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Aviation Medical Page 2 HTML

HTML icon AvMed2.html — HTML, 18 kB (19379 bytes)

File contents

<html>
<head>
<title></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">
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>

</head>

<body onload="">
<img id='BGImage' src="${oscar_image_path}AvMed2.png" style="position: absolute; left: 0px; top: 0px; width:750px">
<form method="post" action="" name="FormName" id="FormName" >

<input name="Name" id="Name" type="text" class="noborder" style="position:absolute; left:48px; top:19px; width:311px; height:24px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;"  oscarDB=patient_name>


<input name="LicenceNumber" id="LicenceNumber" type="text" class="noborder" style="position:absolute; left:426px; top:19px; width:276px; height:24px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="">


<input name="Height" id="Height" type="text" class="noborder" style="position:absolute; left:15px; top:72px; width:81px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;"  oscarDB=m$HT#value>


<input name="Weight" id="Weight" type="text" class="noborder" style="position:absolute; left:103px; top:73px; width:80px; height:19px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;"  oscarDB=m$WT#value>


<input name="HairColour" id="HairColour" type="text" class="noborder" style="position:absolute; left:189px; top:71px; width:89px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="">


<input name="EyeColour" id="EyeColour" type="text" class="noborder" style="position:absolute; left:287px; top:71px; width:68px; height:22px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="">


<input name="Bloodpressures" id="Bloodpressures" type="text" class="noborder" style="position:absolute; left:359px; top:71px; width:179px; height:22px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;"  oscarDB=m$BP#value>


<input name="MarksScars" id="MarksScars" type="text" class="noborder" style="position:absolute; left:543px; top:71px; width:192px; height:21px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="">


<input name="NutritionN" id="NutritionN" type="checkbox" style="position:absolute; left:288px; top:109px; " checked>


<input name="NutritionA" id="NutritionA" type="checkbox" style="position:absolute; left:325px; top:109px; ">


<input name="NoseandThroatN" id="NoseandThroatN" type="checkbox" style="position:absolute; left:288px; top:123px; " checked>


<input name="NoseandThroatA" id="NoseandThroatA" type="checkbox" style="position:absolute; left:325px; top:123px; ">


<input name="EarsN" id="EarsN" type="checkbox" style="position:absolute; left:288px; top:136px; " checked>


<input name="EarsA" id="EarsA" type="checkbox" style="position:absolute; left:324px; top:136px; ">


<input name="RespiratoryN" id="RespiratoryN" type="checkbox" style="position:absolute; left:288px; top:149px; " checked>


<input name="RespiratoryA" id="RespiratoryA" type="checkbox" style="position:absolute; left:324px; top:149px; ">


<input name="CVSN" id="CVSN" type="checkbox" style="position:absolute; left:288px; top:163px; " checked>


<input name="CVSA" id="CVSA" type="checkbox" style="position:absolute; left:324px; top:163px; ">


<input name="GIN" id="GIN" type="checkbox" style="position:absolute; left:288px; top:176px; " checked>


<input name="GIA" id="GIA" type="checkbox" style="position:absolute; left:324px; top:176px; ">


<input name="GUN" id="GUN" type="checkbox" style="position:absolute; left:288px; top:189px; " checked>


<input name="GUA" id="GUA" type="checkbox" style="position:absolute; left:325px; top:189px; ">


<input name="LocomotorN" id="LocomotorN" type="checkbox" style="position:absolute; left:288px; top:203px; " checked>


<input name="LocomotorA" id="LocomotorA" type="checkbox" style="position:absolute; left:325px; top:203px; ">


<input name="NeuroN" id="NeuroN" type="checkbox" style="position:absolute; left:288px; top:216px; " checked>


<input name="NeuroA" id="NeuroA" type="checkbox" style="position:absolute; left:325px; top:216px; ">


<input name="MentalN" id="MentalN" type="checkbox" style="position:absolute; left:288px; top:229px; " checked>


<input name="MentalA" id="MentalA" type="checkbox" style="position:absolute; left:325px; top:229px; ">


<input name="IntegumentN" id="IntegumentN" type="checkbox" style="position:absolute; left:288px; top:242px; " checked>


<input name="IntegumentA" id="IntegumentA" type="checkbox" style="position:absolute; left:325px; top:242px; ">


<textarea name="Elaborate" id="Elaborate" class="noborder" style="position:absolute; left:360px; top:109px; width:373px; height:147px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" ></textarea>


<input name="RtUncorrected" id="RtUncorrected" type="text" class="noborder" style="position:absolute; left:144px; top:296px; width:88px; height:16px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="">


<input name="RtGlasses" id="RtGlasses" type="text" class="noborder" style="position:absolute; left:322px; top:296px; width:70px; height:16px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="">


<input name="RtContacts" id="RtContacts" type="text" class="noborder" style="position:absolute; left:395px; top:295px; width:71px; height:17px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="">


<input name="LeftUncorrected" id="LeftUncorrected" type="text" class="noborder" style="position:absolute; left:144px; top:314px; width:89px; height:17px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="">


<input name="LeftGlasses" id="LeftGlasses" type="text" class="noborder" style="position:absolute; left:322px; top:314px; width:70px; height:17px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="">


<input name="LeftContacts" id="LeftContacts" type="text" class="noborder" style="position:absolute; left:396px; top:315px; width:70px; height:16px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="">


<input name="BothUncorrected" id="BothUncorrected" type="text" class="noborder" style="position:absolute; left:144px; top:334px; width:90px; height:17px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="">


<input name="BothGlasses" id="BothGlasses" type="text" class="noborder" style="position:absolute; left:321px; top:333px; width:71px; height:16px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="">


<input name="BothContacts" id="BothContacts" type="text" class="noborder" style="position:absolute; left:396px; top:333px; width:70px; height:17px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="">


<input name="FundiN" id="FundiN" type="checkbox" style="position:absolute; left:588px; top:312px; ">


<input name="FundiA" id="FundiA" type="checkbox" style="position:absolute; left:666px; top:311px; ">


<input name="FieldsN" id="FieldsN" type="checkbox" style="position:absolute; left:590px; top:331px; ">


<input name="FieldsA" id="FieldsA" type="checkbox" style="position:absolute; left:667px; top:331px; ">


<input name="RtUncorrectedY" id="RtUncorrectedY" type="checkbox" style="position:absolute; left:327px; top:385px; ">


<input name="RtUncorrectedN" id="RtUncorrectedN" type="checkbox" style="position:absolute; left:365px; top:386px; ">


<input name="RtCorrectedYes" id="RtCorrectedYes" type="checkbox" style="position:absolute; left:401px; top:386px; ">


<input name="RtCorrectedN" id="RtCorrectedN" type="checkbox" style="position:absolute; left:437px; top:386px; ">


<input name="LeftUncorrectedYes" id="LeftUncorrectedYes" type="checkbox" style="position:absolute; left:327px; top:404px; ">


<input name="LeftUncorrectedNo" id="LeftUncorrectedNo" type="checkbox" style="position:absolute; left:365px; top:404px; ">


<input name="LeftCorrectedY" id="LeftCorrectedY" type="checkbox" style="position:absolute; left:401px; top:404px; ">


<input name="LeftCorrectedN" id="LeftCorrectedN" type="checkbox" style="position:absolute; left:437px; top:404px; ">


<input name="Ortho" id="Ortho" type="checkbox" style="position:absolute; left:541px; top:371px; " checked>


<input name="Hyper" id="Hyper" type="text" class="noborder" style="position:absolute; left:530px; top:390px; width:57px; height:15px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:white;" value="">


<input name="Eso" id="Eso" type="text" class="noborder" style="position:absolute; left:636px; top:374px; width:58px; height:13px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="0">


<input name="Exo" id="Exo" type="text" class="noborder" style="position:absolute; left:636px; top:389px; width:57px; height:15px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="0">


<input name="CoverTest" id="CoverTest" type="text" class="noborder" style="position:absolute; left:554px; top:407px; width:160px; height:17px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:white;" value="Normal">


<input name="RtSphere" id="RtSphere" type="text" class="noborder" style="position:absolute; left:325px; top:448px; width:59px; height:17px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="">


<input name="RtCylinder" id="RtCylinder" type="text" class="noborder" style="position:absolute; left:403px; top:447px; width:57px; height:18px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="">


<input name="LtSphere" id="LtSphere" type="text" class="noborder" style="position:absolute; left:325px; top:467px; width:60px; height:16px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="">


<input name="LtCylinder" id="LtCylinder" type="text" class="noborder" style="position:absolute; left:403px; top:467px; width:57px; height:16px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="">


<input name="ReferralYes" id="ReferralYes" type="checkbox" style="position:absolute; left:653px; top:453px; ">


<input name="ReferralNo" id="ReferralNo" type="checkbox" style="position:absolute; left:691px; top:452px; " checked>


<input name="Ishihara" id="Ishihara" type="text" class="noborder" style="position:absolute; left:247px; top:507px; width:141px; height:22px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="Ishihara">


<input name="NumberofPlates" id="NumberofPlates" type="text" class="noborder" style="position:absolute; left:471px; top:506px; width:84px; height:23px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="16">


<input name="NumberofErrors" id="NumberofErrors" type="text" class="noborder" style="position:absolute; left:647px; top:506px; width:68px; height:24px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="0">


<input name="RightWhispered" id="RightWhispered" type="text" class="noborder" style="position:absolute; left:182px; top:568px; width:82px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" value="2.0">


<input name="LeftWhispered" id="LeftWhispered" type="text" class="noborder" style="position:absolute; left:182px; top:589px; width:82px; height:17px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:white;" value="2.0">


<input name="Rt500" id="Rt500" type="text" class="noborder" style="position:absolute; left:373px; top:574px; width:34px; height:17px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:white;" value="">


<input name="Rt1000" id="Rt1000" type="text" class="noborder" style="position:absolute; left:439px; top:574px; width:27px; height:17px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:white;" value="">


<input name="Rt2000" id="Rt2000" type="text" class="noborder" style="position:absolute; left:501px; top:574px; width:29px; height:16px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:white;" value="">


<input name="Rt3000" id="Rt3000" type="text" class="noborder" style="position:absolute; left:563px; top:574px; width:29px; height:17px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:white;" value="">


<input name="Rt4000" id="Rt4000" type="text" class="noborder" style="position:absolute; left:628px; top:574px; width:31px; height:16px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:white;" value="">


<input name="Rt6000" id="Rt6000" type="text" class="noborder" style="position:absolute; left:690px; top:575px; width:29px; height:16px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:white;" value="">


<input name="Lt500" id="Lt500" type="text" class="noborder" style="position:absolute; left:373px; top:589px; width:34px; height:16px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:white;" value="">


<input name="Lt1000" id="Lt1000" type="text" class="noborder" style="position:absolute; left:437px; top:590px; width:30px; height:16px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:white;" value="">


<input name="Lt2000" id="Lt2000" type="text" class="noborder" style="position:absolute; left:501px; top:589px; width:29px; height:16px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:white;" value="">


<input name="Lt3000" id="Lt3000" type="text" class="noborder" style="position:absolute; left:562px; top:590px; width:31px; height:15px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:white;" value="">


<input name="Lt4000" id="Lt4000" type="text" class="noborder" style="position:absolute; left:628px; top:589px; width:32px; height:16px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:white;" value="">


<input name="Lt6000" id="Lt6000" type="text" class="noborder" style="position:absolute; left:689px; top:591px; width:31px; height:14px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:white;" value="">


<input name="Glucose" id="Glucose" type="text" class="noborder" style="position:absolute; left:63px; top:631px; width:107px; height:17px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:white;" value="Negative">


<input name="UrineOther" id="UrineOther" type="text" class="noborder" style="position:absolute; left:255px; top:629px; width:448px; height:17px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:white;" value="Negative">


<textarea name="Comments" id="Comments" class="noborder" style="position:absolute; left:15px; top:657px; width:718px; height:112px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:13px; text-align:center; background-color:transparent;" ></textarea>




 <div class="DoNotPrint" id="BottomButtons" style="position: absolute; top:966px; left:0px;">
	 <table><tr><td>
		 Subject: <input name="subject" size="40" type="text"> 
			<input value="Submit" name="SubmitButton" id="SubmitButton" type="submit" onclick=" releaseDirtyFlag();"> 
			<input value="Reset" name="ResetButton" id="ResetButton" type="reset"> 
			<input value="Print" name="PrintButton" id="PrintButton" type="button" onclick="formPrint();"> 
			<input value="Print & Submit" name="PrintSubmitButton" id="PrintSubmitButton" type="button" onclick="formPrint();releaseDirtyFlag();setTimeout('SubmitButton.click()',1000);"> 
	 </td></tr></table>
 </div>
 </form>

</body>
</html>

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