document.write("<script language=\"javascript\" type=\"text/javascript\" src=\"http://www.gbdbk.com/statics/js/dialog.js\"></script><link href=\"http://www.gbdbk.com/statics/css/table_form.css\" rel=\"stylesheet\" type=\"text/css\" /><link href=\"http://www.gbdbk.com/statics/css/dialog.css\" rel=\"stylesheet\" type=\"text/css\" /><script type=\"text/javascript\" src=\"http://www.gbdbk.com/statics/js/dialog.js\"></script><div class=\"box\">    <div class=\"content\"><form method=\"post\" action=\"http://www.gbdbk.com/index.php?m=formguide&c=index&a=show&formid=12&siteid=1\" name=\"myform\" id=\"myform\"><table class=\"table_form\" width=\"100%\" cellspacing=\"0\"><tbody> <tr>      <th> <font color=\"red\">*</font> 患者姓名  </th>      <td><input type=\"text\" name=\"info[lxr]\" id=\"lxr\" size=\"30\" value=\"\"  class=\"input-text\"  >  </td>    </tr><tr>      <th> <font color=\"red\">*</font> 性别  </th>      <td><label class=\"ib\" style=\"width:80px\"><input type=\"radio\" name=\'info[sex]\' id=\"sex_male\"  value=\"male\"> 男</label><label class=\"ib\" style=\"width:80px\"><input type=\"radio\" name=\'info[sex]\' id=\"sex_female\"  value=\"female\"> 女</label>  </td>    </tr><tr>      <th> <font color=\"red\">*</font> 年龄  </th>      <td><input type=\'text\' name=\'info[age]\' id=\'age\' value=\'\' size=\'30\'  class=\'input-text\'  >  </td>    </tr><tr>      <th> <font color=\"red\">*</font> 联系电话  </th>      <td><input type=\"text\" name=\"info[yyphone]\" id=\"yyphone\" size=\"30\" value=\"\"  class=\"input-text\"  >  </td>    </tr><tr>      <th> <font color=\"red\">*</font> 预约科室  </th>      <td><select name=\'info[yyks]\' id=\'yyks\'><option value=\"\" selected> </option><option value=\"xnk\" >心内科</option><option value=\"snk\" >肾内科</option><option value=\"xhnk\" >消化内科</option><option value=\"sjnk\" >神经内科</option><option value=\"hxnk\" >呼吸内科</option><option value=\"pwk\" >普外科</option><option value=\"gk\" >骨科</option><option value=\"ttk\" >疼痛科</option><option value=\"pfk\" >皮肤科</option><option value=\"fk\" >妇科</option><option value=\"ck\" >产科</option><option value=\"byk\" >不孕科</option><option value=\"fsk\" >放射科</option><option value=\"CT\" >CT室</option><option value=\"jyk\" >检验科</option><option value=\"ccs\" >彩超室</option><option value=\"xdts\" >心电图室</option><option value=\"gys\" >供应室</option><option value=\"bas\" >病案室</option><option value=\"yjk\" >药剂科</option><option value=\"sss\" >手术室</option><option value=\"kqk\" >口腔科</option><option value=\"ssk\" >碎石科</option><option value=\"zyk\" >中医科</option><option value=\"kfk\" >康复科</option><option value=\"ebhk\" >耳鼻喉科</option><option value=\"jzk\" >急诊科</option><option value=\"tjk\" >体检科</option><option value=\"zzyxk\" >重症医学科</option><option value=\"xytx\" >血液透析</option></select>  </td>    </tr><tr>      <th> <font color=\"red\">*</font> 挂号时间  </th>      <td><link rel=\"stylesheet\" type=\"text/css\" href=\"http://www.gbdbk.com/statics/js/calendar/jscal2.css\"/><link rel=\"stylesheet\" type=\"text/css\" href=\"http://www.gbdbk.com/statics/js/calendar/border-radius.css\"/><link rel=\"stylesheet\" type=\"text/css\" href=\"http://www.gbdbk.com/statics/js/calendar/win2k.css\"/><script type=\"text/javascript\" src=\"http://www.gbdbk.com/statics/js/calendar/calendar.js\"></script><script type=\"text/javascript\" src=\"http://www.gbdbk.com/statics/js/calendar/lang/en.js\"></script><input type=\"text\" name=\"info[yytime]\" id=\"yytime\" value=\"\" size=\"10\" class=\"date\" readonly>&nbsp;<script type=\"text/javascript\">Calendar.setup({weekNumbers: true,    inputField : \"yytime\",    trigger    : \"yytime\",    dateFormat: \"%Y-%m-%d\",    showTime: false,    minuteStep: 1,    onSelect   : function() {this.hide();}});        </script>  </td>    </tr><tr>      <th> <font color=\"red\">*</font> 病情描述  </th>      <td><textarea name=\'info[des]\' id=\'des\' style=\'width:319%;height:90px;\'   ></textarea>  </td>    </tr><tr><td></td><td><div class=\"submit ib\"><input type=\"submit\" name=\"dosubmit\" id=\"dosubmit\" value=\" 提交 \"></div> </td></tr></tbody></table></form>    </div></div>");