procurinarydiversionsopform.ascx

医疗决策支持系统

<%@ Control Language="c#" AutoEventWireup="false" Codebehind="ProcUrinaryDiversionsOpForm.ascx.cs" Inherits="Caisis.UI.Modules.Bladder.DataEntryForms.ProcUrinaryDiversionsOpForm" TargetSchema="http://schemas.microsoft.com/intellisense/ie5" %>

<%@ Register TagPrefix="uc1" TagName="helpToolTip" Src="../../../Core/Help/helpToolTip.ascx" %>
<%@ Register TagPrefix="val" TagName="DataEntryCommonFields" Src="../../../Core/DataEntryForms/DataEntryCommonFields.ascx" %>
<%@ Register TagPrefix="val" Namespace="Caisis.UI.Core.Classes" Assembly="Caisis.UI" %>
 
<val:DataEntryCommonFields id="commonFields" runat=server></val:DataEntryCommonFields>

<table align="center" class="pdFormTable" width="440">

	<input type="hidden" id="SurgeryId" runat=server NAME="SurgeryId"/>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpSurgeon_PdLabel" Text="Surgeon:" Field="OpSurgeon" Required="No" runat=server /></td>
		<td><val:ComboBox Id="OpSurgeon" RefBy="OpSurgeon" runat=server /></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpSurgeonType_PdLabel" Text="Type:" Field="OpSurgeonType" Required="No" runat=server /></td>
		<td><select id="OpSurgeonType" class="pdFormField" runat=server NAME="OpSurgeonType"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpAssistant_PdLabel" Text="Assistant:" Field="OpAssistant" Required="No" runat=server /></td>
		<td><val:ComboBox Id="OpAssistant" RefBy="OpAssistant" runat=server /></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpAssistantType_PdLabel" Text="Assistant Type:" Field="OpAssistantType" Required="No" runat=server /></td>
		<td><select id="OpAssistantType" class="pdFormField" runat=server NAME="OpAssistantType"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpType_PdLabel" Text="Operation Type:" Field="OpType" Required="No" runat=server /></td>
		<td><select id="OpType" class="pdFormField" runat=server NAME="OpType"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpCPT_Code_PdLabel" Text="CPT Code:" Field="OpCPT_Code" Required="No" runat=server /></td>
		<td><input type="text" id="OpCPT_Code" class="pdFormField" maxlength="50" runat=server NAME="OpCPT_Code"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpCPT_Description_PdLabel" Text="CPT Description:" Field="OpCPT_Description" Required="No" runat=server /></td>
		<td><input type="text" id="OpCPT_Description" class="pdFormField" maxlength="250" runat=server NAME="OpCPT_Description"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpTermIleumLength_PdLabel" Text="Term Ileum Length:" Field="OpTermIleumLength" Required="No" runat=server /></td>
		<td><input type="text" id="OpTermIleumLength" class="pdFormField" maxlength="50" runat=server NAME="OpTermIleumLength"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpR_ColonLength_PdLabel" Text="Right Colon Length:" Field="OpR_ColonLength" Required="No" runat=server /></td>
		<td><input type="text" id="OpR_ColonLength" class="pdFormField" maxlength="50" runat=server NAME="OpR_ColonLength"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpSigmoidLength_PdLabel" Text="Sigmoid Length:" Field="OpSigmoidLength" Required="No" runat=server /></td>
		<td><input type="text" id="OpSigmoidLength" class="pdFormField" maxlength="50" runat=server NAME="OpSigmoidLength"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpTransColonLength_PdLabel" Text="Transverse Colon Length:" Field="OpTransColonLength" Required="No" runat=server /></td>
		<td><input type="text" id="OpTransColonLength" class="pdFormField" maxlength="50" runat=server NAME="OpTransColonLength"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpIlealBasedLength_PdLabel" Text="Ileal Based Length:" Field="OpIlealBasedLength" Required="No" runat=server /></td>
		<td><input type="text" id="OpIlealBasedLength" class="pdFormField" maxlength="50" runat=server NAME="OpIlealBasedLength"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpAppendixLength_PdLabel" Text="Appendix Length:" Field="OpAppendixLength" Required="No" runat=server /></td>
		<td><input type="text" id="OpAppendixLength" class="pdFormField" maxlength="50" runat=server NAME="OpAppendixLength"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpOtherSegment_PdLabel" Text="Other Segment:" Field="OpOtherSegment" Required="No" runat=server /></td>
		<td><input type="text" id="OpOtherSegment" class="pdFormField" maxlength="50" runat=server NAME="OpOtherSegment"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpOtherSegmentLength_PdLabel" Text="Other Segment Length:" Field="OpOtherSegmentLength" Required="No" runat=server /></td>
		<td><input type="text" id="OpOtherSegmentLength" class="pdFormField" maxlength="50" runat=server NAME="OpOtherSegmentLength"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpStomaType_PdLabel" Text="Stoma Type:" Field="OpStomaType" Required="No" runat=server /></td>
		<td><select id="OpStomaType" class="pdFormField" runat=server NAME="OpStomaType"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpStomaLocation_PdLabel" Text="Stoma Location:" Field="OpStomaLocation" Required="No" runat=server /></td>
		<td><select id="OpStomaLocation" class="pdFormField" runat=server NAME="OpStomaLocation"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpNumFascialSutures_PdLabel" Text="# Fascial Sutures:" Field="OpNumFascialSutures" Required="No" runat=server /></td>
		<td><input type="text" id="OpNumFascialSutures" class="pdFormField" maxlength="50" runat=server NAME="OpNumFascialSutures"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpUreterStents_PdLabel" Text="Ureter Stents:" Field="OpUreterStents" Required="No" runat=server /></td>
		<td><select id="OpUreterStents" class="pdFormField" runat=server NAME="OpUreterStents"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpUreterStentExternalized_PdLabel" Text="Ureter Stent Externalized:" Field="OpUreterStentExternalized" Required="No" runat=server /></td>
		<td><select id="OpUreterStentExternalized" class="pdFormField" runat=server NAME="OpUreterStentExternalized"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpEvertedMucosa_PdLabel" Text="Everted Mucosa:" Field="OpEvertedMucosa" Required="No" runat=server /></td>
		<td><select id="OpEvertedMucosa" class="pdFormField" runat=server NAME="OpEvertedMucosa"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpUreterAnast_PdLabel" Text="Ureter Anastamosis:" Field="OpUreterAnast" Required="No" runat=server /></td>
		<td><select id="OpUreterAnast" class="pdFormField" runat=server NAME="OpUreterAnast"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpNB_Configuration_PdLabel" Text="Neo Bladder Configuration:" Field="OpNB_Configuration" Required="No" runat=server /></td>
		<td><select id="OpNB_Configuration" class="pdFormField" runat=server NAME="OpNB_Configuration"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpNB_ChimneyNum_PdLabel" Text="Neo Bladder # Chimneys:" Field="OpNB_ChimneyNum" Required="No" runat=server /></td>
		<td><input type="text" id="OpNB_ChimneyNum" class="pdFormField" maxlength="50" runat=server NAME="OpNB_ChimneyNum"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpNB_ChimneyLength1_PdLabel" Text="Neo Bladder Chimney 1 Length:" Field="OpNB_ChimneyLength1" Required="No" runat=server /></td>
		<td><input type="text" id="OpNB_ChimneyLength1" class="pdFormField" maxlength="50" runat=server NAME="OpNB_ChimneyLength1"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpNB_ChimneyLength2_PdLabel" Text="Neo Bladder Chimney 2 Length:" Field="OpNB_ChimneyLength2" Required="No" runat=server /></td>
		<td><input type="text" id="OpNB_ChimneyLength2" class="pdFormField" maxlength="50" runat=server NAME="OpNB_ChimneyLength2"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpNB_AfferentLimbLength_PdLabel" Text="Neo Bladder Afferent Limb Length:" Field="OpNB_AfferentLimbLength" Required="No" runat=server /></td>
		<td><input type="text" id="OpNB_AfferentLimbLength" class="pdFormField" maxlength="50" runat=server NAME="OpNB_AfferentLimbLength"/></td>
	</tr>
	<tr><!-- input type ns in meta data, input text used -->
		<td class="pdFormFieldLabel"><val:PDLabel id="OpBladderNeckTube_PdLabel" Text="Bladder Neck Tube:" Field="OpBladderNeckTube" Required="No" runat=server /></td>
		<td><select id="OpBladderNeckTube" class="pdFormField" runat=server NAME="OpBladderNeckTube"/></td>
	</tr>
	<tr><!-- input type ns in meta data, input text used -->
		<td class="pdFormFieldLabel"><val:PDLabel id="OpBladderNeckTubeLength_PdLabel" Text="Tube Length:" Field="OpBladderNeckTubeLength" Required="No" runat=server /></td>
		<td><input type="text" id="OpBladderNeckTubeLength" class="pdFormField" maxlength="50" runat=server NAME="OpBladderNeckTubeLength"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpNumSutures_PdLabel" Text="# Sutures:" Field="OpNumSutures" Required="No" runat=server /></td>
		<td><input type="text" id="OpNumSutures" class="pdFormField" maxlength="50" runat=server NAME="OpNumSutures"/></td>
	</tr>
	<tr><!-- input type ns in meta data, input text used -->
		<td class="pdFormFieldLabel"><val:PDLabel id="OpNB_NumUrethraSutures_PdLabel" Text="# Urethra Sutures:" Field="OpNB_NumUrethraSutures" Required="No" runat=server /></td>
		<td><input type="text" id="OpNB_NumUrethraSutures" class="pdFormField" maxlength="50" runat=server NAME="OpNB_NumUrethraSutures"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpNB_UrethraSutureType_PdLabel" Text="Urethra Suture Type:" Field="OpNB_UrethraSutureType" Required="No" runat=server /></td>
		<td><select id="OpNB_UrethraSutureType" class="pdFormField" runat=server NAME="OpNB_UrethraSutureType"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpNB_UrethraSutureQuality_PdLabel" Text="Urethra Suture Quality:" Field="OpNB_UrethraSutureQuality" Required="No" runat=server /></td>
		<td><select id="OpNB_UrethraSutureQuality" class="pdFormField" runat=server NAME="OpNB_UrethraSutureQuality"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpContMech_PdLabel" Text="Continence Mechanism:" Field="OpContMech" Required="No" runat=server /></td>
		<td><select id="OpContMech" class="pdFormField" runat=server NAME="OpContMech"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpContMechSubtype_PdLabel" Text="Cont Mech Subtype:" Field="OpContMechSubtype" Required="No" runat=server /></td>
		<td><select id="OpContMechSubtype" class="pdFormField" runat=server NAME="OpContMechSubtype"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpContMechLength_PdLabel" Text="Cont Mech Length:" Field="OpContMechLength" Required="No" runat=server /></td>
		<td><input type="text" id="OpContMechLength" class="pdFormField" maxlength="50" runat=server NAME="OpContMechLength"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpDrainJP_PdLabel" Text="JP Drain:" Field="OpDrainJP" Required="No" runat=server /></td>
		<td><select id="OpDrainJP" class="pdFormField" runat=server NAME="OpDrainJP"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpDrainPelvic_PdLabel" Text="Pelvic Drain:" Field="OpDrainPelvic" Required="No" runat=server /></td>
		<td><select id="OpDrainPelvic" class="pdFormField" runat=server NAME="OpDrainPelvic"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpDrainPenrose_PdLabel" Text="Penrose Drain:" Field="OpDrainPenrose" Required="No" runat=server /></td>
		<td><select id="OpDrainPenrose" class="pdFormField" runat=server NAME="OpDrainPenrose"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpDrainSuprapubic_PdLabel" Text="Suprapubic Drain:" Field="OpDrainSuprapubic" Required="No" runat=server /></td>
		<td><select id="OpDrainSuprapubic" class="pdFormField" runat=server NAME="OpDrainSuprapubic"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpDrainStomal_PdLabel" Text="Stomal Drain:" Field="OpDrainStomal" Required="No" runat=server /></td>
		<td><select id="OpDrainStomal" class="pdFormField" runat=server NAME="OpDrainStomal"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpDrainUrethra_PdLabel" Text="Urethra Drain:" Field="OpDrainUrethra" Required="No" runat=server /></td>
		<td><select id="OpDrainUrethra" class="pdFormField" runat=server NAME="OpDrainUrethra"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpPouch_PdLabel" Text="Pouch:" Field="OpPouch" Required="No" runat=server /></td>
		<td><select id="OpPouch" class="pdFormField" runat=server NAME="OpPouch"/></td>
	</tr>
	<tr>
		<td class="pdFormFieldLabel"><val:PDLabel id="OpNotes_PdLabel" Text="Notes:" Field="OpNotes" Required="No" runat=server /></td>
		<td><textarea id="OpNotes" class="pdFormNotesField" cols="32" rows="5" maxlength="1000" runat=server NAME="OpNotes"></textarea></td>
	</tr>
 
</table>