imagus_diagnostic_imaging.html
by
dchan
—
last modified
2006-12-07 15:05
Click here to get the file
Size
7.5 kB
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File type
text/html
File contents
<html>
<head>
<!-- CSS Script that removes textarea and textbox borders when printing -->
<style type="text/css" media="print">
td.subjectline {
display:none;
}
input.noborder {
border : 0px;
background: transparent;
}
textarea.noborder {
scrollbar-3dlight-color: transparent;
scrollbar-3dlight-color: transparent;
scrollbar-arrow-color: transparent;
scrollbar-base-color: transparent;
scrollbar-darkshadow-color: transparent;
scrollbar-face-color: transparent;
scrollbar-highlight-color: transparent;
scrollbar-shadow-color: transparent;
scrollbar-track-color: transparent;
background: transparent;
overflow: hidden;
//scrollbar : none;
border : 0px;
}
</style>
<!-- ------------------------------------------------------------------ -->
<!-- ------------------------------------------- -->
</head>
<body width="750px">
<div style="position: absolute; left: 12; top: 16; z-index:'-1'"><IMG SRC="../../OscarDocument/oscar_sfhc/eform/images/imagus.gif"></div>
<!-- You can remove ../../OscarDocument/oscar_sfhc/eform/images/ as you develop the form, but make sure you put it back before uploading to OSCAR otherwise the image wouldn't show.
<!-- Also note: the image filename IS CASE SENSITIVE INCLUDING THE EXTENSION. It may work otherwise in Windows, but not in OSCAR because it's based on a Linux platform -->
<form method="POST" action="">
<!-- ----------------------------All textfields/checkboxes/textareas go here...------ -->
<!-- ---Patient Info--- -->
<div style="position: absolute; left:135px; top:100px;">
<input type="text" class="noborder" name="text1" oscarDB=patient_name style="width: 325px; font-family: Arial; font-size: 12px;" tabindex="1">
</div>
<div style="position: absolute; left:505px; top:100px;">
<input type="text" class="noborder" name="text2" oscarDB=phone style="width: 195px; font-family: Arial; font-size: 12px;" tabindex="2">
</div>
<div style="position: absolute; left:100px; top:124px;">
<input type="text" class="noborder" name="text3" oscarDB=addressline style="width: 360px; font-family: Arial; font-size: 12px;" tabindex="3">
</div>
<div style="position: absolute; left:546px; top:124px;">
<input type="text" class="noborder" name="text4" oscarDB=DOB style="width: 154px; font-family: Arial; font-size: 12px;" tabindex="4">
</div>
<div style="position: absolute; left:515px; top:148px;">
<input type="text" class="noborder" name="text5" oscarDB=HIN style="width: 185px; font-family: Arial; font-size: 12px;" tabindex="5">
</div>
<div style="position: absolute; left:50px; top:189px;">
<input type="text" class="noborder" name="text6" oscarDB=doctor style="width: 321px; font-family: Arial; font-size: 12px;" tabindex="6">
</div>
<div style="position: absolute; left:377px; top:189px;">
<input type="text" class="noborder" name="text7" style="width: 323px; font-family: Arial; font-size: 12px;" tabindex="7">
</div>
<div style="position: absolute; left:400px; top:240px;">
<input type="text" class="noborder" name="text8" oscarDB=clinic_fax style="width: 128px; font-family: Arial; font-size: 12px;" tabindex="8">
</div>
<div style="position: absolute; left:582px; top:241px;">
<input type="checkbox" name="checkbox1">
</div>
<!-- ---Ultrasound Examination--- -->
<div style="position: absolute; left:51px; top:281px;">
<input type="checkbox" name="checkbox2">
</div>
<div style="position: absolute; left:127px; top:281px;">
<input type="checkbox" name="checkbox3">
</div>
<div style="position: absolute; left:51px; top:298px;">
<input type="checkbox" name="checkbox4">
</div>
<div style="position: absolute; left:127px; top:298px;">
<input type="checkbox" name="checkbox5">
</div>
<div style="position: absolute; left:51px; top:315px;">
<input type="checkbox" name="checkbox6">
</div>
<div style="position: absolute; left:127px; top:315px;">
<input type="checkbox" name="checkbox7">
</div>
<div style="position: absolute; left:76px; top:332px;">
<input type="checkbox" name="checkbox8">
</div>
<div style="position: absolute; left:51px; top:366px;">
<input type="checkbox" name="checkbox9">
</div>
<div style="position: absolute; left:127px; top:366px;">
<input type="checkbox" name="checkbox10">
</div>
<div style="position: absolute; left:51px; top:382px;">
<input type="checkbox" name="checkbox11">
</div>
<div style="position: absolute; left:51px; top:398px;">
<input type="checkbox" name="checkbox12">
</div>
<div style="position: absolute; left:51px; top:415px;">
<input type="checkbox" name="checkbox13">
</div>
<div style="position: absolute; left:51px; top:449px;">
<input type="checkbox" name="checkbox14">
</div>
<div style="position: absolute; left:120px; top:449px;">
<input type="checkbox" name="checkbox15">
</div>
<div style="position: absolute; left:51px; top:466px;">
<input type="checkbox" name="checkbox16">
</div>
<div style="position: absolute; left:120px; top:466px;">
<input type="checkbox" name="checkbox17">
</div>
<!-- ---X Ray Ultrasound--- -->
<div style="position: absolute; left:378px; top:284px;">
<textarea class="noborder" name="txtarea1" style="height: 147px; width: 320px; font-family: Arial; font-size: 12px;" tabindex="9"></textarea>
</div>
<div style="position: absolute; left:378px; top:435px;">
<input type="checkbox" name="checkbox18">
</div>
<div style="position: absolute; left:378px; top:476px;">
<textarea class="noborder" name="txtarea2" style="height: 110px; width: 320px; font-family: Arial; font-size: 12px;" tabindex="10"></textarea>
</div>
<div style="position: absolute; left:376px; top:611px;">
<input type="text" class="noborder" name="text9" style="width: 325px; font-family: Arial; font-size: 12px;" tabindex="11">
</div>
<!-- ---Fluoroscopic Examination--- -->
<div style="position: absolute; left:51px; top:541px;">
<input type="checkbox" name="checkbox19">
</div>
<div style="position: absolute; left:51px; top:567px;">
<input type="checkbox" name="checkbox20">
</div>
<div style="position: absolute; left:51px; top:592px;">
<input type="checkbox" name="checkbox21">
</div>
<div style="position: absolute; left:51px; top:616px;">
<input type="checkbox" name="checkbox22">
</div>
<!-- ---Clinic locations--- -->
<div style="position: absolute; left:43px; top:853px;">
<input type="checkbox" name="checkbox23">
</div>
<div style="position: absolute; left:255px; top:853px;">
<input type="checkbox" name="checkbox24">
</div>
<!-- ---Appointment Date and Time--- -->
<div style="position: absolute; left:470px; top:875px;">
<input type="text" class="noborder" name="text10" style="width: 230px; font-family: Arial; font-size: 12px;" tabindex="12">
</div>
<!-- --------------------------------------------------------------------- -->
<!-- The submit/print/reset buttons -->
<div style="position: absolute; top: 922px; left: 27px;">
<table>
<tr>
<td class="subjectline">
Subject: <input type="text" name=subject size="40">
<input type="submit" value="Submit" name="B1">
<input type="reset" value="Reset" name="B2">
<input type=button value=Print onclick="javascript:window.print()">
</td>
</tr>
</table>
</div>
</form>
</body>
</html>
