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</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="BlankScrotalUSTable" runat="server">
<tr>
<td colspan="3"> <img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13">
Microlithiasis <img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13">
Macrolithiasis <img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13">Heterogeneity</td>
</tr>
<tr>
<td class="FormInsideTableTopLeftCell">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">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">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>
</table></td>
<td class="FormInsideTableRegCell"> </td>
</tr>
</table></td>
</tr>
<tr>
<td class="FormOuterTableRow"> <table width="650" border="0" cellspacing="0" cellpadding="4">
<tr>
<td> <asp:Repeater ID="CTChest" runat=server>
<HeaderTemplate> <span class="blackBoldText">Chest CT</span><br/>
<br/>
</HeaderTemplate>
<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="642" border="0" cellpadding="1" cellspacing="0" id="BlankChestCTTable" runat="server">
<tr>
<td colspan="2" class="FormInnerRowBottomBorder"><span class="blackBoldText">Chest
CT</span><span><img src="../../Images/shim.gif" border="0" width="20" height="8"></span>
<input type="checkbox" name="Films Reviewed24">
Normal</td>
<td colspan="2" class="FormInsideTableTopLeftCell">Date:</td>
<td colspan="2" class="FormInsideTableTopLeftCell">Date:</td>
<td colspan="2" class="FormInsideTableTopLeftCell">Date:</td>
</tr>
<tr>
<td width="52" align="center" class="FormInsideTableLeftCell"><span>Site</span></td>
<td width="90" align="center" class="FormInnerRowBottomBorder">Side</td>
<td width="83" align="center" valign="top" class="FormInsideTableLeftCell">Size</td>
<td width="83" align="center" valign="top" class="FormInsideTableRegCell">Nodes</td>
<td width="83" align="center" valign="top" class="FormInsideTableLeftCell">Size</td>
<td width="83" align="center" valign="top" class="FormInsideTableRegCell">Nodes</td>
<td width="83" align="center" valign="top" class="FormInsideTableLeftCell">Size</td>
<td width="83" align="center" valign="top" class="FormInsideTableRegCell">Nodes</td>
</tr>
<tr>
<td rowspan="2" class="FormInsideTableLeftCell"><p>Lung</p></td>
<td align="center" class="FormInnerRowBottomBorder"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absbottom">Left <img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absbottom">Right</td>
<td class="FormInsideTableLeftCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
</tr>
<tr>
<td align="center" class="FormInnerRowBottomBorder"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absbottom">Left <img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absbottom">Right</td>
<td class="FormInsideTableLeftCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
</tr>
<tr>
<td rowspan="2" class="FormInsideTableLeftCell">Mediastinal</td>
<td align="center" class="FormInnerRowBottomBorder"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absbottom">Left <img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absbottom">Right</td>
<td class="FormInsideTableLeftCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
</tr>
<tr>
<td align="center" class="FormInnerRowBottomBorder"><img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absbottom">Left <img src="../../Images/FormImages/WinCheckbox.gif" width="13" height="13" vspace="2" align="absbottom">Right</td>
<td class="FormInsideTableLeftCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
<td class="FormInsideTableRegCell"> </td>
</tr>
</table></td>
</tr>
</table></td>
</tr>
--> <tr>
<td height="14" align="center" valign="bottom" class="blackBoldText">GU10<img src="../../Images/shim.gif" border="0" width="45" height="1">U14<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">5</span><img src="../../Images/shim.gif" border="0" width="45" height="1">B/02.070.<span class="blackBoldTextSmall">10</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">*U14*</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="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 Testis Follow-Up Patient</span></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="11"><span class="blackBoldText">Date: <% =apptClinicDate %></span></td>
</tr>
<!-- <tr>
<td class="FormOuterTableRow">
<table width="100%" border="0" cellspacing="0" cellpadding="4" id="BlankCTAbdomenPelvisTable" runat="server">
<tr>
<td width="50%"><span class="blackBoldText">CT Scan (Abdomen / Pelvis)</span><br>
<input type="checkbox" name="Films Reviewed2">Liver Mets<img src="../../Images/shim.gif" border="0" width="6" height="1">
<input type="checkbox" name="Compared to Past2">Other Visc. Mets<input type="checkbox" name="Reviewed with Radiologist2">Lymphocele</td>
<td width="50%" align="left">Primary Landing⌨️ 快捷键说明
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