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Copy pathDysplasia.xml
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Dysplasia.xml
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<?xml version="1.0" encoding="UTF-8"?>
<xf:xforms xmlns:xf="http://www.w3.org/2002/xforms" xmlns:h="http://www.w3.org/1999/xhtml"
xmlns:xsd="http://www.w3.org/2001/XMLSchema" xmlns:xs="http://www.w3.org/2001/XMLSchema"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:jr="http://openrosa.org/javarosa">
<xf:head>
<xf:title>CCSP Dysplasia Form</xf:title>
<xf:model id="openmrs_model">
<xf:instance id="openmrs_model_instance">
<form id="425" name="Dysplasia Form" version="1.0"
xmlns:openmrs="https://amrs.ampath.or.ke/amrs/moduleServlet/formentry/forms/schema/401-32"
xmlns:xd="http://schemas.microsoft.com/office/infopath/2003">
<header>
<enterer/>
<date_entered/>
<session/>
<uid/>
</header>
<patient>
<patient.patient_id openmrs_table="patient" openmrs_attribute="patient_id"/>
<patient_identifier.identifier_type_id openmrs_table="patient_identifier" openmrs_attribute="identifier_type_id"/>
<patient.medical_record_number openmrs_table="patient_identifier" openmrs_attribute="identifier"/>
<patient.birthdate openmrs_table="patient" openmrs_attribute="birthdate"/>
<patient.birthdate_estimated openmrs_table="patient" openmrs_attribute="birthdate_estimated"/>
<patient.family_name openmrs_table="patient_name" openmrs_attribute="family_name"/>
<patient.given_name openmrs_table="patient_name" openmrs_attribute="given_name"/>
<patient.middle_name openmrs_table="patient_name" openmrs_attribute="middle_name"/>
<patient.sex openmrs_table="patient" openmrs_attribute="gender"/>
<patient.uuid openmrs_table="patient" openmrs_attribute="uuid"/>
<no_male/>
</patient>
<encounter>
<encounter.encounter_datetime openmrs_table="encounter" openmrs_attribute="encounter_datetime"/>
<encounter.location_id openmrs_table="encounter" openmrs_attribute="location_id"/>
<encounter.provider_id openmrs_table="encounter" openmrs_attribute="provider_id"/>
<tmp>
<provider_id_select/>
<provider_id_text/>
</tmp>
</encounter>
<obs openmrs_concept="1238^MEDICAL RECORD OBSERVATIONS^99DCT" openmrs_datatype="ZZ">
<temporary.registration.uuid openmrs_concept="9000^TEMPORARY REGISTRATION UUID^99DCT" openmrs_datatype="CWE"/>
<start_time openmrs_concept="1693^START TIME^99DCT" openmrs_datatype="TM">
<value/>
</start_time>
<start_now/>
<end_time openmrs_concept="1694^END TIME^99DCT" openmrs_datatype="TM">
<value/>
</end_time>
<current_visit_type openmrs_concept="1839^CURRENT VISIT TYPE^99DCT" openmrs_datatype="CWE">
<value></value>
</current_visit_type>
<menstruation_status openmrs_concept="2061^MENSTRUATION STATUS^99DCT" openmrs_datatype="CWE" multiple="0">
<date/>
<time/>
<value/>
</menstruation_status>
<last_menstrual_period_date openmrs_concept="1836^LAST MENSTRUAL PERIOD DATE^99DCT" openmrs_datatype="DT">
<date/>
<time/>
<value/>
</last_menstrual_period_date>
<urine_pregnancy_test_qualitative openmrs_concept="45^URINE PREGNANCY TEST, QUALITATIVE^99DCT" openmrs_datatype="CWE" multiple="0">
<date/>
<time/>
<value/>
</urine_pregnancy_test_qualitative>
<reason_for_lack_of_period openmrs_concept="8252^REASON FOR LACK OF PERIOD^99DCT" openmrs_datatype="CWE" multiple="0">
<date/>
<time/>
<value/>
</reason_for_lack_of_period>
<gravida openmrs_concept="5624^GRAVIDA^99DCT" openmrs_datatype="NM">
<date/>
<time/>
<value/>
</gravida>
<parity openmrs_concept="1053^PARITY^99DCT" openmrs_datatype="NM">
<date/>
<time/>
<value/>
</parity>
<hiv_status openmrs_concept="6709^HIV STATUS^99DCT" openmrs_datatype="CWE" multiple="0">
<date/>
<time/>
<value/>
</hiv_status>
<last_cd4_by_facs openmrs_concept="1871^MOST RECENT CD4^99DCT" openmrs_datatype="NM">
<date/>
<time/>
<value/>
</last_cd4_by_facs>
<history_of_dysplasia openmrs_concept="7379^HISTORY OF DYSPLASIA^99DCT" openmrs_datatype="CWE" multiple="0">
<date/>
<time/>
<value/>
</history_of_dysplasia>
<most_recent_visual_inspection_with_acetic_acid_result openmrs_concept="7381^MOST RECENT VISUAL INSPECTION WITH ACETIC ACID RESULT^99DCT" openmrs_datatype="CWE" multiple="0">
<date/>
<time/>
<value/>
</most_recent_visual_inspection_with_acetic_acid_result>
<most_recent_papanicolaou_smear_result openmrs_concept="7423^MOST RECENT PAPANICOLAOU SMEAR RESULT^99DCT" openmrs_datatype="CWE" multiple="1">
<date/>
<time/>
<normal openmrs_concept="1115^NORMAL^99DCT">false</normal>
<atypical_squamous_cells_of_undetermined_significance openmrs_concept="7417^ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE^99DCT">false</atypical_squamous_cells_of_undetermined_significance>
<atypical_glandular_cells_of_undetermined_significance openmrs_concept="7418^ATYPICAL GLANDULAR CELLS OF UNDETERMINED SIGNIFICANCE^99DCT">false</atypical_glandular_cells_of_undetermined_significance>
<low_grade_squamous_intraepithelial_lesion openmrs_concept="7419^LOW GRADE SQUAMOUS INTRAEPITHELIAL LESION^99DCT">false</low_grade_squamous_intraepithelial_lesion>
<high_grade_squamous_intraepithelial_lesion openmrs_concept="7420^HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESION^99DCT">false</high_grade_squamous_intraepithelial_lesion>
<squamous_cell_carcinoma_not_otherwise_specified openmrs_concept="7421^SQUAMOUS CELL CARCINOMA, NOT OTHERWISE SPECIFIED^99DCT">false</squamous_cell_carcinoma_not_otherwise_specified>
<adenocarcinoma openmrs_concept="7422^ADENOCARCINOMA^99DCT">false</adenocarcinoma>
<not_applicable openmrs_concept="1175^NOT_APPLICABLE^99DCT">false</not_applicable>
<do_not_know openmrs_concept="1624^DO NOT KNOW^99DCT">false</do_not_know>
<xforms_value/>
</most_recent_papanicolaou_smear_result>
<most_recent_colposcopy_result openmrs_concept="7426^MOST RECENT COLPOSCOPY RESULT^99DCT" openmrs_datatype="CWE" multiple="1">
<date/>
<time/>
<normal openmrs_concept="1115^NORMAL^99DCT">false</normal>
<cervical_intraepithelial_neoplasia_grade_1 openmrs_concept="7424^CERVICAL INTRAEPITHELIAL NEOPLASIA GRADE 1^99DCT">false</cervical_intraepithelial_neoplasia_grade_1>
<cervical_intraepithelial_neoplasia_grade_2 openmrs_concept="7425^CERVICAL INTRAEPITHELIAL NEOPLASIA GRADE 2^99DCT">false</cervical_intraepithelial_neoplasia_grade_2>
<cervical_intraepithelial_neoplasia_grade_3 openmrs_concept="7216^CERVICAL INTRAEPITHELIAL NEOPLASIA GRADE 3^99DCT">false</cervical_intraepithelial_neoplasia_grade_3>
<cervical_cancer openmrs_concept="6537^CERVICAL CANCER^99DCT">false</cervical_cancer>
<not_applicable openmrs_concept="1175^NOT_APPLICABLE^99DCT">false</not_applicable>
<do_not_know openmrs_concept="1624^DO NOT KNOW^99DCT">false</do_not_know>
<xforms_value/>
</most_recent_colposcopy_result>
<most_recent_biopsy_result openmrs_concept="7400^MOST RECENT BIOPSY RESULT^99DCT" openmrs_datatype="ST">
<date/>
<time/>
<value/>
</most_recent_biopsy_result>
<past_treatment_of_dysplasia_detailed openmrs_concept="7580^PAST TREATMENT OF DYSPLASIA, DETAILED^99DCT" openmrs_datatype="ZZ">
<past_treatment_of_dysplasia openmrs_concept="7467^PAST TREATMENT OF DYSPLASIA^99DCT" openmrs_datatype="CWE" multiple="1">
<date/>
<time/>
<loop_electrosurgical_excision_procedure openmrs_concept="7147^LOOP ELECTROSURGICAL EXCISION PROCEDURE^99DCT">false</loop_electrosurgical_excision_procedure>
<other_non-coded openmrs_concept="5622^OTHER NON-CODED^99DCT">false</other_non-coded>
<hysterectomy openmrs_concept="5276^HYSTERECTOMY^99DCT">false</hysterectomy>
<cryotherapy openmrs_concept="7466^CRYOTHERAPY^99DCT">false</cryotherapy>
<none openmrs_concept="1107^NONE^99DCT">false</none>
<not_applicable openmrs_concept="1175^NOT_APPLICABLE^99DCT">false</not_applicable>
<xforms_value/>
</past_treatment_of_dysplasia>
<dysplasia_histopathological_findings_based_on_last_treatment openmrs_concept="7579^DYSPLASIA HISTOPATHOLOGICAL FINDINGS BASED ON LAST TREATMENT^99DCT" openmrs_datatype="CWE" multiple="1">
<date/>
<time/>
<normal openmrs_concept="1115^NORMAL^99DCT">false</normal>
<cervical_intraepithelial_neoplasia_grade_1 openmrs_concept="7424^CERVICAL INTRAEPITHELIAL NEOPLASIA GRADE 1^99DCT">false
</cervical_intraepithelial_neoplasia_grade_1>
<cervical_intraepithelial_neoplasia_grade_2 openmrs_concept="7425^CERVICAL INTRAEPITHELIAL NEOPLASIA GRADE 2^99DCT">false</cervical_intraepithelial_neoplasia_grade_2>
<cervical_intraepithelial_neoplasia_grade_3 openmrs_concept="7216^CERVICAL INTRAEPITHELIAL NEOPLASIA GRADE 3^99DCT">false</cervical_intraepithelial_neoplasia_grade_3>
<squamous_cell_carcinoma_not_otherwise_specified openmrs_concept="7421^SQUAMOUS CELL CARCINOMA, NOT OTHERWISE SPECIFIED^99DCT">false</squamous_cell_carcinoma_not_otherwise_specified>
<adenocarcinoma openmrs_concept="7422^ADENOCARCINOMA^99DCT">false</adenocarcinoma>
<other_non-coded openmrs_concept="5622^OTHER NON-CODED^99DCT">false</other_non-coded>
<do_not_know openmrs_concept="1624^DO NOT KNOW^99DCT">false</do_not_know>
<xforms_value/>
</dysplasia_histopathological_findings_based_on_last_treatment>
<visual_vulval_exam_findings openmrs_concept="7487^VISUAL VULVAL EXAM FINDINGS^99DCT" openmrs_datatype="CWE" multiple="1">
<date/>
<time/>
<normal openmrs_concept="1115^NORMAL^99DCT">false</normal>
<positive_visual_inspection_with_acetic_acid_with_aceto_white_area openmrs_concept="7507^POSITIVE VISUAL INSPECTION WITH ACETIC ACID WITH ACETO WHITE AREA^99DCT">false</positive_visual_inspection_with_acetic_acid_with_aceto_white_area>
<!-- <condyloma_or_vulvar_intraepithelial_neoplasia_grade_1 openmrs_concept="7489^CONDYLOMA OR VULVAR INTRAEPITHELIAL NEOPLASIA GRADE 1^99DCT">false</condyloma_or_vulvar_intraepithelial_neoplasia_grade_1>-->
<!-- <vulvar_intraepithelial_neoplasia_grade_2 openmrs_concept="7488^VULVAR INTRAEPITHELIAL NEOPLASIA GRADE 2^99DCT">false</vulvar_intraepithelial_neoplasia_grade_2>-->
<other_non-coded openmrs_concept="5622^OTHER NON-CODED^99DCT">false</other_non-coded>
<not_applicable openmrs_concept="1175^NOT_APPLICABLE^99DCT">false</not_applicable>
<do_not_know openmrs_concept="1624^DO NOT KNOW^99DCT">false</do_not_know>
<xforms_value/>
</visual_vulval_exam_findings>
<visual_vaginal_exam_findings openmrs_concept="7490^VISUAL VAGINAL EXAM FINDINGS^99DCT" openmrs_datatype="CWE" multiple="1">
<date/>
<time/>
<normal openmrs_concept="1115^NORMAL^99DCT">false</normal>
<vaginal_intraepithelial_neoplasia_grade_1 openmrs_concept="7492^VAGINAL INTRAEPITHELIAL NEOPLASIA GRADE 1^99DCT">false</vaginal_intraepithelial_neoplasia_grade_1>
<vaginal_intraepithelial_neoplasia_grade_2 openmrs_concept="7491^VAGINAL INTRAEPITHELIAL NEOPLASIA GRADE 2^99DCT">false</vaginal_intraepithelial_neoplasia_grade_2>
<vaginal_intraepithelial_neoplasia_grade_3 openmrs_concept="7435^VAGINAL INTRAEPITHELIAL NEOPLASIA GRADE 3^99DCT">false</vaginal_intraepithelial_neoplasia_grade_3>
<other_non-coded openmrs_concept="5622^OTHER NON-CODED^99DCT">false</other_non-coded>
<not_applicable openmrs_concept="1175^NOT_APPLICABLE^99DCT">false</not_applicable>
<do_not_know openmrs_concept="1624^DO NOT KNOW^99DCT">false</do_not_know>
<xforms_value/>
</visual_vaginal_exam_findings>
<visual_cervical_exam_findings openmrs_concept="7484^VISUAL CERVICAL EXAM FINDINGS^99DCT" openmrs_datatype="CWE" multiple="1">
<date/>
<time/>
<normal openmrs_concept="1115^NORMAL^99DCT">false</normal>
<cervical_intraepithelial_neoplasia_grade_1 openmrs_concept="7424^CERVICAL INTRAEPITHELIAL NEOPLASIA GRADE 1^99DCT">false</cervical_intraepithelial_neoplasia_grade_1>
<cervical_intraepithelial_neoplasia_grade_2 openmrs_concept="7425^CERVICAL INTRAEPITHELIAL NEOPLASIA GRADE 2^99DCT">false</cervical_intraepithelial_neoplasia_grade_2>
<cervical_intraepithelial_neoplasia_grade_3 openmrs_concept="7216^CERVICAL INTRAEPITHELIAL NEOPLASIA GRADE 3^99DCT">false</cervical_intraepithelial_neoplasia_grade_3>
<cervical_cancer openmrs_concept="6537^CERVICAL CANCER^99DCT">false</cervical_cancer>
<other_non-coded openmrs_concept="5622^OTHER NON-CODED^99DCT">false</other_non-coded>
<positive_visual_inspection_with_acetic_acid_with_aceto_white_area openmrs_concept="7507^POSITIVE VISUAL INSPECTION WITH ACETIC ACID WITH ACETO WHITE AREA^99DCT">false</positive_visual_inspection_with_acetic_acid_with_aceto_white_area>
<positive_visual_inspection_with_acetic_acid_with_suspicious_lesion openmrs_concept="7508^POSITIVE VISUAL INSPECTION WITH ACETIC ACID WITH SUSPICIOUS LESION^99DCT">false</positive_visual_inspection_with_acetic_acid_with_suspicious_lesion>
<not_applicable openmrs_concept="1175^NOT_APPLICABLE^99DCT">false</not_applicable>
<do_not_know openmrs_concept="1624^DO NOT KNOW^99DCT">false</do_not_know>
<xforms_value/>
</visual_cervical_exam_findings>
</past_treatment_of_dysplasia_detailed>
<ccsp_satisfactory_colpo openmrs_concept="7428^SUCCESSFUL COMPLETION OF COLPOSCOPY^99DCT" openmrs_datatype="CWE">
<date/>
<time/>
<value/>
</ccsp_satisfactory_colpo>
<ccsp_lesion openmrs_concept="7477^SIZE OF CERVICAL LESION, CODED^99DCT" openmrs_datatype="CWE">
<date/>
<time/>
<value/>
</ccsp_lesion>
<ccsp_findings openmrs_concept="7383^COLPOSCOPY^99DCT" openmrs_datatype="CWE">
<date/>
<time/>
<value/>
</ccsp_findings>
<ccsp_procedures_done openmrs_concept="7479^PROCEDURES DONE THIS VISIT^99DCT" openmrs_datatype="CWE" multiple="0">
<date/>
<time/>
<value/>
</ccsp_procedures_done>
<procedures_done_this_visit_detailed openmrs_concept="7480^PROCEDURES DONE THIS VISIT, DETAILED^99DCT" openmrs_datatype="ZZ" multiple="1">
<number_of_specimen_collected openmrs_concept="7482^NUMBER OF SPECIMEN COLLECTED^99DCT" openmrs_datatype="NM">
<date/>
<time/>
<value/>
</number_of_specimen_collected>
<tmp_procedures_done_this_visit_detailed/>
<body_part openmrs_concept="8265^BODY PART^99DCT" openmrs_datatype="CWE" multiple="0">
<date/>
<time/>
<value/>
</body_part>
<procedures_done_this_visit openmrs_concept="7479^PROCEDURES DONE THIS VISIT^99DCT" openmrs_datatype="CWE" multiple="0">
<date/>
<time/>
<value/>
</procedures_done_this_visit>
<anatomic_location_description openmrs_concept="8268^ANATOMIC LOCATION DESCRIPTION^99DCT" openmrs_datatype="CWE" multiple="0">
<date/>
<time/>
<value/>
</anatomic_location_description>
<clock_face_cervical_biopsy_location openmrs_concept="7481^CLOCK FACE CERVICAL BIOPSY LOCATION^99DCT" openmrs_datatype="NM">
<date/>
<time/>
<value/>
</clock_face_cervical_biopsy_location>
<pathological_diagnosis_added openmrs_concept="8278^PATHOLOGICAL DIAGNOSIS ADDED^99DCT" openmrs_datatype="CWE" multiple="0">
<date/>
<time/>
<value/>
</pathological_diagnosis_added>
<pathological_diagnosis_added_cervix/>
<pathological_diagnosis_added_vagina/>
<pathological_diagnosis_added_vulva/>
</procedures_done_this_visit_detailed>
<ccsp_plan openmrs_concept="7500^GYNECOLOGIC ONCOLOGY PLAN^99DCT" openmrs_datatype="CWE" multiple="0">
<date/>
<time/>
<value/>
</ccsp_plan>
<ccsp_directive_fp openmrs_concept="6681^FAMILY PLANNING COUNSELING PERFORMED^99DCT" openmrs_datatype="CWE" multiple="0">
<date/>
<time/>
<value/>
</ccsp_directive_fp>
<ccsp_refill_dispense openmrs_concept="7495^FAMILY PLANNING REFILL PROVIDED^99DCT" openmrs_datatype="CWE" multiple="1">
<date/>
<time/>
<condoms openmrs_concept="190^CONDOMS^99DCT">false</condoms>
<female_sterilization openmrs_concept="5276^FEMALE STERILIZATION^99DCT">false</female_sterilization>
<intrauterine_device openmrs_concept="5275^INTRAUTERINE DEVICE^99DCT">false</intrauterine_device>
<diaphragm openmrs_concept="5278^DIAPHRAGM^99DCT">false</diaphragm>
<family_planning_via_oral_contraceptive_pills openmrs_concept="5274^FAMILY PLANNING VIA ORAL CONTRACEPTIVE PILLS^99DCT">false</family_planning_via_oral_contraceptive_pills>
<natural_family_planning openmrs_concept="5277^NATURAL FAMILY PLANNING^99DCT">false</natural_family_planning>
<injectable_contraceptives openmrs_concept="5279^INJECTABLE CONTRACEPTIVES^99DCT">false</injectable_contraceptives>
<other_non-coded openmrs_concept="5622^OTHER NON-CODED^99DCT">false</other_non-coded>
<night openmrs_concept="1642^NIGHT^99DCT">false</night>
<do_not_know openmrs_concept="1624^DO NOT KNOW^99DCT">false</do_not_know>
<none openmrs_concept="1107^NONE^99DCT">false</none>
<xforms_value/>
</ccsp_refill_dispense>
<ccsp_new_method openmrs_concept="7240^FAMILY PLANNING METHOD CHOSEN^99DCT" openmrs_datatype="CWE" multiple="1">
<date/>
<time/>
<condoms openmrs_concept="190^CONDOMS^99DCT">false</condoms>
<female_sterilization openmrs_concept="5276^FEMALE STERILIZATION^99DCT">false</female_sterilization>
<intrauterine_device openmrs_concept="5275^INTRAUTERINE DEVICE^99DCT">false</intrauterine_device>
<diaphragm openmrs_concept="5278^DIAPHRAGM^99DCT">false</diaphragm>
<family_planning_via_oral_contraceptive_pills openmrs_concept="5274^FAMILY PLANNING VIA ORAL CONTRACEPTIVE PILLS^99DCT">false</family_planning_via_oral_contraceptive_pills>
<natural_family_planning openmrs_concept="5277^NATURAL FAMILY PLANNING^99DCT">false</natural_family_planning>
<injectable_contraceptives openmrs_concept="5279^INJECTABLE CONTRACEPTIVES^99DCT">false</injectable_contraceptives>
<other_non-coded openmrs_concept="5622^OTHER NON-CODED^99DCT">false</other_non-coded>
<night openmrs_concept="1642^NIGHT^99DCT">false</night>
<do_not_know openmrs_concept="1624^DO NOT KNOW^99DCT">false</do_not_know>
<none openmrs_concept="1107^NONE^99DCT">false</none>
<xforms_value/>
</ccsp_new_method>
<return_visit_date openmrs_concept="5096^RETURN VISIT DATE^99DCT" openmrs_datatype="DT">
<date/>
<time/>
<value/>
</return_visit_date>
<freetext_general openmrs_concept="1915^FREETEXT GENERAL^99DCT" openmrs_datatype="ST">
<date/>
<time/>
<value/>
</freetext_general>
<ccsp_currentfp openmrs_concept="374^METHOD OF FAMILY PLANNING^99DCT" openmrs_datatype="CWE" multiple="1">
<date/>
<time/>
<condoms openmrs_concept="190^CONDOMS^99DCT">false</condoms>
<female_sterilization openmrs_concept="5276^FEMALE STERILIZATION^99DCT">false</female_sterilization>
<intrauterine_device openmrs_concept="5275^INTRAUTERINE DEVICE^99DCT">false</intrauterine_device>
<diaphragm openmrs_concept="5278^DIAPHRAGM^99DCT">false</diaphragm>
<family_planning_via_oral_contraceptive_pills openmrs_concept="5274^FAMILY PLANNING VIA ORAL CONTRACEPTIVE PILLS^99DCT">false</family_planning_via_oral_contraceptive_pills>
<natural_family_planning openmrs_concept="5277^NATURAL FAMILY PLANNING^99DCT">false</natural_family_planning>
<injectable_contraceptives openmrs_concept="5279^INJECTABLE CONTRACEPTIVES^99DCT">false</injectable_contraceptives>
<other_non-coded openmrs_concept="5622^OTHER NON-CODED^99DCT">false</other_non-coded>
<night openmrs_concept="1642^NIGHT^99DCT">false</night>
<do_not_know openmrs_concept="1624^DO NOT KNOW^99DCT">false</do_not_know>
<none openmrs_concept="1107^NONE^99DCT">false</none>
<xforms_value/>
</ccsp_currentfp>
</obs>
</form>
</xf:instance>
<bind id="start_now" nodeset="/form/obs/start_now" calculate="now()" type="time"/>
<bind id="start_time" nodeset="/form/obs/start_time/value" jr:preload="time" jr:preloadParams="start" type="time"/>
<bind id="end_time" nodeset="/form/obs/end_time/value" jr:preload="time" jr:preloadParams="end" type="time"/>
<bind id="current_visit_type" nodeset="/form/obs/current_visit_type/value" required="true()" type="string"/>
<bind id="encounter.encounter_datetime" nodeset="/form/encounter/encounter.encounter_datetime" required="true()" type="date"
constraint=". < (today() + 1)" jr:constraintMsg="Encounter date cannot be after today"/>
<bind id="encounter.location_id" nodeset="/form/encounter/encounter.location_id" type="string" required="true()"/>
<bind id="provider_id_select" nodeset="/form/encounter/tmp/provider_id_select" type="select1"/>
<bind id="provider_id_text" nodeset="/form/encounter/tmp/provider_id_text" type="string" required="true()"
relevant="../provider_id_select = ''" constraint="regex(., '^\w+[-]?\d{1}') and (checkdigit(.))"
jr:constraintMsg="Invalid ID format and/or CheckDigit. Please Re-enter your ID."/>
<bind id="encounter.provider_id" nodeset="/form/encounter/encounter.provider_id" type="string"
calculate="if(../tmp/provider_id_select != '',../tmp/provider_id_select,../tmp/provider_id_text)"/>
<bind id="encounter" nodeset="/form/encounter" relevant="../patient/patient.sex= 'F'"/>
<bind id="patient" nodeset="/form/patient"/>
<bind id="patient.patient_id" nodeset="/form/patient/patient.patient_id" type="int" required="true()"/>
<bind id="patient_identifier.identifier_type_id" nodeset="/form/patient/patient_identifier.identifier_type_id" calculate="3" type="integer"/>
<bind id="patient.medical_record_number" nodeset="/form/patient/patient.medical_record_number" type="string"/>
<bind id="patient.birthdate" nodeset="/form/patient/patient.birthdate" type="date"
constraint=". <=today()" jr:constraintMsg="Birth date cannot be in the future"/>
<bind id="patient.birthdate_estimated" nodeset="/form/patient/patient.birthdate_estimated" type="string"/>
<bind id="patient.family_name" nodeset="/form/patient/patient.family_name" type="string" required="true()"/>
<bind id="patient.given_name" nodeset="/form/patient/patient.given_name" type="string" required="true()"/>
<bind id="patient.middle_name" nodeset="/form/patient/patient.middle_name" type="string"/>
<bind id="patient.sex" nodeset="/form/patient/patient.sex" type="string" required="true()"/>
<bind id="patient.uuid" nodeset="/form/patient/patient.uuid" type="string"/>
<bind id="no_male" nodeset="/form/patient/no_male" type="string" readonly="true()" relevant="../patient/patient.sex= 'M'"/>
<bind id="obs" nodeset="/form/obs" relevant="../patient/patient.sex= 'F'"/>
<bind id="gravida" nodeset="/form/obs/gravida/value" required="true()" type="int"
constraint="not(. <=-1)" jr:constraintMsg="Value cannot be negative"/>
<bind id="parity" nodeset="/form/obs/parity/value" required="true()" type="int"
constraint=". <=../../gravida/value and not(. <=0)" jr:constraintMsg="Deliveries cannot be negative or more than number of pregnancies"
relevant="../../gravida/value >0"/>
<bind id="menstruation_status" nodeset="/form/obs/menstruation_status/value" type="string" required="true()"/>
<bind id="last_menstrual_period_date" nodeset="/form/obs/last_menstrual_period_date/value" type="date" required="true()"
constraint=". < (today() + 1)" jr:constraintMsg="LMP cannot be in the future"
relevant="not(selected(../../menstruation_status/value,'2060^AMENORRHEA^99DCT')) and
not(selected(../../menstruation_status/value,'6496^POST-MENOPAUSAL^99DCT'))"/>
<bind id="urine_pregnancy_test_qualitative" nodeset="/form/obs/urine_pregnancy_test_qualitative/value" type="string" required="true()"
relevant="(today()-../../last_menstrual_period_date/value >35)"/>
<bind id="reason_for_lack_of_period" nodeset="/form/obs/reason_for_lack_of_period/value" type="string" required="true()"
relevant="(selected(../../menstruation_status/value,'6496^POST-MENOPAUSAL^99DCT')) or
(selected(../../menstruation_status/value,'2060^AMENORRHEA^99DCT'))"/>
<bind id="hiv_status" nodeset="/form/obs/hiv_status/value" type="string"/>
<bind id="last_cd4_by_facs" nodeset="/form/obs/last_cd4_by_facs/value" type="xsd:decimal"
relevant="(selected(../../hiv_status/value,'703^POSITIVE^99DCT'))"
constraint=". >=0" jr:constraintMsg="Value cannot be negative"/>
<bind id="date_of_last_cd4_by_facs" nodeset="/form/obs/last_cd4_by_facs/date" type="date" required="true()"
relevant="(selected(../../hiv_status/value,'703^POSITIVE^99DCT'))"
constraint=". < (today() + 1)" jr:constraintMsg="Test date cannot be in the future"/>
<bind id="history_of_dysplasia" nodeset="/form/obs/history_of_dysplasia/value" type="string" required="true()"/>
<bind id="most_recent_colposcopy_result" nodeset="/form/obs/most_recent_colposcopy_result/xforms_value" type="string" required="true()"
constraint="not((selected(., 'normal') or selected(., 'do_not_know') or selected(., 'not_applicable'))and count-selected(.) > 1)"
jr:constraintMsg="If normal, not applicable or don't know is selected, it should be the only option"/>
<bind id="date_of_most_recent_colposcopy_result" nodeset="/form/obs/most_recent_colposcopy_result/date" type="date" required="true()"
relevant="not(selected(../xforms_value,'do_not_know') or selected(../xforms_value,'not_applicable'))"
constraint=". < (today() + 1)" jr:constraintMsg="Test date cannot be in the future"/>
<bind id="past_treatment_of_dysplasia_detailed" nodeset="/form/obs/past_treatment_of_dysplasia_detailed"/>
<bind id="past_treatment_of_dysplasia" nodeset="/form/obs/past_treatment_of_dysplasia_detailed/past_treatment_of_dysplasia/xforms_value" type="string" required="true()"
constraint="not((selected(., 'none') or selected(., 'not_applicable'))and count-selected(.) > 1)"
jr:constraintMsg="If not applicable or don't know is selected, it should be the only option"/>
<bind id="dysplasia_histopathological_findings_based_on_last_treatment" nodeset="/form/obs/past_treatment_of_dysplasia_detailed/dysplasia_histopathological_findings_based_on_last_treatment/xforms_value" type="string" required="true()"
relevant="not(selected(../../past_treatment_of_dysplasia/xforms_value, 'not_applicable')
or selected(../../past_treatment_of_dysplasia/xforms_value, 'none'))"
constraint="not((selected(., 'do_not_know') or selected(., 'normal'))and count-selected(.) > 1)"
jr:constraintMsg="If normal or don't know is selected, it should be the only option"/>
<bind id="visual_vulval_exam_findings" nodeset="/form/obs/past_treatment_of_dysplasia_detailed/visual_vulval_exam_findings/xforms_value" type="string" required="true()"
constraint="not((selected(., 'normal') or selected(., 'do_not_know') or selected(., 'not_applicable'))and count-selected(.) > 1)"
jr:constraintMsg="If normal, not applicable or don't know is selected, it should be the only option"/>
<bind id="visual_vaginal_exam_findings" nodeset="/form/obs/past_treatment_of_dysplasia_detailed/visual_vaginal_exam_findings/xforms_value" type="string" required="true()"
constraint="not((selected(., 'normal') or selected(., 'do_not_know') or selected(., 'not_applicable'))and count-selected(.) > 1)"
jr:constraintMsg="If normal, not applicable or don't know is selected, it should be the only option"/>
<bind id="visual_cervical_exam_findings" nodeset="/form/obs/past_treatment_of_dysplasia_detailed/visual_cervical_exam_findings/xforms_value" type="string" required="true()"
constraint="not((selected(., 'normal') or selected(., 'do_not_know') or selected(., 'not_applicable'))and count-selected(.) > 1)"
jr:constraintMsg="If normal, not applicable or don't know is selected, it should be the only option"/>
<bind id="most_recent_visual_inspection_with_acetic_acid_result" nodeset="/form/obs/most_recent_visual_inspection_with_acetic_acid_result/value" type="string" required="true()"
constraint="not((selected(., 'normal') or selected(., 'do_not_know') or selected(., 'not_applicable'))and count-selected(.) > 1)"
jr:constraintMsg="If normal, not applicable or don't know is selected, it should be the only option"/>
<bind id="date_of_most_recent_visual_inspection_with_acetic_acid_result" nodeset="/form/obs/most_recent_visual_inspection_with_acetic_acid_result/date" type="date" required="true()"
relevant="(selected(../value,'703^POSITIVE^99DCT') or selected(../value,'664^NEGATIVE^99DCT'))"
constraint=". <=today()" jr:constraintMsg="Test date cannot be in the future"/>
<bind id="most_recent_papanicolaou_smear_result" nodeset="/form/obs/most_recent_papanicolaou_smear_result/xforms_value" type="string" required="true()"
constraint="not((selected(., 'normal') or selected(., 'do_not_know') or selected(., 'not_applicable'))and count-selected(.) > 1)"
jr:constraintMsg="If normal, not applicable or don't know is selected, it should be the only option"/>
<bind id="date_of_most_recent_papanicolaou_smear_result" nodeset="/form/obs/most_recent_papanicolaou_smear_result/date" type="date" required="true()"
relevant="not(selected(../xforms_value,'do_not_know') or selected(../xforms_value,'not_applicable'))"
constraint=". < (today() + 1)" jr:constraintMsg="Test date cannot be in the future"/>
<bind id="ccsp_satisfactory_colpo" nodeset="/form/obs/ccsp_satisfactory_colpo/value" type="string" required="true()"/>
<bind id="ccsp_lesion" nodeset="/form/obs/ccsp_lesion/value" type="string" required="true()"
relevant="not(selected(../../ccsp_satisfactory_colpo/value,'1118^Colposcopy not done today^99DCT'))"/>
<bind id="most_recent_biopsy_result" nodeset="/form/obs/most_recent_biopsy_result/value" type="string"/>
<bind id="date_of_most_recent_biopsy_result" nodeset="/form/obs/most_recent_biopsy_result/date" type="date"
relevant="../value != ''" constraint=". < (today() + 1)" jr:constraintMsg="Test date cannot be in the future"/>
<bind id="ccsp_findings" nodeset="/form/obs/ccsp_findings/value" type="string" required="true()"
relevant="not(selected(../../ccsp_satisfactory_colpo/value,'1118^Colposcopy not done today^99DCT'))"
constraint="not(selected(., '1115^Normal^99DCT') or selected(., '1624^Dont_know^99DCT') and count-selected(.)>1 )"
jr:constraintMsg="If normal or don't know, is selected, it should be the only option"/>
<bind id="ccsp_procedures_done" nodeset="/form/obs/ccsp_procedures_done/value" type="string" required="true()"/>
<bind id="procedures_done_this_visit_detailed" nodeset="/form/obs/procedures_done_this_visit_detailed"/>
<bind id="number_of_specimen_collected" nodeset="/form/obs/procedures_done_this_visit_detailed/number_of_specimen_collected/value" type="int" required="true()"
relevant="../../procedures_done_this_visit/value = '7147^Loop electrosurgical excision procedure^99DCT'"/>
<bind id="body_part" nodeset="/form/obs/procedures_done_this_visit_detailed/body_part/value" type="string" required="true()"/>
<bind id="procedures_done_this_visit" nodeset="/form/obs/procedures_done_this_visit_detailed/procedures_done_this_visit/value" type="string" required="true()"
constraint="not(selected(., '1107^None^99DCT') and count-selected(.)>1)"
jr:constraintMsg="If None, is selected, it should be the only option"/>
<bind id="anatomic_location_description" nodeset="/form/obs/procedures_done_this_visit_detailed/anatomic_location_description/value" type="string"
relevant="../../procedures_done_this_visit/value = '7147^LOOP ELECTROSURGICAL EXCISION PROCEDURE^99DCT'"/>
<bind id="clock_face_cervical_biopsy_location" nodeset="/form/obs/procedures_done_this_visit_detailed/clock_face_cervical_biopsy_location/value" type="int"
relevant="../../procedures_done_this_visit/value = '6511^Biopsies^99DCT'"
constraint=". >= 1 and . <= 12" jr:constraintMsg="Values should be between 1 and 12 inclusive"/>
<bind id="pathological_diagnosis_added_cervix" nodeset="/form/obs/procedures_done_this_visit_detailed/pathological_diagnosis_added_cervix" type="string" required="true()" relevant="../body_part/value='8279^CERVIX^99DCT'"/>
<bind id="pathological_diagnosis_added_vagina" nodeset="/form/obs/procedures_done_this_visit_detailed/pathological_diagnosis_added_vagina" type="string" required="true()" relevant="../body_part/value='8280^VAGINA^99DCT'"/>
<bind id="pathological_diagnosis_added_vulva" nodeset="/form/obs/procedures_done_this_visit_detailed/pathological_diagnosis_added_vulva" type="string" required="true()" relevant="../body_part/value='8281^VULVA^99DCT'"/>
<bind id="pathological_diagnosis_added" nodeset="/form/obs/procedures_done_this_visit_detailed/pathological_diagnosis_added/value" type="string"
calculate="if(../../body_part/value='8279^CERVIX^99DCT',../../pathological_diagnosis_added_cervix,
if(../../body_part/value='8280^VAGINA^99DCT',../../pathological_diagnosis_added_vagina,../../pathological_diagnosis_added_vulva))"/>
<bind id="tmp_procedures_done_this_visit_detailed" nodeset="/form/obs/procedures_done_this_visit_detailed/tmp_procedures_done_this_visit_detailed" type="string" readonly="true()"/>
<bind id="ccsp_plan" nodeset="/form/obs/ccsp_plan/value" type="string" required="true()"/>
<bind id="ccsp_directive_fp" nodeset="/form/obs/ccsp_directive_fp/value" type="string" required="true()"/>
<bind id="ccsp_refill_dispense" nodeset="/form/obs/ccsp_refill_dispense/xforms_value" type="string" required="true()"
relevant="not(selected(../../ccsp_currentfp/xforms_value, 'none') or
selected(../../ccsp_currentfp/xforms_value,'do_not_know'))"
constraint="not((selected(., 'condoms') and not(selected(../../ccsp_currentfp/xforms_value,'condoms'))) or
(selected(., 'female_sterilization') and not(selected(../../ccsp_currentfp/xforms_value,'female_sterilization'))) or
(selected(., 'intrauterine_device') and not(selected(../../ccsp_currentfp/xforms_value,'intrauterine_device'))) or
(selected(., 'diaphragm') and not(selected(../../ccsp_currentfp/xforms_value,'diaphragm'))) or
(selected(., 'family_planning_via_oral_contraceptive_pills') and not(selected(../../ccsp_currentfp/xforms_value,'family_planning_via_oral_contraceptive_pills'))) or
(selected(., 'natural_family_planning') and not(selected(../../ccsp_currentfp/xforms_value,'natural_family_planning'))) or
(selected(., 'injectable_contraceptives') and not(selected(../../ccsp_currentfp/xforms_value,'injectable_contraceptives'))) or
(selected(., 'other_non-coded') and not(selected(../../ccsp_currentfp/xforms_value,'other_non-coded'))) or
(selected(., 'none') or selected(., 'do_not_know') and count-selected(.)>1 ))"
jr:constraintMsg="You can only refill a current family planning method and cannot select normal or don't know with any other choice"/>
<bind id="ccsp_new_method" nodeset="/form/obs/ccsp_new_method/xforms_value" type="string" required="true()"
constraint="not((selected(., 'condoms') and selected(../../ccsp_currentfp/xforms_value,'condoms')) or
(selected(., 'female_sterilization') and selected(../../ccsp_currentfp/xforms_value,'female_sterilization')) or
(selected(., 'intrauterine_device') and selected(../../ccsp_currentfp/xforms_value,'intrauterine_device')) or
(selected(., 'diaphragm') and selected(../../ccsp_currentfp/xforms_value,'diaphragm')) or
(selected(., 'family_planning_via_oral_contraceptive_pills') and selected(../../ccsp_currentfp/xforms_value,'family_planning_via_oral_contraceptive_pills')) or
(selected(., 'natural_family_planning') and selected(../../ccsp_currentfp/xforms_value,'natural_family_planning')) or
(selected(., 'injectable_contraceptives') and selected(../../ccsp_currentfp/xforms_value,'injectable_contraceptives')) or
(selected(., 'none') or selected(., 'do_not_know') and count-selected(.)>1 ))"
jr:constraintMsg="Patient is already using one of selected family planning method or don't or none selected in combination"/>
<bind id="return_visit_date" nodeset="/form/obs/return_visit_date/value" required="true()" type="date"
constraint=". > today()" jr:constraintMsg="Return visit date must be in the future"/>
<bind id="freetext_general" nodeset="/form/obs/freetext_general/value" type="string"/>
<bind id="ccsp_currentfp" nodeset="/form/obs/ccsp_currentfp/xforms_value" type="string" required="true()"
constraint="not((selected(., 'none') or selected(., 'do_not_know'))and count-selected(.) > 1)"
jr:constraintMsg="If none or don't know is selected, it should be the only option"/>
</xf:model>
</xf:head>
<xf:body>
<group appearance="field-list" bind="patient">
<label>Patient Demographics</label>
<input bind="patient.given_name">
<label>Given Name</label>
</input>
<input bind="patient.family_name">
<label>Family Name</label>
</input>
<input bind="patient.middle_name">
<label>Middle Name</label>
</input>
<input bind="patient.medical_record_number">
<label>AMRS ID Number</label>
</input>
<select1 bind="patient.sex">
<label>Gender</label>
<item>
<label>Male</label>
<value>M</value>
</item>
<item>
<label>Female</label>
<value>F</value>
</item>
</select1>
<input bind="patient.birthdate">
<label>Date Of Birth</label>
</input>
</group>
<input bind="no_male">
<label>Cervical cancer screening cannot be done on a male. This form will be closed</label>
</input>
<group appearance="field-list">
<select1 bind="current_visit_type">
<label>Current Visit Type</label>
<hint>What is the current visit type?</hint>
<item>
<label>New visit</label>
<value>7850^INITIAL VISIT^99DCT</value>
</item>
<item>
<label>Revisit</label>
<value>2345^FOLLOW-UP^99DCT</value>
</item>
<item>
<label>Review of pathology results</label>
<value>7588^REVIEW OF PATHOLOGY RESULTS^99DCT</value>
</item>
</select1>
</group>
<group appearance="field-list" bind="encounter">
<label>Encounter Details</label>
<input bind="encounter.encounter_datetime">
<label>Encounter Date</label>
</input>
<select1 bind="encounter.location_id">
<label>Screening Site</label>
<item>
<label>AMPATH-MTRH</label>
<value>84</value>
</item>
<item>
<label>Busia</label>
<value>19</value>
</item>
<item>
<label>Chulaimbo</label>
<value>7</value>
</item>
<item>
<label>Iten</label>
<value>17</value>
</item>
<item>
<label>Kitale</label>
<value>11</value>
</item>
<item>
<label>Mosoriot Health Centre</label>
<value>2</value>
</item>
<item>
<label>Port Victorial</label>
<value>20</value>
</item>
<item>
<label>Teso District Hospital</label>
<value>12</value>
</item>
<item>
<label>Turbo Health Centre</label>
<value>3</value>
</item>
<item>
<label>Webuye</label>
<value>8</value>
</item>
</select1>
<select1 bind="provider_id_select">
<label>Provider For This Encounter</label>
<item>
<label>Daurine Achieng Agumba</label>
<value>3419-9</value>
</item>
<item>
<label>Irene Chepkosgei Kurgat</label>
<value>3420-7</value>
</item>
<item>
<label>Rose Cheruto Toroitich</label>
<value>3421-5</value>
</item>
<item>
<label>Mary Kipkurui Kimosop</label>
<value>3422-3</value>
</item>
<item>
<label>Jacqueline Chemom Ndiema</label>
<value>3423-1</value>
</item>
<item>
<label>Grace Wanjiru Mwangi </label>
<value>3424-9</value>
</item>
<item>
<label>Collette Mabia Palapala</label>
<value>3425-6</value>
</item>
<item>
<label>Dorice Erima Wekesa Female </label>
<value>3426-4</value>
</item>
<item>
<label>Agnes Kagure Boen</label>
<value>120-6</value>
</item>
<item>
<label>Linet Kerubo Onyancha</label>
<value>3427-2</value>
</item>
<item>
<label>Delinah Muchai Tanui</label>
<value>1208-8</value>
</item>
<item>
<label>Hellen Mushimbi Indumbwe </label>
<value>1208-8</value>
</item>
<item>
<label>Lydia Cherugut Samoei </label>
<value>1525-5</value>
</item>
<item>
<label>Ruth Kalunda Nzili</label>
<value>1529-7</value>
</item>
<item>
<label>Lucy Cheruto Birgen</label>
<value>3428-0</value>
</item>
<item>
<label>Gratiah Nafuna Khaemba</label>
<value>1409-2</value>
</item>
<item>
<label>Leonida Chemutai Mengich</label>
<value>1357-3</value>
</item>
<item>
<label>Ann Wangoi Maina </label>
<value>1412-6</value>
</item>
<item>
<label>Elkanah Omenge Orango</label>
<value>1474-6</value>
</item>
<item>
<label>Peter Mukhanadale Istura </label>
<value>1478-7</value>
</item>
<item>
<label>Hillary Mabeya</label>
<value>1476-1</value>
</item>
<item>
<label>Astrid Christoffersen Deb </label>
<value>1237-7</value>
</item>
<item>
<label>Philip Kipkirui Tonui
</label>
<value>1485-7</value>
</item>
</select1>
<input bind="provider_id_text">
<label>Enter provider's system-id</label>
</input>
</group>
<select1 appearance="minimal" bind="menstruation_status">
<label>How are Your Menstrual Periods?</label>
<hint>(Screener to select one best option)</hint>
<item>
<label>Normal</label>
<value>1115^NORMAL^99DCT</value>
</item>
<item>
<label>Abnormal periods</label>
<value>1116^ABNORMAL^99DCT</value>
</item>
<item>
<label>Completely absent</label>
<value>2060^AMENORRHEA^99DCT</value>
</item>
<item>
<label>Pre-menopausal</label>
<value>7023^PRE-MENOPAUSAL^99DCT</value>
</item>
<item>
<label>Menopausal</label>
<value>5990^MENOPAUSAL^99DCT</value>
</item>
<!-- <item>-->
<!-- <label>Post-menopausal</label>-->
<!-- <value>6496^POST-MENOPAUSAL^99DCT</value>-->
<!-- </item>-->
<item>
<label>Abnormal bleeding not related to periods</label>
<value>6497^DYSFUNCTIONAL UTERINE BLEEDING^99DCT</value>
</item>
</select1>
<input bind="last_menstrual_period_date">
<label>First Day Of Your Last Period (LMP)</label>
</input>
<select1 bind="urine_pregnancy_test_qualitative">
<label>Urine Pregnancy Test</label>
<hint>Test that determines pregnancy status through measure of hormone content in urine.</hint>
<item>
<label>Negative</label>
<value>664^NEGATIVE^99DCT</value>
</item>
<item>
<label>Positive</label>
<value>703^POSITIVE^99DCT</value>
</item>
<item>
<label>Indeterminate</label>
<value>1138^INDETERMINATE^99DCT</value>
</item>
<item>
<label>Poor sample quality</label>
<value>1304^POOR SAMPLE QUALITY^99DCT</value>
</item>
<item>
<label>Not done</label>
<value>1118^NOT DONE^99DCT</value>
</item>
<item>
<label>Refusal</label>
<value>1958^REFUSAL^99DCT</value>
</item>
</select1>
<select1 bind="reason_for_lack_of_period">
<label>Do You Know Why You Are Not Having Your Period?</label>
<item>
<label>Pregnant</label>
<value>1484^PREGNANT^99DCT</value>
</item>
<item>
<label>Breastfeeding</label>
<value>1402^BREASTFED^99DCT</value>
</item>
<item>
<label>Due to age</label>
<value>6496^POST-MENOPAUSAL^99DCT</value>
</item>
<item>
<label>Do not know</label>
<value>1624^DO NOT KNOW^99DCT</value>
</item>
<item>
<label>Other</label>
<value>5622^OTHER NON-CODED^99DCT</value>
</item>
</select1>
<input bind="gravida">
<label>Number Of Previous Pregnancies</label>
<hint>If client has never been pregnant, Enter '0'</hint>
</input>
<input bind="parity">
<label>Number Of Previous Deliveries</label>
<hint>The number of children a woman has delivered.</hint>
</input>
<select appearance="full" bind="ccsp_currentfp">
<label>Current Family Planning Method</label>
<item>
<label>Condoms</label>
<value>condoms</value>
</item>
<item>
<label>Sterilization/Hysterectomy</label>
<value>female_sterilization</value>
</item>
<item>
<label>Intrauterine device</label>
<value>intrauterine_device</value>
</item>
<item>
<label>Diaphragm/Cervical Cap</label>
<value>diaphragm</value>
</item>
<item>
<label>Oral contraceptive pills</label>
<value>family_planning_via_oral_contraceptive_pills</value>
</item>
<item>
<label>Natural family planning</label>
<value>natural_family_planning</value>
</item>
<item>
<label>Injectable hormones</label>
<value>injectable_contraceptives</value>
</item>
<item>
<label>Other non-coded</label>
<value>other_non-coded</value>
</item>
<item>
<label>None</label>
<value>none</value>
</item>
<item>
<label>Don't know</label>
<value>do_not_know</value>
</item>
</select>
<select1 bind="hiv_status">
<label>HIV Status</label>
<hint>What is the patient's HIV Status?</hint>
<item>
<label>Negative</label>
<value>664^NEGATIVE^99DCT</value>
</item>
<item>
<label>Positive</label>
<value>703^POSITIVE^99DCT</value>
</item>
<item>
<label>Unknown</label>
<value>1067^UNKNOWN^99DCT</value>
</item>
</select1>
<input bind="last_cd4_by_facs">
<label>Latest CD4 Count</label>
<hint>The most recent CD4 count (CD4 by FACS)</hint>
</input>
<input bind="date_of_last_cd4_by_facs">
<label>Date of Latest CD4 Count</label>
<hint>The date of most recent CD4 count (CD4 by FACS)</hint>
</input>
<select1 bind="history_of_dysplasia">
<label>History of Dysplasia </label>
<hint>A question to ask whether or not the patient has a history of dysplasia.</hint>
<item>
<label>Yes</label>
<value>1065^YES^99DCT</value>
</item>
<item>
<label>No</label>
<value>1066^NO^99DCT</value>
</item>
</select1>
<select1 bind="most_recent_visual_inspection_with_acetic_acid_result">
<label>Prior VIA Results</label>
<hint>Patient's most recent Visual Inspection with Acetic Acid (VIA) screening.</hint>
<item>
<label>Positive</label>
<value>703^POSITIVE^99DCT</value>
</item>
<item>
<label>Negative</label>
<value>664^NEGATIVE^99DCT</value>
</item>
<item>
<label>Don't know</label>
<value>do_not_know</value>
</item>
<item>
<label>Not applicable</label>
<value>not_applicable</value>
</item>
</select1>
<input bind="date_of_most_recent_visual_inspection_with_acetic_acid_result">
<label>Date Of Most Recent VIA Result</label>
</input>
<select bind="most_recent_papanicolaou_smear_result">
<label>Prior PAP Results</label>
<hint>A question to ask the results of the patient's most recent pap smear exam.</hint>
<item>
<label>Normal</label>
<value>normal</value>
</item>
<item>
<label>Atypical squamous cells of undetermined significance</label>
<value>atypical_squamous_cells_of_undetermined_significance</value>
</item>
<item>
<label>Atypical glandular cells of undetermined significance</label>
<value>atypical_glandular_cells_of_undetermined_significance</value>
</item>
<item>
<label>Low grade squamous intraepithelial lesion</label>
<value>low_grade_squamous_intraepithelial_lesion</value>
</item>
<item>
<label>High grade squamous intraepithelial lesion</label>
<value>high_grade_squamous_intraepithelial_lesion</value>
</item>
<item>
<label>Squamous cell carcinoma</label>
<value>squamous_cell_carcinoma_not_otherwise_specified</value>
</item>
<item>
<label>Adenocarcinoma</label>
<value>adenocarcinoma</value>
</item>
<item>
<label>Not Applicable</label>
<value>not_applicable</value>
</item>
<item>
<label>Don't know</label>
<value>do_not_know</value>
</item>
</select>
<input bind="date_of_most_recent_papanicolaou_smear_result">
<label>Date Of Most Recent PAP Result</label>
</input>
<select bind="most_recent_colposcopy_result">
<label>Prior Colposcopy Results</label>
<item>
<label>Normal</label>
<value>normal</value>
</item>
<item>
<label>Cervical intraepithelial neoplasia grade 1</label>
<value>cervical_intraepithelial_neoplasia_grade_1</value>
</item>
<item>
<label>Cervical intraepithelial neoplasia grade 2</label>
<value>cervical_intraepithelial_neoplasia_grade_2</value>
</item>
<item>
<label>Cervical intraepithelial neoplasia grade 3</label>
<value>cervical_intraepithelial_neoplasia_grade_3</value>
</item>
<item>
<label>Cervical cancer</label>
<value>cervical_cancer</value>
</item>
<item>
<label>Not Applicable</label>
<value>not_applicable</value>
</item>
<item>
<label>Don't know</label>
<value>do_not_know</value>
</item>
</select>
<input bind="date_of_most_recent_colposcopy_result">
<label>Date Of Most Recent Colposcopy Result</label>
<hint>The date of most recent colposcopy Result</hint>
</input>
<input bind="most_recent_biopsy_result">
<label>Other Biopsy Results</label>
<hint>Generic question to collect text information on the patient's most recent biopsy findings.</hint>
</input>
<input bind="date_of_most_recent_biopsy_result">
<label>Date Of Most Recent Biopsy Result</label>
<hint>Date of the most recent biopsy result.</hint>
</input>
<group>
<repeat bind="past_treatment_of_dysplasia_detailed">
<hint>A question set to ask what past treatments the patient has received for Dysplasia, the date of that treatment, and the pathology of the treatment.</hint>
<select bind="past_treatment_of_dysplasia">
<label>Past Treatment Of Dysplasia</label>
<hint>A question to ask what past treatments the patient has received for Dysplasia.</hint>
<item>
<label>Loop electrosurgical excision procedure</label>
<value>loop_electrosurgical_excision_procedure</value>
</item>
<item>
<label>Other non-coded</label>
<value>other_non-coded</value>
</item>
<item>
<label>Hysterectomy</label>
<value>Hysterectomy</value>
</item>
<item>
<label>Cryotherapy</label>
<value>cryotherapy</value>
</item>
<item>
<label>None</label>
<value>none</value>
</item>
<item>
<label>Not applicable</label>
<value>not_applicable</value>
</item>
</select>
<select bind="dysplasia_histopathological_findings_based_on_last_treatment">
<label>Dysplasia Histopathology Found During the Past Treatment</label>
<hint>The histo-pathological findings regarding dysplasia as found by the most recent treatment for the condition.</hint>
<item>
<label>Normal</label>
<value>normal</value>
</item>