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          <tr>
            <th>Tracking ID</th>
            <!-- removed case id as per #369 -->
            <th colspan="2">Procedure</th>
            <th>Image Type</th>
            <th id="requested_by_header">Requested By</th>
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            <td title='Vista order status is ACTIVE'>
                1213</td>
            <!-- removed case id as per #369 -->
            <td colspan="2">CT ABDOMEN W/CONT</td>
            <td>CT SCAN</td>
            <td>PROVIDER,ONEHUNDREDNINETYONE</td>
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          <tr>
                          <td>DEC 23, 1997@10:31 / 2016-09-10 16:45:00</td>
            <td>MENTAL HYGIENE-OPC</td>
            <td></td>
            <td>666-00-0046</td>
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          <tr>
            <td>FORTYSIX,PATIENT</td>
            <td>81</td>
            <td></td>
            <td>04-07-1935</td>
            <td> </td>
            <td></td>
            <td>M</td>
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                            <th>Status</th>
                          </tr>
                        </thead>
                        <tbody>
                                                                                                        <tr>
                            <td>ASPIRIN TAB,EC</td>
                            <td><span class="generic-warning-area" > YES</span></td>
                            <td>Active</td>
                          </tr>
                                                  </tbody>
                      </table>
                      (<a href="#" class="details" id="medications_detail">see medications detail</a>
                      					  )

                      <h3>Vitals</h3>
					  <div id="thumbnail-chart"></div>
                      <table class="dashboard-table">
                        <thead>
                          <tr>
                            <th>Date</th>
                            <th>Vital</th>
                            <th>Value</th>
                          </tr>
                        </thead>
                        <tbody>
                                                    							  							  							  <tr>
								<td>07/08/1998 13:37</td>
								<td>Temperature</td>
								<td>98.6 F</td>
							  </tr>
							  
							                            							                            							  							  							  <tr>
								<td>06/06/1997 16:49</td>
								<td>Blood Pressure</td>
								<td>150/80 mmHg</td>
							  </tr>
							  
							                            							  							  							  <tr>
								<td>04/05/2003 15:15</td>
								<td>Height</td>
								<td>70 in (177.8 cms)</td>
							  </tr>
							  
							                            							  							  							  <tr>
								<td>08/18/1998 10:15</td>
								<td>Weight</td>
								<td>199 lb (90.3 kgs)</td>
							  </tr>
							  
							                            							  							  							  <tr>
								<td>08/18/1998 10:15</td>
								<td>Body Mass Index</td>
								<td>29*</td>
							  </tr>
							  
							                                                    </tbody>
                      </table>
                      (<a href="#" class="details" id="vitals_detail">see vitals detail</a>
                      					  )

                      <h3>Allergies</h3>
                      <table class="dashboard-table">
                        <thead>
                          <tr>
                            <th>Allergy Reactant</th>
                            <th>Allergy Type</th>
                            <th title='Observed/Historical'>O/H</th>
                          </tr>
                        </thead>
                        <tbody>
                                                                                                        <tr>
                            <td>PENICILLIN</td>
                            <td>DRUG</td>
                            <td>HISTORICAL</td>
                          </tr>
                                                                              <tr>
                            <td>CHOCOLATE</td>
                            <td>DRUG, FOOD</td>
                            <td>HISTORICAL</td>
                          </tr>
                                                  </tbody>
                      </table>
                      (<a href="#" class="details" id="allergies_detail">see allergies detail</a>
                      					  )

                      <h3>Labs</h3>
                      <table class="dashboard-table">
                        <thead>
                          <tr>
                            <th colspan="3">RENAL PANEL</th>
                          </tr>
                          <tr>
                            <th>Date</th>
                            <th>Creatinine</th>
                            <th>eGFR</th>
                          </tr>
                        </thead>
                        <tbody>
                                                      
                          
                          <tr>
                            <td>03-16-2010</td>
                            <td>1.3 mg/dL</td>
                            <td class="medical-health-warn">56  mL/min/1.73 m^2</td>
                          </tr>

                            
                          
                          <tr>
                            <td>03-16-2010</td>
                            <td>1.1 mg/dL</td>
                            <td class="medical-health-good">68  mL/min/1.73 m^2</td>
                          </tr>

                            
                          
                          <tr>
                            <td>03-16-2010</td>
                            <td>1.3 mg/dL</td>
                            <td class="medical-health-warn">56  mL/min/1.73 m^2</td>
                          </tr>

                            
                          
                          <tr>
                            <td>03-16-2010</td>
                            <td><span class='medical-value-danger'>!! 1.5 mg/dL !!</span></td>
                            <td class="medical-health-warn">48  mL/min/1.73 m^2</td>
                          </tr>

                            
                          
                          <tr>
                            <td>03-16-2010</td>
                            <td>1.2 mg/dL</td>
                            <td class="medical-health-good">62  mL/min/1.73 m^2</td>
                          </tr>

                            
                                                  </tbody>
                      </table>
                      (<a href="#" class="details" id="labs_detail">see labs detail</a>
                      <span class='summary-warning'> for more values ; only 5 of 20 rows are displayed here.</span>					  )

                      <h3>Radiology Reports</h3>
                      <table class="dashboard-table">
                        <thead>
                          <tr>
                            <th>Title</th>
                            <th>Date</th>
                          </tr>
                        </thead>
                        <tbody>
                                                                                                        <tr>
                            <td>ARTHROGRAM ELBOW S&I</td>
                            <td>04/01/1999 10:41</td>
                          </tr>
                                                                              <tr>
                            <td>ABDOMEN 2 VIEWS [01]</td>
                            <td>02/12/1998 08:02</td>
                          </tr>
                                                                              <tr>
                            <td>CT ABDOMEN W/CONT</td>
                            <td>12/23/1997 10:30</td>
                          </tr>
                                                                              <tr>
                            <td>NECK SOFT TISSUE</td>
                            <td>06/26/1997 07:30</td>
                          </tr>
                                                                              <tr>
                            <td>WRIST 2 VIEWS</td>
                            <td>05/14/1997 09:43</td>
                          </tr>
                                                                            </tbody>
                      </table>
                      (<a href="#" class="details" id="radiology_detail">see radiology detail</a>
                      <span class='summary-warning'> for more values ; only 5 of 13 rows are displayed here.</span>					  )
                    </section> 
                    <!-- end of Left Side -->

                    <!-- User Input Areas -->
                    <form class="raptor-glue-protocolinfo-form-builder" action="/RSite500/protocol?rawrtid=[1213]" method="post" id="raptor-glue-protocolinfo-form-builder" accept-charset="UTF-8"><div>
<section id='input-right-side' class='right-side'>
<fieldset class="data-entry1-area form-wrapper" id="edit-protocol1-fieldset"><legend><span class="fieldset-legend"><span class="raptor-active-field">Protocol Name</span><span class="form-required" title="This field is required.">*</span></span></legend><div class="fieldset-wrapper"><div class="form-item form-type-select form-item-protocol1-nm">
 <select class="select2 form-select" id="edit-protocol1-nm" name="protocol1_nm"><optgroup label=""><option value="" selected="selected">- Select -</option></optgroup><optgroup label="Short List"><option value="RPID145">CT Abdomen and pelvis with IV and oral contrast</option><option value="RPID144">CT Abdomen and pelvis with no oral or IV contrast</option><option value="WAV008">CT Abdomen and pelvis with oral contrast only</option><option value="RPID249">CT Chest, abdomen and pelvis with IV and oral contrast</option><option value="WAV007">CT Chest, Abdomen and pelvis with oral contrast only</option><option value="WAV999">Other (See notes)</option></optgroup><optgroup label="CT List"><option value="RPID145">CT Abdomen and pelvis with IV and oral contrast</option><option value="RPID144">CT Abdomen and pelvis with no oral or IV contrast</option><option value="WAV008">CT Abdomen and pelvis with oral contrast only</option><option value="WAV015">CT adrenal mass protocol</option><option value="WAV017">CT aortic dissection protocol</option><option value="WAV022">CT CERVICAL SPINE TRAUMA DETAILED Non-Contrast (helical)</option><option value="WAV023">CT CERVICAL SPINE TRAUMA SCREEN Non-Contrast (helical)</option><option value="RPID21">CT CERVICAL SPINE without CONTRAST</option><option value="WAV025">CT Chest Pulmonary Angiogram</option><option value="RPID18">CT Chest with IV contrast</option><option value="RPID16">CT Chest without IV contrast</option><option value="RPID249">CT Chest, abdomen and pelvis with IV and oral contrast</option><option value="WAV007">CT Chest, Abdomen and pelvis with oral contrast only</option><option value="WAV026">CT FACIAL TRAUMA - CORONAL REFORMAT Non-Contrast (helical)</option><option value="WAV010">CT Four-phase liver</option><option value="WAV033">CT HEAD ANGIOGRAPHY (CTA) Ð ANEURYSM with and without Contrast (axial &amp; helical)</option><option value="RPID22">CT HEAD Non-Contrast (axial)</option><option value="RPID96">CT HEAD PERFUSION with Contrast (axial)</option><option value="RPID24">CT HEAD with Contrast (axial)</option><option value="RPID23">CT HEAD without and with Contrast (axial)</option><option value="RPID160">CT HEAD- POSTERIOR FOSSA (3mm) Non-Contrast (axial) B</option><option value="RPID159">CT HEAD- POSTERIOR FOSSA (3mm) with Contrast (axial) A</option><option value="WAV034">CT HEAD-RADIATION TREATMENT PLANNING with Contrast (helicial)</option><option value="WAV035">CT HEAD-STEALTH STEREOTACTIC with Contrast (helicial)</option><option value="WAV036">CT HEAD-STEREOTACTIC THALAMOTOMY Non-Contrast (helicial)</option><option value="WAV004">CT High Resolution Spiral Chest (supine or prone)</option><option value="WAV013">CT IVP</option><option value="WAV012">CT KUB (normal, low dose)</option><option value="WAV037">CT LARYNX TUMOR with Contrast (helical and angled axial)</option><option value="WAV038">CT LUMBAR SPINE DEGENERATIVE Non-Contrast (helical)</option><option value="RPID33">CT LUMBAR SPINE with Contrast (helical)</option><option value="RPID31">CT LUMBAR SPINE without CONTRAST</option><option value="RPID66">CT NECK ANGIOGRAPHY (CTA) (helical) only</option><option value="WAV042">CT NECK ANGIOGRAPHY (CTA) (helical), plus HEAD with and without Contrast (axial)</option><option value="RPID39">CT NECK with Contrast (helical)</option><option value="WAV044">CT NECK, ORAL, CAVITY, LARYNX, THYROID, without &amp; with CONTRAST</option><option value="WAV045">CT ODONTOID TRAUMA Non-Contrast (helical)</option><option value="WAV046">CT ORBIT SCREEN PRE-MRI (helical)</option><option value="WAV047">CT ORBIT with Contrast (axial) with CORONAL SAGITTAL REFORMATS</option><option value="RPID42">CT ORBIT without &amp; with CONTRAST</option><option value="WAV016">CT pancreas mass protocol</option><option value="WAV049">CT PITUITARY (helical) and HEAD CT with Contrast (axial)</option><option value="WAV019">CT pre-stent evaluation (or R/O AAA leak)</option><option value="WAV014">CT renal mass protocol</option><option value="WAV050">CT SINUSITIS - CORONAL REFORMAT PRE-OP (helical)</option><option value="WAV051">CT SINUSITIS AXIAL SCREEN (In-Patient/Elderly) (axial)</option><option value="WAV052">CT SINUSITIS DIRECT CORONAL DETAILED PRE-OP (axial)</option><option value="WAV054">CT TEMPORAL BONE (High Res) (axial) &amp; CORONAL Non-Contrast (axial)</option><option value="WAV053">CT TEMPORAL BONE (High Res) (axial) &amp; SPIRAL Non-Contrast (helical)</option><option value="WAV018">CT thoracic aortic aneurysm protocol</option><option value="WAV011">CT Three-phase liver</option><option value="WAV020">CT Three-phase post-stent evaluation</option><option value="WAV021">CT Two-phase post-stent evaluation</option></optgroup><optgroup label="MR List"><option value="WAV070">MR adrenal mass protocol</option><option value="WAV058">MR ankle (left, right)</option><option value="WAV075">MR ankle arthrogram (left)</option><option value="WAV074">MR ankle arthrogram (right)</option><option value="WAV109">MR BRACHIAL PLEXUS without &amp; with CONTRAST</option><option value="WAV088">MR CERVICAL SPINE- (MULTIPLE SCLEROSIS) with CONTRAST ONLY</option><option value="WAV068">MR CP</option><option value="WAV063">MR elbow (left, right)</option><option value="WAV078">MR elbow arthrogram (left)</option><option value="WAV077">MR elbow arthrogram (right)</option><option value="WAV089">MR ELBOW NEUROGRAM (MRN) without &amp; with CONTRAST</option><option value="WAV080">MR foot (left)</option><option value="WAV079">MR foot (right)</option><option value="WAV082">MR foot OSTEO/Mass with Contrast (left)</option><option value="WAV081">MR foot OSTEO/Mass with Contrast (right)</option><option value="WAV072">MR gynecologic study</option><option value="WAV099">MR gynecologic study</option><option value="WAV090">MR HEAD &amp; COW MRA without CONTRAST</option><option value="WAV087">MR HEAD VENOGRAM (MRV) without &amp; with CONTRAST</option><option value="WAV092">MR HEAD, NECK, &amp; ARCH MRA without &amp; with CONTRAST</option><option value="WAV091">MR HEAD- (MULTIPLE SCLEROSIS) without &amp; with CONTRAST</option><option value="WAV110">MR HEAD- (SEIZURE) without &amp; with CONTRAST</option><option value="WAV059">MR hip (left, right)</option><option value="WAV060">MR hip arthrogram (left, right)</option><option value="WAV076">MR hip AVN/Fracture screen</option><option value="WAV093">MR IAC &amp; HEAD without &amp; with CONTRAST</option><option value="WAV094">MR KNEE NEUROGRAM (MRN) without &amp; with CONTRAST</option><option value="WAV067">MR liver</option><option value="WAV073">MR pelvic venogram</option><option value="WAV083">MR Pelvis OSTEO with Contrast</option><option value="WAV095">MR PITUITARY &amp; HEAD without &amp; with CONTRAST</option><option value="WAV101">MR PITUITARY &amp; HEAD without &amp; with CONTRAST</option><option value="WAV100">MR PITUITARY (helical) and HEAD CT with Contrast (axial)</option><option value="WAV096">MR POST-OP LUMBAR SPINE without &amp; with CONTRAST</option><option value="WAV065">MR Renal</option><option value="WAV069">MR renal mass protocol</option><option value="WAV064">MR run-off</option><option value="WAV097">MR SACRAL PLEXUS without &amp; with CONTRAST</option><option value="WAV056">MR shoulder (left, right)</option><option value="WAV057">MR shoulder arthrogram (left, right)</option><option value="WAV098">MR SINUS TUMOR without &amp; with CONTRAST</option><option value="WAV102">MR SKULL BASE &amp; PAROTID without &amp; with CONTRAST</option><option value="WAV086">MR Soft Tissue Mass with Contrast</option><option value="WAV085">MR Subcutaneous Lipoma</option><option value="WAV084">MR Thighs Myosittis without Contrast</option><option value="WAV066">MR thoracic aortogram</option><option value="WAV104">MR THORACIC SPINE without CONTRAST</option><option value="WAV103">MR THORACIC SPINE- (MULTIPLE SCLEROSIS) with CONTRAST ONLY</option><option value="WAV105">MR TOTAL CORD SCREEN (C &amp; T-Sp) for MULTIPLE SCLEROSIS without &amp; with CONTRAST</option><option value="WAV106">MR TOTAL SPINE SCREEN without &amp; with CONTRAST</option><option value="WAV107">MR TRIGEMINAL NEURALGIA (TIC DOLOREAUX) without &amp; with CONTRAST</option><option value="WAV071">MR urogram</option><option value="WAV061">MR wrist (left, right)</option><option value="WAV062">MR wrist arthrogram (left, right)</option><option value="WAV108">MR WRIST NEUROGRAM (MRN) without &amp; with CONRAST</option></optgroup><optgroup label="NM List"><option value="WAV111">NM Bone Marrow</option><option value="WAV112">NM Bone Scan</option><option value="WAV113">NM Brain Imaging</option><option value="WAV114">NM Cisternogram</option><option value="WAV115">NM CSF Shunt Eval</option><option value="WAV116">NM Dacrocystogram</option><option value="NM-EXAMPLE">NM Example Placeholder NM Protocol</option><option value="WAV117">NM Gallium Scan</option><option value="WAV118">NM Gastric Emptying</option><option value="WAV119">NM GI Bleed Loc.</option><option value="WAV120">NM Hepatobillary</option><option value="WAV121">NM Liver Blood Pool</option><option value="WAV122">NM Liver/ Spleen</option><option value="WAV123">NM Lung Perfusion</option><option value="WAV124">NM Lung Ventilation</option><option value="WAV125">NM Lymph Node Map</option><option value="WAV126">NM Meckles</option><option value="WAV127">NM MIBG</option><option value="WAV128">NM Myocardial Perfusion Resting Dual or Stress with proto</option><option value="WAV129">NM Myocardial Perfusion Resting high/high (two day) with proto 240# - 280#</option><option value="WAV130">NM Myocardial Perfusion Resting high/high (two day) with proto over 280#</option><option value="WAV131">NM Myocardial Perfusion Resting high/high (two day) with proto up to 240#</option><option value="WAV132">NM Myocardial Perfusion Resting low/high (one day) with proto</option><option value="WAV133">NM Myocardial Perfusion Stress one or two day proto 240# - 280#</option><option value="WAV134">NM Myocardial Perfusion Stress one or two day proto over 280#</option><option value="WAV135">NM Myocardial Perfusion Stress one or two day proto up to 240#</option><option value="WAV136">NM Myocardial Perfusion Viability</option><option value="WAV137">NM Octreotide Scan</option><option value="WAV138">NM Parathyroid</option><option value="WAV139">NM Platelet</option><option value="WAV141">NM Renal Scan</option><option value="WAV140">NM Renal Scan with GFR</option><option value="WAV144">NM Thyroid Scan</option><option value="WAV146">NM Thyroid Uptake and Scan</option><option value="WAV147">NM Thyroid Whole Body Scan by rTSH stimulation</option><option value="WAV148">NM Thyroid Whole Body Scan by withdrawal</option><option value="WAV150">NM White Blood Cell Scan	with 99mTc-HMPAO</option><option value="WAV149">NM White Blood Cell Scan	with IN-111 Oxine</option></optgroup><optgroup label="US List"><option value="US-EXAMPLE">US Example Placeholder Ultrasound Protocol</option></optgroup></select>
<div class="description">A standard protocol from the hospital's radiology notebook.</div>
</div>
</div></fieldset>
<fieldset class="data-entry1-area form-wrapper" id="edit-protocol2-fieldset"><legend><span class="fieldset-legend"><span class="raptor-disabled-field">Secondary Protocol Name</span></span></legend><div class="fieldset-wrapper"><div class="form-item form-type-select form-item-protocol2-nm form-disabled">
 <select class="select2 form-select" disabled="disabled" id="edit-protocol2-nm" name="protocol2_nm"><optgroup label=""><option value="" selected="selected"></option></optgroup><optgroup label="Short List"><option value="RPID145">CT Abdomen and pelvis with IV and oral contrast</option><option value="RPID144">CT Abdomen and pelvis with no oral or IV contrast</option><option value="WAV008">CT Abdomen and pelvis with oral contrast only</option><option value="WAV015">CT adrenal mass protocol</option><option value="WAV017">CT aortic dissection protocol</option><option value="WAV022">CT CERVICAL SPINE TRAUMA DETAILED Non-Contrast (helical)</option><option value="WAV023">CT CERVICAL SPINE TRAUMA SCREEN Non-Contrast (helical)</option><option value="RPID21">CT CERVICAL SPINE without CONTRAST</option><option value="WAV025">CT Chest Pulmonary Angiogram</option><option value="RPID18">CT Chest with IV contrast</option><option value="RPID16">CT Chest without IV contrast</option><option value="RPID249">CT Chest, abdomen and pelvis with IV and oral contrast</option><option value="WAV007">CT Chest, Abdomen and pelvis with oral contrast only</option><option value="WAV026">CT FACIAL TRAUMA - CORONAL REFORMAT Non-Contrast (helical)</option><option value="WAV010">CT Four-phase liver</option><option value="WAV033">CT HEAD ANGIOGRAPHY (CTA) Ð ANEURYSM with and without Contrast (axial &amp; helical)</option><option value="RPID22">CT HEAD Non-Contrast (axial)</option><option value="RPID96">CT HEAD PERFUSION with Contrast (axial)</option><option value="RPID24">CT HEAD with Contrast (axial)</option><option value="RPID23">CT HEAD without and with Contrast (axial)</option><option value="RPID160">CT HEAD- POSTERIOR FOSSA (3mm) Non-Contrast (axial) B</option><option value="RPID159">CT HEAD- POSTERIOR FOSSA (3mm) with Contrast (axial) A</option><option value="WAV034">CT HEAD-RADIATION TREATMENT PLANNING with Contrast (helicial)</option><option value="WAV035">CT HEAD-STEALTH STEREOTACTIC with Contrast (helicial)</option><option value="WAV036">CT HEAD-STEREOTACTIC THALAMOTOMY Non-Contrast (helicial)</option><option value="WAV004">CT High Resolution Spiral Chest (supine or prone)</option><option value="WAV013">CT IVP</option><option value="WAV012">CT KUB (normal, low dose)</option><option value="WAV037">CT LARYNX TUMOR with Contrast (helical and angled axial)</option><option value="WAV038">CT LUMBAR SPINE DEGENERATIVE Non-Contrast (helical)</option><option value="RPID33">CT LUMBAR SPINE with Contrast (helical)</option><option value="RPID31">CT LUMBAR SPINE without CONTRAST</option><option value="RPID66">CT NECK ANGIOGRAPHY (CTA) (helical) only</option><option value="WAV042">CT NECK ANGIOGRAPHY (CTA) (helical), plus HEAD with and without Contrast (axial)</option><option value="RPID39">CT NECK with Contrast (helical)</option><option value="WAV044">CT NECK, ORAL, CAVITY, LARYNX, THYROID, without &amp; with CONTRAST</option><option value="WAV045">CT ODONTOID TRAUMA Non-Contrast (helical)</option><option value="WAV046">CT ORBIT SCREEN PRE-MRI (helical)</option><option value="WAV047">CT ORBIT with Contrast (axial) with CORONAL SAGITTAL REFORMATS</option><option value="RPID42">CT ORBIT without &amp; with CONTRAST</option><option value="WAV016">CT pancreas mass protocol</option><option value="WAV049">CT PITUITARY (helical) and HEAD CT with Contrast (axial)</option><option value="WAV019">CT pre-stent evaluation (or R/O AAA leak)</option><option value="WAV014">CT renal mass protocol</option><option value="WAV050">CT SINUSITIS - CORONAL REFORMAT PRE-OP (helical)</option><option value="WAV051">CT SINUSITIS AXIAL SCREEN (In-Patient/Elderly) (axial)</option><option value="WAV052">CT SINUSITIS DIRECT CORONAL DETAILED PRE-OP (axial)</option><option value="WAV054">CT TEMPORAL BONE (High Res) (axial) &amp; CORONAL Non-Contrast (axial)</option><option value="WAV053">CT TEMPORAL BONE (High Res) (axial) &amp; SPIRAL Non-Contrast (helical)</option><option value="WAV018">CT thoracic aortic aneurysm protocol</option><option value="WAV011">CT Three-phase liver</option><option value="WAV020">CT Three-phase post-stent evaluation</option><option value="WAV021">CT Two-phase post-stent evaluation</option><option value="WAV070">MR adrenal mass protocol</option><option value="WAV058">MR ankle (left, right)</option><option value="WAV075">MR ankle arthrogram (left)</option><option value="WAV074">MR ankle arthrogram (right)</option><option value="WAV109">MR BRACHIAL PLEXUS without &amp; with CONTRAST</option><option value="WAV088">MR CERVICAL SPINE- (MULTIPLE SCLEROSIS) with CONTRAST ONLY</option><option value="WAV068">MR CP</option><option value="WAV063">MR elbow (left, right)</option><option value="WAV078">MR elbow arthrogram (left)</option><option value="WAV077">MR elbow arthrogram (right)</option><option value="WAV089">MR ELBOW NEUROGRAM (MRN) without &amp; with CONTRAST</option><option value="WAV080">MR foot (left)</option><option value="WAV079">MR foot (right)</option><option value="WAV082">MR foot OSTEO/Mass with Contrast (left)</option><option value="WAV081">MR foot OSTEO/Mass with Contrast (right)</option><option value="WAV072">MR gynecologic study</option><option value="WAV099">MR gynecologic study</option><option value="WAV090">MR HEAD &amp; COW MRA without CONTRAST</option><option value="WAV087">MR HEAD VENOGRAM (MRV) without &amp; with CONTRAST</option><option value="WAV092">MR HEAD, NECK, &amp; ARCH MRA without &amp; with CONTRAST</option><option value="WAV091">MR HEAD- (MULTIPLE SCLEROSIS) without &amp; with CONTRAST</option><option value="WAV110">MR HEAD- (SEIZURE) without &amp; with CONTRAST</option><option value="WAV059">MR hip (left, right)</option><option value="WAV060">MR hip arthrogram (left, right)</option><option value="WAV076">MR hip AVN/Fracture screen</option><option value="WAV093">MR IAC &amp; HEAD without &amp; with CONTRAST</option><option value="WAV094">MR KNEE NEUROGRAM (MRN) without &amp; with CONTRAST</option><option value="WAV067">MR liver</option><option value="WAV073">MR pelvic venogram</option><option value="WAV083">MR Pelvis OSTEO with Contrast</option><option value="WAV095">MR PITUITARY &amp; HEAD without &amp; with CONTRAST</option><option value="WAV101">MR PITUITARY &amp; HEAD without &amp; with CONTRAST</option><option value="WAV100">MR PITUITARY (helical) and HEAD CT with Contrast (axial)</option><option value="WAV096">MR POST-OP LUMBAR SPINE without &amp; with CONTRAST</option><option value="WAV065">MR Renal</option><option value="WAV069">MR renal mass protocol</option><option value="WAV064">MR run-off</option><option value="WAV097">MR SACRAL PLEXUS without &amp; with CONTRAST</option><option value="WAV056">MR shoulder (left, right)</option><option value="WAV057">MR shoulder arthrogram (left, right)</option><option value="WAV098">MR SINUS TUMOR without &amp; with CONTRAST</option><option value="WAV102">MR SKULL BASE &amp; PAROTID without &amp; with CONTRAST</option><option value="WAV086">MR Soft Tissue Mass with Contrast</option><option value="WAV085">MR Subcutaneous Lipoma</option><option value="WAV084">MR Thighs Myosittis without Contrast</option><option value="WAV066">MR thoracic aortogram</option><option value="WAV104">MR THORACIC SPINE without CONTRAST</option><option value="WAV103">MR THORACIC SPINE- (MULTIPLE SCLEROSIS) with CONTRAST ONLY</option><option value="WAV105">MR TOTAL CORD SCREEN (C &amp; T-Sp) for MULTIPLE SCLEROSIS without &amp; with CONTRAST</option><option value="WAV106">MR TOTAL SPINE SCREEN without &amp; with CONTRAST</option><option value="WAV107">MR TRIGEMINAL NEURALGIA (TIC DOLOREAUX) without &amp; with CONTRAST</option><option value="WAV071">MR urogram</option><option value="WAV061">MR wrist (left, right)</option><option value="WAV062">MR wrist arthrogram (left, right)</option><option value="WAV108">MR WRIST NEUROGRAM (MRN) without &amp; with CONRAST</option><option value="WAV111">NM Bone Marrow</option><option value="WAV112">NM Bone Scan</option><option value="WAV113">NM Brain Imaging</option><option value="WAV114">NM Cisternogram</option><option value="WAV115">NM CSF Shunt Eval</option><option value="WAV116">NM Dacrocystogram</option><option value="NM-EXAMPLE">NM Example Placeholder NM Protocol</option><option value="WAV117">NM Gallium Scan</option><option value="WAV118">NM Gastric Emptying</option><option value="WAV119">NM GI Bleed Loc.</option><option value="WAV120">NM Hepatobillary</option><option value="WAV121">NM Liver Blood Pool</option><option value="WAV122">NM Liver/ Spleen</option><option value="WAV123">NM Lung Perfusion</option><option value="WAV124">NM Lung Ventilation</option><option value="WAV125">NM Lymph Node Map</option><option value="WAV126">NM Meckles</option><option value="WAV127">NM MIBG</option><option value="WAV128">NM Myocardial Perfusion Resting Dual or Stress with proto</option><option value="WAV129">NM Myocardial Perfusion Resting high/high (two day) with proto 240# - 280#</option><option value="WAV130">NM Myocardial Perfusion Resting high/high (two day) with proto over 280#</option><option value="WAV131">NM Myocardial Perfusion Resting high/high (two day) with proto up to 240#</option><option value="WAV132">NM Myocardial Perfusion Resting low/high (one day) with proto</option><option value="WAV133">NM Myocardial Perfusion Stress one or two day proto 240# - 280#</option><option value="WAV134">NM Myocardial Perfusion Stress one or two day proto over 280#</option><option value="WAV135">NM Myocardial Perfusion Stress one or two day proto up to 240#</option><option value="WAV136">NM Myocardial Perfusion Viability</option><option value="WAV137">NM Octreotide Scan</option><option value="WAV138">NM Parathyroid</option><option value="WAV139">NM Platelet</option><option value="WAV141">NM Renal Scan</option><option value="WAV140">NM Renal Scan with GFR</option><option value="WAV144">NM Thyroid Scan</option><option value="WAV146">NM Thyroid Uptake and Scan</option><option value="WAV147">NM Thyroid Whole Body Scan by rTSH stimulation</option><option value="WAV148">NM Thyroid Whole Body Scan by withdrawal</option><option value="WAV150">NM White Blood Cell Scan	with 99mTc-HMPAO</option><option value="WAV149">NM White Blood Cell Scan	with IN-111 Oxine</option><option value="US-EXAMPLE">US Example Placeholder Ultrasound Protocol</option><option value="WAV999">Other (See notes)</option></optgroup><optgroup label="CT List"><option value="RPID145">CT Abdomen and pelvis with IV and oral contrast</option><option value="RPID144">CT Abdomen and pelvis with no oral or IV contrast</option><option value="WAV008">CT Abdomen and pelvis with oral contrast only</option><option value="WAV015">CT adrenal mass protocol</option><option value="WAV017">CT aortic dissection protocol</option><option value="WAV022">CT CERVICAL SPINE TRAUMA DETAILED Non-Contrast (helical)</option><option value="WAV023">CT CERVICAL SPINE TRAUMA SCREEN Non-Contrast (helical)</option><option value="RPID21">CT CERVICAL SPINE without CONTRAST</option><option value="WAV025">CT Chest Pulmonary Angiogram</option><option value="RPID18">CT Chest with IV contrast</option><option value="RPID16">CT Chest without IV contrast</option><option value="RPID249">CT Chest, abdomen and pelvis with IV and oral contrast</option><option value="WAV007">CT Chest, Abdomen and pelvis with oral contrast only</option><option value="WAV026">CT FACIAL TRAUMA - CORONAL REFORMAT Non-Contrast (helical)</option><option value="WAV010">CT Four-phase liver</option><option value="WAV033">CT HEAD ANGIOGRAPHY (CTA) Ð ANEURYSM with and without Contrast (axial &amp; helical)</option><option value="RPID22">CT HEAD Non-Contrast (axial)</option><option value="RPID96">CT HEAD PERFUSION with Contrast (axial)</option><option value="RPID24">CT HEAD with Contrast (axial)</option><option value="RPID23">CT HEAD without and with Contrast (axial)</option><option value="RPID160">CT HEAD- POSTERIOR FOSSA (3mm) Non-Contrast (axial) B</option><option value="RPID159">CT HEAD- POSTERIOR FOSSA (3mm) with Contrast (axial) A</option><option value="WAV034">CT HEAD-RADIATION TREATMENT PLANNING with Contrast (helicial)</option><option value="WAV035">CT HEAD-STEALTH STEREOTACTIC with Contrast (helicial)</option><option value="WAV036">CT HEAD-STEREOTACTIC THALAMOTOMY Non-Contrast (helicial)</option><option value="WAV004">CT High Resolution Spiral Chest (supine or prone)</option><option value="WAV013">CT IVP</option><option value="WAV012">CT KUB (normal, low dose)</option><option value="WAV037">CT LARYNX TUMOR with Contrast (helical and angled axial)</option><option value="WAV038">CT LUMBAR SPINE DEGENERATIVE Non-Contrast (helical)</option><option value="RPID33">CT LUMBAR SPINE with Contrast (helical)</option><option value="RPID31">CT LUMBAR SPINE without CONTRAST</option><option value="RPID66">CT NECK ANGIOGRAPHY (CTA) (helical) only</option><option value="WAV042">CT NECK ANGIOGRAPHY (CTA) (helical), plus HEAD with and without Contrast (axial)</option><option value="RPID39">CT NECK with Contrast (helical)</option><option value="WAV044">CT NECK, ORAL, CAVITY, LARYNX, THYROID, without &amp; with CONTRAST</option><option value="WAV045">CT ODONTOID TRAUMA Non-Contrast (helical)</option><option value="WAV046">CT ORBIT SCREEN PRE-MRI (helical)</option><option value="WAV047">CT ORBIT with Contrast (axial) with CORONAL SAGITTAL REFORMATS</option><option value="RPID42">CT ORBIT without &amp; with CONTRAST</option><option value="WAV016">CT pancreas mass protocol</option><option value="WAV049">CT PITUITARY (helical) and HEAD CT with Contrast (axial)</option><option value="WAV019">CT pre-stent evaluation (or R/O AAA leak)</option><option value="WAV014">CT renal mass protocol</option><option value="WAV050">CT SINUSITIS - CORONAL REFORMAT PRE-OP (helical)</option><option value="WAV051">CT SINUSITIS AXIAL SCREEN (In-Patient/Elderly) (axial)</option><option value="WAV052">CT SINUSITIS DIRECT CORONAL DETAILED PRE-OP (axial)</option><option value="WAV054">CT TEMPORAL BONE (High Res) (axial) &amp; CORONAL Non-Contrast (axial)</option><option value="WAV053">CT TEMPORAL BONE (High Res) (axial) &amp; SPIRAL Non-Contrast (helical)</option><option value="WAV018">CT thoracic aortic aneurysm protocol</option><option value="WAV011">CT Three-phase liver</option><option value="WAV020">CT Three-phase post-stent evaluation</option><option value="WAV021">CT Two-phase post-stent evaluation</option></optgroup><optgroup label="MR List"><option value="WAV070">MR adrenal mass protocol</option><option value="WAV058">MR ankle (left, right)</option><option value="WAV075">MR ankle arthrogram (left)</option><option value="WAV074">MR ankle arthrogram (right)</option><option value="WAV109">MR BRACHIAL PLEXUS without &amp; with CONTRAST</option><option value="WAV088">MR CERVICAL SPINE- (MULTIPLE SCLEROSIS) with CONTRAST ONLY</option><option value="WAV068">MR CP</option><option value="WAV063">MR elbow (left, right)</option><option value="WAV078">MR elbow arthrogram (left)</option><option value="WAV077">MR elbow arthrogram (right)</option><option value="WAV089">MR ELBOW NEUROGRAM (MRN) without &amp; with CONTRAST</option><option value="WAV080">MR foot (left)</option><option value="WAV079">MR foot (right)</option><option value="WAV082">MR foot OSTEO/Mass with Contrast (left)</option><option value="WAV081">MR foot OSTEO/Mass with Contrast (right)</option><option value="WAV072">MR gynecologic study</option><option value="WAV099">MR gynecologic study</option><option value="WAV090">MR HEAD &amp; COW MRA without CONTRAST</option><option value="WAV087">MR HEAD VENOGRAM (MRV) without &amp; with CONTRAST</option><option value="WAV092">MR HEAD, NECK, &amp; ARCH MRA without &amp; with CONTRAST</option><option value="WAV091">MR HEAD- (MULTIPLE SCLEROSIS) without &amp; with CONTRAST</option><option value="WAV110">MR HEAD- (SEIZURE) without &amp; with CONTRAST</option><option value="WAV059">MR hip (left, right)</option><option value="WAV060">MR hip arthrogram (left, right)</option><option value="WAV076">MR hip AVN/Fracture screen</option><option value="WAV093">MR IAC &amp; HEAD without &amp; with CONTRAST</option><option value="WAV094">MR KNEE NEUROGRAM (MRN) without &amp; with CONTRAST</option><option value="WAV067">MR liver</option><option value="WAV073">MR pelvic venogram</option><option value="WAV083">MR Pelvis OSTEO with Contrast</option><option value="WAV095">MR PITUITARY &amp; HEAD without &amp; with CONTRAST</option><option value="WAV101">MR PITUITARY &amp; HEAD without &amp; with CONTRAST</option><option value="WAV100">MR PITUITARY (helical) and HEAD CT with Contrast (axial)</option><option value="WAV096">MR POST-OP LUMBAR SPINE without &amp; with CONTRAST</option><option value="WAV065">MR Renal</option><option value="WAV069">MR renal mass protocol</option><option value="WAV064">MR run-off</option><option value="WAV097">MR SACRAL PLEXUS without &amp; with CONTRAST</option><option value="WAV056">MR shoulder (left, right)</option><option value="WAV057">MR shoulder arthrogram (left, right)</option><option value="WAV098">MR SINUS TUMOR without &amp; with CONTRAST</option><option value="WAV102">MR SKULL BASE &amp; PAROTID without &amp; with CONTRAST</option><option value="WAV086">MR Soft Tissue Mass with Contrast</option><option value="WAV085">MR Subcutaneous Lipoma</option><option value="WAV084">MR Thighs Myosittis without Contrast</option><option value="WAV066">MR thoracic aortogram</option><option value="WAV104">MR THORACIC SPINE without CONTRAST</option><option value="WAV103">MR THORACIC SPINE- (MULTIPLE SCLEROSIS) with CONTRAST ONLY</option><option value="WAV105">MR TOTAL CORD SCREEN (C &amp; T-Sp) for MULTIPLE SCLEROSIS without &amp; with CONTRAST</option><option value="WAV106">MR TOTAL SPINE SCREEN without &amp; with CONTRAST</option><option value="WAV107">MR TRIGEMINAL NEURALGIA (TIC DOLOREAUX) without &amp; with CONTRAST</option><option value="WAV071">MR urogram</option><option value="WAV061">MR wrist (left, right)</option><option value="WAV062">MR wrist arthrogram (left, right)</option><option value="WAV108">MR WRIST NEUROGRAM (MRN) without &amp; with CONRAST</option></optgroup><optgroup label="NM List"><option value="WAV111">NM Bone Marrow</option><option value="WAV112">NM Bone Scan</option><option value="WAV113">NM Brain Imaging</option><option value="WAV114">NM Cisternogram</option><option value="WAV115">NM CSF Shunt Eval</option><option value="WAV116">NM Dacrocystogram</option><option value="NM-EXAMPLE">NM Example Placeholder NM Protocol</option><option value="WAV117">NM Gallium Scan</option><option value="WAV118">NM Gastric Emptying</option><option value="WAV119">NM GI Bleed Loc.</option><option value="WAV120">NM Hepatobillary</option><option value="WAV121">NM Liver Blood Pool</option><option value="WAV122">NM Liver/ Spleen</option><option value="WAV123">NM Lung Perfusion</option><option value="WAV124">NM Lung Ventilation</option><option value="WAV125">NM Lymph Node Map</option><option value="WAV126">NM Meckles</option><option value="WAV127">NM MIBG</option><option value="WAV128">NM Myocardial Perfusion Resting Dual or Stress with proto</option><option value="WAV129">NM Myocardial Perfusion Resting high/high (two day) with proto 240# - 280#</option><option value="WAV130">NM Myocardial Perfusion Resting high/high (two day) with proto over 280#</option><option value="WAV131">NM Myocardial Perfusion Resting high/high (two day) with proto up to 240#</option><option value="WAV132">NM Myocardial Perfusion Resting low/high (one day) with proto</option><option value="WAV133">NM Myocardial Perfusion Stress one or two day proto 240# - 280#</option><option value="WAV134">NM Myocardial Perfusion Stress one or two day proto over 280#</option><option value="WAV135">NM Myocardial Perfusion Stress one or two day proto up to 240#</option><option value="WAV136">NM Myocardial Perfusion Viability</option><option value="WAV137">NM Octreotide Scan</option><option value="WAV138">NM Parathyroid</option><option value="WAV139">NM Platelet</option><option value="WAV141">NM Renal Scan</option><option value="WAV140">NM Renal Scan with GFR</option><option value="WAV144">NM Thyroid Scan</option><option value="WAV146">NM Thyroid Uptake and Scan</option><option value="WAV147">NM Thyroid Whole Body Scan by rTSH stimulation</option><option value="WAV148">NM Thyroid Whole Body Scan by withdrawal</option><option value="WAV150">NM White Blood Cell Scan	with 99mTc-HMPAO</option><option value="WAV149">NM White Blood Cell Scan	with IN-111 Oxine</option></optgroup><optgroup label="US List"><option value="US-EXAMPLE">US Example Placeholder Ultrasound Protocol</option></optgroup></select>
<div class="description">Select a second protocol only if more than one is needed for this study.</div>
</div>
</div></fieldset>
<fieldset class="data-entry1-area collapsible collapsed form-wrapper" style="display:none" id="edit-contrast-fieldset"><legend><span class="fieldset-legend"><span class="raptor-disabled-field">Contrast</span></span></legend><div class="fieldset-wrapper"><fieldset class="form-wrapper" id="edit-contrast-fieldset-col1"><div class="fieldset-wrapper"><div id="edit-contrast-cd" class="form-checkboxes"><div class="form-item form-type-checkbox form-item-contrast-cd-none form-disabled">
 <input onchange="notDefaultValuesInSectionAndSetCheckboxes(&quot;contrast&quot;,this)" disabled="disabled" type="checkbox" id="edit-contrast-cd-none" name="contrast_cd[none]" value="none" class="form-checkbox" />  <label class="option" for="edit-contrast-cd-none">None </label>

</div>
<div class="form-item form-type-checkbox form-item-contrast-cd-enteric form-disabled">
 <input onchange="notDefaultValuesInSectionAndSetCheckboxes(&quot;contrast&quot;,this)" disabled="disabled" type="checkbox" id="edit-contrast-cd-enteric" name="contrast_cd[enteric]" value="enteric" class="form-checkbox" />  <label class="option" for="edit-contrast-cd-enteric">Enteric </label>

</div>
<div class="form-item form-type-checkbox form-item-contrast-cd-iv form-disabled">
 <input onchange="notDefaultValuesInSectionAndSetCheckboxes(&quot;contrast&quot;,this)" disabled="disabled" type="checkbox" id="edit-contrast-cd-iv" name="contrast_cd[iv]" value="iv" class="form-checkbox" />  <label class="option" for="edit-contrast-cd-iv">IV </label>

</div>
</div><input disabled="disabled" type="hidden" name="contrast_enteric__inputmode" value="" />
<input disabled="disabled" type="hidden" name="contrast_iv__inputmode" value="" />
</div></fieldset>
<fieldset class="form-wrapper" id="edit-contrast-fieldset-col2"><div class="fieldset-wrapper"><div class="v-spacer-select">&nbsp;</div><fieldset class="container-inline form-wrapper" id="edit-inline-enteric"><div class="fieldset-wrapper"><div class="form-item form-type-textfield form-item-contrast-enteric-customtx form-disabled">
 <input disabled="disabled" type="text" id="edit-contrast-enteric-customtx" name="contrast_enteric_customtx" value="" size="60" maxlength="128" class="form-text" />
</div>
</div></fieldset>
<fieldset class="container-inline form-wrapper" id="edit-inline-iv"><div class="fieldset-wrapper"><div class="form-item form-type-textfield form-item-contrast-iv-customtx form-disabled">
 <input disabled="disabled" type="text" id="edit-contrast-iv-customtx" name="contrast_iv_customtx" value="" size="60" maxlength="128" class="form-text" />
</div>
</div></fieldset>
</div></fieldset>
<fieldset class="form-wrapper" id="edit-contrast-fieldset-col3"><div class="fieldset-wrapper"></div></fieldset>
<fieldset class="form-wrapper" id="edit-contrast-fieldset-row2"><div class="fieldset-wrapper"><input disabled="disabled" type="hidden" name="require_acknowledgement_for_contrast" value="no" />
</div></fieldset>
</div></fieldset>
<fieldset class="data-entry1-area form-wrapper" id="edit-consentreq-fieldset"><legend><span class="fieldset-legend"><span class="raptor-disabled-field">Consent Required</span></span></legend><div class="fieldset-wrapper"><fieldset class="form-wrapper" id="edit-consentreq-fieldset-col1"><div class="fieldset-wrapper"><div id="edit-consentreq-radio-cd" class="form-radios"><div class="form-item form-type-radio form-item-consentreq-radio-cd form-disabled">
 <input onchange="notDefaultValuesInSection(&quot;consentreq&quot;)" disabled="disabled" type="radio" id="edit-consentreq-radio-cd-unknown" name="consentreq_radio_cd" value="unknown" checked="checked" class="form-radio" />  <label class="option" for="edit-consentreq-radio-cd-unknown">Unknown </label>

</div>
<div class="form-item form-type-radio form-item-consentreq-radio-cd form-disabled">
 <input onchange="notDefaultValuesInSection(&quot;consentreq&quot;)" disabled="disabled" type="radio" id="edit-consentreq-radio-cd-no" name="consentreq_radio_cd" value="no" class="form-radio" />  <label class="option" for="edit-consentreq-radio-cd-no">No </label>

</div>
<div class="form-item form-type-radio form-item-consentreq-radio-cd form-disabled">
 <input onchange="notDefaultValuesInSection(&quot;consentreq&quot;)" disabled="disabled" type="radio" id="edit-consentreq-radio-cd-yes" name="consentreq_radio_cd" value="yes" class="form-radio" />  <label class="option" for="edit-consentreq-radio-cd-yes">Yes </label>

</div>
</div></div></fieldset>
<fieldset class="form-wrapper" id="edit-consentreq-fieldset-col3"><div class="fieldset-wrapper"></div></fieldset>
<fieldset class="form-wrapper" id="edit-consentreq-fieldset-row2"><div class="fieldset-wrapper"><input disabled="disabled" type="hidden" name="require_acknowledgement_for_consentreq" value="no" />
</div></fieldset>
</div></fieldset>
<fieldset class="data-entry1-area collapsible collapsed form-wrapper" style="display:none" id="edit-hydration-fieldset"><legend><span class="fieldset-legend"><span class="raptor-disabled-field">Hydration</span></span></legend><div class="fieldset-wrapper"><fieldset class="form-wrapper" id="edit-hydration-fieldset-col1"><div class="fieldset-wrapper"><div id="edit-hydration-radio-cd" class="form-radios"><div class="form-item form-type-radio form-item-hydration-radio-cd form-disabled">
 <input onchange="notDefaultValuesInSectionRadios(&quot;hydration&quot;,this)" disabled="disabled" type="radio" id="edit-hydration-radio-cd-none" name="hydration_radio_cd" value="none" class="form-radio" />  <label class="option" for="edit-hydration-radio-cd-none">None </label>

</div>
<div class="form-item form-type-radio form-item-hydration-radio-cd form-disabled">
 <input onchange="notDefaultValuesInSectionRadios(&quot;hydration&quot;,this)" disabled="disabled" type="radio" id="edit-hydration-radio-cd-oral" name="hydration_radio_cd" value="oral" class="form-radio" />  <label class="option" for="edit-hydration-radio-cd-oral">Oral </label>

</div>
<div class="form-item form-type-radio form-item-hydration-radio-cd form-disabled">
 <input onchange="notDefaultValuesInSectionRadios(&quot;hydration&quot;,this)" disabled="disabled" type="radio" id="edit-hydration-radio-cd-iv" name="hydration_radio_cd" value="iv" class="form-radio" />  <label class="option" for="edit-hydration-radio-cd-iv">IV </label>

</div>
</div><input disabled="disabled" type="hidden" name="hydration_oral__inputmode" value="" />
<input disabled="disabled" type="hidden" name="hydration_iv__inputmode" value="" />
</div></fieldset>
<fieldset class="form-wrapper" id="edit-hydration-fieldset-col2"><div class="fieldset-wrapper"><div class="v-spacer-select">&nbsp;</div><fieldset class="container-inline form-wrapper" id="edit-inline-oral"><div class="fieldset-wrapper"><div class="form-item form-type-textfield form-item-hydration-oral-customtx form-disabled">
 <input disabled="disabled" type="text" id="edit-hydration-oral-customtx" name="hydration_oral_customtx" value="" size="60" maxlength="128" class="form-text" />
</div>
</div></fieldset>
<fieldset class="container-inline form-wrapper" id="edit-inline-iv--2"><div class="fieldset-wrapper"><div class="form-item form-type-textfield form-item-hydration-iv-customtx form-disabled">
 <input disabled="disabled" type="text" id="edit-hydration-iv-customtx" name="hydration_iv_customtx" value="" size="60" maxlength="128" class="form-text" />
</div>
</div></fieldset>
</div></fieldset>
<fieldset class="form-wrapper" id="edit-hydration-fieldset-col3"><div class="fieldset-wrapper"></div></fieldset>
<fieldset class="form-wrapper" id="edit-hydration-fieldset-row2"><div class="fieldset-wrapper"><input disabled="disabled" type="hidden" name="require_acknowledgement_for_hydration" value="no" />
</div></fieldset>
</div></fieldset>
<fieldset class="data-entry1-area collapsible collapsed form-wrapper" style="display:none" id="edit-sedation-fieldset"><legend><span class="fieldset-legend"><span class="raptor-disabled-field">Sedation</span></span></legend><div class="fieldset-wrapper"><fieldset class="form-wrapper" id="edit-sedation-fieldset-col1"><div class="fieldset-wrapper"><div id="edit-sedation-radio-cd" class="form-radios"><div class="form-item form-type-radio form-item-sedation-radio-cd form-disabled">
 <input onchange="notDefaultValuesInSectionRadios(&quot;sedation&quot;,this)" disabled="disabled" type="radio" id="edit-sedation-radio-cd-none" name="sedation_radio_cd" value="none" class="form-radio" />  <label class="option" for="edit-sedation-radio-cd-none">None </label>

</div>
<div class="form-item form-type-radio form-item-sedation-radio-cd form-disabled">
 <input onchange="notDefaultValuesInSectionRadios(&quot;sedation&quot;,this)" disabled="disabled" type="radio" id="edit-sedation-radio-cd-oral" name="sedation_radio_cd" value="oral" class="form-radio" />  <label class="option" for="edit-sedation-radio-cd-oral">Oral </label>

</div>
<div class="form-item form-type-radio form-item-sedation-radio-cd form-disabled">
 <input onchange="notDefaultValuesInSectionRadios(&quot;sedation&quot;,this)" disabled="disabled" type="radio" id="edit-sedation-radio-cd-iv" name="sedation_radio_cd" value="iv" class="form-radio" />  <label class="option" for="edit-sedation-radio-cd-iv">IV </label>

</div>
</div><input disabled="disabled" type="hidden" name="sedation_oral__inputmode" value="" />
<input disabled="disabled" type="hidden" name="sedation_iv__inputmode" value="" />
</div></fieldset>
<fieldset class="form-wrapper" id="edit-sedation-fieldset-col2"><div class="fieldset-wrapper"><div class="v-spacer-select">&nbsp;</div><fieldset class="container-inline form-wrapper" id="edit-inline-oral--2"><div class="fieldset-wrapper"><div class="form-item form-type-textfield form-item-sedation-oral-customtx form-disabled">
 <input disabled="disabled" type="text" id="edit-sedation-oral-customtx" name="sedation_oral_customtx" value="" size="60" maxlength="128" class="form-text" />
</div>
</div></fieldset>
<fieldset class="container-inline form-wrapper" id="edit-inline-iv--3"><div class="fieldset-wrapper"><div class="form-item form-type-textfield form-item-sedation-iv-customtx form-disabled">
 <input disabled="disabled" type="text" id="edit-sedation-iv-customtx" name="sedation_iv_customtx" value="" size="60" maxlength="128" class="form-text" />
</div>
</div></fieldset>
</div></fieldset>
<fieldset class="form-wrapper" id="edit-sedation-fieldset-col3"><div class="fieldset-wrapper"></div></fieldset>
<fieldset class="form-wrapper" id="edit-sedation-fieldset-row2"><div class="fieldset-wrapper"><input disabled="disabled" type="hidden" name="require_acknowledgement_for_sedation" value="no" />
</div></fieldset>
</div></fieldset>
<fieldset class="data-entry1-area collapsible collapsed form-wrapper" style="display:none" id="edit-radioisotope-fieldset"><legend><span class="fieldset-legend"><span class="raptor-disabled-field">Radionuclide</span></span></legend><div class="fieldset-wrapper"><fieldset class="form-wrapper" id="edit-radioisotope-fieldset-col1"><div class="fieldset-wrapper"><div id="edit-radioisotope-cd" class="form-checkboxes"><div class="form-item form-type-checkbox form-item-radioisotope-cd-none form-disabled">
 <input onchange="notDefaultValuesInSectionAndSetCheckboxes(&quot;radioisotope&quot;,this)" disabled="disabled" type="checkbox" id="edit-radioisotope-cd-none" name="radioisotope_cd[none]" value="none" class="form-checkbox" />  <label class="option" for="edit-radioisotope-cd-none">None </label>

</div>
<div class="form-item form-type-checkbox form-item-radioisotope-cd-enteric form-disabled">
 <input onchange="notDefaultValuesInSectionAndSetCheckboxes(&quot;radioisotope&quot;,this)" disabled="disabled" type="checkbox" id="edit-radioisotope-cd-enteric" name="radioisotope_cd[enteric]" value="enteric" class="form-checkbox" />  <label class="option" for="edit-radioisotope-cd-enteric">Enteric </label>

</div>
<div class="form-item form-type-checkbox form-item-radioisotope-cd-iv form-disabled">
 <input onchange="notDefaultValuesInSectionAndSetCheckboxes(&quot;radioisotope&quot;,this)" disabled="disabled" type="checkbox" id="edit-radioisotope-cd-iv" name="radioisotope_cd[iv]" value="iv" class="form-checkbox" />  <label class="option" for="edit-radioisotope-cd-iv">IV </label>

</div>
</div><input disabled="disabled" type="hidden" name="radioisotope_enteric__inputmode" value="" />
<input disabled="disabled" type="hidden" name="radioisotope_iv__inputmode" value="" />
</div></fieldset>
<fieldset class="form-wrapper" id="edit-radioisotope-fieldset-col2"><div class="fieldset-wrapper"><div class="v-spacer-select">&nbsp;</div><fieldset class="container-inline form-wrapper" id="edit-inline-enteric--2"><div class="fieldset-wrapper"><div class="form-item form-type-textfield form-item-radioisotope-enteric-customtx form-disabled">
 <input disabled="disabled" type="text" id="edit-radioisotope-enteric-customtx" name="radioisotope_enteric_customtx" value="" size="60" maxlength="128" class="form-text" />
</div>
</div></fieldset>
<fieldset class="container-inline form-wrapper" id="edit-inline-iv--4"><div class="fieldset-wrapper"><div class="form-item form-type-textfield form-item-radioisotope-iv-customtx form-disabled">
 <input disabled="disabled" type="text" id="edit-radioisotope-iv-customtx" name="radioisotope_iv_customtx" value="" size="60" maxlength="128" class="form-text" />
</div>
</div></fieldset>
</div></fieldset>
<fieldset class="form-wrapper" id="edit-radioisotope-fieldset-col3"><div class="fieldset-wrapper"></div></fieldset>
<fieldset class="form-wrapper" id="edit-radioisotope-fieldset-row2"><div class="fieldset-wrapper"><input disabled="disabled" type="hidden" name="require_acknowledgement_for_radioisotope" value="no" />
</div></fieldset>
</div></fieldset>
<fieldset class="data-entry1-area form-wrapper" id="edit-allergy-fieldset"><legend><span class="fieldset-legend"><span class="raptor-disabled-field">Allergy (patient has)</span></span></legend><div class="fieldset-wrapper"><div id="edit-allergy-cd" class="form-radios container-inline"><div class="form-item form-type-radio form-item-allergy-cd form-disabled">
 <input class="container-inline form-radio" disabled="disabled" type="radio" id="edit-allergy-cd-unknown" name="allergy_cd" value="unknown" />  <label class="option" for="edit-allergy-cd-unknown">Unknown </label>

</div>
<div class="form-item form-type-radio form-item-allergy-cd form-disabled">
 <input class="container-inline form-radio" disabled="disabled" type="radio" id="edit-allergy-cd-no" name="allergy_cd" value="no" />  <label class="option" for="edit-allergy-cd-no">No </label>

</div>
<div class="form-item form-type-radio form-item-allergy-cd form-disabled">
 <input class="container-inline form-radio" disabled="disabled" type="radio" id="edit-allergy-cd-yes" name="allergy_cd" value="yes" />  <label class="option" for="edit-allergy-cd-yes">Yes </label>

</div>
</div></div></fieldset>
<fieldset class="data-entry1-area form-wrapper" id="edit-claustrophobic-fieldset"><legend><span class="fieldset-legend"><span class="raptor-disabled-field">Claustrophobic (patient is)</span></span></legend><div class="fieldset-wrapper"><div id="edit-claustrophobic-cd" class="form-radios container-inline"><div class="form-item form-type-radio form-item-claustrophobic-cd form-disabled">
 <input class="container-inline form-radio" disabled="disabled" type="radio" id="edit-claustrophobic-cd-unknown" name="claustrophobic_cd" value="unknown" />  <label class="option" for="edit-claustrophobic-cd-unknown">Unknown </label>

</div>
<div class="form-item form-type-radio form-item-claustrophobic-cd form-disabled">
 <input class="container-inline form-radio" disabled="disabled" type="radio" id="edit-claustrophobic-cd-no" name="claustrophobic_cd" value="no" />  <label class="option" for="edit-claustrophobic-cd-no">No </label>

</div>
<div class="form-item form-type-radio form-item-claustrophobic-cd form-disabled">
 <input class="container-inline form-radio" disabled="disabled" type="radio" id="edit-claustrophobic-cd-yes" name="claustrophobic_cd" value="yes" />  <label class="option" for="edit-claustrophobic-cd-yes">Yes </label>

</div>
</div></div></fieldset>

</section>
<input type="hidden" name="show_reset_button" value="1" />
<input type="hidden" name="tid" value="1213" />
<input type="hidden" name="procName" value="CT ABDOMEN W/CONT" />
<input type="hidden" name="modality_abbr" value="" />
<input type="hidden" name="selected_vid" value="" />
<input type="hidden" name="commit_esig" value="" />
<input type="hidden" name="collaboration_uid" value="" />
<input type="hidden" name="collaboration_note_tx" value="" />

<div id='protocol-template-data'>
<div id='json-default-values-all-sections' style='visibility:hidden; height:0px;'>{"message":"nothing found"}</div>

</div>
<section id='input-bottom-protocol' class='bottom-protocol'>

<div class='prev-protocolnotes'>

<div class="existing-note existing-scheduler-note"><span class="datetime">2016-09-07 16:14:00</span> <span class="author-name">Scheduler</span> <span class="scheduled-time-details"> (09/10/2016@16:45)</span> <div class="note-text">Assigned a suggested collaborator
</div> </div><div class="existing-note existing-collabrequest-note active-note"><span class="datetime">2016-09-07 16:14:17</span> <span class="context-indicator">Collaboration request from</span> <span class="author-name">Ms Seattle Scheduler</span> <div class="note-text">Needs Attention</div> </div>
</div>

<div id="ci-already-acknowledged"><!-- None --></div>
<div id="ci-not-acknowledged">
<fieldset class="contraindication form-wrapper" id="edit-contraindication-ra"><legend><span class="fieldset-legend"><span class="raptor-active-field">Contraindications Requiring Acknowledgement</span><span class="form-required" title="This field is required.">*</span></span></legend><div class="fieldset-wrapper"><div class="form-item form-type-checkbox form-item-ci-responses-Age-risk-chk-ack">
 <input type="checkbox" id="edit-ci-responses-age-risk-chk-ack" name="ci_responses[Age risk][chk_ack]" value="1" class="form-checkbox" />  <label class="option" for="edit-ci-responses-age-risk-chk-ack">Acknowledgement of Age risk </label>

</div>
<input type="hidden" name="ci_responses[Age risk][ci_rules][RISK_AGE]" value="RISK_AGE" />
<ul>
<li>
<a href='javascript:showContraIndicationsExplanationPopup(1231001);'>Patient is over age 60</a><data-explanation hidden id='1231001'>Routine creatinine testing prior to contrast administration is not necessary in all patients.  The major indications are age over 60, history of renal insufficiency, diabetes mellitus, or hypertension. </data-explanation></li></ul></div></fieldset>

</div>

</section>

<section id='static-warnings' class='read-only'>

<ul>
<li id='static_1_0_RISK_AGE__1'>Age risk
</ul>
</section>

<section class='page-action'>
<div class="form-action form-wrapper" id="edit-page-action-buttons-area"><input title="Save this order as approved and return to the worklist." type="submit" id="edit-approve-button" name="op" value="Approve" class="form-submit" /><input id="raptor-protocol-collaborate" type="button" value="Collaborate" title="Assign this order to a specialist with current edits saved and return to the worklist."><input onclick="javascript:window.onbeforeunload=null;window.location.href=&quot;http://192.168.1.159/RSite500/protocol?pbatch=CONTINUE&amp;releasedticket=TRUE&quot;;return false;" title="Release this order without saving changes and return to the worklist." class="action-button form-submit" type="submit" id="edit-release-button" name="op" value="Release back to Worklist without Saving" /><input title="Assign this order to yourself with current edits saved and return to the worklist." type="submit" id="edit-reserve-button" name="op" value="Reserve (already assigned to Dr Fresno Resident)" class="form-submit" /><input id="raptor-protocol-replace-order-button" type="button" value="Replace Order" title="Replace this order in VistA with a new order"><input title="Cancel this order in VistA and return to the worklist." type="submit" id="edit-cancelorder-button" name="op" value="Cancel Order" class="form-submit" /><br><br><br><!-- Bottom gap --></div>
</section>
<input type="hidden" name="form_build_id" value="form-rC0hjXYvx-4eeQBBub_zO83JLOj2EtolJaGQc7HAaac" />
<input type="hidden" name="form_token" value="UuKGpY24S9p3K59U5ErWWv8am0jip9C8XxXoUWl5F4o" />
<input type="hidden" name="form_id" value="raptor_glue_protocolinfo_form_builder" />
</div></form>                         
                    
                    <div class="clear_fix"></div>
                </div>
              </li>

            <li>
                <input type="radio" name="tabs" id="tab2" accesskey="m">
                <label for="tab2">Medications</label>
                <div id="tab-content2" class="tab-content animated fadeIn">
                  <!-- Readonly -->
                  <section class="read-only2">
                    <p>Searched for at risk meds: 
                        Aldesleukin, <span class='medical-value-danger' style='background-color: yellow; font-weight: bold;'>Aspirin</span>, Avandamet, Clopidogrel, Coumadin, Dalteparin, Enoxaparin, Fragmin, Glucophage, Glucovance, Heparin, Lovenox, Metaglys, Metformin, Plavix, Proleukin, Sample, Warfarin                    </p>
                    <table class="dataTable">
                      <thead>
                        <tr>
                          <th>Medication</th>
                          <th>At Risk ?</th>
                          <th>Status</th>
                        </tr>
                      </thead>
                      <tbody>
                                                <tr>
                          <td>ASPIRIN TAB,EC</td>
                          <td><span class="generic-warning-area" >
                              YES                              </span>
                          </td>
                          <td>Active</td>
                        </tr>
                                              </tbody>
                    </table>
                    <a class="back-to-protocol-tab-link" style="cursor:pointer; color: blue;">Back to Protocol</a>
                  </section>
                  <!-- page content -->

                </div>
            </li>

            <li>
                <input type="radio" name="tabs" id="tab3" accesskey="v">
                <label for="tab3">Vitals</label>
                <div id="tab-content3" class="tab-content animated fadeIn">

                  <!-- Readonly -->
                  <section class="read-only2">
    				<div id="vitals-chart"></div>
					
                  <table class="dataTable vitals-tab-table">
                    <thead>
                      <tr>
                        <th>Date</th>
                        <th>Temp</th>
                        <th>Height</th>
                        <th>Weight</th>
                        <th>BMI</th>
                        <th>Blood Pressure</th>
                        <th>Pulse</th>
                        <th>Resp</th>                        
                        <th>Pain</th>                        
                        <th>C/G</th>                        
                        <th>POx</th>                        
                        <th>CVP</th>                        
                        <th>Blood Glucose</th>                        
                      </tr>
                    </thead>
                    <tbody>
                                            <tr>
                        <td>03/05/2010 09:00</td>
                        <td>98.5 F</td>
                        <td> </td>
                        <td>178 lb</td>
                        <td>25 </td>
                        <td>134/81 mmHg</td>
                        <td>74 /min</td>
                        <td> </td>
                        <td>1 </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>12/01/2009 08:53</td>
                        <td>98.4 F</td>
                        <td> </td>
                        <td>182 lb</td>
                        <td>25 </td>
                        <td>143/87 mmHg</td>
                        <td>78 /min</td>
                        <td> </td>
                        <td>2 </td>
                        <td> </td>
                        <td>98 %SpO2</td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>08/24/2009 14:00</td>
                        <td>98.9 F</td>
                        <td>71 in</td>
                        <td>190 lb</td>
                        <td>27 </td>
                        <td>154/90 mmHg</td>
                        <td>82 /min</td>
                        <td>18 /min</td>
                        <td>6 </td>
                        <td> </td>
                        <td>97 %SpO2</td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>04/17/2009 12:00</td>
                        <td>99.2 F</td>
                        <td> </td>
                        <td>185 lb</td>
                        <td>26 </td>
                        <td>143/90 mmHg</td>
                        <td>88 /min</td>
                        <td>17 /min</td>
                        <td>4 </td>
                        <td> </td>
                        <td>97 %SpO2</td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>11/10/2008 08:00</td>
                        <td>98.2 F</td>
                        <td> </td>
                        <td>180 lb</td>
                        <td>25 </td>
                        <td>135/86 mmHg</td>
                        <td>80 /min</td>
                        <td>18 /min</td>
                        <td>2 </td>
                        <td> </td>
                        <td>97 %SpO2</td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>06/10/2008 11:00</td>
                        <td>98.8 F</td>
                        <td>71 in</td>
                        <td>172 lb</td>
                        <td>24 </td>
                        <td>124/80 mmHg</td>
                        <td>82 /min</td>
                        <td> </td>
                        <td>0 </td>
                        <td> </td>
                        <td>98 %SpO2</td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>05/20/2008 11:00</td>
                        <td>101 F</td>
                        <td>71 in</td>
                        <td>170 lb</td>
                        <td>24 </td>
                        <td>158/104 mmHg</td>
                        <td>82 /min</td>
                        <td> </td>
                        <td>3 </td>
                        <td> </td>
                        <td>98 %SpO2</td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>05/06/2008 10:00</td>
                        <td>99.2 F</td>
                        <td>71 in</td>
                        <td>174 lb</td>
                        <td>24 </td>
                        <td>156/96 mmHg</td>
                        <td>82 /min</td>
                        <td> </td>
                        <td>3 </td>
                        <td> </td>
                        <td>98 %SpO2</td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>01/30/2008 11:00</td>
                        <td>98.8 F</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td>145/94 mmHg</td>
                        <td>80 /min</td>
                        <td> </td>
                        <td>2 </td>
                        <td> </td>
                        <td>98 %SpO2</td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>12/28/2007 09:00</td>
                        <td>98.6 F</td>
                        <td>71 in</td>
                        <td>166 lb</td>
                        <td>23 </td>
                        <td>140/90 mmHg</td>
                        <td>80 /min</td>
                        <td> </td>
                        <td>1 </td>
                        <td> </td>
                        <td>98 %SpO2</td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>11/28/2007 08:00</td>
                        <td>98.6 F</td>
                        <td>71 in</td>
                        <td>168 lb</td>
                        <td>23 </td>
                        <td>138/88 mmHg</td>
                        <td>80 /min</td>
                        <td> </td>
                        <td>0 </td>
                        <td> </td>
                        <td>98 %SpO2</td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>04/24/2007 08:00</td>
                        <td> </td>
                        <td> </td>
                        <td>175 lb</td>
                        <td>24 </td>
                        <td>136/70 mmHg</td>
                        <td>82 /min</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>04/11/2007 07:45</td>
                        <td> </td>
                        <td> </td>
                        <td>184 lb</td>
                        <td>26 </td>
                        <td>156/92 mmHg</td>
                        <td>87 /min</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>03/15/2007 08:00</td>
                        <td> </td>
                        <td> </td>
                        <td>196 lb</td>
                        <td>27 </td>
                        <td>160/97 mmHg</td>
                        <td>92 /min</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>03/16/2005 10:00</td>
                        <td>99 F</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td>168/68 mmHg</td>
                        <td>72 /min</td>
                        <td>18 /min</td>
                        <td>1 </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>03/16/2005 06:00</td>
                        <td>102.6 F</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td>176/82 mmHg</td>
                        <td>88 /min</td>
                        <td>21 /min</td>
                        <td>3 </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>03/15/2005 11:30</td>
                        <td>98.2 F</td>
                        <td>71 in</td>
                        <td>199 lb</td>
                        <td>28* </td>
                        <td>182/88 mmHg</td>
                        <td>76 /min</td>
                        <td>18 /min</td>
                        <td>3 </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>03/30/2004 21:31</td>
                        <td>98.6 F</td>
                        <td>70 in</td>
                        <td>185 lb</td>
                        <td>27 </td>
                        <td>120/86 mmHg</td>
                        <td>68 /min</td>
                        <td>18 /min</td>
                        <td>2 </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>04/15/2003 16:05</td>
                        <td>98.7 F</td>
                        <td> </td>
                        <td>174 lb</td>
                        <td>25 </td>
                        <td>146/92 mmHg</td>
                        <td>72 /min</td>
                        <td>10 /min</td>
                        <td>5 </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>04/05/2003 15:15</td>
                        <td>98.4 F</td>
                        <td>70 in</td>
                        <td>172 lb</td>
                        <td>25 </td>
                        <td>146/84 mmHg</td>
                        <td>76 /min</td>
                        <td>12 /min</td>
                        <td>4 </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>04/06/2001 09:28</td>
                        <td>98.5 F</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td>132/98 mmHg</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>05/21/2000 11:21</td>
                        <td>102 F</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td>120/70 mmHg</td>
                        <td>74 /min</td>
                        <td>33 /min</td>
                        <td>0 </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>05/10/2000 11:21</td>
                        <td>101 F</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td>130/80 mmHg</td>
                        <td>80 /min</td>
                        <td>40 /min</td>
                        <td>2 </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>05/06/2000 11:20</td>
                        <td>99 F</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td>130/80 mmHg</td>
                        <td>80 /min</td>
                        <td>40 /min</td>
                        <td>3 </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>03/10/1999 15:22</td>
                        <td>98 F</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td>80 /min</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>03/09/1999 13:00</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td>4 </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>08/18/1998 10:15</td>
                        <td> </td>
                        <td> </td>
                        <td>199 lb</td>
                        <td>29* </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>08/18/1998 10:00</td>
                        <td>98.6 F</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td>120/80 mmHg</td>
                        <td>62 /min</td>
                        <td>30 /min</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
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                                            <tr>
                        <td>07/08/1998 13:37</td>
                        <td>98.6 F</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td>60 /min</td>
                        <td>40 /min</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                      </tr>
                                            <tr>
                        <td>06/06/1997 16:49</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td>150/80 mmHg</td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
                        <td> </td>
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                        <td>03/19/2005</td>
                        <td>PENICILLIN</td>
                        <td>DRUG</td>
                                                <td>ITCHING,WATERING EYES</td>
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                        <td>12/17/2007</td>
                        <td>CHOCOLATE</td>
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                        <td>HISTORICAL</td>
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                        <td>03-16-2010</td>
                        <td>1.3 mg/dL</td>
                        <td>56  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
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                        <td>03-16-2010</td>
                        <td>1.1 mg/dL</td>
                        <td>68  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
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                        <td>03-16-2010</td>
                        <td>1.3 mg/dL</td>
                        <td>56  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
                      </tr>

                      
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                        <td>03-16-2010</td>
                        <td><span class='medical-value-danger'>!! 1.5 mg/dL !!</span></td>
                        <td>48  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
                      </tr>

                      
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                        <td>03-16-2010</td>
                        <td>1.2 mg/dL</td>
                        <td>62  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
                      </tr>

                      
                      <tr>
                        <td>01-31-2008</td>
                        <td>1 mg/dL</td>
                        <td>76  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
                      </tr>

                      
                      <tr>
                        <td>01-31-2008</td>
                        <td>1.1 mg/dL</td>
                        <td>68  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
                      </tr>

                      
                      <tr>
                        <td>01-31-2008</td>
                        <td>1.2 mg/dL</td>
                        <td>62  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
                      </tr>

                      
                      <tr>
                        <td>04-24-2007</td>
                        <td>1.1 mg/dL</td>
                        <td>68  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
                      </tr>

                      
                      <tr>
                        <td>04-24-2007</td>
                        <td>1.3 mg/dL</td>
                        <td>56  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
                      </tr>

                      
                      <tr>
                        <td>04-24-2007</td>
                        <td>1.2 mg/dL</td>
                        <td>62  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
                      </tr>

                      
                      <tr>
                        <td>03-17-2005</td>
                        <td>1.1 mg/dL</td>
                        <td>68  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
                      </tr>

                      
                      <tr>
                        <td>03-28-2004</td>
                        <td>1.2 mg/dL</td>
                        <td>62  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
                      </tr>

                      
                      <tr>
                        <td>11-24-1998</td>
                        <td><span class='medical-value-danger'>!! 2.3 mg/dL !!</span></td>
                        <td>29  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
                      </tr>

                      
                      <tr>
                        <td>11-24-1998</td>
                        <td><span class='medical-value-danger'>!! .5 mg/dL !!</span></td>
                        <td>170  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
                      </tr>

                      
                      <tr>
                        <td>10-22-1998</td>
                        <td>1.2 mg/dL</td>
                        <td>62  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
                      </tr>

                      
                      <tr>
                        <td>09-25-1998</td>
                        <td>1.2 mg/dL</td>
                        <td>62  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
                      </tr>

                      
                      <tr>
                        <td>06-09-1998</td>
                        <td><span class='medical-value-danger'>!! 2.1 mg/dL !!</span></td>
                        <td>32  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
                      </tr>

                      
                      <tr>
                        <td>04-02-1998</td>
                        <td>.9 mg/dL</td>
                        <td>86  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
                      </tr>

                      
                      <tr>
                        <td>04-01-1998</td>
                        <td><span class='medical-value-danger'>!! .5 mg/dL !!</span></td>
                        <td>170  mL/min/1.73 m^2</td>
                        <td>(eGFR calculated) .9 - 1.4</td>
                      </tr>

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                          <td>Surgical Pathology Report</td>
                          <td>01/21/1999</td>
                          <td><a href="#" class="raptor-details">TOE...</a><div class="hide"><dl><br />                                 ---- SURGICAL PATHOLOGY ----<br />Date Spec taken: Jan 21, 1999        Pathologist:<br />Date Spec rec'd: Jan 21, 1999 16:39  Resident: <br />REPORT INCOMPLETE                    Accession #: SP 99 99<br />Submitted by:                        Practitioner:<br />-----------------------------------------------------------------------------------------------<br />Specimen: <br />TOE<br />Report not verified</dl></div></td>
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                          <td>Surgical Pathology Report</td>
                          <td>07/23/1998</td>
                          <td><a href="#" class="raptor-details">FINGERNAIL, RIGHT INDEX FINGER...</a><div class="hide"><dl><br />                                 ---- SURGICAL PATHOLOGY ----<br />Date Spec taken: Jul 23, 1998        Pathologist:SIXTEEN PROVIDER<br />Date Spec rec'd: Jul 23, 1998 17:00  Resident: <br />Date  completed: Jul 24, 1998        Accession #: SP 98 9<br />Submitted by: BONES T. MCCOY MD      Practitioner:ONEHUNDREDNINETYONE PROVIDER<br />-----------------------------------------------------------------------------------------------<br />Specimen: <br />FINGERNAIL, RIGHT INDEX FINGER<br />Brief Clinical History:<br />This is the modified text for the brief clinical history.<br />date 9/24/98.<br /><br />2mo. history of fingernail thickening, yellowing<br />Preoperative Diagnosis:<br />R/O yeast infection<br />Gross description:<br />                           *+* MODIFIED REPORT *+*<br />(Last modified: Sep 24, 1998 11:37 typed by WARDCLERK,FIFTYTHREE)<br />Specimen measured 3.5 cm by .1 mm by 5.1 cm in length.<br />yellowed, thickened nail<br />Microscopic exam/diagnosis: (Date Spec taken: Jul 23, 1998)<br />looks bad<br />Diagnosis:<br />probable yeast infection</dl></div></td>
                        </tr>
                                                <tr>
                          <td>Surgical Pathology Report</td>
                          <td>05/14/1998 17:00</td>
                          <td><a href="#" class="raptor-details">PROSTATE CHIPS...</a><div class="hide"><dl><br />                                 ---- SURGICAL PATHOLOGY ----<br />Date Spec taken: May 14, 1998 17:00  Pathologist:SIXTEEN PROVIDER<br />Date Spec rec'd: May 14, 1998 18:30  Resident: <br />REPORT INCOMPLETE                    Accession #: SP 98 8<br />Submitted by: BONES T. MCCOY MD      Practitioner:ONEHUNDREDNINETYONE PROVIDER<br />-----------------------------------------------------------------------------------------------<br />Specimen: <br />PROSTATE CHIPS<br />Report not verified</dl></div></td>
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                          <th>Date</th>
                          <th>Details</th>
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                                                <tr>
                          <td>LEFT INGUINAL HERNIA REPAIR WITH MESH</td>
                          <td>01-24-2007 073</td>
                          <td><a href="#" class="raptor-details">LOCAL TITLE: OPERATION REPORT           ...</a><div class="hide"><dl> LOCAL TITLE: OPERATION REPORT                                   
<br />DATE OF NOTE: JAN 24, 2007@07:30     ENTRY DATE: JAN 24, 2007@12:43:06      
<br />     SURGEON: PROVIDER,ONE            ATTENDING: TDPROVIDER,ONE               
<br />     URGENCY:                            STATUS: COMPLETED                     
<br />     SUBJECT: Case #: 10053                                                    
<br />
<br />SURGEON:                PROVIDER,ONE 
<br /> 
<br /> 1ST ASST:               PROVIDER,TWO 
<br /> 
<br /> ATTENDING:              TDPROVIDER,ONE 
<br /> 
<br /> PROCEDURE:            LEFT INGUINAL HERNIA REPAIR WITH MESH
<br /> 
<br /> HISTORY:  Essentially patient  underwent  preop evaluation  for  left 
<br /> inguinal mass  noted  since  September 2004.    Recently  PT became  more 
<br /> symptomatic with  increased size and  tenderness.  Patient  denied any 
<br /> history of melena or bloody stools.   Denied a history of constipation or
<br /> diarrhea. No recent fevers or chills.   He was admitted on January 23,
<br /> 2007, for an elective left inguinal hernia repair.
<br /> 
<br /> SUMMARY OF PROCEDURES:   After  consent was  obtained,  the  patient was 
<br /> prepped and  draped in  sterile fashion.   Lidocaine  1% was  used to 
<br /> anesthetize the  skin and a 5-cm incision was made in the left groin. 
<br /> The skin and subcu was dissected down to the  external oblique fascia. 
<br /> The fascia was incised to the external ring and the spermatic cord and
<br /> all its contents were isolated  with a Penrose drain.  The  hernia sac
<br /> was  then dissected and reduced into the large direct inguinal defect. 
<br /> Three large  mesh plugs were secured  together and  used to  plug the
<br /> direct  defect  and  secured  in place  with  2  interrupted  Prolene
<br /> stitches.   An onlay patch was  then applied and secured  to the pubic
<br /> tubercle  and secured to the fascial edges using a running 2-0 Prolene
<br /> suture on  either side.  The external oblique was then closed over the
<br /> repair, being cognizant  of the ilioinguinal  nerve. All superficial
<br /> bleeding was  controlled with electrocautery.   Copious irrigation
<br /> was used  and additional 1% Lidocaine  was used to  anesthetize the subcu 
<br /> and fascia.  Scarpa  fascia was closed  using 4-0 Vicryl.   Additional
<br /> 4-0 Vicryl was  used in  a subcuticular  fashion  to close  the skin. 
<br /> Steri-Strips were applied and dressings.   The patient  was extubated and
<br /> stable to recovery, tolerated the procedure well.   The attending
<br /> physician, TDPROVDIER,ONE, was scrubbed during the entire case.
<br /> 
<br />/es/ ONE PROVIDER
<br />MD
<br />Signed: 01/24/2007 12:46
<br /> 
<br />/es/ ONE TDPROVIDER
<br />MD
<br />Cosigned: 01/24/2007 16:50
<br />=========================================================================
<br /></dl></div></td>
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                          <td>Hypertension (ICD-9-CM 401.9)</td>
                          <td></td>
                          <td><a href="#" class="raptor-details">04/07/2005</a><div class="hide"><dl><dt>Type of Note:</dt><dd>Problem</dd><dt>Provider Narrative:</dt><dd>Hypertension (ICD-9-CM 401.9)</dd><dt>Note Narrative:</dt><dd>04/07/2005</dd><dt>Status:</dt><dd>A</dd><dt>Observer:</dt><dd></dd><dt>Comment:</dt><dd>04/10/2007</dd><dt>Facility:</dt><dd>CAMP MASTER;500</dd></dl></div></td>
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                          <td>Hyperlipidemia (ICD-9-CM 272.4)</td>
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                          <td><a href="#" class="raptor-details">04/07/2005</a><div class="hide"><dl><dt>Type of Note:</dt><dd>Problem</dd><dt>Provider Narrative:</dt><dd>Hyperlipidemia (ICD-9-CM 272.4)</dd><dt>Note Narrative:</dt><dd>04/07/2005</dd><dt>Status:</dt><dd>A</dd><dt>Observer:</dt><dd></dd><dt>Comment:</dt><dd>04/10/2007</dd><dt>Facility:</dt><dd>CAMP MASTER;500</dd></dl></div></td>
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                          <td>Acute myocardial infarction, unspecified site, episode of care unspecified (ICD-9-CM 410.90)</td>
                          <td></td>
                          <td><a href="#" class="raptor-details">03/17/2005</a><div class="hide"><dl><dt>Type of Note:</dt><dd>Problem</dd><dt>Provider Narrative:</dt><dd>Acute myocardial infarction, unspecified site, episode of care unspecified (ICD-9-CM 410.90)</dd><dt>Note Narrative:</dt><dd>03/17/2005</dd><dt>Status:</dt><dd>A</dd><dt>Observer:</dt><dd></dd><dt>Comment:</dt><dd>03/19/2005</dd><dt>Facility:</dt><dd>CAMP MASTER;500</dd></dl></div></td>
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                          <td>Chronic Systolic Heart failure (ICD-9-CM 428.22)</td>
                          <td></td>
                          <td><a href="#" class="raptor-details">03/15/2004</a><div class="hide"><dl><dt>Type of Note:</dt><dd>Problem</dd><dt>Provider Narrative:</dt><dd>Chronic Systolic Heart failure (ICD-9-CM 428.22)</dd><dt>Note Narrative:</dt><dd>03/15/2004</dd><dt>Status:</dt><dd>A</dd><dt>Observer:</dt><dd></dd><dt>Comment:</dt><dd>04/02/2004</dd><dt>Facility:</dt><dd>CAMP MASTER;500</dd></dl></div></td>
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                          <td>Diabetes Mellitus Type II or unspecified (ICD-9-CM 250.00)</td>
                          <td></td>
                          <td><a href="#" class="raptor-details">Diabetes Mellitus Type II or unspecified...</a><div class="hide"><dl><dt>Type of Note:</dt><dd>Problem</dd><dt>Provider Narrative:</dt><dd>Diabetes Mellitus Type II or unspecified (ICD-9-CM 250.00)</dd><dt>Note Narrative:</dt><dd></dd><dt>Status:</dt><dd>A</dd><dt>Observer:</dt><dd></dd><dt>Comment:</dt><dd>04/01/2004</dd><dt>Facility:</dt><dd>CAMP MASTER;500</dd></dl></div></td>
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