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- <html>
- <head>
- <meta charset="UTF-8" />
- <title>2型糖尿病患者随访服务记录表</title>
- <style type="text/css" media="all">
- * {
- margin: 0;
- padding: 0;
- font-size: 12px;
- }
- table {
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- <body>
- <div id="content">
- <!-- <div class="header">
- <span>档案号:</span>
- <div class="line"></div>
- <button type="button" class="btn hid">打印</button>
- <div>
- <button type="button" class="btn">导出</button>
- <button type="button" class="btn">作废</button>
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- <button type="button" class="btn hid">保存</button>
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- <div class="main">
- <h3 class="textAlign" style="font-weight: bold">
- 2型糖尿病患者随访服务记录表
- </h3>
- <div class="tableHeader">
- <span class="require">姓名:<span></span></span><span></span>
- </div>
- <table>
- <tbody>
- <tr>
- <td colspan="2" class="boldTd require">随访日期</td>
- <td colspan="2" class="boldTd">
- <span id="Follow_Time1"></span>
- </td>
- <td colspan="2" class="boldTd">
- <span id="Follow_Time2"></span>
- </td>
- <td colspan="2" class="boldTd">
- <span id="Follow_Time3"></span>
- </td>
- <td colspan="2" class="boldTd">
- <span id="Follow_Time4"></span>
- </td>
- </tr>
- <tr>
- <td colspan="2" class="boldTd require">随访方式</td>
- <td colspan="2">
- <span>1 门诊 2 家庭 3 电话</span>
- <div class="boxPosition">
- <span id="Follow_Type1" class="box"></span>
- </div>
- </td>
- <td colspan="2">
- <span>1 门诊 2 家庭 3 电话</span>
- <div class="boxPosition">
- <span id="Follow_Type2" class="box"></span>
- </div>
- </td>
- <td colspan="2">
- <span>1 门诊 2 家庭 3 电话</span>
- <div class="boxPosition">
- <span id="Follow_Type3" class="box"></span>
- </div>
- </td>
- <td colspan="2">
- <span>1 门诊 2 家庭 3 电话</span>
- <div class="boxPosition">
- <span id="Follow_Type4" class="box"></span>
- </div>
- </td>
- </tr>
- <tr>
- <td rowspan="2" class="boldTd2 require">症 状</td>
- <td rowspan="2" class="boldTd require">
- 1 无症状 <br />2 多饮<br />3 多食<br />4
- 多尿<br />5 视力模糊<br />6 感染<br />7
- 手脚麻木<br />8 下肢浮肿<br />9 体重明显下降<br />10
- 其他
- </td>
- <td colspan="2">
- <div class="textRight">
- <div id="Symptom1" class="checkBox" data-param="4">
- <!-- 使用JavaScript生成10个方框 -->
- </div>
- </div>
- </td>
- <td colspan="2">
- <div class="textRight">
- <div id="Symptom2" class="checkBox" data-param="4">
- <!-- 使用JavaScript生成10个方框 -->
- </div>
- </td>
- <td colspan="2">
- <div class="textRight">
- <div id="Symptom3" class="checkBox" data-param="4">
- <!-- 使用JavaScript生成10个方框 -->
- </div>
- </td>
- <td colspan="2">
- <div class="textRight">
- <div id="Symptom4" class="checkBox" data-param="4">
- <!-- 使用JavaScript生成10个方框 -->
- </div>
- </td>
- </tr>
- <tr>
- <td colspan="2" class="boldTd3">
- 其他:<span></span>
- </td>
- <td colspan="2" class="boldTd3">
- 其他:<span></span>
- </td>
- <td colspan="2" class="boldTd3">
- 其他:<span></span>
- </td>
- <td colspan="2" class="boldTd3">
- 其他:<span></span>
- </td>
- </tr>
- <tr>
- <td rowspan="8" class="boldTd2 require">体征</td>
- <td class="boldTd">血压(mmHg)</td>
- <td colspan="2" id="Right1"><span></span></td>
- <td colspan="2" id="Right2"><span></span></td>
- <td colspan="2" id="Right3"><span></span></td>
- <td colspan="2" id="Right4"><span></span></td>
- </tr>
- <tr>
- <td class="boldTd require">体重(kg)</td>
- <td colspan="2" id="Weight1"></td>
- <td colspan="2" id="Weight2"></td>
- <td colspan="2" id="Weight3"></td>
- <td colspan="2" id="Weight4"></td>
- </tr>
- <tr>
- <td class="boldTd require">下次随访目标(kg)</td>
- <td colspan="2" id="Weight_Next1"></td>
- <td colspan="2" id="Weight_Next2"></td>
- <td colspan="2" id="Weight_Next3"></td>
- <td colspan="2" id="Weight_Next4"></td>
- </tr>
- <tr>
- <td class="boldTd require">身高(cm)</td>
- <td colspan="2" id="Height1"></td>
- <td colspan="2" id="Height2"></td>
- <td colspan="2" id="Height3"></td>
- <td colspan="2" id="Height4"></td>
- </tr>
- <tr>
- <td class="boldTd">体质指数(BMI)kg/m²</td>
- <td colspan="2" id="Bmi1"></td>
- <td colspan="2" id="Bmi2"></td>
- <td colspan="2" id="Bmi3"></td>
- <td colspan="2" id="Bmi4"></td>
- </tr>
- <tr>
- <td class="boldTd">下次随访目标(kg/m²)</td>
- <td colspan="2" id="Bmi_Next1"></td>
- <td colspan="2" id="Bmi_Next2"></td>
- <td colspan="2" id="Bmi_Next3"></td>
- <td colspan="2" id="Bmi_Next4"></td>
- </tr>
- <tr>
- <td class="boldTd require">足背动脉搏动</td>
- <td colspan="2">
- <span>不正常(左侧:减弱,右侧:消失)</span>
- </td>
- <td colspan="2">
- <span>不正常(左侧:减弱,右侧:消失)</span>
- </td>
- <td colspan="2">
- <span>不正常(左侧:减弱,右侧:消失)</span>
- </td>
- <td colspan="2">
- <span>不正常(左侧:减弱,右侧:消失)</span>
- </td>
- </tr>
- <tr>
- <td class="boldTd require">其他</td>
- <td colspan="2" id="Sign_Other1"></td>
- <td colspan="2" id="Sign_Other2"></td>
- <td colspan="2" id="Sign_Other3"></td>
- <td colspan="2" id="Sign_Other4"></td>
- </tr>
- <tr>
- <td rowspan="10" class="boldTd2 require">
- 生活方式指导
- </td>
- <td class="boldTd">日吸烟量(支)</td>
- <td colspan="2" id="Smoking_Daily1"></td>
- <td colspan="2" id="Smoking_Daily2"></td>
- <td colspan="2" id="Smoking_Daily3"></td>
- <td colspan="2" id="Smoking_Daily4"></td>
- </tr>
- <tr>
- <td class="boldTd">下次随访目标(支)</td>
- <td colspan="2">
- <span id="Goal_Smoking1"></span>
- </td>
- <td colspan="2">
- <span id="Goal_Smoking2"></span>
- </td>
- <td colspan="2">
- <span id="Goal_Smoking3"></span>
- </td>
- <td colspan="2">
- <span id="Goal_Smoking4"></span>
- </td>
- </tr>
- <tr>
- <td class="boldTd require">日饮酒量(两)</td>
- <td colspan="2" id="Drinking_Daily1"></td>
- <td colspan="2" id="Drinking_Daily2"></td>
- <td colspan="2" id="Drinking_Daily3"></td>
- <td colspan="2" id="Drinking_Daily4"></td>
- </tr>
- <tr>
- <td class="boldTd require">下次随访目标(两)</td>
- <td colspan="2">
- <span id="Goal_Drinking1"></span>
- </td>
- <td colspan="2">
- <span id="Goal_Drinking2"></span>
- </td>
- <td colspan="2">
- <span id="Goal_Drinking3"></span>
- </td>
- <td colspan="2">
- <span id="Goal_Drinking4"></span>
- </td>
- </tr>
- <tr>
- <td class="boldTd require">运动</td>
- <td colspan="2">
- <span><span id="">1</span>次/周</span> <span><span
- id="">1</span>分钟/次</span>
- </td>
- <td colspan="2">
- <span> <span id="">1</span>次/周</span> <span><span
- id="">1</span>分钟/次</span>
- </td>
- <td colspan="2">
- <span><span id="">1</span>次/周</span> <span><span
- id="">1</span>分钟/次</span>
- </td>
- <td colspan="2">
- <span><span id="">1</span>次/周</span> <span><span
- id="">1</span>分钟/次</span>
- </td>
- </tr>
- <tr>
- <td class="boldTd require">下次随访目标</td>
- <td colspan="2">
- <span>5次/周</span> <span>60分钟/次</span>
- </td>
- <td colspan="2">
- <span>5次/周</span> <span>60分钟/次</span>
- </td>
- <td colspan="2">
- <span>5次/周</span> <span>60分钟/次</span>
- </td>
- <td colspan="2">
- <span>5次/周</span> <span>60分钟/次</span>
- </td>
- </tr>
- <tr>
- <td class="boldTd require">主食(克/天)</td>
- <td colspan="2">9</td>
- <td colspan="2">9</td>
- <td colspan="2">9</td>
- <td colspan="2">9</td>
- </tr>
- <tr>
- <td class="boldTd require">
- 下次随访<br />目标(克/天)
- </td>
- <td colspan="2">1</td>
- <td colspan="2">1</td>
- <td colspan="2">1</td>
- <td colspan="2">1</td>
- </tr>
- <tr>
- <td class="boldTd require">心理调整</td>
- <td colspan="2" id="Psychol_Adjust1"></td>
- <td colspan="2" id="Psychol_Adjust2"></td>
- <td colspan="2" id="Psychol_Adjust3"></td>
- <td colspan="2" id="Psychol_Adjust4"></td>
- </tr>
- <tr>
- <td class="boldTd require">遵医行为</td>
- <td colspan="2" id="Compliance1"></td>
- <td colspan="2" id="Compliance2"></td>
- <td colspan="2" id="Compliance3"></td>
- <td colspan="2" id="Compliance4"></td>
- </tr>
- <tr>
- <td colspan="2" class="boldTd require">
- 辅助检查*
- </td>
- <td colspan="2" id="Auxiliary_Other1"></td>
- <td colspan="2" id="Auxiliary_Other2"></td>
- <td colspan="2" id="Auxiliary_Other3"></td>
- <td colspan="2" id="Auxiliary_Other4"></td>
- </tr>
- <tr>
- <td colspan="2" class="boldTd require">
- 服药依从性
- </td>
- <td colspan="2" id="Compliance_Drug1"></td>
- <td colspan="2" id="Compliance_Drug2"></td>
- <td colspan="2" id="Compliance_Drug3"></td>
- <td colspan="2" id="Compliance_Drug4"></td>
- </tr>
- <tr>
- <td colspan="2" class="boldTd require">
- 药物不良反应
- </td>
- <td colspan="2" id="Adverse1"></td>
- <td colspan="2" id="Adverse2"></td>
- <td colspan="2" id="Adverse3"></td>
- <td colspan="2" id="Adverse4"></td>
- </tr>
- <tr>
- <td colspan="2" class="boldTd require">
- 低血糖反应
- </td>
- <td colspan="2"><span>偶尔</span></td>
- <td colspan="2"><span>偶尔</span></td>
- <td colspan="2"><span>偶尔</span></td>
- <td colspan="2"><span>偶尔</span></td>
- </tr>
- <tr>
- <td colspan="2" class="boldTd require">
- 此次随访分类
- </td>
- <td colspan="2" id="Follow_Up_Classify1"></td>
- <td colspan="2" id="Follow_Up_Classify2"></td>
- <td colspan="2" id="Follow_Up_Classify3"></td>
- <td colspan="2" id="Follow_Up_Classify4"></td>
- </tr>
- <tr>
- <td colspan="2" class="boldTd">药物名称</td>
- <td colspan="2" class="boldTd" id="Appraisal1"></td>
- <td colspan="2" class="boldTd" id="Appraisal2"></td>
- <td colspan="2" class="boldTd" id="Appraisal3"></td>
- <td colspan="2" class="boldTd" id="Appraisal4"></td>
- </tr>
- <tr>
- <td rowspan="2" class="boldTd2">转诊</td>
- <td class="boldTd require">原因</td>
- <td colspan="2" id="Referral_Hospital1"></td>
- <td colspan="2" id="Referral_Hospital2"></td>
- <td colspan="2" id="Referral_Hospital3"></td>
- <td colspan="2" id="Referral_Hospital4"></td>
- </tr>
- <tr>
- <td class="boldTd require">机构及科别</td>
- <td colspan="2" id="Referral_Hospital1"></td>
- <td colspan="2" id="Referral_Hospital2"></td>
- <td colspan="2" id="Referral_Hospital3"></td>
- <td colspan="2" id="Referral_Hospital4"></td>
- </tr>
- <tr>
- <td colspan="2" class="boldTd">下次随访日期</td>
- <td colspan="2" class="require" id="Next_Follow_Up_Time1"></td>
- <td colspan="2" class="require" id="Next_Follow_Up_Time2"></td>
- <td colspan="2" class="require" id="Next_Follow_Up_Time3"></td>
- <td colspan="2" class="require" id="Next_Follow_Up_Time4"></td>
- </tr>
- <!-- <tr>
- <td colspan="2" class="boldTd require">
- 随访医生签名
- </td>
- <td colspan="2">
- <img
- alt=""
- class="sign-name"
- src="https://img.health.gagctv.com//open/file/download?data=yr2aRn1UUQ8kLh1v%2Fch92FimOpvsqWt1x7Fe%2BRMGALf4SmOUq0kne2nXZK3H7t9m"
- />
- </td>
- </tr> -->
- </tbody>
- </table>
- <!-- <img
- src="https://img.health.gagctv.com//open/file/download?data=yr2aRn1UUQ8kLh1v%2Fch92E6hIr3Mpqp7BGhVkwCSJ7lgYEpZmqo%2BxDz7YYCqEktf"
- /> -->
- <!---->
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- const data = window.parent.tableData;
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- let length = 0;
- if (container.getAttribute('data-param')) {
- length = container.getAttribute('data-param');
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- // 生成10个方框,并填充值
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