urobladcystfu.ascx

医疗决策支持系统

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

<link href="../../../StyleSheets/formStyles.css" rel="stylesheet" type="text/css">


<div id="PaperFormStart">

<div align="center">

<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">*U08*</div>
	<div class="VerticalBarCodeAcctType"><% =BarCodeAcctType %></div>
	<div class="VerticalBarCodeDate"><% =BarCodeDate %></div>
<%--	<div  class="VerticalBarCodeDateTextBG"><img src="../../Images/FormImages/WhiteShim.gif" border="0" width="8" height="60"></div>
	<div  class="VerticalBarCodeDateText">< =apptClinicDate ></div> --%>
	</div>
</div>

<font style="font-size: 12px;">CONTAINS PROTECTED  HEALTH INFORMATION - HANDLE ACCORDING TO <%= institutionShortName%> POLICY</font> <br>
  <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 Cystectomy Follow-Up Patient</span><br> </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  %>
                    &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 height="20" class="FormOuterTableRow"><img src="../../Images/shim.gif" border="0" width="4" height="1"><span class="blackBoldText">Date: 
        <% =apptClinicDate %>
        <img src="../../Images/shim.gif" border="0" width="220" height="1">Physician: 
        <% =apptPhysicianName %>
        </span></td>
    </tr>
    <tr> 
      <td class="FormOuterTableRow"> <table align="center" border="0" width="100%" cellpadding="0" cellspacing="0">
          <tr > 
            <td align="left" height="22"><img src="../../Images/shim.gif" border="0" width="4" height="0">Referring&nbsp;M.D.: 
              <asp:Repeater ID="ReferringMD" runat=server > 
                <ItemTemplate> 
                  <%# DataBinder.Eval(Container.DataItem, "phFirstName") %>
                  <%# DataBinder.Eval(Container.DataItem, "phLastName") %>
                  ( 
                  <%# DataBinder.Eval(Container.DataItem, "phInstitution") %>
                  )</ItemTemplate>
                <SeparatorTemplate>, </SeparatorTemplate>
              </asp:Repeater> <asp:Label ID="blankReferrringMD" Runat="server"></asp:Label> 
            </td>
          </tr>
        </table>
		</td>
    </tr>
	<tr>
		<td class="FormOuterTableRow"><img src="../../Images/shim.gif" border="0" width="4" height="1"><span class="blackBoldText">Diagnosis</span><img src="../../Images/shim.gif" border="0" width="20" height="1">Date: <asp:Label ID="DxDateLabel" Runat="server" /><img src="../../Images/shim.gif" border="0" width="50" height="1">
		2002 TNM Cystectomy Stage: <asp:Label ID="CystectomyStageLabel" Runat="server" /><img src="../../Images/shim.gif" border="0" width="60" height="1">Nodes: <asp:Label ID="CystectomyNodesLabel" Runat="server" /></td>
	</tr>
    <tr> 
      <td height="230" valign="top" class="FormOuterTableRow"><img src="../../Images/shim.gif" border="0" width="4" height="1"><span class="blackBoldText">HPI</span> 
        <table cellpadding="4" cellspacing="0" border="0">
          <tr> 
            <td class="HPITextBladder" valign="top" width="*"> <asp:Repeater ID="hpi" runat=server OnItemDataBound="hpiItemDataBound"> 
                <ItemTemplate> 
                  <%# DataBinder.Eval(Container.DataItem, "patientHPI") %>
                  <br>
                  <asp:Literal ID="StartNextHpiColumn" Runat="server" />
                </ItemTemplate>
              </asp:Repeater> <asp:Repeater ID="HpiProstatectomies" runat=server OnItemDataBound="HpiProstatectomiesItemDataBound"> 
                <ItemTemplate> <strong> 
                  <%# DataBinder.Eval(Container.DataItem, "OpType") %>
                  </strong> on 
                  <%# DataBinder.Eval(Container.DataItem, "SurgDateText") %>
                  <asp:Label ID="CaseSurgeonLabel" Runat="server">by 
                    <%# DataBinder.Eval(Container.DataItem, "SurgCaseSurgeon") %>
                  </asp:Label>
                  <br>
                  <asp:Literal ID="StartNextHpiColumn" Runat="server" />
                </ItemTemplate>
              </asp:Repeater> <asp:Label ID="PreTxPot" Runat="server" /> <asp:Repeater ID="hpiProtocols" runat=server OnItemDataBound="appendToHpiItemDataBound"> 
                <ItemTemplate> Protocol 
                  <%# DataBinder.Eval(Container.DataItem, "ProtocolNum") %>
                  <%# DataBinder.Eval(Container.DataItem, "ProtocolNotes") %>
                  <%# DataBinder.Eval(Container.DataItem, "PtProtocolStatus") %>
                  <br>
                  <asp:Literal ID="StartNextHpiColumn" Runat="server" />
                </ItemTemplate>
              </asp:Repeater> <asp:Repeater ID="hpiBiopsies" runat=server > 
                <ItemTemplate> Biopsy:&nbsp; 
                  <%# DataBinder.Eval(Container.DataItem, "BxDateText") %>
                  &nbsp;&nbsp; 
                  <%# DataBinder.Eval(Container.DataItem, "BxType") %>
                  &nbsp;&nbsp;Result:&nbsp; 
                  <%# DataBinder.Eval(Container.DataItem, "BxResult") %>
                  &nbsp;&nbsp; 
                  <%# DataBinder.Eval(Container.DataItem, "bxQuality") %>
                  <br>
                  <asp:Literal ID="StartNextHpiColumn" Runat="server" />
                </ItemTemplate>
              </asp:Repeater> <asp:Label ID="NVB_Left" Runat="server" /> <asp:Label ID="NVB_Right" Runat="server" /> 
            </td>
          </tr>
        </table>
		</td>
    </tr>
    <tr> 
      <td align="left" valign="top" height="70" class="FormOuterTableRow"><img src="../../Images/shim.gif" border="0" width="4" height="1"><span class="blackBoldText">Interval History</span></td>
    </tr>
    <tr> 
      <td class="FormOuterTableRow"><img src="../../Images/shim.gif" border="0" width="4" height="1"><span class="blackBoldText">Early Complications</span>&nbsp;<span>(&lt;30 Days)</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="350" align="center" valign="middle" class="FormInsideTableTopCell">Complaint</td>
            <td width="150" align="center" valign="middle" class="FormInsideTableTopCell">Relation</td>
            <td width="80" align="center" valign="middle" class="FormInsideTableTopCell">Data Source</td>
          </tr>
          <asp:Repeater ID="EarlyComplications" runat=server> 
            <ItemTemplate> 
              <tr> 
                <td height="25" class="FormInsideTableLeftCell">&nbsp;<strong> 
                  <%# DataBinder.Eval(Container.DataItem, "ToxDateText") %>
                  </strong></td>
                <td class="FormInsideTableRegCell">&nbsp;<strong> 
                  <%# DataBinder.Eval(Container.DataItem, "ToxName") %>
                  </strong></td>
                <td class="FormInsideTableRegCell">&nbsp;<strong> 
                  <%# DataBinder.Eval(Container.DataItem, "ToxRelatedTo") %>
                  </strong></td>
                <td class="FormInsideTableRegCell">&nbsp;<strong> 
                  <%# DataBinder.Eval(Container.DataItem, "ToxDataSource") %>
                  </strong></td>
              </tr>
            </ItemTemplate>
          </asp:Repeater>
        </table></td>
    </tr>
    <tr> 
      <td class="FormOuterTableRow"><img src="../../Images/shim.gif" border="0" width="4" height="1"><span class="blackBoldText">Late Complications</span>&nbsp;<span>(&gt;30 Days)</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="350" align="center" valign="middle" class="FormInsideTableTopCell">Complaint</td>
            <td width="150" align="center" valign="middle" class="FormInsideTableTopCell">Relation</td>
            <td width="80" align="center" valign="middle" class="FormInsideTableTopCell">Date Source</td>
          </tr>
          <tr id="LateComplicationsUreteroentericRow" runat="server"> 
            <td height="25" class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell"><input type="checkbox" name="Films Reviewed2">Ureteroenteric Complication</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr id="LateComplicationsHerniaRow" runat="server"> 
            <td height="25" class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell"><input type="checkbox" name="Films Reviewed22">Abdominal Wall Hernia</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>