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Colposcopy_Bookng_Form_JPOCSC.html

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HTML icon Colposcopy_Bookng_Form_JPOCSC.html — HTML, 18 kB (18533 bytes)

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<html>
<head>
<title>Colposcopy_Bookng_Form_JPOCSC</title>
<style type="text/css" media="print">
 .DoNotPrint {
	 display: none;
 }
 .noborder {
	 border : 0px;
	 background: transparent;
	 scrollbar-3dlight-color: transparent;
	 scrollbar-3dlight-color: transparent;
	 scrollbar-arrow-color: transparent;
	 scrollbar-base-color: transparent;
	 scrollbar-darkshadow-color: transparent;
	 scrollbar-face-color: transparent;
	 scrollbar-highlight-color: transparent;
	 scrollbar-shadow-color: transparent;
	 scrollbar-track-color: transparent;
	 background: transparent;
	 overflow: hidden;
 }
 </style>
 
 	<script language="javascript" type="text/javascript">
		/****************************
		startup functions 
		****************************/
		function startUp()
		{			
			// shows the forms on development machine from notepad ++ - saves you from uploading to the server to input alignments
			var strLoc = window.location.href.toLowerCase();
			if(strLoc.indexOf("https") == -1)
			{
				//page1
				var src = document.getElementById('BGImage').src;				
				document.getElementById('BGImage').src = src.replace('$%7Boscar_image_path%7D','');
			}
		}
		
		


		
		/****************************
			submit and print functions 
		****************************/
		function printSubmit()
		{
			printLetter();
			releaseDirtyFlag();			
			submission();
		}

		function printLetter()
		{
			// hide the bottom buttons
			if (document.getElementById('BottomButtons').style.display == '')
				document.getElementById('BottomButtons').style.display = 'none';
			// print the letter
			window.print();
		} 

		function submission()
		{
			setFlag();
			setTimeout('document.FormName.submit()',1000);			
		}

		function setFlag()
		{
		// indicate that the form has been submitted
		if (document.getElementById("newForm").value == 'True')
			document.getElementById("newForm").value = 'False';
		}
		
		function showButtons()
		{
			//show the bottom buttons if they are hidden
			if (document.getElementById('BottomButtons').style.display == 'none')
				document.getElementById('BottomButtons').style.display = '';
		}
		
		/****************************
			checkbox functions 
		****************************/
		function changeValue(x)
		{
			if (document.getElementById(x).value == '')
				document.getElementById(x).value = 'X';
			else
				document.getElementById(x).value = '';
		}

		function displayKeyCode(evt,x)
		{
			var charCode = (evt.which) ? evt.which : event.keyCode
			// any key press except tab will constitute a value change to the checkbox
			if (charCode != 9)
			{
				changeValue(x);
				return false;
			}
		}
</script>

<!-----------------script for current date--------->

<script language="javascript">

<!-- hide javascript

function doDate() {
      var digital = new Date();
      var days = digital.getDate();
      var months = digital.getMonth()*1 +1;
      var years = digital.getFullYear();
      var date =" " + days + "/" + months + "/" + years + " " ;
      return date;
}

// done hiding -->

</script>

<!--------------------- calendar code ---------------------------------------------------->

<link rel="stylesheet" type="text/css" media="all" href="../share/calendar/calendar.css" title="win2k-cold-1" />


<!-- main calendar program -->


<script type="text/javascript" src="../share/calendar/calendar.js">
</script>


<!-- language for the calendar -->


<script type="text/javascript" src="../share/calendar/lang/calendar-en.js">
</script>


<!-- the following script defines the Calendar.setup helper function, which makes
       adding a calendar a matter of 1 or 2 lines of code. -->


<script type="text/javascript" src="../share/calendar/calendar-setup.js">
</script>

<!--------------------- end calendar code ---------------------------------------------------->



<script language="javascript">
function formPrint(){
			window.print();
} 
</script>

<!-- scripts to confirm closing of window if it hadn't been saved yet -->
<script language="javascript">
//keypress events trigger dirty flag
var needToConfirm = false;
document.onkeyup=setDirtyFlag;
function setDirtyFlag(){
		needToConfirm = true;
}
function releaseDirtyFlag(){
		needToConfirm = false; //Call this function if doesn't requires an alert.
//this could be called when save button is clicked
}
window.onbeforeunload = confirmExit;
function confirmExit(){
	 if (needToConfirm){
		 return "You have attempted to leave this page. If you have made any changes to the fields without clicking the Save button, your changes will be lost. Are you sure you want to exit this page?";
	 }
}
</script>

<!-------Script to optimize window on loading----------->

<script language="JavaScript">

	top.window.moveTo(0,0);

	if (document.all)

	{

		top.window.resizeTo(screen.availWidth,screen.availHeight);

	}

	else if (document.layers||document.getElementById)

	{

	if (top.window.outerHeight<screen.availHeight||top.window.outerWidth<screen.availWidth)

	{

	top.window.outerHeight = screen.availHeight;

	top.window.outerWidth = 850;

	}

	}

</script>

<!----------End optimize window script---------->


</head>

<body onload="startUp();"  onMouseDown="showButtons();">
<img id='BGImage' src="${oscar_image_path}Colposcopy-Booking--Form.png" style="position: absolute; left: 0px; top: 0px; width:750px">
<form method="post" action="" name="FormName" id="FormName" >

<textarea name="DemographicLabel" id="DemographicLabel" class="noborder" style="position:absolute; left:425px; top:4px; width:289px; height:182px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white;"  oscarDB=label></textarea>


<input name="PtSurname" id="PtSurname" type="text" class="noborder" style="position:absolute; left:31px; top:292px; width:159px; height:29px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white;"  oscarDB=patient_nameL>


<input name="PtFirstname" id="PtFirstname" type="text" class="noborder" style="position:absolute; left:199px; top:292px; width:140px; height:29px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white;"  oscarDB=patient_nameF>


<input name="PtOthername" id="PtOthername" type="text" class="noborder" style="position:absolute; left:346px; top:292px; width:129px; height:29px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white;" value="">


<input name="DOB" id="DOB" type="text" class="noborder" style="position:absolute; left:479px; top:292px; width:111px; height:29px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white;"  oscarDB=dobc>


<input name="Age" id="Age" type="text" class="noborder" style="position:absolute; left:596px; top:292px; width:108px; height:29px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white;"  oscarDB=age>


<input name="StreetAddress" id="StreetAddress" type="text" class="noborder" style="position:absolute; left:99px; top:325px; width:284px; height:33px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white;"  oscarDB=address_street_number_and_name>


<input name="City" id="City" type="text" class="noborder" style="position:absolute; left:31px; top:377px; width:123px; height:21px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white;"  oscarDB=city>


<input name="Prov" id="Prov" type="text" class="noborder" style="position:absolute; left:159px; top:377px; width:116px; height:21px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white;"  oscarDB=province>


<input name="PostalCode" id="PostalCode" type="text" class="noborder" style="position:absolute; left:281px; top:377px; width:103px; height:21px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white;"  oscarDB=postal>


<input name="ResPhone" id="ResPhone" type="text" class="noborder" style="position:absolute; left:388px; top:342px; width:146px; height:21px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white;"  oscarDB=phone>


<input name="CellPhone" id="CellPhone" type="text" class="noborder" style="position:absolute; left:543px; top:342px; width:160px; height:21px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:transparent;"  oscarDB=cell>


<input name="BusPhone" id="BusPhone" type="text" class="noborder" style="position:absolute; left:388px; top:376px; width:143px; height:21px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white;"  oscarDB=phone2>


<input name="PhoneExt" id="PhoneExt" type="text" class="noborder" style="position:absolute; left:543px; top:376px; width:160px; height:21px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white;"  oscarDB=phone_extension>


<input name="ReferringPhysician" id="ReferringPhysician" type="text" class="noborder" style="position:absolute; left:31px; top:416px; width:353px; height:25px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:transparent;"  oscarDB=current_user>


<input name="ClinicPhone" id="ClinicPhone" type="text" class="noborder" style="position:absolute; left:91px; top:442px; width:293px; height:21px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:transparent;"  oscarDB=clinic_phone>


<span style="position: absolute; left:498px; top:402px; font-size:10px; font-family: Arial;">(yyyy/mm/dd)</span>


<input name="Today" id="Today" type="text" class="noborder" style="position:absolute; left:387px; top:415px; width:316px; height:35px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white;"  oscarDB=today>


<input name="ConsultingSurgeon" id="ConsultingSurgeon" type="text" class="noborder" style="position:absolute; left:55px; top:481px; width:211px; height:30px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white;" value="">


<input name="ConsultingSurgeonPh" id="ConsultingSurgeonPh" type="text" class="noborder" style="position:absolute; left:89px; top:514px; width:176px; height:29px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white;" value="">


<span style="position: absolute; left:430px; top:470px; font-size:10px; font-family: Arial;">(yyyy/mm/dd)</span>

<div style="position: absolute; left: 272px; top: 481px; ">


<input type="text" name="DateReceived" id="DateReceived"
	 value="" 
	 size='14' maxlength='14' style="zIndex:7">

<img src="../images/cal.gif" id="DateReceived_cal" class="DoNotPrint"/>

</div>

<span style="position: absolute; left:630px; top:470px; font-size:12px; font-family: Arial;"><b>(yyyy/mm/dd)</b></span>


<div style="position: absolute; left: 506px; top: 481px; ">


<input type="text" name="ProcedureDate" id="ProcedureDate"
	 value="" 
	 size='14' maxlength='14' style="zIndex:7">

<img src="../images/cal.gif" id="ProcedureDate_cal" class="DoNotPrint"/>

</div>


<input name="2B" id="2B" type="text" style="position:absolute; left:152px; top:556px; width:16px; height:16px;border: 1px solid #000000;font-weight:bold;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);setDirtyFlag()" onkeypress="javascript:return displayKeyCode(event,this.id);">


<input name="3A" id="3A" type="text" style="position:absolute; left:291px; top:556px; width:16px; height:16px;border: 1px solid #000000;font-weight:bold;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);setDirtyFlag()" onkeypress="javascript:return displayKeyCode(event,this.id);">


<input name="3B" id="3B" type="text" style="position:absolute; left:429px; top:556px; width:16px; height:16px;border: 1px solid #000000;font-weight:bold;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);setDirtyFlag()" onkeypress="javascript:return displayKeyCode(event,this.id);">


<input name="Procedure" id="Procedure" type="text" class="noborder" style="position:absolute; left:75px; top:648px; width:629px; height:30px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white;" value="">


<input name="m$CYTO#value" id="m$CYTO#value" type="text" class="noborder" style="position:absolute; left:119px; top:689px; width:112px; height:24px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white;"  oscarDB=m$CYTO#value>


<div style="position: absolute; left: 366px; top: 690px; ">


<input type="text" name="LastSmearDone" id="LastSmearDone"
	 value="" 
	 size='10' maxlength='10' style="zIndex:7">

<img src="../images/cal.gif" style="float: right; margin-left: 0em; margin-top: -2em;"id="LastSmearDone_cal" class="DoNotPrint"/>

</div>


<div style="position: absolute; left: 596px; top: 690px; ">


<input type="text" name="PositivePapDate" id="PositivePapDate"
	 value="" 
	 size='11' maxlength='11' style="zIndex:7">

<img src="../images/cal.gif" id="PositivePapDate_cal" class="DoNotPrint"/>

</div>


<input name="PreviousColpoNo" id="PreviousColpoNo" type="text" style="position:absolute; left:229px; top:720px; width:16px; height:16px;border: 1px solid #000000;font-weight:bold;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);setDirtyFlag()" onkeypress="javascript:return displayKeyCode(event,this.id);">


<input name="PreviousColpoYes" id="PreviousColpoYes" type="text" style="position:absolute; left:293px; top:720px; width:16px; height:16px;border: 1px solid #000000;font-weight:bold;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);setDirtyFlag()" onkeypress="javascript:return displayKeyCode(event,this.id);">


<input name="PreviousColpoDateLoc" id="PreviousColpoDateLoc" type="text" class="noborder" style="position:absolute; left:451px; top:717px; width:245px; height:23px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white; text-decoration:underline;" value="">


<textarea name="SmearReport" id="SmearReport" class="noborder" style="position:absolute; left:32px; top:771px; width:671px; height:115px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white; text-decoration:underline;" ></textarea>


<input name="InterpreterYes" id="InterpreterYes" type="text" style="position:absolute; left:188px; top:912px; width:16px; height:16px;border: 1px solid #000000;font-weight:bold;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);setDirtyFlag()" onkeypress="javascript:return displayKeyCode(event,this.id);">


<input name="Language" id="Language" type="text" class="noborder" style="position:absolute; left:373px; top:893px; width:330px; height:38px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white; text-decoration:underline;" value="">


<input name="BookingFormReceived" id="BookingFormReceived" type="text" class="noborder" style="position:absolute; left:266px; top:937px; width:428px; height:25px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:14px; text-align:left; background-color:white; text-decoration:underline;" value="">




 <!-- The submit/print/reset buttons ------------------------------------------------------------->
<div class="DoNotPrint" id="BottomButtons" >
		<table style="position: absolute; left:20px; top:1000px;text-align: left; width: 90%;   font-size:12px; font-family:Arial;" border="0" cellpadding="0" cellspacing="0">
		<tr><td>
		<input type="hidden" id="newForm" name="newForm" value="True" />				
		Subject: <input name="subject" size="40" type="text"> 
		<input value="Submit" name="SubmitButton" id="SubmitButton" type="submit" onclick="releaseDirtyFlag();document.FormName.submit();SubmitImage(); document.forms[0].submit();">
		<input value="Reset" name="ResetButton" id="ResetButton" type="reset"> 
		<input value="Print" name="PrintButton" id="PrintButton" type="button" onclick="printLetter()"> 			
		<input value="Print and Submit" name="PrintSubmitButton" type="button" onClick="printLetter(); releaseDirtyFlag(); setTimeout('SubmitButton.click()',1000);"> 
		</td></tr>
		</table>
</div>
<!-- ------End of submit/print/reset buttons----------------------------------------------------->
 </form>
 
  <!-- ----------------------Calendar Setup for each field---------------------->
 
 <script type="text/javascript">

Calendar.setup( { inputField : "DateReceived", ifFormat : "%Y-%m-%d", showsTime :false, button : "DateReceived_cal", singleClick : true, step : 1 } );
Calendar.setup( { inputField : "ProcedureDate", ifFormat : "%Y-%m-%d", showsTime :false, button : "ProcedureDate_cal", singleClick : true, step : 1 } );
Calendar.setup( { inputField : "LastSmearDone", ifFormat : "%Y-%m-%d", showsTime :false, button : "LastSmearDone_cal", singleClick : true, step : 1 } );
Calendar.setup( { inputField : "PositivePapDate", ifFormat : "%Y-%m-%d", showsTime :false, button : "PositivePapDate_cal", singleClick : true, step : 1 } );

</script>

 <!-- ----------------------End Calendar Setup for each field---------------------->


</body>
</html>

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