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              <li class="overview"><a href="#">Overview</a></li>
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        <table width="100%" border="0" cellspacing="0" cellpadding="0">
          <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>
            <th>Submit Request To</th>
            <th>Category of Exam</th>
          </tr>
          <tr>
            <td title='Vista order status is PENDING'>
                2009</td>
            <!-- removed case id as per #369 -->
            <td colspan="2">CT LUMBAR SPINE W/O CONT</td>
            <td>CT SCAN</td>
            <td>RADIOLOGIST,FIVE</td>
            <td></td>
            <td>OUTPATIENT</td>
          </tr>
          <tr>
            <th>Ordered/Due Date</th>
            <th>Requesting Location</th>
            <th>Reason for Study</th>
            <th>SSN</th>
            <th>PCP</th>
            <th>Transport</th>
            <th>Urgency</th>
          </tr>
          <tr>
                          <td>SEP 13, 2016@14:37 / 2016-09-21 11:00:00</td>
            <td>7A GEN MED</td>
            <td>TEST</td>
            <td>666-00-9002</td>
            <td></td>
            <td>AMBULATORY</td>
            <td>ROUTINE</td>
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          <tr>
            <th>Patient Name</th>
            <th>Age</th>
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            <th>DOB</th>
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            <th>Gender</th>
          </tr>
          <tr>
            <td>AWARE,GEORGE</td>
            <td>55</td>
            <td></td>
            <td>01-01-1961</td>
            <td> </td>
            <td></td>
            <td>M</td>
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                      <h3>Medications</h3>
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                            <th>At Risk ?</th>
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                      (<a href="#" class="details" id="medications_detail">see medications detail</a>
                      					  )

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                                                                            </tbody>
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                      (<a href="#" class="details" id="vitals_detail">see vitals detail</a>
                      					  )

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                            <th>Allergy Reactant</th>
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                                                                            </tbody>
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                      (<a href="#" class="details" id="allergies_detail">see allergies detail</a>
                      					  )

                      <h3>Labs</h3>
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                            <th colspan="3">RENAL PANEL</th>
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                            <th>Date</th>
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                            <th>eGFR</th>
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                      (<a href="#" class="details" id="labs_detail">see labs detail</a>
                      					  )

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<fieldset class="data-entry1-area form-wrapper" id="edit-protocol1-fieldset"><legend><span class="fieldset-legend"><span class="raptor-disabled-field">Protocol Name</span></span></legend><div class="fieldset-wrapper"><div class="form-item form-type-select form-item-protocol1-nm form-disabled">
 <select class="select2 form-select" disabled="disabled" id="edit-protocol1-nm" name="protocol1_nm"><optgroup label=""><option value="">- Select -</option></optgroup><optgroup label="Short List"><option value="RPID31" selected="selected">CT LUMBAR SPINE without 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="RPID21">CT CERVICAL SPINE without CONTRAST</option><option value="RPID16">CT Chest without IV contrast</option><option value="RPID22">CT HEAD Non-Contrast (axial)</option><option value="RPID160">CT HEAD- POSTERIOR FOSSA (3mm) Non-Contrast (axial) B</option><option value="WAV004">CT High Resolution Spiral Chest (supine or prone)</option><option value="WAV042">CT NECK ANGIOGRAPHY (CTA) (helical), plus HEAD with and without Contrast (axial)</option><option value="WAV044">CT NECK, ORAL, CAVITY, LARYNX, THYROID, without &amp; with CONTRAST</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" selected="selected">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" checked="checked" 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 form-wrapper" 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" checked="checked" 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="500cc H2O over 2hr pre-scan + post-scan" 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" checked="checked" 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" checked="checked" />  <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" checked="checked" />  <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="2009" />
<input type="hidden" name="procName" value="CT LUMBAR SPINE W/O CONT" />
<input type="hidden" name="modality_abbr" value="CT" />
<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;'>{"hydration":-1,"sedation":-1,"contrast":{"enteric":-1,"iv":-1},"radioisotope":{"iv":-1,"enteric":-1},"consentreq":"unknown","protocolnotes":-1,"examnotes":-1}</div>

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

<div class='prev-protocolnotes'>

<div class="existing-note existing-scheduler-note"><span class="datetime">2016-09-13 11:00:00</span> <span class="author-name">Scheduler</span> <span class="scheduled-time-details"> (09/21/2016@11:00)</span> <div class="note-text">Assigned a suggested collaborator
</div> </div>
</div>
<fieldset class="checklist-dataentry-area form-wrapper" id="edit-page-checklist-area1"><legend><span class="fieldset-legend"><span class="raptor-active-field">Safety Checklist</span><span class="form-required" title="This field is required.">*</span></span></legend><div class="fieldset-wrapper"><div class="safety-checklist">
<div class="question-block"><input type="hidden" name="questions[thisuser][GOT_PATIENT][shortname]" value="GOT_PATIENT" />
<input type="hidden" name="questions[thisuser][GOT_PATIENT][showcommentonvalues]" value="[no][notsure]" />
<div class="form-item form-type-radios form-item-questions-thisuser-GOT-PATIENT-response">
  <label for="edit-questions-thisuser-got-patient-response"><span class="raptor-active-field">Core Question 1</span><span class="form-required" title="This field is required.">*</span> </label>
 <div id="edit-questions-thisuser-got-patient-response" class="form-radios question-options"><div class="form-item form-type-radio form-item-questions-thisuser-GOT-PATIENT-response">
 <input onclick="manageChecklistQuestionCommentByName(this.value,&quot;[no][notsure]&quot;,&quot;questions[thisuser][GOT_PATIENT][comment]&quot;);" class="question-options form-radio" type="radio" id="edit-questions-thisuser-got-patient-response-yes" name="questions[thisuser][GOT_PATIENT][response]" value="yes" />  <label class="option" for="edit-questions-thisuser-got-patient-response-yes">Yes </label>

</div>
<div class="form-item form-type-radio form-item-questions-thisuser-GOT-PATIENT-response">
 <input onclick="manageChecklistQuestionCommentByName(this.value,&quot;[no][notsure]&quot;,&quot;questions[thisuser][GOT_PATIENT][comment]&quot;);" class="question-options form-radio" type="radio" id="edit-questions-thisuser-got-patient-response-no" name="questions[thisuser][GOT_PATIENT][response]" value="no" />  <label class="option" for="edit-questions-thisuser-got-patient-response-no">No </label>

</div>
<div class="form-item form-type-radio form-item-questions-thisuser-GOT-PATIENT-response">
 <input onclick="manageChecklistQuestionCommentByName(this.value,&quot;[no][notsure]&quot;,&quot;questions[thisuser][GOT_PATIENT][comment]&quot;);" class="question-options form-radio" type="radio" id="edit-questions-thisuser-got-patient-response-notsure" name="questions[thisuser][GOT_PATIENT][response]" value="notsure" />  <label class="option" for="edit-questions-thisuser-got-patient-response-notsure">Not Sure </label>

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

<div class="question">Correct patient?</div>
<div name="questions[thisuser][GOT_PATIENT][comment]-wrapper" class="comment-wrapper" style="display:none" ><div class="form-item form-type-textarea form-item-questions-thisuser-GOT-PATIENT-comment">
  <label for="edit-questions-thisuser-got-patient-comment"><span class="raptor-active-field">Explain why the patient identity cannot be confirmed as appropriate for the procedure.</span> </label>
 <div class="form-textarea-wrapper resizable"><textarea id="edit-questions-thisuser-got-patient-comment" name="questions[thisuser][GOT_PATIENT][comment]" cols="60" rows="5" class="form-textarea"></textarea></div>
</div>

</div> <!-- End of questions[thisuser][GOT_PATIENT][comment]-wrapper -->
</div>
<div class="question-block"><input type="hidden" name="questions[thisuser][GOT_IMG_SITE][shortname]" value="GOT_IMG_SITE" />
<input type="hidden" name="questions[thisuser][GOT_IMG_SITE][showcommentonvalues]" value="[no][notsure]" />
<div class="form-item form-type-radios form-item-questions-thisuser-GOT-IMG-SITE-response">
  <label for="edit-questions-thisuser-got-img-site-response"><span class="raptor-active-field">Core Question 2</span><span class="form-required" title="This field is required.">*</span> </label>
 <div id="edit-questions-thisuser-got-img-site-response" class="form-radios question-options"><div class="form-item form-type-radio form-item-questions-thisuser-GOT-IMG-SITE-response">
 <input onclick="manageChecklistQuestionCommentByName(this.value,&quot;[no][notsure]&quot;,&quot;questions[thisuser][GOT_IMG_SITE][comment]&quot;);" class="question-options form-radio" type="radio" id="edit-questions-thisuser-got-img-site-response-yes" name="questions[thisuser][GOT_IMG_SITE][response]" value="yes" />  <label class="option" for="edit-questions-thisuser-got-img-site-response-yes">Yes </label>

</div>
<div class="form-item form-type-radio form-item-questions-thisuser-GOT-IMG-SITE-response">
 <input onclick="manageChecklistQuestionCommentByName(this.value,&quot;[no][notsure]&quot;,&quot;questions[thisuser][GOT_IMG_SITE][comment]&quot;);" class="question-options form-radio" type="radio" id="edit-questions-thisuser-got-img-site-response-no" name="questions[thisuser][GOT_IMG_SITE][response]" value="no" />  <label class="option" for="edit-questions-thisuser-got-img-site-response-no">No </label>

</div>
<div class="form-item form-type-radio form-item-questions-thisuser-GOT-IMG-SITE-response">
 <input onclick="manageChecklistQuestionCommentByName(this.value,&quot;[no][notsure]&quot;,&quot;questions[thisuser][GOT_IMG_SITE][comment]&quot;);" class="question-options form-radio" type="radio" id="edit-questions-thisuser-got-img-site-response-notsure" name="questions[thisuser][GOT_IMG_SITE][response]" value="notsure" />  <label class="option" for="edit-questions-thisuser-got-img-site-response-notsure">Not Sure </label>

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

<div class="question">Confirmed imaging site?</div>
<div name="questions[thisuser][GOT_IMG_SITE][comment]-wrapper" class="comment-wrapper" style="display:none" ><div class="form-item form-type-textarea form-item-questions-thisuser-GOT-IMG-SITE-comment">
  <label for="edit-questions-thisuser-got-img-site-comment"><span class="raptor-active-field">Explain why the imaging site cannot be confirmed.</span> </label>
 <div class="form-textarea-wrapper resizable"><textarea id="edit-questions-thisuser-got-img-site-comment" name="questions[thisuser][GOT_IMG_SITE][comment]" cols="60" rows="5" class="form-textarea"></textarea></div>
</div>

</div> <!-- End of questions[thisuser][GOT_IMG_SITE][comment]-wrapper -->
</div>
<div class="question-block"><input type="hidden" name="questions[thisuser][SET_PAT_POSITION][shortname]" value="SET_PAT_POSITION" />
<input type="hidden" name="questions[thisuser][SET_PAT_POSITION][showcommentonvalues]" value="[no][notsure]" />
<div class="form-item form-type-radios form-item-questions-thisuser-SET-PAT-POSITION-response">
  <label for="edit-questions-thisuser-set-pat-position-response"><span class="raptor-active-field">Core Question 3</span><span class="form-required" title="This field is required.">*</span> </label>
 <div id="edit-questions-thisuser-set-pat-position-response" class="form-radios question-options"><div class="form-item form-type-radio form-item-questions-thisuser-SET-PAT-POSITION-response">
 <input onclick="manageChecklistQuestionCommentByName(this.value,&quot;[no][notsure]&quot;,&quot;questions[thisuser][SET_PAT_POSITION][comment]&quot;);" class="question-options form-radio" type="radio" id="edit-questions-thisuser-set-pat-position-response-yes" name="questions[thisuser][SET_PAT_POSITION][response]" value="yes" />  <label class="option" for="edit-questions-thisuser-set-pat-position-response-yes">Yes </label>

</div>
<div class="form-item form-type-radio form-item-questions-thisuser-SET-PAT-POSITION-response">
 <input onclick="manageChecklistQuestionCommentByName(this.value,&quot;[no][notsure]&quot;,&quot;questions[thisuser][SET_PAT_POSITION][comment]&quot;);" class="question-options form-radio" type="radio" id="edit-questions-thisuser-set-pat-position-response-no" name="questions[thisuser][SET_PAT_POSITION][response]" value="no" />  <label class="option" for="edit-questions-thisuser-set-pat-position-response-no">No </label>

</div>
<div class="form-item form-type-radio form-item-questions-thisuser-SET-PAT-POSITION-response">
 <input onclick="manageChecklistQuestionCommentByName(this.value,&quot;[no][notsure]&quot;,&quot;questions[thisuser][SET_PAT_POSITION][comment]&quot;);" class="question-options form-radio" type="radio" id="edit-questions-thisuser-set-pat-position-response-notsure" name="questions[thisuser][SET_PAT_POSITION][response]" value="notsure" />  <label class="option" for="edit-questions-thisuser-set-pat-position-response-notsure">Not Sure </label>

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

<div class="question">Correct patient positioning?</div>
<div name="questions[thisuser][SET_PAT_POSITION][comment]-wrapper" class="comment-wrapper" style="display:none" ><div class="form-item form-type-textarea form-item-questions-thisuser-SET-PAT-POSITION-comment">
  <label for="edit-questions-thisuser-set-pat-position-comment"><span class="raptor-active-field">Explain why the correct positioning cannot be answered as Yes.</span> </label>
 <div class="form-textarea-wrapper resizable"><textarea id="edit-questions-thisuser-set-pat-position-comment" name="questions[thisuser][SET_PAT_POSITION][comment]" cols="60" rows="5" class="form-textarea"></textarea></div>
</div>

</div> <!-- End of questions[thisuser][SET_PAT_POSITION][comment]-wrapper -->
</div>
<div class="question-block"><input type="hidden" name="questions[thisuser][GOT_IMG_PROTOCOL][shortname]" value="GOT_IMG_PROTOCOL" />
<input type="hidden" name="questions[thisuser][GOT_IMG_PROTOCOL][showcommentonvalues]" value="[no][notsure][notapplicable]" />
<div class="form-item form-type-radios form-item-questions-thisuser-GOT-IMG-PROTOCOL-response">
  <label for="edit-questions-thisuser-got-img-protocol-response"><span class="raptor-active-field">Modality Specific Question 4</span><span class="form-required" title="This field is required.">*</span> </label>
 <div id="edit-questions-thisuser-got-img-protocol-response" class="form-radios question-options"><div class="form-item form-type-radio form-item-questions-thisuser-GOT-IMG-PROTOCOL-response">
 <input onclick="manageChecklistQuestionCommentByName(this.value,&quot;[no][notsure][notapplicable]&quot;,&quot;questions[thisuser][GOT_IMG_PROTOCOL][comment]&quot;);" class="question-options form-radio" type="radio" id="edit-questions-thisuser-got-img-protocol-response-yes" name="questions[thisuser][GOT_IMG_PROTOCOL][response]" value="yes" />  <label class="option" for="edit-questions-thisuser-got-img-protocol-response-yes">Yes </label>

</div>
<div class="form-item form-type-radio form-item-questions-thisuser-GOT-IMG-PROTOCOL-response">
 <input onclick="manageChecklistQuestionCommentByName(this.value,&quot;[no][notsure][notapplicable]&quot;,&quot;questions[thisuser][GOT_IMG_PROTOCOL][comment]&quot;);" class="question-options form-radio" type="radio" id="edit-questions-thisuser-got-img-protocol-response-no" name="questions[thisuser][GOT_IMG_PROTOCOL][response]" value="no" />  <label class="option" for="edit-questions-thisuser-got-img-protocol-response-no">No </label>

</div>
<div class="form-item form-type-radio form-item-questions-thisuser-GOT-IMG-PROTOCOL-response">
 <input onclick="manageChecklistQuestionCommentByName(this.value,&quot;[no][notsure][notapplicable]&quot;,&quot;questions[thisuser][GOT_IMG_PROTOCOL][comment]&quot;);" class="question-options form-radio" type="radio" id="edit-questions-thisuser-got-img-protocol-response-notsure" name="questions[thisuser][GOT_IMG_PROTOCOL][response]" value="notsure" />  <label class="option" for="edit-questions-thisuser-got-img-protocol-response-notsure">Not Sure </label>

</div>
<div class="form-item form-type-radio form-item-questions-thisuser-GOT-IMG-PROTOCOL-response">
 <input onclick="manageChecklistQuestionCommentByName(this.value,&quot;[no][notsure][notapplicable]&quot;,&quot;questions[thisuser][GOT_IMG_PROTOCOL][comment]&quot;);" class="question-options form-radio" type="radio" id="edit-questions-thisuser-got-img-protocol-response-notapplicable" name="questions[thisuser][GOT_IMG_PROTOCOL][response]" value="notapplicable" />  <label class="option" for="edit-questions-thisuser-got-img-protocol-response-notapplicable">Not Applicable </label>

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

<div class="question">Correct imaging protocol?</div>
<div name="questions[thisuser][GOT_IMG_PROTOCOL][comment]-wrapper" class="comment-wrapper" style="display:none" ><div class="form-item form-type-textarea form-item-questions-thisuser-GOT-IMG-PROTOCOL-comment">
  <label for="edit-questions-thisuser-got-img-protocol-comment"><span class="raptor-active-field">Explain why the imaging protocol does not appear to be correct and what action you will take.</span> </label>
 <div class="form-textarea-wrapper resizable"><textarea id="edit-questions-thisuser-got-img-protocol-comment" name="questions[thisuser][GOT_IMG_PROTOCOL][comment]" cols="60" rows="5" class="form-textarea"></textarea></div>
</div>

</div> <!-- End of questions[thisuser][GOT_IMG_PROTOCOL][comment]-wrapper -->
</div>
<div class="question-block"><input type="hidden" name="questions[thisuser][SET_SCNR_PARAMS][shortname]" value="SET_SCNR_PARAMS" />
<input type="hidden" name="questions[thisuser][SET_SCNR_PARAMS][showcommentonvalues]" value="[no][notsure][notapplicable]" />
<div class="form-item form-type-radios form-item-questions-thisuser-SET-SCNR-PARAMS-response">
  <label for="edit-questions-thisuser-set-scnr-params-response"><span class="raptor-active-field">Modality Specific Question 5</span><span class="form-required" title="This field is required.">*</span> </label>
 <div id="edit-questions-thisuser-set-scnr-params-response" class="form-radios question-options"><div class="form-item form-type-radio form-item-questions-thisuser-SET-SCNR-PARAMS-response">
 <input onclick="manageChecklistQuestionCommentByName(this.value,&quot;[no][notsure][notapplicable]&quot;,&quot;questions[thisuser][SET_SCNR_PARAMS][comment]&quot;);" class="question-options form-radio" type="radio" id="edit-questions-thisuser-set-scnr-params-response-yes" name="questions[thisuser][SET_SCNR_PARAMS][response]" value="yes" />  <label class="option" for="edit-questions-thisuser-set-scnr-params-response-yes">Yes </label>

</div>
<div class="form-item form-type-radio form-item-questions-thisuser-SET-SCNR-PARAMS-response">
 <input onclick="manageChecklistQuestionCommentByName(this.value,&quot;[no][notsure][notapplicable]&quot;,&quot;questions[thisuser][SET_SCNR_PARAMS][comment]&quot;);" class="question-options form-radio" type="radio" id="edit-questions-thisuser-set-scnr-params-response-no" name="questions[thisuser][SET_SCNR_PARAMS][response]" value="no" />  <label class="option" for="edit-questions-thisuser-set-scnr-params-response-no">No </label>

</div>
<div class="form-item form-type-radio form-item-questions-thisuser-SET-SCNR-PARAMS-response">
 <input onclick="manageChecklistQuestionCommentByName(this.value,&quot;[no][notsure][notapplicable]&quot;,&quot;questions[thisuser][SET_SCNR_PARAMS][comment]&quot;);" class="question-options form-radio" type="radio" id="edit-questions-thisuser-set-scnr-params-response-notsure" name="questions[thisuser][SET_SCNR_PARAMS][response]" value="notsure" />  <label class="option" for="edit-questions-thisuser-set-scnr-params-response-notsure">Not Sure </label>

</div>
<div class="form-item form-type-radio form-item-questions-thisuser-SET-SCNR-PARAMS-response">
 <input onclick="manageChecklistQuestionCommentByName(this.value,&quot;[no][notsure][notapplicable]&quot;,&quot;questions[thisuser][SET_SCNR_PARAMS][comment]&quot;);" class="question-options form-radio" type="radio" id="edit-questions-thisuser-set-scnr-params-response-notapplicable" name="questions[thisuser][SET_SCNR_PARAMS][response]" value="notapplicable" />  <label class="option" for="edit-questions-thisuser-set-scnr-params-response-notapplicable">Not Applicable </label>

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

<div class="question">Correct scanner parameters?</div>
<div name="questions[thisuser][SET_SCNR_PARAMS][comment]-wrapper" class="comment-wrapper" style="display:none" ><div class="form-item form-type-textarea form-item-questions-thisuser-SET-SCNR-PARAMS-comment">
  <label for="edit-questions-thisuser-set-scnr-params-comment"><span class="raptor-active-field">Explain why you cannot confirm the scanner parameters are correct for this procedure.</span> </label>
 <div class="form-textarea-wrapper resizable"><textarea id="edit-questions-thisuser-set-scnr-params-comment" name="questions[thisuser][SET_SCNR_PARAMS][comment]" cols="60" rows="5" class="form-textarea"></textarea></div>
</div>

</div> <!-- End of questions[thisuser][SET_SCNR_PARAMS][comment]-wrapper -->
</div></div><!-- end of safety checklist for modality=[CT] of protocol=[RPID31] --></div></fieldset>

</section>

<section class='page-action'>
<div class="form-action form-wrapper" id="edit-page-action-buttons-area"><input title="Acknowledge the presented protocol so the exam can begin." class="state-completed form-submit" type="submit" id="edit-acknowledge-button" name="op" value="Acknowledge Protocol" /><input title="Mark workflow as finished and commit the details to VistA" class="commit-to-vista form-submit" type="submit" id="edit-finish-ap-button-and-commit" name="op" value="Acknowledge Protocol and Commit Details to VistA" /><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 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" /><input title="Save this order as unapproved so protocol items can be edited." type="submit" id="edit-unapprove-button" name="op" value="Unapprove" class="form-submit" /><br><br><br><!-- Bottom gap --></div>
</section>
<input type="hidden" name="form_build_id" value="form-x-GFAO5taP85sV1ikGCeylyRKMhG8Y1JQjZNAPBXiYc" />
<input type="hidden" name="form_token" value="hDmHmMBbVj17Y3PXx9y3q2WO7xGyy0Nul2EyRyXEW2Y" />
<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, Aspirin, 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>
                                              </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>
                                          </tbody>
                  </table>
                  <a class="back-to-protocol-tab-link" style="cursor:pointer; color: blue;">Back to Protocol</a>
                </section> 
                  <!-- end of Readonly -->
                  
                </div>
              </li>

            <li>
              <input type="radio" name="tabs" id="tab4" accesskey="a">
              <label for="tab4">Allergies</label>
              <div id="tab-content4" class="tab-content animated fadeIn">

                <!-- Readonly -->
                <section class="read-only2">
                  <table class="dataTable allergies-tab-table">
                    <thead>
                      <tr>
                        <th>Date Reported</th>
                        <th>Item</th>
                        <th>Causative Agent</th>
                        <th>Signs/Symptoms</th>
                        <th>Observed/Historical</th>                        
                      </tr>
                    </thead>
                    <tbody>
                                          </tbody>
                  </table>
                  <a class="back-to-protocol-tab-link" style="cursor:pointer; color: blue;">Back to Protocol</a>
                </section> 
                <!-- end of Readonly -->

                </div>
              </li>

              <li>
                <input type="radio" name="tabs" id="tab5" accesskey="l">
                <label for="tab5">Labs</label>
                <div id="tab-content5" class="tab-content animated fadeIn">

                  <!-- Readonly -->
                  <section class="read-only2">

                    <div id="labs-chart"></div>

                  <table class="dataTable labs-tab-table">
                    <thead>
                      <tr>
                        <th>Date</th>
                        <th>Creatinine</th>
                        <th>eGFR</th>
                        <th>Ref</th>
                      </tr>
                    </thead>
                    <tbody>
                                          </tbody>
                  </table>
					
                    <a class="back-to-protocol-tab-link" style="cursor:pointer; color: blue;">Back to Protocol</a>		
                  </section> 
                  <!-- end of Readonly -->
                  
                </div>
              </li>

              <li>
                <input type="radio" name="tabs" id="tab6" accesskey="h">
                <label for="tab6">Rad Watch</label>
                <div id="tab-content6" class="tab-content animated fadeIn">
                  <!-- Readonly -->
                  <section class="read-only2" data-url="http://192.168.1.159/RSite500/raptor/getradiationdosehxtab">
                      
                  </section> 
                  <!-- end of Readonly -->
                  <section>
                      <a class="back-to-protocol-tab-link" style="cursor:pointer; color: blue;">Back to Protocol</a>
                  </section>
                  
                </div>
              </li>

              <li>
                <input type="radio" name="tabs" id="tab7" accesskey="c">
                <label for="tab7">Clin rpts</label>
                <div id="tab-content7" class="tab-content animated fadeIn">

                  <!-- Readonly -->
                  <section class="read-only2">
                    <!-- <h3>Medications Page</h3>
                    <p>Content goes here...</p> -->
                    <h3>Pathology Reports</h3>
                    <table class="dataTable clinical-reports-tab-table-pathologly">
                      <thead>
                        <tr>
                          <th>Title</th>
                          <th>Date</th>
                          <th>Details</th>
                        </tr>
                      </thead>
                      <tbody>
                                              </tbody>
                    </table>
                    <h3>Surgery Reports</h3>
                    <table class="dataTable clinical-reports-tab-table-surgery">
                      <thead>
                        <tr>
                          <th>Title</th>
                          <th>Date</th>
                          <th>Details</th>
                        </tr>
                      </thead>
                      <tbody>
                                              </tbody>
                    </table>
                    <a class="back-to-protocol-tab-link" style="cursor:pointer; color: blue;">Back to Protocol</a>
                  </section> 
                  <!-- end of Readonly -->

                </div>
              </li>

              <li>
                <input type="radio" name="tabs" id="tab8" accesskey="o">
                <label for="tab8">Problem List</label>
                <div id="tab-content8" class="tab-content animated fadeIn">

                 <!-- Readonly -->
                  <section class="read-only2">
                    <!-- <h3>Medications Page</h3>
                    <p>Content goes here...</p> -->
                    <table class="dataTable problem-list-tab-table">
                      <thead>
                        <tr>
                          <th>Title</th>
                          <th>Onset Date</th>
                          <th>Details</th>
                        </tr>
                      </thead>
                      <tbody>
                                                <tr>
                          <td>Traumatic brain injury with moderate loss of consciousness (SCT 127300000) (ICD-10-CM R69.)</td>
                          <td></td>
                          <td><a href="#" class="raptor-details">10/01/2014</a><div class="hide"><dl><dt>Type of Note:</dt><dd>Problem</dd><dt>Provider Narrative:</dt><dd>Traumatic brain injury with moderate loss of consciousness (SCT 127300000) (ICD-10-CM R69.)</dd><dt>Note Narrative:</dt><dd>10/01/2014</dd><dt>Status:</dt><dd>A</dd><dt>Observer:</dt><dd></dd><dt>Comment:</dt><dd>11/21/2014</dd><dt>Facility:</dt><dd>CAMP MASTER;500</dd></dl></div></td>
                        </tr>
                                              </tbody>
                    </table>
                    <a class="back-to-protocol-tab-link" style="cursor:pointer; color: blue;">Back to Protocol</a>
                  </section> 
                  <!-- end of Readonly -->

                </div>
              </li>

              <li>
                <input type="radio" name="tabs" id="tab9" accesskey="n">
                <label for="tab9">Notes</label>
                <div id="tab-content9" class="tab-content animated fadeIn">
                  <!-- Readonly -->
                  <section class="read-only2" data-url="http://192.168.1.159/RSite500/raptor/getnotestab">
          
                  </section> 
                  <!-- end of Readonly -->
                  <section class="read-only3">
                      <a class="back-to-protocol-tab-link" style="cursor:pointer; color: blue;">Back to Protocol</a>
                  </section>
                </div>
              </li>

              <li>
                <input type="radio" name="tabs" id="tab10" accesskey="r">
                <label for="tab10">Rad rpts</label>
                <div id="tab-content10" class="tab-content animated fadeIn">
                  <iframe id="iframe_a" style="display:none;" name="iframe_a" width="100%" height="600px" ></iframe>

                  <!-- Readonly -->
                  <section class="read-only2" data-url="http://192.168.1.159/RSite500/raptor/getradrptstab">
                  </section> 
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