4 <meta http-equiv=
"content-type" content=
"text/html; charset=UTF-8">
5 <title>{label_webpage_title}
</title>
6 <style type=
"text/css">
8 font-family: sans-serif
;
11 background-color: #fff;
19 border-color: #000000;
27 border-collapse: collapse
;
29 .bigtable, .linetable {
36 border-collapse: collapse
;
49 border-width: 0 0 1px 0;
50 border-color: #999999;
80 background-color: #999999;
81 margin: 12pt 0 12pt 0;
97 <!-- The double div resolves a difference between Firefox and IE in treatment of padding. -->
98 <div class='borderdiv'
><div class='paddingdiv'
>
100 <table class=
"bigtable">
102 <td class='mainhead'
style=
"vertical-align:top">
104 <span class='subhead'
>{label_subhead_clinic}
</span>
106 <td style=
"text-align:right;width:10%;white-space:nowrap">
107 <table border='
1'
style=
"padding:2px;border-spacing:0;border-collapse:collapse">
110 <td style="white-space:nowrap">{label_clinic_id}</td>
111 <td style='width:60pt;white-space:nowrap'>{fac_facility_npi}</td>
115 <td style=
"white-space:nowrap">{label_client_id}
</td>
116 <td style=
"white-space:nowrap">{pt_pubpid}
</td>
120 <td style="white-space:nowrap">{label_control_no}</td>
121 <td style="white-space:nowrap">{ref_id}</td>
125 <td style=
"white-space:nowrap">{label_date}
</td>
126 <td style=
"white-space:nowrap;min-width:54pt">{ref_refer_date}
</td>
133 <br /> <br />{label_history_summary}:
135 <table cellspacing='
0' cellpadding='
0' class='linetable'
>
137 <td width='
1%' nowrap
>{label_bp}
</td>
138 <td class='under'
>{v_bps}/{v_bpd}
</td>
139 <td width='
1%' nowrap
> {label_ht}
</td>
140 <td class='under'
>{v_height}
</td>
141 <td width='
1%' nowrap
> {label_wt}
</td>
142 <td class='under'
>{v_weight}
</td>
146 <table class='linetable'
>
148 <td style=
"width:1%;white-space:nowrap">{label_name}
</td>
149 <td class='under'
>{pt_title} {pt_fname} {pt_mname} {pt_lname}
</td>
150 <td style=
"width:1%;white-space:nowrap"> {label_age}
</td>
151 <td class='under'
>{pt_age}
</td>
152 <td style=
"width:1%;white-space:nowrap"> {label_gender}
</td>
153 <td class='under'
>{pt_sex}
</td>
157 <table class='linetable'
>
159 <td style=
"width:1%;white-space:nowrap">{label_address}
</td>
160 <td class='under'
>{pt_street}, {pt_city} {pt_state}
</td>
161 <td style=
"width:1%;white-space:nowrap"> {label_postal}
</td>
162 <td class='under'
>{pt_postal_code}
</td>
163 <td style=
"width:1%;white-space:nowrap"> {label_phone}
</td>
164 <td class='under'
>{pt_phone_home}
</td>
168 <table class='linetable'
>
170 <td style=
"width:1%;white-space:nowrap">{label_ref_reason}
</td>
171 <td class='under'
>{ref_body}
</td>
175 <table class='linetable'
>
177 <td style=
"width:1%;white-space:nowrap">{label_diagnosis}
</td>
178 <td class='under'
>{ref_refer_diag}
</td>
182 <table class='linetable'
>
184 <td style=
"width:1%;white-space:nowrap">{label_ref_class}
</td>
185 <td class='under'
>{ref_refer_risk_level}
</td>
189 <table class='linetable'
>
191 <td style=
"width:1%;white-space:nowrap">{label_dr_name_sig}
</td>
192 <td class='under'
>{ref_refer_from}
</td>
196 <table class='linetable'
>
198 <td style=
"width:1%;white-space:nowrap">{label_refer_to}
</td>
199 <td class='under'
>{ref_refer_to} / {to_organization}
</td>
205 <table class=
"bigtable">
207 <td class='mainhead'
>
209 <span class='subhead'
>{label_subhead_patient}
</span>
211 <td style=
"text-align:right;vertical-align:top;width:10%;white-space:nowrap">
212 <table border='
1'
style=
"padding:2px;border-spacing:0;border-collapse:collapse">
215 <td style="white-space:nowrap">{label_clinic_id}</td>
216 <td style='width:60pt;white-space:nowrap'>{fac_facility_npi}</td>
220 <td style=
"white-space:nowrap">{label_client_id}
</td>
221 <td style=
"white-space:nowrap">{pt_pubpid}
</td>
225 <td style="white-space:nowrap">{label_control_no}</td>
226 <td style="white-space:nowrap">{ref_id}</td>
230 <td style=
"white-space:nowrap">{label_date}
</td>
231 <td style=
"white-space:nowrap;min-width:54pt">{ref_refer_date}
</td>
238 <table class='linetable'
>
240 <td style=
"width:1%;white-space:nowrap">{label_name}
</td>
241 <td class='under'
>{pt_title} {pt_fname} {pt_mname} {pt_lname}
</td>
242 <td style=
"width:1%;white-space:nowrap"> Age
</td>
243 <td class='under'
>{pt_age}
</td>
244 <td style=
"width:1%;white-space:nowrap"> {label_gender}
</td>
245 <td class='under'
>{pt_sex}
</td>
249 <table class='linetable'
>
251 <td style=
"width:1%;white-space:nowrap">{label_clinic}
</td>
252 <td class='under'
>{to_organization}
</td>
256 <table class='linetable'
>
258 <td style=
"width:1%;white-space:nowrap">{label_address}
</td>
259 <td class='under'
>{to_street}, {to_city} {to_state}
</td>
260 <td style=
"width:1%;white-space:nowrap"> {label_postal}
</td>
261 <td class='under'
>{to_zip}
</td>
262 <td style=
"width:1%;white-space:nowrap"> {label_phone}
</td>
263 <td class='under'
>{to_phone}
</td>
267 <table class='linetable'
>
269 <td style=
"width:1%;white-space:nowrap">{label_ref_reason}
</td>
270 <td class='under'
>{ref_body}
</td>
274 <br /> <br />{label_history_summary}:
276 <table class='linetable'
>
278 <td style=
"width:1%;white-space:nowrap">{label_bp}
</td>
279 <td class='under'
>{v_bps}/{v_bpd}
</td>
280 <td style=
"width:1%;white-space:nowrap"> {label_ht}
</td>
281 <td class='under'
>{v_height}
</td>
282 <td style=
"width:1%;white-space:nowrap"> {label_wt}
</td>
283 <td class='under'
>{v_weight}
</td>
289 <table class='linetable'
>
291 <td style=
"width:1%;white-space:nowrap">{label_ref_name_sig}
</td>
292 <td class='under'
>{ref_refer_from}
</td>
296 <table class='linetable'
>
298 <td style=
"width:1%;white-space:nowrap">{label_special_name_sig}
</td>
299 <td class='under'
>{ref_refer_to}
</td>
304 <br style=
"clear:both;" /><!-- kludge to fix bizarre Firefox problem with page breaks -->
305 <p style='page-break-after: always'
></p>
306 <div class='borderdiv'
><div class='paddingdiv'
>
308 <table class=
"bigtable">
310 <td class='mainhead'
>
312 <span class='subhead'
>{label_subhead_referred}
</span>
314 <td style=
"text-align:right;vertical-align:top;width:10%;white-space:nowrap">
315 <table border='
1'
style=
"padding:2px;border-spacing:0;border-collapse:collapse">
318 <td style="white-space:nowrap">{label_clinic_id}</td>
319 <td style='width:60pt;white-space:nowrap'>{fac_facility_npi}</td>
323 <td style=
"white-space:nowrap">{label_client_id}
</td>
324 <td style=
"white-space:nowrap">{pt_pubpid}
</td>
328 <td style="white-space:nowrap">{label_control_no}</td>
329 <td style="white-space:nowrap">{ref_id}</td>
333 <td style=
"white-space:nowrap">{label_date}
</td>
334 <td style=
"white-space:nowrap;min-width:54pt">{ref_reply_date}
</td>
341 <table class='linetable'
>
343 <td style=
"width:1%;white-space:nowrap">{label_name}
</td>
344 <td class='under'
>{pt_title} {pt_fname} {pt_mname} {pt_lname}
</td>
345 <td style=
"width:1%;white-space:nowrap"> {label_age}
</td>
346 <td class='under'
>{pt_age}
</td>
347 <td style=
"width:1%;white-space:nowrap"> {label_gender}
</td>
348 <td class='under'
>{pt_sex}
</td>
352 <table class='linetable'
>
354 <td style=
"width:1%;white-space:nowrap">{label_clinic}
</td>
355 <td class='under'
>{to_organization}
</td>
359 <table class='linetable'
>
361 <td style=
"width:1%;white-space:nowrap">{label_diagnosis}
</td>
362 <td class='under'
>{ref_reply_init_diag}
</td>
366 <table class='linetable'
>
368 <td style=
"width:1%;white-space:nowrap">{label_findings}
</td>
369 <td class='under'
>{ref_reply_findings}
</td>
373 <table class='linetable'
>
375 <td style=
"width:1%;white-space:nowrap">{label_final_diagnosis}
</td>
376 <td class='under'
>{ref_reply_final_diag}
</td>
380 <table class='linetable'
>
382 <td style=
"width:1%;white-space:nowrap">{label_services_provided}
</td>
383 <td class='under'
>{ref_reply_services}
</td>
387 <table class='linetable'
>
389 <td style=
"width:1%;white-space:nowrap">{label_recommendations}
</td>
390 <td class='under'
>{ref_reply_recommend}
</td>
394 <table class='linetable'
>
396 <td style=
"width:1%;white-space:nowrap">{label_scripts_and_referrals}
</td>
397 <td class='under'
>{ref_reply_rx_refer}
</td>
401 <table class='linetable'
>
403 <td style=
"width:1%;white-space:nowrap">{label_special_name_sig}
</td>
404 <td class='under'
>{ref_refer_to}
</td>
410 <!-- This should really be in the onload handler but that seems to be unreliable and can crash Firefox 3. -->
411 <script type=
"text/javascript">
412 var win
= top
.printLogPrint
? top
: opener
.top
;
413 win
.printLogPrint(window
);