장기이식 의뢰서 등록

<caption id="caption5" class="tit_2" style="left:315px; top:10px; width:134px; height:14px; ">감작력</caption>
			<line id="line1" class="line_1" style="x1:1px; y1:25px; x2:617px; y2:25px; "/>
			<select1 id="combo4" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/organ1" class="combo_essential" appearance="minimal" style="left:94px; top:32px; width:120px; height:19px; ">
				<choices>
					<item>
						<label>Kidney</label>
						<value>Kidney</value>
					</item>
					<item>
						<label>liver</label>
						<value>liver</value>
					</item>
					<item>
						<label>heart</label>
						<value>heart</value>
					</item>
					<item>
						<label>pancreas</label>
						<value>pancreas</value>
					</item>
					<item>
						<label>intestine</label>
						<value>intestine</value>
					</item>
					<item>
						<label>other</label>
						<value>other</value>
					</item>
				</choices>
			</select1>
			<line id="line3" class="line_2" style="x1:0px; y1:54px; x2:617px; y2:54px; "/>
			<line id="line4" class="line_2" style="x1:315px; y1:132px; x2:617px; y2:132px; "/>
			<select1 id="radio1" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/TP" appearance="full" cellspacing="60" cols="2" overflow="visible" style="left:441px; top:34px; width:164px; height:16px; border-style:none; ">
				<choices>
					<item>
						<label>Yes</label>
						<value>Yes</value>
					</item>
					<item>
						<label>No</label>
						<value>No</value>
					</item>
				</choices>
				<script type="javascript" ev:event="xforms-select">
					<![CDATA[
						if(radio1.value == "Yes"){
							input14.disabled = false;
						}else{
							input14.value = "No";
							input14.disabled = true;
						}
					]]>
				</script>
			</select1>
			<input id="input8" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/date" class="input_default" inputtype="date" style="left:441px; top:58px; width:120px; height:19px; "/>
			<select1 id="radio2" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/pregnancy" appearance="full" cellspacing="30" cols="2" overflow="visible" style="left:441px; top:112px; width:116px; height:16px; border-style:none; ">
				<choices>
					<item>
						<label>Yes</label>
						<value>Yes</value>
					</item>
					<item>
						<label>No</label>
						<value>No</value>
					</item>
				</choices>
			</select1>
			<caption id="caption8" class="cell_1" style="left:1px; top:224px; width:90px; height:121px; vertical-align:middle; ">기타사항</caption>
			<line id="line5" class="line_2" style="x1:0px; y1:106px; x2:617px; y2:106px; "/>
			<line id="line6" class="line_2" style="x1:1px; y1:346px; x2:617px; y2:346px; "/>
			<line id="line9" class="line_2" style="x1:315px; y1:80px; x2:617px; y2:80px; "/>
			<caption id="caption10" class="cell_1" style="left:315px; top:160px; width:124px; height:23px; vertical-align:middle; ">Previous CM pos.</caption>
			<caption id="caption1" class="cell_1" style="left:1px; top:56px; width:91px; height:49px; vertical-align:middle; ">의뢰목적</caption>
			<caption id="caption2" class="cell_1" style="left:315px; top:30px; width:124px; height:23px; vertical-align:middle; ">Previous TP</caption>
			<caption id="caption3" class="cell_1" style="left:315px; top:56px; width:124px; height:23px; vertical-align:middle; ">최근 이식일</caption>
			<caption id="caption4" class="cell_1" style="left:315px; top:186px; width:124px; height:23px; vertical-align:middle; ">DS-HLA항체판정의뢰</caption>
			<caption id="caption13" class="cell_1" style="left:1px; top:30px; width:91px; height:23px; vertical-align:middle; ">organ</caption>
			<caption id="caption7" class="cell_1" style="left:315px; top:108px; width:124px; height:23px; vertical-align:middle; ">임신</caption>
			<caption id="caption9" class="cell_1" style="left:315px; top:134px; width:124px; height:23px; vertical-align:middle; ">Previous PRA pos.</caption>
			<caption id="caption6" class="cell_1" style="left:1px; top:108px; width:90px; height:113px; vertical-align:middle; ">환자정보</caption>
			<caption id="caption11" class="cell_1" style="left:315px; top:82px; width:124px; height:23px; vertical-align:middle; ">수혈여부</caption>
			<input id="input2" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/pid" class="input_default" visibility="hidden" style="left:175px; top:2px; width:116px; height:19px; "/>
			<select1 id="radio3" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/tnsyn" appearance="full" cellspacing="30" cols="2" overflow="visible" style="left:441px; top:85px; width:116px; height:16px; border-style:none; ">
				<choices>
					<item>
						<label>Yes</label>
						<value>Yes</value>
					</item>
					<item>
						<label>No</label>
						<value>No</value>
					</item>
				</choices>
			</select1>
			<caption id="caption12" class="cell_1" style="left:315px; top:212px; width:84px; height:133px; vertical-align:middle; ">공여자정보</caption>
			<line id="line8" class="line_2" style="x1:1px; y1:222px; x2:310px; y2:222px; "/>
			<input id="input4" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/dnorpid" class="input_default" style="left:501px; top:231px; width:115px; height:19px; "/>
			<input id="input11" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/dnornm" class="input_default" style="left:501px; top:212px; width:115px; height:19px; "/>
			<select1 id="radio4" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/reqpurpose" appearance="full" overflow="visible" style="left:94px; top:55px; width:215px; height:51px; border-style:none; ">
				<choices>
					<item>
						<label>Pre-TP work-up</label>
						<value>Pre-TP work-up</value>
					</item>
					<item>
						<label>Post-TP monitoring</label>
						<value>Post-TP monitoring</value>
					</item>
					<item>
						<label>Others</label>
						<value>Others</value>
					</item>
				</choices>
			</select1>
			<caption id="caption15" style="left:94px; top:108px; width:80px; height:19px; ">PP*IVIG</caption>
			<caption id="caption16" style="left:94px; top:127px; width:80px; height:19px; ">Rituximab</caption>
			<caption id="caption17" style="left:94px; top:146px; width:80px; height:19px; ">HLA typing A</caption>
			<caption id="caption18" style="left:158px; top:165px; width:35px; height:19px; ">B</caption>
			<caption id="caption19" style="left:158px; top:184px; width:35px; height:19px; ">DR</caption>
			<caption id="caption20" style="left:158px; top:203px; width:35px; height:19px; ">Other</caption>
			<input id="input3" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/patother" class="input_default" style="left:193px; top:203px; width:116px; height:19px; "/>
			<input id="input5" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/pata" class="input_default" style="left:193px; top:146px; width:116px; height:19px; "/>
			<input id="input6" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/patb" class="input_default" style="left:193px; top:165px; width:116px; height:19px; "/>
			<input id="input7" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/patdr" class="input_default" style="left:193px; top:184px; width:116px; height:19px; "/>
			<line id="line10" class="line_1" style="x1:310px; y1:29px; x2:310px; y2:346px; "/>
			<line id="line11" class="line_2" style="x1:315px; y1:158px; x2:617px; y2:158px; "/>
			<line id="line12" class="line_2" style="x1:315px; y1:184px; x2:617px; y2:184px; "/>
			<line id="line13" class="line_2" style="x1:315px; y1:210px; x2:617px; y2:210px; "/>
			<caption id="caption14" style="left:401px; top:212px; width:35px; height:19px; ">성명</caption>
			<caption id="caption21" style="left:401px; top:231px; width:50px; height:19px; ">등록번호</caption>
			<caption id="caption22" style="left:401px; top:250px; width:78px; height:19px; ">환자와의 관계</caption>
			<caption id="caption23" style="left:401px; top:269px; width:74px; height:19px; ">HLA typing A</caption>
			<caption id="caption24" style="left:466px; top:288px; width:35px; height:19px; ">B</caption>
			<caption id="caption25" style="left:466px; top:307px; width:35px; height:19px; ">DR</caption>
			<caption id="caption26" style="left:466px; top:326px; width:35px; height:19px; ">Other</caption>
			<input id="input1" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/dnora" class="input_default" style="left:501px; top:269px; width:115px; height:19px; "/>
			<input id="input9" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/dnorb" class="input_default" style="left:501px; top:288px; width:115px; height:19px; "/>
			<input id="input10" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/dnordr" class="input_default" style="left:501px; top:307px; width:115px; height:19px; "/>
			<input id="input12" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/dnorother" class="input_default" style="left:501px; top:326px; width:115px; height:19px; "/>
			<input id="input13" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/relation" class="input_default" style="left:501px; top:250px; width:115px; height:19px; "/>
			<select1 id="radio5" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/ppra" appearance="full" cellspacing="30" cols="2" overflow="visible" style="left:441px; top:137px; width:115px; height:16px; border-style:none; ">
				<choices>
					<item>
						<label>Yes</label>
						<value>Yes</value>
					</item>
					<item>
						<label>No</label>
						<value>No</value>
					</item>
				</choices>
			</select1>
			<select1 id="radio6" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/pcm" appearance="full" cellspacing="30" cols="2" overflow="visible" style="left:441px; top:163px; width:115px; height:17px; border-style:none; ">
				<choices>
					<item>
						<label>Yes</label>
						<value>Yes</value>
					</item>
					<item>
						<label>No</label>
						<value>No</value>
					</item>
				</choices>
			</select1>
			<select1 id="radio7" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/dshla" appearance="full" cellspacing="30" cols="2" overflow="visible" style="left:441px; top:190px; width:115px; height:16px; border-style:none; ">
				<choices>
					<item>
						<label>Yes</label>
						<value>Yes</value>
					</item>
					<item>
						<label>No</label>
						<value>No</value>
					</item>
				</choices>
			</select1>
			<input id="input14" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/pcnt" class="input_default" disabled="true" style="left:488px; top:32px; width:25px; height:19px; "/>
			<caption id="caption27" style="left:516px; top:33px; width:20px; height:19px; ">회</caption>
			<caption id="caption28" class="tit_2" style="left:0px; top:10px; width:134px; height:14px; ">장기이식 의뢰서</caption>
			<select1 id="radio8" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/ritux" appearance="full" cellspacing="30" cols="2" overflow="visible" style="left:193px; top:127px; width:116px; height:16px; border-style:none; ">
				<choices>
					<item>
						<label>Yes</label>
						<value>Yes</value>
					</item>
					<item>
						<label>No</label>
						<value>No</value>
					</item>
				</choices>
			</select1>
			<select1 id="radio9" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/patpp" appearance="full" cellspacing="30" cols="2" overflow="visible" style="left:193px; top:109px; width:116px; height:16px; border-style:none; ">
				<choices>
					<item>
						<label>Yes</label>
						<value>Yes</value>
					</item>
					<item>
						<label>No</label>
						<value>No</value>
					</item>
				</choices>
			</select1>
		</group>
		<group id="group3" style="left:219px; top:346px; width:400px; height:27px; ">
			<line id="line2" class="line_2" style="x1:0px; y1:0px; x2:400px; y2:0px; "/>
			<button id="btn_save" class="btn4_letter2" style="left:283px; top:3px; width:56px; height:22px; ">
				<caption>확인</caption>
				<script type="javascript" ev:event="DOMActivate">
					<![CDATA[
						fExeClinicSave();
					]]>
				</script>
			</button>
			<button id="btn_close" class="btn4_letter2" style="left:342px; top:3px; width:56px; height:22px; ">
				<caption>닫기</caption>
				<script type="javascript" ev:event="DOMActivate">
					<![CDATA[
						fSetClose();
					]]>
				</script>
			</button>
		</group>
	</xhtml:body>
</xhtml:html>