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<script>
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$(function() {
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$( ".css_date" ).datepicker({
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showWeek: true,
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dateFormat: 'dd/M/yy',
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firstDay: 1
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});
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$('.shedule_time_PK').timepicker({
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timeOnlyTitle: 'Choose Time',
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timeText:'Time',
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hourText:'Hour',
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minuteText:'Minute',
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secondText:'Second',
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currentText:'Now',
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closeText:'Done'
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});
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});
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</script>
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<style>
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.box-table-a
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{
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font-family: "Verdana";
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font-size: 10px;
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margin: 0px 0 0px 0;
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width: 650px;
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text-align: left;
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border-collapse: collapse;
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}
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.box-table-a th
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{
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font-size: 10px;
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font-weight: normal;
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padding: 5px 0px 5px 0px;
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background: #fff;
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border: 1px solid #000;
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color: #333;
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}
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.box-table-a td
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{
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padding: 8px 3px 8px 5px ;
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background: #fff;
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border: 1px solid #000;
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color: #333;
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border-top: 1px solid transparent;
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}
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.box-table-a tr:hover td
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{
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background: #fff;
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color: #333 ;
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}
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.inputxt_20{
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width: 20px;
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border: 0px !important;
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border-bottom:1px solid #000 !important;
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padding: 0 !important;
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font-size: 10px !important;
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text-align: center !important;
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}
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.inputxt_75{
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width: 75px;
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border: 0px !important;
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border-bottom:1px dashed #000 !important;
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padding: 0 !important;
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font-size:10px !important;
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text-align: center !important;
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}
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.inputxt_80{
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width: 80px;
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border: 0px !important;
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border-bottom:1px solid #000 !important;
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padding: 0 !important;
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font-size:10px !important;
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text-align: center !important;
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}
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.inputxt_40{
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width: 40px;
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border: 0px !important;
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border-bottom:1px solid #000 !important;
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padding: 0 !important;
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font-size: 10px !important;
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text-align: center !important;
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}
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.cbx_css{
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width: 50px;
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border: 1px solid #000;
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font-size: 10px;
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font-family:Verdana;
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}
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.cbx_css80{
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width: 80px;
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border: 1px solid #000;
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font-size: 10px;
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font-family:Verdana;
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}
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.css_comments{
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width: 190px;
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border: 0px solid #f00 !important;
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font-size: 10px;
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font-family:Verdana;
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padding: 0 !important;
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margin: 0 !important;
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}
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.css_textarea{
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font-size: 10px;
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font-family:Verdana;
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width: 200px;
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height: 70px;
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border: 0;
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}
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.css_textarea2{
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font-size: 10px;
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font-family:Verdana;
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width: 130px;
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height: 70px;
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border: 0;
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}
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</style>
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<div style="display: block; width: 100%; text-align: center; font-family: Arial; font-size: 14px; font-weight: bold; padding-top: 10px; padding-bottom: 5px;">
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28 Day Cycle#<input type="text" name="arr_cycle" style="width: 15px" />,<br/>Tumor Assessment<br/>
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by Standard Method (MRI,CT, etc)<br />(use if labs need to be transcribed)
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</div>
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<div style="display: block; width: 100%; text-align: left; padding-top: 25px; margin-bottom: 45px">
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<label for="txt_date" style="float: left; width: 50px;">Date:</label>
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<input type="text" name="txt_date" id="txt_date" class="css_date" style="float:left; color: #666" onfocus="if(this.value=='DD/MMM/YYYY') this.value='';" onblur="if(this.value=='') this.value='DD/MMM/YYYY';" value="DD/MMM/YYYY"/>
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</div>
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<table class="box-table-a" width="100%">
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<thead>
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<tr>
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<th align="center" scope="col" width="15%">Test</th>
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<th align="center" scope="col" width="15%">Result</th>
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<th align="center" scope="col" width="16%">Flag <br /> (Normal/Abnormal)</th>
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<th align="center" scope="col" width="16%">Clinically <br />Significant? (Y/N)</th>
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<th align="center" scope="col" width="15%">Repeated? (Y/N)</th>
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<th align="center" scope="col" >If No, Comments</th>
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</tr>
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</thead>
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<tbody>
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<tr>
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<td align="center">
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<input type="text" name="arr_test[]" class="inputxt_80">
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</td>
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<td align="center">
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<input type="text" name="arr_test[]" class="inputxt_80">
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</td>
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<td align="center">
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<select class="cbx_css80">
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<option value="0">--Select--</option>
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<option value="1">Normal</option>
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<option value="1">Anormal</option>
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</select>
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</td>
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<td align="center">
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<select class="cbx_css80">
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<option value="0">--Select--</option>
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<option value="1">Yes</option>
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<option value="1">No</option>
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</select>
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</td>
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<td align="center">
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<select class="cbx_css80">
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<option value="0">--Select--</option>
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<option value="1">Yes</option>
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<option value="1">No</option>
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</select>
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</td>
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<td align="center">
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<textarea name="arr_comments[]" class="css_textarea2"></textarea>
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</td>
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</tr>
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<tr>
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<td align="center">
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<input type="text" name="arr_test[]" class="inputxt_80">
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</td>
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<td align="center">
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<input type="text" name="arr_test[]" class="inputxt_80">
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</td>
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<td align="center">
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<select class="cbx_css80">
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<option value="0">--Select--</option>
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<option value="1">Normal</option>
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<option value="1">Anormal</option>
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</select>
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</td>
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<td align="center">
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<select class="cbx_css80">
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<option value="0">--Select--</option>
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<option value="1">Yes</option>
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<option value="1">No</option>
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</select>
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</td>
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<td align="center">
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<select class="cbx_css80">
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<option value="0">--Select--</option>
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<option value="1">Yes</option>
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<option value="1">No</option>
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</select>
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</td>
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<td align="center">
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<textarea name="arr_comments[]" class="css_textarea2"></textarea>
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</td>
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</tr>
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</tbody>
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</table>
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<div style="display:block; width: 300px; clear: both; padding-top: 120px ">
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<label style="display:block; width: 150px;">Place copy of <br />Report</label>
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</div>
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<div style="display:block; width: 500px; clear: both; padding-top: 45px ">
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<label style="float:left; width: 150px;">Disease <br />Progression?</label>
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<div style="float:left; width: 50px;">
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<input type="radio" name="arr_disease[]"><br /> Yes
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</div>
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<div style="float:left; width: 150px;">
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<input type="radio" name="arr_disease[]"> <br />No
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</div>
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</div>
|
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