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        arturo
    
creando directorios base para el desarrollo

              r0
            
      <label>ECG</label><br/>

      <label>28 Cycle 1 Dosing Day 1</label>

      <br/><br/>

      <label>Rate: </label><input type="text" name="txt_rate" />&nbsp;<label>Intervals: </label>

      <input type="checkbox" name="chk_opt1" />PR

      <input type="checkbox" name="chk_opt2" />QRS

      <input type="checkbox" name="chk_opt3" />QT

      <input type="checkbox" name="chk_opt4" />QTc

      <br/><br/>

      <label>Machine Interpretation: </label><br/>

      <textarea cols="50" rows="5"></textarea>

      <br/>

      <label>Does the Investigator agree or disagree with this interpretation?</label><br/>

      <input type="radio" name="rbn_opt" />Agree

      <input type="radio" name="rbn_opt" />Disagree

      <br/><br/>

      <label>*If disagrees, alternative interpretation must be provided below:</label><br/>

      <textarea cols="50" rows="5"></textarea>

      <br/>

      <label>Were findings clinically significant?</label><br/>

      <input type="radio" name="rbn_opt" />Yes**

      <input type="radio" name="rbn_opt" />No

      <br/><label>**Report on AE page.</label>

      <br/><br/>

      <table border="1">

      <thead>

      <tr>

          <th>Date<br/>DD/MM/YYYY</th>

          <th>Interval<br/>Hoour</th>

          <th>Select<br/>Appropiate</th>

          <th>Target</th>

          <th>Actual Time</th>

      </tr>

      </thead>

      <tbody>

      <tr>

          <td><input type="text" name="txt_date1" /></td>

          <td>Immediately<br/>(Pre-Dose)</td>

          <td><input type="text" name="txt_dateRep" value="" /></td>

          <td><input type="text" name="txt_dateRep" value="" /></td>

          <td><input type="text" name="txt_dateRep" /></td>

      </tr>

      <tr>

          <td></td>

          <td>End of<br/>Infusion(hr. 4)</td>

          <td><input type="text" name="txt_dateRep" value="" /></td>

          <td><input type="text" name="txt_date1" /></td>

          <td><input type="text" name="txt_dateRep" /></td>

      </tr>

      </tbody>

      </table>

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arturo creando directorios base para el desarrollo	r0	<label>ECG</label><br/>
		<label>28 Cycle 1 Dosing Day 1</label>
		<br/><br/>
		<label>Rate: </label><input type="text" name="txt_rate" /> <label>Intervals: </label>
		<input type="checkbox" name="chk_opt1" />PR
		<input type="checkbox" name="chk_opt2" />QRS
		<input type="checkbox" name="chk_opt3" />QT
		<input type="checkbox" name="chk_opt4" />QTc
		<br/><br/>
		<label>Machine Interpretation: </label><br/>
		<textarea cols="50" rows="5"></textarea>
		<br/>
		<label>Does the Investigator agree or disagree with this interpretation?</label><br/>
		<input type="radio" name="rbn_opt" />Agree
		<input type="radio" name="rbn_opt" />Disagree
		<br/><br/>
		<label>*If disagrees, alternative interpretation must be provided below:</label><br/>
		<textarea cols="50" rows="5"></textarea>
		<br/>
		<label>Were findings clinically significant?</label><br/>
		<input type="radio" name="rbn_opt" />Yes**
		<input type="radio" name="rbn_opt" />No
		<br/><label>**Report on AE page.</label>
		<br/><br/>
		<table border="1">
		<thead>
		<tr>
		<th>Date<br/>DD/MM/YYYY</th>
		<th>Interval<br/>Hoour</th>
		<th>Select<br/>Appropiate</th>
		<th>Target</th>
		<th>Actual Time</th>
		</tr>
		</thead>
		<tbody>
		<tr>
		<td><input type="text" name="txt_date1" /></td>
		<td>Immediately<br/>(Pre-Dose)</td>
		<td><input type="text" name="txt_dateRep" value="" /></td>
		<td><input type="text" name="txt_dateRep" value="" /></td>
		<td><input type="text" name="txt_dateRep" /></td>
		</tr>
		<tr>
		<td></td>
		<td>End of<br/>Infusion(hr. 4)</td>
		<td><input type="text" name="txt_dateRep" value="" /></td>
		<td><input type="text" name="txt_date1" /></td>
		<td><input type="text" name="txt_dateRep" /></td>
		</tr>
		</tbody>
		</table>