세포유전학검사 의뢰서 등록

유전검사의뢰서(삼성서울병원) 의뢰병원 담당의사 가계도

<line id="line3" class="line_3" style="x1:0px; y1:48px; x2:540px; y2:48px; "/>
			<line id="line4" class="line_3" style="x1:0px; y1:73px; x2:540px; y2:73px; "/>
			<line id="line5" class="line_3" style="x1:0px; y1:98px; x2:540px; y2:98px; "/>
			<line id="line6" class="line_3" style="x1:0px; y1:123px; x2:540px; y2:123px; "/>
			<line id="line7" class="line_3" style="x1:0px; y1:148px; x2:540px; y2:148px; "/>
			<line id="line8" class="line_3" style="x1:0px; y1:173px; x2:540px; y2:173px; "/>
			<line id="line9" class="line_3" style="x1:0px; y1:198px; x2:540px; y2:198px; "/>
			<line id="line10" class="line_3" style="x1:0px; y1:273px; x2:540px; y2:273px; "/>
			<line id="line11" class="line_3" style="x1:0px; y1:298px; x2:540px; y2:298px; "/>
			<line id="line12" class="line_3" style="x1:0px; y1:323px; x2:540px; y2:323px; "/>
			<line id="line16" class="line_1" style="x1:0px; y1:340px; x2:540px; y2:340px; "/>
			<caption id="caption18" class="cell_1" style="left:270px; top:50px; width:100px; height:23px; text-align:left; vertical-align:middle; ">의뢰일</caption>
			<caption id="caption19" class="cell_1" style="left:270px; top:25px; width:100px; height:23px; text-align:left; vertical-align:middle; ">진료과</caption>
			<input id="input12" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para2" style="left:372px; top:26px; width:168px; height:19px; "/>
			<input id="input13" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para4" class="input_s_essential" inputtype="date" style="left:372px; top:51px; width:165px; height:19px; font-weight:normal; "/>
			<caption id="caption2" class="cell_1" style="left:0px; top:75px; width:100px; height:23px; text-align:left; vertical-align:middle; ">전화번호</caption>
			<input id="input14" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para5" style="left:102px; top:76px; width:163px; height:19px; "/>
			<caption id="caption20" class="cell_1" style="left:270px; top:75px; width:100px; height:23px; text-align:left; vertical-align:middle; ">팩스번호</caption>
			<caption id="caption3" class="cell_1" style="left:270px; top:100px; width:100px; height:23px; text-align:left; vertical-align:middle; ">E-mail</caption>
			<caption id="caption21" class="cell_1" style="left:0px; top:100px; width:100px; height:23px; text-align:left; vertical-align:middle; ">휴대전화번호</caption>
			<input id="input15" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para7" style="left:102px; top:101px; width:163px; height:19px; "/>
			<caption id="caption4" class="cell_1" style="left:0px; top:125px; width:100px; height:23px; text-align:left; vertical-align:middle; background-color:#99ccff; ">환자이름</caption>
			<caption id="caption6" class="cell_1" style="left:270px; top:125px; width:100px; height:23px; text-align:left; vertical-align:middle; background-color:#99ccff; ">주민등록번호</caption>
			<input id="input17" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para9" style="left:102px; top:126px; width:163px; height:19px; "/>
			<input id="input3" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para6" style="left:372px; top:76px; width:168px; height:19px; "/>
			<input id="input16" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para8" style="left:372px; top:101px; width:168px; height:19px; "/>
			<input id="input18" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para10" style="left:372px; top:126px; width:168px; height:19px; "/>
			<caption id="caption7" class="cell_1" style="left:0px; top:175px; width:100px; height:23px; text-align:left; vertical-align:middle; background-color:#99ccff; ">주소</caption>
			<input id="input20" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para13" style="left:102px; top:176px; width:438px; height:19px; "/>
			<line id="line17" class="line_3" style="x1:0px; y1:223px; x2:540px; y2:223px; "/>
			<caption id="caption8" class="cell_1" style="left:0px; top:200px; width:100px; height:23px; text-align:left; vertical-align:middle; background-color:#99ccff; ">진단명</caption>
			<input id="input21" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para14" style="left:102px; top:201px; width:438px; height:19px; "/>
			<caption id="caption22" class="cell_1" style="left:0px; top:150px; width:100px; height:23px; text-align:left; vertical-align:middle; background-color:#99ccff; ">전화번호</caption>
			<caption id="caption23" class="cell_1" style="left:270px; top:150px; width:100px; height:23px; text-align:left; vertical-align:middle; background-color:#99ccff; ">인종</caption>
			<input id="input19" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para11" style="left:102px; top:151px; width:163px; height:19px; "/>
			<input id="input22" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para12" style="left:372px; top:151px; width:168px; height:19px; "/>
			<input id="input23" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para15" style="left:102px; top:226px; width:438px; height:19px; "/>
			<line id="line18" class="line_3" style="x1:0px; y1:248px; x2:540px; y2:248px; "/>
			<caption id="caption24" class="cell_1" style="left:0px; top:225px; width:100px; height:23px; text-align:left; vertical-align:middle; background-color:#99ccff; ">현병력 및 과거력</caption>
			<caption id="caption26" class="cell_1" style="left:0px; top:300px; width:100px; height:23px; text-align:left; vertical-align:middle; background-color:#99ccff; ">가족력</caption>
			<select id="checkbox1" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para18" overflow="visible" appearance="full" style="left:100px; top:304px; width:60px; height:20px; border-style:none; ">
				<choices>
					<item>
						<label>유</label>
						<value>V</value>
					</item>
				</choices>
			</select>
			<select id="checkbox2" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para19" overflow="visible" appearance="full" style="left:160px; top:304px; width:60px; height:20px; border-style:none; ">
				<choices>
					<item>
						<label>무</label>
						<value>V</value>
					</item>
				</choices>
			</select>
			<select id="checkbox3" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para20" overflow="visible" appearance="full" style="left:215px; top:304px; width:60px; height:20px; border-style:none; ">
				<choices>
					<item>
						<label>모름</label>
						<value>V</value>
					</item>
				</choices>
			</select>
			<input id="input4" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para16" style="left:102px; top:251px; width:438px; height:19px; "/>
			<caption id="caption9" class="cell_1" style="left:0px; top:250px; width:100px; height:23px; text-align:left; vertical-align:middle; background-color:#99ccff; ">주요증상</caption>
			<line id="line19" class="line_3" style="x1:0px; y1:298px; x2:540px; y2:298px; "/>
			<input id="input5" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para17" style="left:102px; top:276px; width:438px; height:19px; "/>
			<caption id="caption10" class="cell_1" style="left:0px; top:275px; width:100px; height:23px; text-align:left; vertical-align:middle; background-color:#99ccff; ">관련검사결과</caption>
			<caption id="caption11" class="cell_1" style="left:0px; top:435px; width:100px; height:23px; text-align:left; vertical-align:middle; background-color:#99ccff; ">의뢰검사명</caption>
			<line id="line13" class="line_3" style="x1:0px; y1:458px; x2:540px; y2:458px; "/>
			<select id="checkbox4" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para22" overflow="visible" appearance="full" style="left:100px; top:439px; width:95px; height:20px; border-style:none; ">
				<choices>
					<item>
						<label>분자유전검사</label>
						<value>V</value>
					</item>
				</choices>
			</select>
			<select id="checkbox5" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para23" overflow="visible" appearance="full" style="left:195px; top:439px; width:95px; height:20px; border-style:none; ">
				<choices>
					<item>
						<label>세포유전검사</label>
						<value>V</value>
					</item>
				</choices>
			</select>
			<select id="checkbox6" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para24" overflow="visible" appearance="full" style="left:290px; top:439px; width:95px; height:20px; border-style:none; ">
				<choices>
					<item>
						<label>FISH검사</label>
						<value>V</value>
					</item>
				</choices>
			</select>
			<select id="checkbox7" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para25" overflow="visible" appearance="full" style="left:385px; top:439px; width:110px; height:20px; border-style:none; ">
				<choices>
					<item>
						<label>유전생화학검사</label>
						<value>V</value>
					</item>
				</choices>
			</select>
			<caption id="caption12" class="cell_1" style="left:0px; top:460px; width:100px; height:23px; text-align:left; vertical-align:middle; background-color:#99ccff; ">검사명</caption>
			<input id="input6" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para26" style="left:102px; top:461px; width:438px; height:19px; "/>
			<line id="line14" class="line_3" style="x1:0px; y1:483px; x2:540px; y2:483px; "/>
			<line id="line15" class="line_3" style="x1:0px; y1:508px; x2:540px; y2:508px; "/>
			<caption id="caption13" class="cell_1" style="left:0px; top:485px; width:145px; height:23px; text-align:left; vertical-align:middle; background-color:#99ccff; ">검체종류 (검체채취일시)</caption>
			<input id="input8" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para27" class="input_s_essential" inputtype="date" style="left:147px; top:486px; width:118px; height:19px; font-weight:normal; "/>
			<input id="input7" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para28" class="input_search" format="hh:nn" style="left:266px; top:486px; width:50px; height:19px; "/>
			<select id="checkbox8" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para29" overflow="visible" appearance="full" style="left:0px; top:514px; width:85px; height:20px; border-style:none; ">
				<choices>
					<item>
						<label>혈액(EDTA)</label>
						<value>V</value>
					</item>
				</choices>
			</select>
			<select id="checkbox9" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para30" overflow="visible" appearance="full" style="left:85px; top:514px; width:100px; height:20px; border-style:none; ">
				<choices>
					<item>
						<label>혈액(Heparin)</label>
						<value>V</value>
					</item>
				</choices>
			</select>
			<select id="checkbox10" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para31" overflow="visible" appearance="full" style="left:185px; top:514px; width:55px; height:20px; border-style:none; ">
				<choices>
					<item>
						<label>골수</label>
						<value>V</value>
					</item>
				</choices>
			</select>
			<select id="checkbox11" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para32" overflow="visible" appearance="full" style="left:240px; top:514px; width:100px; height:20px; border-style:none; ">
				<choices>
					<item>
						<label>Amniotic Fluid</label>
						<value>V</value>
					</item>
				</choices>
			</select>
			<select id="checkbox12" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para33" overflow="visible" appearance="full" style="left:340px; top:514px; width:100px; height:20px; border-style:none; ">
				<choices>
					<item>
						<label>Chorionic villi</label>
						<value>V</value>
					</item>
				</choices>
			</select>
			<select id="checkbox13" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para34" overflow="visible" appearance="full" style="left:440px; top:514px; width:100px; height:20px; border-style:none; ">
				<choices>
					<item>
						<label>Skin fibroblast</label>
						<value>V</value>
					</item>
				</choices>
			</select>
			<select id="checkbox14" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para35" overflow="visible" appearance="full" style="left:0px; top:539px; width:60px; height:20px; border-style:none; ">
				<choices>
					<item>
						<label>기타</label>
						<value>V</value>
					</item>
				</choices>
			</select>
			<input id="input9" ref="/root/main/reqfrm/reqfrmtbl/reqfrminfo/inptitem01/para36" style="left:82px; top:539px; width:438px; height:19px; "/>
			<line id="line20" class="line_3" style="x1:0px; y1:558px; x2:540px; y2:558px; "/>
		</group>
		<group id="group3" style="left:0px; top:565px; width:545px; height:27px; ">
			<line id="line2" class="line_2" style="x1:0px; y1:0px; x2:490px; y2:0px; "/>
			<button id="btn_close" class="btn4_letter2" style="left:489px; top:5px; width:56px; height:22px; ">
				<caption>닫기</caption>
				<script type="javascript" ev:event="DOMActivate">
					<![CDATA[
						fSetClose();
					]]>
				</script>
			</button>
			<button id="btn_save" class="btn4_letter2" style="left:430px; top:5px; width:56px; height:22px; ">
				<caption>확인</caption>
				<script type="javascript" ev:event="DOMActivate">
					<![CDATA[
						fExeClinicSave();
					]]>
				</script>
			</button>
		</group>
	</xhtml:body>
</xhtml:html>