Page Comparison

<htmlform>
&nbsp;&nbsp;&nbsp; <macros>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; lightgrey=#e0e0e0
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; lightblue=#95ADCA
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; darkblue=#4444ff
&nbsp;&nbsp;&nbsp; </macros>
&nbsp;
<div style="background-color: $lightblue"><b><center>Hospital Admission Form</center></b></div>
&nbsp;
<table border="1" width="800px"&nbsp; cellspacing="0" align="center" cellpadding="1">
<tr>
<td colspan="3">
<table border="1" width="100%"&nbsp; valign="middle" cellspacing="0" cellpadding="1" ><tr><td><b>LAST NAME</b></td><td><b>FIRST NAME</b></td><td><b>DATE OF BIRTH</b></td><td><b>DOSSIER #</b> </td></tr>
<tr>
<td><span><lookup expression="patient.personName.familyName"/></span></td>
<td><span><lookup expression="patient.personName.givenName"/></span></td>
<td><span><lookup expression="patient.birthdate"/></span></td>
<td><span><lookup expression="patient.getPatientIdentifier(1)"/></span></td>
</tr>
<tr><td colspan="2"><B>LOCALITY</B></td><td><B>ADDRESS</B></td><td><B>CITY</B></td></tr>
<tr><td colspan="2"><lookup complexExpression="
\#set( $locality = 0 )
\#set( $locality = $personAttributes.get('Tribe') )
\#if( $locality == 0 \|\| $locality == 'no tribe name specified' )
&nbsp;&nbsp;&nbsp; OUT DISTRICT
\#else
&nbsp;&nbsp;&nbsp; $locality
\#end
"/></td>
<td><lookup expression="patient.personAddress.address1"/></td>
<td><lookup expression="patient.personAddress.cityVillage"/></td>
</tr>

<tr><td><B>PATIENT AGE</B></td><td><B>GENDER</B></td><td colspan="2"><B>PARENT (Mother)</B></td></tr>
<tr><td><span> <lookup expression="patient.age"/></span></td>
<td>&nbsp;&nbsp; <span><lookup expression="patient.gender" codePrefix="gender_"/></span></td>
<td colspan="2"><lookup complexExpression="#foreach ( $relationship in $relationshipList )
&nbsp;&nbsp;&nbsp; #if( $relationship.relationshipType.bIsToA == 'Parent' )
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; #if( \!($relationship.personB.patientId == $patient.patientId ))
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; #if( $relationship.personB.gender == 'F' )
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; $relationship.personB.personName
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; #end
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; #end
&nbsp;&nbsp;&nbsp; #end
\#end
"/>
</td>
</tr>

</table>
</td><td align="center" valign="middle">
<img src="http://intranet.hashaiti.org:81/image/HASlogo_circle_black_small_whitebackground.gif"&nbsp; />
<br />

<lookup complexExpression="
<img src="[http://intranet.hashaiti.org:81/frontdesk/barre_code.php?string=$]{patient.getPatientIdentifier(1)}"/>
" />

</td>
</tr>
</table>
<table border="1" width="800px" cellspacing="0" align="center" cellpadding="1">
<tr>
<td valign="middle" style="width:220px"><br/><b>Services: </b><br/><br/></td><td style="width:256px">
<obs conceptId="1827" required="true" answerConceptIds="1691,2037,6206,2034,3036,2036,1542,2035,1692,6196,6194" answerLabels="ADULT.ISOLATION,ADULT.SURGERY (GENERAL),CHOLERA,INTERNAL.MEDICINE,MALNUTRITION,OBGYN,OBSERVATION,PEDIATRIC.GENERAL,PEDITRIC.ISOLATION,PEDIATRIC.NEONATAL,PEDIATRIC.SURGERY" />
</td><td ></td>
</tr>
<tr><td><b>Durée de l'hospitalisation:</b><br/>(Duration of Hospitalization)</td><td><b>Du</b> (From)<encounterDate default="today" /></td><td><b>Au</b> (To)<obs conceptId="1829" /></td></tr>

<tr ><td valign="top"><b>Diagnostics(s)<br/></b>(Diagnosis)</td><td colspan="3" >

<obs conceptId="6042" answerClasses="Diagnosis" style="autocomplete" labelText="1" size="80" /><br/>

<obs conceptId="6042" answerClasses="Diagnosis" style="autocomplete" labelText="2" size="80"/><br/>

<obs conceptId="6042" answerClasses="Diagnosis" style="autocomplete" labelText="3" size="80" /><br/>

<obs conceptId="6042" answerClasses="Diagnosis" style="autocomplete" labelText="4" size="80" />

</td></tr>

<tr><td valign="top"><b>Traitement ou Procédure</b><br/>(Treatment or Procedure)</td> <td colspan="3"><obs conceptId="6193" answerClasses="Procedure" style="autocomplete" labelText="1" size="80"/><br/>
<br/>
<obs conceptId="6193" answerClasses="Procedure" style="autocomplete" labelText="2" size="80"/><br/>

<obs conceptId="2630" size="80" labelText="Non-Coded"/>
</td></tr>
<tr><td valign="top"><b>Transféré à </b><br/>(Tranferred to)</td><td colspan="2"><obs conceptId="1285" /></td></tr>
<tr><td valign="top"><b>Condition à L'éxeat</b><br/>(Status at Discharge)</td><td colspan="3"><obs conceptId="2044" style="radio"/></td></tr>
<tr><td><b>Rendez vous:</b><br/>(Return Visit)</td><td><b>Date de Rendez-vous</b><br/><obs conceptId="5096" allowFutureDates="true" />&nbsp; </td><td><b> Lieu </b>(Place)<br/><obs conceptId="2639" answers="HAS,Dispensaire HAS,Dispensaire non HAS,HIV/TB Clinic" /></td>
</tr>

<tr>
<td&nbsp; colspan="4" align="center"> <b>Lieu</b> (Location) <encounterLocation default="15" order="15" type="hidden" /> <b>Nom du Medecin</b> (Doctor Name)<encounterProvider role="Provider"/>
<submit />
</td>
</tr>&nbsp;&nbsp;&nbsp; &nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;
</table>
</htmlform>