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Wound Clinic VGH HTML

VCH for Vancouver Costal Health Region

HTML icon WoundHealingClinicVCH.html — HTML, 14 kB (15230 bytes)

File contents

<html>

<head>

<script type="text/javascript" src="${oscar_javascript_path}eforms/faxControl.js"> </script>



	<link rel="stylesheet" type="text/css" media="print" href="${oscar_image_path}JSMPC.css" />

	<!--<script language="javascript" type="text/javascript" media="print" src="${oscar_image_path}JSMPC.js"></script>	-->

	

<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','');

		}

		setDocumentTitle('Wound Healing Clinic',document.getElementById('PtName').value);

		setDefaults();			

	}

	

	function setDocumentTitle(Title,PtName)

	{

		// set document title

		document.title = Title + ' - ' + PtName;					

						

	}



	function setDefaults()

	{	            

		// check the newform flag to ensure this is the initial load of the form

		if (document.getElementById("newForm").value == 'True')

		{

		document.getElementById("MSP").value = 'X';	

		document.getElementById("GP").value = 'X';	

		}   

	}



	/****************************

		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 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 = 875;

	}

	}

</script>

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



<!-- scripts to confirm closing of window if haven't saved yet -->

<script language="javascript">

	//keypress events trigger dirty flag

	var needToConfirm = true;

	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>

</head>



<body onload="startUp();" onMouseDown="showButtons();">

	<form method="post" action="" name="FormName" id="FormName" >



<div id="page1" style="position: relative; left: 0px; top: 0px; width:850px;" class="pagebreak">

<img id="BGImage" src="${oscar_image_path}Wound_Healing_Clinic_Ref.png" width="850">	



<input name="TodaysDate" type="text" class="noborder" style="position:absolute; left:115px; top:300px; width:100px; font-family:sans-serif; font-size:16px; text-align:center; text-decoration:underline; background-color:transparent;" oscardb=today>



<input name="PtName" id="PtName" type="text" class="noborder" style="position:absolute; left:190px; top:327px; width:610px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; text-decoration:underline; background-color:transparent;" oscarDB=patient_name>



<input name="DOB" type="text" class="noborder" style="position:absolute; left:175px; top:354px; width:150px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; text-decoration:underline; background-color:transparent;" oscarDB=dob>

<input name="PHN" id="PHN" type="text" class="noborder" style="position:absolute; left:435px; top:354px; width:210px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; text-decoration:underline; background-color:transparent;" oscarDB=hinc>



<input name="Address" type="text" class="noborder" style="position:absolute; left:140px; top:383px; width:660px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; text-decoration:underline; background-color:transparent;" oscarDB=addressline>



<input name="HomePhone" type="text" class="noborder" style="position:absolute; left:205px; top:410px; width:171px; height:22px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; text-decoration:underline; background-color:transparent;" oscarDB=phone>

<input name="AlternatePhone" type="text" class="noborder" style="position:absolute; left:545px; top:410px; width:195px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; text-decoration:underline; background-color:transparent;" oscarDB=phone2>



<textarea name="AdditionalInfo" style="position:absolute; left:75px; top:456px; width:725px; height:55px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; background-color:transparent;"></textarea>



<!-- --------------Reason for Referral----------------------------- -->

<input name="Unknown" id="Unknown" type="text" style="position:absolute; left:75px; top:570px; width:14px; height:14px; border: 1px solid #000000;font-weight:bold; text-align: center; background-color:transparent;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);" onkeypress="javascript:return displayKeyCode(event,this.id);">

<input name="Venous" id="Venous" type="text" style="position:absolute; left:237px; top:570px; width:14px; height:14px; border: 1px solid #000000;font-weight:bold; text-align: center; background-color:transparent;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);" onkeypress="javascript:return displayKeyCode(event,this.id);">

<input name="Arterial" id="Arterial" type="text" style="position:absolute; left:390px; top:570px; width:14px; height:14px; border: 1px solid #000000;font-weight:bold; text-align: center; background-color:transparent;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);" onkeypress="javascript:return displayKeyCode(event,this.id);">

<input name="DiabeticYes" id="DiabeticYes" type="text" style="position:absolute; left:627px; top:570px; width:14px; height:14px; border: 1px solid #000000;font-weight:bold; text-align: center; background-color:transparent;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);" onkeypress="javascript:return displayKeyCode(event,this.id);">

<input name="DiabeticNo" id="DiabeticNo" type="text" style="position:absolute; left:702px; top:570px; width:14px; height:14px; border: 1px solid #000000;font-weight:bold; text-align: center; background-color:transparent;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);" onkeypress="javascript:return displayKeyCode(event,this.id);">



<input name="PressureSore" type="text" class="noborder" style="position:absolute; left:275px; top:595px; width:525px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; text-decoration:underline; background-color:transparent;">

<input name="TraumaticWound" type="text" class="noborder" style="position:absolute; left:207px; top:620px; width:220px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; text-decoration:underline; background-color:transparent;">

<input name="PostSurgFailure" type="text" class="noborder" style="position:absolute; left:625px; top:620px; width:175px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; text-decoration:underline; background-color:transparent;">



<input name="AmbulatoryYes" id="AmbulatoryYes" type="text" style="position:absolute; left:250px; top:648px; width:14px; height:14px; border: 1px solid #000000;font-weight:bold; text-align: center; background-color:transparent;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);" onkeypress="javascript:return displayKeyCode(event,this.id);">

<input name="AmbulatoryNo" id="AmbulatoryNo" type="text" style="position:absolute; left:323px; top:648px; width:14px; height:14px; border: 1px solid #000000;font-weight:bold; text-align: center; background-color:transparent;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);" onkeypress="javascript:return displayKeyCode(event,this.id);">



<input name="WheelchairYes" id="WheelchairYes" type="text" style="position:absolute; left:628px; top:648px; width:14px; height:14px; border: 1px solid #000000;font-weight:bold; text-align: center; background-color:transparent;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);" onkeypress="javascript:return displayKeyCode(event,this.id);">

<input name="WheelchairNo" id="WheelchairNo" type="text" style="position:absolute; left:703px; top:648px; width:14px; height:14px; border: 1px solid #000000;font-weight:bold; text-align: center; background-color:transparent;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);" onkeypress="javascript:return displayKeyCode(event,this.id);">



<input name="ParaYes" id="ParaYes" type="text" style="position:absolute; left:178px; top:676px; width:14px; height:14px; border: 1px solid #000000;font-weight:bold; text-align: center; background-color:transparent;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);" onkeypress="javascript:return displayKeyCode(event,this.id);">

<input name="ParaNo" id="ParaNo" type="text" style="position:absolute; left:233px; top:676px; width:14px; height:14px; border: 1px solid #000000;font-weight:bold; text-align: center; background-color:transparent;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);" onkeypress="javascript:return displayKeyCode(event,this.id);">

<input name="TransferSelf" type="text" class="noborder" style="position:absolute; left:540px; top:673px; width:260px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; text-decoration:underline; background-color:transparent;" oscarDB=phone2>



<textarea name="WoundHx" style="position:absolute; left:75px; top:795px; width:725px; height:90px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; background-color:transparent;"></textarea>



<!-- ---------------Referring Physician----------------------------- -->

<input name="ReferringPhysician" type="text" class="noborder" style="position:absolute; left:250px; top:930px; width:300px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; text-weight:bold; text-decoration:underline; background-color:transparent;" oscarDB=current_user>

<input name="MSP" type="text" class="noborder" style="position:absolute; left:705px; top:930px; width:75px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; text-weight:bold; text-decoration:underline; background-color:transparent;" oscarDB=current_user_ohip_no>

<input name="PhysicianPhone" type="text" class="noborder" style="position:absolute; left:220px; top:954px; width:210px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; text-weight:bold; text-decoration:underline; background-color:transparent;" oscarDB=clinic_phone>

<input name="PhysicianFax" type="text" class="noborder" style="position:absolute; left:570px; top:954px; width:210px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; text-weight:bold; text-decoration:underline; background-color:transparent;" oscarDB=clinic_fax>

</div>



<div class="DoNotPrint" id="BottomButtons" style="position:absolute; left:75px; top:1050px;">

  <div id="faxControl">&nbsp;</div>

	<table><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="button" onclick="javascript:submission();"> 			

				<input value="Reset" name="ResetButton" id="ResetButton" type="reset"> 

				<input value="Print" name="PrintButton" id="PrintButton" type="button" onclick="printLetter()"> 			

				<input value="Print & Submit" name="PrintSubmitButton" id="PrintSubmitButton" type="button" onclick="printSubmit()"> 

	 </td></tr></table>

</div>

</form>

</body></html>

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