116 lines
4.6 KiB
HTML
116 lines
4.6 KiB
HTML
<html>
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<head>
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<meta charset="utf-8">
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<script type="text/javascript" src="js/search.js"></script>
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<style type="text/css">
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table.curvedEdges {
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border:10px solid Grey;
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-webkit-border-radius:13px;
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-moz-border-radius:13px;
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-ms-border-radius:13px;
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-o-border-radius:13px;
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border-radius:13px;
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}
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table.curvedEdges td {
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padding: 5px;
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background-color: #DFDDDD;
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}
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</style>
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<style>
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/* css for timepicker */
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.ui-timepicker-div .ui-widget-header { margin-bottom: 8px; }
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.ui-timepicker-div dl { text-align: left; }
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.ui-timepicker-div dl dt { height: 25px; margin-bottom: -25px; }
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.ui-timepicker-div dl dd { margin: 0 10px 10px 65px; }
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.ui-tpicker-grid-label { background: none; border: none; margin: 0; padding: 0; }
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</style>
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</head>
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<body>
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<div id='newQueryParamDiv'>
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<table class="curvedEdges">
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<tr>
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<td>Patient Name</td>
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<td><input type="text" id="patName" /> </td>
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</tr>
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<tr>
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<td>Patient ID</td>
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<td><input type="text" id="patId" /> </td>
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</tr>
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<tr>
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<td>Accession No.</td>
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<td><input type="text" id="accessionNo" /> </td>
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</tr>
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<tr>
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<td>Date of Birth</td>
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<td><input type="text" id="birthDate" /></td>
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</tr>
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<tr>
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<td>Study Date</td>
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<td>
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<table>
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<tbody>
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<tr><td>From </td><td> <input type="text" id="fromDate" /></td></tr>
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<tr><td>To </td><td> <input type="text" id="toDate" /></td></tr>
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</tbody>
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</table>
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</td>
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</tr>
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<tr>
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<td>Study Description</td>
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<td><input type="text" id="studyDesc" /> </td>
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</tr>
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<tr>
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<td>Referring Physician</td>
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<td><input type="text" id="referPhysician" /> </td>
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</tr>
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<tr>
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<td>Modality</td>
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<td>
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<table id="modalitiesTable" style="width: 103%">
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<tbody><tr>
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<td> <input type="checkbox" name="modality" value="CT">CT</td>
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<td> <input type="checkbox" name="modality" value="CR">CR</td>
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<td> <input type="checkbox" name="modality" value="DX">DX</td>
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</tr>
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<tr>
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<td> <input type="checkbox" name="modality" value="MR">MR</td>
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<td> <input type="checkbox" name="modality" value="SC">SC</td>
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<td> <input type="checkbox" name="modality" value="US">US</td>
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</tr>
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<tr>
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<td> <input type="checkbox" name="modality" value="DR">DR</td>
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<td> <input type="checkbox" name="modality" value="NM">NM</td>
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<td> <input type="checkbox" name="modality" value="PX">PX</td>
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</tr>
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<tr>
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<td> <input type="checkbox" name="modality" value="XA">XA</td>
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<td> <input type="checkbox" name="modality" value="MG">MG</td>
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<td> <input type="checkbox" name="modality" value="OT">OT</td>
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</tr>
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<tr>
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<td colspan="6">
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<input type="text" id="modalities" size="22">
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</td>
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</tr>
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</tbody>
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</table>
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</td>
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</tr>
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</table>
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<br>
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<button id="okBtn">OK</button>
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<button id="resetBtn">Clear</button>
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<a href='#' id='close'>close</a>
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</div>
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</body>
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</html> |