|
|
<script>
|
|
|
$(function() {
|
|
|
$(".txt_DRdate").datepicker({
|
|
|
showWeek: true,
|
|
|
dateFormat: 'dd/M/yy',
|
|
|
firstDay: 1
|
|
|
});
|
|
|
$('.shedule_time_DR').timepicker({
|
|
|
timeOnlyTitle: 'Choose Time',
|
|
|
timeText:'Time',
|
|
|
hourText:'Hour',
|
|
|
minuteText:'Minute',
|
|
|
secondText:'Second',
|
|
|
currentText:'Now',
|
|
|
closeText:'Done'
|
|
|
});
|
|
|
});
|
|
|
</script>
|
|
|
|
|
|
<label>28 Day Cycle# </label><input type="text" name="txt_cycle" style="width: 15px" />
|
|
|
<br/>
|
|
|
<label>Dosing Record</label>
|
|
|
<br/><br/>
|
|
|
<table border="1">
|
|
|
<thead>
|
|
|
<tr>
|
|
|
<th>Date<br/>DD/MM/YYYY</th>
|
|
|
<th>Study<br/>Day</th>
|
|
|
<th>Dosing<br/>Interval</th>
|
|
|
<th>Actual Dosing<br/>Time<br/>Hr:Min</th>
|
|
|
<th>Comments</th>
|
|
|
</tr>
|
|
|
</thead>
|
|
|
<tbody>
|
|
|
<tr><td colspan="5">Treatment Week 1</td></tr>
|
|
|
<tr>
|
|
|
<td width="400px"><input type="text" name="txt_date1" class="txt_DRdate" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" value="1" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" value="1" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" class="shedule_time_DR" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" /></td>
|
|
|
</tr>
|
|
|
<tr>
|
|
|
<td width="400px"><input type="text" name="txt_date1" class="txt_DRdate" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" value="3" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" value="2" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" class="shedule_time_DR" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" /></td>
|
|
|
</tr>
|
|
|
<tr>
|
|
|
<td width="400px"><input type="text" name="txt_date1" class="txt_DRdate" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" value="5" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" value="3" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" class="shedule_time_DR" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" /></td>
|
|
|
</tr>
|
|
|
<tr><td colspan="5">Treatment Week 2</td></tr>
|
|
|
<tr>
|
|
|
<td width="400px"><input type="text" name="txt_date1" class="txt_DRdate" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" value="8" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" value="4" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" class="shedule_time_DR" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" /></td>
|
|
|
</tr>
|
|
|
<tr>
|
|
|
<td width="400px"><input type="text" name="txt_date1" class="txt_DRdate" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" value="10" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" value="5" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" class="shedule_time_DR" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" /></td>
|
|
|
</tr>
|
|
|
<tr>
|
|
|
<td width="400px"><input type="text" name="txt_date1" class="txt_DRdate" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" value="12" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" value="6" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" class="shedule_time_DR" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" /></td>
|
|
|
</tr>
|
|
|
<tr><td colspan="5">Treatment Week 3</td></tr>
|
|
|
<tr>
|
|
|
<td width="400px"><input type="text" name="txt_date1" class="txt_DRdate" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" value="15" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" value="7" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" class="shedule_time_DR" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" /></td>
|
|
|
</tr>
|
|
|
<tr>
|
|
|
<td width="400px"><input type="text" name="txt_date1" class="txt_DRdate" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" value="17" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" value="8" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" class="shedule_time_DR" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" /></td>
|
|
|
</tr>
|
|
|
<tr>
|
|
|
<td width="400px"><input type="text" name="txt_date1" class="txt_DRdate" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" value="19" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" value="9" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" class="shedule_time_DR" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" /></td>
|
|
|
</tr>
|
|
|
<tr><td colspan="5">Treatment Week 4</td></tr>
|
|
|
<tr>
|
|
|
<td width="400px"><input type="text" name="txt_date1" class="txt_DRdate" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" value="22" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" value="10" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" class="shedule_time_DR" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" /></td>
|
|
|
</tr>
|
|
|
<tr>
|
|
|
<td width="400px"><input type="text" name="txt_date1" class="txt_DRdate" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" value="24" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" value="11" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" class="shedule_time_DR" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" /></td>
|
|
|
</tr>
|
|
|
<tr>
|
|
|
<td width="400px"><input type="text" name="txt_date1" class="txt_DRdate" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" value="26" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" value="12" style="width: 20px" /></td>
|
|
|
<td><input type="text" name="txt_dateObt" class="shedule_time_DR" /></td>
|
|
|
<td><input type="text" name="txt_dateRep" /></td>
|
|
|
</tr>
|
|
|
</tbody>
|
|
|
</table>
|