{% block scripts %}
    {% if mode is defined %}
        <script>
            var upload_image_mamas = '{{ asset('bundles/utilities/uploads/imageMammography') }}' ;
            var url_findData_mammography = '{{ path('DataMammography')  }}';
        </script>
        <script src="{{ asset('bundles/main/js/jquery-1.9.1.js') }}"></script>
        <script>
            $(document).ready(function(){
                var appCode = '{{ appCode }}';
                var rutaImagen = upload_image_mamas;
                $.ajax({
                    url: url_findData_mammography,
                    type: "POST",
                    data: {
                        'appCode': appCode,
                        'rutaImagen': rutaImagen
                    },
                    success: function (resp) {

                        document.getElementById("canvasimg").src = '';
                        var jsonResp = JSON.parse(resp);
                        for (var i = 0; i < jsonResp['ResultQuery'].length; i++) {
                            var biopsiaDerecha = jsonResp['ResultQuery'][0]['dataClinical'][0];
                            if (biopsiaDerecha == 'biop_der_si') {
                                $("#dtc-biop_der_no").prop('checked', true);
                            }
                            var biopsiaIzquierda = jsonResp['ResultQuery'][0]['dataClinical'][1];
                            if (biopsiaIzquierda == 'biop_izq_si') {
                                $("#dtc-biop_izq_no").prop('checked', true);
                            }
                            var CirugiaSenoDerecha = jsonResp['ResultQuery'][0]['dataClinical'][2];
                            if (CirugiaSenoDerecha == 'cir_der_si') {
                                $("#dtc-cir_der_no").prop('checked', true);
                            }
                            var CirugiaSenoIzquierda = jsonResp['ResultQuery'][0]['dataClinical'][3];
                            if (CirugiaSenoIzquierda == 'cir_izq_si') {
                                $("#dtc-cir_izq_no").prop('checked', true);
                            }
                            var mastectomiaDerecha = jsonResp['ResultQuery'][0]['dataClinical'][4];
                            if (mastectomiaDerecha == 'mas_der_si') {
                                $("#dtc-mas_der_no").prop('checked', true);
                            }
                            var mastectomiaIzquierda = jsonResp['ResultQuery'][0]['dataClinical'][5];
                            if (mastectomiaIzquierda == 'mas_izq_si') {
                                $("#dtc-mas_izq_no").prop('checked', true);
                            }
                            var mmclDerecha = jsonResp['ResultQuery'][0]['dataClinical'][6];
                            if (mmclDerecha == 'mmc_der_si') {
                                $("#dtc-mmc_der_no").prop('checked', true);
                            }
                            var mmclIzquierda = jsonResp['ResultQuery'][0]['dataClinical'][7];
                            if (mmclIzquierda == 'mmc_izq_si') {
                                $("#dtc-mmc_izq_no").prop('checked', true);
                            }
                            var controlPerDerecha = jsonResp['ResultQuery'][0]['dataClinical'][8];
                            if (controlPerDerecha == 'control_der_si') {
                                $("#dtc-control_der_no").prop('checked', true);
                            }
                            var controlPerIzquierda = jsonResp['ResultQuery'][0]['dataClinical'][9];
                            if (controlPerIzquierda == 'control_izq_si') {
                                $("#dtc-control_izq_no").prop('checked', true);
                            }
                            var sensibildiadDerecha = jsonResp['ResultQuery'][0]['dataClinical'][10];
                            if (sensibildiadDerecha == 'sens_der_si') {
                                $("#dtc-sens_der_no").prop('checked', true);
                            }
                            var sensibilidadIzquierda = jsonResp['ResultQuery'][0]['dataClinical'][11];
                            if (sensibilidadIzquierda == 'sens_izq_si') {
                                $("#dtc-sens_izq_no").prop('checked', true);
                            }
                            var dolorDerecha = jsonResp['ResultQuery'][0]['dataClinical'][12];
                            if (dolorDerecha == 'dolor_der_si') {
                                $("#dtc-dolor_der_no").prop('checked', true);
                            }
                            var dolorIzquierda = jsonResp['ResultQuery'][0]['dataClinical'][13];
                            if (dolorIzquierda == 'dolor_izq_si') {
                                $("#dtc-dolor_izq_no").prop('checked', true);
                            }
                            var secrecionDerecha = jsonResp['ResultQuery'][0]['dataClinical'][14];
                            if (secrecionDerecha == 'secr_der_si') {
                                $("#dtc-secr_der_no").prop('checked', true);
                            }
                            var secrecionIzquierda = jsonResp['ResultQuery'][0]['dataClinical'][15];
                            if (secrecionIzquierda == 'secr_izq_si') {
                                $("#dtc-secr_izq_no").prop('checked', true);
                            }
                            var pezonInvDerecha = jsonResp['ResultQuery'][0]['dataClinical'][16];
                            if (pezonInvDerecha == 'peInv_der_si') {
                                $("#dtc-peInv_der_no").prop('checked', true);
                            }
                            var pezonInvIzquierda = jsonResp['ResultQuery'][0]['dataClinical'][17];
                            if (pezonInvIzquierda == 'peInv_izq_si') {
                                $("#dtc-peInv_izq_no").prop('checked', true);
                            }
                            var nodulosDerecha = jsonResp['ResultQuery'][0]['dataClinical'][18];
                            if (nodulosDerecha == 'nod_der_si') {
                                $("#dtc-nod_der_no").prop('checked', true);
                            }
                            var nodulosIzquierda = jsonResp['ResultQuery'][0]['dataClinical'][19];
                            if (nodulosIzquierda == 'nod_izq_si') {
                                $("#dtc-nod_izq_no").prop('checked', true);
                            }
                            var infeccionDerecha = jsonResp['ResultQuery'][0]['dataClinical'][20];
                            if (infeccionDerecha == 'inf_der_si') {
                                $("#dtc-inf_der_no").prop('checked', true);
                            }
                            var infeccionIzquierda = jsonResp['ResultQuery'][0]['dataClinical'][21];
                            if (infeccionIzquierda == 'inf_izq_si') {
                                $("#dtc-inf_izq_no").prop('checked', true);
                            }
                            var traumaDerecha = jsonResp['ResultQuery'][0]['dataClinical'][22];
                            if (traumaDerecha == 'trauma_der_si') {
                                $("#dtc-trauma_der_no").prop('checked', true);
                            }
                            var traumaIzquierda = jsonResp['ResultQuery'][0]['dataClinical'][23];
                            if (traumaIzquierda == 'trauma_izq_si') {
                                $("#dtc-trauma_izq_no").prop('checked', true);
                            }
                            var desc_der = $("input[type='checkbox'].descripcion_der");
                            if(desc_der.filter(":checked").length > 0){
                                $("#dtc-otro-derecho").val(jsonResp['ResultQuery'][0]['dataClinical'][24]);
                                $("#dtc-otro-derecho").prop('readonly', true).css('background', '#aeaeae');
                                $("#dtc-otro-derecho").removeClass('required');
                            }else{
                                $("#dtc-otro-derecho").val(jsonResp['ResultQuery'][0]['dataClinical'][24]);
                                $("#dtc-otro-derecho").prop('readonly', false).css('background', '#fff');
                                $("#dtc-otro-derecho").addClass('required');
                            }

                            var desc_izq = $("input[type='checkbox'].descripcion_izq");
                            if(desc_izq.filter(":checked").length > 0){
                                $("#dtc-otro-izquierdo").val(jsonResp['ResultQuery'][0]['dataClinical'][25]);
                                $("#dtc-otro-izquierdo").prop('readonly', true).css('background', '#aeaeae');
                                $("#dtc-otro-izquierdo").removeClass('required');
                            }else{
                                $("#dtc-otro-izquierdo").val(jsonResp['ResultQuery'][0]['dataClinical'][25]);
                                $("#dtc-otro-izquierdo").prop('readonly', false).css('background', '#fff');
                                $("#dtc-otro-izquierdo").addClass('required');
                            }

                            $("#dtc-menarquia").val(jsonResp['ResultQuery'][0]['dataClinical'][26]);
                            $("#dtc-menopausia").val(jsonResp['ResultQuery'][0]['dataClinical'][27]);
                            $("#dtc-ultimoPeriodo").val(jsonResp['ResultQuery'][0]['dataClinical'][28]);
                            $("#dtc-histerectomia").val(jsonResp['ResultQuery'][0]['dataClinical'][29]);
                            var oral = jsonResp['ResultQuery'][0]['dataClinical'][30];
                            if (oral == 'oral-si') {
                                $("#dtc-oral").prop('checked', true);
                            }
                            var parche = jsonResp['ResultQuery'][0]['dataClinical'][31];
                            if (parche == 'oral-si') {
                                $("#dtc-parche").prop('checked', true);
                            }
                            var medicamentos = jsonResp['ResultQuery'][0]['dataClinical'][32];
                            if (medicamentos == 'medicamentos-si') {
                                $("#dtc-medicamentos").prop('checked', true);
                            }
                            $("#dtc-" + jsonResp['ResultQuery'][0]['dataClinical'][33]).prop('checked', true);
                            if (jsonResp['ResultQuery'][0]['dataClinical'][33] === 'mamoprevia-si') {
                                $('#fecmamoprevia').attr('style', 'display:block');
                                $('#fecmamoprevia').val(jsonResp['ResultQuery'][0]['dataClinical'][51]);
                            }
                            $("#dtc-reportados").val(jsonResp['ResultQuery'][0]['dataClinical'][34]);
                            $("#dtc-" + jsonResp['ResultQuery'][0]['dataClinical'][35]).prop('checked', true);
                            $("#dtc-ciclosRadioterapia").val(jsonResp['ResultQuery'][0]['dataClinical'][36]);
                            $("#dtc-" + jsonResp['ResultQuery'][0]['dataClinical'][37]).prop('checked', true);
                            $("#dtc-ciclosRadioterapia2").val(jsonResp['ResultQuery'][0]['dataClinical'][38]);
                            $("#dtc-abuela").val(jsonResp['ResultQuery'][0]['dataClinical'][39]);
                            $("#dtc-madre").val(jsonResp['ResultQuery'][0]['dataClinical'][40]);
                            $("#dtc-hermana").val(jsonResp['ResultQuery'][0]['dataClinical'][41]);
                            $("#dtc-hijas").val(jsonResp['ResultQuery'][0]['dataClinical'][42]);
                            $("#dtc-tias").val(jsonResp['ResultQuery'][0]['dataClinical'][43]);
                            $("#dtc-" + jsonResp['ResultQuery'][0]['dataClinical'][44]).prop('checked', true);
                            $("#dtc-primer_parto").val(jsonResp['ResultQuery'][0]['dataClinical'][45]);
                            $("#dtc-" + jsonResp['ResultQuery'][0]['dataClinical'][46]).prop('checked', true);
                            $("#dtc-mAs_caudal").val(jsonResp['ResultQuery'][0]['dataClinical'][47]);
                            $("#dtc-Kv_caudal").val(jsonResp['ResultQuery'][0]['dataClinical'][48]);
                            $("#dtc-mAs_oblicua").val(jsonResp['ResultQuery'][0]['dataClinical'][49]);
                            $("#dtc-Kv_oblicua").val(jsonResp['ResultQuery'][0]['dataClinical'][50]);

                            if ($('#dtc-numero_embarazos-0').is(':checked')) {
                                $("#dtc-primer_parto").prop('readonly', true).css('background', '#aeaeae');
                            }
                            if ($('#dtc-radioterapia-no').is(':checked')) {
                                $("#dtc-ciclosRadioterapia").prop('readonly', true).css('background', '#aeaeae');
                            } else if ($('#dtc-radioterapia-si').is(':checked')) {
                                $("#dtc-ciclosRadioterapia").prop('readonly', false).css('background', '#fff');
                            }
                            if ($('#dtc-quimioterapia-no').is(':checked')) {
                                $("#dtc-ciclosRadioterapia2").prop('readonly', true).css('background', '#aeaeae');
                            } else if ($('#dtc-quimioterapia-si').is(':checked')) {
                                $("#dtc-ciclosRadioterapia2").prop('readonly', false).css('background', '#fff');
                            }

                             // new
                            $("#dtc-" + jsonResp['ResultQuery'][0]['dataClinical'][52]).prop('checked', true);
                            if (jsonResp['ResultQuery'][0]['dataClinical'][52] === 'ecoprevia-si') {
                                $('#fececoprevia').val(jsonResp['ResultQuery'][0]['dataClinical'][53]).show('fast');
                            }
                            $("#tiempolactancia").val(jsonResp['ResultQuery'][0]['dataClinical'][54]);
                            $("#dtc-" + jsonResp['ResultQuery'][0]['dataClinical'][55]).prop('checked', true);
                            $("#organocancer").val(jsonResp['ResultQuery'][0]['dataClinical'][56]);
                            $("#edadcancer").val(jsonResp['ResultQuery'][0]['dataClinical'][57]);

                            var camImplanDerecho = jsonResp['ResultQuery'][0]['dataClinical'][58];
                            if (camImplanDerecho == 'camimp_der_si') {
                                $("#dtc-camimp_der_no").prop('checked', true);
                            }

                            var camImplanIzquierdo = jsonResp['ResultQuery'][0]['dataClinical'][59];
                            if (camImplanIzquierdo == 'camimp_izq_si') {
                                $("#dtc-camimp_izq_no").prop('checked', true);
                            }

                            $("#dtc-" + jsonResp['ResultQuery'][0]['dataClinical'][60]).prop('checked', true);
                            $("#dtc-espcirugia").val(jsonResp['ResultQuery'][0]['dataClinical'][61]);

                            $("#dtc-" + jsonResp['ResultQuery'][0]['dataClinical'][62]).prop('checked', true);

                            $("#dtc-ooforectomia").val(jsonResp['ResultQuery'][0]['dataClinical'][63]);

                            $("#dtc-primas").val(jsonResp['ResultQuery'][0]['dataClinical'][64]);

                            var tamoxifeno = jsonResp['ResultQuery'][0]['dataClinical'][65];
                            if (tamoxifeno == 'tamoxifeno-si') {
                                $("#dtc-tamoxifeno").prop('checked', true);
                            }

                            var aromasin = jsonResp['ResultQuery'][0]['dataClinical'][66];
                            if (aromasin == 'aromasin-si') {
                                $("#dtc-aromasin").prop('checked', true);
                            }

                            var femara = jsonResp['ResultQuery'][0]['dataClinical'][67];
                            if (femara == 'femara-si') {
                                $("#dtc-femara").prop('checked', true);
                            }
                        }

                        var urlImage = jsonResp['findImageMama'];
                        var img = new Image();
                        img.src = jsonResp['findImageMama'];
                        img.onload = function () {
                            var canvas = document.getElementById('sketchpad');
                            // Si el navegador soporta canvas, toma 2d context
                            //if (canvas.getContext)
                            var ctx = canvas.getContext('2d');
                            ctx.drawImage(img, 0, 0);
                            $("#canvasimg").attr('src', urlImage).css('backgroundColor', "#888").css('border', "1px solid").css('display', 'inline');
                        }

                    },
                    onFailure: function () {
                        //alert('Se ha producido un error');
                    }


                });
            });
        </script>
    {% endif %}
    <script type="text/javascript" src="{{ asset('bundles/utilities/js/ajax/canvasImage.js') }}"></script>
{% endblock %}
{% block content %}
    {% block stylesheets %}

        {#Bootstrap#}
        {#<script type="text/javascript" src="{{ asset('bundles/shedule/js/blockUI.js') }}"></script>#}
        {#<style>
            .panel-body{
                background:#252525;
                font-size:14px;
            }
            .ui-dialog { z-index: 1001 !important ;}
        </style>#}
        {# JS #}
        <script type="text/javascript" src="{{ asset('bundles/shedule/bootstrap/js/bootstrap.js') }}"></script>
        <link rel="stylesheet" href="{{ asset('bundles/main/css/bootstrap.css') }}"/>
        <link rel="stylesheet" href="{{ asset('bundles/shedule/'~ hrk_skin ~'/dataTableCustom.css') }}"/>
        <link href="{{ asset('bundles/utilities/css/canvasImage.css') }}" type="text/css" rel="stylesheet"/>
       {% if ( is_granted('ROLE_READING') or is_granted('ROLE_VR'))  %}
            <style>
                .table > thead{
                    background:#111;
                    color:#fff;
                }
                .form-control[disabled], .form-control[readonly], fieldset[disabled] .form-control{
                    color: #000;
                }
                .table-responsive{
                    background:#fff;
                    color:#000;
                }
            </style>
        {% endif %}
    {% endblock %}
    <div class="row">
        <div class="table-responsive encuesta-mammo">
        <div class="col-md-4">
            <table class="table table-condensed table-bordered table-mammo" style="width:100%;font-size:12px;">
                <thead>
                    <tr>
                        <th style="text-align: center;">{{ 'labels.antecedentes'|trans([],'LocalizationBundle') }}</th>
                        <th style="text-align: center;">{{ 'labels.right'|trans([],'LocalizationBundle') }}</th>
                        <th style="text-align: center;">{{ 'labels.left'|trans([],'LocalizationBundle') }}</th>
                    </tr>
                </thead>
                <tbody>
                    <tr>
                        <td>{{ 'labels.mammo.biopAspira'|trans([],'LocalizationBundle') }}</td>
                        <td style="text-align: center;"><input id="dtc-biop_der_no" value="biop_der_no" name="dtc-biop_der_no" type="checkbox"></td>
                        <td style="text-align: center;"><input id="dtc-biop_izq_no" value="biop_izq_no" name="dtc-biop_izq_no" type="checkbox"></td>
                    </tr>
                    <tr>
                        <td>{{ 'labels.mammo.cirugias'|trans([],'LocalizationBundle') }}:</td>
                        <td style="text-align: center;"><input id="dtc-cir_der_no" value="cir_der_no" name="dtc-cir_der_no" type="checkbox"></td>
                        <td style="text-align: center;"><input id="dtc-cir_izq_no" value="cir_izq_no" name="dtc-cir_izq_no" type="checkbox"></td>
                    </tr>
                    <tr>
                        <td>{{ 'labels.mammo.mastectomia'|trans([],'LocalizationBundle') }}:</td>
                        <td style="text-align: center;"><input id="dtc-mas_der_no" value="mas_der_no" name="dtc-mas_der_no" type="checkbox"></td>
                        <td style="text-align: center;"><input id="dtc-mas_izq_no" value="mas_izq_no" name="dtc-mas_izq_no" type="checkbox"></td>
                    </tr>
                    <tr>
                        <td>{{ 'labels.mammo.marcas'|trans([],'LocalizationBundle') }}:</td>
                        <td style="text-align: center;"><input id="dtc-mmc_der_no" value="mmc_der_no" name="dtc-mmc_der_no" type="checkbox"></td>
                        <td style="text-align: center;"><input id="dtc-mmc_izq_no" value="mmc_izq_no" name="dtc-mmc_izq_no" type="checkbox"></td>
                    </tr>
                    <tr>{# campo agregado clinica la mujer#}
                        <td>{{ 'labels.mammo.cambioImplante'|trans([],'LocalizationBundle') }}</td>
                        <td style="text-align: center;"><input id="dtc-camimp_der_no" value="camimp_der_no" name="dtc-camimp_der_no" type="checkbox"></td>
                        <td style="text-align: center;"><input id="dtc-camimp_izq_no" value="camimp_izq_no" name="dtc-camimp_izq_no" type="checkbox"></td>
                    </tr>
                    <tr>
                        <th colspan="3" style="text-align: center;">{{ 'labels.mammo.descrProblema'|trans([],'LocalizationBundle') }}:</th>
                    </tr>
                    <tr>
                        <td>{{ 'labels.mammo.control'|trans([],'LocalizationBundle') }}</td>
                        <td style="text-align: center;"><input id="dtc-control_der_no" class="descripcion_der" value="control_der_no" name="dtc-control_der_no" type="checkbox"></td>
                        <td style="text-align: center;"><input id="dtc-control_izq_no" class="descripcion_izq" value="control_izq_no" name="dtc-control_izq_no" type="checkbox"></td>
                    </tr>
                    <tr>
                        <td>{{ 'labels.mammo.sensibilidad'|trans([],'LocalizationBundle') }}</td>
                        <td style="text-align: center;"><input id="dtc-sens_der_no" class="descripcion_der" value="sens_der_no" name="dtc-sens_der_no" type="checkbox"></td>
                        <td style="text-align: center;"><input id="dtc-sens_izq_no" class="descripcion_izq" value="sens_izq_no" name="dtc-sens_izq_no" type="checkbox"></td>
                    </tr>
                    <tr>
                        <td>{{ 'labels.mammo.dolor'|trans([],'LocalizationBundle') }}</td>
                        <td style="text-align: center;"><input id="dtc-dolor_der_no" class="descripcion_der" value="dolor_der_no" name="dtc-dolor_der_no" type="checkbox"></td>
                        <td style="text-align: center;"><input id="dtc-dolor_izq_no" class="descripcion_izq" value="dolor_izq_no" name="dtc-dolor_izq_no" type="checkbox"></td>
                    </tr>
                    <tr>
                        <td>{{ 'labels.mammo.secrecion'|trans([],'LocalizationBundle') }}</td>
                        <td style="text-align: center;"><input id="dtc-secr_der_no" class="descripcion_der" value="secr_der_no" name="dtc-secr_der_no" type="checkbox"></td>
                        <td style="text-align: center;"><input id="dtc-secr_izq_no" class="descripcion_izq" value="secr_izq_no" name="dtc-secr_izq_no" type="checkbox"></td>
                    </tr>
                    <tr>
                        <td>{{ 'labels.mammo.pezonInvertido'|trans([],'LocalizationBundle') }}</td>
                        <td style="text-align: center;"><input id="dtc-peInv_der_no" class="descripcion_der" value="peInv_der_no" name="dtc-peInv_der_no" type="checkbox"></td>
                        <td style="text-align: center;"><input id="dtc-peInv_izq_no" class="descripcion_izq" value="peInv_izq_no" name="dtc-peInv_izq_no" type="checkbox"></td>
                    </tr>
                    <tr>
                        <td>{{ 'labels.mammo.nodulos'|trans([],'LocalizationBundle') }}</td>
                        <td style="text-align: center;"><input id="dtc-nod_der_no" class="descripcion_der" value="nod_der_no" name="dtc-nod_der_no" type="checkbox"></td>
                        <td style="text-align: center;"><input id="dtc-nod_izq_no" class="descripcion_izq" value="nod_izq_no" name="dtc-nod_izq_no" type="checkbox"></td>
                    </tr>
                    <tr>
                        <td>{{ 'labels.mammo.infeccion'|trans([],'LocalizationBundle') }}</td>
                        <td style="text-align: center;"><input id="dtc-inf_der_no" class="descripcion_der" value="inf_der_no" name="dtc-inf_der_no" type="checkbox"></td>
                        <td style="text-align: center;"><input id="dtc-inf_izq_no" class="descripcion_izq" value="inf_izq_no" name="dtc-inf_izq_no" type="checkbox"></td>
                    </tr>
                    <tr>
                        <td>{{ 'labels.mammo.trauma'|trans([],'LocalizationBundle') }}</td>
                        <td style="text-align: center;"><input id="dtc-trauma_der_no" class="descripcion_der" value="trauma_der_no" name="dtc-trauma_der_no" type="checkbox"></td>
                        <td style="text-align: center;"><input id="dtc-trauma_izq_no" class="descripcion_izq" value="trauma_izq_no" name="dtc-trauma_izq_no" type="checkbox"></td>
                    </tr>
                    <tr>
                        <td>{{ 'labels.otro'|trans([],'LocalizationBundle') }} - {{ 'labels.especifique'|trans([],'LocalizationBundle') }}(*)</td>
                        <td style="text-align: center;"><input id="dtc-otro-derecho" name="dtc-otro-derecho" class="required form-control" type="text"></td>
                        <td style="text-align: center;"><input id="dtc-otro-izquierdo" name="dtc-otro-izquierdo" class="required form-control" type="text"></td>
                    </tr>
                </tbody>
            </table>
        </div>
        <div class="col-md-4">
            <table class="table table-condensed table-bordered table-mammo" style="width:100%;font-size:12px;">
                <thead>
                    <tr>
                        <th colspan="4" style="text-align: center;">{{ 'labels.mammo.histoMenstrual'|trans([],'LocalizationBundle') }}</th>
                    </tr>
                </thead>
                <tbody>
                    <tr>
                        <td colspan="3">{{ 'labels.mammo.menarquia'|trans([],'LocalizationBundle') }}(*):</td>
                        <td><input id="dtc-menarquia" name="dtc-menarquia" class="required form-control" type="text"></td>
                    </tr>
                    <tr>
                        <td colspan="3">{{ 'labels.mammo.menopausia'|trans([],'LocalizationBundle') }}(*):</td>
                        <td><input id="dtc-menopausia" name="dtc-menopausia" class="required form-control" type="text"></td>
                    </tr>
                    <tr>
                        <td colspan="3">{{ 'labels.mammo.ultimoPeriodo'|trans([],'LocalizationBundle') }}(*):</td>
                        <td><input id="dtc-ultimoPeriodo" name="dtc-ultimoPeriodo" class="required form-control" type="text"></td>
                    </tr>
                    <tr>
                        <td colspan="3">{{ 'labels.mammo.histerectomia'|trans([],'LocalizationBundle') }}(*):</td>
                        <td><input id="dtc-histerectomia" name="dtc-histerectomia" class="required form-control" type="text"></td>
                    </tr>
                    <tr>{# campo agregado clinica de la mujer#}
                        <td colspan="3">{{ 'labels.mammo.ooforectomia'|trans([],'LocalizationBundle') }}:</td>
                        <td><input id="dtc-ooforectomia" name="dtc-ooforectomia" class="form-control" type="text"></td>
                    </tr>
                    <tr>
                        <th colspan="4" style="text-align: center;" valign="middle">{{ 'labels.medicamentos.label'|trans([],'LocalizationBundle') }}</th>
                    </tr>
                    <tr>
                        <td colspan="2">{{ 'labels.mammo.terapiaHormonal'|trans([],'LocalizationBundle') }}</td>
                        <td>{{ 'labels.medicamentos.oral'|trans([],'LocalizationBundle') }}: <input  id="dtc-oral" value="oral-no" name="dtc-oral" type="checkbox"></td>
                        <td>{{ 'labels.medicamentos.parche'|trans([],'LocalizationBundle') }}: <input id="dtc-parche" value="parche-no" name="dtc-parche" type="checkbox"></td>
                    </tr>

                    <tr>
                        <td colspan="4">{{ 'labels.others'|trans([],'LocalizationBundle') }} {{ 'labels.medicamentos.label'|trans([],'LocalizationBundle') }}:&nbsp;&nbsp; <input id="dtc-medicamentos" value="medicamentos-no" name="dtc-medicamentos" type="checkbox"></td>
                    </tr>
                    <tr>
                        <td>{{ 'labels.mammo.previas'|trans([],'LocalizationBundle') }}:</td>
                        <td colspan="2">{{ 'labels.yes'|trans([],'LocalizationBundle') }}:&nbsp;&nbsp;<input id="dtc-mamoprevia-si" name="dtc-mamoprevia" value="mamoprevia-si" type="radio">&nbsp;&nbsp;
                        {{ 'labels.no'|trans([],'LocalizationBundle') }}:&nbsp;&nbsp;<input id="dtc-mamoprevia-no" name="dtc-mamoprevia" value="mamoprevia-no" type="radio" checked="checked"></td>
                        <td>{{ 'labels.date.normal'|trans([],'LocalizationBundle') }}:&nbsp;<input type="text" name="fecmamoprevia" id="fecmamoprevia" class="datepicker" style="display:none" /></td>
                    </tr>
                    <tr>
                        <td>{{ 'labels.mammo.USprevias'|trans([],'LocalizationBundle') }}:</td>
                        <td colspan="2">{{ 'labels.yes'|trans([],'LocalizationBundle') }}:&nbsp;&nbsp;<input id="dtc-ecoprevia-si" name="dtc-ecoprevia" value="ecoprevia-si" type="radio">&nbsp;&nbsp;
                            {{ 'labels.no'|trans([],'LocalizationBundle') }}:&nbsp;&nbsp;<input id="dtc-ecoprevia-no" name="dtc-ecoprevia" value="ecoprevia-no" type="radio" checked="checked"></td>
                        <td>{{ 'labels.date.normal'|trans([],'LocalizationBundle') }}:&nbsp;<input type="text" name="fececoprevia" id="fececoprevia" class="datepicker" style="display:none" /></td>
                    </tr>
                    <tr>{# agregado clinica la mujer #}
                        <th colspan="4" style="text-align:center;">{{ 'labels.mammo.diagCancer'|trans([],'LocalizationBundle') }}</th>
                    </tr>
                    <tr>{# agregado clinica la mujer #}
                        <td colspan="2">
                            {{ 'labels.yes'|trans([],'LocalizationBundle') }} &nbsp;&nbsp;<input id="dtc-diagcancer-si" name="dtc-diagcancer" value="diagcancer-si" type="radio">&nbsp;&nbsp;
                            {{ 'labels.no'|trans([],'LocalizationBundle') }} &nbsp;&nbsp;<input id="dtc-diagcancer-no" name="dtc-diagcancer" value="diagcancer-no" type="radio" checked="checked"></td>
                        <td>{{ 'labels.mammo.organo'|trans([],'LocalizationBundle') }}:&nbsp;<input type="text" name="organocancer" id="organocancer" class="form-control"/></td>
                        <td>{{ 'labels.patient.age'|trans([],'LocalizationBundle') }}:&nbsp;<input type="text" name="edadcancer" id="edadcancer" class="form-control"/></td>
                    </tr>
                    {# campo agregado clinica de la mujer#}
                    <tr>
                        <th colspan="4" style="text-align: center;" valign="middle">{{ 'labels.actRecibe.label'|trans([],'LocalizationBundle') }}:</th>
                    </tr>
                    <tr>
                        <td colspan="2">{{ 'labels.actRecibe.tamoxifeno'|trans([],'LocalizationBundle') }}: <input id="dtc-tamoxifeno" value="tamoxifeno-no" name="dtc-tamoxifeno" type="checkbox"> </td>
                        <td>{{ 'labels.actRecibe.aromasin'|trans([],'LocalizationBundle') }}: <input id="dtc-aromasin" value="aromasin-no" name="dtc-aromasin" type="checkbox"> </td>
                        <td>{{ 'labels.actRecibe.femara'|trans([],'LocalizationBundle') }}: <input id="dtc-femara" value="femara-no" name="dtc-femara" type="checkbox"> </td>
                    </tr>
                     <tr>{# agregado clinica la mujer #}
                        <th colspan="4" style="text-align:center;">{{ 'labels.mammo.cirugiaSeno'|trans([],'LocalizationBundle') }}</th>
                    </tr>
                    <tr>{# agregado clinica la mujer #}
                        <td colspan="2">{{ 'labels.yes'|trans([],'LocalizationBundle') }} &nbsp;&nbsp;<input id="dtc-cirugiaseno-si" name="dtc-cirugiaseno" value="cirugiaseno-si" type="radio">&nbsp;&nbsp;
                        {{ 'labels.no'|trans([],'LocalizationBundle') }} &nbsp;&nbsp;<input id="dtc-cirugiaseno-no" name="dtc-cirugiaseno" value="cirugiaseno-no" type="radio" checked="checked"></td>
                        <td colspan="2">{{ 'labels.especifique'|trans([],'LocalizationBundle') }}:<textarea id="dtc-espcirugia" class="form-control" rows="2" name="espcirugia-seno" style="resize:none;"></textarea></td>

                    </tr>
                    <tr>
                        <td colspan="2">{{ 'labels.mammo.marcaAxila'|trans([],'LocalizationBundle') }}</td>
                        <td>{{ 'labels.yes'|trans([],'LocalizationBundle') }}&nbsp; <input id="dtc-marcaxila-si" name="dtc-marcaxila" value="marcaxila-si" type="radio"></td>
                        <td>{{ 'labels.no'|trans([],'LocalizationBundle') }}&nbsp; <input id="dtc-marcaxila-no" name="dtc-marcaxila" value="marcaxila-no" type="radio" checked="checked"></td>
                    </tr>
                    <tr>
                        <th colspan="4">(*){{ 'labels.patient.clinicalData'|trans([],'LocalizationBundle') }} {{ 'labels.mammo.reportados'|trans([],'LocalizationBundle') }}:</th>
                    </tr>
                    <tr>
                        <td colspan="4"><textarea id="dtc-reportados" name="dtc-reportados" class="required form-control" rows="3" style="resize:none;"></textarea></td>
                    </tr>
                    <tr>
                        <td></td>
                        <th align="center">{{ 'labels.yes'|trans([],'LocalizationBundle') }}</th>
                        <th align="center">{{ 'labels.no'|trans([],'LocalizationBundle') }}</th>
                        <th align="center">{{ 'labels.mammo.ciclos'|trans([],'LocalizationBundle') }}</th>
                    </tr>
                    <tr>
                        <td style="text-align: center;">{{ 'labels.mammo.radio'|trans([],'LocalizationBundle') }}</td>
                        <td style="text-align: center;"><input id="dtc-radioterapia-si" name="dtc-radioterapia" value="radioterapia-si" type="radio"></td>
                        <td style="text-align: center;"><input id="dtc-radioterapia-no" name="dtc-radioterapia" value="radioterapia-no" type="radio" checked="checked"></td>
                        <td style="text-align: center;"><input id="dtc-ciclosRadioterapia" name="dtc-ciclosRadioterapia" class="form-control" type="text"></td>
                    </tr>
                    <tr>
                        <td style="text-align: center;">{{ 'labels.mammo.quimio'|trans([],'LocalizationBundle') }}</td>
                        <td style="text-align: center;"><input id="dtc-quimioterapia-si" name="dtc-quimioterapia" value="quimioterapia-si" type="radio"></td>
                        <td style="text-align: center;"><input id="dtc-quimioterapia-no" name="dtc-quimioterapia" value="quimioterapia-no" type="radio" checked="checked"></td>
                        <td style="text-align: center;"><input id="dtc-ciclosRadioterapia2" name="dtc-ciclosRadioterapia2" class="form-control" type="text"></td>
                    </tr>
                </tbody>
            </table>
        </div>
        <div class="col-md-4">
            <table class="table table-condensed table-bordered table-mammo" style="width:100%;font-size:12px;">
                <thead>
                    <tr>
                        <th style="text-align: center;" colspan="3">{{ 'labels.mammo.cancerSenoFlia'|trans([],'LocalizationBundle') }}:</th>
                        <th style="text-align: center;">{{ 'labels.patient.age'|trans([],'LocalizationBundle') }}</th>
                    </tr>
                </thead>
                <tbody>
                    <tr>
                        <td colspan="3">{{ 'labels.patient.flia.abuela'|trans([],'LocalizationBundle') }} (*):</td>
                        <td><input id="dtc-abuela" name="dtc-abuela" class="required form-control" type="text"></td>
                    </tr>
                    <tr>
                        <td colspan="3">{{ 'labels.patient.flia.madre'|trans([],'LocalizationBundle') }} (*):</td>
                        <td><input id="dtc-madre" name="dtc-madre" class="required form-control" type="text"></td>
                    </tr>
                    <tr>
                        <td colspan="3">{{ 'labels.patient.flia.hermana'|trans([],'LocalizationBundle') }} (*):</td>
                        <td><input id="dtc-hermana" name="dtc-hermana" class="required form-control" type="text"></td>
                    </tr>
                    <tr>
                        <td colspan="3">{{ 'labels.patient.flia.hijas'|trans([],'LocalizationBundle') }} (*):</td>
                        <td><input id="dtc-hijas" name="dtc-hijas" class="required form-control" type="text"></td>
                    </tr>
                    <tr>
                        <td colspan="3">{{ 'labels.patient.flia.tias'|trans([],'LocalizationBundle') }} (*):</td>
                        <td><input id="dtc-tias" name="dtc-tias" class="required form-control" type="text"></td>
                    </tr>
                    <tr>{# campo agregado clinica la mujer #}
                        <td colspan="3">{{ 'labels.patient.flia.primas'|trans([],'LocalizationBundle') }}:</td>
                        <td><input id="dtc-primas" name="dtc-primas" class="form-control" type="text"></td>
                    </tr>
                    <tr>
                        <th style="text-align: center;" colspan="4">{{ 'labels.embarazos.label'|trans([],'LocalizationBundle') }}</th>
                    </tr>
                    <tr>
                        <td colspan="4" style="text-align: center;">
                            0:<input id="dtc-numero_embarazos-0" name="dtc-numero_embarazos" type="radio" value="numero_embarazos-0">
                            1:<input id="dtc-numero_embarazos-1" name="dtc-numero_embarazos" type="radio" value="numero_embarazos-1" checked="checked">
                            2:<input id="dtc-numero_embarazos-2" name="dtc-numero_embarazos" type="radio" value="numero_embarazos-2">
                            3:<input id="dtc-numero_embarazos-3" name="dtc-numero_embarazos" type="radio" value="numero_embarazos-3">
                            4:<input id="dtc-numero_embarazos-4" name="dtc-numero_embarazos" type="radio" value="numero_embarazos-4">
                            5:<input id="dtc-numero_embarazos-5" name="dtc-numero_embarazos" type="radio" value="numero_embarazos-5">
                            6:<input id="dtc-numero_embarazos-6" name="dtc-numero_embarazos" type="radio" value="numero_embarazos-6">
                            7:<input id="dtc-numero_embarazos-7" name="dtc-numero_embarazos" type="radio" value="numero_embarazos-7">
                            8:<input id="dtc-numero_embarazos-8" name="dtc-numero_embarazos" type="radio" value="numero_embarazos-8">
                            9:<input id="dtc-numero_embarazos-9" name="dtc-numero_embarazos" type="radio" value="numero_embarazos-9">
                            10:<input id="dtc-numero_embarazos-10" name="dtc-numero_embarazos" type="radio" value="numero_embarazos-10">
                            +:<input id="dtc-numero_embarazos-mas" name="dtc-numero_embarazos" type="radio" value="numero_embarazos-mas">
                        </td>
                    </tr>
                    <tr>
                        <td colspan="3">{{ 'labels.embarazos.edad'|trans([],'LocalizationBundle') }}:</td>
                        <td><input id="dtc-primer_parto" class="form-control" name="dtc-primer_parto" type="text"> </td>
                    </tr>
                    <tr>
                        <td colspan="2">{{ 'labels.embarazos.lactancia'|trans([],'LocalizationBundle') }}:</td>
                        <td>{{ 'labels.yes'|trans([],'LocalizationBundle') }}:&nbsp;<input id="dtc-lactancia-si" name="dtc-lactancia" value="lactancia-si" type="radio"></td>
                        <td>{{ 'labels.no'|trans([],'LocalizationBundle') }}:&nbsp;<input id="dtc-lactancia-no" name="dtc-lactancia" value="lactancia-no" type="radio" checked="checked"></td>
                    </tr>
                    {# campo agregado clinica la mujer #}
                    <tr>
                        <td colspan="3">{{ 'labels.embarazos.tiempo'|trans([],'LocalizationBundle') }}:</td>
                        <td><input name="tiempolactancia" id="tiempolactancia" class="form-control"></td>
                    </tr>
                    <tr>
                        <th style="text-align: center;" colspan="4">{{ 'labels.mammo.tecnica.label'|trans([],'LocalizationBundle') }}:</th>
                    </tr>
                    <tr>
                        <td colspan="4">{{ 'labels.mammo.tecnica.craneo'|trans([],'LocalizationBundle') }}</td>
                    </tr>
                    <tr>
                        <td>{{ 'labels.mas'|trans([],'LocalizationBundle') }} (*):</td>
                        <td><input id="dtc-mAs_caudal" name="dtc-mAs_caudal" class="required form-control" type="text"></td>
                        <td>{{ 'labels.kv'|trans([],'LocalizationBundle') }} (*):</td>
                        <td><input id="dtc-Kv_caudal" name="dtc-Kv_caudal" class="required form-control" type="text"></td>
                    </tr>
                    <tr>
                        <td colspan="4">{{ 'labels.mammo.tecnica.Oblicua'|trans([],'LocalizationBundle') }}</td>
                    </tr>
                    <tr>
                        <td>{{ 'labels.mas'|trans([],'LocalizationBundle') }} (*):</td>
                        <td><input id="dtc-mAs_oblicua" name="dtc-mAs_oblicua" class="required form-control" type="text"></td>
                        <td>{{ 'labels.kv'|trans([],'LocalizationBundle') }} (*):</td>
                        <td><input id="dtc-Kv_oblicua" name="dtc-Kv_oblicua" class="required form-control" type="text"></td>
                    </tr>
                    <tr>
                        <td colspan="4">
                            {# Creación y generación de canvas #}
                            <div id="sketchpadapp">
                                <div class="rightside">
                                    <canvas id="sketchpad" height="200" width="333">
                                    </canvas>
                                </div>
                            </div>
                            {# imagen que se genera #}
                            <div class="leftside" style="display: none">
                                <img id="canvasimg">
                            </div>
                            {# limpiar elementos flotantes #}
                            <div class="clearfix">

                                {# Botones limpiar y guardar #}
                                <div class="botones">
                                    <span href="#" id="limpiar" class="ui-button ui-widget ui-state-default ui-corner-all ui-button-text-only" role="button" aria-disabled="false" style="visibility: visible;" onclick="clearCanvas(canvas,ctx);">
                                        <span class="ui-button-text btn btn-default">{{ 'button.delete'|trans([],'LocalizationBundle') }}</span>
                                    </span>
                                </div>
                            </div>
                        </td>
                    </tr>
                </tbody>
            </table>
        </div>
    </div>
    </div>
    <div class="clearfix"></div>

{% endblock %}