Smoking2008.html
Content based on the 2008 form updated to include newer agents
smoking2008.html
—
HTML,
17Kb
File contents
<html>
<head>
<title>smoking</title>
<style type="Text/css">
input.largerCheckbox {
-moz-transform:scale(1.3); /*scale up image 1.3x - Firefox specific */
-webkit-transform:scale(1.3); /*Chrome, Safari and any other Webkit based 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); /*Chrome, Safari and any other Webkit based browser */
}
</style>
<!--[if IE]>
<style type="text/css">
input.largerCheckbox {
height: 30px; /*30px checkboxes for IE 5 to IE 7 */
width: 30px;
}
</style>
<![endif]-->
<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>
<!-- scripts to confirm closing of window if haven't 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>
<script type="text/javascript" language="javascript">
function checkSmoker(){
if (document.getElementById('smokingStatus').value == 'Y'){
document.getElementById('smokerY').checked = true;
}else if (document.getElementById('smokingStatus').value == 'N'){
document.getElementById('smokerN').checked = true;
}
}
function updateSmoking(){
if (document.getElementById('smokerY').checked = true){
document.getElementById('smokingStatus').value = 'Y';
}else if (document.getElementById('quit1').checked = true){
document.getElementById('smokingStatus').value = 'X';
}else if (document.getElementById('quit2').checked = true){
document.getElementById('smokingStatus').value = 'X';
}
}
</script>
<body onload="checkSmoker();">
<div >
<img src="${oscar_image_path}2008SmokingCessation.png" style="position: absolute; left: 0px; top: 0px; width:750">
<form method="post" action="" name="FormName" id="FormName" >
<input name="m$SMK#value" id="smokingStatus" type="hidden" oscarDB=m$SMK#value>
<input name="patient" id="patient" type="text" class="noborder" style="position:absolute; left:137px; top:30px; width:374px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" oscarDB=patient_name>
<input name="date" id="date" type="text" class="noborder" style="position:absolute; left:555px; top:30px; width:175px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" oscarDB=today>
<input name="smokerN" id="smokerN" type="checkbox" class="largerCheckbox" style="position:absolute; left:167px; top:56px; ">
<input name="smokerY" id="smokerY" type="checkbox" class="largerCheckbox" style="position:absolute; left:206px; top:56px; ">
<input name="yrs" id="yrs" type="text" class="noborder" style="position:absolute; left:385px; top:59px; width:39px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" value="">
<input name="m$NOSK#value" type="text" class="noborder" style="position:absolute; left:534px; top:59px; width:49px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" oscarDB=m$NOSK#value>
<input name="prevAttemptY" id="prevAttemptY" type="checkbox" class="largerCheckbox" style="position:absolute; left:631px; top:65px; ">
<input name="prevAttemptN" id="prevAttemptN" type="checkbox" class="largerCheckbox" style="position:absolute; left:668px; top:66px; ">
<input name="a61" id="a61" type="text" class="noborder" style="position:absolute; left:675px; top:118px; width:60px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" value="">
<input name="a62" id="a62" type="checkbox" class="largerCheckbox" style="position:absolute; left:221px; top:288px; ">
<input name="a63" id="a63" type="checkbox" class="largerCheckbox" style="position:absolute; left:298px; top:288px; ">
<input name="a64" id="a64" type="checkbox" class="largerCheckbox" style="position:absolute; left:459px; top:288px; ">
<input name="a65" id="a65" type="checkbox" class="largerCheckbox" style="position:absolute; left:553px; top:288px; ">
<input name="a66" id="a66" type="checkbox" class="largerCheckbox" style="position:absolute; left:655px; top:288px; ">
<input name="a67" id="a67" type="checkbox" class="largerCheckbox" style="position:absolute; left:221px; top:315px; ">
<input name="a68" id="a68" type="checkbox" class="largerCheckbox" style="position:absolute; left:298px; top:315px; ">
<input name="a69" id="a69" type="checkbox" class="largerCheckbox" style="position:absolute; left:393px; top:315px; ">
<input name="a70" id="a70" type="checkbox" class="largerCheckbox" style="position:absolute; left:459px; top:315px; ">
<input name="a71" id="a71" type="checkbox" class="largerCheckbox" style="position:absolute; left:553px; top:315px; ">
<input name="a72" id="a72" type="checkbox" class="largerCheckbox" style="position:absolute; left:655px; top:315px; ">
<input name="a73" id="a73" type="text" class="noborder" style="position:absolute; left:592px; top:360px; width:142px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" value="">
<input name="a74" id="a74" type="text" class="noborder" style="position:absolute; left:233px; top:386px; width:152px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" value="">
<input name="a75" id="a75" type="text" class="noborder" style="position:absolute; left:233px; top:409px; width:152px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" value="">
<input name="a76" id="a76" type="text" class="noborder" style="position:absolute; left:233px; top:439px; width:152px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" value="">
<input name="a77" id="a77" type="text" class="noborder" style="position:absolute; left:233px; top:462px; width:152px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" value="">
<input name="a78" id="a78" type="text" class="noborder" style="position:absolute; left:233px; top:490px; width:152px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" value="">
<textarea name="a79" id="a79" class="noborder" style="position:absolute; left:404px; top:394px; width:338px; height:117px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" ></textarea>
<input name="a80" id="a80" type="checkbox" class="largerCheckbox" style="position:absolute; left:218px; top:512px; ">
<input name="a81" id="a81" type="checkbox" class="largerCheckbox" style="position:absolute; left:325px; top:512px; ">
<input name="a82" id="a82" type="checkbox" class="largerCheckbox" style="position:absolute; left:432px; top:512px; ">
<input name="a83" id="a83" type="checkbox" class="largerCheckbox" style="position:absolute; left:556px; top:512px; ">
<input name="a84" id="a84" type="checkbox" class="largerCheckbox" style="position:absolute; left:657px; top:512px; ">
<input name="a85" id="a85" type="text" class="noborder" style="position:absolute; left:227px; top:543px; width:511px; height:22px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" value="">
<input name="quit1" id="quit1" type="checkbox" class="largerCheckbox" style="position:absolute; left:243px; top:578px; ">
<input name="a87" id="a87" type="checkbox" class="largerCheckbox" style="position:absolute; left:322px; top:578px; ">
<input name="a88" id="a88" type="checkbox" class="largerCheckbox" style="position:absolute; left:386px; top:578px; ">
<input name="a89" id="a89" type="checkbox" class="largerCheckbox" style="position:absolute; left:445px; top:578px; ">
<input name="a90" id="a90" type="checkbox" class="largerCheckbox" style="position:absolute; left:492px; top:578px; ">
<input name="a91" id="a91" type="text" class="noborder" style="position:absolute; left:579px; top:575px; width:157px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" value="">
<input name="a92" id="a92" type="checkbox" class="largerCheckbox" style="position:absolute; left:218px; top:596px; ">
<input name="a93" id="a93" type="checkbox" class="largerCheckbox" style="position:absolute; left:327px; top:596px; ">
<input name="a94" id="a94" type="checkbox" class="largerCheckbox" style="position:absolute; left:435px; top:596px; ">
<input name="a95" id="a95" type="checkbox" class="largerCheckbox" style="position:absolute; left:560px; top:596px; ">
<input name="a96" id="a96" type="checkbox" class="largerCheckbox" style="position:absolute; left:660px; top:596px; ">
<input name="a97" id="a97" type="checkbox" class="largerCheckbox" style="position:absolute; left:234px; top:624px; ">
<input name="a98" id="a98" type="checkbox" class="largerCheckbox" style="position:absolute; left:379px; top:624px; ">
<input name="a99" id="a99" type="checkbox" class="largerCheckbox" style="position:absolute; left:506px; top:624px; ">
<input name="a100" id="a100" type="checkbox" class="largerCheckbox" style="position:absolute; left:635px; top:624px; ">
<input name="a101" id="a101" type="checkbox" class="largerCheckbox" style="position:absolute; left:230px; top:652px; ">
<input name="a102" id="a102" type="text" class="noborder" style="position:absolute; left:354px; top:654px; width:171px; height:17px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" value="">
<input name="a103" id="a103" type="checkbox" class="largerCheckbox" style="position:absolute; left:531px; top:654px; ">
<input name="a104" id="a104" type="text" class="noborder" style="position:absolute; left:231px; top:725px; width:152px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" value="">
<input name="a105" id="a105" type="text" class="noborder" style="position:absolute; left:231px; top:750px; width:152px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" value="">
<input name="a106" id="a106" type="text" class="noborder" style="position:absolute; left:231px; top:776px; width:152px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" value="">
<input name="a107" id="a107" type="text" class="noborder" style="position:absolute; left:231px; top:801px; width:152px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" value="">
<input name="a108" id="a108" type="text" class="noborder" style="position:absolute; left:231px; top:829px; width:152px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" value="">
<textarea name="a109" id="a109" class="noborder" style="position:absolute; left:408px; top:735px; width:331px; height:114px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" ></textarea>
<input name="a110" id="a110" type="checkbox" class="largerCheckbox" style="position:absolute; left:218px; top:856px; ">
<input name="a111" id="a111" type="checkbox" class="largerCheckbox" style="position:absolute; left:322px; top:856px; ">
<input name="a112" id="a112" type="checkbox" class="largerCheckbox" style="position:absolute; left:430px; top:856px; ">
<input name="a113" id="a113" type="checkbox" class="largerCheckbox" style="position:absolute; left:555px; top:856px; ">
<input name="a114" id="a114" type="checkbox" class="largerCheckbox" style="position:absolute; left:655px; top:856px; ">
<input name="a115" id="a115" type="text" class="noborder" style="position:absolute; left:226px; top:883px; width:507px; height:20px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" value="">
<input name="quit2" id="quit2" type="checkbox" class="largerCheckbox" style="position:absolute; left:228px; top:917px; ">
<input name="a117" id="a117" type="checkbox" class="largerCheckbox" style="position:absolute; left:291px; top:917px; ">
<input name="a118" id="a118" type="checkbox" class="largerCheckbox" style="position:absolute; left:346px; top:917px; ">
<input name="a119" id="a119" type="checkbox" class="largerCheckbox" style="position:absolute; left:405px; top:917px; ">
<input name="a120" id="a120" type="checkbox" class="largerCheckbox" style="position:absolute; left:453px; top:917px; ">
<input name="a121" id="a121" type="text" class="noborder" style="position:absolute; left:534px; top:915px; width:201px; height:19px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:12px; text-align:left; background-color:transparent;" value="">
<input name="a122" id="a122" type="checkbox" class="largerCheckbox" style="position:absolute; left:218px; top:940px; ">
<input name="a123" id="a123" type="checkbox" class="largerCheckbox" style="position:absolute; left:325px; top:940px; ">
<input name="a124" id="a124" type="checkbox" class="largerCheckbox" style="position:absolute; left:430px; top:940px; ">
<input name="a125" id="a125" type="checkbox" class="largerCheckbox" style="position:absolute; left:555px; top:940px; ">
<input name="a5" id="a5" type="checkbox" class="largerCheckbox" style="position:absolute; left:655px; top:940px; ">
<input name="a126" id="a126" type="checkbox" class="largerCheckbox" style="position:absolute; left:239px; top:964px; ">
<input name="a127" id="a127" type="checkbox" class="largerCheckbox" style="position:absolute; left:382px; top:964px; ">
<input name="a128" id="a128" type="checkbox" class="largerCheckbox" style="position:absolute; left:510px; top:964px; ">
<input name="a129" id="a129" type="checkbox" class="largerCheckbox" style="position:absolute; left:638px; top:964px; ">
<input name="a130" id="a130" type="checkbox" class="largerCheckbox" style="position:absolute; left:227px; top:995px; ">
<input name="a131" id="a131" type="checkbox" class="largerCheckbox" style="position:absolute; left:531px; top:995px; ">
<input name="a132" id="a132" type="checkbox" class="largerCheckbox" style="position:absolute; left:167px; top:140px; ">
<input name="a133" id="a133" type="checkbox" class="largerCheckbox" style="position:absolute; left:226px; top:140px; ">
<input name="a134" id="a134" type="checkbox" class="largerCheckbox" style="position:absolute; left:290px; top:140px; ">
<input name="a135" id="a135" type="checkbox" class="largerCheckbox" style="position:absolute; left:359px; top:140px; ">
<input name="a136" id="a136" type="checkbox" class="largerCheckbox" style="position:absolute; left:427px; top:140px; ">
<input name="a137" id="a137" type="checkbox" class="largerCheckbox" style="position:absolute; left:481px; top:140px; ">
<input name="a138" id="a138" type="checkbox" class="largerCheckbox" style="position:absolute; left:539px; top:140px; ">
<input name="a139" id="a139" type="checkbox" class="largerCheckbox" style="position:absolute; left:601px; top:140px; ">
<input name="a140" id="a140" type="checkbox" class="largerCheckbox" style="position:absolute; left:660px; top:140px; ">
<input name="a141" id="a141" type="checkbox" class="largerCheckbox" style="position:absolute; left:724px; top:140px; ">
<div class="DoNotPrint" style="position: absolute; top:1022px; left:0px;">
<table><tr><td>
Subject: <input name="subject" size="40" type="text">
<input value="Submit" name="SubmitButton" id="SubmitButton" type="submit" onclick="releaseDirtyFlag(); updateSmoking();">
<input value="Reset" name="ResetButton" id="ResetButton" type="reset">
<input value="Print" name="PrintButton" id="PrintButton" type="button" onclick="window.print();">
<input value="Print Submit" name="PrintSubmitButton" id="PrintSubmitButton" type="button" onclick="window.print();releaseDirtyFlag();updateSmoking();setTimeout('document.forms[0].submit();',1000);">
</td></tr></table>
</div>
</form>
</body>
</html>
