Customize form (DataSet)

Dear All,

I have the problem in DHIS2 about the customize data entry form (Data set).

You can see my problem in this attached image.

Here is my html and javaScript code:

*

UR: 

Data elements Values Tariff
OPD under 5 years
* Please give me a hand??? (._.) Viengthong CHONGWAXIONG Software Developer (Java technology) Tel: +85620 91132319 Email: v.chongwaxiong@gmail.com/gerxiong@softwarelao.com GIXON Team ![image](upload://xBiVExvndSKdk1BnPfzjgBah7vC.png)