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医疗决策支持系统

            <td class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <tr id="LateComplicationsStomaRow" runat="server"> 
            <td height="25" class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell"><input type="checkbox" name="Films Reviewed222">Stoma</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
          <asp:Repeater ID="LateComplications" 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>
          <tr> 
            <td height="25" class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
<!--          <tr> 
            <td height="25" class="FormInsideTableLeftCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
            <td class="FormInsideTableRegCell">&nbsp;</td>
          </tr>
-->        </table>
		</td>
    </tr>
    <tr> 
      <td align="center" class="FormOuterTableRow">
	  <table border="0" width="100%" cellpadding="0" cellspacing="0">
          <tr> 
            <td align="left" valign="top" class="FormInnerRowBottomBorder"><img src="../../Images/shim.gif" border="0" width="4" height="1"><span class="blackBoldText">Protocols</span> 
              <table align="center" border="0" width="100%" cellpadding="0" cellspacing="0">
                <tr> 
                  <td width="20%" align="center" class="FormInsideTableTopCell">Start Date</td>
                  <td width="20%" align="center" class="FormInsideTableTopCell">Protocol #</td>
                  <td width="40%" align="center" class="FormInsideTableTopCell">Treatment</td>
                  <td width="20%" align="center" class="FormInsideTableTopCell">Stop Date</td>
                </tr>
                <tr> 
                  <td height="21" class="FormInsideTableRegCell">&nbsp;</td>
                  <td height="12" class="FormInsideTableRegCell">&nbsp;</td>
                  <td height="12" class="FormInsideTableRegCell">&nbsp;</td>
                  <td height="12" class="FormInsideTableRegCell">&nbsp;</td>
                </tr>
                <tr> 
                  <td height="21" class="FormInsideTableRegCell">&nbsp;</td>
                  <td height="12" class="FormInsideTableRegCell">&nbsp;</td>
                  <td height="12" class="FormInsideTableRegCell">&nbsp;</td>
                  <td height="12" class="FormInsideTableRegCell">&nbsp;</td>
                </tr>
              </table>
			 </td>
          </tr>
        </table>
		</td>
    </tr>
    <tr> 
      <td height="14" align="center" valign="bottom" class="blackBoldText">GU04<img src="../../Images/shim.gif" border="0" width="45" height="8">U08<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:09/08/06<img src="../../Images/shim.gif" border="0" width="45" height="1">Page 
        <span id="PageNumber">1</span> of <span id="TotalPages">6</span><img src="../../Images/shim.gif" border="0" width="45" height="1">B/02.070.<span class="blackBoldTextSmall">04</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">*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></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="15" 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"><img src="../../Images/shim.gif" border="0" width="4" height="1"><span class="blackBoldText">CT / MRI</span><img src="../../Images/shim.gif" border="0" width="25" height="1"><input type="checkbox" name="Films Reviewed">Films Reviewed
		<table align="center" border="0" width="100%" cellpadding="0" cellspacing="0">
          <tr> 
            <td width="100" height="18" align="center" valign="middle" class="FormInsideTableTopLeftCell">Date</td>
            <td width="100" align="center" valign="middle" class="FormInsideTableTopCell">Study</td>
            <td width="150" align="center" valign="middle" class="FormInsideTableTopCell">Results</td>
            <td width="300" align="center" valign="middle" class="FormInsideTableTopCell">Notes</td>
          </tr>
          <asp:Repeater ID="CtMri" runat=server> 
            <ItemTemplate> 
              <tr> 
                <td height="18" class="FormInsideTableLeftCell" align="center">&nbsp;<strong> 
                  <%# DataBinder.Eval(Container.DataItem, "DxDateText") %>
                  </strong></td>
                <td class="FormInsideTableRegCell">&nbsp;<strong> 
                  <%# DataBinder.Eval(Container.DataItem, "DxType") %>
                  </strong></td>
                <td class="FormInsideTableRegCell">&nbsp;<strong> 
                  <%# DataBinder.Eval(Container.DataItem, "DxResult") %>
                  </strong></td>
                <td class="FormInsideTableRegCell">&nbsp;<strong> 
                  <%# DataBinder.Eval(Container.DataItem, "DxNotes") %>
                  </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">Other Images</span><img src="../../Images/shim.gif" border="0" width="12" height="1"><input type="checkbox" name="Films Reviewed">Films Reviewed
		<table align="center" border="0" width="100%" cellpadding="0" cellspacing="0">
          <tr> 
            <td width="100" height="18" align="center" valign="middle" class="FormInsideTableTopLeftCell">Date</td>
            <td width="100" align="center" valign="middle" class="FormInsideTableTopCell">Study</td>
            <td width="150" align="center" valign="middle" class="FormInsideTableTopCell">Results</td>
            <td width="300" align="center" valign="middle" class="FormInsideTableTopCell">Notes</td>
          </tr>
          <asp:Repeater ID="images" runat=server> 
            <ItemTemplate> 
              <tr> 
                <td height="18" class="FormInsideTableLeftCell"  align="center">&nbsp;<strong> 
                  <%# DataBinder.Eval(Container.DataItem, "DxDateText") %>
                  </strong></td>
                <td class="FormInsideTableRegCell">&nbsp;<strong> 
                  <%# DataBinder.Eval(Container.DataItem, "DxType") %>
                  </strong></td>
                <td class="FormInsideTableRegCell">&nbsp;<strong> 
                  <%# DataBinder.Eval(Container.DataItem, "DxResult") %>
                  </strong></td>
                <td class="FormInsideTableRegCell">&nbsp;<strong> 
                  <%# DataBinder.Eval(Container.DataItem, "DxNotes") %>
                  </strong></td>