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modificaciones del componente areas
modificaciones del componente areas
arturo - - Load All Authors

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r0:1
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frm_06.php
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/ trunk / components / com_data / views / frm_06.php
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arturo
creando directorios base para el desarrollo
 r0 <?php
?>
<script>
$(function() {
//alert('hola');
$( "#date_exam" ).datepicker({
showWeek: true,
dateFormat: 'dd/M/yy',
firstDay: 1
});
});
</script>
<div style="width:650px; margin:0 auto;">
<table id="" class="" style="" >
<tbody>
<tr>
<td>Date</td>
<td style="text-align:right;"><input type="text" id="date_exam" name="datos[date_exam]" value="" /></td>
</tr>
</tbody>
</table>
<h1>Screening Laboratory Measures</h1>
<h2>(within 21 Days prior to Dose 1)</h2>
<table width="100%" id="" class="" style="" >
<tbody>
<tr>
<td style="text-align:center;"></td>
<td style="text-align:center;">Date Obtained<br/>DD/MMM/YYYY</td>
<td style="text-align:center;">If repeat, List date<br/>DD/MMM/YYYY</td>
</tr>
<tr>
<td style="text-align:left;">Chemistry obtained :</td>
<td style="text-align:center;"><input type="text" id="che_obt" name="datos[che_obt]" value="" /></td>
<td style="text-align:center;"><input type="text" id="che_obt_repeat" name="datos[che_obt_repeat]" value="" /></td>
</tr>
<tr>
<td style="text-align:left;">Hematology obtained :</td>
<td style="text-align:center;"><input type="text" id="hema_obt" name="datos[hema_obt]" value="" /></td>
<td style="text-align:center;"><input type="text" id="hema_obt_repeat" name="datos[hema_obt_repeat]" value="" /></td>
</tr>
<tr>
<td style="text-align:left;">HIV, Hep B & C obtained :</td>
<td style="text-align:center;"><input type="text" id="hiv_hep_obt" name="datos[hiv_hep_obt]" value="" /></td>
<td style="text-align:center;"><input type="text" id="hiv_hep_obt_repeat" name="datos[hiv_hep_obt_repeat]" value="" /></td>
</tr>
<tr>
<td style="text-align:left;">Serum pregnancy obtained :</td>
<td style="text-align:center;"><input type="text" id="sepo_obt" name="datos[sepo_obt]" value="" /></td>
<td style="text-align:center;"><input type="text" id="sepo_obt_repeat" name="datos[sepo_obt_repeat]" value="" /></td>
</tr>
<tr>
<td style="text-align:left;">Urinalysis obtained :</td>
<td style="text-align:center;"><input type="text" id="uo_obt" name="datos[uo_obt]" value="" /></td>
<td style="text-align:center;"><input type="text" id="uo_obt_repeat" name="datos[uo_obt_repeat]" value="" /></td>
</tr>
<tr>
<td style="text-align:left;">Urine Droug screen (indicate if whith or whitout ETOH):</td>
<td style="text-align:center;"><input type="text" id="uds_obt" name="datos[uds_obt]" value="" /></td>
<td style="text-align:center;"><input type="text" id="uds_obt_repeat" name="datos[uds_obt_repeat]" value="" /></td>
</tr>
<tr>
<td style="text-align:left;">Liber functions tests :</td>
<td style="text-align:center;"><input type="text" id="lf_obt" name="datos[lf_obt]" value="" /></td>
<td style="text-align:center;"><input type="text" id="lf_obt_repeat" name="datos[lf_obt_repeat]" value="" /></td>
</tr>
<tr>
<td style="text-align:left;">PT/PTT/INR:</td>
<td style="text-align:center;"><input type="text" id="pt_ptt_inr_obt" name="datos[pt_ptt_inr_obt]" value="" /></td>
<td style="text-align:center;"><input type="text" id="pt_ptt_inr_obt_repeat" name="datos[pt_ptt_inr_obt_repeat]" value="" /></td>
</tr>
</tbody>
<tfoot>
<tr>
<td colspan="4" style="text-align:right;"><input type="submit" value="save" id="btn_save" name="btn_save"><input type="reset" value="clear" id="btn_clear" name="btn_clear"></td>
</tr>
</tfoot>
</table>
</div>