Template for eForm with just a patient label and different types of inputs
<html>
<head>
<style type="text/css" media="print">
td.subjectline {
display:none;
}
input.noborder {
border : 0px;
background: transparent;
}
textarea.noscroll{
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;
//scrollbar : none;
border : 0px;
}
</style>
<style type="text/css">
textarea.noscroll{
//scrollbar : none;
}
</style>
</head>
<body width="750px">
<script language="JavaScript">
<!--
function setfocus() {
this.focus();
}
var ox = 0;
var oy = 0;
//x: left margin, y:top margin, w: width, h:height
function ff(x,y,w,h,name) { //need escape to name for ' and "
x = eval(ox+x);
y = eval(oy+y);
document.writeln('<div ID="bdiv1" STYLE="position:absolute; visibility:visible; z-index:2; left:'+x+'px; top:'+y+'px; width:'+w+'px; height:'+h+'px;"> ');
document.writeln(name);
document.writeln('</div>');
}
-->
</SCRIPT>
<p>
<span style="position: absolute; left: 11; top: 16; z-index:'-1'">
<IMG SRC="${oscar_image_path}ConcessionXrayUltrasound1.gif" width="594" height="700"></span>
<form method="POST" action="">
<div style="position:absolute; left:324px; top:41px;">
<textarea class="noscroll" oscarDB=label name="patientinfo" value = "" tabindex="1" style="height: 93px; width: 217px; font-family: Arial; font-size: 12px"></textarea>
</div>
<div style="position:absolute; left:414px; top:149px;">
<input type="text" class="noborder" oscarDB=doctor name="physicianname" tabindex="2" style="width: 178px; font-family: Arial; font-size: 12px">
</div>
<div style="position:absolute; left:324px; top:193px;">
<textarea class="noscroll" name="clinicalinfo" style="height: 116px; width: 217px; font-family: Arial; font-size: 12px" tabindex="3"></textarea>
</div>
<div style="position:absolute; left:19px; top:127px;">
<input type="checkbox" class="noborder" name="xray" value = "" tabindex="4">
</div>
<div style="position:absolute; left:147px; top:128px;">
<input type="checkbox" class="noborder" name="ultrasound" value = "" tabindex="5">
</div>
<div style="position:absolute; left:19px; top:147px;">
<input type="checkbox" class="noborder" name="mammography" value = "" tabindex="6">
</div>
<div style="position:absolute; left:147px; top:149px;">
<input type="checkbox" class="noborder" name="bonedensitometry" value = "" tabindex="7">
</div>
<div style="position:absolute; left:55px; top:260px;">
<input type="text" class="noborder" name="regionexam1" tabindex="8" style="width: 233px; font-family: Arial; font-size: 12px">
</div>
<div style="position:absolute; left:55px; top:289px;">
<input type="text" class="noborder" name="regionexam2" tabindex="9" style="width: 233px; font-family: Arial; font-size: 12px">
</div>
<div style="position:absolute; left:55px; top:319px;">
<input type="text" class="noborder" name="regionexam3" value = "" tabindex="10" style="width: 233px; font-family: Arial; font-size: 12px">
</div>
<div style="position:absolute; left:15px; top:387px;">
<input type="checkbox" class="noborder" name="uppergi" value = "" tabindex="12">
</div>
<div style="position:absolute; left:15px; top:417px;">
<input type="checkbox" class="noborder" name="barium" value = "" tabindex="13">
</div>
<div style="position:absolute; left:15px; top:490px;">
<input type="checkbox" class="noborder" name="mammography123" value = "" tabindex="14">
</div>
<div style="position:absolute; left:15px; top:533px;">
<input type="checkbox" class="noborder" name="abdomonalUltrasound" value = "" tabindex="15">
</div>
<div style="position:absolute; left:15px; top:564px;">
<input type="checkbox" class="noborder" name="pelvicUltrasound" value = "" tabindex="16">
</div>
<div style="position:absolute; left:15px; top:606px;">
<input type="checkbox" class="noborder" name="abdominalPevicUltrasound" value = "" tabindex="17">
</div>
<div style="position:absolute; left:15px; top:661px;">
<input type="checkbox" class="noborder" name="bonedensit567" value = "" tabindex="18">
</div>
<div style="position: absolute; top: 714px; left: 11px;">
<table>
<td class="subjectline">
Subject: <input type="text" name=subject size="40">
<input type="submit" value="Submit" name="B1">
<input type="reset" value="Reset" name="B2">
<input type=button value=Print onclick="javascript:window.print()">
</td></table>
</div>
</form>
</body>
</html>
