contrib/forms/xmlformgen/history_form.xml

   1 <?xml version="1.0" encoding="ISO-8859-1"?>
   2     <!-- Generated by Hand -->
   3 <form>
   4     <table type="form">form_history</table>
   5     <RealName>History Form</RealName>
   6     <safename>history_form</safename>
   7     <style cells_per_row="4">layout</style>
   8     <acl table="patients">med</acl>
   9
  10     <manual>
  11            <section name="patient_particulars" label="Patient Particulars">
  12                         <field name="pt_name" label="Patient Name" type="textfield" size="30" maxlength="255" hoverover="" labelcols="1" cols="1"/>
  13                 <field name="date_visit" label="Date of Visit" type="date" labelcols="1" cols="1"/>
  14                     <field name="pt_age" label="Age" type="textfield" size="10" maxlength="255" hoverover="" labelcols="1" cols="1"/>
  15                         <field name="pt_respo" label="Respondent" type="dropdown_list" size="20" list="Respondent" hoverover="" maxlength="255" labelcols="1" cols="1"/>
  16                         <field name="pt_rel" label="Relation to Patient" type="dropdown_list" size="20" list="Relationship_list" hoverover="" maxlength="255" labelcols="1" cols="1"/>
  17                         <field name="pt_dem" label="Demographics Complete" type="dropdown_list" size="20" list="yesno" hoverover="" maxlength="255" labelcols="1" cols="1"/>
  18                 </section>
  19
  20                 <section name="history_proper" label="History Proper">
  21                         <field name="ch_comp" label="Chief Complaints" type="textarea" hoverover="" columns="50" labelcols="1" cols="1"/>
  22                         <field name="pr_his" label="Present History" type="textarea" hoverover="" columns="50" labelcols="1" cols="1"/>
  23                     <field name="past_his" label="Past History" type="textarea" hoverover="" columns="50" labelcols="1" cols="3"/>
  24                 </section>
  25
  26                 <section name="pers_his" label="Personal History">
  27                         <field name="sleep" label="Sleep" type="textfield" size="30" maxlength="255" hoverover="" labelcols="1" cols="1"/>
  28                         <field name="appetite" label="Appetite" type="textfield" size="30" maxlength="255" hoverover="" labelcols="1" cols="1"/>
  29                         <field name="addiction" label="Addiction" type="dropdown_list" size="20" list="addiction_status" hoverover="" maxlength="255" labelcols="1" cols="1"/>
  30                         <field name="bowel_habit" label="Bowel Habit" type="textfield" size="30" maxlength="255" hoverover="" labelcols="1" cols="1"/>
  31                         <field name="bladder_habit" label="Bladder Habit" type="textfield" size="30" maxlength="255" hoverover="" labelcols="1" cols="1"/>
  32                 </section>
  33
  34                 <section name="other_history" label="Other History">
  35                     <field name="fam_his" label="Family History" type="checkbox_list" list="hist_take" hoverover="" labelcols="1" cols="1"/>
  36                         <field name="soc_his" label="Socioeconomic History" type="checkbox_list" list="hist_take" hoverover="" labelcols="1" cols="1"/>
  37                         <field name="trt_his" label="Treatment History" type="textarea" hoverover="" columns="60" labelcols="1" cols="1"/>
  38                 </section>
  39
  40                 <section name="misc" label="Miscellaneous">
  41                     <field name="next_visit" label="Follow Up Needed" type="dropdown_list" size="20" list="yesno" hoverover="" maxlength="255" labelcols="1" cols="1"/>
  42                         <field name="app_done" Label="Appointment Done" type="dropdown_list" size="20" list="yesno" hoverover="" maxlength="255" labelcols="1" cols="1"/>
  43                         <field name="follow_date" label="Follow up date" type="date" labelcols="1" cols="1"/>
  44                 </section>
  45
  46         </manual>
  47
  48         <list id="addiction_status" name="addiction_status" label="Addiction Status" type="standard" import="yes">
  49             <listitem id='1' label="Smoker for 1 to 5 years" order='1'>Smoker for 1 to 5 years</listitem>
  50                 <listitem id='2' label="Smoker for 6 to 10 years" order='2'>Smoker for 6 to 10 years</listitem>
  51                 <listitem id='3' label="Smoker for 11 to 15 years" order='3'>Smoker for 11 to 15 years</listitem>
  52                 <listitem id='4' label="Smoker for 16 to 20 years" order='4'>Smoker for 16 to 20 years</listitem>
  53                 <listitem id='5' label="Smoker for 21 to 25 years" order='5'>Smoker for 21 to 25 years</listitem>
  54                 <listitem id='6' label="Smoker for more than 25 years" order='6'>Smoker for more than 25 years</listitem>
  55                 <listitem id='7' label="Alcohol occassionally" order='7'>Alcohol occassionally</listitem>
  56                 <listitem id='8' label="Alcohol frequently" order='8'>Alcohol frequently</listitem>
  57                 <listitem id='9' label="Alcohol for more than 8 years" order='9'>Alcohol for more than 8 years</listitem>
  58                 <listitem id='10' label="Beetel Leaf" order='10'>Beetel Leaf</listitem>
  59                 <listitem id='11' label="Chewing Tobacco" order='11'>Chewing Tobacco</listitem>
  60                 <listitem id='12' label="No Addiction" order='12'>No Addiction</listitem>
  61         </list>
  62
  63         <list id="hist_take" name="hist_take" label="History Taken" type="standard" import="yes">
  64                 <listitem id='1' label="In Demographics History Section" order='1'>In Demographics History Section</listitem>
  65                 <listitem id='2' label="Not In Demographics History Section" order='2'>Not In Demographics History Section</listitem>
  66         </list>
  67
  68         <list name="yesno" label="Yes/No" type="standard" id="yesno" import="no"/>
  69         <list name="Respondent" label="Respondent" type="standard" id="Respondent" import="no"/>
  70         <list name="Relationship_list" label="Relationship List" type="standard" id="Relationship_list" import="no"/>
  71 </form>
  72
  73