpadding="2" cellspacing="0">
<tr>
<td width="10%" align="center" class="FormInsideTableRegCell">Marker</td>
<td width="18%" class="FormInsideTableRegCell">Date:</td>
<td width="18%" class="FormInsideTableRegCell">Date:</td>
<td width="18%" class="FormInsideTableRegCell">Date:</td>
<td width="18%" class="FormInsideTableRegCell">Date:</td>
<td width="18%" class="FormInsideTableRegCell">Date:</td>
</tr>
<tr>
<td align="center" class="FormInsideTableRegCell"><span style="font-family: Symbol;">b</span>HCG</td>
<td height="12" class="FormInsideTableRegCell"> </td>
<td height="12" class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
</tr>
<tr>
<td align="center" class="FormInsideTableRegCell">AFP</td>
<td height="12" class="FormInsideTableRegCell"> </td>
<td height="12" class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
</tr>
<tr>
<td align="center" class="FormInsideTableRegCell">LDH</td>
<td height="12" class="FormInsideTableRegCell"> </td>
<td height="12" class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
</tr>
<tr>
<td align="center" class="FormInsideTableRegCell"> </td>
<td height="12" class="FormInsideTableRegCell"> </td>
<td height="12" class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
</tr>
</table>
</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>
<img src="../../Images/shim.gif" border="0" width="12" height="1"><input type="checkbox" name="Films Reviewed">Films Reviewed<br>
<table align="center" border="0" width="100%" cellpadding="2" cellspacing="0">
<tr>
<td width="12%" align="center" valign="middle" class="FormInsideTableTopCell">Date</td>
<td width="15%" align="center" valign="middle" class="FormInsideTableTopCell">Study</td>
<td width="19%" align="center" valign="middle" class="FormInsideTableTopCell">Target</td>
<td width="44%" align="center" valign="middle" class="FormInsideTableTopCell">Results</td>
<td width="10%" align="center" valign="middle" class="FormInsideTableTopCell">MSKCC</td>
</tr>
<asp:Repeater ID="images" runat=server>
<ItemTemplate>
<tr>
<td height="18" align="center" class="FormInsideTableRegCell"> <strong><%# DataBinder.Eval(Container.DataItem, "DxDateText") %></strong></td>
<td class="FormInsideTableRegCell"> <strong><%# DataBinder.Eval(Container.DataItem, "DxType") %></strong></td>
<td class="FormInsideTableRegCell"><strong><%# DataBinder.Eval(Container.DataItem, "DxTarget") %> </strong></td>
<td class="FormInsideTableRegCell"> <strong><%# DataBinder.Eval(Container.DataItem, "DxResult") %></strong></td>
<td class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle">Yes <img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle">No</td>
</tr>
</ItemTemplate>
</asp:Repeater>
</table>
</td>
</tr>
<tr>
<td class="FormOuterTableRow"> <table width="650" border="0" cellspacing="0" cellpadding="0">
<tr>
<td width="325" valign="top">
<table width="100%" border="0" cellspacing="0" cellpadding="1">
<tr>
<td width="130"><span class="blackBoldText"> Relapse<br></span></td>
<td width="60"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle">Yes</td>
<td width="135"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle">No</td>
</tr>
<tr>
<td> Late Relapse</td>
<td><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle">Yes</td>
<td><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle">No</td>
</tr>
<tr>
<td> Date:</td>
<td> </td>
<td> </td>
</tr>
<tr>
<td> <img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle">Elevated Markers</td>
<td colspan="2" align="left"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle">Failed Surveillance</td>
</tr>
<tr>
<td> Infield Recurrence</td>
<td><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle">Yes </td>
<td><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle">No</td>
</tr>
</table>
</td>
<td width="50%" valign="top">
<table width="100%" border="0" cellspacing="0" cellpadding="1">
<tr>
<td colspan="3"> </td>
</tr>
<tr>
<td width="50"><strong>Site</strong></td>
<td width="138"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle"> Retroperitoneum</td>
<td width="137"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle"> Liver</td>
</tr>
<tr>
<td> </td>
<td><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle"> Retrocrural</td>
<td width="137"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle"> Mediastinum</td>
</tr>
<tr>
<td> </td>
<td><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle"> Lung</td>
<td><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle"> Brain</td>
</tr>
<tr>
<td> </td>
<td> </td>
<td> </td>
</tr>
</table>
</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="15" height="1">
<input type="checkbox" name="Films Reviewed">
Films Reviewed<img src="../../Images/shim.gif" border="0" width="18" height="8">
<input type="checkbox" name="Compared to Past">
Compared to Past<img src="../../Images/shim.gif" border="0" width="18" height="1">
<input type="checkbox" name="Reviewed with Radiologist">
Reviewed with Radiologist<img src="../../Images/shim.gif" border="0" width="18" height="1">
<input type="checkbox" name="Digitized">
Digitized<br>
</span> <table align="center" border="0" width="100%" cellpadding="2" cellspacing="0">
<tr>
<td width="70" align="center" valign="middle" class="FormInsideTableTopLeftCell">Date</td>
<td width="70" align="center" valign="middle" class="FormInsideTableTopCell">Study</td>
<td width="310" align="center" valign="middle" class="FormInsideTableTopCell">Results</td>
<td width="200" align="center" valign="middle" class="FormInsideTableTopCell">Notes</td>
</tr>
<tr>
<td height="25" class="FormInsideTableLeftCell"> </td>
<td align="center" valign="top" class="FormInsideTableRegCell"><br>
CXR</td>
<td class="FormInsideTableRegCell"> <asp:Repeater ID="XRayChest" runat=server>
<ItemTemplate> <strong>
<%# DataBinder.Eval(Container.DataItem, "DxDateText") %>
</strong> <strong>
<%# DataBinder.Eval(Container.DataItem, "DxType") %>
</strong> <strong>
<%# DataBinder.Eval(Container.DataItem, "DxTarget") %>
</strong> <strong>
<%# DataBinder.Eval(Container.DataItem, "DxSide") %>
</strong> <strong>
<%# DataBinder.Eval(Container.DataItem, "DxResult") %>
<%# DataBinder.Eval(Container.DataItem, "DxNotes") %>
</strong> <br/>
</ItemTemplate>
</asp:Repeater> <table width="100%" border="0" cellspacing="0" cellpadding="1" id="BlankCXRTable" runat="server">
<tr>
<td class="FormInsideTableTopLeftCell">Site</td>
<td class="FormInsideTableTopCell">Side</td>
<td class="FormInsideTableTopCell" width="70">Size</td>
<td class="FormInsideTableTopCell" width="70">Nodes</td>
</tr>
<tr>
<td class="FormInsideTableLeftCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle">Normal</td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
</tr>
<tr>
<td class="FormInsideTableLeftCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle">Lung</td>
<td class="FormInsideTableRegCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle">Left <img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle">Right</td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
</tr>
<tr>
<td class="FormInsideTableLeftCell"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absmiddle">Mediastinal</td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
</tr>
</table></td>
<td class="FormInsideTableRegCell"> </td>
</tr>
<tr>
<td height="25" class="FormInsideTableLeftCell"> </td>
<td align="center" valign="top" class="FormInsideTableRegCell">Scrotal
U/S</td>
<td valign="top" class="FormInsideTableRegCell"> <asp:Repeater ID="ScrotalUS" runat=server>
<ItemTemplate> <strong>
<%# DataBinder.Eval(Container.DataItem, "DxDateText") %>
</strong> <strong>
<%# DataBinder.Eval(Container.DataItem, "DxType") %>
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