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<script>
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$(function(){
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$( ".txt_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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$('.schedule_time').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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<div class="header_frm_page">
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<span>
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<label class="title4">28 Days Cycle #</label><input type="text" name="txt_cycle" style="width: 15px" />
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<label class="title4">, Day</label><input type="text" name="txt_styDay" style="width: 15px" />
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</span>
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<label class="title2">Vital Signs and AE Query</label>
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</div>
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<br/>
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<table border="0" class="tbl_general">
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<thead>
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<tr>
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<th style="width:80px">Study<br/>Day</th>
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<th style="width:120px">Date<br/><small>DD/MM/YYYY</small></th>
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<th style="width:100px">Interval<br/>Hr pre<br/>or pro dose</th>
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<th>Initial Reading and<br/>Repeat Readings<br/>(check box if needed)</th>
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<th style="width:80px">Time<br/>Hr:Min</th>
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<th style="width:120px">Blood<br/>Pressure<br/>nmHg</th>
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<th style="width:100px">Pulse<br/>Rate<br/>bpm</th>
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<th style="width:100px">Respirations<br/>rpm</th>
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<th style="width:100px;">Temperature<br/>°C</th>
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<th style="width:100px;">AE?<br/>(Y/N)</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><input type="text" name="txt_stdDay" style="width:20px"/></td>
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<td><input type="text" name="txt_date1" style="width:60px" class="txt_date" /></td>
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<td><input type="text" name="txt_interval" value="" style="width:60px" /></td>
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<td>Initial</td>
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<td><input type="text" name="txt_time" style="width:40px" class="schedule_time" /></td>
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<td><input type="text" name="txt_blood" style="width:60px" /></td>
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<td><input type="text" name="txt_pulse" style="width:60px" /></td>
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<td><input type="text" name="txt_respirations" style="width:60px" /></td>
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<td><input type="text" name="txt_dateRep" style="width:60px" /></td>
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<td><select name="ae" class="form_select" style="width: 50px"><option>Yes</option><option>No</option></select></td>
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</tr>
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<tr>
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<td><input type="text" name="txt_date1" style="width:20px" /></td>
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<td><input type="text" name="txt_date1" style="width:60px" class="txt_date" /></td>
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<td><input type="text" name="txt_dateRep" value="" style="width:60px" /></td>
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<td>1st repeat</td>
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<td><input type="text" name="txt_time" style="width:40px" class="schedule_time" /></td>
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<td><input type="text" name="txt_blood" style="width:60px" /></td>
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<td><input type="text" name="txt_pulse" style="width:60px" /></td>
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<td><input type="text" name="txt_respirations" style="width:60px" /></td>
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<td><input type="text" name="txt_dateRep" style="width:60px" /></td>
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<td><select name="ae" class="form_select" style="width: 50px"><option>Yes</option><option>No</option></select></td>
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</tr>
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<tr>
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<td><input type="text" name="txt_date1" style="width:20px" /></td>
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<td><input type="text" name="txt_date1" style="width:60px" class="txt_date" /></td>
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<td><input type="text" name="txt_dateRep" value="" style="width:60px" /></td>
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<td>2nd repeat</td>
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<td><input type="text" name="txt_time" style="width:40px" class="schedule_time" /></td>
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<td><input type="text" name="txt_blood" style="width:60px" /></td>
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<td><input type="text" name="txt_pulse" style="width:60px" /></td>
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<td><input type="text" name="txt_respirations" style="width:60px" /></td>
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<td><input type="text" name="txt_dateRep" style="width:60px" /></td>
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<td><select name="ae" class="form_select" style="width: 50px"><option>Yes</option><option>No</option></select></td>
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</tr>
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<tr>
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<td><input type="text" name="txt_date1" style="width:20px" /></td>
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<td><input type="text" name="txt_date1" style="width:60px" class="txt_date" /></td>
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<td></td>
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<td>Initial</td>
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<td><input type="text" name="txt_time" style="width:40px" class="schedule_time" /></td>
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<td><input type="text" name="txt_blood" style="width:60px" /></td>
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<td><input type="text" name="txt_pulse" style="width:60px" /></td>
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<td><input type="text" name="txt_respirations" style="width:60px" /></td>
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<td><input type="text" name="txt_dateRep" style="width:60px" /></td>
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<td><select name="ae" class="form_select" style="width: 50px"><option>Yes</option><option>No</option></select></td>
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</tr>
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<tr>
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<td><input type="text" name="txt_date1" style="width:20px" /></td>
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<td><input type="text" name="txt_date1" style="width:60px" class="txt_date" /></td>
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<td><input type="text" name="txt_dateRep" value="" style="width:60px" /></td>
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<td>1st repeat</td>
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<td><input type="text" name="txt_time" style="width:40px" class="schedule_time" /></td>
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<td><input type="text" name="txt_blood" style="width:60px" /></td>
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<td><input type="text" name="txt_pulse" style="width:60px" /></td>
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<td><input type="text" name="txt_respirations" style="width:60px" /></td>
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<td><input type="text" name="txt_dateRep" style="width:60px" /></td>
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<td><select name="ae" class="form_select" style="width: 50px"><option>Yes</option><option>No</option></select></td>
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</tr>
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<tr>
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<td><input type="text" name="txt_date1" style="width:20px" /></td>
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<td><input type="text" name="txt_date1" style="width:60px" class="txt_date" /></td>
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<td><input type="text" name="txt_dateRep" value="" style="width:60px" /></td>
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<td>2nd repeat</td>
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<td><input type="text" name="txt_time" style="width:40px" class="schedule_time" /></td>
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<td><input type="text" name="txt_blood" style="width:60px" /></td>
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<td><input type="text" name="txt_pulse" style="width:60px" /></td>
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<td><input type="text" name="txt_respirations" style="width:60px" /></td>
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<td><input type="text" name="txt_dateRep" style="width:60px" /></td>
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<td><select name="ae" class="form_select" style="width: 50px"><option>Yes</option><option>No</option></select></td>
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</tr>
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</tbody>
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</table>
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<a href="#">Add</a>
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