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kaweesi/gist:3975c50a3fa1bdcb16f905de381181e0

Created October 31, 2018 11:49
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gistfile1.txt
<htmlform
formUuid="06807e2b-ce97-4d65-8796-e955fcbe057d"
formEncounterType="fa6f3ff5-b784-43fb-ab35-a08ab7dbf074"
formName="Medical History"
formDescription="Personal and family history for NCD baseline consultation"
formVersion="1.1" formAddMetadata="yes"
formUILocation="patientDashboard.visitActions">
<!-- Autogenerated example form (template from 01-Nov-2010 -->
<macros>
paperFormId = (Fill this in)
headerColor =#009d8e
fontOnHeaderColor = white
</macros>
<script type="text/javascript">
jq(document).ready(function () {
<ifMode mode="VIEW">
jq('button.no-print').hide();
</ifMode>
});
</script>
<script type="text/javascript">
if (jQuery) {
jq(document).ready(function () {
<!-- handle operation buttons -->
jq(".msf-operation-button").on("click", function() {
jq("#msf-operation").attr("value", this.value);
return true;
});
});
}
</script>
<div class="wrapper">
<uiInclude provider="msfcore" fragment="leftMenu"/>
<div class="right-form-display">
<div class="hidden">
<section headerLabel="Encounter Details">
<table class="baseline-aligned">
<tr>
<td>Date:</td>
<td>
<encounterDate default="now" disallowMultipleEncountersOnDate="block"/>
</td>
</tr>
<tr>
<td>Location:</td>
<td>
<encounterLocation default="SessionAttribute:emrContext.sessionLocationId"/>
</td>
</tr>
<tr>
<td>Provider:</td>
<td>
<encounterProvider default="currentUser"/>
</td>
</tr>
</table>
</section>
</div>
<div class="sections-container">
<section><!--MEDICAL HISTORY-->
<h3>
<a name="medicalhistory">1.<lookup expression="fn.message('msfcore.ncdbaseline.medicalhistory.title')"/></a>
</h3>
<h4><lookup expression="fn.getConcept('e556545d-405f-4dde-9752-2b259140d84d').name" /></h4>
<p>
<i>- <lookup expression="fn.message('msfcore.ncdbaseline.medicalhistory.info')"/></i>
</p>
<table width="90%">
<obsgroup groupingConceptId="e556545d-405f-4dde-9752-2b259140d84d">
<tr>
<td width="30%">
<obs conceptId="e556545d-405f-4dde-9752-2b259140d84d" answerConceptId="MSF:DBCC219B-76B8-44A8-A371-2B17E6EA107A"
id="antecedents_angina_pectoris" style="checkbox" />
</td>
<td width="30%">
<obs conceptId="e556545d-405f-4dde-9752-2b259140d84d" answerConceptId="MSF:FFAA1C14-D8C5-40DE-B336-7244D0B62A6E"
id="antecedents_MI"
style="checkbox"/>
</td>
<td width="30%">
<obs conceptId="e556545d-405f-4dde-9752-2b259140d84d" answerConceptId="MSF:341072E2-40EF-4BF4-A250-8D0CE0957A8C"
id="antecedents_CABG"
style="checkbox"/>
</td>
</tr>
<tr>
<td>
<obs conceptId="e556545d-405f-4dde-9752-2b259140d84d" answerConceptId="MSF:B3D3C626-C4CC-4067-8587-8DBAD8134200"
id="antecedents_Angioplasty" style="checkbox"/>
</td>
<td>
<obs conceptId="e556545d-405f-4dde-9752-2b259140d84d" answerConceptId="MSF:EEA48CF0-D33C-4115-9271-63A80045301B"
id="antecedents_CVA"
style="checkbox"/>
</td>
<td>
<obs conceptId="e556545d-405f-4dde-9752-2b259140d84d" answerConceptId="MSF:63872D45-53D7-41FF-B689-155B5823A8DC"
id="antecedents_carotid_endarterectomy" style="checkbox"/>
</td>
</tr>
<tr>
<td>
<obs conceptId="e556545d-405f-4dde-9752-2b259140d84d" answerConceptId="MSF:D8533C83-6087-45AA-AD8E-7726142542E0"
id="antecedents_claudication" style="checkbox"/>
</td>
<td>
<obs conceptId="e556545d-405f-4dde-9752-2b259140d84d" answerConceptId="MSF:779CEFEA-E7EC-4B0A-B83A-3458AA4820F5"
id="antecedents_ischaemic_ulcer_amputation" style="checkbox"/>
</td>
<td>
&#160;
</td>
</tr>
</obsgroup>
</table>
<h4><lookup expression="fn.getConcept('ef656ae9-897d-4236-b640-ae060f71796f').name" />:</h4>
<table width="90%">
<obsgroup groupingConceptId="ef656ae9-897d-4236-b640-ae060f71796f">
<tr>
<td width="30%">
<obs conceptId="ef656ae9-897d-4236-b640-ae060f71796f" answerConceptId="MSF:979B865F-44D9-46E8-9AE6-3457952B5880"
id="antecedents_heart_failure" style="checkbox"/>
</td>
<td width="30%">
<obs conceptId="ef656ae9-897d-4236-b640-ae060f71796f" answerConceptId="MSF:86A85208-8E02-425A-AF15-0D2F2234EC2C"
id="antecedents_left_ventricular_hypertrophy" style="checkbox"/>
</td>
<td width="30%">
<obs conceptId="ef656ae9-897d-4236-b640-ae060f71796f" answerConceptId="MSF:5F457C57-8747-4817-A2FA-26BC2A6B438E"
id="antecedents_retinopathy" style="checkbox"/>
</td>
</tr>
<tr>
<td>
<obs conceptId="ef656ae9-897d-4236-b640-ae060f71796f" answerConceptId="MSF:E889434F-3CB9-47B6-942A-6D714ECB8899"
id="antecedents_renal_failure" style="checkbox"/>
</td>
<td>
<obs conceptId="ef656ae9-897d-4236-b640-ae060f71796f" answerConceptId="MSF:7ABB956F-81FA-4CB2-9D7D-6136B1CBF1F1"
id="antecedents_diabetes_renal_impairment" style="checkbox"/>
</td>
<td>
<obs conceptId="ef656ae9-897d-4236-b640-ae060f71796f" answerConceptId="MSF:40D2D1D7-1382-42D6-8719-67C0757E4D3C"
id="antecedents_hypertension_renal_impairment"
style="checkbox"/>
</td>
</tr>
</obsgroup>
</table>
<h4><lookup expression="fn.getConcept('39979ffb-48b1-4c74-84f2-6df36a253cb1').name" />:</h4>
<table>
<obsgroup groupingConceptId="39979ffb-48b1-4c74-84f2-6df36a253cb1">
<tr>
<td class="left-th" width="14%">
<span>
<lookup expression="fn.getConcept('a2c36065-0377-435c-b06f-c48e4a609ee4').name"/>
</span>
</td>
<td class="cv-risk-options" width="82%">
<obs conceptId="a2c36065-0377-435c-b06f-c48e4a609ee4" answerConceptIds="14dd482d-a42b-46d0-bb14-4d3f8c743f32,65faaf98-3caf-47d0-8b92-6bb1d222ad9c,256de010-3614-4e1c-91fa-183236c6e7f2,3b3db397-ed73-4250-84b0-0feabcb4f498,5c6ac484-0ebb-4e81-83e2-e42b801810a5"
style="radio"/>
</td>
</tr>
<tr>
<td class="left-th">
<span>
<lookup expression="fn.getConcept('8e31892a-57da-42b2-94b6-a5776e1c7fa8').name"/>
</span>
</td>
<td class="cv-risk-options">
<obs conceptId="8e31892a-57da-42b2-94b6-a5776e1c7fa8" answerConceptIds="14dd482d-a42b-46d0-bb14-4d3f8c743f32,65faaf98-3caf-47d0-8b92-6bb1d222ad9c,256de010-3614-4e1c-91fa-183236c6e7f2,3b3db397-ed73-4250-84b0-0feabcb4f498,5c6ac484-0ebb-4e81-83e2-e42b801810a5"
style="radio"/>
</td>
</tr>
</obsgroup>
</table>
<h4><lookup expression="fn.message('msfcore.ncdbaseline.medicalhistory.otherpastmedicalhistory')"/>:</h4>
<obs conceptId="160221AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA" rows="4" cols="60"/>
<h4> <lookup expression="fn.message('msfcore.ncdbaseline.medicalhistory.familyhistory')"/>:</h4>
<table width="90%">
<obsgroup groupingConceptId="23b6f689-0484-4b5f-8094-2d83ce733335">
<tr>
<td>
<obs conceptId="23b6f689-0484-4b5f-8094-2d83ce733335" answerConceptId="5108a071-b9b6-4405-8afa-9f7657b247b9"
style="checkbox"/>
</td>
</tr>
<tr>
<td>
<obs conceptId="23b6f689-0484-4b5f-8094-2d83ce733335" answerConceptId="2e7b4eb2-a6c9-4d8f-9734-2832d0706066"
style="checkbox"/>
</td>
</tr>
<tr>
<td>
<obs conceptId="23b6f689-0484-4b5f-8094-2d83ce733335" answerConceptId="135315AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
style="checkbox"/>
</td>
</tr>
</obsgroup>
</table>
<!-- Submit -->
<div class="bottom-of-form">
<button class="primary right msf-operation-button no-print" value="ncd.baseline.medicalhistory.next"><lookup expression="fn.message('msfcore.next')"/></button>
</div>
</section>
</div>
</div>
</div>
<!-- When this form is saved forward to the Family History Form -->
<postSubmissionAction class="org.openmrs.module.msfcore.formaction.handler.HtmlFormPostSubmissionAction" />
</htmlform>
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