document.write("<script language=\"javascript\" type=\"text/javascript\" src=\"http://www.oasismedical.cn/statics/js/dialog.js\"></script><link href=\"http://www.oasismedical.cn/statics/css/table_form.css\" rel=\"stylesheet\" type=\"text/css\" /><link href=\"http://www.oasismedical.cn/statics/css/dialog.css\" rel=\"stylesheet\" type=\"text/css\" /><script type=\"text/javascript\" src=\"http://www.oasismedical.cn/statics/js/dialog.js\"></script><div class=\"box\">    <h5>我要预约</h5>    <div class=\"content\"><form method=\"post\" action=\"/index.php?m=formguide&c=index&a=show&formid=20&siteid=3\" name=\"myform\" id=\"myform\"><table class=\"table_form\" width=\"100%\" cellspacing=\"0\"><tbody> <tr>      <th width=\"80\"> <font color=\"red\">*</font> 预约科室  </th>      <td><select name=\'info[keshi]\' id=\'keshi\'><option value=\"quanke\" >全科</option><option value=\"fuke\" >妇科</option><option value=\"erke\" >儿科</option></select>  </td>    </tr><tr>      <th width=\"80\"> 性别  </th>      <td><select name=\'info[sex]\' id=\'sex\'><option value=\"1\" >男</option><option value=\"2\" >女</option></select>  </td>    </tr><tr>      <th width=\"80\"> <font color=\"red\">*</font> 姓名  </th>      <td><input type=\"text\" name=\"info[name]\" id=\"name\" size=\"50\" value=\"\"  class=\"input-text\"  >  </td>    </tr><tr>      <th width=\"80\"> <font color=\"red\">*</font> 出生日期  </th>      <td><link rel=\"stylesheet\" type=\"text/css\" href=\"http://www.oasismedical.cn/statics/js/calendar/jscal2.css\"/><link rel=\"stylesheet\" type=\"text/css\" href=\"http://www.oasismedical.cn/statics/js/calendar/border-radius.css\"/><link rel=\"stylesheet\" type=\"text/css\" href=\"http://www.oasismedical.cn/statics/js/calendar/win2k.css\"/><script type=\"text/javascript\" src=\"http://www.oasismedical.cn/statics/js/calendar/calendar.js\"></script><script type=\"text/javascript\" src=\"http://www.oasismedical.cn/statics/js/calendar/lang/en.js\"></script><input type=\"text\" name=\"info[birthday]\" id=\"birthday\" value=\"\" size=\"10\" class=\"date\" readonly>&nbsp;<script type=\"text/javascript\">Calendar.setup({weekNumbers: true,    inputField : \"birthday\",    trigger    : \"birthday\",    dateFormat: \"%Y-%m-%d\",    showTime: false,    minuteStep: 1,    onSelect   : function() {this.hide();}});        </script>  </td>    </tr><tr>      <th width=\"80\"> 家庭住址  </th>      <td><input type=\"text\" name=\"info[address]\" id=\"address\" size=\"50\" value=\"\"  class=\"input-text\"  >  </td>    </tr><tr>      <th width=\"80\"> <font color=\"red\">*</font> 电话号码  </th>      <td><input type=\"text\" name=\"info[tel]\" id=\"tel\" size=\"30\" value=\"\"  class=\"input-text\"  >  </td>    </tr><tr>      <th width=\"80\"> <font color=\"red\">*</font> 邮件地址  </th>      <td><input type=\"text\" name=\"info[email]\" id=\"email\" size=\"50\" value=\"\"  class=\"input-text\"  >  </td>    </tr><tr>      <th width=\"80\"> 目前症状  </th>      <td><input type=\"text\" name=\"info[zhengzhuang]\" id=\"zhengzhuang\" size=\"50\" value=\"\"  class=\"input-text\"  >  </td>    </tr><tr>      <th width=\"80\"> 发病时期  </th>      <td><input type=\"text\" name=\"info[fangbingdate]\" id=\"fangbingdate\" size=\"50\" value=\"\"  class=\"input-text\"  >  </td>    </tr><tr>      <th width=\"80\"> 门诊语言  </th>      <td><input type=\"text\" name=\"info[menzhenyuyan]\" id=\"menzhenyuyan\" size=\"50\" value=\"\"  class=\"input-text\"  >  </td>    </tr><tr>      <th width=\"80\"> 就诊语言  </th>      <td><select name=\'info[jiuzhenyuyan]\' id=\'jiuzhenyuyan\'><option value=\"zh\" >中文</option><option value=\"en\" >英文</option></select>  </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>");