@charset "utf-8";
/* CSS Document */

body {
	margin: 0px;
	margin-bottom:0;
	margin-top:0;
	margin-left:0;
	margin-right:0;
	height:950px;
}

/* ***************************************************** */

div#image {
position:absolute;
top:0px;
left: 0px;
margin-bottom:0px;
margin-top:0px;
margin-left:0px;
margin-right:0px;
width: 1280px;
height: 1632px;
margin-left:0px;
margin-top: 0px;
z-index:0;

}

div#form {
position:absolute;
top:0px;
left: 0px;
margin-bottom:0px;
margin-top:0px;
margin-left:0px;
margin-right:0px;
z-index:1;

}

/* ******************************************************* */
input {
	font-family: "Times New Roman", Times, serif
	font-size: 12px;
	color: #000000;
    /*background-color:#0099CC;*/
	border-top-style: none;
	border-right-style: none;
	border-bottom-style: none;
	border-left-style: none;
	border-top-width: 0px;
	border-right-width: 0px;
	border-bottom-width: 0px;
	border-left-width: 0px;
	text-align: left;
	height: 12px;
}


/* ******************************************************* */

.f01 {
	position:absolute;
	top: 120px;
	left: 35px;
	width: 213px;
}

.f02 {
	position:absolute;
	top: 120px;
	left: 330px;
	width: 15px;
}

.f03 {
	position:absolute;
	top: 120px;
	left: 356px;
	width: 15px;
}

.f04 {
	position:absolute;
	top: 120px;
	left: 381px;
	width: 15px;
}

.f05 {
	position:absolute;
	top: 120px;
	left: 486px;
	width: 15px;
}

.f06 {
	position:absolute;
	top: 120px;
	left: 511px;
	width: 15px;
}

.f07 {
	position:absolute;
	top: 120px;
	left: 534px;
	width: 15px;
}

.f08 {
	position:absolute;
	top: 120px;
	left: 584px;
	width: 30px;
}

.cb1 {
	position:absolute;
	top: 126px;
	left: 649px;
	width: 7px;
	height: 7px;
}

.cb2 {
	position:absolute;
	top: 126px;
	left: 678px;
	width: 7px;
	height: 7px;
}

.f09 {
	position:absolute;
	top: 137px;
	left: 174px;
	width: 113px;
}
.cb3 {
	position:absolute;
	top: 144px;
	left: 348px;
	width: 7px;
	height: 7px;
}
.cb4 {
	position:absolute;
	top: 144px;
	left: 413px;
	width: 7px;
	height: 7px;
}
.cb5 {
	position:absolute;
	top: 144px;
	left: 465px;
	width: 7px;
	height: 7px;
}
.f10 {
	position:absolute;
	top: 137px;
	left: 582px;
	width: 111px;
}

.f11 {
	position:absolute;
	top: 156px;
	left: 104px;
	width: 575px;
}

.f12 {
	position:absolute;
	top: 173px;
	left: 133px;
	width: 544px;
}

.f13 {
	position:absolute;
	top: 190px;
	left: 87px;
	width: 585px;
}

.f14 {
	position:absolute;
	top: 209px;
	left: 175px;
	width: 496px;
}

.cb6 {
	position:absolute;
	top: 233px;
	left: 147px;
	width: 7px;
	height: 7px;
}

.cb7 {
	position:absolute;
	top: 233px;
	left: 179px;
	width: 7px;
	height: 7px;
}

.f15 {
	position:absolute;
	top: 226px;
	left: 269px;
	width: 96px;
}

.f16 {
	position:absolute;
	top: 226px;
	left: 400px;
	width: 256px;
}

.cb8 {
	position:absolute;
	top: 250px;
	left: 89px;
	width: 7px;
	height: 7px;
}

.cb9 {
	position:absolute;
	top: 250px;
	left: 121px;
	width: 7px;
	height: 7px;
}

.f17 {
	position:absolute;
	top: 244px;
	left: 210px;
	width: 49px;
}

.cb10 {
	position:absolute;
	top: 250px;
	left: 268px;
	width: 7px;
	height: 7px;
}

.cb11 {
	position:absolute;
	top: 250px;
	left: 407px;
	width: 7px;
	height: 7px;
}

.f18 {
	position:absolute;
	top: 244px;
	left: 460px;
	width: 183px;
}

.cb12 {
	position:absolute;
	top: 313px;
	left: 94px;
	width: 7px;
	height: 7px;
}

.cb13 {
	position:absolute;
	top: 325px;
	left: 94px;
	width: 7px;
	height: 7px;
}

.cb14 {
	position:absolute;
	top: 337px;
	left: 94px;
	width: 7px;
	height: 7px;
}

.f19 {
	position:absolute;
	top: 331px;
	left: 129px;
	width: 54px;
}

.cb15 {
	position:absolute;
	top: 349px;
	left: 94px;
	width: 7px;
	height: 7px;
}

.cb16 {
	position:absolute;
	top: 313px;
	left: 279px;
	width: 7px;
	height: 7px;
}

.cb17 {
	position:absolute;
	top: 325px;
	left: 279px;
	width: 7px;
	height: 7px;
}

.cb18 {
	position:absolute;
	top: 337px;
	left: 279px;
	width: 7px;
	height: 7px;
}

.cb19 {
	position:absolute;
	top: 349px;
	left: 279px;
	width: 7px;
	height: 7px;
}

.cb20 {
	position:absolute;
	top: 313px;
	left: 372px;
	width: 7px;
	height: 7px;
}

.cb21 {
	position:absolute;
	top: 325px;
	left: 372px;
	width: 7px;
	height: 7px;
}

.cb22 {
	position:absolute;
	top: 337px;
	left: 372px;
	width: 7px;
	height: 7px;
}

.f20 {
	position:absolute;
	top: 331px;
	left: 407px;
	width: 54px;
}

.cb23 {
	position:absolute;
	top: 349px;
	left: 372px;
	width: 7px;
	height: 7px;
}

.cb24 {
	position:absolute;
	top: 313px;
	left: 557px;
	width: 7px;
	height: 7px;
}

.cb25 {
	position:absolute;
	top: 325px;
	left: 557px;
	width: 7px;
	height: 7px;
}

.cb26 {
	position:absolute;
	top: 337px;
	left: 557px;
	width: 7px;
	height: 7px;
}

.f21 {
	position:absolute;
	top: 384px;
	left: 247px;
	width: 446px;
}

.f22 {
	position:absolute;
	top: 420px;
	left: 136px;
	width: 556px;
}
/* SKIN */
.cb27 {
	position:absolute;
	top: 455px;
	left: 8px;
	width: 7px;
	height: 7px;
}

.cb28 {
	position:absolute;
	top: 467px;
	left: 8px;
	width: 7px;
	height: 7px;
}

.f23 {
	position:absolute;
	top: 464px;
	left: 91px;
	height:10px;
	font-size:10px;
	width: 66px;
}

.cb29 {
	position:absolute;
	top: 479px;
	left: 8px;
	width: 7px;
	height: 7px;
}

.cb30 {
	position:absolute;
	top: 491px;
	left: 8px;
	width: 7px;
	height: 7px;
}

/* INFECTIONS */

.cb31 {
	position:absolute;
	top: 514px;
	left: 8px;
	width: 7px;
	height: 7px;
}

.cb32 {
	position:absolute;
	top: 526px;
	left: 8px;
	width: 7px;
	height: 7px;
}

.cb33 {
	position:absolute;
	top: 538px;
	left: 8px;
	width: 7px;
	height: 7px;
}

.cb34 {
	position:absolute;
	top: 550px;
	left: 8px;
	width: 7px;
	height: 7px;
}

.cb35 {
	position:absolute;
	top: 562px;
	left: 8px;
	width: 7px;
	height: 7px;
}

.cb36 {
	position:absolute;
	top: 574px;
	left: 8px;
	width: 7px;
	height: 7px;
}

.cb37 {
	position:absolute;
	top: 586px;
	left: 8px;
	width: 7px;
	height: 7px;
}

.f24 {
	position:absolute;
	top: 582px;
	left: 45px;
	width: 116px;
	height:10px;
	font-size:10px;
}

/* CONSTITUTIONAL SYMPTOMS */

.cb38 {
	position:absolute;
	top: 609px;
	left: 8px;
	width: 7px;
	height: 7px;
}

.cb39 {
	position:absolute;
	top: 621px;
	left: 8px;
	width: 7px;
	height: 7px;
}

.cb40 {
	position:absolute;
	top: 633px;
	left: 8px;
	width: 7px;
	height: 7px;
}

.cb41 {
	position:absolute;
	top: 645px;
	left: 8px;
	width: 7px;
	height: 7px;
}

.cb42 {
	position:absolute;
	top: 657px;
	left: 8px;
	width: 7px;
	height: 7px;
}

.f25 {
	position:absolute;
	top: 653px;
	left: 45px;
	width: 116px;
	height:10px;
	font-size:10px;
}

/* CARDIOVASCULAR */

.cb43 {
	position:absolute;
	top: 455px;
	left: 182px;
	width: 7px;
	height: 7px;
}

.cb44 {
	position:absolute;
	top: 467px;
	left: 182px;
	width: 7px;
	height: 7px;
}

.cb45 {
	position:absolute;
	top: 479px;
	left: 182px;
	width: 7px;
	height: 7px;
}

.cb46 {
	position:absolute;
	top: 491px;
	left: 182px;
	width: 7px;
	height: 7px;
}

.cb47 {
	position:absolute;
	top: 502px;
	left: 182px;
	width: 7px;
	height: 7px;
}


.cb48 {
	position:absolute;
	top: 514px;
	left: 182px;
	width: 7px;
	height: 7px;
}

.cb49 {
	position:absolute;
	top: 526px;
	left: 182px;
	width: 7px;
	height: 7px;
}

.cb50 {
	position:absolute;
	top: 538px;
	left: 182px;
	width: 7px;
	height: 7px;
}

.cb51 {
	position:absolute;
	top: 550px;
	left: 182px;
	width: 7px;
	height: 7px;
}

.f26 {
	position:absolute;
	top: 544px;
	left: 280px;
	width: 54px;
	height:10px;
	font-size:10px;
}

.cb52 {
	position:absolute;
	top: 562px;
	left: 182px;
	width: 7px;
	height: 7px;
}

.cb53 {
	position:absolute;
	top: 574px;
	left: 182px;
	width: 7px;
	height: 7px;
}

.f27 {
	position:absolute;
	top: 570px;
	left: 219px;
	width: 115px;
	height:10px;
	font-size:10px;
}

/* ENDOCRINE */

.cb54 {
	position:absolute;
	top: 598px;
	left: 182px;
	width: 7px;
	height: 7px;
}

.cb55 {
	position:absolute;
	top: 610px;
	left: 182px;
	width: 7px;
	height: 7px;
}

.cb56 {
	position:absolute;
	top: 622px;
	left: 182px;
	width: 7px;
	height: 7px;
}

.cb57 {
	position:absolute;
	top: 634px;
	left: 182px;
	width: 7px;
	height: 7px;
}
.cb58 {
	position:absolute;
	top: 646px;
	left: 182px;
	width: 7px;
	height: 7px;
}

.cb59 {
	position:absolute;
	top: 658px;
	left: 182px;
	width: 7px;
	height: 7px;
}

.f28 {
	position:absolute;
	top: 653px;
	left: 219px;
	width: 115px;
	height:10px;
	font-size:10px;
}

/* GASTROINTESTINAL*/

.cb60 {
	position:absolute;
	top: 455px;
	left: 355px;
	width: 7px;
	height: 7px;
}

.cb61 {
	position:absolute;
	top: 467px;
	left: 355px;
	width: 7px;
	height: 7px;
}

.cb62 {
	position:absolute;
	top: 479px;
	left: 355px;
	width: 7px;
	height: 7px;
}

.cb63 {
	position:absolute;
	top: 491px;
	left: 355px;
	width: 7px;
	height: 7px;
}

.cb64 {
	position:absolute;
	top: 503px;
	left: 355px;
	width: 7px;
	height: 7px;
}

.cb65 {
	position:absolute;
	top: 515px;
	left: 355px;
	width: 7px;
	height: 7px;
}

.f29 {
	position:absolute;
	top: 511px;
	left: 391px;
	width: 117px;
	height:10px;
	font-size:10px;
}

/* HEMATOLOGIC/LYMPH */

.cb66 {
	position:absolute;
	top: 538px;
	left: 355px;
	width: 7px;
	height: 7px;
}

.cb67 {
	position:absolute;
	top: 550px;
	left: 355px;
	width: 7px;
	height: 7px;
}

.cb68 {
	position:absolute;
	top: 562px;
	left: 355px;
	width: 7px;
	height: 7px;
}

.cb69 {
	position:absolute;
	top: 574px;
	left: 355px;
	width: 7px;
	height: 7px;
}

.cb70 {
	position:absolute;
	top: 586px;
	left: 355px;
	width: 7px;
	height: 7px;
}

.cb71 {
	position:absolute;
	top: 598px;
	left: 355px;
	width: 7px;
	height: 7px;
}

.f30 {
	position:absolute;
	top: 593px;
	left: 391px;
	width: 117px;
	height:10px;
	font-size:10px;
}

/* MUSCULOSKELETAL */

.cb72 {
	position:absolute;
	top: 621px;
	left: 355px;
	width: 7px;
	height: 7px;
}

.cb73 {
	position:absolute;
	top: 633px;
	left: 355px;
	width: 7px;
	height: 7px;
}

.cb74 {
	position:absolute;
	top: 645px;
	left: 355px;
	width: 7px;
	height: 7px;
}

.cb75{
	position:absolute;
	top: 657px;
	left: 355px;
	width: 7px;
	height: 7px;
}

.f31 {
	position:absolute;
	top: 652px;
	left: 391px;
	width: 117px;
	height:10px;
	font-size:10px;
}

/* NEUROLOGICAL */

.cb76{
	position:absolute;
	top: 455px;
	left: 533px;
	width: 7px;
	height: 7px;
}

.cb77{
	position:absolute;
	top: 467px;
	left: 533px;
	width: 7px;
	height: 7px;
}

.cb78{
	position:absolute;
	top: 479px;
	left: 533px;
	width: 7px;
	height: 7px;
}

.cb79{
	position:absolute;
	top: 491px;
	left: 533px;
	width: 7px;
	height: 7px;
}

.f32 {
	position:absolute;
	top: 487px;
	left: 569px;
	width: 117px;
	height:10px;
	font-size:10px;
}
/* PSYCHIATRIC*/

.cb80{
	position:absolute;
	top: 515px;
	left: 533px;
	width: 7px;
	height: 7px;
}

.cb81{
	position:absolute;
	top: 527px;
	left: 533px;
	width: 7px;
	height: 7px;
}

.cb82{
	position:absolute;
	top: 539px;
	left: 533px;
	width: 7px;
	height: 7px;
}

.cb83{
	position:absolute;
	top: 551px;
	left: 533px;
	width: 7px;
	height: 7px;
}

.f33 {
	position:absolute;
	top: 546px;
	left: 569px;
	width: 117px;
	height:10px;
	font-size:10px;
}

/* RESPIRATORY */

.cb84{
	position:absolute;
	top: 574px;
	left: 533px;
	width: 7px;
	height: 7px;
}

.cb85{
	position:absolute;
	top: 586px;
	left: 533px;
	width: 7px;
	height: 7px;
}

.cb86{
	position:absolute;
	top: 598px;
	left: 533px;
	width: 7px;
	height: 7px;
}

.cb87{
	position:absolute;
	top: 610px;
	left: 533px;
	width: 7px;
	height: 7px;
}

.f34 {
	position:absolute;
	top: 605px;
	left: 569px;
	width: 117px;
	height:10px;
	font-size:10px;
}

/* EARS / EYES / NOSE / THROAT */

.cb88{
	position:absolute;
	top: 633px;
	left: 533px;
	width: 7px;
	height: 7px;
}

.cb89{
	position:absolute;
	top: 645px;
	left: 533px;
	width: 7px;
	height: 7px;
}

.cb90{
	position:absolute;
	top: 657px;
	left: 533px;
	width: 7px;
	height: 7px;
}

.f35 {
	position:absolute;
	top: 653px;
	left: 569px;
	width: 117px;
	height:10px;
	font-size:10px;
}

/* PAST HISTORY */

.cb91{
	position:absolute;
	top: 681px;
	left: 354px;
	width: 7px;
	height: 7px;
}

.cb92{
	position:absolute;
	top: 681px;
	left: 386px;
	width: 7px;
	height: 7px;
}

.cb93{
	position:absolute;
	top: 681px;
	left: 505px;
	width: 7px;
	height: 7px;
}

.cb94{
	position:absolute;
	top: 681px;
	left: 559px;
	width: 7px;
	height: 7px;
}

.cb95{
	position:absolute;
	top: 707px;
	left: 184px;
	width: 7px;
	height: 7px;
}

.cb96{
	position:absolute;
	top: 707px;
	left: 216px;
	width: 7px;
	height: 7px;
}

.f36 {
	position:absolute;
	top: 701px;
	left: 306px;
	width: 107px;
}

.cb97{
	position:absolute;
	top: 725px;
	left: 95px;
	width: 7px;
	height: 7px;
}

.cb98{
	position:absolute;
	top: 725px;
	left: 137px;
	width: 7px;
	height: 7px;
}

.f37 {
	position:absolute;
	top: 720px;
	left: 170px;
	width: 523px;
}

.cb99{
	position:absolute;
	top: 743px;
	left: 223px;
	width: 7px;
	height: 7px;
}

.cb100{
	position:absolute;
	top: 743px;
	left: 256px;
	width: 7px;
	height: 7px;
}

.f38 {
	position:absolute;
	top: 737px;
	left: 360px;
	width: 209px;
}

.f39 {
	position:absolute;
	top: 737px;
	left: 607px;
	width: 87px;
}

.cb101{
	position:absolute;
	top: 762px;
	left: 114px;
	width: 7px;
	height: 7px;
}

.cb102{
	position:absolute;
	top: 762px;
	left: 147px;
	width: 7px;
	height: 7px;
}

.cb103{
	position:absolute;
	top: 762px;
	left: 210px;
	width: 7px;
	height: 7px;
}

.cb104{
	position:absolute;
	top: 762px;
	left: 313px;
	width: 7px;
	height: 7px;
}

.cb105{
	position:absolute;
	top: 762px;
	left: 355px;
	width: 7px;
	height: 7px;
}

.cb106{
	position:absolute;
	top: 762px;
	left: 404px;
	width: 7px;
	height: 7px;
}

.f40 {
	position:absolute;
	top: 755px;
	left: 438px;
	width: 256px;
}

.f41 {
	position:absolute;
	top: 772px;
	left: 309px;
	width: 385px;
}

.cb107{
	position:absolute;
	top: 819px;
	left: 175px;
	width: 7px;
	height: 7px;
}

.cb108{
	position:absolute;
	top: 819px;
	left: 218px;
	width: 7px;
	height: 7px;
}

.cb109{
	position:absolute;
	top: 819px;
	left: 281px;
	width: 7px;
	height: 7px;
}

.cb110{
	position:absolute;
	top: 819px;
	left: 342px;
	width: 7px;
	height: 7px;
}

.cb111{
	position:absolute;
	top: 819px;
	left: 421px;
	width: 7px;
	height: 7px;
}

.f42 {
	position:absolute;
	top: 813px;
	left: 459px;
	width: 234px;
}

.cb112{
	position:absolute;
	top: 851px;
	left: 179px;
	width: 7px;
	height: 7px;
}

.cb113{
	position:absolute;
	top: 851px;
	left: 229px;
	width: 7px;
	height: 7px;
}

.cb114{
	position:absolute;
	top: 851px;
	left: 308px;
	width: 7px;
	height: 7px;
}

.cb115{
	position:absolute;
	top: 851px;
	left: 365px;
	width: 7px;
	height: 7px;
}

.cb116{
	position:absolute;
	top: 851px;
	left: 472px;
	width: 7px;
	height: 7px;
}

.cb117{
	position:absolute;
	top: 851px;
	left: 504px;
	width: 7px;
	height: 7px;
}

.f43 {
	position:absolute;
	top: 845px;
	left: 615px;
	width: 75px;
}

.cb118{
	position:absolute;
	top: 878px;
	left: 44px;
	width: 7px;
	height: 7px;
}

.cb119{
	position:absolute;
	top: 878px;
	left: 76px;
	width: 7px;
	height: 7px;
}

.cb120{
	position:absolute;
	top: 878px;
	left: 126px;
	width: 7px;
	height: 7px;
}

.f44 {
	position:absolute;
	top: 871px;
	left: 217px;
	width: 44px;
}

.cb121{
	position:absolute;
	top: 878px;
	left: 279px;
	width: 7px;
	height: 7px;
}

.cb122{
	position:absolute;
	top: 878px;
	left: 318px;
	width: 7px;
	height: 7px;
}

.cb123{
	position:absolute;
	top: 878px;
	left: 360px;
	width: 7px;
	height: 7px;
}

.cb124{
	position:absolute;
	top: 878px;
	left: 450px;
	width: 7px;
	height: 7px;
}

.f45 {
	position:absolute;
	top: 890px;
	left: 514px;
	width: 178px;
}

.button {
	position:absolute;
	top: 940px;
	left: 314px;
	width: 65px;
	height:25px;
	font-family:"Times New Roman", Times, serif;
	font-size:14px;
	color:#000000;
	text-align:center;
}