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HTML for 4 signature form

HTML icon 4095.html — HTML, 17 kB (18103 bytes)

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<html>
<head>
<title>4096</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 type="text/javascript" language="javascript">
function checkGender(){
     if (document.getElementById('PatientGender').value == 'M'){
     document.getElementById('Male').checked = true;
     }else if (document.getElementById('PatientGender').value == 'F'){
     document.getElementById('Female').checked = true;
    }
 }
</script>

<!-- js graphics scripts -->
<script type="text/javascript" src="${oscar_image_path}jsgraphics.js"></script>
<!-- mousefunction scripts -->
<script type="text/javascript" src="${oscar_image_path}mouse.js"></script>

<script language="javascript">
function show(x){
    document.getElementById(x).style.display = 'block';
}
function hide(x){
    document.getElementById(x).style.display = 'none';
}
</script>

<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>

<style type="Text/css">
input.largerCheckbox {
    -moz-transform:scale(1.3);         /*scale up image 1.3x - Firefox specific */
    -webkit-transform:scale(1.3);      /*Webkit based browser eg Chrome, Safari */
    -o-transform:scale(1.3);           /*Opera browser */
}
</style>
<style type="text/css" media="print">
input.largerCheckbox {
    -moz-transform:scale(1.8);         /*scale up image 1.8x - Firefox specific */
    -webkit-transform:scale(1.3);      /*Webkit based browser eg Chrome, Safari */
    -o-transform:scale(1.3);           /*Opera browser */
}
</style>
<!--[if IE]>
<style type="text/css">
input.largerCheckbox {
    height: 30px;                     /*30px checkboxes for IE 5 to IE 7 */
    width: 30px;
}
</style>
<![endif]-->

<script type="text/javascript">
function reorderSignature(){
    document.getElementById('BGImage').style.zIndex = '-100';
    document.getElementById('preview1').style.zIndex = '-90';
    document.getElementById('preview2').style.zIndex = '-91';
    document.getElementById('preview3').style.zIndex = '-92';
    document.getElementById('preview4').style.zIndex = '-93';
    document.getElementById('SignCanvas1').style.zIndex = '-80';
    document.getElementById('SignCanvas2').style.zIndex = '-80';
    document.getElementById('SignCanvas3').style.zIndex = '-80';
    document.getElementById('SignCanvas4').style.zIndex = '-80';

}
</script>

</head>

<body onload="checkGender();init();ReloadImage();reorderSignature();">
<img id='BGImage' src="${oscar_image_path}4096.gif" style="position: absolute; left: 0px; top: 0px; width:750px">
<form method="post" action="" name="FormName" id="FormName" >

<input name="doctor" id="doctor" type="text" class="noborder" style="position:absolute; left:79px; top:87px; width:375px; height:26px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:11px; text-align:left; background-color:white;"  oscarDB=doctor>


<input name="doctor_ohip_no" id="doctor_ohip_no" type="text" class="noborder" style="position:absolute; left:624px; top:98px; width:79px; height:15px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:11px; text-align:left; background-color:white;"  oscarDB=doctor_ohip_no>


<input name="hinc" id="hinc" type="text" class="noborder" style="position:absolute; left:46px; top:147px; width:161px; height:17px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:11px; text-align:left; background-color:white;"  oscarDB=hinc>


<input name="patient_nameL" id="patient_nameL" type="text" class="noborder" style="position:absolute; left:212px; top:147px; width:283px; height:18px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:11px; text-align:left; background-color:white;"  oscarDB=patient_nameL>


<input name="patient_nameF" id="patient_nameF" type="text" class="noborder" style="position:absolute; left:502px; top:148px; width:201px; height:16px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:11px; text-align:left; background-color:white;"  oscarDB=patient_nameF>


<input name="dobc2" id="dobc2" type="text" class="noborder" style="position:absolute; left:47px; top:175px; width:89px; height:17px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:11px; text-align:left; background-color:white;"  oscarDB=dobc2>


<input name="phone" id="phone" type="text" class="noborder" style="position:absolute; left:191px; top:177px; width:128px; height:18px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:11px; text-align:left; background-color:white;"  oscarDB=phone>


<input name="phone2" id="phone2" type="text" class="noborder" style="position:absolute; left:323px; top:177px; width:132px; height:18px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:11px; text-align:left; background-color:white;"  oscarDB=phone2>


<input name="AutoName33" id="AutoName33" type="checkbox" class="largerCheckbox" style="position:absolute; left:637px; top:165px; ">


<input name="AutoName34" id="AutoName34" type="checkbox" class="largerCheckbox" style="position:absolute; left:637px; top:178px; ">


<input name="address" id="address" type="text" class="noborder" style="position:absolute; left:51px; top:207px; width:647px; height:55px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:white;"  oscarDB=address>


<input name="AutoName35" id="AutoName35" type="text" class="noborder" style="position:absolute; left:299px; top:328px; width:59px; height:18px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:11px; text-align:left; background-color:white;" value="">


<input name="AutoName36" id="AutoName36" type="text" class="noborder" style="position:absolute; left:363px; top:328px; width:140px; height:18px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:11px; text-align:left; background-color:white;" value="">


<input name="AutoName37" id="AutoName37" type="text" class="noborder" style="position:absolute; left:535px; top:328px; width:39px; height:17px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:11px; text-align:left; background-color:white;" value="">


<input name="AutoName38" id="AutoName38" type="text" class="noborder" style="position:absolute; left:577px; top:328px; width:121px; height:16px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:11px; text-align:left; background-color:white;" value="">


<input name="AutoName39" id="AutoName39" type="text" class="noborder" style="position:absolute; left:427px; top:351px; width:88px; height:24px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:11px; text-align:left; background-color:white;" value="">


<input name="AutoName40" id="AutoName40" type="text" class="noborder" style="position:absolute; left:523px; top:358px; width:52px; height:17px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:11px; text-align:left; background-color:white;" value="">


<input name="AutoName41" id="AutoName41" type="text" class="noborder" style="position:absolute; left:578px; top:358px; width:123px; height:17px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:11px; text-align:left; background-color:white;" value="">


<input name="today" id="today" type="text" class="noborder" style="position:absolute; left:503px; top:397px; width:186px; height:31px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:white;"  oscarDB=today>


<input name="AutoName42" id="AutoName42" type="text" class="noborder" style="position:absolute; left:48px; top:480px; width:350px; height:23px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:white;" value="">


<input name="AutoName43" id="AutoName43" type="text" class="noborder" style="position:absolute; left:542px; top:479px; width:159px; height:23px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:white;" value="">


<textarea name="address1" id="address1" class="noborder" style="position:absolute; left:57px; top:521px; width:640px; height:52px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:white;"  oscarDB=address></textarea>


<input name="AutoName44" id="AutoName44" type="checkbox" class="largerCheckbox" style="position:absolute; left:56px; top:576px; ">


<input name="AutoName45" id="AutoName45" type="checkbox" class="largerCheckbox" style="position:absolute; left:56px; top:600px; ">


<input name="AutoName46" id="AutoName46" type="checkbox" class="largerCheckbox" style="position:absolute; left:167px; top:577px; ">


<input name="AutoName47" id="AutoName47" type="checkbox" class="largerCheckbox" style="position:absolute; left:167px; top:599px; ">


<input name="AutoName48" id="AutoName48" type="checkbox" class="largerCheckbox" style="position:absolute; left:258px; top:577px; ">


<input name="AutoName49" id="AutoName49" type="checkbox" class="largerCheckbox" style="position:absolute; left:49px; top:770px; ">


<input name="AutoName50" id="AutoName50" type="checkbox" class="largerCheckbox" style="position:absolute; left:160px; top:770px; ">


<input name="tut" id="tut" type="checkbox" class="largerCheckbox" style="position:absolute; left:251px; top:770px; ">


<input name="manda" id="manda" type="checkbox" class="largerCheckbox" style="position:absolute; left:316px; top:770px; ">


<input name="Curat" id="Curat" type="checkbox" class="largerCheckbox" style="position:absolute; left:398px; top:770px; ">


<input name="guardphone" id="guardphone" type="text" class="noborder" style="position:absolute; left:379px; top:603px; width:129px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;"  oscarDB=phone>


<input name="GuardPhjone2" id="GuardPhjone2" type="text" class="noborder" style="position:absolute; left:512px; top:604px; width:183px; height:19px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:white;"  oscarDB=phone2>


<input name="today1" id="today1" type="text" class="noborder" style="position:absolute; left:505px; top:625px; width:184px; height:24px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:white;"  oscarDB=today>


<input name="today2" id="today2" type="text" class="noborder" style="position:absolute; left:502px; top:792px; width:186px; height:33px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:white;"  oscarDB=today>


<input name="today3" id="today3" type="text" class="noborder" style="position:absolute; left:505px; top:896px; width:182px; height:31px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:white;"  oscarDB=today>


<input name="doctor_ohip_no1" id="doctor_ohip_no1" type="text" class="noborder" style="position:absolute; left:358px; top:910px; width:108px; height:26px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:white;"  oscarDB=doctor_ohip_no>


<input name="PatientGender" id="PatientGender" type="hidden" oscarDB=sex>
<input name="Male" id="Male" type="checkbox" class="noborder" style="position:absolute; left: 139px; top: 179px">
<input name="Female" id="Female" type="checkbox" class="noborder" style="position:absolute; left: 165px; top: 179px">

<input type="hidden" name="TempData1" id="TempData1">
<input type="hidden" name="DrawData1" id="DrawData1">
<input type="hidden" name="SubmitData1" id="SubmitData1">
<input type="button" name="ClearSignature1" id="ClearSignature1" style="position:absolute; display:none; top:407px; left:467px; height:32px" value='Clear Signature1';
    onmouseover="show(this.id);" onmouseout="hide(this.id);" onclick="Clear('SignCanvas1');">
<div id="preview1" style="position:absolute; left:101px; top:407px; width:366px; height:38px; background-color:grey;opacity:0.5;filter:alpha(opacity=50);" class="DoNotPrint"></div>
<div id="SignCanvas1" style="position:absolute; left:101px; top:407px; width:366px; height:38px"
        onmouseover="SetDrawOn(); show('ClearSignature1');"
        onmouseout="SetDrawOff(); hide('ClearSignature1');"
        onmousedown="SetMouseDown();SetStart(this.id);"
        onmouseup="SetMouseUp();  DrawMarker();"
        onmousemove="DrawPreview();">
</div>

<input type="hidden" name="TempData2" id="TempData2">
<input type="hidden" name="DrawData2" id="DrawData2">
<input type="hidden" name="SubmitData2" id="SubmitData2">
<input type="button" name="ClearSignature2" id="ClearSignature2" style="position:absolute; display:none; top:626px; left:463px; height:27px" value='Clear Signature2';
    onmouseover="show(this.id);" onmouseout="hide(this.id);" onclick="Clear('SignCanvas2');">
<div id="preview2" style="position:absolute; left:105px; top:625px; width:358px; height:32px; background-color:grey;opacity:0.5;filter:alpha(opacity=50);" class="DoNotPrint"></div>
<div id="SignCanvas2" style="position:absolute; left:105px; top:625px; width:358px; height:32px"
        onmouseover="SetDrawOn(); show('ClearSignature2');"
        onmouseout="SetDrawOff(); hide('ClearSignature2');"
        onmousedown="SetMouseDown();SetStart(this.id);"
        onmouseup="SetMouseUp();  DrawMarker(jg2);"
        onmousemove="DrawPreview(pv2);">
</div>

<input type="hidden" name="TempData3" id="TempData3">
<input type="hidden" name="DrawData3" id="DrawData3">
<input type="hidden" name="SubmitData3" id="SubmitData3">
<input type="button" name="ClearSignature3" id="ClearSignature3" style="position:absolute; display:none; top:787px; left:466px; height:54px" value='Clear Signature3';
    onmouseover="show(this.id);" onmouseout="hide(this.id);" onclick="Clear('SignCanvas3');">
<div id="preview3" style="position:absolute; left:103px; top:787px; width:363px; height:54px; background-color:grey;opacity:0.5;filter:alpha(opacity=50);" class="DoNotPrint"></div>
<div id="SignCanvas3" style="position:absolute; left:103px; top:787px; width:363px; height:54px"
        onmouseover="SetDrawOn(); show('ClearSignature3');"
        onmouseout="SetDrawOff(); hide('ClearSignature3');"
        onmousedown="SetMouseDown();SetStart(this.id);"
        onmouseup="SetMouseUp();  DrawMarker(jg3);"
        onmousemove="DrawPreview(pv3);">
</div>

<input type="hidden" name="TempData4" id="TempData4">
<input type="hidden" name="DrawData4" id="DrawData4">
<input type="hidden" name="SubmitData4" id="SubmitData4">
<input type="button" name="ClearSignature4" id="ClearSignature4" style="position:absolute; display:none; top:905px; left:354px; height:34px" value='Clear Signature4';
	onmouseover="show(this.id);" onmouseout="hide(this.id);" onclick="Clear('SignCanvas4');">
<div id="preview4" style="position:absolute; left:107px; top:905px; width:247px; height:34px; background-color:grey;opacity:0.5;filter:alpha(opacity=50);" class="DoNotPrint"></div>
<div id="SignCanvas4" style="position:absolute; left:107px; top:905px; width:247px; height:34px"
		onmouseover="SetDrawOn(); show('ClearSignature4');"
		onmouseout="SetDrawOff(); hide('ClearSignature4');"
		onmousedown="SetMouseDown();SetStart(this.id);"
		onmouseup="SetMouseUp();  DrawMarker(jg4);"
		onmousemove="DrawPreview(pv4);"> 
</div>


 <div class="DoNotPrint" id="BottomButtons" style="position: absolute; top:971px; left:0px;">
     <table><tr><td>
         Subject: <input name="subject" size="40" type="text">
            <input value="Submit" name="SubmitButton" id="SubmitButton" type="submit" onclick=" SubmitImage(); 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>

<!-- freehand signature scripts -->
<script type="text/javascript" src="${oscar_image_path}4SignatureScripts.js"></script>
</body>
</html>

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