frm_32.php
646 lines
| 36.1 KiB
| text/x-php
|
XmlPhpLexer
|
r0 | <script> | |
$(function() { | |||
$( ".css_date" ).datepicker({ | |||
showWeek: true, | |||
dateFormat: 'dd/M/yy', | |||
firstDay: 1 | |||
}); | |||
$('.schedule_time').timepicker({ | |||
timeOnlyTitle: 'Choose Time', | |||
timeText:'Time', | |||
hourText:'Hour', | |||
minuteText:'Minute', | |||
secondText:'Second', | |||
currentText:'Now', | |||
closeText:'Done' | |||
}); | |||
}); | |||
</script> | |||
<style> | |||
.box-table-a | |||
{ | |||
font-family: "Verdana"; | |||
font-size: 9px; | |||
margin: 0px 0 0px 0; | |||
width: 650px; | |||
text-align: left; | |||
border-collapse: collapse; | |||
} | |||
.box-table-a th | |||
{ | |||
font-size: 8px; | |||
font-weight: normal; | |||
padding: 5px 0px 5px 0px; | |||
background: #fff; | |||
border: 1px solid #000; | |||
color: #333; | |||
} | |||
.box-table-a td | |||
{ | |||
padding: 8px 3px 8px 5px ; | |||
background: #fff; | |||
border: 1px solid #000; | |||
color: #333; | |||
border-top: 1px solid transparent; | |||
} | |||
.box-table-a tr:hover td | |||
{ | |||
background: #fff; | |||
color: #333 ; | |||
} | |||
.inputxt_20{ | |||
width: 20px; | |||
border: 0px !important; | |||
border-bottom:1px solid #000 !important; | |||
padding: 0 !important; | |||
font-size: 8px !important; | |||
text-align: center !important; | |||
} | |||
.inputxt_75{ | |||
width: 75px; | |||
border: 0px !important; | |||
border-bottom:1px dashed #000 !important; | |||
padding: 0 !important; | |||
font-size: 8px !important; | |||
text-align: center !important; | |||
} | |||
.inputxt_40{ | |||
width: 40px; | |||
border: 0px !important; | |||
border-bottom:1px solid #000 !important; | |||
padding: 0 !important; | |||
font-size: 8px !important; | |||
text-align: center !important; | |||
} | |||
.cbx_css{ | |||
width: 50px; | |||
border: 1px solid #000; | |||
font-size: 8px; | |||
font-family:Verdana; | |||
} | |||
</style> | |||
<div style="width: 650px; margin: 0pt auto;"> | |||
<div style="display: block; width: 100%; text-align: center; font-family: Arial; font-size: 14px; font-weight: bold; padding-top: 10px; padding-bottom: 5px;"> | |||
28 Day Cycle #<input type="text" name="arr_cycle" style="width: 15px" />, Day <input type="text" name="arr_day" style="width: 15px" /><br /> | |||
Vital Signs and AE Query | |||
</div> | |||
<div style="clear: both; height: 20px; width: 100%"></div> | |||
<table class="box-table-a" width="100%"> | |||
<thead> | |||
<tr> | |||
<th align="center" scope="col" width="5%">Study Day</th> | |||
<th align="center" scope="col" width="13%">Date<br />DD/MMM/YYYY</th> | |||
<th align="center" scope="col" width="7%">Interval <br />Hr pre<br /> or post<br /> dose</th> | |||
<th align="center" scope="col" width="14%">Initial Reading and Repeat Readings (check boc if needed)</th> | |||
<th align="center" scope="col" width="10%">Time <br /> Hr: Min</th> | |||
<th align="center" scope="col" width="20%">Blood Pressure<br />mmHg</th> | |||
<th align="center" scope="col" width="8%">Pulse Rate <br />bmp</th> | |||
<th align="center" scope="col" width="8%">Respirations<br />rpm</th> | |||
<th align="center" scope="col" width="8%">Temperature<br />ºC</th> | |||
<th align="center" scope="col" >AE <br />(Y/N)</th> | |||
</tr> | |||
</thead> | |||
<tbody> | |||
<tr> | |||
<td align="center"> | |||
<input type="text" name="arr_studyday[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_date[]" class="inputxt_75 css_date" onfocus="if(this.value=='DD/MMM/YYYY') this.value='';" onblur="if(this.value=='') this.value='DD/MMM/YYYY';" value="DD/MMM/YYYY"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_interval[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
Initial | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_time[]" class="schedule_time inputxt_40" onfocus="if(this.value=='00:00') this.value='';" onblur="if(this.value=='') this.value='00:00';" value="00:00"/> | |||
</td> | |||
<td align="center"> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood1[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Supine</div> | |||
</div> | |||
<div style="width: 3px; float: left; border: 0px solid #f00; padding-left: 5px; padding-right: 5px;padding-top: 5px"> / </div> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood2[]"style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Standing</div> | |||
</div> | |||
<div style="font-size: 8px;float: right; border: 0px solid #f00; padding-right: 5px; padding-top: 5px"> <strong>mmHg</strong> </div> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_pulse[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_respirations[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_temperature[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<select name="cbx_ae[]" class="cbx_css"> | |||
<option value="0">Select</option> | |||
<option value="1">Yes</option> | |||
<option value="2">No</option> | |||
</select> | |||
</td> | |||
</tr> | |||
<tr> | |||
<td align="center"> | |||
<input type="text" name="arr_studyday[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_date[]" class="inputxt_75 css_date" /> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_interval[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="checkbox" name="arr_initial[]" style="float:left" /> 1st repeat | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_time[]" class="schedule_time inputxt_40" onfocus="if(this.value=='DD/MMM/YYYY') this.value='';" onblur="if(this.value=='') this.value='00:00';" value="00:00"/> | |||
</td> | |||
<td align="center"> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood1[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Supine</div> | |||
</div> | |||
<div style="width: 3px; float: left; border: 0px solid #f00; padding-left: 5px; padding-right: 5px;padding-top: 5px"> / </div> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood2[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Standing</div> | |||
</div> | |||
<div style="font-size: 8px;float: right; border: 0px solid #f00; padding-right: 5px; padding-top: 5px"> <strong>mmHg</strong> </div> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_pulse[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_respirations[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_temperature[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center" style="background-color: #A6A6A6"> | |||
<select name="cbx_ae" class="cbx_css"> | |||
<option value="0">Select</option> | |||
<option value="1">Yes</option> | |||
<option value="2">No</option> | |||
</select> | |||
</td> | |||
</tr> | |||
<tr> | |||
<td align="center"> | |||
<input type="text" name="arr_studyday[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_date[]" class="inputxt_75 css_date" /> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_interval[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="checkbox" name="arr_initial[]" style="float:left" /> 2st repeat | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_time[]" class="schedule_time inputxt_40" onfocus="if(this.value=='DD/MMM/YYYY') this.value='';" onblur="if(this.value=='') this.value='00:00';" value="00:00"/> | |||
</td> | |||
<td align="center"> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood1[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Supine</div> | |||
</div> | |||
<div style="width: 3px; float: left; border: 0px solid #f00; padding-left: 5px; padding-right: 5px;padding-top: 5px"> / </div> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood2[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Standing</div> | |||
</div> | |||
<div style="font-size: 8px;float: right; border: 0px solid #f00; padding-right: 5px; padding-top: 5px"> <strong>mmHg</strong> </div> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_pulse[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_respirations[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_temperature[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center" style="background-color: #A6A6A6"> | |||
<select name="cbx_ae" class="cbx_css"> | |||
<option value="0">Select</option> | |||
<option value="1">Yes</option> | |||
<option value="2">No</option> | |||
</select> | |||
</td> | |||
</tr> | |||
<tr> | |||
<td align="center"> | |||
<input type="text" name="arr_studyday[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center" style="background-color: #A6A6A6; "> | |||
<input type="text" name="arr_date[]" style="background-color: #A6A6A6; color:#fff" class="inputxt_75 css_date" onfocus="if(this.value=='') this.value='';" onblur="if(this.value=='') this.value='';" value=""/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_interval[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
Initial | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_time[]" class="schedule_time inputxt_40" onfocus="if(this.value=='00:00') this.value='';" onblur="if(this.value=='') this.value='00:00';" value="00:00"/> | |||
</td> | |||
<td align="center"> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood1[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Supine</div> | |||
</div> | |||
<div style="width: 3px; float: left; border: 0px solid #f00; padding-left: 5px; padding-right: 5px;padding-top: 5px"> / </div> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood2[]"style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Standing</div> | |||
</div> | |||
<div style="font-size: 8px;float: right; border: 0px solid #f00; padding-right: 5px; padding-top: 5px"> <strong>mmHg</strong> </div> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_pulse[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_respirations[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_temperature[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<select name="cbx_ae[]" class="cbx_css"> | |||
<option value="0">Select</option> | |||
<option value="1">Yes</option> | |||
<option value="2">No</option> | |||
</select> | |||
</td> | |||
</tr> | |||
<tr> | |||
<td align="center"> | |||
<input type="text" name="arr_studyday[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_date[]" class="inputxt_75 css_date" /> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_interval[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="checkbox" name="arr_initial[]" style="float:left" /> 1st repeat | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_time[]" class="schedule_time inputxt_40" onfocus="if(this.value=='DD/MMM/YYYY') this.value='';" onblur="if(this.value=='') this.value='00:00';" value="00:00"/> | |||
</td> | |||
<td align="center"> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood1[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Supine</div> | |||
</div> | |||
<div style="width: 3px; float: left; border: 0px solid #f00; padding-left: 5px; padding-right: 5px;padding-top: 5px"> / </div> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood2[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Standing</div> | |||
</div> | |||
<div style="font-size: 8px;float: right; border: 0px solid #f00; padding-right: 5px; padding-top: 5px"> <strong>mmHg</strong> </div> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_pulse[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_respirations[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_temperature[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center" style="background-color: #A6A6A6"> | |||
<select name="cbx_ae" class="cbx_css"> | |||
<option value="0">Select</option> | |||
<option value="1">Yes</option> | |||
<option value="2">No</option> | |||
</select> | |||
</td> | |||
</tr> | |||
<tr> | |||
<td align="center"> | |||
<input type="text" name="arr_studyday[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_date[]" class="inputxt_75 css_date" /> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_interval[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="checkbox" name="arr_initial[]" style="float:left" /> 2st repeat | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_time[]" class="schedule_time inputxt_40" onfocus="if(this.value=='DD/MMM/YYYY') this.value='';" onblur="if(this.value=='') this.value='00:00';" value="00:00"/> | |||
</td> | |||
<td align="center"> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood1[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Supine</div> | |||
</div> | |||
<div style="width: 3px; float: left; border: 0px solid #f00; padding-left: 5px; padding-right: 5px;padding-top: 5px"> / </div> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood2[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Standing</div> | |||
</div> | |||
<div style="font-size: 8px;float: right; border: 0px solid #f00; padding-right: 5px; padding-top: 5px"> <strong>mmHg</strong> </div> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_pulse[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_respirations[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_temperature[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center" style="background-color: #A6A6A6"> | |||
<select name="cbx_ae" class="cbx_css"> | |||
<option value="0">Select</option> | |||
<option value="1">Yes</option> | |||
<option value="2">No</option> | |||
</select> | |||
</td> | |||
</tr> | |||
<tr> | |||
<td align="center"> | |||
<input type="text" name="arr_studyday[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_date[]" class="inputxt_75 css_date" onfocus="if(this.value=='DD/MMM/YYYY') this.value='';" onblur="if(this.value=='') this.value='DD/MMM/YYYY';" value="DD/MMM/YYYY"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_interval[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
Initial | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_time[]" class="schedule_time inputxt_40" onfocus="if(this.value=='DD/MMM/YYYY') this.value='';" onblur="if(this.value=='') this.value='00:00';" value="00:00"/> | |||
</td> | |||
<td align="center"> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood1[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Supine</div> | |||
</div> | |||
<div style="width: 3px; float: left; border: 0px solid #f00; padding-left: 5px; padding-right: 5px;padding-top: 5px"> / </div> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood2[]"style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Standing</div> | |||
</div> | |||
<div style="font-size: 8px;float: right; border: 0px solid #f00; padding-right: 5px; padding-top: 5px"> <strong>mmHg</strong> </div> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_pulse[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_respirations[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_temperature[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<select name="cbx_ae[]" class="cbx_css"> | |||
<option value="0">Select</option> | |||
<option value="1">Yes</option> | |||
<option value="2">No</option> | |||
</select> | |||
</td> | |||
</tr> | |||
<tr> | |||
<td align="center"> | |||
<input type="text" name="arr_studyday[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_date[]" class="inputxt_75 css_date" /> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_interval[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="checkbox" name="arr_initial[]" style="float:left" /> 1st repeat | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_time[]" class="schedule_time inputxt_40" onfocus="if(this.value=='DD/MMM/YYYY') this.value='';" onblur="if(this.value=='') this.value='00:00';" value="00:00"/> | |||
</td> | |||
<td align="center"> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood1[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Supine</div> | |||
</div> | |||
<div style="width: 3px; float: left; border: 0px solid #f00; padding-left: 5px; padding-right: 5px;padding-top: 5px"> / </div> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood2[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Standing</div> | |||
</div> | |||
<div style="font-size: 8px;float: right; border: 0px solid #f00; padding-right: 5px; padding-top: 5px"> <strong>mmHg</strong> </div> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_pulse[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_respirations[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_temperature[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center" style="background-color: #A6A6A6"> | |||
<select name="cbx_ae" class="cbx_css"> | |||
<option value="0">Select</option> | |||
<option value="1">Yes</option> | |||
<option value="2">No</option> | |||
</select> | |||
</td> | |||
</tr> | |||
<tr> | |||
<td align="center"> | |||
<input type="text" name="arr_studyday[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_date[]" class="inputxt_75 css_date" /> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_interval[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="checkbox" name="arr_initial[]" style="float:left" /> 2st repeat | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_time[]" class="schedule_time inputxt_40" onfocus="if(this.value=='DD/MMM/YYYY') this.value='';" onblur="if(this.value=='') this.value='00:00';" value="00:00"/> | |||
</td> | |||
<td align="center"> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood1[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Supine</div> | |||
</div> | |||
<div style="width: 3px; float: left; border: 0px solid #f00; padding-left: 5px; padding-right: 5px;padding-top: 5px"> / </div> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood2[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Standing</div> | |||
</div> | |||
<div style="font-size: 8px;float: right; border: 0px solid #f00; padding-right: 5px; padding-top: 5px"> <strong>mmHg</strong> </div> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_pulse[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_respirations[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_temperature[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center" style="background-color: #A6A6A6"> | |||
<select name="cbx_ae" class="cbx_css"> | |||
<option value="0">Select</option> | |||
<option value="1">Yes</option> | |||
<option value="2">No</option> | |||
</select> | |||
</td> | |||
</tr> | |||
<tr> | |||
<td align="center"> | |||
<input type="text" name="arr_studyday[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center" style="background-color: #A6A6A6; "> | |||
<input type="text" name="arr_date[]" style="background-color: #A6A6A6; color:#fff" class="inputxt_75 css_date" onfocus="if(this.value=='') this.value='';" onblur="if(this.value=='') this.value='';" value=""/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_interval[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
Initial | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_time[]" class="schedule_time inputxt_40" onfocus="if(this.value=='DD/MMM/YYYY') this.value='';" onblur="if(this.value=='') this.value='00:00';" value="00:00"/> | |||
</td> | |||
<td align="center"> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood1[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Supine</div> | |||
</div> | |||
<div style="width: 3px; float: left; border: 0px solid #f00; padding-left: 5px; padding-right: 5px;padding-top: 5px"> / </div> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood2[]"style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Standing</div> | |||
</div> | |||
<div style="font-size: 8px;float: right; border: 0px solid #f00; padding-right: 5px; padding-top: 5px"> <strong>mmHg</strong> </div> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_pulse[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_respirations[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_temperature[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center" style="background-color: #A6A6A6"> | |||
<select name="cbx_ae[]" class="cbx_css"> | |||
<option value="0">Select</option> | |||
<option value="1">Yes</option> | |||
<option value="2">No</option> | |||
</select> | |||
</td> | |||
</tr> | |||
<tr> | |||
<td align="center"> | |||
<input type="text" name="arr_studyday[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_date[]" class="inputxt_75 css_date" /> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_interval[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="checkbox" name="arr_initial[]" style="float:left" /> 1st repeat | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_time[]" class="schedule_time inputxt_40" onfocus="if(this.value=='DD/MMM/YYYY') this.value='';" onblur="if(this.value=='') this.value='00:00';" value="00:00"/> | |||
</td> | |||
<td align="center"> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood1[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Supine</div> | |||
</div> | |||
<div style="width: 3px; float: left; border: 0px solid #f00; padding-left: 5px; padding-right: 5px;padding-top: 5px"> / </div> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood2[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Standing</div> | |||
</div> | |||
<div style="font-size: 8px;float: right; border: 0px solid #f00; padding-right: 5px; padding-top: 5px"> <strong>mmHg</strong> </div> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_pulse[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_respirations[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_temperature[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center" style="background-color: #A6A6A6"> | |||
<select name="cbx_ae" class="cbx_css"> | |||
<option value="0">Select</option> | |||
<option value="1">Yes</option> | |||
<option value="2">No</option> | |||
</select> | |||
</td> | |||
</tr> | |||
<tr> | |||
<td align="center"> | |||
<input type="text" name="arr_studyday[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_date[]" class="inputxt_75 css_date" /> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_interval[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="checkbox" name="arr_initial[]" style="float:left" /> 2st repeat | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_time[]" class="schedule_time inputxt_40" onfocus="if(this.value=='DD/MMM/YYYY') this.value='';" onblur="if(this.value=='') this.value='00:00';" value="00:00"/> | |||
</td> | |||
<td align="center"> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood1[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Supine</div> | |||
</div> | |||
<div style="width: 3px; float: left; border: 0px solid #f00; padding-left: 5px; padding-right: 5px;padding-top: 5px"> / </div> | |||
<div style="width: 25px; float: left; border: 0px solid #f00"> | |||
<input type="text" name="arr_blood2[]" style="width: 90%; border-left:0; border-right: 0; border-top: 0; border-bottom: 1px solid #000"/> | |||
<div style="display: block; font-size: 8px; text-align: center; width: 100%; ">Standing</div> | |||
</div> | |||
<div style="font-size: 8px;float: right; border: 0px solid #f00; padding-right: 5px; padding-top: 5px"> <strong>mmHg</strong> </div> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_pulse[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_respirations[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center"> | |||
<input type="text" name="arr_temperature[]" class="inputxt_20"/> | |||
</td> | |||
<td align="center" style="background-color: #A6A6A6"> | |||
<select name="cbx_ae" class="cbx_css"> | |||
<option value="0">Select</option> | |||
<option value="1">Yes</option> | |||
<option value="2">No</option> | |||
</select> | |||
</td> | |||
</tr> | |||
</tbody> | |||
</table> | |||
</div> |