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PDF formatting incorrect

Last post 11-13-2012, 10:18 AM by MDECK. 3 replies.


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10-18-2012, 7:59 AM 75016

MDECK
Joined on 10-18-2012
Posts 3

PDF formatting incorrect

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I bought the control, but am having a problem with the PDF conversion specifically the formatting

here are some screenshots...Design in editor, no problems Print out is fine

However when calling the savePDF, The output does not show the controls correctly

Filed under: PDF

10-18-2012, 8:03 AM 75017 in reply to 75016

MDECK
Joined on 10-18-2012
Posts 3

Re: PDF formatting incorrect

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the print out image is at

www.curam.me/images/printout1.jpg

and the editor image is at

http://curam.me/images/editor1.jpg

I am under a tight deadline, Thanks!

10-19-2012, 7:24 AM 75034 in reply to 75017

Kenneth
Joined on 02-13-2008
Posts 3,886

Re: PDF formatting incorrect

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Hi MDECK,

Can you show me the full steps to reproduce this issue on http://cutesoft.net/example/createPDF.aspx?

Regards,

Ken

11-13-2012, 10:18 AM 75239 in reply to 75034

MDECK
Joined on 10-18-2012
Posts 3

Re: PDF formatting incorrect

Reply Quote

#1 Clear the HTML code from the editor on the webpage

#2 Paste in the HTML code from form:

<div style="text-align: center;"><strong style="font-size: 18pt;">SKILLED NURSING PROGRESS NOTE</strong></div> <hr /> <div></div> </div> <div><fieldset><legend title="VITAL SIGNS"><span style="color: #ff0000; font-size: 14pt;">VITAL SIGNS</span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>Temp:<input runat="server" id="TempTEXT" value="" value="" value="" name="TempTEXT" type="text" /></td>               <td>BP:<input runat="server" id="BPTEXT" value="" value="" value="" name="BPTEXT" type="text" /></td>           </tr>       </tbody>       <tbody>           <tr>               <td>PR:<input runat="server" id="PRTEXT" value="" value="" value="" name="PRTEXT" type="text" /></td>               <td>RR:<input runat="server" id="RRTEXT" value="" value="" value="" name="RRTEXT" type="text" /></td>           </tr>       </tbody>       <tbody>           <tr>               <t
d>WT:<input runat="server" id="WTTEXT" value="" value="" value="" name="WTTEXT" type="text" /></td>               <td>Pulse OX:<input runat="server" id="PulseOXTEXT" value="" value="" value="" name="PulseOXTEXT" type="text" /></td>           </tr>       </tbody>       <tbody>           <tr>               <td>RBS:<input runat="server" id="RBSTEXT" value="" value="" value="" name="RBSTEXT" type="text" /></td>               <td>Time:<input runat="server" id="RBSTimeTEXT" value="" value="" value="" name="RBSTimeTEXT" type="text" /></td>           </tr>       </tbody>       <tbody>           <tr>               <td>FBS:<input runat="server" id="FBSTEXT" value="" value="" value="" name="FBSTEXT" type="text" /></td>               <td>Time:<input runat="server" id="FBSTimeTEXT" value="" value="" value="" name="FBSTimeTEXT" type="text" /></td>           </tr>       </tbody>       <tbody>           <tr>               <td> <span><input runat="server" id="GlucometerteCHECKBOXst" name="GlucometertestCHECKBOX" value="ch
eckBox5" type="checkbox" />Glucometer Test Completed Today</span></td>               <td> <span><input runat="server" id="patAlertOrientedCHECKBOX" name="patAlertOrientedCHECKBOX" value="checkBox5" type="checkbox" />Patient Alert and Oriented</span></td>           </tr>       </tbody> </table> </fieldset> </div> <div><fieldset><legend title=""><span style="color: #ff0000; font-size: 14pt;"></span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>               Pain:<select name="PainDROPDOWN" size="0" runat="server" id="PainDROPDOWN">               <option selected=""></option>               <option value="0">0</option>               <option value="1">1</option>               <option value="2">2</option>               <option value="3">3</option>               <option value="4">4</option>               <option value="5">5</option>               <option value="6">6</o
ption>               <option value="7">7</option>               <option value="8">8</option>               <option value="9">9</option>               <option value="10">10</option>               </select>(0-No Pain, 10 Severe pain) </td> <td> Location:<textarea cols="60" rows="4" name="LocationTEXT" runat="server" id="LocationTEXT" value="Location of pain revised" value="Location of pain">Location of pain</textarea> </td>           </tr>       </tbody> </table> </fieldset> <div><fieldset><legend title="NURSING ASSESSMENT OF SIGNS AND SYMPTOMS"><span style="color: #ff0000; font-size: 14pt;">NURSING ASSESSMENT OF SIGNS AND SYMPTOMS</span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td><span><input runat="server" id="problemnotedCHECKBOX" name="problemnotedCHECKBOX" value="checkBox1" type="checkbox" />Problems Noted<label for="checkBox1"></label></span></td>
<td><span><input runat="server" id="noproblemnotedCHECKBOX" name="noproblemnotedCHECKBOX" value="checkBox1" type="checkbox" />No Problems Noted<label for="checkBox1"></label></span></td>           </tr>       </tbody> </table> </fieldset> </div> <div><fieldset><legend title="Nervous System"><span style="color: #ff0000; font-size: 14pt;">NERVOUS SYSTEM</span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td> <span><input runat="server" id="HeadacheCHECKBOX" name="HeadacheCHECKBOX" value="checkBox9" type="checkbox" />Headache<br />               </span></td>               <td>  <span><input runat="server" id="SyncopeCHECKBOX" name="SyncopeCHECKBOX" value="checkBox10" type="checkbox" />Syncope</span> </td>           </tr>       </tbody>       <tbody>       </tbody>       <tbody>           <tr>               <td> Grasp:</td>               <td>  <span><input ru
nat="server" id="RtCHECKBOX" name="RtCHECKBOX" value="checkBox10" type="checkbox" />Rt</span> </td>               <td>  <span><input runat="server" id="LtCHECKBOX" name="LtCHECKBOX" value="checkBox10" type="checkbox" />Lt</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td> Movement:</td>               <td>  <span><input runat="server" id="RUECHECKBOX" name="RUECHECKBOX" value="checkBox10" type="checkbox" />RUE</span> </td>               <td>  <span><input runat="server" id="LUECHECKBOX" name="LUECHECKBOX" value="checkBox10" type="checkbox" />LUE</span> </td>               <td>  <span><input runat="server" id="RLECHECKBOX" name="RLECHECKBOX" value="checkBox10" type="checkbox" />RLE</span> </td>               <td>  <span><input runat="server" id="LLECHECKBOX" name="LLECHECKBOX" value="checkBox10" type="checkbox" />LLE</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td> Pupillary Reaction:</td>               <
td> <span><input runat="server" id="PPRCHECKBOXt" name="PPRtCHECKBOX" value="checkBox10" type="checkbox" />Rt</span> </td>               <td>  <span><input runat="server" id="PPLtCHECKBOX" name="PPLtCHECKBOX" value="checkBox10" type="checkbox" />Lt</span> </td>               <td>  <span><input runat="server" id="TremorCHECKBOX" name="TremorCHECKBOX" value="checkBox10" type="checkbox" />Tremor</span> </td>               <td>  <span><input runat="server" id="VertigoCHECKBOX" name="VertigoCHECKBOX" value="checkBox10" type="checkbox" />Vertigo</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>Sensory </td>               <td>  <span><input runat="server" id="SpeechImpairmentCHECKBOX" name="SpeechImpairmentCHECKBOX" value="checkBox10" type="checkbox" />Speech Impairment</span> </td>               <td>  <span><input runat="server" id="VisualImpairmentCHECKBOX" name="VisualImpairmentCHECKBOX" value="checkBox10" type="checkbox" />Visual Impairment</
span> </td>               <td>  <span><input runat="server" id="HearingImpairmentCHECKBOX" name="HearingImpairmenCHECKBOXt" value="checkBox10" type="checkbox" />Hearing Impairment</span> </td>               <td>  <span><input runat="server" id="TactileSenseCHECKBOX" name="TactileSenseCHECKBOX" value="checkBox10" type="checkbox" />Tactile Sense</span> </td>           </tr>       </tbody> </table> </fieldset></div> <div><fieldset><legend title="Nervous System"><span style="color: #ff0000; font-size: 14pt;">GENITO URINARY</span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>  <span><input runat="server" id="BurningCHECKBOX" name="BurningCHECKBOX" value="checkBox10" type="checkbox" />Burning</span> </td>               <td>  <span><input runat="server" id="DistentionCHECKBOX" name="DistentionCHECKBOX" value="checkBox10" type="checkbox" />Distention/Retent
ion</span> </td>               <td>  <span><input runat="server" id="FrequencyCHECKBOX" name="FrequencyCHECKBOX" value="checkBox10" type="checkbox" />Frequency/Urgency</span> </td>               <td>  <span><input runat="server" id="BladderCHECKBOX" name="BladderCHECKBOX" value="checkBox10" type="checkbox" />Bladder Incontinence</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>  <span><input runat="server" id="CatheterCHECKBOX" name="CatheterCHECKBOX" value="checkBox10" type="checkbox" />Catheter</span>               <select name="catheterDROPDOWN" size="0" runat="server" id="catheterDROPDOWN">               <option selected=""></option>               <option value="Foley">Foley</option>               <option value="Suprapubic">Suprapubic</option>               <option value="Condom">Condom</option>               </select> </td>               <td>  <span><input runat="server" id="PainCHECKBOX" name="PainCHECKBOX" value="checkBox10" type="checkbox" /
>Pain</span>               </td>               <td>  <span><input runat="server" id="HesitancyCHECKBOX" name="HesitancyCHECKBOX" value="checkBox10" type="checkbox" />Hesitancy</span>               </td>               <td>  <span><input runat="server" id="HematuriaCHECKBOX" name="HematuriaCHECKBOX" value="checkBox10" type="checkbox" />Hematuria</span>               </td>           </tr>       </tbody>       <tbody>           <tr>               <td>  <span><input runat="server" id="UrineColorCHECKBOX" name="UrineColorCHECKBOX" value="checkBox10" type="checkbox" />Urine Color</span> </td>               <td>  <span><input runat="server" id="UrineSedimentCHECKBOX" name="UrineSedimentCHECKBOX" value="checkBox10" type="checkbox" />Urine Sediment</span> </td>               <td>  <span><input runat="server" id="UrineOdorCHECKBOX" name="UrineOdorCHECKBOX" value="checkBox10" type="checkbox" />Urine Odor</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>Mus
culo/Skeletal</td>               <td>  <span><input runat="server" id="BalUnsteadygaitCHECKBOX" name="BalUnsteadygaitCHECKBOX" value="checkBox10" type="checkbox" />Bal/Unsteady gait</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>Weakness</td>               <td>  <span><input runat="server" id="WeaknessRtCHECKBOX" name="WeaknessRtCHECKBOX" value="checkBox10" type="checkbox" />Rt</span> </td>               <td>  <span><input runat="server" id="WeaknessLtCHECKBOX" name="WeaknessLtCHECKBOX" value="checkBox10" type="checkbox" />Lt</span> </td>               <td>  <span><input runat="server" id="WeaknessMobilityCHECKBOX" name="WeaknessMobilityCHECKBOX" value="checkBox10" type="checkbox" />Mobility</span> </td>           </tr>       </tbody> </table> </fieldset></div> <div><fieldset><legend title="CARDIOPULMONARY"><span style="color: #ff0000; font-size: 14pt;">CARDIOPULMONARY</span></legend> <table style="width: 902px; height: 48px;" align="center" b
order="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td> <span><input runat="server" id="ChestPainCHECKBOX" name="ChestPainCHECKBOX" value="checkBox10" type="checkbox" />Chest Pain</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>Edema</td>               <td>               <select name="edemaRUEDROPDOWN" size="0" runat="server" id="edemaRUEDROPDOWN">               <option selected=""></option>               <option value="T">T</option>               <option value="1">1+</option>               <option value="2">2+</option>               <option value="3">3+</option>               <option value="4">4+</option>               </select>RUE </td>               <td>               <select name="edemaLUEDROPDOWN" size="0" runat="server" id="edemaLUEDROPDOWN">               <option selected=""></option>               <option value="T">T</option>               <option value="1">1+</option>               <option val
ue="2">2+</option>               <option value="3">3+</option>               <option value="4">4+</option>               </select>LUE </td>           </tr>       </tbody>       <tbody>           <tr>               <td><br />               </td>               <td><select name="edemaRLEDROPDOWN" size="0" runat="server" id="edemaRLEDROPDOWN">               <option selected=""></option>               <option value="T">T</option>               <option value="1">1+</option>               <option value="2">2+</option>               <option value="3">3+</option>               <option value="4">4+</option>               </select>RLE </td>               <td> <select name="edemaLLEDROPDOWN" size="0" runat="server" id="edemaLLEDROPDOWN">               <option selected=""></option>               <option value="T">T</option>               <option value="1">1+</option>               <option value="2">2+</option>               <option value="3">3+</option>               <option value="4">4+</option>               </select>LLE
</td>           </tr>       </tbody>       <tbody>           <tr>               <td>  <span><input runat="server" id="DizzinessCHECKBOX" name="DizzinessCHECKBOX" value="checkBox10" type="checkbox" />Dizziness</span> </td>               <td>  <span><input runat="server" id="ArrythmiaCHECKBOX" name="ArrythmiaCHECKBOX" value="checkBox10" type="checkbox" />Arrythmia</span> </td>               <td>  <span><input runat="server" id="NeckVeinDistentionCHECKBOX" name="NeckVeinDistentionCHECKBOX" value="checkBox10" type="checkbox" />Neck Vein Distention</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>Peripheral Pulses</td>               <td>  <span><input runat="server" id="PeripheralPulsesRtCHECKBOX" name="PeripheralPulsesRtCHECKBOX" value="checkBox10" type="checkbox" />Rt</span> </td>               <td>  <span><input runat="server" id="PeripheralPulsesLtCHECKBOX" name="PeripheralPulsesLtCHECKBOX" value="checkBox10" type="checkbox" />Lt</span>
       <select name="edemaLLEDROPDOWN" size="0" runat="server" id="edemaLLEDROPDOWN">               <option selected=""></option>               <option value="Pedal">Pedal</option>               <option value="Poplateal">Poplateal</option>               </select></td>           </tr>       </tbody>       <tbody>           <tr>               <td>Respiratory:</td>           </tr>       </tbody>       <tbody>           <tr>               <td>  <span><input runat="server" id="RalesRhonchiWheezesCHECKBOX" name="RalesRhonchiWheezesCHECKBOX" value="checkBox10" type="checkbox" />Rales/Rhonchi/Wheezes</span> </td>               <td>  <span><input runat="server" id="CoughCHECKBOX" name="CougCHECKBOXh" value="checkBox10" type="checkbox" />Cough</span> </td>               <td>  <span><input runat="server" id="DyspneaSOBCHECKBOX" name="DyspneaSOBCHECKBOX" value="checkBox10" type="checkbox" />Dyspnea/SOB</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>  <span><i
nput runat="server" id="OrthopneaCHECKBOX" name="OrthopneaCHECKBOX" value="checkBox10" type="checkbox" />Orthopnea</span> </td>               <td>  <span><input runat="server" id="DiminishedBSCHECKBOX" name="DiminishedBSCHECKBOX" value="checkBox10" type="checkbox" />Diminished BS</span> </td>           </tr>       </tbody> </table> </fieldset></div> <div><fieldset><legend title="SKIN/INTEGUMENTARY"><span style="color: #ff0000; font-size: 14pt;">SKIN/INTEGUMENTARY</span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>  <span><input runat="server" id="ClammyCHECKBOX" name="ClammyCHECKBOX" value="checkBox10" type="checkbox" />Clammy</span> </td>               <td>  <span><input runat="server" id="JaundiceCHECKBOX" name="JaundiceCHECKBOX" value="checkBox10" type="checkbox" />Jaundice</span> </td>               <td>  <span><input runat="server" id="PallorC
HECKBOX" name="PallorCHECKBOX" value="checkBox10" type="checkbox" />Pallor</span> </td>               <td>  <span><input runat="server" id="TurgorCHECKBOX" name="TurgorCHECKBOX" value="checkBox10" type="checkbox" />Turgor</span> </td>               <td>  <span><input runat="server" id="RashCHECKBOX" name="RashCHECKBOX" value="checkBox10" type="checkbox" />Rash</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>  <span><input runat="server" id="DrynessCHECKBOX" name="DrynessCHECKBOX" value="checkBox10" type="checkbox" />Dryness</span> </td>               <td>  <span><input runat="server" id="ShinglesLesionsCHECKBOX" name="ShinglesLesionsCHECKBOX" value="checkBox10" type="checkbox" />Shingles Lesions</span> </td>               <td>  <span><input runat="server" id="SurgicalWoundCHECKBOX" name="SurgicalWoundCHECKBOX" value="checkBox10" type="checkbox" />Surgical Wound</span> </td>               <td>  <span><input runat="server" id="PressureSores
CHECKBOX" name="PressureSoresCHECKBOX" value="checkBox10" type="checkbox" />Pressure Sores</span> </td>               <td>  <span><input runat="server" id="DiabeticUlcerCHECKBOX" name="DiabeticUlcerCHECKBOX" value="checkBox10" type="checkbox" />Diabetic Ulcer</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>  <span><input runat="server" id="RecentSkinGraftCHECKBOX" name="RecentSkinGraftCHECKBOX" value="checkBox10" type="checkbox" />Recent Skin Graft</span> </td>               <td>  <span><input runat="server" id="FungalInfectionCHECKBOX" name="FungalInfectionCHECKBOX" value="checkBox10" type="checkbox" />Fungal Infection</span> </td>               <td>  <span><input runat="server" id="OtherWoundCHECKBOX" name="OtherWoundCHECKBOX" value="checkBox10" type="checkbox" />Other Wound</span> </td>           </tr>       </tbody> </table> </fieldset></div> <div><fieldset><legend title="DIGESTIVE"><span style="color: #ff0000; font-size: 14pt;">DIGESTIVE</s
pan></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>  <span><input runat="server" id="NauseaVomitingCHECKBOX" name="NauseaVomitingCHECKBOX" value="checkBox10" type="checkbox" />Nausea/Vomiting</span> </td>               <td>  <span><input runat="server" id="AnorexiaCHECKBOX" name="AnorexiaCHECKBOX" value="checkBox10" type="checkbox" />Anorexia</span> </td>               <td>  <span><input runat="server" id="EpigastricDistressCHECKBOX" name="EpigastricDistressCHECKBOX" value="checkBox10" type="checkbox" />Epigastric Distress</span> </td>               <td>  <span><input runat="server" id="DiffSwallowingCHECKBOX" name="DiffSwallowingCHECKBOX" value="checkBox10" type="checkbox" />Diff. Swallowing</span> </td>               <td>  <span><input runat="server" id="DiarrheaCHECKBOX" name="DiarrheaCHECKBOX" value="checkBox10" type="checkbox" />Diarrhea</span
> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>  <span><input runat="server" id="ConstipImpactionCHECKBOX" name="ConstipImpactionCHECKBOX" value="checkBox10" type="checkbox" />Constip/Impaction</span> </td>               <td>  <span><input runat="server" id="BowelIncontinenceCHECKBOX" name="BowelIncontinenceCHECKBOX" value="checkBox10" type="checkbox" />Bowel Incontinence</span> </td>               <td>  <span><input runat="server" id="ColostomyCHECKBOX" name="ColostomyCHECKBOX" value="checkBox10" type="checkbox" />Colostomy</span> </td>               <td>  <span><input runat="server" id="PegTubeCHECKBOX" name="PegTubeCHECKBOX" value="checkBox10" type="checkbox" />Peg Tube</span> </td>               <td>  <span><input runat="server" id="AbsentBowelSoundsCHECKBOX" name="AbsentBowelSoundsCHECKBOX" value="checkBox10" type="checkbox" />Absent Bowel Sounds</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>Emotio
nal/Mental:</td>           </tr>       </tbody>       <tbody>           <tr>               <td>  <span><input runat="server" id="AnxiousCHECKBOX" name="AnxiousCHECKBOX" value="checkBox10" type="checkbox" />Anxious</span> </td>               <td>  <span><input runat="server" id="DisorientedCHECKBOX" name="DisorientedCHECKBOX" value="checkBox10" type="checkbox" />Disoriented</span> </td>               <td>  <span><input runat="server" id="ForgetfulCHECKBOX" name="ForgetfulCHECKBOX" value="checkBox10" type="checkbox" />Forgetful</span> </td>               <td>  <span><input runat="server" id="DepressedCHECKBOX" name="DepressedCHECKBOX" value="checkBox10" type="checkbox" />Depressed</span> </td>               <td>  <span><input runat="server" id="LethargicCHECKBOX" name="LethargicCHECKBOX" value="checkBox10" type="checkbox" />Lethargic</span> </td>           </tr>       </tbody> </table> </fieldset></div> <div><fieldset><legend title="INTERVENTIONS/INSTRUCTIONS (Skilled Services Rendere
d):"><span style="color: #ff0000; font-size: 14pt;">INTERVENTIONS/INSTRUCTIONS (Skilled Services Rendered):</span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>  <span><input runat="server" id="SkilledObservationCHECKBOX" name="SkilledObservationCHECKBOX" value="checkBox10" type="checkbox" />Skilled Observation</span> </td>               <td>  <span><input runat="server" id="O2SafetyCHECKBOX" name="O2SafetyCHECKBOX" value="checkBox10" type="checkbox" />O2 Safety</span> </td>               <td>  <span><input runat="server" id="FingerstickBloodSugarCHECKBOX" name="FingerstickBloodSugarCHECKBOX" value="checkBox10" type="checkbox" />Prep/Adm. Insulin</span> </td>               <td>  <span><input runat="server" id="DepressedCHECKBOX" name="DepressedCHECKBOX" value="checkBox10" type="checkbox" />Fingerstick Blood Sugar</span> </td>           </tr>       </tb
ody>       <tbody>           <tr>               <td>  <span><input runat="server" id="BowelBladderTrainingCHECKBOX" name="BowelBladderTrainingCHECKBOX" value="checkBox10" type="checkbox" />Bowel/Bladder Training</span> </td>               <td>  <span><input runat="server" id="FoleyCareInsertionCHECKBOX" name="FoleyCareInsertionCHECKBOX" value="checkBox10" type="checkbox" />Foley Care/Insertion</span> </td>               <td>  <span><input runat="server" id="EvalADLsCHECKBOX" name="EvalADLsCHECKBOX" value="checkBox10" type="checkbox" />Eval ADLs</span> </td>               <td>  <span><input runat="server" id="DisimpactionEnemaCHECKBOX" name="DisimpactionEnemaCHECKBOX" value="checkBox10" type="checkbox" />Disimpaction Enema</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>  <span><input runat="server" id="TeachAdmTubeFeedCHECKBOX" name="TeachAdmTubeFeedCHECKBOX" value="checkBox10" type="checkbox" />Teach/Adm Tube Feed</span> </td>               <
td>  <span><input runat="server" id="WoundCareDressingCHECKBOX" name="WoundCareDressingCHECKBOX" value="checkBox10" type="checkbox" />Wound Care/Dressing</span> </td>               <td>  <span><input runat="server" id="TeachDisProcessCHECKBOX" name="TeachDisProcessCHECKBOX" value="checkBox10" type="checkbox" />Teach Dis. Process</span> </td>               <td>  <span><input runat="server" id="PostOPCareCHECKBOX" name="PostOPCareCHECKBOX" value="checkBox10" type="checkbox" />Post OP Care</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>  <span><input runat="server" id="TeachERPlanCHECKBOX" name="TeachERPlanCHECKBOX" value="checkBox10" type="checkbox" />Teach ER Plan</span> </td>               <td>  <span><input runat="server" id="TrachCareObservationCHECKBOX" name="TrachCareObservationCHECKBOX" value="checkBox10" type="checkbox" />Trach Care/Observation</span> </td>               <td>  <span><input runat="server" id="TeachSafetyMeasuresCHEC
KBOX" name="TeachSafetyMeasuresCHECKBOX" value="checkBox10" type="checkbox" />Teach Safety Measures</span> </td>               <td>  <span><input runat="server" id="MedReconciliationCHECKBOX" name="MedReconciliationCHECKBOX" value="checkBox10" type="checkbox" />Med Reconciliation</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>  <span><input runat="server" id="VenipunctureCHECKBOX" name="VenipunctureCHECKBOX" value="checkBox10" type="checkbox" />Venipuncture</span> </td>               <td>  <span><input runat="server" id="TeachAdmINHRxCHECKBOX" name="TeachAdmINHRxCHECKBOX" value="checkBox10" type="checkbox" />Teach/Adm INH Rx</span> </td>               <td>  <span><input runat="server" id="TeachAdmIVCHECKBOX" name="TeachAdmIVCHECKBOX" value="checkBox10" type="checkbox" />Teach/Adm IV</span>               <select name="teachadminDROPDOWN" size="0" runat="server" id="teachadminDROPDOWN">               <option selected=""></option>               <opti
on value="Lovenox">Lovenox</option>               <option value="Procrit">Procrit</option>               <option value="B12">B12</option>               </select></td>               <td>  <span><input runat="server" id="TeachDietHydrationCHECKBOX" name="TeachDietHydrationCHECKBOX" value="checkBox10" type="checkbox" />Teach Diet/Hydration</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>  <span><input runat="server" id="PainAssessMgmtCHECKBOX" name="PainAssessMgmtCHECKBOX" value="checkBox10" type="checkbox" />Pain Assess/Mgmt</span> </td>               <td>  <span><input runat="server" id="FallPrecautionsCHECKBOX" name="FallPrecautionsCHECKBOX" value="checkBox10" type="checkbox" />Fall Precautions</span> </td>               <td>  <span><input runat="server" id="TeachDiabCareObservationCHECKBOX" name="TeachDiabCareObservationCHECKBOX" value="checkBox10" type="checkbox" />Teach Diab Care/Observation</span> </td>               <td>  <span><input run
at="server" id="TeachProvideOstomyCareCHECKBOX" name="TeachProvideOstomyCareCHECKBOX" value="checkBox10" type="checkbox" />Teach/Provide Ostomy Care</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>  <span><input runat="server" id="EvalTeachMedESECHECKBOX" name="EvalTeachMedESECHECKBOX" value="checkBox10" type="checkbox" />Eval/Teach Med E/SE</span> </td>               <td>  <span><input runat="server" id="ManagementEvalCHECKBOX" name="ManagementEvalCHECKBOX" value="checkBox10" type="checkbox" />Management Eval</span> </td>           </tr>       </tbody> </table> </fieldset></div> <div><fieldset><legend title=""><span style="color: #ff0000; font-size: 14pt;"></span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>  <span><input runat="server" id="OthersCHECKBOX" name="OthersCHECKBOX" value="checkBox10" type="checkbo
x" />Others</span> <textarea cols="48" rows="4" name="IntInsOtherTEXT" runat="server" id="IntInsOtherTEXT" value=",,," value=",,,">,</textarea></td>           </tr>       </tbody> </table> </fieldset></div> <div><fieldset><legend title=""><span style="color: #ff0000; font-size: 14pt;"></span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td> Subjective Data <textarea cols="48" rows="4" name="SubjectiveDataTEXT" runat="server" id="SubjectiveDataTEXT"></textarea> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>Objective Data <textarea cols="48" rows="4" name="ObjectiveDataTEXT" runat="server" id="ObjectiveDataTEXT"></textarea> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>Specific Clinical Problem <textarea cols="48" rows="4" name="SpecificClinicalProblemTEXT" runat="server" id="SpecificClinicalP
roblemTEXT"></textarea> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>Nursing Action Related to Services Provided <textarea cols="48" rows="4" name="NursingActionRelatedtoServicesProvidedTEXT" runat="server" id="NursingActionRelatedtoServicesProvidedTEXT"></textarea> </td>           </tr>       </tbody> </table> </fieldset></div> <div><fieldset><legend title="INTERVENTIONS/INSTRUCTIONS (Skilled Services Rendered):"><span style="color: #ff0000; font-size: 14pt;">INTERVENTIONS/INSTRUCTIONS (Skilled Services Rendered):</span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>  <span><input runat="server" id="RequiresassistancetoambulateCHECKBOX" name="RequiresassistancetoambulateCHECKBOX" value="checkBox10" type="checkbox" />Requires assistance to ambulate</span> </td>               <td>  <span><input runat="server" id="Unable
tosafelyleaveCHECKBOX" name="UnabletosafelyleaveCHECKBOX" value="checkBox10" type="checkbox" />Unable to safely leave the home unassisted</span> </td>               <td>  <span><input runat="server" id="SevereSOBDyspneaCHECKBOX" name="SevereSOBDyspneaCHECKBOX" value="checkBox10" type="checkbox" />Severe SOB/Dyspnea upon exertion</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>  <span><input runat="server" id="DependentuponadaptiveCHECKBOX" name="DependentuponadaptiveCHECKBOX" value="checkBox10" type="checkbox" />Dependent upon adaptive device(s)</span> </td>               <td>  <span><input runat="server" id="O2DependentCHECKBOX" name="O2DependentCHECKBOX" value="checkBox10" type="checkbox" />O2 Dependent</span> </td>               <td>  <span><input runat="server" id="NeedsassistanceCHECKBOX" name="NeedsassistanceCHECKBOX" value="checkBox10" type="checkbox" />Needs assistance for all activities/ADL</span> </td>           </tr>       </tbody>
<tbody>           <tr>               <td>  <span><input runat="server" id="MedicalrestrictionCHECKBOX" name="MedicalrestrictionCHECKBOX" value="checkBox10" type="checkbox" />Medical restriction</span> </td>               <td>  <span><input runat="server" id="ImpairedmobilityCHECKBOX" name="ImpairedmobilityCHECKBOX" value="checkBox10" type="checkbox" />Impaired mobility/Muscle weakness</span> </td>               <td>  <span><input runat="server" id="CVInstabilityCHECKBOX" name="CVInstabilityCHECKBOX" value="checkBox10" type="checkbox" />CV Instability</span> </td>           </tr>       </tbody> </table> </fieldset></div> <div><fieldset><legend title=""><span style="color: #ff0000; font-size: 14pt;"></span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>  <span><input runat="server" id="patreqothers" name="patreqothers" value="checkBox10" type="checkbo
x" />Others</span> <textarea cols="48" rows="4" name="IntInsOtherTEXT" runat="server" id="IntInsOtherTEXT" value=",,," value=",,,">,</textarea> </td>           </tr>       </tbody> </table> </fieldset></div> <div><fieldset><legend title="CLIENT / CAREGIVER RESPONSE OUTCOME:"><span style="color: #ff0000; font-size: 14pt;">CLIENT / CAREGIVER RESPONSE OUTCOME:</span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>  <span><input runat="server" id="FollowthroughConsistencyCHECKBOX" name="FollowthroughConsistencyCHECKBOX" value="checkBox10" type="checkbox" />Follow through Consistency</span> </td>               <td>  <span><input runat="server" id="DemonstrateReturnDemoCHECKBOX" name="DemonstrateReturnDemoCHECKBOX" value="checkBox10" type="checkbox" />Demonstrate/Return Demo</span> </td>               <td>  <span><input runat="server" id="FollowthroughInconsis
tencyCHECKBOX" name="FollowthroughInconsistencyCHECKBOX" value="checkBox10" type="checkbox" />Follow through Inconsistency</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>  <span><input runat="server" id="InadequatecomprehensionCHECKBOX" name="InadequatecomprehensionCHECKBOX" value="checkBox10" type="checkbox" />Inadequate comprehension</span> </td>               <td>  <span><input runat="server" id="RequiresContinuesTeachingCHECKBOX" name="RequiresContinuesTeachingCHECKBOX" value="checkBox10" type="checkbox" />Requires Continues Teaching</span> </td>               <td>  <span><input runat="server" id="ImprovingCHECKBOX" name="ImprovingCHECKBOX" value="checkBox10" type="checkbox" />Improving</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>  <span><input runat="server" id="AnxiousCHECKBOX" name="AnxiousCHECKBOX" value="checkBox10" type="checkbox" />Unstable</span> </td>               <td>  <span><input
runat="server" id="DisorientedCHECKBOX" name="DisorientedCHECKBOX" value="checkBox10" type="checkbox" />Deteriorating</span> </td>               <td>  <span><input runat="server" id="ForgetfulCHECKBOX" name="ForgetfulCHECKBOX" value="checkBox10" type="checkbox" />Verbal Undestanding</span> </td>           </tr>       </tbody> </table> </fieldset></div> <div><fieldset><legend title="AIDE SUPERVISORY VISIT:"><span style="color: #ff0000; font-size: 14pt;">AIDE SUPERVISORY VISIT:</span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>Aide in the Case?  <span><input runat="server" id="AideyesCHECKBOX" name="AideyesCHECKBOX" value="checkBox10" type="checkbox" />Yes</span>               <span><input runat="server" id="AidnoCHECKBOX" name="AidnoCHECKBOX" value="checkBox10" type="checkbox" />No</span> </td>           </tr>       </tbody> </table> </fieldset></div> <d
iv><fieldset><legend title=""><span style="color: #ff0000; font-size: 14pt;"></span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>Aide present on this visit?  <input runat="server" id="presentyesCHECKBOX" name="presentyesCHECKBOX" value="checkBox10" type="checkbox" />Yes               <span><input runat="server" id="presentnoCHECKBOX" name="presentnoCHECKBOX" value="checkBox10" type="checkbox" />No</span> </td>           </tr>       </tbody> </table> </fieldset></div> <div><fieldset><legend title=""><span style="color: #ff0000; font-size: 14pt;"></span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>Aide following care plan?   <input runat="server" id="followingyesCHECKBOX" name="followingyesCHECKBOX" value="chec
kBox10" type="checkbox" />Yes               <span><input runat="server" id="followingnoCHECKBOX" name="followingnoCHECKBOX" value="checkBox10" type="checkbox" />No</span> </td>           </tr>       </tbody> </table> </fieldset></div> <div><fieldset><legend title=""><span style="color: #ff0000; font-size: 14pt;"></span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>Courteous and Polite?   <input runat="server" id="courteousyesCHECKBOX" name="courteousyesCHECKBOX" value="checkBox10" type="checkbox" />Yes               <span><input runat="server" id="courteousnoCHECKBOX" name="courteousnoCHECKBOX" value="checkBox10" type="checkbox" />No</span> </td>           </tr>       </tbody> </table> </fieldset></div> <div><fieldset><legend title=""><span style="color: #ff0000; font-size: 14pt;"></span></legend> <table style="width: 902px; height: 48px;" align="center"
border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>Patient Satisfied with care?  <input runat="server" id="satisfiedyesCHECKBOX" name="satisfiedyesCHECKBOX" value="checkBox10" type="checkbox" />Yes               <span><input runat="server" id="satisfiednoCHECKBOX" name="satisfiednoCHECKBOX" value="checkBox10" type="checkbox" />No</span> </td>           </tr>       </tbody> </table> </fieldset></div> <div><fieldset><legend title=""><span style="color: #ff0000; font-size: 14pt;"></span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>Changes made to care plan?  <input runat="server" id="changesyesCHECKBOX" checked checked name="changesyesCHECKBOX" value="checkBox10" type="checkbox" />Yes               <span><input runat="server" id="changesnoCHECKBOX" name="changesnoCHECKBOX" value="check
Box10" type="checkbox" />No</span> </td>           </tr>       </tbody> </table> </fieldset></div> <div><fieldset><legend title=""><span style="color: #ff0000; font-size: 14pt;"></span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>Comments    <textarea cols="48" rows="4" name="aideCommentsTEXT" runat="server" id="aideCommentsTEXT"></textarea> </td>           </tr>       </tbody> </table> </fieldset></div> <div><fieldset><legend title="COMMUNICATION:"><span style="color: #ff0000; font-size: 14pt;">COMMUNICATION:</span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>COORDINATION MADE WITH: </td>               <td>  <span><input runat="server" id="COORDINATIONPTCHECKBOX" name="COORDINATIONPTCHECKBOX" value=
"checkBox10" type="checkbox" />PT</span> </td>               <td>  <span><input runat="server" id="COORDINATIONOTCHECKBOX" name="COORDINATIONOTCHECKBOX" value="checkBox10" type="checkbox" />OT</span> </td>               <td>  <span><input runat="server" id="COORDINATIONCHHACHECKBOX" name="COORDINATIONCHHACHECKBOX" value="checkBox10" type="checkbox" />CHHA</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td> </td>               <td>  <span><input runat="server" id="COORDINATIONMSWCHECKBOX" name="COORDINATIONMSWCHECKBOX" value="checkBox10" type="checkbox" />MSW</span> </td>               <td>  <span><input runat="server" id="COORDINATIONSTCHECKBOX" name="COORDINATIONSTCHECKBOX" value="checkBox10" type="checkbox" />ST</span> </td>               <td>  <span><input runat="server" id="COORDINATIONMDCHECKBOX" name="COORDINATIONMDCHECKBOX" value="checkBox10" type="checkbox" />MD</span> </td>           </tr>       </tbody>       <tbody>           <tr>
               <td> </td>               <td>  <span><input runat="server" id="COORDINATIONRNCHECKBOX" name="COORDINATIONRNCHECKBOX" value="checkBox10" type="checkbox" />RN SUPERVISOR</span> </td>               <td>  <span><input runat="server" id="COORDINATIONDIETCHECKBOX" name="COORDINATIONDIETCHECKBOX" value="checkBox10" type="checkbox" />DIETICIAN</span> </td>               <td>  <span><input runat="server" id="COORDINATIONCLIENTCHECKBOX" name="COORDINATIONCLIENTCHECKBOX" value="checkBox10" type="checkbox" />CLIENT SERVICES</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>REGARDING PATIENTS: </td>               <td>  <span><input runat="server" id="REGARDINGTODAYCHECKBOX" name="REGARDINGTODAYCHECKBOX" value="checkBox10" type="checkbox" />Todays Visit/Assessment</span> </td>               <td>  <span><input runat="server" id="REGARDINGfunctionalCHECKBOX" name="REGARDINGfunctionalCHECKBOX" value="checkBox10" type="checkbox" />Functio
nal Status</span> </td>               <td>  <span><input runat="server" id="REGARDINGpocCHECKBOX" name="REGARDINGpocCHECKBOX" value="checkBox10" type="checkbox" />Plan of Care</span> </td>           </tr>       </tbody> </table> </fieldset></div> <div><fieldset><legend title=""><span style="color: #ff0000; font-size: 14pt;"></span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bordercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>Others:    <textarea cols="48" rows="4" name="REGARDINGotherTEXT" runat="server" id="REGARDINGotherTEXT"></textarea> </td>           </tr>       </tbody> </table> </fieldset></div> <div><fieldset><legend title="Pt/Family Informed of Changes and Participated in Plan of Care::"><span style="color: #ff0000; font-size: 14pt;">Pt/Family Informed of Changes and Participated in Plan of Care:</span></legend> <table style="width: 902px; height: 48px;" align="center" border="1" bor
dercolor="" cellpadding="2" cellspacing="2" width="902">       <tbody>           <tr>               <td>Changes made to care plan?   <input runat="server" id="ChangespocyesCHECKBOX" name="ChangespocyesCHECKBOX" value="checkBox10" type="checkbox" />Yes               <span><input runat="server" id="ChangespocnoCHECKBOX" name="ChangespocnoCHECKBOX" value="checkBox10" type="checkbox" />No</span> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>Remarks:    <textarea cols="48" rows="4" name="remarksotherTEXT" runat="server" id="remarksotherTEXT"></textarea> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>Plan for next visit:    <textarea cols="48" rows="4" name="POCnextvisitTEXT" runat="server" id="POCnextvisitTEXT"></textarea> </td>           </tr>       </tbody>       <tbody>           <tr>               <td>Patient has wound:   <input runat="server" id="patwoundyesTEXT" name="patwoundyesTEX
T" value="checkBox10" type="checkbox" />Yes               <span><input runat="server" id="patwoundnoTEXT" name="patwoundnoTEXT" value="checkBox10" type="checkbox" />No</span> </td>           </tr>       </tbody> </table> </fieldset></div> </div>

#4, Look at the PDF created.

#5, Rendering to printer shows correctly.

Thanks!