<!-- BEGIN hmrn/data/lymphoid.tt -->
[% # PROCESS dumper.tt dump = hmrn_data.precursor %]
[% IF not_using_validationEngine_jquery # then use 'basic' jquery val %]
<script type="text/javascript">
$(document).ready(function() {
$("#lymphoid").validate({
rules: { },
});
});
</script>
[% ELSE %]
<script type="text/javascript">
$(document).ready(function() {
$("#lymphoid").validationEngine()
})
</script>
[% END %]
<h4 class="indent">
3. Lymphoproliferative data:
[% div_name = 'lymphoidData'; INCLUDE site/snippets/toggleview.tt %]
</h4>
<div id="[% div_name %]" class="[% hmrn_data.params.lymphoid.size
|| c.query.param('data_set') == 'lymphoid' ? 'visible' : 'itemhidden' %]">
<form method="post" name="lymphoid" id="lymphoid"
action="[% app_url %]/hmrn_data/edit/[% data.id %]/[% patient.id %]">
<input type="hidden" name="data_set" value="lymphoid" />
[% IF error_clls_or_non_cll %]
<p class="error indent">require a CLL or non-CLL data set (or both)</p>
[% END %]
<table class="indent">
<tr>
<td class="label">ECOG:</td>
<td class="content">
[% PROCESS build_select_field
name = 'ecog'
type = 'lymphoid'
%]
[% error_ecog %]
</td>
<td class="label">Hb:</td>
<td class="content">
[% PROCESS build_text_field
type = 'lymphoid'
name = 'hb'
size = 2
%]
[% error_hb || '[g/dL]' %]
</td>
<td class="grey borderless">[common]</td>
</tr>
<tr>
<td class="label">Bone marrow:</td>
<td class="content">
[% PROCESS build_select_field
name = 'bm'
type = 'lymphoid'
%]
[% error_bm %]
</td>
<td class="label">WBC:</td>
<td class="content">
[% PROCESS build_text_field
type = 'wbc'
name = 'hb'
size = 4
%]
[% error_wbc || '[x 10<sup>9</sup>/L]' %]
</td>
<td class="grey borderless">[common]</td>
</tr>
<tr>
<td class="label">Sweats:</td>
<td class="content">
[% PROCESS build_select_field
name = 'sweats'
type = 'lymphoid'
%]
[% error_sweats %]
</td>
<td class="label">Lymphocytes:</td>
<td class="content">
[% PROCESS build_text_field
type = 'lymphoid'
name = 'lymphs'
size = 4
%]
[% error_lymphs || '[x 10<sup>9</sup>/L]' %]
</td>
<td class="grey borderless">[common]</td>
</tr>
<tr>
<td class="label">Fever:</td>
<td class="content">
[% PROCESS build_select_field
name = 'fever'
type = 'lymphoid'
%]
[% error_fever %]
</td>
<td class="label">Albumin:</td>
<td class="content">
[% PROCESS build_text_field
type = 'lymphoid'
name = 'albumin'
size = 4
%]
[% error_albumin || '[g/L]' %]
</td>
<td class="grey borderless">[common]</td>
</tr>
<tr>
<td class="label">Weight loss:</td>
<td class="content">
[% PROCESS build_select_field
name = 'wt_loss'
type = 'lymphoid'
%]
[% error_wt_loss %]
</td>
<td class="label">β<sub>2</sub>m:</td>
<td class="content">
[% PROCESS build_text_field
type = 'lymphoid'
name = 'b2m'
size = 4
%]
[% error_b2m || '[mg/L]' %]
</td>
<td class="grey borderless">[common]</td>
</tr>
<tr>
<td class="label">CT scan:</td>
<td class="content">
[% PROCESS build_select_field
name = 'ct'
type = 'lymphoid'
%]
[% error_ct_scan %]
</td>
<td class="label">LDH:</td>
<td class="content">
[% PROCESS build_select_field
name = 'ldh'
type = 'lymphoid'
%]
[% error_ldh %]
</td>
<td class="grey borderless">[common]</td>
</tr>
<tr>
<td class="label">Binet stage:</td>
<td class="hmrnCLL">
[% PROCESS build_select_field
name = 'binet'
type = 'lymphoid'
%]
[% error_binet %]
</td>
<td class="label">Platelets:</td>
<td class="hmrnCLL">
[% PROCESS build_text_field
type = 'lymphoid'
name = 'plts'
size = 4
%]
[% error_plts || '[x 10<sup>9</sup>/L]' %]
</td>
<td class="grey borderless">[CLL data]</td>
</tr>
<tr>
<td class="label">Ann-Arbour:</td>
<td class="hmrnLPD">
[% PROCESS build_select_field
name = 'stage'
type = 'lymphoid'
%]
[% error_stage %]
</td>
<td colspan="2" class="borderless"></td>
<td class="grey borderless">[non-CLL data]</td>
</tr>
[% INCLUDE hmrn_submit %]
</table>
</form>
</div>
<!-- END hmrn/data/lymphoid.tt -->