Created
March 1, 2016 05:30
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How do I create a JSP Form to use during Patient Registration, Below is the HTML version of the form
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<htmlform> <!-- Examination Form 2015 Antenatal--> <macros> | |
paperFormId = (Fill this in) </macros> | |
<style> | |
.section { | |
border: 1px solid$headerColor; | |
padding: 2px; | |
text-align: left; | |
margin-bottom: 1em; | |
} | |
.sectionHeader { | |
background-color: $headerColor; | |
color: $fontOnHeaderColor; | |
display: block; | |
padding: 2px; | |
font-weight: bold; | |
} | |
table.baseline-aligned td { | |
vertical-align: baseline; | |
} | |
</style> | |
<h2>History on Booking(v1.0)</h2> | |
<section headerLabel="1. Encounter Details"> | |
<table class="baseline-aligned"> | |
<tr> | |
<td>Date:</td> | |
<td><encounterDate default="today" /></td> | |
</tr> | |
<tr> | |
<td>Location:</td> | |
<td><encounterLocation /></td> | |
</tr> | |
<tr> | |
<td>Provider:</td> | |
<td><encounterProvider /></td> | |
</tr> | |
<tr> | |
<td>Patient Name:</td> | |
<td><lookup class="value" expression="patient.personName" /></td> | |
</tr> | |
</table> | |
<!-- End of Encounter Section Details --> | |
<!-- Start of Examination Section here --> | |
<!-- End of Encounter Section Details --> | |
</section> | |
<!-- Start of Antenatal History Section here --> | |
<section headerLabel="2. Examination"> | |
<table border="1" cellspacing="0" class="baseline-aligned"> | |
<tr> | |
<td> | |
<table border="1" cellspacing="0"> | |
<tr> | |
<td> | |
<table> | |
<tr> | |
<td><b>Reason For Visit:</b></td> | |
<td><obs conceptId="CIEL:48" style="radio" | |
answerConceptIds="460,1499" | |
answerLabels="Planning Pregnancy, Currently Pregnant, Other" /> | |
</td> | |
</tr> | |
</table> | |
<table> | |
<tr> | |
<td><b>If Pregnant, was <br />pregnancy intended? | |
</b></td> | |
<td><obs conceptId="CIEL:48" style="radio" | |
answerConceptIds="1065,1066,1067" | |
answerLabels="Yes, No, Unknown" /></td> | |
</tr> | |
</table> | |
</td> | |
</tr> | |
<tr> | |
<td> | |
<table> | |
<tr> | |
<td><b>Last Menstrual Period:</b> <encounterDate | |
default="today" /></td> | |
</tr> | |
</table> | |
</td> | |
</tr> | |
<tr> | |
<td> | |
<table> | |
<tr> | |
<td><b>Date of Delivery:</b> <encounterDate | |
default="today" /></td> | |
</tr> | |
</table> | |
</td> | |
</tr> | |
<tr> | |
<td> | |
<table> | |
<tr> | |
<td><b>Blood Type:</b></td> | |
<td><obs conceptId="CIEL:48" style="radio" | |
answerConceptIds="460, 5088,5089, 5090, 5092,1001, 1002,1004" | |
answerLabels="A+, A-, B+, B-, 0+, 0-,AB+, AB-" /></td> | |
</tr> | |
</table> | |
</td> | |
</tr> | |
</table> | |
</td> | |
<td> | |
<table border="1" cellspacing="0"> | |
<tr> | |
<td> | |
<table> | |
<tr> | |
<td><b>HIV Test:</b></td> | |
<td><obs conceptId="CIEL:138405" style="radio" | |
answerConceptIds="1065,1066,1067" | |
answerLabels="Yes, No, Unknown" /></td> | |
</tr> | |
</table> | |
</td> | |
</tr> | |
<tr> | |
<td> | |
<table> | |
<tr> | |
<td><b>Partner's HIV Status:</b></td> | |
<td><obs conceptId="CIEL:138405" style="radio" | |
answerConceptIds="1065,1066,1067" | |
answerLabels="Negative, Positive, Unknown" /></td> | |
</tr> | |
</table> | |
</td> | |
</tr> | |
</table> | |
</td> | |
<td> | |
<table> | |
<tr> | |
<td><b>Recent Contraceptive Use:</b> <br /> <obs | |
conceptId="CIEL:48" answerConceptId="460" answerLabel="None" | |
style="checkbox" /> <br /> <obs conceptId="CIEL:460" | |
answerConceptId="460" answerLabel="Oral Contraception" | |
style="checkbox" /> <br /> <obs conceptId="CIEL:460" | |
answerConceptId="460" answerLabel="Condoms" style="checkbox" /> | |
<br /> <obs conceptId="CIEL:460" answerConceptId="460" | |
answerLabel="Natural Planning / Rhythm" style="checkbox" /> <br /> | |
<obs conceptId="CIEL:460" answerConceptId="460" | |
answerLabel="Diaphragm" style="checkbox" /> <br /> <obs | |
conceptId="CIEL:460" answerConceptId="460" | |
answerLabel="Depo-Provera" style="checkbox" /> <br /> <obs | |
conceptId="CIEL:460" answerConceptId="460" | |
answerLabel="Norplant" style="checkbox" /> <br /> <obs | |
conceptId="CIEL:460" answerConceptId="460" answerLabel="Surgery" | |
style="checkbox" /> <br /> <obs conceptId="CIEL:460" | |
answerConceptId="460" answerLabel="Other" style="checkbox" /> <br /> | |
</td> | |
</tr> | |
</table> | |
</td> | |
<td> | |
<table> | |
<tr> | |
<td><b>Previous Pregnancy:</b> <br /> <obs | |
conceptId="CIEL:48" answerConceptId="117399" | |
answerLabel="Hypertensive Disorders" style="checkbox" /> <br /> | |
<obs conceptId="CIEL:48" answerConceptId="117399" | |
answerLabel="Low Birth Weight Baby" style="checkbox" /> <br /> | |
<obs conceptId="CIEL:48" answerConceptId="117399" | |
answerLabel="Neonatal loss" style="checkbox" /> <br /> <obs | |
conceptId="CIEL:48" answerConceptId="117399" | |
answerLabel="Miscarriage / Still birth" style="checkbox" /> <br /> | |
<obs conceptId="CIEL:48" answerConceptId="160865" | |
answerLabel="Previous Cesarean " style="checkbox" /> <br /> <obs | |
conceptId="CIEL:48" answerConceptId="117399" | |
answerLabel="Antepartum Hemorrhage" style="checkbox" /> <br /> | |
<obs conceptId="CIEL:230" answerConceptId="160210" | |
answerLabel="Postpartum Hemorrhage" style="checkbox" /> <br /> | |
<obs conceptId="CIEL:230" answerConceptId="123841" | |
answerLabel="Postterm delivery" style="checkbox" /> <br /> <obs | |
conceptId="CIEL:48" answerConceptId="117399" | |
answerLabel="Prolonged Labor" style="checkbox" /> <br /> <obs | |
conceptId="CIEL:48" answerConceptId="117399" | |
answerLabel="Recto-vaginal Fistula" style="checkbox" /> <br /> | |
<obs conceptId="CIEL:48" answerConceptId="117399" | |
answerLabel="Severe Anaemia" style="checkbox" /> <br /> | |
<p> | |
<label><uimessage | |
code="coreapps.consult.freeTextComments" /></label> | |
<obs conceptId="CIEL:162169" style="textarea" rows="5" /> | |
</p></td> | |
</tr> | |
</table> | |
</td> | |
</tr> | |
</table> | |
</section> | |
<submit/> | |
</htmlform> |
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