frm_51.php
62 lines
| 3.4 KiB
| text/x-php
|
XmlPhpLexer
|
r0 | <script> | |
$(function() { | |||
$( "#txt_date" ).datepicker({ | |||
showWeek: true, | |||
dateFormat: 'dd/M/yy', | |||
firstDay: 1 | |||
}); | |||
}); | |||
</script> | |||
<div class="header_frm_page"> | |||
<label class="title1">At the MTD</label> | |||
<label class="title1">Liver Function Tests</label> | |||
<label class="title3">(Use if need to be transcribed)</label> | |||
</div> | |||
<span> | |||
<label>Date of Report:</label> | |||
<input type="text" id="txt_date" name="txt_date" style="border-top: 0; border-right: 0; border-left: 0; text-align: center" onfocus="if(this.value=='DD/MMM/YYYY') this.value='';" onblur="if(this.value=='') this.value='DD/MMM/YYYY';" value="DD/MMM/YYYY" /> | |||
</span> | |||
<table class="tbl_general"> | |||
<thead> | |||
<tr><th style="width:120px">Test</th> | |||
<th style="width:120px">Result</th> | |||
<th style="width:100px">Flag<br/>(Normal/<br/>Abnormal)</th> | |||
<th style="width:80px">Clinically<br/>Significant<br/>(Y/N)?</th> | |||
<th style="width:80px">Repeated?<br/>(Y/N)</th> | |||
<th style="width:120px">If No,<br/><small>Comment</small></th> | |||
</tr> | |||
</thead> | |||
<tbody> | |||
<tr> | |||
<td><input type="text" name="txt_test" style="width:120px" /></td> | |||
<td><input type="text" name="txt_result" style="width:120px" /></td> | |||
<td><select name="flag" class="form_select" style="width: 80px"><option>Normal</option><option>Abnormal</option></select></td> | |||
<td><select name="clinical" class="form_select" style="width: 60px"><option>Yes</option><option>No</option></select></td> | |||
<td><select name="repeat" class="form_select" style="width: 60px"><option>Yes</option><option>No</option></select></td> | |||
<td><input type="text" name="txt_comment" style="width:120px" /></td> | |||
</tr> | |||
<tr> | |||
<td><input type="text" name="txt_test" style="width:120px" /></td> | |||
<td><input type="text" name="txt_result" style="width:120px" /></td> | |||
<td><select name="flag" class="form_select" style="width: 80px"><option>Normal</option><option>Abnormal</option></select></td> | |||
<td><select name="clinical" class="form_select" style="width: 60px"><option>Yes</option><option>No</option></select></td> | |||
<td><select name="repeat" class="form_select" style="width: 60px"><option>Yes</option><option>No</option></select></td> | |||
<td><input type="text" name="txt_comment" style="width:120px" /></td> | |||
</tr> | |||
<tr> | |||
<td><input type="text" name="txt_test" style="width:120px" /></td> | |||
<td><input type="text" name="txt_result" style="width:120px" /></td> | |||
<td><select name="flag" class="form_select" style="width: 80px"><option>Normal</option><option>Abnormal</option></select></td> | |||
<td><select name="clinical" class="form_select" style="width: 60px"><option>Yes</option><option>No</option></select></td> | |||
<td><select name="repeat" class="form_select" style="width: 60px"><option>Yes</option><option>No</option></select></td> | |||
<td><input type="text" name="txt_comment" style="width:120px" /></td> | |||
</tr> | |||
<tr> | |||
<td><input type="text" name="txt_test" style="width:120px" /></td> | |||
<td><input type="text" name="txt_result" style="width:120px" /></td> | |||
<td><select name="flag" class="form_select" style="width: 80px"><option>Normal</option><option>Abnormal</option></select></td> | |||
<td><select name="clinical" class="form_select" style="width: 60px"><option>Yes</option><option>No</option></select></td> | |||
<td><select name="repeat" class="form_select" style="width: 60px"><option>Yes</option><option>No</option></select></td> | |||
<td><input type="text" name="txt_comment" style="width:120px" /></td> | |||
</tr> | |||
</tbody> | |||
</table> |