##// END OF EJS Templates
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modificada la instancia de la clase SessionModel
modificada la instancia de la clase SessionModel
arturo - - Load All Authors

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r0:1
r11:12
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frm_65.php
44 lines | 1.6 KiB | text/x-php | XmlPhpLexer
/ trunk / components / com_data / views / frm_65.php
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<?php
?>
<script>
$(function() {
$( "#txt_date" ).datepicker({
showWeek: true,
dateFormat: 'dd/M/yy',
firstDay: 1
});
$( "#txt_dateDeath" ).datepicker({
showWeek: true,
dateFormat: 'dd/M/yy',
firstDay: 1
});
});
</script>
<label>End of Treatment Follow Up Period<br/>(Contact Subject every 2-3 M&omicron; for 6 Months)</label><br/><br/>
<label>Contact Date: </label><input type="text" name="txt_date" id="txt_date" /><br/><br/>
<label>Has the subject experienced any AEs?</label>&nbsp;
<input type="radio" name="rbn_opt"/>Yes&nbsp;&nbsp;<input type="radio" name="rbn_opt"/>No*<br/>
<small>*If yes, document AEs</small><br/><br/>
<label>Primary reason for early termination (Select only one). Comment required below.</label><br/>
<input type="checkbox" name="chkReasons"/>Adverse Event<br/>
<input type="checkbox" name="chkReasons"/>Death<br/>
<input type="checkbox" name="chkReasons"/>Protocol Violation<br/>
<input type="checkbox" name="chkReasons"/>Noncompliance<br/>
<input type="checkbox" name="chkReasons"/>Lost to follow-up<br/>
<input type="checkbox" name="chkReasons"/>Voluntary withdrawal<br/>
<input type="checkbox" name="chkReasons"/>Other<br/>
<br/>
<label>Date of death: </label><input type="text" name="txt_dateDeath" id="txt_dateDeath" value="" /><br/>
<label>Comments required:</label><br/>
<textarea name="txa_comment" cols="50" rows="5"></textarea>
<br/><br/>
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