document.write("  <div class=\"list_list\"><h2 class=\"gh_h2\">预约挂号</h2><p class=\"gh_p\">预约挂号让看病更方便，濉溪县中医医院全心为您服务，祝您早日康复！</p><div class=\"form_gh\"><form method=\"post\" action=\"https://sxxzyyy.com/index.php?m=formguide&c=index&a=show&formid=15&siteid=1\" name=\"myform\" id=\"myform\"><ul><li>  <label > 姓名:</label>  <input type=\"text\" name=\"info[mane]\" id=\"mane\" size=\"50\" value=\"\"  class=\"input-text\"  >  </li><li>  <label > 身份证号:</label>  <input type=\"text\" name=\"info[IDcard]\" id=\"IDcard\" size=\"50\" value=\"\"  class=\"input-text\"  >  </li><li>  <label > 电话:</label>  <input type=\"text\" name=\"info[dianhua]\" id=\"dianhua\" size=\"50\" value=\"\"  class=\"input-text\"  >  </li><li>  <label > 时间:</label>  <link rel=\"stylesheet\" type=\"text/css\" href=\"https://sxxzyyy.com/statics/js/calendar/jscal2.css\"/><link rel=\"stylesheet\" type=\"text/css\" href=\"https://sxxzyyy.com/statics/js/calendar/border-radius.css\"/><link rel=\"stylesheet\" type=\"text/css\" href=\"https://sxxzyyy.com/statics/js/calendar/win2k.css\"/><script type=\"text/javascript\" src=\"https://sxxzyyy.com/statics/js/calendar/calendar.js\"></script><script type=\"text/javascript\" src=\"https://sxxzyyy.com/statics/js/calendar/lang/en.js\"></script><input type=\"text\" name=\"info[time]\" id=\"time\" value=\"\" size=\"21\" class=\"date\" readonly>&nbsp;<script type=\"text/javascript\">Calendar.setup({weekNumbers: true,    inputField : \"time\",    trigger    : \"time\",    dateFormat: \"%Y-%m-%d %H:%M:%S\",    showTime: true,    minuteStep: 1,    onSelect   : function() {this.hide();}});        </script>  </li><li>  <label > 科室名称:</label>  <select name=\'info[keshi]\' id=\'keshi\'><option value=\"外一科（普外科）\" >外一科（普外科）</option><option value=\"外二科（泌尿外科 创伤科）\" >外二科（泌尿外科 创伤科）</option><option value=\"内二科（肿瘤 血液科）\" >内二科（肿瘤 血液科）</option><option value=\"内三科（呼吸 消化科）\" >内三科（呼吸 消化科）</option><option value=\"内四科（肾病 内分泌科）\" >内四科（肾病 内分泌科）</option></select>  </li><li>  <label > 专家:</label>  <input type=\"text\" name=\"info[zhuanjia]\" id=\"zhuanjia\" size=\"50\" value=\"\"  class=\"input-text\"  >  </li><li>  <label > 病情描述:</label>  <textarea name=\'info[miaoshu]\' id=\'miaoshu\' style=\'width:100%%;height:46px;\'   ></textarea>  </li><li style=\"overflow: hidden;\"><label style=\"text-align:left; float: left; \">验证码:</label><div class=\"fl\"><span title=\"点击更换验证码\" style=\" cursor:pointer;\"><input type=\"text\" id=\"code\" name=\"code\" size=\"8\" class=\"input-text\"><img id=\'code_img\' onclick=\'this.src=this.src+\"&\"+Math.random()\' src=\'https://sxxzyyy.com/api.php?op=checkcode&code_len=4&font_size=14&width=100&height=30&font_color=&background=\'></span></div></li>  </ul>  <input  class=\"tj_btn\" type=\"submit\" name=\"dosubmit\" id=\"dosubmit\" value=\" 提交 \"></form></div><p class=\"gh_p\">本院将认真保护患者的隐私，请放心预约！</p>     </div>");