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SJH_Diagnostic_Imaging.html

by dchan — last modified 2006-12-07 15:00

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Size 4.6 kB - File type text/html

File contents


 

<html>

<head>
<meta http-equiv="Content-Type" content="text/html; charset=windows-1252">
<title>Diagnostic Imaging Department</title>

<style type="text/css" media="print">
td.subjectline {
    display:none;
}
input.noborder {
    border : 0px;
    background: transparent;
}

textarea.noscroll{
	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>

<div style="position: absolute; left: 12; top: 16; z-index:'-1'">
	<img SRC="../../OscarDocument/oscar_sfhc/eform/images/DiagnosticImagingDepartment1.GIF">
</div>
<form method="POST" action="savemyform.jsp?demographic_no=92601002&fid=51&form_name=HHS+Radiology+Request+Form">

<div ID="bdiv1" STYLE="position:absolute; visibility:visible; z-index:2; left:405px; top:37px">
	<textarea name="label" class="noscroll" style="height: 110; width: 211; font-family: Arial; font-size: 12px" oscarDB=Label tabindex="1"></textarea>
</div>
	
<div id="bdiv9" style="position:absolute; visibility:visible; z-index:9; left:170px; top:160px;">
	<input type="text" name="CAHS" class="noborder" value style="width: 40px; font-family: Arial; font-size: 12px; text-align: center;" tabindex="2">
</div>
	
<div id="bdiv9" style="position:absolute; visibility:visible; z-index:9; left:257px; top:160px;">
	<input type="text" name="Unit" class="noborder" style="width: 70px; font-family: Arial; font-size: 12px; text-align: center;" tabindex="3">
</div>
	
<div id="bdiv9" style="position:absolute; visibility:visible; z-index:9; left:437px; top:160px;">
	<input type="text" name="OtherFacility" class="noborder" style="width: 203px; font-family: Arial; font-size: 12px;" tabindex="4">
</div>
	
<div id="bdiv9" style="position:absolute; visibility:visible; z-index:9; left:26px; top:225px;">
	<textarea name="ImagingStudiesRequested" class="noscroll" style="height: 80px; width: 300px; font-family: Arial; font-size: 12px;" tabindex="5"></textarea>
</div>
	
<div id="bdiv9" style="position:absolute; visibility:visible; z-index:9; left:355px; top:225px;">
	<textarea name="ClinicalHistory" class="noscroll" style="height: 80px; width: 300px; font-family: Arial; font-size: 12px;" tabindex="6"></textarea>
</div>
	
<div id="bdiv9" style="position:absolute; visibility:visible; z-index:9; left:22px; top:342px">
	<input type="checkbox" name="24Hr" value="checked">
</div>
	
<div id="bdiv9" style="position:absolute; visibility:visible; z-index:9; left:84px; top:342px">
	<input type="checkbox" name="48Hr" value="checked">
</div>
	
<div id="bdiv9" style="position:absolute; visibility:visible; z-index:9; left:355px; top:325px;">
	<textarea name="Medications" class="noscroll" style="height: 50px; width: 300px; font-family: Arial; font-size: 12px;" tabindex="7"></textarea>
</div>
	
<div id="bdiv9" style="position: absolute; visibility: visible; z-index: 9; left: 215px; top: 390px;">
	<input type="text" name="UrgentReportPhone" class="noborder" style="width: 75px; font-family: Arial; font-size: 12px; text-align: center;" tabindex="8">
</div>

<div id="bdiv9" style="position:absolute; visibility:visible; z-index:9; left:325px; top:390px;">
	<input type="text" name="UrgentReportFax" class="noborder" style="width: 75px; font-family: Arial; font-size: 12px; text-align: center;" tabindex="9">
</div>

<div id="bdiv9" style="position:absolute; visibility:visible; z-index:9; left:572px; top:390px;">
		<input type="text" name="UrgentReport" class="noborder" style="width: 100px; font-family: Arial; font-size: 12px; text-align: center;" tabindex="10">
</div>
	
<div id="bdiv3" style="position:absolute; visibility:visible; z-index:4; left:28px; top:430px;">
		<input type="text" name="date" class="noborder" style="width: 170px; font-family: Arial; font-size: 12px; text-align:center" oscardb=Today tabindex="11">
</div>
	
<div id="bdiv9" style="position: absolute; visibility: visible; z-index: 9; left: 16; top: 874; width: 681; height: 25">
	<table>
		<tr>
			<td class="subjectline">Subject: 
				<input type="text" name="subject" size="60">&nbsp;
				<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>
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