This is the info from the add new patient frame on allscripts. The script is listed on greeseyfork under allscripts.
Veradigm ePrescribe - Add Patient
.auto-style1 {
width: 61px;
}
<input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="E3BA02E7" />
<input type="hidden" name="____Ticket" id="____Ticket" value="1" />
<script type="text/javascript">
var sysApplication = Sys.WebForms.PageRequestManager.getInstance();
ignoreIeEvents();
sysApplication.add_initializeRequest(beginRequest);
sysApplication.add_endRequest(endRequest);
function beginRequest() {
document.getElementById("divLoading").style.display = "inline";
//You can show a div or
}
function endRequest() {
document.getElementById("divLoading").style.display = "none";
}
RegisterPopupOvelay('');
</script>
<table id="Content" width="100%" cellspacing="0" cellpadding="0">
<tr>
<td style="width: 80%">
<script type="text/javascript" language="javascript">
function CalculateLbsAndOzsFromKgs()
{
var kgValue = $('#ctl00_ContentPlaceHolder1_txtWeightKg').val();
if (kgValue == "")
kgValue = 0;
var ozs = Math.round(((kgValue * 2.20462) % 1) * 16);
var lbs = Math.floor(kgValue * 2.20462);
if(ozs === 16)
{
ozs = 0;
lbs = lbs+1;
}
$('#ctl00_ContentPlaceHolder1_txtWeightLbs').val(lbs);
$('#ctl00_ContentPlaceHolder1_txtWeightOzs').val(ozs);
}
function UpdateKgFromLbsAndOzs()
{
var lbs = document.getElementById( 'ctl00_ContentPlaceHolder1_txtWeightLbs').value;
var ozs = document.getElementById('ctl00_ContentPlaceHolder1_txtWeightOzs').value;
if (lbs == "")
lbs = 0;
if (ozs == "")
ozs = 0;
var kgs = lbs * .45359237;
var kgs = kgs + (ozs / 16) * .45359237;
$('#ctl00_ContentPlaceHolder1_txtWeightKg').val(kgs.toFixed(2));
}
function UpdateCmFromFtAndIns()
{
var feet = document.getElementById('ctl00_ContentPlaceHolder1_txtHeightFt').value;
var inches = document.getElementById('ctl00_ContentPlaceHolder1_txtHeightIn').value;
if (feet == "")
feet = 0;
if (inches == "")
inches = 0;
var cm = (feet * 30.48) + (inches * 2.54);
$('#ctl00_ContentPlaceHolder1_txtHeightCm').val(cm.toFixed(1));
}
function CalculateFtAndInsFromCm()
{
var cm = document.getElementById('ctl00_ContentPlaceHolder1_txtHeightCm').value;
if (cm == "") {
$('#ctl00_ContentPlaceHolder1_txtHeightFt').val(0);
$('#ctl00_ContentPlaceHolder1_txtHeightIn').val(0);
}
//Begin conversions
var cmValue = $('#ctl00_ContentPlaceHolder1_txtHeightCm').val();
if (cmValue !== "") {
cmValue /= 2.54;
var feet = parseInt(Math.floor(cmValue / 12));
var inches = parseInt(Math.round(cmValue % 12));
if(inches === 12)
{
inches = 0;
feet++;
}
$('#ctl00_ContentPlaceHolder1_txtHeightFt').val(feet);
$('#ctl00_ContentPlaceHolder1_txtHeightIn').val(inches);
}
}
function digitValidation(evt)
{
if (evt.charCode > 31 && (evt.charCode < 48 || evt.charCode > 57))
{
return false;
}
if (evt.keyCode > 31 && (evt.keyCode < 48 || evt.keyCode > 57))
{
return false;
}
}
function digitDecimalValidation(evt) {
if (evt.charCode == 46)
return true;
if (evt.keyCode == 46)
return true;
if (evt.charCode > 31 && (evt.charCode < 48 || evt.charCode > 57)) {
return false;
}
if (evt.keyCode > 31 && (evt.keyCode < 48 || evt.keyCode > 57))
{
return false;
}
}
</script>
<script type="text/javascript" language="javascript" src="js/formUtil.js"></script>
<input type="hidden" name="ctl00$ContentPlaceHolder1$isFromAngularModal" id="isFromAngularModal" value="false" />
<table width="100%" border="0" cellspacing="0" cellpadding="0">
<tr class="h1title indnt">
<td colspan="2">
<span id="ctl00_ContentPlaceHolder1_heading" class="highlight">Add New Patient</span>
</td>
</tr>
<tr class="h4title">
<td colspan="2" style="padding:5px">
<input type="submit" name="ctl00$ContentPlaceHolder1$btnBack" value="Back" id="ctl00_ContentPlaceHolder1_btnBack" title="Click to go back to the Choose Patient page." class="btnstyle" />
<input type="submit" name="ctl00$ContentPlaceHolder1$btnPatientAdd" value="Save" onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl00$ContentPlaceHolder1$btnPatientAdd", "", true, "", "", false, false))" id="ctl00_ContentPlaceHolder1_btnPatientAdd" title="Click to save details." class="btnstyle" />
<input type="submit" name="ctl00$ContentPlaceHolder1$btnAddAllergy" value="Patient Allergy" onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl00$ContentPlaceHolder1$btnAddAllergy", "", true, "", "", false, false))" id="ctl00_ContentPlaceHolder1_btnAddAllergy" title="Click to view list of medications to which patient is allergic or to add a new allergy." class="btnstyle" />
</td>
</tr>
<tr>
<td colspan="2">
<table width="100%" border="0" cellpadding="0" style="width:100%">
<tr>
<td style="height: inherit;">
<table width="100%" border="0" cellpadding="0">
<tr>
<td>
</td>
</tr>
<tr>
<td>
<div id="ctl00_ContentPlaceHolder1_ValidationSummary1" style="display:none;">
Phone: |
*
|
Mobile Phone:
|
*
|
* First Name: |
**
|
Middle Name:
|
*
|
<tr>
<td nowrap="nowrap" align="right">
<span id="ctl00_ContentPlaceHolder1_lblLastNameAsterisk" style="color:Red;">*</span> Last Name:
</td>
<td>
<input name="ctl00$ContentPlaceHolder1$txtLName" type="text" maxlength="35" id="ctl00_ContentPlaceHolder1_txtLName" onblur="capitilizeInitial(this)" style="width:200px;" />
<span id="ctl00_ContentPlaceHolder1_rfvLastName" style="display:inline-block;height:9px;width:6px;visibility:hidden;">*</span><span id="ctl00_ContentPlaceHolder1_revLastName" style="visibility:hidden;">*</span>
</td>
<td align="right">
Patient allows Medication History:
</td>
<td>
<select name="ctl00$ContentPlaceHolder1$ddlMedHistory" id="ctl00_ContentPlaceHolder1_ddlMedHistory" style="width:80px;">
<option value="false">Yes</option>
<option value="true">No</option>
| |
Patient allows Disclosures to Health Plan:
|
Yes
No
|
* Date of Birth: |
*
</td>
<td align="right">
Patient Preferred <br />
Language: </td>
<td colspan="3" style="padding-top:3px">
<select name="ctl00$ContentPlaceHolder1$ddlPatientPreferredLang" id="ctl00_ContentPlaceHolder1_ddlPatientPreferredLang" style="width:100px;">
<option value="amh">Amharic</option>
<option value="ara">Arabic</option>
<option value="hye">Armenian</option>
<option value="ben">Bengali</option>
<option value="zho">Chinese</option>
<option value="hrv">Croatian</option>
<option value="ces">Czech</option>
<option value="dan">Danish</option>
<option value="nld">Dutch</option>
<option selected="selected" value="eng">English</option>
<option value="fin">Finnish</option>
<option value="fra">French</option>
<option value="deu">German</option>
<option value="ell">Greek</option>
<option value="heb">Hebrew</option>
<option value="hin">Hindi(Urdu)</option>
<option value="hun">Hungarian</option>
<option value="ita">Italian</option>
<option value="jpn">Japanese</option>
<option value="kor">Korean</option>
<option value="lit">Lithuanian</option>
<option value="mal">Malayalam</option>
<option value="nav">Navaho</option>
<option value="nno">Norwegian</option>
<option value="oth">Other(not english)</option>
<option value="pan">Panjabi</option>
<option value="fas">Persian</option>
<option value="pol">Polish</option>
<option value="por">Portuguese</option>
<option value="ron">Romanian</option>
<option value="rus">Russian</option>
<option value="smo">Samoan</option>
<option value="slk">Slovak</option>
<option value="spa">Spanish</option>
<option value="swe">Swedish</option>
<option value="tgl">Tagalog</option>
<option value="tha">Thai(Laotian)</option>
<option value="tur">Turkish</option>
<option value="ukr">Ukrainian</option>
<option value="vie">Vietnamese</option>
<option value="yid">Yiddish</option>
|
* Gender:
|
--Select--
Male
Female
Unknown
*
</td>
<td align="right">
<div style="padding-top: 10px">
Current Weight:
</div>
</td>
<td style="padding-top:3px;">
<input name="ctl00$ContentPlaceHolder1$txtWeightLbs" type="text" maxlength="4" id="ctl00_ContentPlaceHolder1_txtWeightLbs" onfocusout="UpdateKgFromLbsAndOzs()" onkeypress="return digitValidation(event)" onkeyup="UpdateKgFromLbsAndOzs()" style="width:40px;" /> lb
<input name="ctl00$ContentPlaceHolder1$txtWeightOzs" type="text" maxlength="2" id="ctl00_ContentPlaceHolder1_txtWeightOzs" onfocusout="UpdateKgFromLbsAndOzs()" onkeypress="return digitValidation(event)" onkeyup="UpdateKgFromLbsAndOzs()" style="width:20px;" /> oz
</td>
</tr>
<tr style="padding-top:20px">
<td align="right">
Patient ID (MRN):
</td>
<td>
<input name="ctl00$ContentPlaceHolder1$txtMRN" type="text" maxlength="25" id="ctl00_ContentPlaceHolder1_txtMRN" />
</td>
<td>
</td>
<td style="padding-top:3px;">
<input name="ctl00$ContentPlaceHolder1$txtWeightKg" type="text" maxlength="6" id="ctl00_ContentPlaceHolder1_txtWeightKg" onfocusout="CalculateLbsAndOzsFromKgs()" onkeypress="return digitDecimalValidation(event)" onkeyup="CalculateLbsAndOzsFromKgs()" style="width:60px;" /> kg
<span id="ctl00_ContentPlaceHolder1_kgDecimalValidation" style="visibility:hidden;">*</span>
</tr>
<tr>
</tr>
<tr>
<td align="right">
<span style="color:Red">*</span> Address 1:
</td>
<td colspan="1">
<input name="ctl00$ContentPlaceHolder1$txtAddress1" type="text" maxlength="40" id="ctl00_ContentPlaceHolder1_txtAddress1" onblur="capitilizeInitial(this)" style="width:300px;" />
<span id="ctl00_ContentPlaceHolder1_rfvAddress1" style="display:inline-block;width:1px;visibility:hidden;">*</span>
</td>
<td align="right">
<div style="padding-top: 10px">
Current Height:
</div>
</td>
<td style="padding-top:3px;" rowspan="2">
<input name="ctl00$ContentPlaceHolder1$txtHeightFt" type="text" maxlength="2" id="ctl00_ContentPlaceHolder1_txtHeightFt" onfocusout="UpdateCmFromFtAndIns()" onkeypress="return digitValidation(event)" onkeyup="UpdateCmFromFtAndIns()" style="width:40px;" /> ft
<input name="ctl00$ContentPlaceHolder1$txtHeightIn" type="text" maxlength="3" id="ctl00_ContentPlaceHolder1_txtHeightIn" onfocusout="UpdateCmFromFtAndIns()" onkeypress="return digitValidation(event)" onkeyup="UpdateCmFromFtAndIns()" style="width:20px;" /> in
<div style="padding-top:7px">
<input name="ctl00$ContentPlaceHolder1$txtHeightCm" type="text" maxlength="7" id="ctl00_ContentPlaceHolder1_txtHeightCm" onfocusout="CalculateFtAndInsFromCm()" onkeypress="return digitDecimalValidation(event)" onkeyup="CalculateFtAndInsFromCm()" style="width:60px;" /> cm
<span id="ctl00_ContentPlaceHolder1_CmDecimalValidation" style="visibility:hidden;">*</span>
</td>
</tr>
<tr>
<td align="right">
Address 2:</td>
<td colspan="2">
<input name="ctl00$ContentPlaceHolder1$txtAddress2" type="text" maxlength="40" id="ctl00_ContentPlaceHolder1_txtAddress2" onblur="capitilizeInitial(this)" style="width:300px;" /></td>
</tr>
<tr>
<td align="right">
<span style="color:Red">*</span> City:</td>
<td style="">
<input name="ctl00$ContentPlaceHolder1$txtCity" type="text" maxlength="35" id="ctl00_ContentPlaceHolder1_txtCity" onblur="capitilizeInitial(this)" style="width:200px;" />
<span id="ctl00_ContentPlaceHolder1_revCity" style="visibility:hidden;">*</span>
<span id="ctl00_ContentPlaceHolder1_rfvCity" style="display:inline-block;width:1px;visibility:hidden;">*</span>
</td>
<td align="right">
<span style="color:Red">*</span> State:</td>
<td>
<select name="ctl00$ContentPlaceHolder1$ddlState" id="ctl00_ContentPlaceHolder1_ddlState" style="width:50px;">
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AR">AR</option>
<option value="AZ">AZ</option>
<option value="CA">CA</option>
<option selected="selected" value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="GU">GU</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="PR">PR</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VI">VI</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
*
|
</tr>
<tr>
<td align="right">
E-mail:</td>
<td >
<input name="ctl00$ContentPlaceHolder1$txtEmail" type="text" maxlength="80" id="ctl00_ContentPlaceHolder1_txtEmail" style="width:200px;" />
<span id="ctl00_ContentPlaceHolder1_revEmail" style="display:inline-block;height:1px;width:1px;visibility:hidden;">*</span>  
</td>
<td align="right" >
<span style="color:Red">*</span> ZIP Code:
</td>
<td style="width:270px">
<input name="ctl00$ContentPlaceHolder1$txtZip" type="text" maxlength="9" id="ctl00_ContentPlaceHolder1_txtZip" onkeypress="return numericKeyPressOnly(this, event);" style="width:97px;" />
<span id="ctl00_ContentPlaceHolder1_revZipCode" style="visibility:hidden;">*</span>
<span id="ctl00_ContentPlaceHolder1_rfvZipCode" style="display:inline-block;width:1px;visibility:hidden;">*</span>
</td>
</tr>
<tr>
<td nowrap="nowrap" align="right">
Selected Pharmacy:</td>
<td colspan="5" style="padding-top:3px">
<span id="ctl00_ContentPlaceHolder1_lblPharmacy" style="font-weight:bold;">None Entered</span>  
<a id="ctl00_ContentPlaceHolder1_lnkEditPharmacy" href="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl00$ContentPlaceHolder1$lnkEditPharmacy", "", true, "", "", false, true))">[edit]</a>
</td>
</tr>
<tr>
<td align="right">
  </td>
<td colspan="5" style="padding-top:3px">
  
</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td colspan="6" style="height: 138px">
<table border="0" cellspacing="5" cellpadding="2" visible="false" width="100%">
<tr>
<td>
<div id="ctl00_ContentPlaceHolder1_gridCoverages" class="RadGrid RadGrid_Allscripts">
|
Insurance Plan Information |
|
|
|
|
No records to display. |
</td>
</tr>
<tr>
<td><input type="submit" name="ctl00$ContentPlaceHolder1$btChangeInsurance" value="Add Plan" onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl00$ContentPlaceHolder1$btChangeInsurance", "", true, "", "", false, false))" id="ctl00_ContentPlaceHolder1_btChangeInsurance" class="btnstyle" /></td>
</tr>
</table>
</td>
</tr>
</table>
<script type="text/javascript">
RegisterBackButton("ctl00_ContentPlaceHolder1_btnBack");
setAngulrModalStatus();
$(document).keypress(function (e) {
if (e.keyCode === 13) {
e.preventDefault();
return false;
}
});
</script>
</td>
<!-- 27/10/06 HA/Kumar.V css class added for right side content color -->
</tr>
</table>
|