csf.html

<htmlform formUuid="324f37a9-1b39-4a85-a8a3-26a09ef83f13" formName="CSF Investigations" formEncounterType="b7d7740b-5767-45b6-8ae3-332476e75abf" formVersion="1.0">
    <style>
        .background {
            background-color: #888;
        }
        table.csf {
            border-collapse: collapse;
            background-color: #000;
        }
        table.csf > tbody > tr > td, table.csf > tbody > tr > th {
            border: 0;
            vertical-align: baseline;
            padding: 2px;
            text-align: left;
            background-color: #F3F9FF;
        }
    </style>
    <h2>CSF Evaluation</h2>
    <div class="background">
        <div style="display:none">
            <td>Evaluation date:<encounterDate id="encounterDate" showTime="false" default="now" /></td>
        </div>
        <table class="csf">

            <tbody>
                <tr>
                    <td>Location:<encounterLocation default="24" /></td>
                    <td>Provider:<encounterProvider default="currentUser"/></td>
                    <td>Date of test:<obs conceptId="163724AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA" allowTime="false" /></td>
                </tr>
                <tr>
                    <td>Appearance:<obs conceptId="159650AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA" /></td>
                    <td>Red Cells (10^6/uL)<obs conceptId="679AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA" /></td>
                    <td>White Cells (10^6/uL)<obs conceptId="678AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA" /></td>
                </tr>
                <tr>
                    <td colspan="3">
                        <label><uimessage code="coreapps.consult.freeTextComments"/></label>
                        <obs conceptId="162169AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA" style="textarea" rows="5"/>
                    </td>
                </tr>
            </tbody>
        </table>
    </div>



    <ifMode mode="VIEW" include="false">
        <div id="buttons">
            <submit submitClass="confirm right" submitCode="general.save"/>
            <button type="button" class="cancel"><uimessage code="general.cancel"/></button>
        </div>
    </ifMode>

</htmlform>