[% sites = hmrn_data.params.staging; # PROCESS dumper.tt dump = sites %] [% BLOCK build_checkbox %] [% IF NOT label; field | ucfirst; ELSE; label; END %]: [% IF cols == 2; field_left = field _ '_left'; field_right = field _ '_right' %] [% ELSE %] [% END %] [% END %]
[% IF user_can_enter_data %] [% END %]

Nodal involvement:

[% INCLUDE build_checkbox label = "Waldeyer's ring" field = 'waldeyer' span = 'tonsillar, adenoidal, pharangeal' %] [% INCLUDE build_checkbox field = 'neck' cols = 2 span = 'cervical, supraclavicular, occipital, preauricular' %] [% INCLUDE build_checkbox field = 'infraclavicular' cols = 2 %] [% INCLUDE build_checkbox label = 'Axillary/Pectoral' field = 'axillary' cols = 2 %] [% INCLUDE build_checkbox field = 'arm' cols = 2 span = 'epitrochlear & brachial' %] [% INCLUDE build_checkbox field = 'thymus' %] [% INCLUDE build_checkbox field = 'hilar' cols = 2 %] [% INCLUDE build_checkbox field = 'mediastinal' %] [% INCLUDE build_checkbox label = 'Para-aortic' field = 'para_aortic' %] [% INCLUDE build_checkbox label = 'Spleen (palpable)' field = 'spleen' %] [% INCLUDE build_checkbox field = 'mesenteric' %] [% INCLUDE build_checkbox field = 'iliac' cols = 2 %] [% INCLUDE build_checkbox label = 'Inguinal/Femoral' field = 'inguinal' cols = 2 %] [% INCLUDE build_checkbox field = 'popliteal' cols = 2 %] [% INCLUDE build_checkbox label = 'Bulky disease' field = 'bulky' %] [% INCLUDE build_checkbox label = 'Check CT scan' field = 'check_ct' %]
Site L | R
 
  

Extranodal involvement:

[% INCLUDE build_checkbox field = 'blood' %] [% INCLUDE build_checkbox field = 'bone' %] [% INCLUDE build_checkbox label = 'CNS' field = 'cns' %] [% INCLUDE build_checkbox label = 'GIT' field = 'git' span = 'gastro-intestinal tract' %] [% INCLUDE build_checkbox label = 'GU' field = 'gu' span = 'genito-urinary tract' %] [% INCLUDE build_checkbox field = 'liver' %] [% INCLUDE build_checkbox field = 'marrow' %] [% INCLUDE build_checkbox field = 'muscle' %] [% INCLUDE build_checkbox field = 'orbit' cols = 2 %] [% INCLUDE build_checkbox field = 'pericardium' %] [% INCLUDE build_checkbox field = 'pulmonary' cols = 2 %] [% INCLUDE build_checkbox label = 'Salivary gland' field = 'salivary_gland' cols = 2 %] [% INCLUDE build_checkbox field = 'skin' %] [% INCLUDE build_checkbox field = 'thyroid' %] [% INCLUDE build_checkbox field = 'extensive' span = 'extensive organ involvement' %]
Site L | R
Other:
[% site.html.submit %] [% site.html.reset %]