contrib/forms/xmlformgen/vaginitis_soap.xml

   1 <?xml version="1.0" encoding="ISO-8859-1"?>
   2         <!-- Generated by Hand -->
   3 <form>
   4         <table type="form">form_vaginitis_soap</table>
   5         <RealName>Vaginitis Complaints</RealName>
   6         <safename>vaginitis_soap</safename>
   7         <style cells_per_row="2">layout</style>
   8         <acl table="patients">med</acl>
   9
  10         <manual>
  11
  12                 <section name="subjective" label="Subjective">
  13                         <field name="vaginitis_complaints" label="Vaginitis Complaints"
  14                                 type="checkbox_combo_list" list="Vaginitis_Complaints" size="140" maxlength="255"
  15                                 labelcols="1" cols="1" />
  16                         <field name="other" label="Other" type="textarea"
  17                                 columns="151" labelcols="1" cols="1" />
  18                         <field name="duration" label="Duration" type="textfield" size="163" maxlength="255" labelcols="1" cols="1"/>
  19
  20                 </section>
  21
  22                 <section name="objective" label="Objective">
  23                         <field name="objective_exam" label="Exam"
  24                                 type="checkbox_combo_list" list="Vaginitis_Exam" size="140" maxlength="255"
  25                                 labelcols="1" cols="1" />
  26                 </section>
  27
  28                 <section name="assessment" label="Assessment">
  29                         <field name="vaginitis" label="Vginitis" type="checkbox_combo_list"
  30                                 list="Vaginitis_Diagnosis" size="140"  maxlength="255" labelcols="1" cols="1" />
  31                 </section>
  32
  33                 <section name="plan" label="Plan">
  34                         <field name="plan_medications" label="Medications" type="checkbox_combo_list"
  35                                 list="Vaginitis_Medications" labelcols="1" cols="1" />
  36                         <field name="plan_behavior_modification" label="Behavior Modification" type="textarea"
  37                                 columns="151" labelcols="1" cols="1" />
  38                         <field name="plan_cultures" label="Cultures" type="checkbox_combo_list"
  39                                 list="Vaginitis_Cultures" labelcols="1" cols="1" />
  40                         <field name="plan_other" label="Other" type="textarea"
  41                                 columns="151" labelcols="1" cols="1" />
  42                 </section>
  43
  44         </manual>
  45
  46         <list name="proc_res_bool" label="Results" type="standard" id="proc_res_bool" import="no"/>
  47
  48         <list id="Vaginitis_Complaints" name="Vaginitis_Complaints" label="Vaginitis Complaints"
  49                 type="standard" import="yes">
  50                 <listitem id='1' label="Itching (pruritus)" order='1'>Itching (pruritus)</listitem>
  51                 <listitem id='2' label="Discharge (leukorrhea)" order='2'>Discharge (leukorrhea)</listitem>
  52                 <listitem id='3' label="Odor" order='3'>Odor</listitem>
  53                 <listitem id='4' label="Pain" order='4'>Pain</listitem>
  54                 <listitem id='6' label="Previous Cultures" order="6">Previous Cultures</listitem>
  55                 <listitem id='7' label="Previous Prescriptions" order="7">Previous Prescriptions</listitem>
  56                 <listitem id='8' label="Other" order='8'>Other</listitem>
  57         </list>
  58
  59         <list id="Vaginitis_Exam" name="Vaginitis_Exam" label="Vaginitis Exam"
  60                 type="standard" import="yes">
  61                 <listitem id='1' label="Vulvar" order="1">"Vulvar"</listitem>
  62                 <listitem id='2' label="Vaginal" order="2">Vaginal</listitem>
  63                 <listitem id='3' label="Cervix" order="3">Cervix</listitem>
  64                 <listitem id='4' label="Uterus" order="4">Uterus</listitem>
  65                 <listitem id='5' label="Adnexae" order="5">Adnexae</listitem>
  66                 <listitem id='6' label="Rectal" order="6">Rectal</listitem>
  67                 <listitem id='7' label="Other" order="7">Other</listitem>
  68         </list>
  69
  70         <list id="Vaginitis_Diagnosis" name="Vaginitis_Diagnosis" label="Vaginitis Diagnosis"
  71                 type="standard" import="yes">
  72                 <listitem id='1' label="Affirm" order="1">Affirm</listitem>
  73                 <listitem id='2' label="Yeast" order="2">Yeast</listitem>
  74                 <listitem id='3' label="Bacterial Vaginosis" order="3">Bacterial Vaginosis</listitem>
  75                 <listitem id='4' label="Vulvar Vaginitis" order="4">Vulvar Vaginitis</listitem>
  76                 <listitem id='5' label="Lichen Schlerosis" order="5">Lichen Schlerosis</listitem>
  77                 <listitem id='6' label="Atrophic Vaginitis" order="6">Atrophic Vaginitis</listitem>
  78                 <listitem id='7' label="Other" order="7">Other</listitem>
  79         </list>
  80
  81         <list id="Vaginitis_Medications" name="Vaginitis_Medications"
  82                 label="Vaginitis Medications" type="standard" import="yes">
  83                 <listitem id='1' label="Estrace Cream" order="1">Estrace Cream</listitem>
  84                 <listitem id='2' label="Flagyl" order="2">Flagyl</listitem>
  85                 <listitem id='3' label="Terazol-3" order="3">Terazol-3</listitem>
  86                 <listitem id='4' label="Terazol-7" order="4">Terazol-7</listitem>
  87                 <listitem id='5' label="Diflucan" order="5">Diflucan</listitem>
  88                 <listitem id='6' label="Lotrisone" order="6">Lotrisone</listitem>
  89                 <listitem id='7' label="Tindamax" order="7">Tindamax</listitem>
  90                 <listitem id='8' label="Other" order="8">Other</listitem>
  91         </list>
  92
  93         <list id="Vaginitis_Cultures" name="Vaginitis_Cultures"
  94                 label="Vaginitis Cultures" type="standard" import="yes">
  95                 <listitem id='1' label="Affirm" order="1">Affirm</listitem>
  96                 <listitem id='2' label="GC/CT" order="2">GC/CT</listitem>
  97                 <listitem id='3' label="Ureaplasma/Mycoplasma" order="3">Ureaplasma/Mycoplasma</listitem>
  98                 <listitem id='4' label="Genital" order="4">Genital</listitem>
  99                 <listitem id='5' label="Viral" order="5">Viral</listitem>
 100                 <listitem id='6' label="Other" order="6">Other</listitem>
 101         </list>
 102 </form>