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<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="650" 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="650" 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"> <strong>
<%# DataBinder.Eval(Container.DataItem, "[0]") %>
</strong> </td>
<td class="FormInsideTableRegCell" align="center"> <strong>
<%# DataBinder.Eval(Container.DataItem, "[1]") %>
</strong> </td>
<td class="FormInsideTableRegCell" align="center"> <strong>
<%# DataBinder.Eval(Container.DataItem, "[2]") %>
</strong> </td>
<td class="FormInsideTableRegCell" align="center"> <strong>
<%# DataBinder.Eval(Container.DataItem, "[3]") %>
</strong> </td>
<td class="FormInsideTableRegCell" align="center"> <strong>
<%# DataBinder.Eval(Container.DataItem, "[4]") %>
</strong> </td>
<td class="FormInsideTableRegCell" align="center"> </td>
</tr>
</ItemTemplate>
</asp:Repeater>
</table></td>
</tr>
<tr id="LabTestsTrendViewBlankTableRow" runat="server">
<td> <table align="center" border="0" width="650" cellpadding="2" cellspacing="0">
<tr>
<td width="130" align="center" class="FormInsideTableRegCell">Marker</td>
<td width="128" class="FormInsideTableRegCell">Date:</td>
<td width="128" class="FormInsideTableRegCell">Date:</td>
<td width="128" class="FormInsideTableRegCell">Date:</td>
<td width="128" 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>
</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>
</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>
</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>
</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>
</tr>
</table></td>
</tr>
</table>
<br> <strong> Circle: S1<span><img src="../../Images/shim.gif" border="0" width="30" height="8">S2<img src="../../Images/shim.gif" border="0" width="30" height="8">S3</span></strong>
</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="650" 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="306" 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") %>
</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") %>
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