Esempio n. 1
0
echo $result;
?>
> <?php 
xl("Colonoscopy", 'e');
?>
 </label></td></tr> 
  
 </table> 
  
 <table> 
    <tr>
    <td align="left" colspan="2">&nbsp;</td>
  </tr>

 <tr><td align="right" width="150"></td> <td><textarea name="note3"  rows="4" cols="60"><?php 
$result = chkdata_Txt($obj, "note3");
echo $result;
?>
</textarea></td></tr> 
  
 </table> 
<input type="submit" name="submit form" value="submit form" /> 
  
 </form> 
<a href='<?php 
echo $GLOBALS['webroot'];
?>
/interface/patient_file/encounter/<?php 
echo $returnurl;
?>
' onclick='top.restoreSession()'> <?php 
Esempio n. 2
0
  
 <tr><td> abdomen</td> <td><input type="text" name="_abdomen" value="<?php 
$result = chkdata_Txt($obj, "_abdomen");
echo $result;
?>
"></td></tr> 
  
 </table> 
                 </td> 
 
                 <td class='text' colspan="2" style="height: 21px"> 
  
 <table> 
  
 <tr><td> gi gu</td> <td><input type="text" name="_gi_gu" value="<?php 
$result = chkdata_Txt($obj, "_gi_gu");
echo $result;
?>
"></td></tr> 
  
 </table> 
                 </td> 
             </tr> 
 
         </table> 
 <table></table><input type="submit" name="submit form" value="submit form" /> 
  
 </form> 
 <?php 
formFooter();
?>
Esempio n. 3
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 <tr><td class="text" > Subscriber ID #</td><td class="text"   ><input type="text" name="_subscriber_id_number" value="<?php 
$result = chkdata_Txt($obj, "_subscriber_id_number");
echo $result;
?>
"></td></tr> 
  
 </table> 
     </td> 
  
    <td class="text"    style="border:solid 1px #000000"   > 
  
 <table> 
  
 <tr><td class="text" > Group #</td><td class="text"   ><input type="text" name="_group_number" value="<?php 
$result = chkdata_Txt($obj, "_group_number");
echo $result;
?>
"></td></tr> 
  
 </table> 
     </td> 
     </tr> 
  
      
  
     </table> 
     </td> 
     </tr> 
  
      
Esempio n. 4
0
 <tr><td class="text" > Type Of Employment</td> <td class="text" ><input type="text" name="_type_of_employment" value="<?php 
$result = chkdata_Txt($obj, "_type_of_employment");
echo $result;
?>
"></td></tr> 
 </table>                             </td> 
                         </tr> 
  
                         <tr> 
  
                             <td class="text"  style="border: solid 1px #000000" _checking_symptoms_of_nervous_systemscolspan="2"> 
  
 <table> 
  
 <tr><td class="text" > Where Were You Taken Immediately Following Accident</td> <td class="text" ><input type="text" name="_where_were_you_taken_immediately_following_accident" value="<?php 
$result = chkdata_Txt($obj, "_where_were_you_taken_immediately_following_accident");
echo $result;
?>
"></td></tr> 
 </table>                             </td> 
                         </tr> 
  
                         <tr> 
  
                             <td class="text"  style="border: solid 1px #000000" _checking_symptoms_of_nervous_systemscolspan="2"> 
  
 <table> 
  
 <tr><td class="text" > If Taken To The Hospital Did You</td> <td class="text" ><label><input type="checkbox" name="_if_taken_to_the_hospital_did_you[]" value="Go by ambulance" <?php 
$result = chkdata_CB($obj, "_if_taken_to_the_hospital_did_you", "Go by ambulance");
echo $result;
Esempio n. 5
0
echo $result;
?>
"></td></tr> 
  
 </table> 
 </td> 
  
<td class='text'    valign="top"> 
  
 <table> 
  
 <tr><td class='text' > <?php 
xl("Reason", 'e');
?>
 <input type="text" name="reason" value="<?php 
$result = chkdata_Txt($obj, "reason");
echo $result;
?>
"></td></tr> 
  
 </table> 
 </td> 
 </tr> 
  
 </table> 
 <table></table><input type="submit" name="submit form" value="submit form" /> 
  
 </form> 
 <?php 
formFooter();
?>
Esempio n. 6
0
?>
"></td></tr> 
  
 </table> 
                     </td> 
                 </tr>   
 
 <tr><td class='text'  colspan='3'> 
  
 <table> 
  
 <tr><td class='text' > <?php 
xl("Examination", 'e');
?>
 </td> <td class='text' ><textarea name="examination"  rows="4" cols="40"><?php 
$result = chkdata_Txt($obj, "examination");
echo $result;
?>
</textarea></td></tr> 
  
 </table> 
 </td></tr>             
 
                  
 
             </table> 
         </td> 
     </tr> 
 
 </table> 
 <table></table><input type="submit" name="submit form" value="submit form" />