You are here: Home → Information for OSCAR Users → EMR Resources → eForms → eForm building resources → Template for eForm with just a patient label and different types of inputs
Personal tools
Navigation
Search Site

 
Document Actions

Template for eForm with just a patient label and different types of inputs

by David Chan — last modified 2007-06-18 14:31

<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">&nbsp;
  <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>