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Sep 16th, 2011
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  1.  
  2.  
  3.  
  4. <!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
  5.  
  6. <html xmlns="http://www.w3.org/1999/xhtml" >
  7. <head><title>
  8.  
  9. </title>
  10.      
  11.    
  12.     <script src="http://ajax.googleapis.com/ajax/libs/jquery/1.6.4/jquery.min.js" type="text/javascript"></script>
  13.     <script src="https://ajax.googleapis.com/ajax/libs/jqueryui/1.8.16/jquery-ui.js" type="text/javascript"></script>
  14.    
  15.    
  16.     <link href="../niceforms/niceforms-default.css" rel="stylesheet" type="text/css" />
  17.     <script src="../niceforms/niceforms.js" type="text/javascript"></script>
  18.    
  19.     <link href="../jquery-ui-1.8.16.custom.css" rel="stylesheet" type="text/css" />
  20.  
  21.  
  22.  
  23.     <script>
  24.         jQuery(function($) {
  25.         //$("#occurrence_dateTextBox").mask("99/99/9999");
  26.         //$("#report_dateTextBox").mask("99/99/9999");
  27.         $("#occurrence_dateTextBox").datepicker();
  28.         $("#report_dateTextBox").datepicker();
  29.         //$(".datepicker").datepicker();
  30.  
  31.     });
  32.     $(function() {
  33.         $.get('../file.txt', function(data) {
  34.             var output = data.split('\n'),
  35.             tmp = '';
  36.             for (i = 0; i < output.length; i++) {
  37.                tmp += '<option value=' + output[i] + '>' + output[i] + '</option>';
  38.             }
  39.             $('#lstProblems').html(tmp);
  40.  
  41.         });
  42.     });
  43.    
  44.     </script>
  45. </head>
  46. <body><div id="container">
  47.     <form name="form1" method="post" action="webform1.aspx" id="form1" class="niceform">
  48. <div>
  49. <input type="hidden" name="__EVENTTARGET" id="__EVENTTARGET" value="" />
  50. <input type="hidden" name="__EVENTARGUMENT" id="__EVENTARGUMENT" value="" />
  51. <input type="hidden" name="__LASTFOCUS" id="__LASTFOCUS" value="" />
  52. <input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE" value="/wEPDwUKLTU2Mzg4ODA5NmQYAQUeX19Db250cm9sc1JlcXVpcmVQb3N0QmFja0tleV9fFgIFC2xzdFByb2JsZW1zBQlDaGVja0JveDFL9/DxXpCA+Wgihd2P093yq+8YZw==" />
  53. </div>
  54.  
  55. <script type="text/javascript">
  56. //<![CDATA[
  57. var theForm = document.forms['form1'];
  58. if (!theForm) {
  59.    theForm = document.form1;
  60. }
  61. function __doPostBack(eventTarget, eventArgument) {
  62.    if (!theForm.onsubmit || (theForm.onsubmit() != false)) {
  63.        theForm.__EVENTTARGET.value = eventTarget;
  64.        theForm.__EVENTARGUMENT.value = eventArgument;
  65.        theForm.submit();
  66.    }
  67. }
  68. //]]>
  69. </script>
  70.  
  71.  
  72. <div>
  73.  
  74.     <input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION" value="/wEWDwKl98qhBAKD5baLBQKZnLKIBQLq34WTAgKNleXoCgKzupqdCgLp2rvfCALY7uLUDQLwl4zNDgLrm8LKAgLMx47jCALzy/PbBQK8/OrEAgKC5Ne7CQKM54rGBtJ+aAZBFYcd1GJp14FQ2yGOadeY" />
  75. </div>
  76.    
  77.         <fieldset>
  78.  
  79.         <legend>Section A</legend>
  80.  
  81.         <dl>
  82.  
  83.             <dt><label for="occurrence_dateTextBox" >Occurrence Date:</label></dt>
  84.             <dd><input name="occurrence_dateTextBox" type="text" id="occurrence_dateTextBox" size="50" /></dd>
  85.         </dl>
  86.        
  87.         <dl>
  88.  
  89.             <dt><label for="report_dateTextBox">Report Date:</label></dt>
  90.             <dd><input name="report_dateTextBox" type="text" id="report_dateTextBox" size="50" /></dd>
  91.         </dl>
  92.        
  93.        
  94.         <dl>
  95.  
  96.             <dt><label for="spec_idTextBox">Specimen ID:</label></dt>
  97.             <dd><input name="spec_idTextBox" type="text" id="spec_idTextBox" size="50" /></dd>
  98.         </dl>
  99.        
  100.         <dl>
  101.  
  102.             <dt><label for="batch_idTextBox">Batch ID:</label></dt>
  103.             <dd><input name="batch_idTextBox" type="text" id="batch_idTextBox" size="50" /></dd>
  104.         </dl>
  105.        
  106.         <dl>
  107.  
  108.             <dt><label for="report_byTextBox">Report By:</label></dt>
  109.             <dd><input name="report_byTextBox" type="text" id="report_byTextBox" size="50" /></dd>
  110.         </dl>
  111.        
  112.         <dl>
  113.  
  114.             <dt><label for="identified_byTextBox">Identified ID:</label></dt>
  115.             <dd><input name="identified_byTextBox" type="text" id="identified_byTextBox" size="50" /></dd>
  116.         </dl>
  117.        
  118.         </fieldset>
  119.        
  120.         <fieldset>
  121.         <legend>Section B</legend>
  122.        
  123.         <dl>
  124.  
  125.             <dt><label for="problemTextBox">Problem:</label></dt>
  126.             <dd><input name="problemTextBox" type="text" id="problemTextBox" size="50" /></dd>
  127.            
  128.            
  129.         </dl>
  130.        
  131.         <dl>
  132.             <dt><label for="lstProblems">Problems List:</label></dt>
  133.             <dd><select size="4" name="lstProblems" multiple="multiple" id="lstProblems" style="height:100%;">
  134.  
  135. </select></dd>
  136.                      
  137.         </dl>  
  138.        
  139.         </fieldset>
  140.        
  141.         <fieldset>
  142.         <legend>Section C</legend>
  143.         <dl>
  144.  
  145.             <dt><label for="section_c_issue_error_identified_byTextBox">Issue/Error Identified By:</label></dt>
  146.             <dd><input name="section_c_issue_error_identified_byTextBox" type="text" id="section_c_issue_error_identified_byTextBox" size="50" /></dd>
  147.            
  148.            
  149.         </dl>
  150.        
  151.         <dl>
  152.  
  153.             <dt><label for="section_c_commentsTextBox">Comments:</label></dt>
  154.             <dd><input name="section_c_commentsTextBox" type="text" id="section_c_commentsTextBox" size="50" /></dd>
  155.            
  156.            
  157.         </dl>      
  158.        
  159.         </fieldset>
  160.        
  161.         <fieldset>
  162.         <legend>Section D</legend>
  163.         <dl>
  164.  
  165.             <dt><label for="section_d_investigationTextBox">Investigation:</label></dt>
  166.             <dd><input name="section_d_investigationTextBox" type="text" id="section_d_investigationTextBox" size="50" /></dd>
  167.            
  168.            
  169.         </dl>
  170.        
  171.         </fieldset>
  172.        
  173.         <fieldset>
  174.         <legend>Section E</legend>
  175.         <dl>
  176.  
  177.             <dt><label for="section_e_corrective_actionTextBox">Corrective Action:</label></dt>
  178.             <dd><textarea name="section_e_corrective_actionTextBox" rows="2" cols="20" id="section_e_corrective_actionTextBox" size="50" style="height:200px;"></textarea></dd>
  179.            
  180.            
  181.         </dl>
  182.        
  183.        
  184.         </fieldset>
  185.        
  186.         <fieldset>
  187.         <legend>Section F</legend>
  188.         <dl>
  189.  
  190.             <dt><label for="section_f_commentsTextBox">Comments:</label></dt>
  191.             <dd><input name="section_f_commentsTextBox" type="text" id="section_f_commentsTextBox" size="50" /></dd>
  192.            
  193.            
  194.         </dl>
  195.        
  196.         </fieldset>
  197.        
  198.         <fieldset>
  199.         <legend>Pre-Analytical</legend>
  200.         <dl>
  201.  
  202.             <dt><label for="prePracticeCodeTextBox">Practice Code:</label></dt>
  203.             <dd></dd>
  204.            
  205.            
  206.         </dl>
  207.        
  208.         <dl>
  209.  
  210.             <dt><label for="preContactTextBox1">Contact:</label></dt>
  211.             <dd></dd>
  212.            
  213.            
  214.         </dl>
  215.        
  216.         <dl>
  217.             <dt><label for="CheckBox1">PreAnalytical?</label></dt>
  218.             <dd> <span OnCheckChanged="CheckBox1_CheckedChanged"><input id="CheckBox1" type="checkbox" name="CheckBox1" onclick="javascript:setTimeout('__doPostBack(\'CheckBox1\',\'\')', 0)" /></span></dd>
  219.         </dl>
  220.        
  221.        
  222.         </fieldset>
  223.        
  224.        
  225.    
  226.         <input type="submit" name="Button1" value="Button" id="Button1" />
  227.        
  228.    
  229.     </form>
  230. </div></body>
  231. </html>
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