Form:DrugProjectForm: Difference between revisions

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Christopher Popma (talk | contribs)
Bureaucrats, exportpages, nocaptcha, Administrators
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Christopher Popma (talk | contribs)
Bureaucrats, exportpages, nocaptcha, Administrators
2,750 edits
No edit summary
Line 217: Line 217:
|{{{field|packLabel|input type=textarea|size=35|editor}}}
|{{{field|packLabel|input type=textarea|size=35|editor}}}
|}
|}
=Pill Characteristics=
{{{field|imageFreeText|input type=textarea|size=35|editor}}}
Is the the drug provided in pill form?
{{{field|isPill|input type=dropdown|values=Yes}}}
Dosage:  {{{field|dosageValue|input type=text|size=40}}} {{{field|dosageUnit| input type=dropdown|values=ug,mg,g,kg,,uL,mL (cc),dL,L,,gtt(s),AU,IU,umol,mmol,U}}}
If the dosage does not fit the above format, you may enter it here: {{{field|dosageFreeText|input type=text|size=40}}}
----
Please enter the following pill characteristics as provided by the FDA:
Pill Imprint:
{{{field|pillImprint|input type=text|size=40}}}
Pill Size (in mm):
{{{field|pillSize|input type=text|size=40}}}
Pill Shape:
{{{field|pillShape|input type=dropdrown|values=Round,Oval,Square,Rectangular,Triangular,Capsule,Pentagon,Hexagon,Diamond,Gear,DoubleCircle,Clover,TearDrop,Octagon,SemiCircle,Bullet,Trapezoid,FreeForm}}}
Pill Color:
{{{field|pillColor|input type=dropdown|values=Brown,Red,Orange,Yellow,Green,Turquoise,Blue,Purple,Pink,Black,Grey,White}}}
Pill Scoring:
{{{field|pillScoring|input type=dropdown|values=1,2,3,4,5,6,7,8,9,10}}}
Please provide to the static link to the drug image you previously uploaded. {{{field|pillImage|input type=text|size=40}}}
The URL should be similar to the following example:
Static URL: <pre>http://static.wikidoc.org/0/0e/No_image.jpg</pre>


=Patient Information=
=Patient Information=
Line 290: Line 252:
{{{for template|PillImage||multiple|add button text=Add Another Image}}}
{{{for template|PillImage||multiple|add button text=Add Another Image}}}


Please Enter the Name of the pill here: {{{field|filename|input text|size=40|uploadable}}}
Please Enter the Name of the pill here: {{{field|fileName|input type=text|size=40|uploadable}}}
 
Please Enter the Name of the Drug here: {{{field|drugName|input type=text|size=40}}}
 
Please Enter the NDC: {{{field|NDC|input type=text|size=40}}}
 
Please Enter the Author of the Drug Label: {{{field|drugAuthor|input type=text|size=40}}}
 
Please Enter all Listed Ingredients separated by a comma: {{{field|ingredients|input type=textbox|size=35|editor}}}
 
Pill Imprint:
{{{field|pillImprint|input type=text|size=40}}}
 
Dosage:  {{{field|dosageValue|input type=text|size=40}}} {{{field|dosageUnit| input type=dropdown|values=ug,mg,g,kg,,uL,mL (cc),dL,L,,gtt(s),AU,IU,umol,mmol,U}}}
 
If the dosage does not fit the above format, you may enter it here: {{{field|dosageFreeText|input type=text|size=40}}}
 
Pill Color:
{{{field|pillColor|input type=dropdown|values=Brown,Red,Orange,Yellow,Green,Turquoise,Blue,Purple,Pink,Black,Grey,White}}}
 
Pill Shape:
{{{field|pillShape|input type=dropdrown|values=Round,Oval,Square,Rectangular,Triangular,Capsule,Pentagon,Hexagon,Diamond,Gear,DoubleCircle,Clover,TearDrop,Octagon,SemiCircle,Bullet,Trapezoid,FreeForm}}}
 
 
Pill Size (in mm):
{{{field|pillSize|input type=text|size=40}}}
 
Pill Scoring:
{{{field|pillScoring|input type=dropdown|values=1,2,3,4,5,6,7,8,9,10}}}
 
}}
 


{{{end template}}}
{{{end template}}}
<headertabs />{{{standard input|save}}} {{{standard input|preview}}} {{{standard input|changes}}} {{{standard input|cancel}}}
<headertabs />{{{standard input|save}}} {{{standard input|preview}}} {{{standard input|changes}}} {{{standard input|cancel}}}
</includeonly>
</includeonly>

Revision as of 19:51, 4 April 2014


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