document.write("<table border=0 cellspacing=0 cellpadding=2>");
document.write("<form action=\"/support/vote.asp?action=ballot&id=1\" method=post>");
document.write("<tr><td align=center height=25><font class=blue><b>服务需求<b></font></td></tr>");

document.write("<tr><td><input type=checkbox class=normal name=dataid value=2>医疗</td></tr>");

document.write("<tr><td><input type=checkbox class=normal name=dataid value=3>预防</td></tr>");

document.write("<tr><td><input type=checkbox class=normal name=dataid value=4>保健</td></tr>");

document.write("<tr><td><input type=checkbox class=normal name=dataid value=5>计划生育技术指导</td></tr>");

document.write("<tr><td><input type=checkbox class=normal name=dataid value=6>康复</td></tr>");

document.write("<tr><td><input type=checkbox class=normal name=dataid value=7>健康教育</td></tr>");

document.write("<tr><td align=center height=25><input type=submit name=_sbt class=btn value=投一票>&nbsp;&nbsp;<a href=\"/support/vote.asp?action=view&id=1\">查看结果</a></td></tr>");
document.write("</form></table>");